• Iron Deficiency Anemia at Time of Vaccination Predicts Decreased Vaccine Response and Iron Supplementation at Time of Vaccination Increases Humoral Vaccine Response: A Birth Cohort Study and a Randomized Trial Follow-Up Study in Kenyan Infants.

      Stoffel, Nicole U; Uyoga, Mary A; Mutuku, Francis M; Frost, Joe N; Mwasi, Edith; Paganini, Daniela; van der Klis, Fiona R M; Malhotra, Indu J; LaBeaud, A Desiráe; Ricci, Cristian; et al. (2020-01-01)
      Background: Iron deficiency may impair adaptive immunity and is common among African infants at time of vaccination. Whether iron deficiency impairs vaccine response and whether iron supplementation improves humoral vaccine response is uncertain. Methods: We performed two studies in southern coastal Kenya. In a birth cohort study, we followed infants to age 18 mo and assessed whether anemia or iron deficiency at time of vaccination predicted vaccine response to three-valent oral polio, diphtheria-tetanus-whole cell pertussis-Haemophilus influenzae type b vaccine, ten-valent pneumococcal-conjugate vaccine and measles vaccine. Primary outcomes were anti-vaccine-IgG and seroconversion at age 24 wk and 18 mo. In a randomized trial cohort follow-up, children received a micronutrient powder (MNP) with 5 mg iron daily or a MNP without iron for 4 mo starting at age 7.5 mo and received measles vaccine at 9 and 18 mo; primary outcomes were anti-measles IgG, seroconversion and avidity at age 11.5 mo and 4.5 y. Findings: In the birth cohort study, 573 infants were enrolled and 303 completed the study. Controlling for sex, birthweight, anthropometric indices and maternal antibodies, hemoglobin at time of vaccination was the strongest positive predictor of: (A) anti-diphtheria and anti-pertussis-IgG at 24 wk (p = 0.0071, p = 0.0339) and 18 mo (p = 0.0182, p = 0.0360); (B) anti-pertussis filamentous hemagglutinin-IgG at 24 wk (p = 0.0423); and (C) anti-pneumococcus 19 IgG at 18 mo (p = 0.0129). Anemia and serum transferrin receptor at time of vaccination were the strongest predictors of seroconversion against diphtheria (p = 0.0484, p = 0.0439) and pneumococcus 19 at 18 mo (p = 0.0199, p = 0.0327). In the randomized trial, 155 infants were recruited, 127 and 88 were assessed at age 11.5 mo and 4.5 y. Compared to infants that did not receive iron, those who received iron at time of vaccination had higher anti-measles-IgG (p = 0.0415), seroconversion (p = 0.0531) and IgG avidity (p = 0.0425) at 11.5 mo. Interpretation: In Kenyan infants, anemia and iron deficiency at time of vaccination predict decreased response to diphtheria, pertussis and pneumococcal vaccines. Primary response to measles vaccine may be increased by iron supplementation at time of vaccination. These findings argue that correction of iron deficiency during early infancy may improve vaccine response.
    • Is aircraft noise exposure associated with cardiovascular disease and hypertension? Results from a cohort study in Athens, Greece.

      Dimakopoulou, Konstantina; Koutentakis, Konstantinos; Papageorgiou, Ifigeneia; Kasdagli, Maria-Iosifina; Haralabidis, Alexandros S; Sourtzi, Panayota; Samoli, Evangelia; Houthuijs, Danny; Swart, Wim; Hansell, Anna L; et al. (2017-11)
      We followed up, in 2013, the subjects who lived near the Athens International Airport and had participated in the cross-sectional multicountry HYENA study in 2004-2006.
    • Is cumulative fossil energy demand a useful indicator for the environmental performance of products?

      Huijbregts, Mark A J; Rombouts, Linda J A; Hellweg, Stefanie; Frischknecht, Rolf; Hendriks, A Jan; Meent, Dik van de; Ragas, Ad M J; Reijnders, Lucas; Struijs, Jaap (2006-02-01)
      The appropriateness of the fossil Cumulative Energy Demand (CED) as an indicator for the environmental performance of products and processes is explored with a regression analysis between the environmental life-cycle impacts and fossil CEDs of 1218 products, divided into the product categories "energy production", "material production", "transport", and "waste treatment". Our results show that, for all product groups but waste treatment, the fossil CED correlates well with most impact categories, such as global warming, resource depletion, acidification, eutrophication, tropospheric ozone formation, ozone depletion, and human toxicity (explained variance between 46% and 100%). We conclude that the use of fossil fuels is an important driver of several environmental impacts and thereby indicative for many environmental problems. It maytherefore serve as a screening indicatorfor environmental performance. However, the usefulness of fossil CED as a stand-alone indicator for environmental impact is limited by the large uncertainty in the product-specific fossil CED-based impact scores (larger than a factor of 10 for the majority of the impact categories; 95% confidence interval). A major reason for this high uncertainty is nonfossil energy related emissions and land use, such as landfill leachates, radionuclide emissions, and land use in agriculture and forestry.
    • Is current risk assessment of non-genotoxic carcinogens protective?

