ABSTRACT Background Clinical trials demonstrated high efficacy of daily and event-driven oral pre-exposure prophylaxis (PrEP) in HIV prevention. Event-driven PrEP involves taking two tablets before and two times one tablet after sexual contact (2-1-1/on-demand). While both are implemented in Dutch clinical practice, evaluating real-world effectiveness requires large-scale data from routine clinical care. This study compared HIV incidence between daily and event-driven PrEP in the Netherlands. Methods We used surveillance data from the Dutch national PrEP program (August 1, 2019-December 31, 2025). Individuals ≥16 years with ≥1 follow-up consultation after PrEP initiation were included; PrEP regimen since last visit was recorded at each visit. Person-time was modeled as time-varying based on the regimen reported at each consultation. HIV incidence rates were calculated per 100 person-years and Cox proportional hazards models estimated hazard ratios between regimens for HIV acquisition, adjusted for sociodemographics, sexual behavior, and history of sexually transmissible infections. Findings 16,469 individuals (15,843 men who have sex with men, 579 transgender and gender diverse persons, 45 women and two men who have sex with women) initiated PrEP and had ≥1 follow-up visit (median follow-up 2·0 years (IQR=0·8-4·0)). Median age was 33 years (IQR=27-44). 49 PrEP users were diagnosed with HIV over 41,092 person-years (IR=0·12/100 py;95%CI=0·09-0·16), of whom 42 event-driven users (IR=0·20/100 py;95%CI=0·15-0·27) and seven daily PrEP users (IR=0·04/100 py;95%CI=0·02-0·07). In multivariable Cox regression, event-driven PrEP use was associated with a higher hazard of HIV acquisition (aHR=7·0;95%CI=3·0-16·4). Interpretation Despite overall low HIV incidence, the incidence rate in the Dutch national PrEP program was seven-fold higher during event-driven PrEP use compared to daily, which may be due to lower adherence. These findings denotes that, in real-world settings, improved person-centered counseling is needed for individuals interested in, or using event-driven PrEP. Research should identify domains and preferred methods of support. Funding None for this study. Research in context Evidence before this study We searched PubMed on 07 July 2026 without language or date restrictions, using the (Mesh)terms (“HIV”[Mesh] OR hiv OR hiv-1 OR hiv-2 OR hiv infections OR acquired immunodeficiency syndrome OR (human immunodeficiency virus* OR human immunodeficiency virus* OR human immuno-deficiency virus* OR human immune-deficiency virus*)) AND (“Incidence”[Mesh] OR incidence) AND (“Pre-Exposure Prophylaxis”[Mesh] OR “Tenofovir”[Mesh] OR “Emtricitabine”[Mesh] OR (“PrEP” OR “Pre-Exposure Prophylaxis” OR “Preexposure Prophylaxis” OR “HIV Pre-Exposure Prophylaxis” OR “HIV PrEP” OR truvada OR emtricitabine OR tenofovir)) AND (event-driven OR intermittent OR on-demand OR 2-1-1 OR “on demand”). This search yielded 213 publications. Clinical trials and cohort studies demonstrated low HIV incidence across both daily and event-driven oral tenofovir disoproxil / emtricitabine (TDF-FTC) PrEP regimens. Most comparative real-world data originated from implementation and demonstration projects in the early oral PrEP era (2014-2020), with follow-up periods ranging from six months to four years. To date, only the ANRS PREVENIR study (a prospective cohort study across 22 sites in the Paris region) provided more recent data with longer follow-up time (i.e., a seven-year follow-up period up to May 2024). Despite high efficacy and effectiveness in study settings, there is evidence that in real-life some event-driven PrEP users incorrectly use PrEP or have more difficulties adhering to the PrEP regimen in comparison to daily PrEP users, in particular young men who have sex with men. A few studies have found a higher HIV incidence among event-driven oral PrEP users than among daily oral PrEP users, related to lower adherence, but these findings were derived from small-scale cohort studies with a low number of participants and restricted to a limited number of clinical sites rather than a national cohort. Added value of this study Using real-world national surveillance data comprising data over six years since nationwide implementation of the Dutch national PrEP programme, we evaluated HIV incidence by PrEP regimen. While the overall HIV incidence was low, we found a seven times higher HIV incidence among individuals who reported having used event-driven oral PrEP compared to those reporting daily oral PrEP use, after adjusting for socio-demographics, sexual health and behavior. To the best of our knowledge, this is the first study reporting a significant difference in HIV incidence between the two oral regimens using national surveillance data over an extended follow-up period. Implications of all the available evidence While event-driven oral PrEP has been demonstrated to be as effective as daily use in study settings, most likely related to good adherence, individual and contextual challenges might have led to insufficient adherence resulting in lower effectiveness in a real-world setting. This underscores the need to better understand the real-world challenges relating to event-driven PrEP use and improved person-centered counseling of event-driven PrEP.

