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Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) led to a significant disease burden and disruptions in health systems. We describe the epidemiology and transmission characteristics of early coronavirus disease 2019 (COVID-19) cases in Bavaria, Germany. Cases were reverse transcription polymerase chain reaction (RT-PCR)-confirmed SARS-CoV-2 infections, reported from 20 January−19 March 2020. The incubation period was estimated using travel history and date of symptom onset. To estimate the serial interval, we identified pairs of index and secondary cases. By 19 March, 3546 cases were reported. A large proportion was exposed abroad (38%), causing further local transmission. Median incubation period of 256 cases with exposure abroad was 3.8 days (95%CI: 3.5–4.2). For 95% of infected individuals, symptom onset occurred within 10.3 days (95%CI: 9.1–11.8) after exposure. The median serial interval, using 53 pairs, was 3.5 days (95%CI: 3.0–4.2; mean: 3.9, s.d.: 2.2). Travellers returning to Germany had an important influence on the spread of SARS-CoV-2 infections in Bavaria in early 2020. Especially in times of low incidence, public health agencies should identify holiday destinations, and areas with ongoing local transmission, to monitor potential importation of SARS-CoV-2 infections. Travellers returning from areas with ongoing community transmission should be advised to quarantine to prevent re-introductions of COVID-19.
An outbreak of measles in the Netherlands in 2013–2014 provided an opportunity to assess the effect of MMR vaccination on severity and infectiousness of measles.
Measles is notifiable in the Netherlands. We used information on vaccination, hospitalisation, complications, and most likely source(s) of infection from cases notified during the outbreak. When a case was indicated as a likely source for at least one other notified case, we defined it as infectious. We estimated the age-adjusted effect of vaccination on severity and infectiousness with logistic regression.
Of 2676 notified cases, 2539 (94.9%) were unvaccinated, 121 (4.5%) were once-vaccinated and 16 (0.6%) were at least twice-vaccinated; 328 (12.3%) cases were reported to have complications and 172 (6.4%) cases were hospitalised. Measles in twice-vaccinated cases led less often to complications and/or hospitalisation than measles in unvaccinated cases (0% and 14.5%, respectively, aOR 0.1 (95% CI 0–0.89), P = 0.03). Of unvaccinated, once-vaccinated and twice-vaccinated cases, respectively, 194 (7.6%), seven (5.1%) and 0 (0%) were infectious. These differences were not statistically significant (P > 0.05).
Our findings suggest a protective effect of vaccination on the occurrence of complications and/or hospitalisation as a result of measles and support the WHO recommendation of a two-dose MMR vaccination schedule.
Measles is a notifiable disease, but not everyone infected seeks care, nor is every consultation reported. We estimated the completeness of reporting during a measles outbreak in The Netherlands in 2013–2014. Children below 15 years of age in a low vaccination coverage community (n = 3422) received a questionnaire to identify measles cases. Cases found in the survey were matched with the register of notifiable diseases to estimate the completeness of reporting. Second, completeness of reporting was assessed by comparing the number of susceptible individuals prior to the outbreak with the number of reported cases in the surveyed community and on a national level.
We found 307 (15%) self-identified measles cases among 2077 returned questionnaires (61%), of which 27 could be matched to a case reported to the national register; completeness of reporting was 8.8%. Based on the number of susceptible individuals and number of reported cases in the surveyed community and on national level, the completeness of reporting was estimated to be 9.1% and 8.6%, respectively. Estimating the completeness of reporting gave almost identical estimates, which lends support to the credibility and validity of both approaches. The size of the 2013–2014 outbreak approximated 31 400 measles infections.
Vaccination programmes are considered a main contributor to the decline of infectious diseases over the 20th century. In recent years, the national vaccination coverage in the Netherlands has been declining, highlighting the need for continuous monitoring and evaluation of vaccination programmes. Our aim was to quantify the impact of long-standing vaccination programmes on notified cases in the Netherlands. We collected and digitised previously unavailable monthly case notifications of diphtheria, poliomyelitis, mumps and rubella in the Netherlands over the period 1919–2015. Poisson regression models accounting for seasonality, multi-year cycles, secular trends and auto-correlation were fit to pre-vaccination periods. Cases averted were calculated as the difference between observed and expected cases based on model projections. In the first 13 years of mass vaccinations, case notifications declined rapidly with 82.4% (95% credible interval (CI): 74.9–87.6) of notified cases of diphtheria averted, 92.9% (95% CI 85.0–97.2) cases of poliomyelitis, and 79.1% (95% CI 67.1–87.4) cases of mumps. Vaccination of 11-year-old girls against rubella averted 49.9% (95% CI 9.3–73.5) of cases, while universal vaccination averted 68.1% (95% CI 19.4–87.3) of cases. These findings show that vaccination programmes have contributed substantially to the reduction of infectious diseases in the Netherlands.
