ECDC Report: STI Control Strategies

On 4 September 2019, ECDC published the report "Developing a national strategy for the prevention and control of sexually transmitted infections". The European Centre for Disease Prevention and Control (ECDC) commissioned this contract through contract ECD.8353, coordinated by Otilia Mardh and Andrew J Amato-Gauci, and produced by Transmissible B.V., represented by Arnold Bosman, Marita van de Laar and Jurgita Pakalniskiene.

A strategy should be evidence-based and take into account national STI epidemiological data. Prevention and control activities should consider the determinants of sexual transmission, for example, factors such as transmissibility of pathogens, contact rates, and duration of infectiousness. A combination of primary, secondary and tertiary prevention activities may be used, based on their proven effectiveness; equally relevant when selecting prevention activities are strategy objectives and the characteristics of the epidemic in question.

The development of a new national strategy and action plan should consider alignment with other policies, strategies and action plans – both national and international – in order to create synergies between related policy areas.

The report proposes a seven-step approach for the development, implementation and monitoring of a national strategy and action plan:
- Establish a national coordination mechanism
- Engage stakeholders in the process
- Perform a situation analysis
- Develop the strategy document
- Develop an action plan
- Coordinate and manage the action plan implementation
- Establish a monitoring and evaluation plan

Simulation Exercise Flu

On 11 and 12 September 2019, we supported Trimension in coordinating a regional Simulation Exercise for severe seasonal influenza. The exercise was held in the east of the Netherlands and involved public health services, hospitals, general practitioners, crisis coordination teams, and other healthcare partners. The exercise aimed to test the preparedness and the functions at a tactical crisis response level.

Transmissible supported the exercise with epidemiological and public health scenario content and counter-play in the exercise response cell.

Micro-learning for busy professionals

Professional life is demanding. At the technical expert level, you are faced with rapid new developments in your field. As an executive manager, you face demands and priorities 360 degrees around you. Even if you are motivated to learn, where will you find the time?

Microlearning offers added value when learners are busy managing many priorities. Microlearning gives learners bite-sized programs that fit into their workday more easily than traditional training. Video lectures of 3-4 minutes are more attractive than those taking 30-40 minutes. But there is a catch! You must resist the temptation to take the easy road, and simply chop up a lecture in 10 smaller parts, without modifying the storyline. Because doing that forces the learner to follow all lectures in a fixed sequence. Plus you risk that a single short video raises more questions than it answers.

Recently, a corporate client approached us with the request to create training for senior managers within the organisation. The topic had technical aspects, as well as tactical and strategic elements. The purpose of the training would require the managers to update knowledge and to align with the global corporate policy. Knowledge and experience varied within the group and as a consequence, so would the individual learning objectives.

Microlearning offered a solution. We categorised the field of knowledge into 6 domains. For each of the domains, we identified six to ten concepts that managers had to know. Each of these concepts could be explained briefly, which is what we did. Together with Vetpot Video productions, we created bite-sized video lectures, varying in length from 3 to 9 minutes. The micro-lectured were designed such, that they could be viewed in any sequence. The lectures could be viewed on a desktop, tablet or smartphone, to optimize the access.

But very short lectures alone are not enough to make micro-learning successful. Motivation to engage with the training is not a matter of course (no pun intended). To achieve this, we introduced three online problem-based debating events, each one around a specific topic. Pegbarians created cartoon invitations, which we sent around to introduce the topics for debate. Also, we distributed a syllabus with an overview of all micro-learning. This included provocative comic book stories created by Jordan Collver, to jumpstart the debate.

This combination of micro-learning and problem-based awareness-raising proved to be very popular and successful. Participants agreed or disagreed with the comic-book narrative. Either way, this filled the online events with lively discussions about perceptions, values and expectations around the three topics. It also helped to separate knowledge from opinions. To share knowledge, we referred to the microlearning videos. This allowed focussing the discussions on opinions and strategic directions.

An additional benefit of microlearning is improved accessibility to the learning content. The short lectures easily fill idle time, for example, while travelling.

Thanks to the ubiquitous mobile devises and connectivity, microlearning can be enjoyed on your own conditions, anytime, anyplace, anywhere.

Our project on HIV Drug Resistance Surveillance

In 2017, Transmissible started a project for ECDC to pilot surveillance of HIV Drug Resistance (HIVDR) in 9 European countries. Marita van de Laar and Arnold Bosman worked with a team of experts from ECDC and 9 pilot countries to design, perform and analyse the pilot.

The article reporting on the outcome of this pilot was published in Eurosurveillance on 9 May 2019. (See below)

Vaccine hesitant mother learned about value of vaccination. The hard way.

When we think about declining vaccination coverage, the first that probably comes to mind is the shouting match on social media between Antivaxxers and ProVaxxers. As often in life, the ones with the loudest mouths do not represent the majority voice.

Antivaccination messages are scary, use false arguments and present falsehoods as facts. They frighten a much larger group of responsible, caring parents into hesitating about vaccination. Vaccine hesitancy has grown, not because the hesitant are stupid, but mainly because they care. They care about their children; some believe there may be truth in the Antivaxx claims that vaccines are bad for a child.

All parents have to weigh the risks for their children. Do I breast-feed, or bottle-feed? Can I let her cycle to school each day, or should she take the bus? Every choice has a risk. Not choosing also has a risk. The question is: which risk do you want to avoid?

