Hepatitis: Sonder GJ

Sonder GJ. · National Coordination Center for Travelers Health Advice, Nieuwe Achtergracht 100, 1018 WT Amsterdam, The Netherlands. · Expert Rev Vaccines. · Pubmed #18564021 No free full text.

Abstract: An increasing number of travelers travel to hepatitis B-endemic countries. In travel medicine, vaccinations should be advised according to risks. The actual incidence of hepatitis B infection in short-term tourists is very low and probably not higher than it is for people who do not travel. There is evidence that long-term travelers and immigrants originating from hepatitis B-endemic countries are at higher risk of infection and they should always be offered vaccination. For all other travelers living in countries with universal hepatitis B vaccination, vaccination could be advised as a catch-up strategy.

Sonder GJ, van Rijckevorsel GG, van den Hoek A. · Public Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands. · J Travel Med. · Pubmed #19192123 No free full text.

Abstract: OBJECTIVES: Behavioral studies in travelers suggest that 33% to 76% of all travelers to hepatitis B virus (HBV)-endemic countries are at risk for HBV infection. We study the incidence and risk factors for HBV infection in travelers. METHODS: Retrospective analysis of the characteristics and risk factors of all reported acute HBV patients in Amsterdam, the Netherlands, from January 1, 1992, until December 31, 2003. RESULTS: The estimated incidence in travelers from Amsterdam to HBV-endemic countries is 4.5/100,000 travelers. Two thirds of these patients were immigrants who lived in Amsterdam and who had visited their friends and relatives in their country of origin. In 12 years, only three Dutch short-term tourists contracted HBV while traveling, all by heterosexual contacts. CONCLUSIONS: Dutch tourists who travel to HBV-endemic countries run a very low risk of contracting HBV. Vaccination of short-term Dutch tourists is not necessary. Immigrants run a higher risk irrespective of travel or duration of travel. This group should be advised vaccination.

Suijkerbuijk AW, Lindeboom R, van Steenbergen JE, Sonder GJ, Doorduyn Y. · Epidemiology and Surveillance Unit, Netherlands Centre for Infectious Disease Control, RIVM, Bilthoven, The Netherlands. · Eur J Public Health. · Pubmed #19174503 No free full text.

Abstract: BACKGROUND: Since 1998 Municipal Public Health Services (MPHSs) in The Netherlands carried out Hepatitis A (HAV) vaccination programs for Turkish and Moroccan children to reduce import and secondary HAV infections. The aim of this study was to assess the effects of the programs on HAV incidence. METHODS: MPHSs were questioned about HAV vaccination programs for migrant children. Notification data of HAV over the period 1995-2006 were analysed. RESULTS: Since 1998, 19 MPHSs (58%) organized vaccination programs for Turkish and Moroccan children. A large variation in the range of activities in HAV vaccination programs was observed. In The Netherlands, HAV incidence declined, from 6.5 per 100,000 inhabitants in 1995 to 1.3 in 2005. HAV incidence in children of Turkish and Moroccan decent declined from 70.3 per 100,000 in 2000 to 13.5 per 100,000 in 2005. Regions where MPHSs organized vaccination campaigns had the steepest decline in HAV incidence. CONCLUSION: The decline in HAV incidence in The Netherlands coincided with that observed for the rest of Europe. Therefore, also other causes than the enhanced vaccination programs could have contributed to this effect. At present, low priority is placed on continuing these HAV vaccination programs, as in areas without enhanced programs the incidence also declined to very low levels. Because HAV is still endemic in Morocco and Turkey, it remains important that all travellers to these countries are vaccinated against HAV, regardless of their country of origin.

Van Rijckevorsel GG, Sonder GJ, Bovée LP, Thiesbrummel HF, Geskus RB, Van Den Hoek A. · Public Health Service Amsterdam, Nieuwe Achtergracht 100, 1018 WT Amsterdam, the Netherlands. · Sex Transm Dis. · Pubmed #18685550 No free full text.

