Belgian Superior Health Council Research Articles

Protecting public health and the environment: towards a general ban on cellulose acetate cigarette filters in the European Union.

After the establishment of a causal relationship between tobacco use and cancer in the 1950s, cellulose acetate filters were introduced with the claim to reduce the adverse health impact of unfiltered cigarettes. Often perceived to be more pleasant and healthy, filters encouraged smoking. However, filtered cigarettes are more deeply inhaled to obtain the same nicotine demand while altered combustion releases more tobacco-specific nitrosamines. The increasing use of cigarette filter ventilation is associated with a sharp rise in lung adenocarcinomas in recent decades. While not preventing adverse health effects, a global environmental problem has been created due to the non-biodegradable filter litter, causing ecotoxicological effects and the spread of microplastics. Recently, the Belgian Superior Health Council advised policymakers to ban cigarette filters as single-use plastics at both national and European levels. This article outlines the arguments used to justify this plea (human health and environment), the expected effects of a filter ban, as well as the public reception and reactions of the tobacco industry. The specific context of the European Union is discussed including the revision of the Single-Use Plastics Directive, affording a new opportunity to ban plastic filters. This perspective article aims to fuel the momentum and cooperation among member states for this purpose.

Cost-utility of 20-valent pneumococcal conjugate vaccine compared to no vaccination and recommended alternative vaccines among Belgian adults

ABSTRACTBackgroundThe Belgian Superior Health Council (SHC) preferentially recommended the 20-valent pneumococcal conjugate vaccine (PCV20) for adults aged ≥65 years, immunocompromised patients, and patients aged ≥50 years suffering from conditions that increase their risk for pneumococcal infections. The objective of this paper is to present the cost-utility of PCV20 compared to no vaccination and the alternative sequence of PCV15 followed by the 23-valent pneumococcal polysaccharide vaccine (PPV23) in this population.Research Design and MethodsThe analysis employed a static Markov model capturing lifetime risk of pneumococcal infections, associated disutility, mortality, and costs from different healthcare payer perspectives.ResultsResults indicated use of PCV20 among Belgian older and at-risk adults is highly cost-effective compared to no vaccination, with an incremental cost per quality-adjusted life-year (QALY) of €4,164. Compared to the sequential regimen (PCV15+PPV23), PCV20 vaccination is a cost-saving strategy. Subgroup analysis indicated PCV20 vaccination of at-risk adults aged 65–84 years would also be cost-saving from the national healthcare perspective.ConclusionBased on current knowledge, this analysis suggests that access to PCV20 should be proposed in all adults recommended for vaccination by the SHC as PCV20 prevents additional hospitalizations and deaths caused by pneumococcal infection at an affordable cost.

Balancing Acute and Chronic Occupational Risks: The Use of Nitrile Butadiene Rubber Undergloves by Firefighters to Reduce Exposure to Toxic Contaminants.

Firefighters are exposed via multi-route exposure to a multitude of chemicals (PAHs, VOCs, flame retardants, dioxins, etc.) that may cause acute and long-term health effects. The dermal absorption of contaminants is a major contributor to the overall exposure and can be reduced by wearing appropriate personal protective equipment. As leather firefighters' gloves cannot be decontaminated regularly by wet cleaning, many Belgian firefighters wear supplementary undergloves made of nitrile butadiene rubber (NBR) to protect against the accumulation of toxicants. However, the safety of this practice has been questioned. In this commentary, the current practice and risks are outlined for the first time, assessed by an interdisciplinary working group of the Belgian Superior Health Council. As NBR sticks to the skin more at high temperatures, the contact time on removal will be prolonged, posing an additional risk for deeper burns. However, based on the physicochemical properties of NBR and the existing experience of firefighters and burn centers, it is estimated that such incidents occur relatively rarely in practice. On the other hand, the risk of repeated exposure to contaminated gloves if no undergloves are worn is unacceptable. Despite the slightly increased risk for deeper burns, it is concluded that wearing disposable NBR gloves under regular firefighters' gloves is an appropriate and effective preventive measure against toxic contamination. The nitrile butadiene rubber must always be fully covered to avoid any contact with the heat.

Editorial Introductions.

