AB_470127
VU Amsterdam
2025-2026
Contents
Lecture 1 Introduction .......................................................................................................... 3
5 steps of Jenkins: for designing an intervention ...................................................................... 4
Lecture 3 Control of infectious diseases ................................................................................ 5
Dynamics of Infectious Diseases .............................................................................................. 6
Epidemiological triangle ........................................................................................................... 7
Containment / control strategies .............................................................................................. 8
Public health surveillance ......................................................................................................... 9
Dutch public health act .......................................................................................................... 10
Lecture 4 transfusion safety and blood-borne infections ........................................................ 11
Some new infectious threats to safety of transfusion .............................................................. 13
Lecture 5 Pandemic preparedness ...................................................................................... 15
Lecture 6 innovating in response to tuberculosis .................................................................. 17
TB as a global health challenge ............................................................................................. 17
An equitable response to TB .................................................................................................. 19
DOTS: a globally coordinated response to TB ........................................................................ 20
Gene xpert – innovating TB diagnostics ................................................................................. 23
Lecture 7 Infectious diseases and Human Rights.................................................................. 24
Siracusa principles ................................................................................................................. 26
Lecture 8 Malaria ............................................................................................................... 27
Part 1: introduction and overview of containment strategies .................................................. 27
Part 2. Malaria vaccines......................................................................................................... 28
Controlled Human Malaria Infections (CHMIs) ....................................................................... 30
Lecture 9 Leishmaniasis control .......................................................................................... 33
Visceral leishmaniasis (VL) (kala-azar) ................................................................................... 33
Cutaneous leishmaniasis (skin) (CL) ...................................................................................... 37
Lecture 10: The Dutch National Immunization Program ........................................................ 40
BASICS of the National immunization program (NIP) ............................................................. 40
Governance and stakeholders ............................................................................................... 42
Monitoring and coverage ....................................................................................................... 43
Actions and Research ............................................................................................................ 44
1
, New: RSV- immunization ........................................................................................................ 45
Lecture 11: Tuberculosis Containment Strategies (prevention & care) .................................... 45
Basic facts ............................................................................................................................. 46
Magnitude of TB problem (drivers/barriers) ............................................................................ 47
General principles of diagnosis, treatment & prevention ........................................................ 49
DOTS to end TB strategy-journey .......................................................................................... 52
Initiatives to accelerate End TB strategy implementation........................................................ 53
Lecture 12 antimicrobial resistance ..................................................................................... 53
Beta-lactam antibiotics .......................................................................................................... 53
Health response to AMR ........................................................................................................ 55
Lecture 13 Patterns of HIV in different contexts & implications for combination prevention ...... 59
Combination prevention: ........................................................................................................ 61
Lecture 15 Health Economics ............................................................................................. 63
QoL/QALY.............................................................................................................................. 66
2
,Lecture 1 Introduction
Isolation → locking somebody up when there is a confirmed case
Quarantine → suspected lock up? Or just prevention
If vaccines/antibiotics weren’t focused on, lifestyle interventions would be much easier to
imply.
HIV/AIDS led to a variety of containment approaches
- VCT = Voluntary counselling and testing
- MTCT = mother to child transmission
- Treatment campaigns
- Micro credits
- Self-help groups
- Behaviour change programs
- Global Fund
Interventions that limit/reduce/spread
= ‘war’ symbolics, strategies to control, eliminate, eradicate disease.
Evidence informed decision making (EIDM)
‘linking the problem to the solution’
- Evidence matters
o Related to the agent, its causes, and the effectiveness of the solutions
- Context matters
o What contextual issues contribute to the problem?
o (solutions) what works where for whom?
- Integration of Evidence, Epistemiological justice (TDR)
o ‘all knowledge matters’. Not all knowledge is equal of course, but experts
have their limits
Precede/proceed model
- Precede → planning and diagnosis (what to do)
- Proceed → implementation and evaluation
- Evaluation phases are not talked about in this
course, be aware that if you want to change
something, you always need to evaluate it.
- Behaviour change and communication models
o Theory of planned behaviour
o Health belief model
3
,5 steps of Jenkins: for designing an intervention
1. What is the problem?
a. Is it a priority health problem?