Abstract: BACKGROUND: Since the mid-1990s, sexually transmitted infections (STIs) among men who have sex with men (MSM) have increased and appear to be related to more risky sexual behavior. We compare trends in hepatitis A, acute hepatitis B, and shigellosis with the trends of gonorrhea and infectious syphilis in Amsterdam MSM more than a period of 15 years. METHODS: We used data of all reported hepatitis A, acute hepatitis B, and shigellosis, and from all patients newly diagnosed with gonorrhea and infectious syphilis who visited the Public Health Service STI outpatient department in Amsterdam between January 1, 1992 and December 31, 2006. RESULTS: Hepatitis A incidence remained unchanged in MSM (mean 0.97 per 1000 MSM, range 0.04-2.27), who had 21% of all 1697 infections. Hepatitis B likewise remained unchanged in MSM (mean 0.47 per 1000 MSM, range 0.19-0.77), who had 41% of all 448 infections. Most shigellosis is travel-related (657/974), and 16% of the infections occurred in MSM. Its incidence dropped in general, but not in MSM. Both gonorrhea and infectious syphilis in MSM show a steep increase, mainly after 1998. DISCUSSION: Hepatitis A, B, and shigellosis do not follow the rising trends of conventional STI in MSM, which are believed to result from increased risky sexual behavior. This disparity in trends implies differences in transmission dynamics. Recent molecular epidemiologic studies suggest that clustered transmission in social MSM networks plays a major role.

Baaten GG, Sonder GJ, Dukers NH, Coutinho RA, Van den Hoek JA. · Department of Infectious Diseases, Municipal Health Service (GGD) Amsterdam, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE Amsterdam, The Netherlands. · J Med Virol. · Pubmed #17935187 No free full text.

Abstract: In order to enhance screening and preventive strategies, this study investigated the seroprevalence of hepatitis A, B, and C in the general adult urban population and in subgroups. In 2004, sera from 1,364 adult residents of Amsterdam were tested for viral markers. Sociodemographic characteristics were collected using a standardized questionnaire. For hepatitis A, 57.0% was immune. Of first-generation immigrants from Turkey and Morocco, 100% was immune. Of all Western persons and second-generation non-Western immigrants, approximately half was still susceptible. For hepatitis B, 9.9% had antibodies to hepatitis B core antigen (anti-HBc) and 0.4% had hepatitis B surface antigen. Anti-HBc seroprevalences were highest among first-generation immigrants from Surinam, Morocco, and Turkey, and correlated with age at the time of immigration, and among men with a sexual preference for men. Seroprevalence among second-generation immigrants was comparable to Western persons. The seroprevalence of hepatitis C virus antibodies was 0.6%. In conclusion, a country with overall low endemicity for viral hepatitis can show higher endemicity in urban regions, indicating the need for differentiated regional studies and prevention strategies. More prevention efforts in cities like Amsterdam are warranted, particularly for hepatitis A and B among second-generation immigrants, for hepatitis B among men with a sexual preference for men, and for hepatitis C. Active case finding strategies are needed for both hepatitis B and C.

van Houdt R, Sonder GJ, Dukers NH, Bovee LP, van den Hoek A, Coutinho RA, Bruisten SM. · GGD, Public Health Service, Department of Infectious Diseases, Amsterdam, The Netherlands. · Vaccine. · Pubmed #16919856 No free full text.

Abstract: To evaluate hepatitis B virus (HBV) risk group vaccination in Amsterdam, which started in 1998, we examined 342 reported acute HBV-cases and sequenced 85 DNA isolates. The reported number of cases declined from 214 in 1992-1997 to 128 in 1998-2003, due to a decline in injecting drug users (IDU) and their heterosexual partners. Phylogenetic analyses showed that after 1998, the IDU cluster nearly disappeared, probably due to a decline in injecting. Acute HBV remained stable among men having sex with men; given their increased sexual risk behavior, vaccination has probably prevented an increase in their acute infections. Currently, 48-72% of the people who should be included in the program are still susceptible to HBV.