If someone says: "Vaccines are completely safe, you will never be hurt", then that simply is not true. There is an extremely small risk attached to any medicine (even preventive) that you take. The important question is: how big is the risk when I do NOT vaccinate?

Well, this we know for as long as medicine exists. Measles kills, Whooping cough kills, Polio kills and paralyses, Rubella kills or cripples your unborn baby. These risks are at least thousands of times larger than the risk of taking the vaccines. It is an established, widely accepted scientific fact that not vaccinating presents a hugely bigger risk than vaccinating. Yes, it is true that a bridge may collapse. But do you really believe it is safer to let your kids swim across the river?

The safest choice you have as a parent is to vaccinate your children. It is a simple as that.

Better than I can ever explain, this Canadian mother tells you her story:

International Epidemiological Association Regional Meeting - Beirut

The East Mediterranean Region of the International Epidemiological Association (IEA) organised the 12th regional conference from 21-23 February 2019 in Beirut, Lebanon, in coordination with the Lebanese Epidemiological Association (LEA).

Arnold participated as a speaker in the program.

What will you give your Valentine this year?

Valentine's Day. We celebrate love. In anticipation of this wonderful day, we have a message prepared for all you lovers out there.

And the winner is.........

Yes, we do have a winner. In fact, we have several prizes to distribute. The 'Year of the Pig'-competition closed yesterday, at the Chinese New Year and we received 14 submissions online.

The fastest solution was submitted by Gudrun Freidl, who solved the Word Puzzle in 204 seconds, and suggested that the following zoonoses were missing from the list: ringworm, campylobacteriosis, pathogenic E. coli, streptococcosis, cryptosporidiosis and tapeworm.

Well done, and congratulations, Gudrun!

Runners up were Lisa Hansen (333 seconds), Joris Sprokholt (543 seconds), Hana Orlikova (591 seconds) and Brandon Patton (time not recorded); together they suggested additional missing pig-related zoonoses:

An honourable mentioning for Hana Orlikova, who also informed us about various antibody-studies in pigs and swine, that linked to the following infections and pathogens: Tuberculosis (Mycobacterium Bovis, M. tuberculosis complex, M.avium), Lyme borreliosis, Anaplasma phagocytophilum, Rickettsia sp., Candidatus Neoehrlichia mikurensis, Tick-borne encephalitis, Japanese encephalitis, and Toxoplasma gondii. Of course, this does not mean that all of these are pig-related zoonoses, but I admire the level of detail. In addition, she was the only one who provided a risk assessment for the image from the PigSaw Puzzle: Well done Hana, for this research !!

Gudrun, Lisa, Joris, Hana and Brandon; I will reach out to you with your well-deserved prize 🙂

Thanks to everyone for being such a good sport, and responding to this playful call!

Mass Game Event

On 23 January 2019, 150 bachelor students at Utrecht University played our educational game 'Greep op Griep' (FluFighters). Students play the game in groups of 5-6 players. This afternoon, five groups played in the same room and got familiar with the roles in outbreak response. During the game, players step in the shoes of four local, national and international organisations and try to solve the problems they face.


In the theme of the Chinese 'Year of the Pig' (5 February 2019 - 24 January 2020), we thought you'd like this jigsaw puzzle. After solving it, we will be most interested in receiving your comprehensive risk assessment for this situation. You can leave it in the comments section below (only for logged in users: registration is free))

Days to Christmas

Our Transmissible Advent Calendar counts down the days to Christmas. Each day, a new post is unveiled. You probably already see the full image that is behind each of the days. No? Just come back tomorrow, and a new part is shown.

[adventcalendar calendar="mindful"]


Click on each day to read the post

World AIDS Day 2018


End isolation
End stigma
End HIV transmission

You’ve helped to fight HIV. Now, let’s end it. This World AIDS Day join the fight to end the negative impact of HIV. World AIDS Day is on December 1, each year. Let's all contribute in our own way.


Mark World AIDS Day in your school by using our free teaching resources. Your students will learn about what life is like with HIV, how to protect themselves and about HIV history with our assembly PowerPoint and illustrated timeline, which you can download here.

ESCAIDE 2018 Interactions

From 21-23 November 2018, the ECDC and network partners organised the annual European Scientific Conference on Applied Infectious Disease Epidemiology: ESCAIDE. This year, the conference was hosted by Malta, at the Hilton Hotel in St. Julian's. The program offered inspiring speakers with a range of perspectives on communicable disease prevention and control.

The conference is coordinated by ECDC since 2007, when it was transformed from the annual EPIET Scientific Seminar (organised by EPIET since 1996) into ESCAIDE.

Among the Keynote speakers opening ESCAIDE were Dr. John Nkengasong (director at the Africa Centres for Disease Control and Prevention, Ethiopia) and Prof. Dr. Christian Drosten (virologist at the Institute of Virology, Campus Charité Mitte, Germany). ECDC Director Andrea Ammon opened the first day by reminding the audience of the conference aims (see picture).


