Failure of cyclophosphamide to prevent cerebritis in Wegener's granulomatosis

Two patients with diffuse cerebritis due to Wegener's granulomatosis are described. The cerebritis developed despite prolonged treatment with cyclophosphamide. This may be the first report of such an occurrence. Both patients had excellent functional recovery with intravenous corticosteroids.     

Analysis of integrated virological and epidemiological reports of norovirus outbreaks collected within the Foodborne Viruses in Europe network from 1 July 2001 to 30 June 2006

The Foodborne Viruses in Europe network has developed integrated epidemiological and virological outbreak reporting with aggregation and sharing of data through a joint database. We analyzed data from reported outbreaks of norovirus (NoV)-caused gastroenteritis from 13 European countries (July 2001 to July 2006) for trends in time and indications of different epidemiology of genotypes and variants. Of the 13 countries participating in this surveillance network, 11 were capable of collecting integrated epidemiological and virological surveillance data and 10 countries reported outbreaks throughout the entire period. Large differences in the numbers and rates of reported outbreaks per country were observed, reflecting the differences in the focus and coverage of national surveillance systems. GII.4 strains predominated throughout the 5-year surveillance period, but the proportion of outbreaks associated with GII.4 rose remarkably during years in which NoV activity was particularly high. Spring and summer peaks indicated the emergence of genetically distinct variants within GII.4 across Europe and were followed by increased NoV activity during the 2002-2003 and 2004-2005 winter seasons. GII.4 viruses predominated in health care settings and in person-to-person transmission. The consecutive emergence of new GII.4 variants is highly indicative of immune-driven selection. Their predominance in health care settings suggests properties that facilitate transmission in settings with a high concentration of people such as higher virus loads in excreta or a higher incidence of vomiting. Understanding the mechanisms driving the changes in epidemiology and clinical impact of these rapidly evolving RNA viruses is essential to design effective intervention and prevention measures.     

Selection of a phylogenetically informative region of the norovirus genome for outbreak linkage

The recognition of a common source norovirus outbreak is supported by finding identical norovirus sequences in patients. Norovirus sequencing has been established in many (national) public health laboratories and academic centers, but often partial and different genome sequences are used. Therefore, agreement on a target sequence of sufficient diversity to resolve links between outbreaks is crucial. Although harmonization of laboratory methods is one of the keystone activities of networks that have the aim to identify common source norovirus outbreaks, this has proven difficult to accomplish, particularly in the international context. Here, we aimed at providing a method enabling identification of the genomic region informative of a common source norovirus outbreak by bio-informatic tools. The data set of 502 unique full length capsid gene sequences available from the public domain, combined with epidemiological data including linkage information was used to build over 3,000 maximum likelihood (ML) trees for different sequence lengths and regions. All ML trees were evaluated for robustness and specificity of clustering of known linked norovirus outbreaks against the background diversity of strains. Great differences were seen in the robustness of commonly used PCR targets for cluster detection. The capsid gene region spanning nucleotides 900–1,400 was identified as the region optimally substituting for the full length capsid region. Reliability of this approach depends on the quality of the background data set, and we recommend periodic reassessment of this growing data set. The approach may be applicable to multiple sequence-based data sets of other pathogens.     

The development of instruments to measure the work disability assessment behaviour of insurance physicians

Background  

Variation in assessments is a universal given, and work disability assessments by insurance physicians are no exception. Little is known about the considerations and views of insurance physicians that may partly explain such variation. On the basis of the Attitude - Social norm - self Efficacy (ASE) model, we have developed measurement instruments for assessment behaviour and its determinants.     