The Dutch national open database on COVID-19 has been incrementally expanded since its start on 30 April 2020 and now includes datasets on symptoms, tests performed, individual-level positive cases and deaths, cases and deaths among vulnerable populations, settings of transmission, hospital and ICU admissions, SARS-CoV-2 variants, viral loads in sewage, vaccinations and the effective reproduction number. This data is collected by municipal health services, laboratories, hospitals, sewage treatment plants, vaccination providers and citizens and is cleaned, analysed and published, mostly daily, by the National Institute for Public Health and the Environment (RIVM) in the Netherlands, using automated scripts. Because these datasets cover the key aspects of the pandemic and are available at detailed geographical level, they are essential to gain a thorough understanding of the past and current COVID-19 epidemiology in the Netherlands. Future purposes of these datasets include country-level comparative analysis on the effect of non-pharmaceutical interventions against COVID-19 in different contexts, such as different cultural values or levels of socio-economic disparity, and studies on COVID-19 and weather factors.

Background Dutch Sexual Health Clinics (SHCs) had to downscale services during the first coronavirus wave, but continued to provide essential STI/PrEP care including testing for persons at highest risk for (symptomatic) gonorrhoea, infectious syphilis (syphilis) and HIV. We describe STI positivity among SHC attendees between 2011–2020. Methods National SHC surveillance data contained information on demographics, sexual behaviour, STI testing and diagnoses. We split 2020 into periods: 1 January-12 March (pre-lockdown), 13 March-31 May (lockdown) and 1 June-31 August (post-lockdown). Chlamydia, gonorrhoea, syphilis and HIV positivity (n positive/N tested) trends were explored by gender and sexual contact. Results In 2020, weekly numbers of consultations varied between 2,803 and 3,515 pre-lockdown, 564 and 1,298 during lockdown and 1,084 and 1,976 post-lockdown. Relatively more MSM, PrEP users and clients notified for or with symptoms of STI were seen during- and post-lockdown compared to pre-lockdown. Chlamydia positivity was around 18% among heterosexual men and 15% among women from 2016–2019, and increased to 21.1% and 16.6% respectively in 2020. Positivity increased during lockdown, up to 32% among heterosexual men, followed by decreases post-lockdown to pre-lockdown levels. Among MSM, the increase during lockdown was smaller, only slightly affecting overall positivity in 2020. Gonorrhoea positivity also increased during lockdown, causing further increasing trends among heterosexuals from 1.8% in 2011 to 2.2% in 2020 and among MSM from 9.0% to 12.1%. Syphilis positivity among MSM fluctuated between 2.0% and 2.9% in 2011–2020. Positivity peaked (6.7%) during lockdown, while the number of diagnoses was similar to pre-lockdown. In contrast, HIV positivity continued to decrease from 2,0% to 0,3% among MSM in 2011–2020. Conclusion Prioritising persons at highest risk caused decreases in diagnoses, especially chlamydia and gonorrhoea, but increases in positivity. More information is needed to understand transmission dynamics, including testing at GPs, self-testing and sexual behaviour during coronavirus pandemic.