Career Compass

The EPIET Alumni Network (EAN) has been a key partner in co-organising ESCAIDE since the very beginning. On the first day, EAN organised the 'Career Compass', an interactive session where the audience can ask a panel questions on career choices. This year, the panel (see picture on the right) included a wide range of public health experts. Behind the table (from right to left), you see Dr. Chris Barbara (Chairman of the Pathology Department at Mater Dei Hospital in Malta), Dr. Grazia Caleo (Public Health Advisor for the Manson Unit in Medecins Sans Frontieres), Dr. Emilie Perron (Pharmaco-epidemiologist at WHO), Dr. Jane Wheelan (senior epidemiologist at GSK vaccines), Thibaut Jombart (Associate Professor outbreak response analytics, Imperial College London, UK), and Dr. Alastair Donachie (graduating EPIET fellow cohort 2016).

Arnold Bosman (Transmissible) moderated the Career Compass session.



Poster Session 22 on Vaccine Effectiveness (see picture left) included 4 presentations on effectiveness of Pneumococcal Vaccines and one on seasonal influenza.

Sebastian Cortaredona presented how likely it is that vaccinated people with diabetes will re-vaccinate next year. Lukas Richter presented the impact of PCV-10 on children and adults in Austria. Camelia Savulescu (EpiConcept) gave a summary of the effectiveness studies of SpidNet for PCV-13. Larisa Savrasova discussed outcomes six years after the introduction of PCV-10 in Latvia. And Anna Alari gave an overview of geographical analysis of vaccine coverage and pneumococcal meningitis in France.

The session was moderated by Arnold Bosman (Transmissible).



Games for Health 2018

Vincent, Tom and Arnold ready for the first keynote speech.

On 1 and 2 October 2018, the 'Greep op Griep-team' joined the Games for Health Europe conference in Eindhoven. Grumpy Owl Games (formerly known as: Jade Owl Studios) and Transmissible designed and developed the educational game 'Influencing Influenza' (Greep op Griep) for the Utrecht University and presented their work at this international meeting.

The Temporary Art Centre (TAC) in Eindhoven hosted the conference. Located opposite the PSV- Philips Stadium. TAC contains 80 workspaces for starting professional artists and has a cultural program with exhibitions, readings, workshops and music. During the first two days of October 2018, this old industrial building hosted the GFHEU conference in a unique, creative atmosphere.

Jeremy explaining the game to Ting Jiang from the Centre for Advanced Hindsight.

Tom and Arnold spent the two days listening to presentations, interacting with health workers and game professionals. Vincent joined the first day, and Jeremy the second. Arnold presented the creation and performance of the game on the first afternoon.

We had two tables in the main room to exhibit the game and that proved a great position. During the breaks, there were always interested participants around our tables, curious to get info or play a round.

Keynote speeches were awesome, on thought provoking topics and state of the art game development.


Outbreak Game in Action

On July 4th, 2018, we ran the second session of the educational outbreak response game 'FluFighters(tm)' at the Utrecht University.

This time, the Julius Center coordinated a survey to assess the educational effect of the game. Students were requested to complete a questionnaire after playing the game. Results will be presented at the Games for Health Europe Conference (8-9 October 2018, Eindhoven).

Greep op Griep (Influencing Influenza) is an educational hybrid digital/card game designed and developed by Transmissible and Grumpy Owl Games (formerly known as: Jade Owl Studios).

Unboxing our new Outbreak Game

Today the new design of our game 'Greep op Griep' arrived ! So the unboxing was exciting: the new design by Tim Schoonhoven looks superb, and the quality production by makes it look very good.

The box comes with a sturdy quality foldable game board and two decks of cards: The Resources and the Information files. The cards have UV protection coating and a linen look and feel to the touch. All together it ensures a great game experience.

Of course, the key feature is the branched narrative of the scenario that the players have to go through, depending on their choices and their ability to get the right resources together in time. That will onfold on the computer screen.


All together, it looks VERY COOL 🙂

Training the Communicable Disease Team

On 28 June we organised a table top training with the Regional Public Health Services 'Hollands Midden', in Leiden, the Netherlands. The Communicable Disease Control team engaged in a challenging scenario, dealing with a biosecurity breach in the region. The scenario unfolded real time, and had started the evening before, when the director of public health called the duty officer with an assignment for support.

Transmissible prepared and executed the training together with collaborative partner Trimension. The training has been accredited for Continuous Professional Development (CPD).


Masterclass Digital Disaster Response

 On 21 June 2018, University College London (UCL) organised a Masterclass on Digital Disaster Response. Participants brought a rich and wide range of professional backgrounds, a majority of which in public health and disaster response. Dr. Patty Kostkova had convened the event, and invited Arnold Bosman from Transmissible (NL) and professor Carlos Castillo from Pompeu University (ES) to present.

In the morning, Arnold started with an overview of public health emergency response, and rapid assessment priorities in complex emergencies. This was followed by an exercise, where participants viewed a video about the earthquake in Haiti (2010) and had to discuss priorities for in that context. With the experience that participants brought in, including Tsunami relief in Banda Aceh (2004/5) and Haiti Earthquake relief (2010), this exercise provided a rich discussion.

In the afternoon, professor Castillo presented datamining from social media streams such as Twitter and Facebook, to achieve rapid assessment of geographical area affected, casualty counts, and severity of impact.


Life-course Immunisation Report Published

The Confederation of Meningitis Organisations (CoMO), the Coalition for Life-Course Immunisation (CLCI), along with Transmissible and other key stakeholders, have co-authored and contributed to a document that was initiated and funded by MSD and produced by the Health Policy Partnership. The report discusses what a life-course approach to vaccination could look like and how it could be implemented into future vaccination policies.

