Rijksinstituut voor Volksgezondheid en Milieu - EPIET
Description of institute
The National Institute of Public Health and the Environment (RIVM) promotes public health and consumer safety, and helps to protect the environment. RIVM collects, analyses and disseminates knowledge and information from various sources, both national and international. This knowledge supports policy-makers, researchers, regulatory authorities and the general public. Each year, RIVM produces numerous reports and publications on all aspects of public health, nutrition and food, health care, disaster management, nature and the environment. The RIVM has three areas of focus: infectious diseases, chronic diseases and environmental health.
The mission of the RIVM - Centre for Infectious Disease Control (RIVM-CIb) is to identify, prevent, control and manage infectious diseases and associated risks in order to maintain and promote public health in the Netherlands.
The RIVM CIb focuses on supporting and coordinating infectious disease control efforts at both national and international level. This is possible through ongoing surveillance and research of endemic infections, and alertness towards any potential large-scale outbreak or an outbreak of a disease which is not endemic to the Netherlands. The work complements and supports that of local and regional health authorities. The RIVM-CIb coordinates development of multidisciplinary guidelines, conducts and participates in research and advises government and professionals. The centre also promotes expertise, quality and uniformity within the discipline of infectious disease control. It makes clear and reliable information available to professionals and the general public, and it promotes effective international cooperation.
EPIET fellows are hosted in the Epidemiology and Surveillance Unit (EPI) which is part of the Centre for Infectious Disease Control (CIb). EPI is responsible for monitoring and studying the epidemiology of infectious diseases. It studies the location and frequency of outbreaks, risk factors and effectiveness of interventions, and aims to identify new or improved interventions to support control.
The unit identifies and analyses trends, and investigates outbreaks. It studies the epidemiology of infectious diseases (how and why they spread), as well as the impact of measures intended to contain or mitigate the outcome of such infections. All such activities help in the support and assessment of current disease control policy, prompting its modification where necessary.
Furthermore EPI initiates and facilitates research into the emergence, spread and control of infectious diseases. It provides assistance and advice to investigations of outbreaks of infectious diseases, and develops new monitoring and surveillance systems. It disseminates knowledge and experience in the form of the various scientific articles and RIVM reports which present the findings of epidemiological research, maintains contact with sister organizations in other European countries, and initiates further joint research where appropriate. The unit acts as a training location for the European (EU) and the Member State (MS) track of the European Programme for Intervention Epidemiology Training (EPIET). There is also close collaboration with the EUPHEM programme.
During the two-year training at the EPI department, there are sufficient opportunities to meet all EPIET training objectives. The trainee can be amply involved in all major activities of the departments and there are also opportunities for international missions.
Susan Hahné (MD, PhD, EPIET, FFPH (UK)) and Miriam Knol (PhD) are the training site supervisors of the EPIET fellows, who further will be supervised by other staff members / senior epidemiologists, depending on the involvement in specific projects.
Within the departments communication in English is possible with all colleagues. However, in order to be actively involved in field investigations and to communicate with the public health services, it is highly recommended to learn to read and speak Dutch. Nearly all fellows manage to do so to a certain degree.
The previous EPIET fellows trained at RIVM and will be happy to answer your questions:
1996 – 1998: Ralf Reintjes (Germany), currently professor at Hamburg University of Applied Sciences
1997 – 1999: Olivier Ronveaux (Belgium), currently at WHO
1998 – 2000: Christine Meffre (France), currently at InVS in Paris
1999 – 2001: Marc-Alain Widdowson (UK), currently at CDC Atlanta
2000 – 2002: Teresa Fernandes (Portugal), currently at DG of Health in Portugal
2003 – 2005: Mary Ward (Ireland), currently at the regional office in Dublin
2004 – 2006: Katrine Borgen (Norway), currently at FHI Oslo