Gonococcal antimicrobial resistance is emerging worldwide, and is monitored in the Netherlands in 18 out of 24 Sexual Health Centres (SHC) that perform culture and susceptibility testing for patients with gonorrhoea. This study describes trends, determinants and regional differences in azithromycin resistance and ceftriaxone decreased susceptibility in 2013–2019. Data on person characteristics, STI diagnoses and MIC values (Minimum Inhibitory Concentration, measured by E-test) for gonorrhoea were reported by participating SHC. We describe azithromycin resistance (AZI-R, MIC >1 mg/L) and ceftriaxone decreased susceptibility (CEF-DS, MIC >0.032 mg/L) over time and per SHC. We use multilevel logistic regression analysis to describe determinants of AZI-R/CEF-DS among MSM and heterosexuals, correcting for SHC region. A separate multilevel model was made to quantify the effect of population differences on the regional variance of AZI-R and CEF-DS. A total of 13,000 isolates were included from 2013–2019. AZI-R significantly increased from 2.8% (95% Confidence Interval 2.1–3.9%) to 9.3% (8.2–10.5%). CEF-DS significantly decreased from 7.0% (5.7–8.5%) to 2.9% (2.3–3.6%). Overall, regional differences were seen between SHC: AZI-R varied from 0.0% to 16.9%, CEF-DS from 0.0% to 7.0%. Regional variance could not be explained by population characteristics. Regression analyses found pharyngeal strain origin and year of consultation significantly associated with AZI-R and CEF-DS among MSM and heterosexuals. Among heterosexuals also a high number of partners was associated with AZI-R and CEF-DS. No resistance or decreasing susceptibility was found for ceftriaxone, the first line gonorrhoea treatment in the Netherlands. However, azithromycin resistance is increasing, similar to trends worldwide. Differing levels of resistance/decreased susceptibility per SHC could not be explained by differences in population characteristics. This indicates the need for nationwide surveillance and reporting of results on a regional level. The association of pharyngeal strain origin with resistance/decreased susceptibility underlines the importance of including extragenital infections in gonococcal antimicrobial resistance surveillance.

Background Chlamydia trachomatis infections can cause reproductive tract problems, but it remains unclear to what extent past infections are associated with reproductive outcomes such as miscarriages, preterm birth and stillbirth. We assessed these outcomes in women with and without a previous chlamydia infection in women participating in the Netherlands Chlamydia Cohort Study (NECCST). Methods NECCST is a cohort of 5,704 women of reproductive age all tested for chlamydia by PCR in a chlamydia screening study between 2008–11. Women were re-invited for NECCST in 2015–16. Chlamydia-status (positive/negative) was defined using results from the screening, CT IgG presence in serum and/or self-reported past chlamydia infections. Data on miscarriages (spontaneous abortion <16 weeks), preterm birth (life birth <37 weeks of pregnancy) and stillbirth (fetal death >15 weeks of pregnancy), was collected via questionnaires in 2019–20. Pregnancy outcomes were compared between chlamydia positive and chlamydia negative women using multivariable logistic regression analyses. Results Of 3,517 (61.7%) women enrolled in the third NECCST round, 1,011 (28.8%) were chlamydia positive and 2,052 (58.3%) had been pregnant at least once. In preliminary results of those 2,052 women, 585 (28.5%) had a miscarriage once, 153 (7.5%) had a preterm birth and 18 (0.9%) a stillbirth. Miscarriages and stillbirths were similar among chlamydia positive and negative women, 30.7% versus 28.3% p=0.280 and 1.1% versus 0.8% p=0.590. Preterm births were more common among chlamydia positive women compared to chlamydia negatives, 9.7% versus 6.6%, p=0.017. However, in multivariable analysis corrected for age, education level, migration background, body mass index and smoking, the odds of a preterm birth were not significantly higher for chlamydia positive versus chlamydia negative women, OR 1.37 (95%CI 0.95–1.96). Conclusion In the NECCST study we found no indication that past Chlamydia trachomatis infections are associated with an increased risk for miscarriages, preterm births or stillbirths.