The report highlights that adopting a life-course approach to vaccination could positively impact individuals, the wider community, and socioeconomic factors. For example:

  • The individual: taking a life-course approach to vaccination may help boost the individuals’ immunity over their lifetime, which may make them more resistant to other diseases
  • Public Health: vaccinating individuals helps to stop the spread of infectious disease to vulnerable, unvaccinated populations.
  • Socioeconomic impact: through preventing illness, vaccinating individuals at all ages can reduce hospitalisation rates and increase productivity in the workplace.

Research suggests that shifting to a life-course approach to vaccination will require policymakers to make several changes.

These changes fall into 5 categories:

  • Involving global, EU and public health leaders
  • Changing the public’s perception of vaccination
  • Engaging healthcare professionals
  • Integrating vaccination into non-healthcare settings, such as schools or workplaces
  • Improving vaccine surveillance, data and research.

Read the full report to find out more:

[aesop_document type="pdf" src="" caption="A life-course approach to vaccination:
adapting European policies"]



Some of the co-authors of the report have also penned an open letter to key members of DG-Santé. In the letter, they call on all stakeholders to adopt a life-course approach to vaccination. Read the open letter here:

[aesop_document type="pdf" src="" caption="Open Letter on Lifelong Vaccination"]


The Health Policy Partnership have created an infographic for members of the general public and policymakers detailing the importance of a life-course approach to vaccination:

[aesop_gallery id="4214" revealfx="off" overlay_revealfx="off"]

Digital Health - The Lyon Conference 2018

The Digital Health community is growing. And it is thanks to conferences like #DH2018 in Lyon, that experts from related disciplines can exchange results, experience and ideas for future developments. Computer scientists, clinicians, nurses, public health specialists, behavioral scientists, epidemiologists, microbiologists and, yes, also philosophers, ethicists and legal experts have a stake in the field of Digital Health.

One of the first invitations that I accepted after staring up Transmissible in June 2016, is to become co-chair of the Digital Health Conference, and join the team of Patty Kostkova, who has been promoting the field of digital health for over a decade. Starting with the eHealth conferences held in London (2008), Istanbul (2009), Casablanca (2010) and Malaga (2011), a next step was made to set up the Public Health in Digital Age Workshop. This workshop was held with WWW conference in Rio de Janeiro (2013) and Seoul (2014). In 2015, this was transformed to a full subconference on Digital Health, held under the WWW Conference in Florence (2015), in Montreal (2016) and independently in London (2017).

The aim of the Digital Health Conference is to bring together public health agencies (WHO, ECDC, CDC, PHE) and computer science and IT and MedTech industry to cross-fertilize ideas and drive this growing interdisciplinary field.

This year, in Lyon, we have set up a program around the theme "Emergency and Humanitarian Medicine". Addressing acute needs of natural and manmade disasters will leverage opportunities created by geo-located big data, mobile technology and crowdsourcing for improving resilience, early warning and response to disasters and emergencies.

Curious for a glimpse in the conference?

New vlog series on Flu Preparedness (Dutch)

To support the Trimension simulation exercise on seasonal influenza, we have created a series of video briefs to explain some key aspects of preparedness for Seasonal Influenza. Below is one example (in Dutch) on hygiene measures.

The series can be found at our Vimeo channel 'Korte Uitleg'.


Playful Introduction to Outbreak Response

The University of Utrecht innovates the medical curriculum and asked Transmissible to develop a game to get students acquainted with outbreak response. In partnership with Jade Owl Studios, we designed 'Influencing Flu', a hybrid game combining an adrenalin raising card-round with a branching online narrative. The scenario starts with a local outbreak of severe influenza at an elementary school. In groups of 5-6 players, the students decide on the information they want to collect for the investigation file. Through a high-paced card game, they have 2 minutes to spend the right resources to gain access to the information. In five rounds, they play roles in the key outbreak response organisations.

The game was beta tested in November 2017, and launched for first play on February 6, 2018.

Transmissible Game now part of Curriculum

We have been working on this serious game in the background for the past 9 months. In November we organized the Beta-test, and last week the general rehearsal with all game-facilitators. The game has been developed by Transmissible and Jade Owl Studios, in an assignment from the Julius Centre at the University Medical Centre of Utrecht (NL).

In 5 rounds, of 25 minutes each, a group of 5-6 students will play through an evolving outbreak scenario. In each round, they will get to learn the role of one of the organizations involved in Dutch outbreak response. Meanwhile, the outbreak spreads further, and the team needs to collect the right information in their file, to inform their decisions for interventions.

As of February 6, 2018, the Transmissible Game(TM) 'Greep op griep' will be part of the curriculum for 3rd year Bachelor Medical students in Utrecht. Instead of a rulebook, we made a podcast to explain the rules of the game.

Influencing Flu - a Transmissible Game(TM) on Vimeo.

Transmissible and Jade Owl Studios will further study the impact of the game, while it is used by the first cohort of students in February 2018.



ECDC Winter Workshop 2017

The ECDC Winter Workshop 2017 is part of the Continuous Professional Development (CPD) efforts of the Centre and was organised from 5-7 December in Stockholm. The course was well attended, by participants from 22 EU Member States, representing all regions of the EU. The event was strongly appreciated by all participants as a valuable networking opportunity.