Over the last decades luminescence dating techniques have been developedthat allow earth scientists to determine the time of deposition ofsediments. In this contribution we review: 1) the development of themethodology; 2) tests of the reliability of luminescence dating onNetherlands’ sediments; and 3) geological applications of the method in theNetherlands. Our review shows that optically stimulated luminescence datingof quartz grains using the single aliquot regenerative dose method yieldsresults in agreement with independent age control for deposits ranging inage from a few years up to 125 ka. Optical dating of quartz has successfullybeen applied to sediments from a wide range of depositional environmentssuch as coastal dunes, cover sands, fluvial channel deposits, colluvialdeposits and fimic soils. These results demonstrate that optical dating is apowerful tool to explore the natural archive of the Netherlands’subsurface.
The fluvial development of the Roer river in the southeastern Netherlands and western Germany is presented for the Late Pleniglacial, Late-glacial and Early Holocene periods. Reconstruction of fluvial-style changes is based on geomorphological and sedimentological analysis. Time control comes from correlation to the pollen-based biochronostratigraphic framework of the Netherlands combined with independent optically stimulated luminescence (OSL) ages. At the Pleniglacial to Late-glacial transition a system and channel pattern change occurred from an aggrading braided to an incising meandering system. Rapid rates of meander migration, as established for the Late-glacial by optical dating, were likely related to the sandy nature of the substratum and the Late-glacial incision of the Meuse that resulted in a higher river gradient in the downstream part of the Roer. In the Roer valley the Younger Dryas cooling is not clearly reflected by a fluvial system response, but this may also be related to Holocene erosion of Younger Dryas fluvial forms. An important incision and terrace formation was established at the Younger Dryas to Early Holocene transition, probably related to forest recovery, reduced sediment supply and base-level lowering of the Meuse. The results of this study show a stepwise reduction in the number of channel courses from a multi-channel braided system in the Pleniglacial, to a double meander-belt system in the Late-glacial and a single-channel meandering system in the Early Holocene. The results show that the forcing factors of fluvial-system change in the Roer valley are climate change (precipitation, permafrost and vegetation) and downstream base-level control by the Meuse.
Eight continuous corings in the west-central Netherlands show a 15 to 25 m thick stacked sequence of sandy to gravelly channel-belt deposits of the Rhine-Meuse system. This succession of fluvial sediments was deposited under net subsiding conditions in the southern part of the North Sea Basin and documents the response of the Rhine-Meuse river system to climate and sea-level change and to the glaciation history. On the basis of grain size characteristics, sedimentological structures, nature and extent of bounding surfaces and palaeo-ecological data, the sequence was subdivided into five fluvial units, an estuarine and an aeolian unit. Optical dating of 34 quartz samples showed that the units have intra Saalian to Weichselian ages (Marine Isotope Stages 8 to 2). Coarse-grained fluvial sediments primarily deposited under cold climatic conditions, with low vegetation cover and continuous permafrost. Finer-grained sediments generally deposited during more temperate climatic conditions with continuous vegetation cover and/or periods of sea-level highstand. Most of the sedimentary units are bounded by unconformities that represent erosion during periods of climate instability, sea-level fall and/or glacio-isostatic uplift.
Gonorrhoea is one of the most common sexually transmitted infections. The control of gonorrhoea is extremely challenging because of the repeated development of resistance to the antibiotics used for its treatment. We explored different strategies to control the spread of antimicrobial resistance and prevent increases in gonorrhoea prevalence. We used a mathematical model that describes gonorrhoea transmission among men who have sex with men and distinguishes gonorrhoea strains sensitive or resistant to three antibiotics. We investigated the impact of combination therapy, switching first-line antibiotics according to resistance thresholds, and other control efforts (reduced sexual risk behaviour, increased treatment rate). Combination therapy can delay the spread of resistance better than using the 5% resistance threshold. Increased treatment rates, expected to enhance gonorrhoea control, may reduce gonorrhoea prevalence only in the short term, but could lead to more resistance and higher prevalence in the long term. Re-treatment of resistant cases with alternative antibiotics can substantially delay the spread of resistance. In conclusion, combination therapy and re-treatment of resistant cases with alternative antibiotics could be the most effective strategies to prevent increases in gonorrhoea prevalence due to antimicrobial resistance.