      Braakhuis, Hedwig M; Slob, Wout; Olthof, Evelyn D; Wolterink, Gerrit; Zwart, Edwin P; Gremmer, Eric R; Rorije, Emiel; van Benthem, Jan; Woutersen, Ruud; van der Laan, Jan Willem; et al. (2018-05-10)
      Non-genotoxic carcinogens (NGTXCs) do not cause direct DNA damage but induce cancer via other mechanisms. In risk assessment of chemicals and pharmaceuticals, carcinogenic risks are determined using carcinogenicity studies in rodents. With the aim to reduce animal testing, REACH legislation states that carcinogenicity studies are only allowed when specific concerns are present; risk assessment of compounds that are potentially carcinogenic by a non-genotoxic mode of action is usually based on subchronic toxicity studies. Health-based guidance values (HBGVs) of NGTXCs may therefore be based on data from carcinogenicity or subchronic toxicity studies depending on the legal framework that applies. HBGVs are usually derived from No-Observed-Adverse-Effect-Levels (NOAELs). Here, we investigate whether current risk assessment of NGTXCs based on NOAELs is protective against cancer. To answer this question, we estimated Benchmark doses (BMDs) for carcinogenicity data of 44 known NGTXCs. These BMDs were compared to the NOAELs derived from the same carcinogenicity studies, as well as to the NOAELs derived from the associated subchronic studies. The results lead to two main conclusions. First, a NOAEL derived from a subchronic study is similar to a NOAEL based on cancer effects from a carcinogenicity study, supporting the current practice in REACH. Second, both the subchronic and cancer NOAELs are, on average, associated with a cancer risk of around 1% in rodents. This implies that for those chemicals that are potentially carcinogenic in humans, current risk assessment of NGTXCs may not be completely protective against cancer. Our results call for a broader discussion within the scientific community, followed by discussions among risk assessors, policy makers, and other stakeholders as to whether or not the potential cancer risk levels that appear to be associated with currently derived HBGVs of NGXTCs are acceptable.
    • Is quality of life impairment associated with chronic diseases dependent on educational level?

      Galenkamp, Henrike; van Oers, Hans A M; Kunst, Anton E; Stronks, Karien (2019-01-18)
      Previous research indicates that quality of life impairment as a result of chronic diseases differs between socioeconomic groups, but the pattern seems to vary between health-related quality of life (HRQOL) outcomes. We tested for a one-item and a multi-item outcome whether associations between diseases and HRQOL varied between educational levels. Data come from Dutch participants of HELIUS (N =4615, aged 18-70). Education was defined as low, middle or high. Myocardial infarction, angina pectoris, hypertension, diabetes, obesity and depressed mood were measured using physical examination and/or self-report. Outcomes were fair/poor self-rated health (SRH) and physical (PCS) and mental (MCS) SF-12 scores. Interaction terms and relative excess risk due to interaction (RERI) were used as measures of additive interaction. SRH and PCS were worst in lower educated participants, whereas MCS was worst in middle educated participants. Out of thirty-six interactions tested, four were statistically significant, with risks of poor HRQOL being both larger and smaller in low vs. high education groups. Obesity was associated with smaller risk of fair/poor SRH in low vs. high educated [RERI=-2.49 (-4.66; -0.33)]. Depressed mood was associated with more [b=-3.34 (-6.14; -0.54)] and hypertension with less reduction in PCS [b=1.23 (0.18; 2.27)] in middle vs. high educated. Depressed mood was highly associated with MCS, but less so in middle vs. high educated [b=4.09 (0.72; 7.47)]. Despite a higher prevalence of diseases in low education groups, if measured in absolute terms, most diseases were not associated with larger impairment of HRQOL in lower vs. higher educated groups, regardless of the outcome measure used.
    • Is there a higher risk of a complicated course of hepatitis A in kidney transplant patients?

