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.

Preanalytical variables influencing the interpretation and reporting of biological tests on blood samples of living and deceased donors for human body materials

With the present paper, the Working Group on Cells, Tissues and Organs and other experts of the Superior Health Council of Belgium aimed to provide stakeholders in material of human origin with advice on critical aspects of serological and nucleic acid test (NAT) testing, to improve virological safety of cell- and tissue and organ donation. The current paper focusses on a number of preanalytical variables which can be critical for any medical biology examination: (1) sampling related variables (type of samples, collection of the samples, volume of the sample, choice of specific tubes, identification of tubes), (2) variables related to transport, storage and processing of blood samples (transport, centrifugation and haemolysis, storage before and after centrifugation, use of serum versus plasma), (3) variables related to dilution (haemodilution, pooling of samples), and (4) test dependent variables (available tests and validation). Depending on the type of donor (deceased donor (heart-beating or non-heart beating) versus living donor (allogeneic, related, autologous), and the type of donated human material (cells, tissue or organs) additional factors can play a role: pre- and post-mortem sampling, conditions of sampling (e.g. morgue), haemodilution, possibility of retesting.

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.

Pneumococcal vaccination coverage and adherence to recommended dosing schedules in adults: a repeated cross-sectional study of the INTEGO morbidity registry

BackgroundSince 2014, Belgium’s Superior Health Council has recommended pneumococcal vaccination for adults aged 19–85 years at increased risk for pneumococcal diseases with a specific vaccine administration sequence and timing. Currently, Belgium has no publicly funded adult pneumococcal vaccination program. This study investigated the seasonal pneumococcal vaccination trends, evolution of vaccination coverage and adherence to the 2014 recommendations.MethodsINTEGO is a general practice morbidity registry in Flanders (Belgium) that represents 102 general practice centres and comprised over 300.000 patients in 2021. A repeated cross-sectional study was performed for the period between 2017 and 2021. Using adjusted odds ratios computed via multiple logistic regression, the association between an individual’s characteristics (gender, age, comorbidities, influenza vaccination status and socioeconomic status) and schedule-adherent pneumococcal vaccination status was assessed.ResultsPneumococcal vaccination coincided with seasonal flu vaccination. The vaccination coverage in the population at risk decreased from 21% in 2017 to 18.2% in 2018 and then started to increase to 23.6% in 2021. Coverage in 2021 was highest for high-risk adults (33.8%) followed by 50- to 85-year-olds with comorbidities (25.5%) and healthy 65- to 85-year-olds (18.7%). In 2021, 56.3% of the high-risk adults, 74.6% of the 50+ with comorbidities persons, and 74% of the 65+ healthy persons had an adherent vaccination schedule. Persons with a lower socioeconomic status had an adjusted odds ratio of 0.92 (95% Confidence Interval (CI) 0.87–0.97) for primary vaccination, 0.67 (95% CI 0.60–0.75) for adherence to the recommended second vaccination if the 13-valent pneumococcal conjugate vaccine was administered first and 0.86 (95% CI 0.76–0.97) if the 23-valent pneumococcal polysaccharide vaccine was administered first.ConclusionPneumococcal vaccine coverage is slowly increasing in Flanders, displaying seasonal peaks in sync with influenza vaccination campaigns. However, with less than one-fourth of the target population vaccinated, less than 60% high-risk and approximately 74% of 50 + with comorbidities and 65+ healthy persons with an adherent schedule, there is still much room for improvement. Furthermore, adults with poor socioeconomic status had lower odds of primary vaccination and schedule adherence, demonstrating the need for a publicly funded program in Belgium to ensure equitable access.

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.

Niet-medicamenteuze behandeling van ADHD bij kleuters, een systematische review

Non-pharmacological Treatment of ADHD in preschoolers, a systematic review Objective: Attention Deficit and Hyperactivity Disorder (ADHD) can be diagnosed from the age of 36 months. The Superior Health Council recommends a parent training program to be offered for children from the age of three when they exhibit behavioral problems suggestive of ADHD. This systematic review investigates the evidence for non-pharmacological interventions. It also investigates if there is a preferential choice. Methods: A search was performed in Pubmed and Web of Science. Randomized controlled trials since 2013 investigating non-pharmacological interventions for ADHD in children under six years of age were included. Exclusion criteria were language and articles in which the effect on ADHD symptoms was not described. The quality of the studies was assessed using the Cochrane risk of bias tool for randomized trials. Results: Eighteen articles were included, most of which described parent training. Parent training had a moderate to large effect on ADHD symptoms reported by parents (non blinded). The observed effects persisted for up to 12 months. A preferential choice in specific parent training program was not found. Other interventions included teacher training, cognitive training and yoga. Conclusion: Despite limited evidence from blinded raters, parent training is recommended as a treatment for preschoolers with ADHD. Alternatives have not yet been sufficiently researched.