Participants said they would recommend this workshop to colleagues, with the intention to share the materials, or use it in their own teaching. Many respondents presented specific plans for such dissemination. This suggests that the Winter Workshop is not just a successful Continuous Professional Development for EU-Member State public health professionals, yet it. The logistic and administrative arrangements received the highest praise from all participants.

The program proved to be well-balanced. Participants greatly appreciated the interactive sessions and practical exercises, and recommended that these should even expand in future editions.


Digital Health Conference 2018

Digital Health 2018

From 23-26 April 2018 the Digital Health Conference will be held in Lyon, France. It is only appropriate to host this event in Europe's City of Health Innovation: the event is focused more and more on public health and digital innovations, so it was only a matter of time for it to be in proximity of so many other health innovations. Lyon is the 1st Smart City in France, the 2nd Digital Cluster, and the place of the 1st European Bike System 'Velo-V'.

The previous Digital Health Conference was the first with a specific public health track. In 2018, we continue this direction, with a focus on vaccine preventable diseases. Below is a glance at this year's programme. Don't miss the opportunity to submit an abstract! The deadline has been extended to 29 January 2018.


[aesop_document type="pdf" src=""]

Join me in my efforts to support Save the Children Federation, Inc.

For the past six years, Syria’s children have been bombed, shot at and starved to death. They’ve seen loved ones killed or injured, right before their eyes. Their homes and schools reduced to rubble. Their families torn apart.

We, the rest of the world, are so far away. In fact, we live in fully different worlds. It is easy to feel powerless, hopeless, and defeated, when thinking of the horrors that Syria's children have to go through, day by day.

Still, great things can start with small gestures.

Save the Children helps us to get organised. With my company Transmissible, I want to motivate people in the network to support this fundraiser, to join the activities this month, and donate to help Syria's Children.

There is lots of space to join our team: the more members, the more funds we can raise.

Donate on our Fundraiser Page on Save the Children.

Thank you for supporting Save the Children Federation, Inc.

Your contribution is greatly appreciated!

Thanks ++,  Arnold


Days to Christmas

Our Transmissible Advent Calendar counts down the days to Christmas. Each day, a new post is unveiled. You probably already see the full image that is behind each of the days. No? Just come back tomorrow, and a new part is shown.

[adventcalendar calendar="transmissible17"]


Click on each day to read the post

Regional Simulation Exercise

Influenza Escalates

On 28 and 29 November 2017, regional authorities and health care providers of the Dutch province Zeeland participated in a simulation exercise dealing with an escalating seasonal influenza scenario.

During 24 tense hours, hospitals, general practitioners, nursing homes, home care providers, ambulance companies, public health services, mayors and city councils had to deal with a simulated flu epidemic that raged over the country.

More than a dozen organizations delegated specialists to populate the response-cell to feed the evolving narrative to the players. The Delft-based company Trimension masterminded this large operation, and Transmissible was contracted to contribute to the training scenario, and provide expertise on influenza epidemiology, prevention and control.

First impressions

Though the formal evaluation is still in progress, all parties involved shared first impressions in a 'hot debrief' at the end of the exercise. As far as testing public health preparedness goes, it is clear that there is no alternative to simulation exercises. It is not only an excellent way to remind oneself of the existing protocols; it makes you better understand the different ways in which your partners respond to emergencies; it shows how agreed emergency plans can still be interpreted differently; it demonstrates that most people struggle to anticipate the response capacity needs for the next month, when they are proudly managing double patient intakes today. These were observations that were shared across the table among all participants, immediately at the end of the exercise.

I look forward to the full evaluation report. Independent of that, I can already comment that such regional simulation exercises that involve operational experts, as well as strategic and tactical decision makers, are vital for a solid health emergency preparedness.

Very much worth the effort.


World AIDS Day 2017


End isolation
End stigma
End HIV transmission

You’ve helped us fight HIV. Now, let’s end it. This World AIDS Day join the fight to end the negative impact of HIV. World AIDS Day is on December 1, each year. Let's all contribute in our own way.


Mark World AIDS Day in your school by using our free teaching resources. Your students will learn about what life is like with HIV, how to protect themselves and about HIV history with our assembly PowerPoint and illustrated timeline, which you can download here.


[h5p id="8"]



A day to remember - Karel Raška

It was 108 years ago today that...

Karel Raška (17 November 1909 – 21 November 1987) born in the South Bohemian town Strašín, in what is now Czech Republic. He was a physician and epidemiologist, who headed the successful international effort during the 1960s to eradicate smallpox. Raska was a Director of the WHO Division of Communicable Disease Control since 1963. His new concept of eliminating the disease was adopted by the WHO in 1967 and eventually led to the eradication of smallpox in 1977.[1] Raška was also a strong promoter of the concept of disease surveillance, which was adopted by WHO in 1968 and has since become a standard practice in epidemiology.[2]

D.A. Henderson commented:

“Dr Raška’s studies in the epidemiology of hepatitis in Czechoslovakia were known to and respected by all epidemiologists concerned with this major infectious disease problem. No other country or area in the world has documented so thoroughly its experience with hepatitis. The surveillance programme in the United States was cut with a different fabric. Its construction for a variety of reasons differs from that of Czechoslovakia. Comparisons of data have to be interpreted cautiously”.