2005 – 2007: Mårten Kivi (Sweden), currently at the Swedish Ministry of Health
2006 – 2008: Ioannis Karagiannis (Greece), currently FETP coordinator at PHE, London
2007 – 2009: Harold Noël (France), currently at InVS in Paris
2008 - 2010 Katie Greenland (United Kingdom), currently at London School of Hygiene and Tropical Medicine
2008 – 2010: Marc Rondy (France), current working at PAHO
2009 – 2011: Jane Whelan (Ireland), current working at GSK
2010 - 2012: Georgia Ladbury (United Kingdom), currently working at University Glasgow
2011 - 2013: Nelly Fournet (France), currently working at InVS in Paris
2012 - 2014: Jussi Sane (Finland) currently at THL, Finland
2012 - 2014: Sandra van Dam (Netherlands), currently at GGD HvB
2013 - 2015: Ewout Fanoy (Netherlands), currently at GGD Rotterdam
2013 - 2015: Laura Nic Lochlainn (Ireland), currently at WHO
2014 - 2016: Saara Parkkali (Finland), currently with the Red Cross
2014 - 2016: Madelief Mollers (Netherlands), currently at RIVM
2015 - 2017: Gudrun Freidl (Austria), currently at WHO-Euro
2015 - 2017: Roan Pijnacker (Netherlands), currently at RIVM
2016-2018: Susana Monge Corella (Spain), currently in Spain
2016-2018: Diederik Brandwagt (Netherlands), currently at GGD Utrecht~
2017-2019: Anna Loenenbach, currently at RKI in Germany
2017-2019: Jossy van de Boogaard, currently at GGD Groningen, The Netherlands
2018-2020: Raissa Tjon-Kon-Fat, current MS track fellow RIVM
2018-2020: Laurene Peckeu, current EU track fellow at RIVM
2019-2021: Anita Shah, current EU track fellow at RIVM
2019-2021: Lola Tulen: current MS track fellow at RIVM
EPIET Alumni at RIVM:
Susan Hahné, 1999 – 2001 at CDSC in Wales
Barbara Schimmer, 2004 – 2006 at FHI in Oslo
Hannelore Gotz, 1998 – 2000 at SMI Sweden
Number of EPIET fellows trained or currently training at our institute: 34 (1996, 1997, 1998, 1999, 2000, 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, 2015, 2016, 2017, 2018, 2019)
Brief description of research programmes and outbreak control in the Epidemiology and Surveillance Unit (A), the Laboratory for Infectious Diseases (B) and the Laboratory for Immunology of Infections and Vaccination.
Epidemiology and Surveillance Unit (EPI)
1. Vaccine Preventable Diseases in the National Immunisation Programme
Notwithstanding the successes of the National Immunisation Programme (NIP) on the incidence of the target diseases, continuous surveillance using various methods is needed. This includes surveillance of disease, vaccination coverage, immune status, pathogen (antigenic variation) and adverse events. In addition we address the need and possibility for extension of NIP with new target diseases, based on the current available knowledge with regard to vaccine, disease, pathogen and cost-effectiveness. Epidemiological studies currently carried out include: study on the optimal vaccination schedule to prevent pneumococcal disease in infants; cost-effectiveness analyses for pertussis cocooning strategy and hepatitis A vaccination; study on the impact of HPV-vaccination in girls eligible for vaccination born in 1993; studies on the seroprevalence of diseases targeted by the NIP; study on the attitude of parents regarding vaccination of their children; mathematical modelling of seroprevalence data on measles, mumps and rubella. In the event of an outbreak investigations are carried out, such as studying risk factors for mumps among students in 2009-2012.
2. Sexually Transmitted Infections (STI)
STI, including HIV, remain a major public health problem because of the persistent high incidence, in particular in specific risk groups, the lack of effective therapy for many viral STI, the often asymptomatic initial course of bacterial STI, the potentially severe sequelae due to untreated or asymptomatic infections, especially among women (like infertility and ectopic pregnancy) and the emergence of antimicrobial resistant pathogens. Using surveillance data (facilitated by a web based reporting system) surveys and research, we analyse (determinants of) trends to improve understanding of transmission networks and assess the effectiveness of interventions. We currently evaluate the ongoing community wide Chlamydia screening pilot study among adolescents and young adults, use mathematical modelling tools to estimate the number of unreported HIV infected people, and based on the surveillance of resistant gonococci explore the development of molecular tools to identify such strains. In 2009, prior to the introduction of HPV vaccination for adolescent girls, we initiated studies to assess the impact of HPV vaccination on the HPV population dynamics, and assess the interaction between different STI (eg HPV-Ct, HPV-HSV) on persistence and reinfection.