A unique complex of multiphased Holocene drift sands and paleosols, with at least two lacustrine phases, was discovered during a major sanitation project in the Laarder Wasmeren area near Hilversum, the Netherlands. The complex could be studied in detail, highly facilitated by the excellent and large-scale exposure of the various deposits and soils. OSL dating was used to establish ages of the phases, where possible differentiating between time of deposition and time of burial by taking into account the potential effects of bioturbation. Pollen analysis served to reconstruct the vegetation during the various phases.
A first minor phase of aeolian activity already started before approx. 5,000 BC, followed around 4,000 BC by a second phase and a rather massive third phase around 3,000 BC. After a long phase of soil formation, the latest, massive drift sand phase started around the 14th to 15th century. It clearly represents the classic drift sand phase that started in the Late Middle Ages in the Netherlands. Sand drifting followed on soil forming phases during which the vegetation became increasingly dominated by ericaceous plants and culminated in heathlands. The first three aeolian phases and associated heathlands are much older than generally assumed for heathland and drift sand to occur in the Netherlands. Moreover, podzolisation was found to have started very early, true podzols already occurring before 4,000 BC.
Around 3,000 BC groundwater in the area reached a maximum altitude of about 230 cm +NAP, resulting in local open water in the area. This rise is probably linked to the development of the Dutch coastal area, where at that time peat accumulated and drainage was poor, inducing a rise of the groundwater level in ‘het Gooi’. This groundwater level fell later on, to never reach this altitude again. The Groot Wasmeer was formed by local stagnation on a slowly permeable podzol and already reached a level of 320-325 cm +NAP by 400 BC, which more or less equals its 20th century level.
The results demonstrate that earlier concepts on the occurrence and age of aeolian phases, podzols and heathland vegetations in the Netherlands are far too schematic, and that early, pre-agricultural cultures may already have had an impact on the stability of fragile cover sand landscapes, e.g. through burning. Results are in line with those from several contemporary studies on early prehistoric cultures and their impact in river dune areas in the Central and Eastern Netherlands.
In the Weichselian, the Lower Rhine in the Dutch-German border region has used three courses, dissecting ice-marginal topography inherited from the Saalian. In the Late Weichselian, the three courses functioned simultaneously, with the central one gaining importance and the outer ones abandoning. This study aims to reconstruct the fluvial development and forcings that culminated in abandonment of the northern branch ‘Oude IJssel-Rhine’, at the time of the Lateglacial to Holocene transition. The fluvial architecture is studied using a cored transect over the full width of the valley, detailed cross-sections over palaeochannels and geomorphological analysis using digital elevation and borehole data. Biostratigraphy, radiocarbon dating and OSL dating provide a timeframe to reconstruct the temporal fluvial development. In its phase of abandonment, the fluvial evolution of the Oude IJssel-Rhine course is controlled by the ameliorating climate and related vegetation and discharge changes, besides by intrinsic (autogenic) fluvial behaviour such as the competition for discharge with the winning central branch and the vicinity of the Lippe tributary confluence. The rapid climate warming at the start of the Late Glacial resulted in flow contraction as the initial response. Other fluvial geomorphic adjustments followed, with some delay. An aggrading braided or transitional system persisted until the start of the Allerød, when channel patterns finally changed to meandering. Floodplain incision occurred at the Allerød - Younger Dryas transition and a multi-channel system developed fed by Rhine discharge. At the start of the Holocene, this system transformed into a small-scale, local meandering system, which was abandoned shortly after the start of the Holocene.
The final abandonment of the Oude IJssel-Rhine and Niers-Rhine courses can be attributed to deep incision of the Central Rhine course in the earliest Holocene and is considered to be controlled by flow contraction induced by climate and related vegetation and discharge changes.