Current Opinion in Oncology was launched in 1989. It is one of a successful series of review journals whose unique format is designed to provide a systematic and critical assessment of the literature as presented in the many primary journals. The field of psychiatry is divided into 15 sections that are reviewed once a year. Each section is assigned a Section Editor, a leading authority in the area, who identifies the most important topics at that time. Here we are pleased to introduce the Journal's Section Editors for this issue. SECTION EDITORS Gil AwadaGil AwadaGil Awada (1990) studied medicine at the Vrije Universiteit Brussel (Brussels, Belgium), graduating in 2015, and subsequently started his training in Internal Medicine. In June 2021, he successfully defended his PhD thesis entitled ‘Expanding the application of targeted therapies and immune checkpoint inhibitors in advanced melanoma and recurrent glioblastoma’, under the supervision of Prof. Dr. Bart Neyns. He is currently finishing his residency in Medical Oncology at the Jules Bordet Institute, Belgium. Gil Awada performs clinical and translational research in the field of melanoma, investigating new applications of targeted agents, combination therapies and the use of novel clinical biomarkers (such as circulating tumor DNA and imaging). His work has been presented at national and international congresses and has been published in peer-reviewed journals. Oliver BechterOliver BechterOliver Bechter earned his MD at the University of Innsbruck, Medical School in Austria in 1998. During his residency he did a postdoctoral fellowship at the Department of Cell Biology, UTSouthwestern in Dallas, TX, USA. He earned his PhD in 2005 and is a board-certified Medical Oncologist and Hematologist since 2007. Since 2012 he is working at the University Hospital in Leuven Belgium and is a professor for Oncology at the Department of Oncology from the KU Leuven. His research focus is telomere biology in human malignancies and melanoma biology. His clinical focus is on malignant melanoma and skin cancers and he is principal investigator of several clinical trials with a focus on drug development of new immune-oncology drugs in melanoma. Jana JeschkeJana JeschkeJana Jeschke studied molecular medicine at the University of Erlangen-Nuremberg, Germany, and performed her PhD research at the Johns Hopkins University in Baltimore, USA, in the groups of Prof. Nita Ahuja and Prof. Jim Herman and in collaboration with Prof. Baylin. During this time, she made several important discoveries in the field, including the identification and functional characterization of aberrantly DNA methylated genes in breast cancer and their assessment as novel biomarkers. In 2013, Dr Jeschke moved to Belgium to start a postdoctoral training in the Laboratory of Cancer Epigenetics at Université Libre de Bruxelles (ULB) in Brussels. Under the supervision of her lead mentor Prof. Fuks and his long-time collaborator Prof. Sotiriou, a breast cancer expert from the Jules Bordet Institute in Brussels, she explored changes of various epigenetic modifications on DNA and RNA in breast and other cancers and the clinical relevance of these aberrations for cancer diagnosis and therapy. Her most notable works include the development of an epigenetic immune signature that predicts survival and response to chemotherapy in breast cancer (JCI 2017) and the discovery of m6A mRNA methylation changes in breast cancer and their impact on pathways driving cancer progression and therapy resistance (Nature Cancer 2021). For her research, Dr Jeschke was awarded a postdoctoral fellowship from the Belgian National Fund for Scientific Research (FNRS) in 2014. In 2022, she obtained the mandate of Chercheuse Qualifiée (Associate Professor) from the FNRS to start her own research group at ULB focusing on precision cancer epigenetics. Dr Jeschke is a member of the Belgian Association for Cancer Research (BACR), European Association for Cancer Research (EACR), American Association for Cancer Research (AACR) and Cancer Epigenetics Society (CES) and a consultant for the “Belgian Superior Health Council”. She is an associate editor for the journal of Current Opinion in Oncology and regularly reviews for other journals publishing studies related to cancer and epigenetics.

Pneumococcal vaccination prevented severe LRTIs in adults: a causal inference framework applied in registry data

ObjectivesWe estimated the effect of pneumococcal vaccination (PV) on acute lower respiratory tract infections (LRTIs) in various age and risk groups using different methods within a causal inference methodological framework. Study design and settingWe used data from a general practitioners’ morbidity registry for the year 2019. Both traditional statistical methods (regression-based and propensity score methods) and machine learning techniques were deployed. Multiple imputation was used to account for missing data. Relative risks (RRs) with 95% confidence intervals were estimated. Sensitivity analyses were performed to account for the severity of LRTIs and differences in vaccination registration. ResultsAll methods showed a standardized mean difference below 0.1 for each covariate. No method was found to be superior to another. PV (combination of conjugate and polysaccharide vaccine) had an overall protective effect for severe LRTIs. PV was protective in different age and risk groups, especially in people aged 50–84 years with an intermediate risk group. ConclusionUsing several techniques, PV was found to prevent severe LRTIs and confirmed the recommendations of the Belgian Superior Health Council.