In those days, Czech studies were far superior and extensive than those in the USA. And Raška had a major influence on them.[3]  Raska received the Edward Jenner Medal awarded by the Royal Society of Medicine.

A tough deal

The recognition by the Royal Society of Medicine and WHO notwithstanding, Raska faced a tough deal back home. Walter Holland, describes the following about Raska in the Central European Journal of Public Health:

"Raška lived in challenging times. Czechoslovakia became an independent republic in 1918, after the First World War. Thus his early years were spent in a country beginning to establish its identity in the face of great uncertainty and turmoil. This culminated with invasion by Germany, Poland and Hungary of the borderlands in 1938 and full occupation by Hitler’s Germany in 1939. The war years were not pleasant for any Czech, and he participated in resistance activities. His involvement in the control of an epidemic typhus outbreak in Terezin is particularly poignant.
For the rest of his life, he worked under the communist regime. This was the time of the Cold War between East and West. There were major differences in policies and paranoia about contacts of individuals from the East with those in the West, particularly the United States and the United Kingdom. Those from Russian dominated regimes who had contacts in the West were viewed with some suspicion in their own country. Persons from the East were also treated with reserve by the West. Every WHO office had an individual from an Eastern country responsible for reporting on the behaviour and contacts of his Eastern colleagues. Only those considered “reliable” were allowed, to a small degree, to collaborate with individuals from the West. Those who did so, showed remarkable courage.

Raška was a good example of a scientist who had the courage to appreciate that medical science had no boundaries and could only advance through collaboration; infectious agents have no ideological principles and do not recognise state boundaries. He suffered the consequences of this behaviour, when he returned to Czechoslovakia, after his service with WHO in the early 1970s. It is particularly unfortunate that his enormous achievements in the control of infectious disease over a long period were not acknowledged in his own country and many of his former colleagues and pupils abandoned him and his achievements."  [3]

And he is not the only one. Look what Vladimir Zikmund writes in the same journal:

"Raška publicly criticized the invasion both at home and abroad and after he returned permanently to Czechoslovakia, he was completely deprived of all positions in public health by the Minister of Health, Prokopec. Raška became an exile in his own country for the rest of his life. It is a pity that Karel Raška was barred from educating medical students and future generations of epidemiologists. His lectures had been informative because he stated concrete cases of fighting infectious diseases. Raška was also not allowed to publish at home. The main hygienist during the period in question wrote a letter to the editor of journal Vesmír that Raška’s scientific capacity had declined and that there was no reason to publish his work. Even citing his work was discouraged. Unfortunately, some authors respected this banishment of Raška all too much." [2]


Raška's legacy

Fortunately, this politically orchestrated isolation that tried to make the world forget about this public health hero, failed.  Raska was a founding member of the International Epidemiological Association (IEA), and key members considered his contribution:

".....inestimable. He brought to the IEA, the views of a highly experienced Infectious Disease Epidemiologist working in Eastern Europe. His support for the Association, from his part of the world, demonstrated that the aims and objectives of the Association could transcend boundaries and Ideologies."

Raska was greatly appreciated by many leaders in public health, among which was Alexander Langmuir. In his "Appreciation of Raska", that was published in the International Journal of Epidemiology the year after his death, Langmuir writes:

"From our first meeting we related warmly to each other. Behind a somewhat stiff, even brusque exterior, my first impression was a warm personality, great enthusiasm for scientific ideas, and a mission to achieve. He deeply believed that the principles of what he termed epidemiological surveillance should be applied worldwide."

D.A. Henderson, director of the active phase of the smallpox eradication program, added:

"Karel made two further important contributions to epidemiology. The first was his enormously successful efforts as a professor, to recruit and to train young Czech physicians in the subject. It was apparent to all of us that of the countries of Europe, Czechoslovakia was one of the strongest in epidemiology and contributed a number of first-rate epidemiologists to WHO programmes. Almost all of these were trained by Karel.
The second was regarding the smallpox eradication: he [Karel] played an important role [....] without which the programme could not have succeeded"

In his article in 1988, Henderson summarized his view on Raska's contribution to smallpox eradication as follows:

“Raška played an important role in gaining acceptance of a number of vital administrative and policy matters without which the program could not have succeeded”.

Imagine how many lives are saved each year, as a legacy of Raska's efforts: the World Health Organization estimates that in 1967 still 15 million people contracted the disease and that two million died in that year. [4]

Karel Raska is one of the people, we owe a debt of gratitude. So let's celebrate his birthday on 17 November.


  1. Karel Raska, from Wikipedia, the free encyclopedia, accessed 12 December 2014
  2. "Karel Raška and Smallpox". Central European Journal of Public Health. March 2010. Retrieved 2010-11-17.
  3. "Karel Raška — The Development of Modern Epidemiology. The role of the IEA.". Central European Journal of Public Health. March 2010. Retrieved 2010-11-17
  4. "Smallpox"WHO Factsheet. Archived from the original on 2007-09-21
  5. AD Langmuir. An Appreciation of Karel Raska. International Journal of Epidemiology, Volume 17, Issue 3, 1 September 1988, Pages 491–492,

Among Europe's Top Competitive Regions

The Utrecht Region continues among the absolute pinnacle of Europe’s most competitive regions. According to the European Commission (EC), Utrecht is ranked equal second, close behind London and ahead of regions such as Paris and Frankfurt. The index was compiled on the basis of over seventy indicators. These relate to topics including innovation, accessibility, digital infrastructure, education, health and the labour market.