- Burden of disease + potential burden
o Many different measures
▪ Mortality/morbidity
▪ Incidence/prevalence
▪ DALY (disability-adjusted life year)
▪ Global burden of disease
o Socio-economic impact (economic costs)
2. What factors cause the problem?
a. Tools to identify causes
- Epidemiological triangle
- Problem tree
o Causal tree: ‘but why’
method!
- Mind map
3. How can these factors be changed?
a. Five basic strategies
- Remove the agent
- Raise host resistance
- Modify environment
- Separate agent form host
- Interrupt transmission (infected to non-infected individual)
b. Preventive programs deal with complex web of etiology (causation)
i. Hence, web of interventions needed in many conditions
1. Risk factor strategy; reducing risks and increasing protective
factors
a. Requires intersectoral cooperation, and personal and
collective behavioural change
2. Primary, secondary, tertiary prevention
4. What overall intervention strategies are most appropriate and cost effective
(including what do people want and what are their needs?)?
a. Intervention analysis, using research methods similar to problem analysis
i. Medical-technical effectiveness
ii. Organization feasibility
iii. Social, cultural and ‘political’ feasibility
iv. Financial feasibility
b. List relevant interventions
c. Review relevant options for intervention
5. What needs to be done to reach the goals? With what (sub)populations shall work
be done, and in what sequence, to solve the problem?
a. Anticipate barriers to implementation and negative side effects
4
,Social determinants of health ecological models
(Some more information for the assignment↓)
Primary prevention → prevention before disease is there (vaccination)
Secondary prevention → person is at risk, early detection of disease and treatment (pap smear,
mammography)
Tertiary prevention → preventing the disease from getting worse (taking care of people living
with HIV or leprosy)
Selecting the best intervention
- Intervention analysis, using research methods similar to problem analysis
- List relevant interventions
- Review relevant options for
• Medical-technical effectiveness: extent to which it controls disease
• Organization feasibility: implementation of intervention (level of facilities, skill of health
workers) – does it fit in with existing services
• Social, cultural and ‘political’ feasibility: acceptability of intervention to community and
(political) leader
• Financial feasibility: costs for personnel and materials, et; economic appraisal and
sustainability
LECTURE 2 IS SKIPPED, AS IT WAS PREQUISITE KNOWLEDGE ABOUT
IMMUNOLOGY/INFECTIOUS DISEASES
Lecture 3 Control of infectious diseases
MDA → Mass drug administration: let’s treat everyone, not diagnose but
just treat.
Infectious disease war is not won because of the human animal
connection. More than 60% of ID is zoonotic!
Q-fever outbreak (~2008): government was neglecting the patients. Q-
fever comes from animals (goats/sheep). Not good for pregnancy.
5
,Malaria has its sexual reproductive in the vector, we are intermediate hosts.
Exposure leads to
- Sickness
o Clinical
▪ Death, carrier, immunity,
no immunity
o Sub-clinical
▪ Carrier, immunity, no
immunity
- Become a carrier
- Die
Dynamics of Infectious Diseases
Latent period → more important than you think
Cases
Case 0/index case → the first case of a disease in a community in one Difference Case 0 &
person primary case: Case 0 is
Primary case → the case that brings the infection into a population about the first detection,
while the primary case is
Secondary → infected by a primary case
about the origin, aka who
Tertiary → infected by a secondary case started the chain of
- These cases can be skipped due to some people being carriers transmission.
R number → how many persons one person can
infect.
- Depends on the agent
- Depends on the relative contacts/exposure
- How many people are susceptible
6
,The following graphs show certain disease peaks. Remember what kind of disease it
was, as this will come on the exam!