      Hanssen, D A T; Dackus, J; Posthouwer, D; Vennema, H; van Loo, I H M (2020-10-01)
    • Is there an association between socioeconomic status and immune response to infant and childhood vaccination in the Netherlands?

      van den Boogaard, J; Rots, NY; van der Klis, F; de Melker, HE; Knol, MJ (2020-02-14)
      Introduction Socioeconomic status (SES) is a well-known determinant of health, but its relation with vaccine-induced immunity is less documented. We explored the association between SES and immunoglobulin G (IgG) levels against vaccine-preventable diseases in vaccinated children in the Dutch National Immunization Programme. Methods Data from a population-wide cross-sectional serosurvey in the Netherlands (2006–2007) were used. We compared geometric mean IgG concentrations/titers (GMC/T ratios) against measles, mumps, rubella, Haemophilus influenzae type b (Hib), Neisseria meningococcus type C, diphtheria, tetanus, poliovirus types 1,2,3 and pertussis in children of high versus low SES by linear regression analysis. We included 894 children (0–12 years) at one of two timeframes: 1 month to 1 year, or 1–3 years after vaccination. Mother’s educational level and net household income served as binary indicators of SES. Results Of 58 possible associations of vaccine-induced antibody responses with educational level and 58 with income, 10 (9%) were statistically significant: 2 favouring (that is, with higher IgG levels at) high educational level (for Hib 1 m-1y after vaccination (GMC/T ratio: 2.99, 95%CI: 1.42–6.30) and polio 2 1 m-1y after the 9-year booster dose (1.14, 1.01–1.27)) and 8 favouring low income (polio 1, 2 and 3 1 m-1y after the 11-month booster (0.74, 0.58–0.94; 0.79, 0.64–0.97; 0.72, 0.55–0.95), polio 3 and pertussis 1-3y after the 11-month booster (0.70, 0.56–0.88; pertussis-prn: 0.60, 0.37–0.98; pertussis-ptx: 0.66, 0.47–0.95), mumps and rubella 1-3y after first vaccination (0.73, 0.55–0.97; 0.70, 0.55–0.90), and rubella 1 m-1y after second vaccination (0.83, 0.55–0.90)). After adjustment for multiple testing, none of the differences remained significant. There was no association between SES and proportion of children with protective IgG levels.
    • Isolation of the genome sequence strain Mycobacterium avium 104 from multiple patients over a 17-year period.

      Horan, Kathleen L; Freeman, Robert; Weigel, Kris; Semret, Makeda; Pfaller, Stacy; Covert, Terry C; Soolingen, Dick van; Leão, Sylvia C; Behr, Marcel A; Cangelosi, Gerard A (2006-03-01)
      The genome sequence strain 104 of the opportunistic pathogen Mycobacterium avium was isolated from an adult AIDS patient in Southern California in 1983. Isolates of non-paratuberculosis M. avium from 207 other patients in Southern California and elsewhere were examined for genotypic identity to strain 104. This process was facilitated by the use of a novel two-step approach. In the first step, all 208 strains in the sample were subjected to a high-throughput, large sequence polymorphism (LSP)-based genotyping test, in which DNA from each strain was tested by PCR for the presence or absence of 4 hypervariable genomic regions. Nineteen isolates exhibited an LSP type that resembled that of strain 104. This subset of 19 isolates was then subjected to high-resolution repetitive sequence-based PCR typing, which identified 10 isolates within the subset that were genotypically identical to strain 104. These isolates came from 10 different patients at 5 clinical sites in the western United States, and they were isolated over a 17-year time span. Therefore, the sequenced genome of M. avium strain 104 has been associated with disease in multiple patients in the western United States. Although M. avium is known for its genetic plasticity, these observations also show that strains of the pathogen can be genotypically stable over extended time periods.
    • Isoniazid (INH) mono-resistance and tuberculosis (TB) treatment success: analysis of European surveillance data, 2002 to 2014.

      Karo, Basel; Kohlenberg, Anke; Hollo, Vahur; Duarte, Raquel; Fiebig, Lena; Jackson, Sarah; Kearns, Cathriona; Ködmön, Csaba; Korzeniewska-Kosela, Maria; Papaventsis, Dimitrios; et al. (2019-03-01)
      Isoniazid (INH) is an essential drug for tuberculosis (TB) treatment. Resistance to INH may increase the likelihood of negative treatment outcome. We aimed to determine the impact of INH mono-resistance on TB treatment outcome in the European Union/European Economic Area and to identify risk factors for unsuccessful outcome in cases with INH mono-resistant TB. In this observational study, we retrospectively analysed TB cases that were diagnosed in 2002-14 and included in the European Surveillance System (TESSy). Multilevel logistic regression models were applied to identify risk factors and correct for clustering of cases within countries. A total of 187,370 susceptible and 7,578 INH mono-resistant TB cases from 24 countries were included in the outcome analysis. Treatment was successful in 74.0% of INH mono-resistant and 77.4% of susceptible TB cases. In the final model, treatment success was lower among INH mono-resistant cases (Odds ratio (OR): 0.7; 95% confidence interval (CI): 0.6-0.9; adjusted absolute difference in treatment success: 5.3%). Among INH mono-resistant TB cases, unsuccessful treatment outcome was associated with age above median (OR: 1.3; 95% CI: 1.2-1.5), male sex (OR: 1.3; 95% CI: 1.1-1.4), positive smear microscopy (OR: 1.3; 95% CI: 1.1-1.4), positive HIV status (OR: 3.3; 95% CI: 1.6-6.5) and a prior TB history (OR: 1.8; 95% CI: 1.5-2.2).
    • Issues currently complicating the risk assessment of synthetic amorphous silica (SAS) nanoparticles after oral exposure.

