- Epidemiological studies on tuberculosis control and respiratory viruses
M.D. de Jong
M.F. Schim van der Loeff
- Award date
- 10 June 2015
- Number of pages
- Document type
- PhD thesis
- Faculty of Medicine (AMC-UvA)
To effectively reach tuberculosis (TB) elimination (defined as TB incidence <1 case per million persons per year) in low-incidence countries, tailored actions, depending on country-specific conditions, are required. The studies described in this thesis investigated various aspects of the epidemiology and disease control of tuberculosis in the Netherlands.
First, we examined whether 24-locus Variable Number of Tandem Repeat (VNTR) typing is suitable to identify recent transmission between TB cases. We concluded that transmission based on clustering by VNTR typing among recently migrated foreign-born people should be interpreted with caution. Second, we assessed the impact of contact investigation on TB prevention in high-risk groups. Our findings suggested that limited impact may be expected of expanding preventive TB treatment. Finally, we investigated whether human biomarkers can be identified to predict which individuals will progress to TB. This study showed that a discriminative signature can be detected months prior to clinical TB diagnosis. Overall, our findings resulted in recommendations for improving TB control in the Netherlands, and in other low-incidence countries with comparable conditions.
Another aim of this thesis was to better understand the clinical relevance of respiratory viruses when detected by polymerase chain reaction (PCR). The interpretation of a positive PCR result in individual (hospitalized) patients remains challenging given the low perceived pathogenic nature of some viruses and their frequent detection in the absence of symptoms. This study provided insights for understanding the contribution of respiratory viruses to severe illness in adults.
- Please note that the sections 'Dankwoord' and 'About the author' (pp. 141-145) are not included in the thesis downloads.
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