1. Point source out-break (food poisoning)
2. Legionella/cholera
3. Covid for example.
Epidemiological triangle
Adequate chain of transmission
agent:
- Infectivity
- Pathogenicity
- Virulence
Host
- Demographic characteristics
- Biological characteristics
- Socioeconomic characteristics
Environment
- Physical environment
7
, - Biological environment
- Social environment
Adequate chain of transmission
- Source for the agent
- Portal of exit
- Mode of transmission
- Portal of entry
Containment / control strategies
Essential steps (similar to Jenkins)
• Problem definition
• Proposal development and assessment of success of implementation
• Economic assessment
• Societal relevance
• Policy development
• Professional and public acceptance
• Political decision
Successful control depends upon:
A knowledge of causation
Dynamics of transmission
Identification of risk factors and risk groups
Availability of prophylactic or early detection and treatment measures
An organization for applying these measures to appropriate persons or groups
Continuous evaluation of and development of procedures applied
Definitions
Endemic disease → disease constantly present in a population
Epidemic disease → disease acquired by many hosts in a given area in a short time
outbreak
Pandemic disease → worldwide epidemic
Levels of limiting ID
- Control: reduction of disease incidence, prevalence, mortality and morbidity
- Elimination: reduction to zero of the incidence of infections caused by a specific
agent
- Eradication: permanent reduction of the incidence of infections worldwide
8
,Concept of control/containment
The term disease control describes ongoing operations aimed at reducing:
- The incidence of disease
- The duration of disease and consequently the risk of transmission.
- The risk of transmission
- The effects of infection, including both the physical and psychosocial
complications
- The financial burden to the community
Despite the limited number of cross-institutional MDRO (multidrug-resistant organisms)
outbreaks which have occurred in the Netherlands to date, and the absence of specific
cross-institutional guidelines, we found a relatively high perceived clarity about the roles
and responsibilities among healthcare actors concerning the joint outbreak response.
1. Primary prevention
Achieved by health promotion & specific protection!
→ the action taken prior to the onset of disease, which removes the possibility that the
disease will ever occur.
- Think about vaccination, prophylactic medications, education / environmental
modifications
- Isolation and quarantine
In case of pandemic threat
- Suspension or restrictions on group assembly
- Cancellation of public events
- Closure of mass public transit
- Closing of public places
- Restriction or scaling back of non-essential travel
- Cordon sanitaire
2. Secondary prevention
Screening and treatment like cervical cancer screening or DOTs, active TB case
detection.
3. Tertiary prevention
Prevention of increasing disability and death
- Treatment
- Care
o Home care movement in HIV
o Leprosy
Public health surveillance
Definition: The systematic collection, analysis and interpretation of health data on an
ongoing basis and its timely distribution to those who need to know and subsequent
use of the data
Goal: To prevent or control the diseases within a population by knowing and timely action
9
, Passive surveillance → using existing structures to identify ID. The stronger the
healthcare system the better the passive surveillance
- Based on data readily available; data reported by health care provider / district
health officer
- Key features for success: knowledgeable & alert primary health care providers;
clear, uniform case definitions; adequately staffed laboratories
- Advantages: inexpensive, covers many diseases; easier to develop for routine
work; allows for international comparisons
- Limitations:
o Dependent on many actors
o Limited access to health facilities
o Under-recognition of diseases
o (new diseases, non-specific symptoms)
o Inadequate laboratory facilities
o Underpaid / overworked staff
o Local outbreaks may be missed
o Small # cases / large total population of a province or country
Active surveillance → contacting your personal connections
- Based on periodic field visits to identify new cases from the disease that have
occurred (case finding)
- Visits are made on a routine basis and after an index case has been reported
- Methods
o Interviews with physicians and patients
o Reviews of medical records
o Surveys in villages and towns.
- Advantages: reporting is more accurate; local outbreaks are generally identified
- Limitations; more difficult to develop for routine work, always different; more
expensive to maintain; potentially invasive of privacy
Dutch public health act
https://wetten.overheid.nl/BWBR0024705/2020-07-01
contains lists of notifiable diseases (A1, A2, B1, B2, C)
contains measures MHS/GGD may take to control infectious diseases
→ it is up to mayors! Not doctors/RIVM/GGD, they are only responsible for giving advice
not per se for making regulations!!!!!