According to the Commission, the Utrecht Region is among the European leaders in the field of education and the labour market. In order to retain this position, however, considerable investments will have to be made during the next few years, to ensure that the skills of Utrecht’s working population adequately match labour market demands. The same applies when it comes to rendering Utrecht attractive to talent from abroad. Furthermore, a higher level of enrolment in IT courses is essential if we are to remain competitive.[1]

Read the report [2].


  2. Utrecht Region continues to lead Europe's most competitive regions. 

The 'other' Saint Martin - Patron Saint of Public Health Workers

No, we are not talking of St. Martin of Tours, the former Bishop of Tours, whose name we celebrate on November 11. This post is about the other Saint Martin, patron Saint of Public Health Workers.

What is said about St. Martin de Torres?

St. Martin de Torres

St. Martin de Porres was born in Lima, Peru on December 9, 1579. Martin was the illegitimate son to a Spanish gentlemen and a freed slave from Panama, of African or possibly Native American descent. At a young age, Martin's father abandoned him, his mother and his younger sister, leaving Martin to grow up in deep poverty. After spending just two years in primary school, Martin was placed with a barber/surgeon where he would learn to cut hair and the medical arts.

As Martin grew older, he experienced a great deal of ridicule for being of mixed-race. In Peru, by law, all descendants of African or Indians were not allowed to become full members of religious orders. Martin, who spent long hours in prayer, found his only way into the community he longed for was to ask the Dominicans of Holy Rosary Priory in Lima to accept him as a volunteer who performed the most menial tasks in the monastery. In return, he would be allowed to wear the habit and live within the religious community. When Martin was 15, he asked for admission into the Dominican Convent of the Rosary in Lima and was received as a servant boy and eventually was moved up to the church officer in charge of distributing money to deserving poor.[1]

Life in the convent

During his time in the Convent, Martin took on his old trades of barbering and healing. He also worked in the kitchen, did laundry and cleaned. After eight more years with the Holy Rosary, Martin was granted the privilege to take his vows as a member of the Third Order of Saint Dominic by the prior Juan de Lorenzana who decided to disregard the law restricting Martin based on race. However, not all of the members in the Holy Rosary were as open-minded as Lorenzana; Martin was called horrible names and mocked for being illegitimate and descending from slaves.

Martin grew to become a Dominican lay brother in 1603 at the age of 24. Ten years later, after he had been presented with the religious habit of a lay brother, Martin was assigned to the infirmary where he would remain in charge until his death. He became known for encompassing the virtues need to carefully and patiently care for the sick, even in the most difficult situations.[1]

Epidemic response with compassion

During an epidemic in Lima, many of the friars in the Convent of the Rosary became very ill. Locked away in a distant section of the convent, they were kept away from the professed. However, on more than one occasion, Martin passed through the locked doors to care for the sick. However, he became disciplined for not following the rules of the Convent, but after replying, "Forgive my error, and please instruct me, for I did not know that the precept of obedience took precedence over that of charity," he was given full liberty to follow his heart in mercy.

In January of 1639, when Martin was 60-years-old, he became very ill with chills, fevers and tremors causing him agonizing pain. He would experience almost a year full of illness until he passed away on November 3, 1639.

He has become the patron saint of people of mixed race, innkeepers, barbers, public health workers and more. His feast day is November 3.




  1. From: 'Catholic Online - Saints and Angels - St Martin de Porres', Accessed 3 November 2017


A day to remember - Double !

What makes 28 October 2017 special?

Jonas Salk

Richard Doll

It is exactly 103 years ago when Jonas Salk was born; an American medical researcher and virologist, who discovered and developed one of the first successful polio vaccines. [1]

It is also 105 years ago, to the day, that Richard Doll was born; a British physiologist who became an epidemiologist, turning the subject into a rigorous science. He was a pioneer in research linking smoking to health problems. [2]

Why celebrate together?

Especially in this day and age, it seems appropriate to celebrate the giants on whose shoulders we stand when it comes to safe and effective vaccines, as well as reliable and convincing epidemiology evidence.

In 1950, Richard Doll undertook with Austin Bradford Hill a study of lung cancer patients in 20 London hospitals, at first under the belief that it was due to the new material tarmac, or motor car fumes, but rapidly discovering that tobacco smoking was the only factor they had in common. Doll himself stopped smoking as a result of his findings, published in the British Medical Journal in 1950, which concluded:

"The risk of developing the disease increases in proportion to the amount smoked. It may be 50 times as great among those who smoke 25 or more cigarettes a day as among non-smokers."

In 1947, Jonas Salk accepted an appointment to the University of Pittsburgh School of Medicine. In 1948, he undertook a project funded by the National Foundation for Infantile Paralysis to determine the number of different types of polio virus. Salk saw an opportunity to extend this project towards developing a vaccine against polio, and, together with the skilled research team he assembled, devoted himself to this work for the next seven years. The field trial set up to test the Salk vaccine was, according to O'Neill,

"the most elaborate program of its kind in history, involving 20,000 physicians and public health officers, 64,000 school personnel, and 220,000 volunteers."

