Activities Report 2022 / 2023
Public Health Rotterdam

Section

Infectious Disease Control

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“Ending epidemics is key in sustainable development”

 

Our ambition is to do research that has a tangible and sustainable influence on the burden of infectious diseases, specifically by informing control policy and practice. Main research activities concern the understanding and prediction of the spread and control of neglected tropical diseases (NTDs), including leprosy, visceral leishmaniasis, and parasitic worm infections. Tuberculosis, HIV/Aids, and other sexually transmitted infections are also important topics of research. We further study antimicrobial resistance in the general population of European countries, and some infectious diseases common among the diverse population of Rotterdam. Within the Pandemic and Disaster Preparedness Center (PDPC) we work on the question how spatial and social connectivity drive societal inequities in transmission and control of infectious disease outbreaks in The Netherlands and how these can be better addressed in future pandemic control. Our research methodologies include mathematical modelling, particularly individual-based simulation, as well as epidemiological data analysis and behavioural studies. Most of our NTD research is part of or linked to the NTD Modelling Consortium, a collaboration of various international modelling teams, funded by the Bill & Melinda Gates Foundation.

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High HIV risk and poor access to treatment for marginalized sex worker populations in Zimbabwe

We collected and analysed unique data on sexual risk behaviour, HIV prevalence, and HIV services uptake of male and transgender sex workers in Zimbabwe. We demonstrated that HIV prevalence among these important key populations is twice as high compared to the general population, coinciding with an alarmingly low uptake of HIV treatment. Only 10% to 15% of all people living with HIV in our sample were receiving antiretroviral therapy.

HIV services for at risk populations are an essential component in moving towards the common goal of ending the HIV pandemic by 2030. In sub-Saharan Africa, the epicentre of the pandemic, HIV prevention and treatment programmes for female sex workers have been successfully launched in many countries, yet cisgender male sex workers, transgender women sex workers and transgender men sex workers are largely neglected. In fact, information about these populations is often missing or biased, making it impossible to adequately design effective programs for these populations. The alarming figures we report signal an urgent need for improved services for these key populations. Our findings were published in The Lancet HIV.

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Photography: Jan Hontelez

Predicting the risk of resistance of intestinal parasites against deworming drugs in developing countries

In developing countries, over 1 billion people are still infected with parasitic intestinal worms, which are an important cause of iron deficiency anaemia and malnutrition. These parasites are primarily controlled via regular large-scale deworming of high-risk groups such as school-age children. Although resistance has not yet been conclusively documented in humans, in veterinary practice, which uses the same class of drugs, drug resistance is already widespread. In recent work, we address the concern that regular deworming of populations living with these intestinal worm infections will eventually lead to drug resistance.

We performed a synthesis of the current knowledge about mechanisms for drug resistance in human and veterinary intestinal worm infections. Based on this, we developed a model to predict trends in infections and drug resistance in humans. Our predictions confirm that the concerns regarding drug resistance for human worms are founded, as ongoing deworming programs may lead to evolution of resistance within a decade. As so far, drug efficacy has not been structurally monitored (or incorrectly so), we have developed new cost-efficient survey designs to monitor drug efficacy. Based on this, the World Health Organization is now updating its guidelines for monitoring and evaluation of these parasites.

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Section: Infectious Disease Control