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author:("coilin, S")
1.  Epidemiological situation of Lyme borreliosis in Belgium, 2003 to 2012 
Archives of Public Health  2015;73(1):33.
Some studies show that the incidence of Lyme borreliosis is increasing in different European countries. In order to evaluate if this is also the case in Belgium, different data sources were consulted to describe the epidemiology of Lyme borreliosis in the country during the last decade.
Data from two databases were analyzed for the time period 2003–2010 and 2003–2012 for respectively: the registration of minimal clinical data from Belgian hospitals (principal and secondary diagnosis), and a sentinel laboratory network reporting positive laboratory results.
The number of hospitalized cases per year remained stable between 2003 and 2010, ranging from 970 (in 2008) to 1453 (in 2006), with a median of 1132.5 cases per year. Between 2003 and 2012, yearly fluctuations in the number of positive tests were reported by the sentinel laboratory network (with a minimum of 996 positive tests in 2007 and a maximum of 1651 positive tests in 2005), but there is no increasing trend over the study period (median = 1200.5 positive tests per year). The highest incidence rates of hospitalization and the highest reported incidence of positive laboratory results are registered in the provinces of Luxemburg, Limburg, Flemish Brabant and Antwerp, with a typical seasonal pattern (peak in September). The age groups affected most are those from 5 to 14 years and 45 to 69.
Based on hospital records and laboratory results, no increasing trend in Lyme disease was observed over the 2003–2012 period in Belgium. These results are in line with the stable incidence of erythema migrans reported by a sentinel network of general practitionners between 2003 and 2009. Multi-source surveillance of vector-borne diseases should be further implemented.
PMCID: PMC4490618  PMID: 26146553
Lyme borreliosis; Belgium; Epidemiology
2.  Landscape and Regional Environmental Analysis of the Spatial Distribution of Hantavirus Human Cases in Europe 
Background: In Europe, the most prevalent hantavirus, Puumala virus, is transmitted by bank voles and causes nephropathia epidemica in human. The European spatial distribution of nephropathia epidemica is investigated here for the first time with a rich set of environmental variables.
Methods: The influence of variables at the landscape and regional level is studied through multilevel logistic regression, and further information on their effects across the different European ecoregions is obtained by comparing an overall niche model (boosted regression trees) with regressions by ecoregion.
Results: The presence of nephropathia epidemica is likely in populated regions with well-connected forests, more intense vegetation activity, low soil water content, mild summers, and cold winters. In these regions, landscapes with a higher proportion of built-up areas in forest ecotones and lower minimum temperature in winter are expected to be more at risk. Climate and forest connectivity have a stronger effect at the regional level. If variables are staying at their current values, the models predict that nephropathia epidemica may know intensification but should not spread (although southern Sweden, the Norwegian coast, and the Netherlands should be kept under watch).
Conclusion: Models indicate that large-scale modeling can lead to a very high predictive power. At large scale, the effect of one variable on disease may follow three response scenarios: the effect may be the same across the entire study area, the effect can change according to the variable value, and the effect can change depending on local specificities. Each of these scenarios impacts large-scale modeling differently.
PMCID: PMC4379737  PMID: 25874194
hantavirus; environmental modeling; spatial model; multilevel logistic regression; large scale model
3.  Lessons learned from a textbook outbreak: EHEC-O157:H7 infections associated with the consumption of raw meat products, June 2012, Limburg, Belgium 
Archives of Public Health  2014;72(1):44.
On 5 June 2012 several enterohemorrhagic Escherichia coli, EHEC, O157:H7 infections were reported to the public health authorities of Limburg.
We performed a case-control study, a trace back/forward investigation and compared strains isolated from human cases and food samples. A case was defined as anyone with a laboratory-confirmed E. coli O157:H7-infection in North-East Limburg from May 30 2012 till July 15 2012. Family members with bloody diarrhea were also included as cases. E. coli O157 was isolated by culture and the presence of the virulence genes was verified using (q)PCR. Isolates were genotyped and compared by Pulsed Field Gel Electrophoresis (PFGE) and insertion sequence 629-printing (IS629-printing).
The outbreak involved 24 cases, of which 17 were laboratory-confirmed. Five cases developed Hemolytic Uremic Syndrome (HUS) and fifteen were hospitalized. Cases reported a significantly higher consumption of “steak tartare”, a raw meat product (OR 48.12; 95% CI; 5.62- 416.01). Cases were also more likely to buy meat-products at certain butcheries (OR 11.67; 95% CI; 1.41 - 96.49). PFGE and IS629-printing demonstrated that the vtx1a vtx2a eae ehxA positive EHEC O157:H7 strains isolated from three meat products and all seventeen human stool samples were identical. In a slaughterhouse, identified by the trace-back investigation, a carcass infected with a different EHEC strain was found and confiscated.
We present a well described and effectively investigated foodborne outbreak associated with meat products. Our main recommendations are the facilitation and acceleration of the outbreak detection and the development of a communication plan to reaches all persons at risk.