Background Syphilis rates are increasing globally among men who have sex with men (MSM). Repeat infections within core groups could contribute to ongoing transmission of syphilis. The aim of this study was to measure the frequency and to explore predictors of repeat infectious syphilis infection among MSM attending Sexual Health Centres (SHCs) in the Netherlands. Methods We analysed national SHC surveillance data between July 2014 and December 2019. A unique identifier enabled individual level analysis of repeat consultations and infections. Infectious syphilis (syphilis) included primary, secondary and early latent syphilis diagnoses. Repeat infection was defined as having two syphilis diagnoses during the study period. Multivariable logistic regression analyses were used to explore predictors of repeat syphilis infection. MSM with at least one syphilis diagnosis and one following consultation were included. Age, education level, ethnicity, HIV infection, having symptoms related to syphilis/HIV, being notified for STI, prior STI, condom use and number of partners at first infectious syphilis diagnosis were included in the analysis. Results There were 184,621 consultations registered among 41,210 MSM who tested repeatedly. Among 3,504 MSM, 4,282 syphilis infections were diagnosed. At first syphilis diagnosis median age was 39 (IQR: 29–49), 32.4% was known HIV positive and 41.4% had 10 or more partners in the past 6 months. Repeat infection occurred in 647 MSM (18.5%; median time to repeat infection: 468 days (IQR: 287–808)). Being HIV positive (aOR: 2.02 [95% CI: 1.69–2.42]) and being notified for STI (aOR: 1.21 [95% CI: 1.01–1.46]) were statistically significant predictors of repeat infection. Conclusion This study showed that repeat infection was common and that HIV infection and being notified for STI at first syphilis diagnosis were predictors of repeat infection among MSM who tested repeatedly. Preventive strategies, including adequate partner management, for repeat syphilis are needed, especially for HIV-positive MSM.

Background Fear of COVID-19 infection and the response measures have affected sexual behaviours of men who have sex with men (MSM) and access to care for sexually transmitted infections (STI). We investigated whether these changes resulted in increased or decreased STI transmission among MSM. Methods We developed a mathematical transmission model for chlamydia and gonorrhoea among MSM. We accounted for 15–35% reduction in the number of casual partners and 50–80% reduction in STI testing during lockdowns (March-May 2020; October 2020 to February 2021); these reductions were 0–10% and 20–35%, respectively, in periods with less restrictive COVID-19 measures (June-September 2020, March-August 2021). Reductions until August 2020 were estimated from Dutch data; other reductions were based on expert opinion. We assumed no changes after August 2021. Two scenarios were examined: with home-testing (in 25% of cases not tested at healthcare facilities) and without home-testing. We calculated the percentage change in prevalence due to COVID-19 associated changes, compared to prevalence in the same year without changes due to COVID-19. Results From the model, we estimated an increase of 8.4% (interquartile range (IQR), 7.6–9.4%) in chlamydia prevalence and an increase of 7.5% (IQR, 6.0–8.9%) in gonorrhoea prevalence at the end of 2020 without home-testing, compared to the prevalence without COVID-19 associated changes. The increase subsided in 2021, but chlamydia and gonorrhoea prevalence remained higher than without COVID-19 until 2025. With home-testing, the percentage increase in 2020, compared to the scenario without COVID-19, was 5.3% (IQR, 4.6–5.9%) for chlamydia and 3.5% (IQR, 2.6–4.4%) for gonorrhoea prevalence. Conclusion The COVID-19 pandemic may have resulted in an increase in chlamydia and gonorrhoea prevalence in 2020. The increase can be smaller after 2020, if STI testing at healthcare facilities and/or at home increases. The findings emphasize the importance of facilitating STI (self) care in times of crisis.

