Erasmus MC : Infectious disease control

Infectious diseases are an increasing health problem worldwide that often needs systematic preventive control interventions. The research section aims at studying the public health consequences of infectious diseases and evaluating the cost-effectiveness of their control. The core activity is the development and application of simulation models describing the transmission and natural history of disease in human populations, including the impact of control measures.

Research started with applied modelling activities for the Onchocerciasis Control Programme in West Africa (OCP) of the WHO. It resulted in the ONCHOSIM microsimulation model for integrated analysis of OCP data and for the planning and evaluation of onchocerciasis control strategies. In more recent years, there has been an expansion of activities, including collection and analysis of field data, design and support of field studies on the epidemiology of diseases and field trials on the effectiveness of control strategies. Also, the scope of research has widened to global infectious disease problems, including both developing and developed countries. Collaboration with existing control projects, and training and technology transfer are an essential part of the activities. The research network includes various scientists and scientific institutes in the developing and developed world, including the WHO and the World Bank.


Public Health Impact
For many years our department has been involved in research in the areas of helminth infections, tuberculosis, leprosy, viral hepatitis, malaria and sexually transmitted diseases, including HIV/AIDS. We work together with international organisations such as the WHO and have contributed extensively to the evaluation of existing, and the development of new control programs for these diseases in developing countries. The “Huisman Research Centre for Infectious Diseases and Public Health” was established in which Erasmus MC and the Municipal Public Health Service work together in the area of infectious disease surveillance and control in the Rotterdam region. Emphasis is on diseases that are closely related to the immigrant population of the city, such as viral hepatitis, tuberculosis, STDs, and HIV/Aids.

The epidemic of Severe Acute Respiratory Syndrome (SARS) showed that new infections spread by close contact are able to spread rapidly across international borders resulting in significant morbidity. They can even cause widespread public alarm and economic loss in unaffected countries. We co-ordinate an integrated multidisciplinary project to aid European policy on emerging infections. This project is funded by the European Commission and aims to improve the public health response to emerging infections such as SARS and influenza through better knowledge of the spread of these viruses, improved risk assessment, mathematical modelling, economic analysis and risk communication strategies.

Another important public health threat is the emergence of methicillin resistant Staphylococcus aureus (MRSA). The prevalence of this bacterium has been low in the Netherlands due to strict preventive measures in hospitals. There are, however, indications of increased spread, particularly in the region of Rotterdam. Together with the department of Medical Microbiology of Erasmus MC, we study how MRSA spreads in the community and assess the cost-effectiveness of preventive strategies both inside and outside the hospital. Results will possibly lead to the adjustment of existing preventive measures against MRSA.

Research Highlight: Mobility and HIV in Tanzanian couples
(Kishamawe/Vissers et al., AIDS 2006)

Mobility is one of the factors that contribute to the AIDS epidemic. People who travel or migrate live away from their families and communities for a certain period, and thus away from social control on sexual behaviour. This may change their sexual risk behaviour and result in a higher risk for HIV infection. Married men often travel alone. The general idea is that mobile Tanzanian men become HIV positive while being away and infect their wives after their return. However, due to factors such as loneliness, peer pressure, and lack of financial support, partners who stay behind may also engage in sexual risk behaviour. Therefore, they may not only be vulnerable to HIV infection by the risk behaviour of their mobile partners, but also by their own risk behaviour.
We studied how mobility was related to sexual risk behaviour and HIV infection in Tanzanian couples, and were particularly interested in the partners staying behind. People were defined as short-term mobile if they had slept outside the household at least one night during the study period, and long-term mobile if they had lived elsewhere for a longer period. Mobile men and women reported more sex partners than residents. However, among residents, those with a long-term mobile partner reported more sexual risk behaviour and also had a higher HIV prevalence than those with a partner at home. Consequently, indeed both mobile persons and their partners staying behind showed more sexual risk behaviour and an increased risk of HIV infection. Interventions aiming at reducing risk behaviour due to mobility should therefore include partners staying behind.

Infectious disease control projects