Botanical microfossils, macroremains and oribatid mites of a Weichselian interstadial deposit in the central Netherlands point to a temporary, sub-arctic wetland in a treeless landscape. Radiocarbon dates and OSL dates show an age between ca. 54.6 and 46.6 ka cal BP. The vegetation succession, starting as a peat-forming wetland that developed into a lake, might well be linked with a Dansgaard-Oeschger climatic cycle. We suggest that during the rapid warming at the start of a D-O cycle, relatively low areas in the landscape became wetlands where peat was formed. During the more gradual temperature decline that followed, evaporation diminished; the wetlands became inundated and lake sediments were formed. During subsequent sub-arctic conditions the interstadial deposits were covered with wind-blown sand. Apart from changes in effective precipitation also the climate-related presence and absence of permafrost conditions may have played a role in the formation of the observed sedimentological sequence from sand to peat, through lacustrine sediment, with coversand on top. The Wageningen sequence may correspond with D-O event 12, 13 or 14. Some hitherto not recorded microfossils were described and illustrated.
The original distribution pattern of Middle-Palaeolithic artefacts may be affected by tectonic movement, sedimentation and periglacial processes. This is e.g. the case in the coversand area of Limburg and Eastern Brabant (NL), where the occurrence of numerous finds in a SW-NE trending zone across the Roer Valley Graben is considered enigmatic. In order to elucidate the processes affecting the spatial distribution and the chance of recovery of such artefacts, we investigated a site in Nederweert. At this site, several Middle-Palaeolithic artefacts had been recovered earlier from unexpectedly shallow depths. A test pit profile and grain size analyses revealed that the shallow sediments at this site have been affected by intense, multi-phase cryoturbation, which has deformed the sand and loam layers and partially mixed them thoroughly. As a result, optically stimulated luminescence dating of these sediments yielded widely scattered single-aliquot equivalent dose distributions. Using a Finite Mixture Model (FMM), it was estimated that cryoturbation caused mixing of sediments deposited between 12 and 50 ka with sediment grains deposited between 60-150 ka. The latter material is probably the original context of the Middle-Paleolithic artefacts. Apparently, cryoturbation and potentially other periglacial processes have transported artefacts closer to the surface. Based on these results, we suggest that the occurrence of Middle-Palaeolithic artefacts is caused by (1) the tectonically-induced spatial distribution of layers of this age and (2) periglacial processes having caused migration of artefacts towards the surface. Although periglacial processes may facilitate finding Middle Palaeolithic artefacts, they may severely disturb the original context to such an extent that Middle Palaeolithic sites can no longer be identified. The results of this study form a basis for improving the Indicative Map of Archaeological Values that is used to predict the presence of archaeological sites. The insights gained are also relevant to other areas where Middle-Palaeolithic sites are affected by periglacial processes.
This article presents a set of Late Pleistocene marine mollusk radiocarbon (AMS) age estimates of 30–50 14C kyr BP, whereas a MIS5 age (>75 ka) is indicated by quartz and feldspar OSL dating, biostratigraphy, U-Th dating, and age-depth relationships with sea level. These results indicate that the 14C dates represent minimum ages. The age discrepancy suggests that the shells are contaminated by younger carbon following shell death. The enigmatic 14C dates cannot be “solved” by removing part of the shell by stepwise dissolution. SEM analysis of the Late Pleistocene shells within a context of geologically younger (recent/modern, Holocene) and older (Pliocene) shells shows the presence of considerable amounts of an intracrystalline secondary carbonate precipitate. The presence of this precipitate is not visible using XRD since it is of the same (aragonitic) polymorph as the original shell carbonate. The combination of nanospherulitic-shaped carbonate crystals, typical cavities, and the presence of fatty acids leads to the conclusion that the secondary carbonate, and hence the addition of younger carbon, has a bacterial origin. As shell material was studied, this study recommends an assessment of possible bacterial imprints in other materials like bone collagen as well.
The impact of hepatitis B vaccination in men having sex with men in Amsterdam has been marginal until now, possibly because of increases in sexual risk behaviour counterbalancing the effect of vaccination. A mathematical model is used to describe the hepatitis B epidemic. The model shows that, with the current vaccination coverage, the decrease in incidence is small in the beginning. However, the number of infections prevented per vaccine administered rises over time. Nevertheless, increased risk behaviour reduces the benefit of vaccination. Targeting high-risk men is more successful in reducing and containing the epidemic than targeting low-risk men. In conclusion, the vaccination campaign is effective and should be intensified. High-risk men should be targeted for vaccination and for risk reduction.
During influenza outbreaks, fever and cough are the most accurate symptoms in predicting influenza virus infection in the community.
To determine the usefulness of fever, cough, and other symptoms for diagnosing influenza virus infection in hospitalized patients.
Prospective cohort study.
Three wards (pulmonology, internal medicine and infectious diseases, and geriatrics) of a tertiary care hospital in the Netherlands.