The impact of Covid-19 on Belgian mental health care: A Delphi study among psychosocial health professionals, patients, and informal caretakers

The Covid-19 pandemic is primarily viewed as a threat to physical health, and therefore, biomedical sciences have become an integral part of the public discourse guiding policy decisions. Nonetheless, the pandemic and the measures implemented have an impact on the population’s psychosocial health. The impact of Covid-19 on the psychosocial care system should be thoroughly investigated to mitigate this effect. In this context, the present study was conducted to establish a consensus about the impact of Covid-19 on psychosocial health and the care system in Belgium. Using the Belgian Superior Health Council’s expert database, a three-round Delphi consensus development process was organized with psychosocial experts (i.e., professionals, patients, and informal caregiver representatives). Overall, 113 of the 148 experts who participated in round 1 fully completed round 2 (76% response rate). Consensus (defined as >70% agreement and an interquartile interval (IQR) of no more than 2) was reached in round 2 for all but three statements. Fifty experts responded to round 3 by providing some final nuances, but none of them reaffirmed their positions or added new points to the discussion (44.25% response rate). The most robust agreement (>80%) was found for three statements: the pandemic has increased social inequalities in society, which increase the risk of long-term psychosocial problems; the fear of contamination creates a constant mental strain on the population, wearing people out; and there is a lack of strategic vision about psychosocial care and an underestimation of the importance of psychosocial health in society. Our findings show that experts believe the psychosocial impact of Covid-19 is underappreciated, which has a negative impact on psychosocial care in Belgium. Several unmet needs were identified, but so were helpful resources and barriers. The Delphi study’s overarching conclusion is that the pandemic does not affect society as a whole in the same way or with the same intensity. The experts, thereby, warn that the psychosocial inequalities in society are on the rise.

The influenza vaccine for nursing and care professionals at emergency services in Flanders

ABSTRACT Background: The Belgian Superior Health Council recommends seasonal influenza vaccination for people working in the health care sector in order to reduce the risk of the influenza virus being transmitted to people at risk. The aim of this study is to provide more insight into the current vaccination rate in nurses and health care professionals in emergency services in Flanders. In addition, the influence of influenza vaccination on absenteeism will be investigated, as well as the motivation to get vaccinated or not. Methods: A quantitative multicentre, cross-sectional study was carried out in which nurses and health care professionals in emergency services in Flanders were questioned by means of an online questionnaire. Results: The survey of nurses and health care professionals in Flanders from 2018 shows that 54% (294/548) gets vaccinated in this year. Respondents who have been vaccinated report a lower absenteeism due to influenza compared to health workers who do not get vaccinated. There is a lack of general knowledge about influenza and vaccination. Thirty-four percent of nurses and health care professionals in emergencies do not know the correct definition of influenza. The main reasons for being vaccinated are: to protect oneself (27%), family members (21.5%) and patients (16%). Reasons for not getting vaccinated are: never having had the influenza before (30%), believing you get the influenza because of the vaccination (12%), no belief or trust in the vaccine (19%). Three percent of respondents who received the influenza vaccine were absent due to flu. The absence due to influenza was higher among the respondents who were not vaccinated, namely 11%. Being vaccinated for influenza or not has been associated with being absent for influenza. Conclusions: Given that there is a lack of general knowledge about influenza and its vaccination, the vaccination campaigns should cover this knowledge gap. Efforts to convince both nursing and care professionals about the protective role of the Influenza vaccine. These efforts can improve the influenza vaccination coverage rate and consequently minimize the absenteeism. Abbreviations: WHO: World Health Organization; UZA: University Hospital of Antwerp; SPSS: Statistical Package for the Social Sciences

Interpretation of EBV serology for human body material donors: Is there a need for early antigen IgG and heterophile antibodies testing?

In this report we evaluated a diagnostic algorithm, proposed by the Belgian Superior Health Council, to detect acute and past Epstein-Barr virus (EBV) infections by means of serology in donors of human body material for transplantation. The available EBV serology parameters were tested on eighty serum samples on three random access analysers: Architect i2000 SR, Liasion XL and BioPlex 2200. The EBV sero-status was determined according to the proposed algorithm and results were compared between the different analysers. Seventy one % of the samples gave concordant interpretations on the three analysers. Most of the discordant results were attributable to early antigen (EA) IgG. The knowledge of the EA IgG and heterophile antibodies (HA) IgM status provided only limited added value and was only useful to distinguish between a very early acute infection and false positivity of viral capsid antigen IgM. The diagnostic algorithm proposed by the Belgian Superior Health Council is merely directive and each individual lab remains responsible for the interpretation and implementation of test combinations for the detection of EBV infections. Our study shows the limited added value of testing for EA IgG and HA IgM, based both on clinical and technical performance.

Cost-effectiveness of PCV13 vaccination in Belgian adults aged 65-84 years at elevated risk of pneumococcal infection.