Background On a national level, the Netherlands is closing in on the ambitious 95–95–95 HIV targets set by UNAIDS for 2025. Here, we investigated to what extent this is also the case on a regional level. Methods From the ATHENA national HIV cohort, we retrieved data about all individuals with an HIV-1 infection living in each of the eight sexually transmitted infection (STI) public health surveillance regions in the Netherlands. Based on those newly-diagnosed during 2002–2019 data, we estimated the number of people remaining undiagnosed by the end of 2019, using ECDC’s HIV Modelling Tool, a CD4 count-based back-calculation method. We subsequently estimated a four-stage HIV care continuum: (i) living with HIV, including those undiagnosed, (ii) diagnosed, (iii) in care and on antiretroviral treatment (ART), and (iv) with viral suppression (HIV RNA <200 copies/ml). The total number of people with HIV was estimated by adding the estimated number remaining undiagnosed to the observed number of diagnosed HIV-positive individuals living in each region. Results The estimated number living with HIV nationwide by the end of 2019 was 23,560 (95% confidence interval [CI] 23,370–23,820), or 135 (134–137) per 100,000 population; approximately 1,770 (1,570–2,030) were still undiagnosed. Numbers living with HIV per 100,000 population were highest in Noord-Holland/Flevoland (273, 95%CI 270–276), Zuid-Holland Noord (164, 159–171), and Zuid-Holland Zuid (144, 142–149), which include the three largest cities Amsterdam, The Hague, and Rotterdam. Across the eight regions, 90%-95% had been diagnosed, 92%-96% of those diagnosed were on ART, and 95%-98% of those on ART had a suppressed viral load. Conclusion All STI surveillance regions are on track of achieving UNAIDS’ 95–95–95 2025 targets. Increased efforts are necessary to reduce the undiagnosed population and the number of individuals not retained in care and on treatment.

Background: On 1 January 2014, the minimum age to buy alcohol increased (16-18 years), accompanied by a public awareness campaign (NIX18). Decreases in alcohol consumption are associated with less risky sexual behaviour. This study analyzed the association between the health reforms andChlamydia trachomatis infections (chlamydia) among young heterosexual people. Methods: Chlamydia positivity rates, age, and gender from all STI-clinic attendees between 16 and 19 years old in the Netherlands of 2010 to 2016 were obtained. Interrupted time-series assessed immediate and gradual trends in chlamydia rates. Results: Among the control group (18-19 year olds) chlamydia rates increased 0.5% each post-ban month (95% Confidence Interval [CI] 1.002-1.008, p=.001). Among 16-17 year olds there was no monthly increase post-ban (Rate Ratio 1.000, 95% CI 0.993-1.007, p =.948). In terms of confounders, only controlling for partner notification dissolved these time trends. Conclusions: We found that chlamydia rates after the alcohol ban differed between 16-17 year olds and 18-19 year olds. This demonstrates that the health reforms might have affected this secondary outcome, but obtaining certainty using national surveillance data is difficult. Specific studies should be designed, as now changes in chlamydia over time could be explained by STI-clinic policy changes, by changes on an individual level including reduced alcohol consumption or most likely by the combination of these factors. (C) 2019 Elsevier B.V. All rights reserved.

Chlamydia trachomatis (CT), the most common bacterial sexually transmitted infection (STI) among young women, can result in serious sequelae. Although the course of infection is often asymptomatic, CT may cause pelvic inflammatory disease (PID), leading to severe complications, such as prolonged time to pregnancy, ectopic pregnancy, and tubal factor subfertility. The risk of and risk factors for complications following CT-infection have not been assessed in a long-term prospective cohort study, the preferred design to define infections and complications adequately.