How can we operationalize the promotion and evaluation of nature-related ‘green’ health care within a One Health perspective?

The healthcare sector has proven to be supportive in stimulating health through contact with nature (Robinson and Breed, 2019; Kondo et al., 2020). Despite the positive practice examples, we see several challenges. There is no clear consensus or common understanding on quality assurance and health impact assessment of green care: there still is a wide range of approaches within different health expert communities and contexts, either with or without some form of qualified support such as coaching. As there is no ‘one size’ prescription fit for all, green care needs to be tailored to individual characteristics and circumstances, both of which are dynamic, e.g., in an environmental sense due to climate change, or related to socio-cultural dynamics (Beute et al., 2020a,b; Superior Health Council Belgium 2021). Sustainable health-related nature contact is not always easy to achieve especially when there is no follow-up with either healthcare professionals or other supporting organizations through social prescription. Accessibility of natural areas is often quite unequally distributed, with the more vulnerable often benefitting least, especially in urbanized areas. Another challenge is to achieve a reciprocal health relationship with nature: a stronger connection with nature and caring for nature helps to sustain a positive healthy relationship (O’Brien et al., 2010; Kurt et al., 2018), which may also contribute to nature conservation in a One Health perspective. As such, the healthcare sector can act as ambassadors for ‘One Healthy’ natural environments.

Organ donation from patients with a rare disease is often safe: the italian guidelines.

Although a disease is defined as rare when it has a prevalence of less than 1:2000, the overall prevalence of rare diseases in the population is greater than 1%. Among potential organ donors, a similar frequency is observed. To date, guidelines have not been established, and operational decisions have been made empirically, case- by-case, based on the experience and expertise of clinicians. For this reason, the Italian Superior Health Council (CSS) has appointed a working Group to address "patients with a rare disease as potential organ donors," with the aim of devising recommendations for the management of transplant cases in which the donors have a rare disease. This group evaluated 493 diseases (10% of all rare diseases, including over 95% of patients with a rare disease) to deliver a technical report dealing with the suitability of organ donation and transplantation, with a focus on the organs most frequently used, including kidney, liver, heart, lung, and pancreas. This work has made it clear that a rare disease "per se" does not contraindicate organ donation at all. Indeed, in donors affected by a rare disease, almost 80% of the organs are suitable for transplantation, approximately 7% are unsuitable, and approximately 14% are suitable as non-standard with an acceptable risk.

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

Ethische aspecten betreffende de prioritering van zorg in tijden van Covid-19

Ethical aspects concerning prioritizing care in times of Covid-19 Healthcare providers, patients, policymakers and the public at large face unseen challenges due to the Covid-19 pandemic, including ethical questions that cover the entire healthcare landscape: from the citizen who is subjected to specific prevention measures, primary care and residential care, and intensive care in specialized hospital wards. By consequence, prioritization decisions are made in different places in the healthcare landscape and by various actors. Moreover, different domains within the healthcare landscape may act as communicating vessels. For example, patients who are denied access to Intensive Care Units have to be cared for elsewhere, and the centralization of resources and manpower in hospitals may complicate access to tests, protective equipment or oxygen in primary care and residential care. Furthermore, the postponement of non-urgent care to create capacity for the care for covid patients has a significant impact on non-covid related care. Against this background, the Belgian Advisory Committee on Bio-ethics provides the current recommendations, in which four decision areas are considered: the organization of care, the patient, medical professionals, and care institutions and primary care. The recommendations were endorsed by the Order of Physicians and the Superior Health Council.