BackgroundThe Belgian Superior Health Council (SHC) recently added a 13-valent pneumococcal conjugate vaccine (PCV13) to its recommendations for adult pneumococcal vaccination. This study addresses the policy question regarding whether a single dose of PCV13 should be reimbursed among Belgian adults aged 65–84 years with chronic comorbidities (“moderate-risk”) or immunosuppression (“high-risk”).MethodsA cohort model was developed to project lifetime risks, consequences, and costs of invasive pneumococcal disease (IPD) and pneumococcal community-acquired pneumonia (CAP). Parameter values were estimated using published literature and available databases, and were reviewed by Belgian experts. PCV13 effectiveness was assumed to be durable during the first 5 years following receipt, and to progressively decline thereafter with 15 years protection. The Belgian National Health Insurance perspective was employed.ResultsUse of PCV13 (vs. no vaccine) in moderate/high-risk persons aged 65–84 years (n = 861,467; 58% vaccination coverage) would be expected to prevent 527 cases of IPD, 1,744 cases of pneumococcal CAP and 176 pneumococcal-related deaths, and reduce medical care costs by €20.1 million. Vaccination costs, however, would increase by €36.9 million and thus total overall costs would increase by €16.8 million. Cost per QALY gained was €17,126. In probabilistic sensitivity analyses, use of PCV13 was cost-effective in 97% of 1,000 simulations.ConclusionsReimbursement of PCV13 in moderate/high-risk Belgian adults aged 65–84 years would be cost-effective from the Belgian healthcare perspective.

Effect of post-harvest starvation and rinsing on the microbial numbers and the bacterial community composition of mealworm larvae ( Tenebrio molitor )

Abstract Specific processing steps after industrial rearing of insects for food and feed, being starvation and rinsing, are assumed to have an impact on their microbial quality. The aim of this study was to assess the effect on the microbiota of starvation (24 or 48 h, 10 or 30 °C) and rinsing (1 min using tap water) at the end of the rearing period of yellow mealworm larvae ( Tenebrio molitor ). Microbial numbers were determined using plate counts and the microbial community composition using metagenetic analyses. Total viable counts ranged from 7.7 to 8.4 log cfu/g for all treatments. Starvation did not evoke prominent shifts in the bacterial community, which was predominated by Proteobacteria and Firmicutes. No bacterial food pathogens were detected using metagenetics. Our data suggest that the processing steps under study do not contribute to a better microbial quality of fresh mealworm larvae. Industrial relevance As insects and insect-based foods are receiving more attention and are already being marketed in some European countries, more insects farms are being established. Rearing companies often optimise their practices by trial and error and no general hygiene codes are available. According to the Netherlands Food and Consumer Product Safety Authority (2014), mealworm larvae are generally starved and rinsed after rearing to empty their gut, but the impact of these practices has not been investigated so far. Hence, the necessity for rearers to incorporate these steps in their rearing procedures has not been demonstrated. The Belgian SHC (Superior Health Council) and FASFC (Federal Agency for the Safety of the Food Chain) have recommended in their advice (2014) to investigate these steps. In addition, as edible insects will be defined as novel foods as from 1 January 2018 according to the European Novel Food Regulation (EU) No. 2015/2283, more information is needed on their safety, which is related to production hygiene.

Dietary sources of animal and plant protein intake among Flemish preschool children and the association with socio-economic and lifestyle-related factors

BackgroundThe aims of this study were to assess the intake of animal, plant and food group-specific protein, and to investigate their associations with socio-economic and lifestyle-related factors in Flemish preschoolers.MethodsThree-day estimated dietary records were collected from 661 preschoolers aged 2.5-6.5 y (338 boys and 323 girls). Multiple linear regression analysis was used to investigate the association between animal, plant, and food group-specific protein intake and socio-economic and lifestyle factors.ResultsAnimal proteins (mean 38 g/d) were the main source of total protein (mean 56 g/d), while mean plant protein intake amounted to 18 g/d. The group of meat, poultry, fish and eggs was the main contributor (51%) to animal protein intake, followed by milk and milk products (35%). Bread and cereals (41%) contributed most to the plant protein intake, followed by low-nutritious, energy-dense foods (21%). With higher educated fathers and mothers as reference, respectively, preschoolers with lower secondary and secondary paternal education had lower animal, dairy-, and meat-derived protein intakes, and those with lower secondary and secondary maternal education consumed less plant, and bread and cereal-derived proteins. Compared to children with high physical activity levels, preschoolers with low and moderate physical activity had lower animal and plant protein intakes. Significantly higher potatoes and grains-, and fish- derived proteins were reported for children of smoking mothers and fathers, respectively, compared to those of non-smoking mothers and fathers.ConclusionsThe total protein intake of Flemish preschoolers was sufficient according to the recommendations of the Belgian Superior Health Council. Parental level of education and smoking status might play a role in the sources of children's dietary proteins.