Sonder GJ, Bovée LP, Baayen TD, Coutinho RA, van den Hoek JA. · GGD, Municipal Health Service Amsterdam, Department of Infectious Diseases, Nieuwe Achtergracht 100, PO Box 2200, 1000 CE Amsterdam, The Netherlands. · Vaccine. · Pubmed #16675076 No free full text.

Abstract: OBJECTIVE: To evaluate the impact and effectiveness of risk-group vaccination against hepatitis A targeted at migrant children living in a country with low endemicity of hepatitis A. METHODS: Retrospective population based data analysis. Routinely collected data on hepatitis A incidence in migrant children and other risk groups in Amsterdam from 1 January 1992 to 2004 were analyzed and related to exposure, immunity and vaccination coverage in migrant children. RESULTS: The overall hepatitis A incidence in Amsterdam declined after a pediatric vaccine was introduced in 1997. This decline was seen in migrant children traveling to hepatitis A-endemic countries, contacts with hepatitis A patients, primary school students, injecting drug users, and persons with unknown source of infection, but not in men who have sex with men (MSM) or in travelers to endemic countries other than migrant children. CONCLUSION: The hepatitis A vaccination campaigns are effective: they reduce both import and secondary HAV cases. The campaigns could be more efficient and cost-effective if the hepatitis B vaccinations currently given to these groups were replaced by a combined hepatitis A and B vaccine. This would increase the hepatitis A vaccination coverage considerably and further reduce the hepatitis A incidence.

Sonder GJ, Regez RM, Brinkman K, Prins JM, Mulder JW, Spaargaren J, Coutinho RA, van den Hoek A. · Department of Infectious Diseases, Nieuwe Achtergracht 100, 1018 WT, Amsterdam, Netherlands. · BMJ. · Pubmed #15817550 links to  free full text

Abstract: PROBLEM: Prophylactic treatment and follow-up after exposure to HIV, hepatitis B, and hepatitis C outside hospital needs to be improved. BACKGROUND AND SETTING: Until January 2000, people in Amsterdam could report exposure outside hospital to either a hospital or the municipal health service. If they reported to the municipal health service, they were then referred to hospitals for HIV prophylaxis, whereas the municipal health service handled treatment and follow-up related to hepatitis B and hepatitis C and traced sources. For cases reported to a hospital, hospital staff often did not trace HIV sources or follow up patients for hepatitis B and hepatitis C. KEY MEASURES FOR IMPROVEMENT: Providing adequate treatment for HIV, hepatitis B and hepatitis C after exposure for all reported exposures outside hospital. STRATEGIES FOR CHANGE: On 1 January 2000, a new protocol was introduced in which three Amsterdam hospitals and the municipal health service collaborated in the treatment and follow-up of exposures outside hospital. Both municipal health service and hospitals can decide whether HIV prophylaxis is necessary and prescribe accordingly. All people exposed in the community who report to hospitals are subsequently referred to the municipal health service for further treatment and follow-up. EFFECTS OF CHANGE: The protocol is effective in that most people comply with treatment and follow-up. When indicated, HIV prophylaxis is started soon after exposure. In nearly two thirds of cases the municipal health service traced and tested the source. LESSONS LEARNT: Provision of treatment and follow-up in one place enables treatment, tracing and testing sources, and follow-up, including counselling and registration of all reported exposures in Amsterdam, which allows for swift identification of emerging epidemiological trends. Since May 2004 all Amsterdam hospitals have participated in the protocol.

Sonder GJ, Bovée LP, Coutinho RA, Baayen D, Spaargaren J, van den Hoek A. · GG & GD Amsterdam, Municipal Health Service Amsterdam, Department of Infectious Diseases, Amsterdam, The Netherlands. · Am J Prev Med. · Pubmed #15710272 No free full text.