Rare Disease Patients as Potential Organ Donors

BackgroundRare diseases (RDs) are a heterogeneous group of pathologies, which, when present in a donor, with their anatomic or functional deficiencies, may put the recipient at risk. The aim of our work is to analyze the incidence of RDs in our donors to support transplant experts in the evaluation of these organs. MethodsWe retrospectively assessed the incidence of RDs in donors from July 2017 to June 2019, along with the risk attributed, the number of transplanted organs, and the follow-up results of the recipients. ResultsOver a 24-month period, we had 19 donors with RDs. Of those, the organs of 4 donors were rejected before the risk assessment, the organs of 4 other donors were deemed an unacceptable risk, the organs of 4 more donors were rejected by transplant centers, and the organs of 7 donors were accepted with 16 organs ultimately transplanted (2 hearts, 3 livers, and 11 kidneys). Three of the recipients died of causes not related to the RDs. Thirteen of the recipients are still alive with a functioning organ with an average follow-up of 9 months. ConclusionsAlthough the evaluation of the results is influenced by the limited follow-up period, the use of donors with RDs has proved safe. One of the critical issues encountered in the evaluation process was the impossibility of carrying out genetic and histologic investigations for each organ in urgency. Moreover, the heterogeneity of RDs and the lack of solid literature data require, for the purpose of assessing the level of risk, a specific assessment of individual cases. To overcome these limitations, a group of experts was set up at the Superior Health Council, who drafted a reference document, which allowed for the assessment of the suitability and risk level of donors with the most frequent RDs.

Medical Legal Aspects of Telemedicine in Italy: Application Fields, Professional Liability and Focus on Care Services During the COVID-19 Health Emergency.

Telemedicine services can be classified into the macro-categories of specialist Telemedicine, Tele-health and Tele-assistance. From a regulatory perspective, in Italy, the first provision dedicated to the implementation of Telemedicine services is represented by the Agreement between the Government and the Regions on the document bearing “Telemedicine—National guidelines,” approved by the General Assembly of the Superior Health Council in the session of 10th July 2012 and by the State Regions Conference in the session of 20th February 2014. Scientifically, several studies in the literature state that information and communication technologies have great potential to reduce the costs of health care services in terms of planning and making appropriate decisions that provide timely tools to patients. Another clear benefit is the equity of access to health care. The evolution of telemedicine poses a series of legal problems ranging from the profiles on the subject of authorization and accreditation to those concerning the protection of patient confidentiality, the definition and solution of which, in the absence of specific regulatory provisions, is mainly left to the assessment of compatibility of the practices adopted so far, with the general regulatory framework. In terms of professional liability, it is necessary to first clarify that the telemedicine service is comparable to any diagnostic-therapeutic health service considering that the telemedicine service does not replace the traditional health service, but integrates the latter to improve its effectiveness, efficiency and appropriateness.

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.

Biological tests carried out on serum/plasma samples from donors of human body material for transplantation: Belgian experience and practical recommendations

This paper on the biological tests carried out on serum/plasma samples from donors of human body material (HBM) is the result of a project of the working Group of Superior Health Council of Belgium formed with experts in the field of HBM and infectious serology. Indeed, uncertainty about the interpretation of biological test results currently leads to the sometimes unjustified cancelling of planned donations or the rejection of harvested HBM, whilst more sophisticated diagnostic algorithms would still allow the use of organs or HBM that would otherwise have been rejected. NAT tests will not be discussed in this publication. In the first part some general aspects as the need for a formal agreement between the Tissue Establishment l and the laboratory responsible for the biological testing, but also some specifications regarding testing material, the choice of additional biological tests, and some general aspects concerning interpretation and reporting are discussed. In a second part, detailed information and recommendations concerning the interpretation are presented for each of the mandatory tests (human immunodeficiency virus, hepatitis B virus, hepatitis C virus and syphilis) is presented. A number of not mandatory, but regularly used optional serological tests (e.g. for the detection of antibodies to Toxoplasma gondii, Epstein–Barr virus, human T cell leukemia virus and cytomegalovirus) are also extensively discussed. Although the project was meant to provide clarification and recommendations concerning the Belgian legislation, the majority of recommendations are also applicable to testing of donors of tissues and cells in other (European) countries.

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.

Fish Pedicure-induced Aeromonas sobria Superficial Necrotic Bullous Dermatitis in a Previously Undiagnosed Diabetes Patient. What are the Risks of Fish Pedicure for Public Health?

Department of Dermatology, Sainte Elisabeth Hospital, B-5000 Namur, Belgium. VIVES University College, Wilgenstraat 32, B-8800 Roeselare, Belgium. University of Liege, Quai Edouard Van Beneden 22, B-4020 Liege, Belgium. Department of Microbial Physiology and Ecology, University of Brussel, Bruxelles, B-1050 Brussels, Belgium. Superior Health Council, Place V. Horta, 40, bte 10, B-1060 Brussels, Belgium. Department of Clinical Microbiology and Infection Control, Saint-Luc University Hospital, Avenue Hippocrate 10, B-1200 Brussels, Belgium. Laboratory of Biodiversity and Evolutionary Genomics, University of Leuven, Ch. Deberiotstraat 32, B-3000 Leuven, Belgium. Department of Dermatology, University of Gent, De Pintelaan 185, B-9000 Gent, Belgium.