- A1: potential pandemic threat→ isolation of patient,
examination, observation quarantine of contacts
- A2: immediate reporting after suspected case→
isolation of patient, examination, observation
quarantine of contacts
o Fe. Small pox; polio; SARS; MERS; Ebola
- B1: all measures except quarantine of contacts
- B2: only exclusions from workplace
- C: only advice, no measures enforceable on patient
10
VU Amsterdam
2025-2026
Contents
Lecture 1 Introduction .......................................................................................................... 3
5 steps of Jenkins: for designing an intervention ...................................................................... 4
Lecture 3 Control of infectious diseases ................................................................................ 5
Dynamics of Infectious Diseases .............................................................................................. 6
Epidemiological triangle ........................................................................................................... 7
Containment / control strategies .............................................................................................. 8
Public health surveillance ......................................................................................................... 9
Dutch public health act .......................................................................................................... 10
Lecture 4 transfusion safety and blood-borne infections ........................................................ 11
Some new infectious threats to safety of transfusion .............................................................. 13
Lecture 5 Pandemic preparedness ...................................................................................... 15
Lecture 6 innovating in response to tuberculosis .................................................................. 17
TB as a global health challenge ............................................................................................. 17
An equitable response to TB .................................................................................................. 19
DOTS: a globally coordinated response to TB ........................................................................ 20
Gene xpert – innovating TB diagnostics ................................................................................. 23
Lecture 7 Infectious diseases and Human Rights.................................................................. 24
Siracusa principles ................................................................................................................. 26
Lecture 8 Malaria ............................................................................................................... 27
Part 1: introduction and overview of containment strategies .................................................. 27
Part 2. Malaria vaccines......................................................................................................... 28
Controlled Human Malaria Infections (CHMIs) ....................................................................... 30
Lecture 9 Leishmaniasis control .......................................................................................... 33
Visceral leishmaniasis (VL) (kala-azar) ................................................................................... 33
Cutaneous leishmaniasis (skin) (CL) ...................................................................................... 37
Lecture 10: The Dutch National Immunization Program ........................................................ 40
BASICS of the National immunization program (NIP) ............................................................. 40
Governance and stakeholders ............................................................................................... 42
Monitoring and coverage ....................................................................................................... 43
Actions and Research ............................................................................................................ 44
1
, New: RSV- immunization ........................................................................................................ 45
Lecture 11: Tuberculosis Containment Strategies (prevention & care) .................................... 45
Basic facts ............................................................................................................................. 46
Magnitude of TB problem (drivers/barriers) ............................................................................ 47
General principles of diagnosis, treatment & prevention ........................................................ 49
DOTS to end TB strategy-journey .......................................................................................... 52
Initiatives to accelerate End TB strategy implementation........................................................ 53
Lecture 12 antimicrobial resistance ..................................................................................... 53
Beta-lactam antibiotics .......................................................................................................... 53
Health response to AMR ........................................................................................................ 55
Lecture 13 Patterns of HIV in different contexts & implications for combination prevention ...... 59
Combination prevention: ........................................................................................................ 61
Lecture 15 Health Economics ............................................................................................. 63
QoL/QALY.............................................................................................................................. 66
2
,Lecture 1 Introduction
Isolation → locking somebody up when there is a confirmed case
Quarantine → suspected lock up? Or just prevention
If vaccines/antibiotics weren’t focused on, lifestyle interventions would be much easier to
imply.
HIV/AIDS led to a variety of containment approaches
- VCT = Voluntary counselling and testing
- MTCT = mother to child transmission
- Treatment campaigns
- Micro credits
- Self-help groups
- Behaviour change programs
- Global Fund
Interventions that limit/reduce/spread
= ‘war’ symbolics, strategies to control, eliminate, eradicate disease.
Evidence informed decision making (EIDM)
‘linking the problem to the solution’
- Evidence matters
o Related to the agent, its causes, and the effectiveness of the solutions
- Context matters
o What contextual issues contribute to the problem?
o (solutions) what works where for whom?
- Integration of Evidence, Epistemiological justice (TDR)
o ‘all knowledge matters’. Not all knowledge is equal of course, but experts
have their limits
Precede/proceed model
- Precede → planning and diagnosis (what to do)
- Proceed → implementation and evaluation
- Evaluation phases are not talked about in this
course, be aware that if you want to change
something, you always need to evaluate it.
- Behaviour change and communication models
o Theory of planned behaviour
o Health belief model
3
,5 steps of Jenkins: for designing an intervention
1. What is the problem?
a. Is it a priority health problem?