Abstract: OBJECTIVES: To assess and evaluate the rate and outcome of occupational exposure to hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV) in the Amsterdam police force. METHODS: Retrospectively, all accidents with risk for viral transmission reported to the Municipal Health Service between January 1, 2000 and December 31, 2003 were described and analyzed in 2004. RESULTS: Over a 4-year period, 112 exposures with a viral transmission risk were reported (the estimated exposure rate was 68/10,000/year). Of these exposures, 89 (79%) sources were tested, finding 4% HBV-positive, 4% HIV-positive, and 18% HCV-positive. Immunoglobulin for HBV infection was given 44 times; HIV post-exposure prophylaxis was prescribed 16 times and 13 of 16 discontinued the course within a few days because the transmission source tested HIV-negative. No seroconversions were seen in persons exposed. CONCLUSIONS: The rate of exposure is low. The majority of the sources could be traced and tested. However, a comprehensive and effective protocol is essential in minimizing the risk of occupational HBV, HCV, and HIV infection in police officers, even if HBV vaccination is provided.

Sonder GJ, van Steenbergen JE, Bovee LP, Peerbooms PG, Coutinho RA, van den Hoek A. · GG&GD, Department of Infectious Diseases, Municipal Health Service, Amsterdam, The Netherlands. · Am J Public Health. · Pubmed #15333325 links to  free full text

Abstract: OBJECTIVES: We evaluated the hepatitis A virus (HAV) control policy (hygienic precautions and passive immunization with immune globulin) for "household contacts" (defined as all people who lived in the same house and who shared the same toilet with the patient, people who took care of an HAV-infected child, and sexual partners of the patient) of acute hepatitis A patients between 1996 and 2000. METHODS: We examined the characteristics and the serological outcomes of household contacts. All susceptible contacts were invited for retesting 6 weeks after they received immune globulin. RESULTS: Of 1242 contacts of 569 HAV patients, more than 50% (n = 672) were found to be HAV immune. Among the remaining contacts, 161 (28.2%) had a concurrent infection, and 86 of these individuals were symptomatic. The remaining 409 susceptible contacts received immune globulin, with 186 (45%) returning for retesting 6 weeks later (64 [34%] were infected, but only 12 had symptoms). CONCLUSIONS: Immune globulin does not protect all household contacts from HAV infection; however, it attenuates symptoms and effectively reduces further HAV transmission.

Sonder GJ, Regez RM, Brinkman K, Prins JM, Mulder JW, Coutinho RA, van den Hoek JA. · Academisch Medisch Centrum/Universiteit van Amsterdam. · Ned Tijdschr Geneeskd. · Pubmed #11957386 No free full text.

Abstract: The Infectious Diseases Department of the Amsterdam Public Health Service regularly sees people who have possibly been exposed to human body fluids infected with hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV), as a result of incidents in either a non-hospital-related occupation or during their leisure time. Until January 2000, people reporting possible exposure were referred to hospitals for HIV post-exposure prophylaxis (HIV-PEP), whereas for HBV and HCV, the tracing of the infection source and the follow-up took place at the Public Health Service clinic. Since the introduction of a new protocol in January 2000, the Public Health Service as well as a hospital can establish an indication for HIV-PEP and prescribe it. In 2000, 322 persons reported to the Public Health Service. The source was tested in 194 incidents and an HIV test was carried out on 104 occasions. In 19 cases HIV antibodies were found or the source was known to be HIV positive. A total of 50 people were prescribed HIV-PEP; 16 times after a needle-stick accident, 22 times after a sexual accident, 6 times after a bite-wound and 6 times after direct exposure to human blood. The sources of 30 PEP recipients could be tested and after this 16 recipients could stop with the treatment due to a negative HIV test. In 4 cases PEP treatment was stopped following a review of the indication. Therefore, 30 people had an indication to complete the PEP treatment. Of these, more than 80% reported side effects and 3 people had to withdraw from the treatment at an early stage because of this. The implementation of the protocol has resulted in less confusion because the follow-up now takes place at one location. Compared to other studies, the average time between exposure and treatment is shorter and compliance is good. In the period up to 15 May 2001, no seroconversions had been observed.

Sonder GJ, van den Hoek JA. · No affiliation provided · Ned Tijdschr Geneeskd. · Pubmed #18240399 No free full text.

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