      Brand, Walter; van Kesteren, Petra C E; Peters, Ruud J B; Oomen, Agnes G (2021-06-01)
      Synthetic amorphous silica (SAS) is applied in food products as food additive E 551. It consists of constituent amorphous silicon dioxide (SiO2) nanoparticles that form aggregates and agglomerates. We reviewed recent oral toxicity studies with SAS. Some of those report tissue concentrations of silicon (Si). The results of those studies were compared with recently determined tissue concentrations of Si (and Si-particles) in human postmortem tissues. We noticed inconsistent results of the various toxicity studies regarding toxicity and reported tissue concentrations, which hamper the risk assessment of SAS. A broad range of Si concentrations is reported in control animals in toxicity studies. The Si concentrations found in human postmortem tissues fall within this range. On the other hand, the mean concentration found in human liver is higher than the reported concentrations causing liver effects in some animal toxicity studies after oral exposure to SAS. Also higher liver concentrations are observed in other, negative animal studies. Those inconsistencies could be caused by the presence of other Si-containing chemical substances or particles (which potentially also includes background SAS) and/or different sample preparation and analytical techniques that were used. Other factors which could explain the inconsistencies in outcome between the toxicity studies are the distinct SAS used and different dosing regimes, such as way of administration (dietary, via drinking water, oral gavage), dispersion of SAS and dose. More research is needed to address these issues and to perform a proper risk assessment for SAS in food. The current review will help to progress research on the toxicity of SAS and the associated risk assessment.
    • 'It is not entirely healthy.' A qualitative study into public appraisals of uncertain risks of chemical substances in food.

      Jansen, Tom; Claassen, Liesbeth; van Kamp, Irene; Timmermans, Daniëlle Rm (2020-01-01)
    • The joint effect of maternal smoking during pregnancy and maternal pre-pregnancy overweight on infants' term birth weight.

      Chattrapiban, Thanin; Smit, Henriette A; Wijga, Alet H; Brunekreef, Bert; Vonk, Judith M; Gehring, Ulrike; van Rossem, Lenie (2020-02-27)
    • Joint sequencing of human and pathogen genomes reveals the genetics of pneumococcal meningitis.

      Lees, John A; Ferwerda, Bart; Kremer, Philip H C; Wheeler, Nicole E; Serón, Mercedes Valls; Croucher, Nicholas J; Gladstone, Rebecca A; Bootsma, Hester J; Rots, Nynke Y; Wijmega-Monsuur, Alienke J; et al. (2019-05-15)
    • Een jongen met tularemie na een modderrace

      Zijlstra, M; Hulsker, C C C; Fanoy, E B; Pijnacker, R; Kraaijeveld, A; Koene, M G J; Wolfs, T F W (2017)
      Tularaemia is a rare disease. In Europe it mostly occurs in Scandinavia. Since 2011 more cases are being reported in the Netherlands. Tularaemia may manifest itself in various ways. It is important to take strict precautions during biopsy, drainage and biopsy processing in order to prevent transmission.
    • Kan het patiëntperspectief LCI-producten verbeteren?

      Adonis TN; Steenbergen JE van; Kessel RPM; Beaujean DJMA (2016-02)
    • Kennisagenda Klimaat en Gezondheid

      Huynen, M; van Vliet, A; Staatsen, B; Hall, L; Zwartkruis, J; Kruize, H; Bergen, C; Verboom, J; Martens, P
    • De Ketenverkenner van de Kennismpuls Waterkwaliteit: biociden, microplastics en consumentenproducten.

      moermond, C; van den Broeke, J; ter Laak, T; Roessink, I; Roex, E; Smit, E; Wezenbeek, J; Marinovic, M; Faber, M; Waaijers, S (2021-05-31)