- Burden of disease + potential burden
o Many different measures
▪ Mortality/morbidity
▪ Incidence/prevalence
▪ DALY (disability-adjusted life year)
▪ Global burden of disease
o Socio-economic impact (economic costs)
2. What factors cause the problem?
a. Tools to identify causes
- Epidemiological triangle
- Problem tree
o Causal tree: ‘but why’
method!
- Mind map
3. How can these factors be changed?
a. Five basic strategies
- Remove the agent
- Raise host resistance
- Modify environment
- Separate agent form host
- Interrupt transmission (infected to non-infected individual)
b. Preventive programs deal with complex web of etiology (causation)
i. Hence, web of interventions needed in many conditions
1. Risk factor strategy; reducing risks and increasing protective
factors
a. Requires intersectoral cooperation, and personal and
collective behavioural change
2. Primary, secondary, tertiary prevention
4. What overall intervention strategies are most appropriate and cost effective
(including what do people want and what are their needs?)?
a. Intervention analysis, using research methods similar to problem analysis
i. Medical-technical effectiveness
ii. Organization feasibility
iii. Social, cultural and ‘political’ feasibility
iv. Financial feasibility
b. List relevant interventions
c. Review relevant options for intervention
5. What needs to be done to reach the goals? With what (sub)populations shall work
be done, and in what sequence, to solve the problem?
a. Anticipate barriers to implementation and negative side effects
4
,Social determinants of health ecological models
(Some more information for the assignment↓)
Primary prevention → prevention before disease is there (vaccination)
Secondary prevention → person is at risk, early detection of disease and treatment (pap smear,
mammography)
Tertiary prevention → preventing the disease from getting worse (taking care of people living
with HIV or leprosy)
Selecting the best intervention
- Intervention analysis, using research methods similar to problem analysis
- List relevant interventions
- Review relevant options for
• Medical-technical effectiveness: extent to which it controls disease
• Organization feasibility: implementation of intervention (level of facilities, skill of health
workers) – does it fit in with existing services
• Social, cultural and ‘political’ feasibility: acceptability of intervention to community and
(political) leader
• Financial feasibility: costs for personnel and materials, et; economic appraisal and
sustainability
LECTURE 2 IS SKIPPED, AS IT WAS PREQUISITE KNOWLEDGE ABOUT
IMMUNOLOGY/INFECTIOUS DISEASES
Lecture 3 Control of infectious diseases
MDA → Mass drug administration: let’s treat everyone, not diagnose but
just treat.
Infectious disease war is not won because of the human animal
connection. More than 60% of ID is zoonotic!
Q-fever outbreak (~2008): government was neglecting the patients. Q-
fever comes from animals (goats/sheep). Not good for pregnancy.
5
,Malaria has its sexual reproductive in the vector, we are intermediate hosts.
Exposure leads to
- Sickness
o Clinical
▪ Death, carrier, immunity,
no immunity
o Sub-clinical
▪ Carrier, immunity, no
immunity
- Become a carrier
- Die
Dynamics of Infectious Diseases
Latent period → more important than you think
Cases
Case 0/index case → the first case of a disease in a community in one Difference Case 0 &
person primary case: Case 0 is
Primary case → the case that brings the infection into a population about the first detection,
while the primary case is
Secondary → infected by a primary case
about the origin, aka who
Tertiary → infected by a secondary case started the chain of
- These cases can be skipped due to some people being carriers transmission.
R number → how many persons one person can
infect.
- Depends on the agent
- Depends on the relative contacts/exposure
- How many people are susceptible
6
,The following graphs show certain disease peaks. Remember what kind of disease it
was, as this will come on the exam!