Foodborne diseases, Shiga-toxigenic Escherichia coli, Enterohemorrhagic Escherichia coli, Meat products, Case control studies, Electrophoresis, Gel, Pulsed-Field
PMCID: PMC4373035  PMID: 25810911
Enterohaemorrhagic E. coli – EHEC; Escherichia coli O157; Food-borne infections; Vero cytotoxin-producing E. coli – VTEC; Outbreaks; Case control studies; PFGE; IS629-printing
4.  Pure and Pseudo-pure Fluid Thermophysical Property Evaluation and the Open-Source Thermophysical Property Library CoolProp 
Over the last few decades, researchers have developed a number of empirical and theoretical models for the correlation and prediction of the thermophysical properties of pure fluids and mixtures treated as pseudo-pure fluids. In this paper, a survey of all the state-of-the-art formulations of thermophysical properties is presented. The most-accurate thermodynamic properties are obtained from multiparameter Helmholtz-energy-explicit-type formulations. For the transport properties, a wider range of methods has been employed, including the extended corresponding states method. All of the thermophysical property correlations described here have been implemented into CoolProp, an open-source thermophysical property library. This library is written in C++, with wrappers available for the majority of programming languages and platforms of technical interest. As of publication, 110 pure and pseudo-pure fluids are included in the library, as well as properties of 40 incompressible fluids and humid air. The source code for the CoolProp library is included as an electronic annex.
PMCID: PMC3944605  PMID: 24623957
6.  Establishment and reinforcement of the national reference centers for human microbiology in Belgium 
Archives of Public Health  2012;70(1):16.
Microbiology reference laboratories are critical in the development of high-quality clinical and public health services. In Belgium, the reference laboratories performed their activities on a voluntary basis and lacked a legal status.
Pathogens or groups of pathogens necessitating a national reference center (NRC) were prioritized based on diagnostic and epidemiologic relevance. Terms of reference for each of these pathogens were developed.
Recently, 40 NRCs for different pathogens or groups of pathogens have been installed in Belgium to fulfill the following core functions: offering reference diagnostics, collecting reference materials, sharing information and scientific advice, participating in national and international networks, collaborating with research workgroups, and contributing to surveillance activities.
These NRCs are important focal points of the national and international network in public health microbiology.
PMCID: PMC3436681  PMID: 22958353
National reference centers; Public health microbiology
7.  Q Fever in Woolsorters, Belgium 
Emerging Infectious Diseases  2011;17(12):2368-2369.
PMCID: PMC3311209  PMID: 22172399
Q fever; Coxiella burnetii; bacteria; seroprevalence; woolsorters; zoonoses; Belgium
9.  Virological surveillance of the influenza A(H1N1)2009 pandemic: the role of the belgian national influenza centre 
Archives of Public Health  2010;68(2):68-75.
PMCID: PMC3463022
Surveillance; Influenza; diagnosis; PCR
10.  Confirmation diagnosis of influenza A(H1N1)2009 by Belgian sentinel laboratories during the epidemic phase 
Archives of Public Health  2010;68(2):76-82.
PMCID: PMC3463024
Influenza; A(H1N1)pandemic; epidemiology; laboratory diagnosis
12.  A prospective study of CSF markers in 250 patients with possible Creutzfeldt–Jakob disease 
Objective: To investigate various cerebrospinal fluid (CSF) markers that could assist in the clinical diagnosis of Creutzfeldt–Jakob disease (CJD).
Methods: CSF samples were analysed for the presence of 14-3-3 protein, microtubule associated protein tau, and ß amyloid in 250 patients with possible CJD. Densitometric analysis was used to quantify the level of 14-3-3 in all patients.
Results: Analysis of the clinical data showed that cerebellar signs or myoclonus combined with progressive dementia were the main features leading to a clinical suspicion of CJD. While 14-3-3 detection had a sensitivity of 100% and a specificity of 92%, tau determination using a threshold of 1300 pg/ml had a sensitivity of 87% and a specificity of 97%. If the protocol for the analysis of 14-3-3 was modified (using densitometric analysis) a higher specificity (97%) could be obtained, but with a lower sensitivity (96%). Maximum sensitivity, specificity, and positive predictive value were obtained with a combination of 14-3-3 and ß amyloid determinations. The concentrations of 14-3-3 and tau in the CSF were reduced in CJD patients with a long duration of disease (more than one year; p < 0.05). The concentrations of 14-3-3 or tau were lowest at the onset or at the end stage of the disease, while the ß amyloid concentration remained low throughout the course of the disease.
Conclusions: Both 14-3-3 and tau protein are sensitive and specific biomarkers for CJD. The combination of 14-3-3 and ß amyloid analysis resulted in the maximum sensitivity, specificity, and positive predictive value. When these biomarkers are used in the diagnosis of CJD, the phase of the disease in which the CSF sample was obtained should be taken into account. Disease duration, dependent on the PrP genotype, also has a significant influence on the level of 14-3-3 and tau in the CSF.
PMCID: PMC1738637  PMID: 12933920
13.  Contribution of respiratory pathogens to influenza-like illness consultations 
Epidemiology and Infection  2012;141(10):2196-2204.
Influenza-like illnesses (ILIs) are caused by several respiratory pathogens. These pathogens show weak to strong seasonal activity implying seasonality in ILI consultations. In this paper, the contribution of pathogens to seasonality of ILI consultations was statistically modelled. Virological count data were first smoothed using modulation models for seasonal time series. Second, Poisson regression was used regressing ILI consultation counts on the smoothed time series. Using ratios of the estimated regression parameters, relative measures of the underreporting of pathogens were obtained. Influenza viruses A and B, parainfluenza virus and respiratory syncytial virus (RSV) significantly contributed to explain the seasonal variation in ILI consultations. We also found that RSV was the least and influenza virus A is the most underreported pathogen in Belgian laboratory surveillance. The proposed methods and results are helpful in interpreting the data of clinical and laboratory surveillance, which are the essential parts of influenza surveillance.
PMCID: PMC3757921  PMID: 23217849
Infectious disease epidemiology; influenza; statistics; surveillance system

Results 1-13 (13)