Influenza vaccination coverage and reasons to refrain among high-risk persons in four European countries

This paper examines influenza vaccine coverage using a population base of an average of 2300 persons in each of four European countries (Germany, Spain, Poland and Sweden). The reasons for non-vaccination of those in the high-risk groups were explored by questionnaire. The vaccine coverage rate (VCR) for elderly ranged from 18% in Poland to 67% in Spain. The VCR for high-risk population under 65 was 10% in Poland, 13% in Sweden, 27% in Germany and 30% in Spain. The most important reasons mentioned for not being vaccinated were: perceived sufficient resistance to flu (33-42%) in all countries; financial barriers in Poland (25%), and not to qualify for the vaccination (30%) and forgetfulness (20%) in Germany. Receiving a personal invitation for the vaccination, results in higher coverage rates in all four countries. We think that future interventions could be directed towards: an information campaign with special attention to the high-risk groups due to disease; promotion of personal invitations; and, for Poland, solving financial barriers to vaccination.     

Does a population survey provide reliable influenza vaccine uptake rates among high-risk groups? A case-study of The Netherlands

All European countries have recommendations for influenza vaccination among the elderly and chronically ill. However, only a few countries are able to provide data on influenza uptake among these groups. The aim of our study is to investigate whether a population survey is an effective method of obtaining vaccination uptake rates in the different risk groups and to find out what reasons people give as to why they have accepted or refused influenza vaccination and whether this varies among the risk groups. A mail questionnaire was sent out to households in The Netherlands, the response rate was 73%. This resulted in data for 4037 individuals on influenza and influenza vaccination during the 2001-2002 influenza season. The uptake rates and size of different risk groups from the panel survey were comparable with other national representative sources (from the National Information Network of GPs (LINH) and Statistics Netherlands (CBS)). The main reason cited for undergoing vaccination was the existence of a chronic condition. The main reasons for refraining from vaccination were having enough resistance to flu and ignorance about the recommendations. In The Netherlands, the GP is the main administrator of influenza vaccines. We believe that population surveys may be useful for revealing influenza vaccination uptake rates for the groups at risk. When combined with questions about reasons for undergoing vaccination, the results may provide useful policy information and can be used to direct vaccination campaigns at under-vaccinated risk groups or to target the information campaign more effectively.     

Income development of General Practitioners in eight European countries from 1975 to 2005

Background  

This study aims to gain insight into the international development of GP incomes over time through a comparative approach. The study is an extension of an earlier work (1975–1990, conducted in five yearly intervals). The research questions to be addressed in this paper are: 1) How can the remuneration system of GPs in a country be characterized? 2) How has the annual GP income developed over time in selected European countries? 3) What are the differences in GP incomes when differences in workload are taken into account? And 4) to what extent do remuneration systems, supply of GPs and gate-keeping contribute to the income position of GPs?     

Influenza vaccination in Europe: an inventory of strategies to reach target populations and optimise vaccination uptake

A study was undertaken to assess influenza vaccine uptake in risk groups and to get insight into vaccination practices in European countries. Questionnaires were completed by national influenza experts from 26 countries. Only 14 were able to provide uptake rates for the elderly. For the other risk groups, even fewer could provide data. Vaccines are usually administrated by GPs. Financial incentives for physicians and patients might work as a strategy to increase uptake rates, but due to the small amount of data, it was not possible to carry out thorough multivariate analyses. The development of a uniform influenza vaccination monitoring method was recommended to allow for comparison of uptake data in Europe.     

Proposal for a unified norovirus nomenclature and genotyping

Noroviruses belong to a genus of genetically diverse viruses within the family Caliciviridae and cause acute gastroenteritis in humans and animals. They are subdivided into genogroups, each of which further segregates into genotypes. Until recently, a new genotype was based on a defined pairwise distance cutoff of complete VP1 sequences, but with the increasing number of available norovirus sequences, this cutoff is no longer accurate, and sequences in the public database have been misclassified. In this paper, we demonstrate that the pairwise distance cutoff method can no longer be used and outline a phylogenetic approach to classify noroviruses. Furthermore, we propose a dual nomenclature using both ORF1 and VP1 sequences, as recombination is common and recognizing recombinant viruses may be relevant. With the continuing emergence of new norovirus lineages, we propose to coordinate nomenclature of new norovirus genotypes through an international norovirus working group.