Introduction: Chlamydia prevalence remains high despite scaled-up control efforts. In the Netherlands, the majority of chlamydia patients are seen by general practitioners (GPs). Partner notification (PN) and partner treatment (PT) are addressed in GP guidelines but may not be fully covered in daily practice. As part of a larger research project into the potential of direct partner treatment for chlamydia (PICC-UP: Patient Initiated Contact treatment for Chlamydia), we investigated current practice and attitude of GPs towards PN/PT. Methods Multiple data-sources were combined. First, we collected information on current practice via two short questionnaires around a national GP conference: a pre-conference survey (n=1411) and a handout one on location (n=271). Furthermore, quantitative data on (potential) PT were obtained from prescriptions in electronic patient data from 311 practices in the NIVEL Primary Care Database and from additional data on STI consultations in a subgroup of 45 sentinel practices. Finally, we obtained more insight into GPs’ attitude towards PN/PT in a vignette study among GPs in the same network (n=268). Results In the questionnaires, the large majority of GPs (>95%) indicated to discuss PN of current and ex-partner(s) with chlamydia patients. Usually, GPs leave further steps to the patients (83%); partners are rarely treated directly (4%), except when partners are registered in the same practice (16%). Of all prescriptions of Azithromycin linked to chlamydia episodes, 2% were double dosages, presumably for PT. At STI consultations, the partners of 6/100 chlamydia patients were treated directly, either via partner prescription or double doses for the index patient. Test-results were communicated over the telephone in two thirds of chlamydia diagnoses, limiting the options for PN/PT. In the vignette study, the GPs’ attitude appeared to be more open to PT than in current practice: 16%–20% of GPs indicated willingness to provide direct PT, depending on patient/partner profile; a larger group (24%–45%) would prescribe treatment for an (unseen) partner if the patient could notify him/her first. Advantages of direct PT given by the GPs were: better transmission control because of a higher chance to treat partners (at the same time), easier, cheaper. Disadvantages mentioned were: no chance to talk and give advice to partners, over-treatment, leading to resistance, impact on patient-GP relation and privacy. GPs were concerned about prescribing antibiotics for a patient they have not seen. The opinion of 10% of GPs was that direct PT should be possible for partners of all chlamydia patients, 21% thought for many, others only for some or by exception, while 11% was not in favour of it at all. Conclusion At present, GPs in the Netherlands rarely treat partners of chlamydia cases directly, except for partners registered in the same practice. GPs may be open to options for direct PT, provided there are clear guidelines to arrange this legally and practically.

OBJECTIVES:Infectious syphilis (syphilis) is diagnosed predominantly among men who have sex with men (MSM) in the Netherlands and is a strong indicator for sexual risk behaviour. Therefore, an increase in syphilis can be an early indicator of resurgence of other STIs, including HIV. National and worldwide outbreaks of syphilis, as well as potential changes in sexual networks were reason to explore syphilis trends and clusters in more depth.METHODS:National STI/HIV surveillance data were used, containing epidemiological, behavioural and clinical data from STI clinics. We examined syphilis positivity rates stratified by HIV status and year. Additionally, we performed space-time cluster analysis on municipality level between 2007 and 2015, using SaTScan to evaluate whether or not there was a higher than expected syphilis incidence in a certain area and time period, using the maximum likelihood ratio test statistic.RESULTS:Among HIV-positive MSM, the syphilis positivity rate decreased between 2007 (12.3%) and 2011 (4.5%), followed by an increasing trend (2015: 8.0%). Among HIV-negative MSM, the positivity rate decreased between 2007 (2.8%) and 2011 also (1.4%) and started to increase from 2013 onwards (2015: 1.8%). In addition, we identified three geospatial clusters. The first cluster consisted of MSM sex workers in the South of the Netherlands (July 2009-September 2010, n=10, p<0.001). The second cluster were mostly HIV-positive MSM (58.5%) (Amsterdam; July 2011-December 2015; n=1123, p<0.001), although the proportion of HIV-negative MSM increased over time. The third cluster was large in space (predominantly the city of Rotterdam; April-September 2015, n=72, p=0.014) and were mostly HIV-negative MSM (62.5%).CONCLUSIONS:Using SaTScan analysis, we observed several not yet recognised outbreaks and a rapid resurgence of syphilis among known HIV-positive MSM first, but more recently, also among HIV-negative MSM. The three identified clusters revealed locations, periods and specific characteristics of the involved MSM that could be used when developing targeted interventions.