All patients staying in the wards during peak national influenza activity in the 2005-2006 and 2006-2007 influenza seasons.
During peak influenza activity, the presence of fever, cough, and/or other symptoms possibly associated with influenza was monitored for all patients, and nose and throat swab samples were taken twice weekly for virologic analysis.
Of 264 patients, 23 (9%) tested positive for influenza virus. The positive predictive value of fever and cough for the diagnosis of influenza virus infection was 23% (95% confidence interval, 0%-62%), and the sensitivity was 35% (95% confidence interval, 11%-58%). The combination of symptoms with the highest positive predictive value (40%) was that of cough, chills, and obstructed nose or coryza. The combination of cough and chills or fever had the highest sensitivity (60%). None of the combinations of symptoms had both a positive predictive value and a sensitivity higher than 40%.
Both the sensitivity and the positive predictive value of fever, cough, and/or other symptoms for the diagnosis of influenza virus infection in hospitalized patients are low. The use of these common symptoms for treatment decisions and infection control management will probably be insufficient to contain a nosocomial outbreak, because many influenza cases will remain unidentified.
We investigated which vaccination schedule gives best protection to the vaccinating population, in case there is a measles epidemic in an area with low vaccine coverage. We considered combinations of an early measles vaccination (none, at 6 months or at 9 months), a measles–mumps–rubella (MMR) vaccination around the first birthday (at either 11 or 14 months), and MMR vaccination at an older age (at either 4 or 9 years). The different estimates on measures of protection (percentage of susceptibles, number of reported cases in an epidemic year, percentage of lifetime spent susceptible) relied on a mathematical model of decline of maternal antibody levels with age, and the impact of that antibody level on seroconversion and immunity. Model parameters were estimated from a Dutch population-based serological survey on measles antibodies. Different measures of protection favoured different vaccination schedules, but dropping the age of second MMR vaccination prevents considerably more cases than an extra early measles vaccination or dropping the age of first MMR vaccination.
The objective of this study is to estimate the measles reproduction ratio for eight Western European vaccination programmes. Because many plausible age-structured transmission patterns result in a similar description of the observations, it is not possible to estimate a unique value of the reproduction ratio. A method is developed to estimate bounds and confidence intervals for plausible values of the reproduction ratios using maximum likelihood methods. Lower and upper bounds for plausible values of the basic reproduction ratio are estimated to be 7·17 (95% CI 7·14–7·20) and 45·41 (95% CI 9·77–49·57), corresponding to lower and upper bounds on critical vaccine coverage of 86·6% and 98·1%. Of the eight evaluated vaccination programmes, four have vaccine coverage below the lower bound and allow measles to persist, and four have vaccine coverage at the upper bound and may eventually eliminate measles.
Thin(<20nm) p-type microcrystalline silicon f'dms have been deposited by PECVD in an unusual parameter regime, specifically optimized for extremely thin films. High conductivity (>10.2 Scm−1) and low activation energy(<0.08eV) of thin films have been achieved on various metal oxide substrates i.e., Coming 7059 glass, SnO2:F, TiO2 and Ta2O5. Crystallinity was confirmed by Raman spectroscopy and UV reflectance. Deposition of p-μc-Si:H is possible on void rich films (a-SiC:H and low temperature deposited a-Si:H) but not on device quality a-Si:H. Cells made in a superstrate structure using p-μc-Si:H as the window layer directly on top of SnO2:F coated glass yielded 9.63% efficiency, with an improvement in the blue spectral response compared to the cell made with a- SiC:H(B) as window layer. Tandem cells (a-Si:H/a-Si:H) incorporating p-μc-Si:H along with n-μc- Si:H in the tunnel junction yielded 8.8% efficiency.
The effect of ion bombardment on the plasma enhanced chemical vapor deposition of a-Si:H and on TCO/a-Si:H interface reactions has been studied. An external DC-bias voltage is applied to the deposition plasma in order to change the ion flux and ion energy. The deposition rate increases with the applied bias-voltage i.e. with the plasma potential. Hydrogenated amorphous silicon is grown on natively rough transparent conductive oxide. With cross-sectional transmission electron microscopy lower density regions can be observed in the a-Si:H in all sharp valleys of the TCO. The appearance of the lower density regions changes under influence of the ion bombardment. The observed changes are in agreement with the changes observed when no ion bombardment is present at all, like in a hot wire chemical vapor deposition process. The increased ion bombardment did not give rise to observable chemical reactions at the TCO/a-Si:H interface.
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