1. University Medical Center Utrecht
Management of VHF in the Netherlands
Andy IM Hoepelman
Head Dept of Medicine & Infectious diseases
University Medical Center Utrecht

2. University Medical Center Utrecht
Merger of the Academic Hospital, Wilhelmina Children’s Hospital and the Medical Faculty of Utrecht University
Merger of medical faculty and academic hospital
8 UMC’s nationwide
Largest health care centre in the Netherlands
9000 employees
3000 students
600 million euro budget
These figures represent 2003
source 2003

4. Children’s Hospital Academic Hospital Medical Faculty
The University Medical Center Utrecht was founded in 1999, as the result of the merger of the Academic Hospital (the oldest university hospital in the Netherlands), the Wilhelmina Children’s Hospital and the Medical Faculty of Utrecht University. The Center works closely with the national military hospital, with which it shares its premises.
Medical Faculty

11. Experience in the NL 2 cases
1980 expatriate from Burkina Faso (Upper Volta)

12. Case 1 Ned Tijdschr Geneesk 1982; 126: 566-69
Male 34 years old admitted on June
In BF since February 1980 As development worker
Beginning of may anorexia, pain on the chest
May 25 fever, exanthema on chest spreading to the arms with edema, conjunctivitis
Treatment in BF with Chloroquine no effect
Flown to the NL (not critically ill, lab Sedimentation rate 37 mm; SGPT 38 SGOT 16 and AF 118, leukocytes and differential normal
No diagnosis although extensive lab works was performed
Fever declined later diagnosed as Lassa fever by serology
No secondary spread although only barrier nursing was performed
Ned Tijdschr Geneesk 1982; 126:

13. Case 2 Afghan surgeon from Sierra Leone
July 11 fever, pain in head, muscle and joints with anorexia, vomiting and diarrhoea (artesunate 2 dd 50 mg since July 12)
Admitted July 15: ill 39.3 C; pulse 80/min, exanthema on chest. BSE 5; Leukocytes 3.7 X 10 9/l; Thr 141; ASAT/ALAT 451/173; LDH 2706 U/L; CPK 1032 U/l. Working diagnosis typhoid fever. R/ netilmicin +cefamandol
July 18 MRSA isolation (single room, with negative pressure with an anteroom. Contacts: gloves, a mask and protective clothing)
July 21 Malaria, sepsis and typhoid fever ruled out, Lassa considered (Persistent fever). Ribavirin started and for lab. procedures and waste management bio safety level 4 was initiated. Strict isolation extended by using face-shields.
July 23 diagnosis confirmed by PCR. Three days later the patient died.

14. Contact investigation
Case 1 No secondary cases
Case 2 (home, medical and laboratory staff who had had direct unprotected physical contact)
128 persons
Three developed fever and Lassa fever was ruled out at the first aid department
Serology afterwards done in 83 unprotected contacts. None (64% of total) showed seroconversion
Swaan et al. JHI 2003; 55:

15. Management guidelines in the Netherlands
1 designated high security infectious disease unit (HSIDU) available in UMCU (6 beds)
Patients hospitalised in one of 6 UMC (AMC, AZG, LUMC, UMCN, UMCU, UMCR or MST or havenziekenhuis)

16. Isolation guidelines
Low vs. high infectivity (bleeding, vomiting, diarrhoea)
Low: strict isolation (Negative air pressure room; Disposable long-sleeved gowns)
High: -Strict +
-Gowns for single use
-Goggles
-Mask FFP-2 (No masks with air supply and HEPA filter)
-No Boots