BackgroundMalaria is a notifiable disease in the Netherlands, a non-endemic country. Imported malaria infections occur regularly among travellers, migrants and visitors. Surveillance data were analysed from 2008 to 2015. Trends in amounts of notifications among risk groups were analysed using Poisson regression. For asylum seekers, yearly incidence was calculated per region of origin, using national asylum request statistics as denominator data. For tourists, denominator data were used from travel statistics to estimate incidence per travel region up to 2012.ResultsA modest increase in overall imported malaria notifications occurred in 2008–2015 (from 222 in 2008 to 344 in 2015). Notably, in 2014 and 2015 sharp increases were seen in malaria among travellers visiting friends and relatives (VFR), and in asylum seekers. Of all Plasmodium falciparum infections, most (1254/1337; 93.8%) were imported from Africa; 1037/1337 (77.6%) were imported from Central and West Africa. Malaria in VFR was mostly caused by P. falciparum infection after visiting Ghana (22%) or Nigeria (19%). Malaria in asylum seekers was mostly caused by Plasmodium vivax infection from the Horn of Africa. The large number of notifications in asylum seekers resulted from both an increase in number of asylum seekers and a striking increase of malaria incidence in this group. Incidence of malaria in asylum seekers from the Horn of Africa ranged between 0.02 and 0.3% in 2008–2013, but rose to 1.6% in 2014 and 1.3% in 2015. In 2008–2012, incidence in tourists visiting Central and West Africa dropped markedly.ConclusionsImported malaria is on the rise again in the Netherlands, most notably since 2013. This is mostly due to immigration of asylum seekers from the Horn of Africa. The predominance of P. vivax infection among asylum seekers warrants vigilance in health workers when a migrant presents with fever, as relapses of this type of malaria can occur long after arrival in the Netherlands.Electronic supplementary materialThe online version of this article (doi:10.1186/s12936-017-1711-5) contains supplementary material, which is available to authorized users.

Abstract. The epidemiology of Guillain-Barré syndrome (GBS) in tropical areas is different compared with developed countries. We investigated the epidemiology of GBS on the Caribbean island of Aruba. Data were collected retrospectively from all 36 patients hospitalized with GBS between 2003 and 2011 in Aruba. We observed a seasonal distribution of GBS cases with a peak in February. The incidence rate (IR) fluctuated heavily between individual years. The overall IR was 3.93/100,000, which is higher than that observed in developed countries. Serological studies indicated a possible relation of GBS cases with dengue virus infections. We also observed a relation between the annual number of dengue cases in Aruba and the number of GBS cases in the same year. We conclude that the epidemiology of GBS in tropical areas can be different from temperate climate regions and that dengue may be a trigger for developing GBS.

BackgroundTyphoid fever mainly occurs in (sub) tropical regions where sanitary conditions remain poor. In other regions it occurs mainly among returning travelers or their direct contacts. The aim of this study was to evaluate the current Dutch guidelines for typhoid vaccination.MethodCrude annual attack rates (AR) per 100,000 Dutch travelers were calculated during the period 1997 to 2014 by dividing the number of typhoid fever cases by the estimated total number of travelers to a specific country or region. Regions of exposure and possible risk factors were evaluated.ResultsDuring the study period 607 cases of typhoid fever were reported. Most cases were imported from Asia (60%). Almost half of the cases were ethnically related to typhoid risk regions and 37% were cases visiting friends and relatives. The overall ARs for travelers to all regions declined significantly. Countries with the highest ARs were India (29 per 100,000), Indonesia (8 per 100,000), and Morocco (10 per 100,000). There was a significant decline in ARs among travelers to popular travel destinations such as Morocco, Turkey, and Indonesia. ARs among travelers to intermediate-risk areas according to the Dutch guidelines such as Latin America or Sub-Saharan Africa remained very low, despite the restricted vaccination policy for these areas compared to many other guidelines.ConclusionThe overall AR of typhoid fever among travelers returning to the Netherlands is very low and has declined in the past 20 years. The Dutch vaccination policy not to vaccinate short-term travelers to Latin-America, Sub-Saharan Africa, Thailand and Malaysia seems to be justified, because the ARs for these destinations remain very low. These results suggest that further restriction of the Dutch vaccination policy is justified.

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Background: Probiotics are microorganisms that are beneficial to the human digestive system. Lactobacillus Casei is a beneficial probiotic bacterium present naturally in the human digestive system. Also, Lactobacillus Casei helps in treatment of several gastric disorders and in inhibiting the growth of Helicobacter Pyroli that causes gastro-intestinal ulcers. Prebiotics, in general, refers to substances that help in stimulating the growth of the beneficial probiotic bacteria. Further, the growth of probiotics is sustained by the optimized concentration of prebiotics.Methods & Materials: In this work, the growth of Lactobacillus Casei, in response to the prebiotic concentration is obtained experimentally. The growth curves of Lactobacillus Casei, in response to a 10% nutrient solution (10grams of milk powder in 100ml) was obtained using UV spectrophotometer (Model: UV 1800) under sterile laboratory conditions. The absorbance was measured at a wavelength of 600nm for a time period of 150 minutes. Further, using the measured data, the growth of Lactobacillus Casei in response to the nutrients was modeled using a mathematical modeling approach namely the transfer function model.Results: Results demonstrate that the developed model is efficient in capturing the dynamics of Lactobacillus Casei growth, with an accuracy of 88.81%. Further, by analyzing the model, it was found that the growth of Lactobacillus Casei is stable. Hence, the model can be efficiently used to develop suitable control systems for sustaining the growth of Lactobacillus Casei. Conclusion:This work appears to be of high clinical and industrial importance since Lactobacillus Casei helps in treatment of several gastric disorders and the development of mathematical models of probiotic growth is highly useful for mass production of probiotics.

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