Fibre intake among the Belgian population by sex–age and sex–education groups and its association with BMI and waist circumference

The objectives of the present study were to assess total dietary fibre intake and the main contributors to fibre intake in the Belgian population by sex-age and sex-education groups and to investigate its relationship with BMI and waist circumference (WC). The participants of the Belgian food consumption survey (2004) were randomly selected. Information about food intake was collected using two repeated, non-consecutive 24 h recall interviews. A total of 3083 individuals ( ≥ 15 years; 1546 men and 1537 women) completed both interviews. The main contributors to total fibre intake (17·8 g/d) were cereals and cereal products (34 %; 5·9 g/d), potatoes and other tubers (18·6 %; 3·3 g/d), fruits (14·7 %; 2·8 g/d) and vegetables (14·4 %; 2·6 g/d). Legume fibre intake was extremely low (0·672 %; 0·139 g/d). In all sex-age and sex-education groups, total fibre intake was below the recommendations of the Belgian Superior Health Council. Men (21 g/d) consumed significantly more fibre than women (17·3 g/d) (P < 0·001). Lower educated men and higher educated women reported the highest fibre intake. A significant inverse association was found between total fibre intake and WC (β = - 0·118, P < 0·001). Fruit-derived fibre was positively associated with WC (β = 0·731, P = 0·001). In summary, total fibre intake was inversely associated with WC, whereas fruit-derived fibre intake was positively associated with WC in the Belgian population.

Temporal bone bank: complying with European union directives on human tissue and cells

Availability of allograft tympano-ossicular systems (ATOS) provides unique reconstructive capabilities, allowing more radical removal of middle ear pathology. To provide ATOS, the University of Antwerp Temporal Bone Bank (UATB) was established in 1988. ATOS use was stopped in many countries because of safety issues concerning human tissue transplantation. Our objective was to maintain an ATOS tissue bank complying with European Union (EU) directives on human tissues and cells. The guidelines of the Belgian Superior Health Council, including EU directive requirements, were rigorously applied to UATB infrastructure, workflow protocols and activity. Workflow protocols were updated and an internal audit was performed to check and improve consistency with established quality systems and changing legislations. The Belgian Federal Agency of Medicines and Health Products performed an inspection to examine compliance with national legislatives and EU directives on human tissues and cells. A sample of important procedures was meticulously examined in its workflow setting next to assessment of the infrastructure and personnel. Results are reported on infrastructure, personnel, administrative workflow, procurement, preparation, processing, distribution, internal audit and inspection by the competent authority. Donors procured: 2006, 93 (45.1%); 2007, 64 (20.6%); 2008, 56 (13.1%); 2009, 79 (6.9%). The UATB was approved by the Minister of Health without critical or important shortcomings. The Ministry accords registration each time for 2 years. An ATOS tissue bank complying with EU regulations on human allografts is feasible and critical to assure that the patient receives tissue, which is safe, individually checked and prepared in a suitable environment.

Dietary Sources of Fiber Intake and Its Association with Socio-Economic Factors among Flemish Preschool Children

The objectives were to assess total dietary fiber intake, identify the major sources of dietary fiber, and examine its association with socio-economic factors among Flemish preschoolers. Three-day estimated dietary records were collected from a representative sample of preschoolers 2.5–6.5 years old (n = 661; 338 boys, 323 girls). The mean dietary fiber intake (13.4 g/d) was lower than the intake level recommended by the Belgian Superior Health Council (70% boys and 81% girls below the guidelines). The most important contributor was the group of bread and cereals (29.5%), followed by fruits (17.8%), potatoes and grains (16.0%), energy-dense, low-nutritious foods (12.4%), and vegetables (11.8%). Multiple linear regression analyses showed that total fiber intake was associated with maternal education and parents’ employment. Overall, fiber intakes from high-nutritious foods (vegetables and fruits) were higher in preschoolers of higher educated mothers and those with one or both parents being employed. In conclusion, the majority of the preschoolers had dietary fiber intakes below the recommended level. Hence, dietary fiber should be promoted among parents of preschoolers and low socio-economic status families should be addressed in particular.

Improving tetanus prophylaxis in the emergency department: a prospective, double-blind cost-effectiveness study

Background: The choice of tetanus prophylaxis for patients with wounds depends on obtaining their vaccination history, which has been demonstrated to be unreliable. Use of a rapid immunoassay (Tétanos Quick...