3. Gastroenteritis and (other) zoonotic diseases
Gastroenteritis has a high incidence and has major socio-economic costs to society. Studies to determine the incidence, aetiology and risk factors of gastroenteritis were carried out in general practices (NIVEL-study 1996-1999) and in the community (SENSOR-study 1999), in hospitals (GEOPS-study 2008-2009) and started as from 1 March 2010 in Child Day Care centers (KizSS-study). The project team also runs enhanced surveillance systems for STEC O157 and Listeria monocytogenes and is responsible for the routine surveillance of Salmonella, Campylobacter, and mandatory reporting of a.o. hepatitis A, Shigella and foodborne infections. These series of studies have been the basis for formal studies on costs and disease burden from the pathogens involved. Within the project team increasingly other zoonotic diseases are studied (lyme disease, dengue, hepatitis E). We contribute to the EU zoonosis reports (EFSA, ECDC) and actively participated in the EU network of excellence MedVetNet, the Foodborne Viruses in Europe network and Enter-net, currently the ECDC FWD-network. Based on laboratory data, an outbreak warning application was developed running since 1997 in which clearly elevated levels of a specific micro-organism (or of specific serotypes or phagetypes for Salmonella) are recognized. Finally, source attribution analysis, employing typing data from human and animal sources or their products, are routinely carried out for Salmonella and on MLST data for Campylobacter. Surveillance and investigation of outbreaks and, where appropriate, support of outbreak management is carried out in collaboration with Food Inspection Services and Municipal Health Services
4. Respiratory infections
A major focus of the respiratory infections group is on the surveillance and analysis of trends in influenza-like illness in the population linked to the virological determination of influenza strains in the population, and vaccination data. Such surveillance has existed for many years among General Practitioners, and has recently been extended to nursing home populations. The 2009 influenza pandemic has led to comprehensive pandemic monitoring efforts and a range of research projects, such as on syndromic surveillance and web-based surveillance tools. Next to influenza, the group is responsible for surveillance of the notifiable respiratory diseases tuberculosis, legionellosis, Q fever and psittacosis. Research is also done on community acquired pneumonia (CAP). For Legionella, international collaboration exists to explore risk factors of travel-associated Legionellosis. Q-fever has become a key focus of the respiratory group after the large 2007-2009 outbreaks, with a very large multidisciplinary research agenda focusing on public health issues and to a lesser extent on individual patient care.
5. Antimicrobial Resistance and Healthcare associated infections
Healthcare associated infections develop unintentionally during a stay in health care facility (i.e. hospital or nursing home). In the Netherlands, 5 to 10% of hospital patients contract a healthcare associated infection. This causes extra suffering for the patient and brings additional costs to the health service. The important questions are thus: is the number of healthcare associated infections increasing or diminishing? Can we prevent them? How can these infections best be counteracted?
EPI is responsible for two surveillance systems on healthcare associated infections. One is PREZIES, which stands for the Prevention of Hospital Infections through Surveillance. Within this surveillance system, professionals in the hospital are responsible for tracing, registering and reporting data concerning hospital infections. The participating hospitals can compare their results with those from other hospitals. The second is SNIV, which is a sentinel surveillance network for infectious diseases in nursing homes, started in 2009 to gain insight in health care associated infections among clients of these homes. Based on data of these surveillance systems research questions are analysed and published and intervention studies can be carried out.
EPI is involved in the national and pan-European Clostridium difficile surveillance and connected research projects. In addition, several research projects are ongoing on interventions to prevent health care associated infections, such as an RCT on the effectiveness of antivirals as post-exposition prophylaxis in nursing homes is ongoing; and a RCT on the use of hygiene bundles.
The EPI department invests and participates in national and international surveillance systems on antimicrobial resistance. For the national surveillance systems, ISIS-AR is developed. This system collects data for 1/3 of all Dutch medical microbiology laboratories in on monthly basis in order: 1) to detect multi institutional outbreak of pathogens or resistance patterns; 2) react actively on new resistance problem and 3) to monitor trends for patient care in hospitals, nursing homes and primary care. At national level, the EPI department collects epidemiological background information of all MRSA strains send to the national reference centre. In addition, the prevalence and potential risk factors for carriage of MRSA and ESBL in animal husbandry, farms and their families is currently under investigation. CPE surveillance has been initiated. Furthermore, several other research projects on MRSA and ESBL are ongoing.
In addition, EPI participates in national antibiotic resistance surveillance systems collecting routine data from medical microbiological laboratories, hospital infection control programs and from first line urinary tract infection projects
6. Mathematical Modelling of Infectious Diseases
Over the last decades, mathematical modelling has become an indispensable tool in planning for infectious disease control. The mathematical modelling project at EPI addresses public health questions such as:
What are the costs and benefits of various alternative hepatitis B vaccination programs?
What will be the effect of a new drug therapy on HIV prevalence among homosexuals in Amsterdam?
What is the impact of an influenza pandemic on health care demand?
Finding answers using classical epidemiological methods is hard, if not impossible. Mathematical modelling is a tool that can handle such questions. The mathematical modelling project at the EPI aims to develop dynamic mathematical models for various infectious diseases, and use these models for answering specific questions from the public health authorities. The work is often done in collaboration with other groups.
7. Early warning and Surveillance
The focus of this department is to support early warning and surveillance within the RIVM-Centre for Infectious Disease Control and municipal health services in the Netherlands. The department hosts the weekly early waning meeting, supports the surveillance systems for notifiable and virological diseases, develops methodology for surveillance and early warning, and hosts EPIET fellows. Furthermore, it takes care of surveillance, outbreak investigation and research of a selected number of infectious diseases, including import diseases such as malaria, viral hemorrhagic fever and Zika, and endemic diseases such as group A and B Streptococcal disease. Yearly, this department produces an overview of infectious diseases in the Netherlands, whereby we aim to include burden of disease, and, in the future, cost of illness estimates.