1. Point source out-break (food poisoning)
2. Legionella/cholera
3. Covid for example.
Epidemiological triangle
Adequate chain of transmission
agent:
- Infectivity
- Pathogenicity
- Virulence
Host
- Demographic characteristics
- Biological characteristics
- Socioeconomic characteristics
Environment
- Physical environment
7
, - Biological environment
- Social environment
Adequate chain of transmission
- Source for the agent
- Portal of exit
- Mode of transmission
- Portal of entry
Containment / control strategies
Essential steps (similar to Jenkins)
• Problem definition
• Proposal development and assessment of success of implementation
• Economic assessment
• Societal relevance
• Policy development
• Professional and public acceptance
• Political decision
Successful control depends upon:
A knowledge of causation
Dynamics of transmission
Identification of risk factors and risk groups
Availability of prophylactic or early detection and treatment measures
An organization for applying these measures to appropriate persons or groups
Continuous evaluation of and development of procedures applied
Definitions
Endemic disease → disease constantly present in a population
Epidemic disease → disease acquired by many hosts in a given area in a short time
outbreak
Pandemic disease → worldwide epidemic
Levels of limiting ID
- Control: reduction of disease incidence, prevalence, mortality and morbidity
- Elimination: reduction to zero of the incidence of infections caused by a specific
agent
- Eradication: permanent reduction of the incidence of infections worldwide
8
,Concept of control/containment
The term disease control describes ongoing operations aimed at reducing:
- The incidence of disease
- The duration of disease and consequently the risk of transmission.
- The risk of transmission
- The effects of infection, including both the physical and psychosocial
complications
- The financial burden to the community
Despite the limited number of cross-institutional MDRO (multidrug-resistant organisms)
outbreaks which have occurred in the Netherlands to date, and the absence of specific
cross-institutional guidelines, we found a relatively high perceived clarity about the roles
and responsibilities among healthcare actors concerning the joint outbreak response.
1. Primary prevention
Achieved by health promotion & specific protection!
→ the action taken prior to the onset of disease, which removes the possibility that the
disease will ever occur.
- Think about vaccination, prophylactic medications, education / environmental
modifications
- Isolation and quarantine
In case of pandemic threat
- Suspension or restrictions on group assembly
- Cancellation of public events
- Closure of mass public transit
- Closing of public places
- Restriction or scaling back of non-essential travel
- Cordon sanitaire
2. Secondary prevention
Screening and treatment like cervical cancer screening or DOTs, active TB case
detection.
3. Tertiary prevention
Prevention of increasing disability and death
- Treatment
- Care
o Home care movement in HIV
o Leprosy
Public health surveillance
Definition: The systematic collection, analysis and interpretation of health data on an
ongoing basis and its timely distribution to those who need to know and subsequent
use of the data
Goal: To prevent or control the diseases within a population by knowing and timely action
9
, Passive surveillance → using existing structures to identify ID. The stronger the
healthcare system the better the passive surveillance
- Based on data readily available; data reported by health care provider / district
health officer
- Key features for success: knowledgeable & alert primary health care providers;
clear, uniform case definitions; adequately staffed laboratories
- Advantages: inexpensive, covers many diseases; easier to develop for routine
work; allows for international comparisons
- Limitations:
o Dependent on many actors
o Limited access to health facilities
o Under-recognition of diseases
o (new diseases, non-specific symptoms)
o Inadequate laboratory facilities
o Underpaid / overworked staff
o Local outbreaks may be missed
o Small # cases / large total population of a province or country
Active surveillance → contacting your personal connections
- Based on periodic field visits to identify new cases from the disease that have
occurred (case finding)
- Visits are made on a routine basis and after an index case has been reported
- Methods
o Interviews with physicians and patients
o Reviews of medical records
o Surveys in villages and towns.
- Advantages: reporting is more accurate; local outbreaks are generally identified
- Limitations; more difficult to develop for routine work, always different; more
expensive to maintain; potentially invasive of privacy
Dutch public health act
https://wetten.overheid.nl/BWBR0024705/2020-07-01
contains lists of notifiable diseases (A1, A2, B1, B2, C)
contains measures MHS/GGD may take to control infectious diseases
→ it is up to mayors! Not doctors/RIVM/GGD, they are only responsible for giving advice
not per se for making regulations!!!!!
- A1: potential pandemic threat→ isolation of patient,
examination, observation quarantine of contacts
- A2: immediate reporting after suspected case→
isolation of patient, examination, observation
quarantine of contacts
o Fe. Small pox; polio; SARS; MERS; Ebola
- B1: all measures except quarantine of contacts
- B2: only exclusions from workplace
- C: only advice, no measures enforceable on patient
10