Objectives Ethnic minorities (EM) from STI-endemic countries are at increased risk to acquire an STI. The objectives of this study were to investigate the difference in STI clinic consultation and positivity rates between ethnic groups, and compare findings between Dutch cities. Methods Aggregated population numbers from 2011 to 2013 of 15–44 year-old citizens of Amsterdam, Rotterdam, The Hague and Utrecht extracted from the population register (N=3 129 941 person-years) were combined with aggregated STI clinic consultation data in these cities from the national STI surveillance database (N=113 536). Using negative binomial regression analyses (adjusted for age and gender), we compared STI consultation and positivity rates between ethnic groups and cities. Results Compared with ethnic Dutch (consultation rate: 40.3/1000 person-years), EM from Eastern Europe, Sub-Sahara Africa, Suriname, the Netherlands Antilles/Aruba and Latin America had higher consultation rates (range relative risk (RR): 1.27–2.26), whereas EM from Turkey, North Africa, Asia and Western countries had lower consultation rates (range RR: 0.29–0.82). Of the consultations among ethnic Dutch, 12.2% was STI positive. Positivity rates were higher among all EM groups (range RR: 1.14–1.81). Consultation rates were highest in Amsterdam and lowest in Utrecht independent of ethnic background (range RR Amsterdam vs Utrecht: 4.30–10.30). Positivity rates differed less between cities. Conclusions There were substantial differences in STI clinic use between ethnic groups and cities in the Netherlands. Although higher positivity rates among EM suggest that these high-risk individuals reach STI clinics, it remains unknown whether their reach is optimal. Special attention should be given to EM with comparatively low consultation rates.

SUMMARY There is limited knowledge about the effect of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) carriage on health-related quality of life (QoL). With this study, we explored whether LA-MRSA causes infections or affects health-related QoL in pig farmers. This prospective cohort study surveyed persons working on 49 farrowing pig farms in The Netherlands for 1 year (2010–2011). On six sampling moments, nasal swabs, environmental samples and questionnaires on activities and infections were collected. At the end of the study year, persons were asked about their QoL using the validated SF-36 and EQ-5D questionnaires. Of 120 persons, 44 (37%) were persistent MRSA carriers. MRSA carriage was not associated with infections, use of antimicrobials, healthcare contact and health-related QoL items in univariate or multivariate analysis, most likely due to the ‘healthy worker effect’. Despite high carriage rates, the impact of LA-MRSA carriage in this population of relatively healthy pig farmers on health and health-related QoL appears limited; more research is needed for confirmation.

Effectiveness of influenza vaccination programme in preventing hospital admissions, Valencia, 2014/15 early results 2 by J Puig-Barberà, A Mira-Iglesias, M Tortajada-Girbés, FX López-Labrador, A Belenguer-Varea, M Carballido-Fernández, E Carbonell-Franco, C Carratalá-Munuera, R Limón-Ramírez, J Mollar-Maseres, M del Carmen Otero-Reigada, G Schwarz-Chavarri, J Tuells, V Gil-Guillén, for the Valencia Hospital Network for the Study of Influenza and Respiratory Viruses Disease

Hand hygiene is considered to be the most effective way of preventing microbial transmission and healthcare-associated infections. The use of alcohol-based hand rubs (AHRs) is the reference standard for effective hand hygiene. AHR consumption is a valuable surrogate parameter for hand hygiene performance, and it can be easily tracked in the healthcare setting. AHR availability at the point of care ensures access to optimal agents, and makes hand hygiene easier by overcoming barriers such as lack of AHRs or inconvenient dispenser locations. Data on AHR consumption and availability at the point of care in European hospitals were obtained as part of the Prevention of Hospital Infections by Intervention and Training (PROHIBIT) study, a framework 7 project funded by the European Commission. Data on AHR consumption were provided by 232 hospitals, and showed median usage of 21 mL (interquartile range (IQR) 9-37 mL) per patient-day (PD) at the hospital level, 66 mL/PD (IQR 33-103 mL/PD) at the intensive-care unit (ICU) level, and 13 mL/PD (IQR 6-25 mL/PD) at the non-ICU level. Consumption varied by country and hospital type. Most ICUs (86%) had AHRs available at 76-100% of points of care, but only approximately two-thirds (65%) of non-ICUs did. The availability of wall-mounted and bed-mounted AHR dispensers was significantly associated with AHR consumption in both ICUs and non-ICUs. The data show that further improvement in hand hygiene behaviour is needed in Europe. To what extent factors at the national, hospital and ward levels influence AHR consumption must be explored further. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.