Over 1,800,000 school children took part in the trial. When news of the vaccine's success was made public on April 12, 1955, Salk was hailed as a "miracle worker" and the day almost became a national holiday. Around the world, an immediate rush to vaccinate began, with countries including Canada, Sweden, Denmark, Norway, West Germany, the Netherlands, Switzerland, and Belgium planning to begin polio immunization campaigns using Salk's vaccine. [1]



In 1966 Doll was elected to the Royal Society. The citation stated:[2]

Doll is distinguished for his researches in epidemiology, and particularly the epidemiology of cancer where in the last 10 years he has played a prominent part in (a) elucidating the causes of lung cancer in industry (asbestos, nickel & coal tar workers) & more generally, in relation to cigarette smoking, and (b) in the investigation of leukaemia particularly in relation to radiation, where using the mortality of patients treated with radiotherapy he has reached a quantitative estimate of the leukaemogenic effects of such radiation. In clinical medicine he has made carefully controlled trials of treatments for gastric ulcer. He has been awarded the United Nations prize for outstanding research into the causes & control of cancer & the Bisset Hawkins medal of the Royal College of Physicians for his contributions to preventative medicine.

1977, Jonas Salk was awarded the Presidential Medal of Freedom from President Jimmy Carter, with the following statement accompanying the medal: [1]

"Because of Doctor Jonas E. Salk, our country is free from the cruel epidemics of poliomyelitis that once struck almost yearly. Because of his tireless work, untold hundreds of thousands who might have been crippled are sound in body today. These are Doctor Salk's true honors, and there is no way to add to them. This Medal of Freedom can only express our gratitude, and our deepest thanks."2014,

On the 100th anniversary of Salk's birth, a Google Doodle was created to honor the physician and medical researcher. The doodle shows happy and healthy children and adults playing and going about their lives with two children hold up a sign saying:[3]

"Thank you, Dr. Salk!"



  1. Jonas Salk, in: Wikipedia, accessed 28 October 2017
  2. Richard Doll, in: Wikipedia, accessed 28 October 2017

A day to remember - Rudolf Virchow

It was 196 years ago when..

Rudolf Ludwig Carl Virchow (13 October 1821 – 5 September 1902) was born in Schievelbein in eastern Pomerania, Prussia (now Świdwin in Poland). He was the only child of Carl Christian Siegfried Virchow (1785–1865) and Johanna Maria née Hesse (1785–1857). His father was a farmer and the city treasurer. Academically brilliant, he always topped in his classes and was fluent in German, Latin, Greek, Hebrew, English, Arabic, French, Italian, and Dutch. He progressed to the gymnasium in Köslin (now Koszalin in Poland) in 1835 with the goal to become a pastor. He graduated in 1839 upon a thesis titled A Life Full of Work and Toil is not a Burden but a Benediction. However, he chose to start studying medicine mainly because he considered his voice too weak for preaching.[1] His uncle was a high-ranking officer, which may have helped him gain admission into the most prestigious medical school of the time-a military medical school in Berlin with a selective acceptance policy.[2]

The pope of medicine

It was from that medical school that Virchow would further develop into a physician, anthropologist, pathologist, prehistorian, biologist, writer, editor, and politician, known for his advancement of public health. He is known as "the father of modern pathology" because his work helped to discredit humourism, bringing more science to medicine. He is also known as the founder of social medicine and veterinary pathology, and to his colleagues, the "Pope of medicine".[1]

At the early age of 27 he was appointed to a government commission to investigate a typhus epidemic in Upper Silesia (1847-1848). At that time, typhus, typhoid, and recurrent fever were not yet clearly separated diagnostic entities. The study came at an explosive time in European and especially German history, and his report on the aetiology of the epidemic, expressed in radically antiestablishment social and political terms typified the professional radicalism of the period. [2]

"The logical answer to the question as to how conditions similar to those unfolded before our eyes in Upper Silesia can be prevented in the future is, therefore, very easy and simple: education, with its daughters, liberty and prosperity."

The ravages of the epidemic must have made a lasting impression on young Virchow, shaping not only his character, but also his professional perspective. He wrote in his report:

"A devastating epidemic and a terrible famine simultaneously ravaged a poor, ignorant and apathetic population. In a single year 10% of the population died in the Pless district, 6.48% of starvation combined with the epidemic, and, according to official figures, 1.3% solely of starvation. In 8 months, in the district of Rybnik, 14.3% of the population were affected by typhus, of whom 20.46% died. . . . At the beginning of the year, 3% of the population of both districts were orphans. . . ." [3]

Even though he was not particularly successful in combating the epidemic, his 190-paged Report on the Typhus Epidemic in Upper Silesia in 1848 became a turning point in politics and public health in Germany. From it, he coined a well known aphorism:

"Medicine is a social science, and politics is nothing else but medicine on a large scale".

He returned to Berlin on 10 March 1848, and only eight days later, a revolution broke out against the government in which he played an active part. To fight political injustice he helped finding Die medicinische Reform (Medical Reform), a weekly newspaper for promoting social medicine, in July of that year. The newspaper ran under the banners "medicine is a social science" and "the physician is the natural attorney of the poor". Political pressures forced him terminate the publication in June 1849 and became expelled from his official position. After five years, Charité invited him back to direct its newly built Institute for Pathology, and simultaneously becoming the first Chair of Pathological Anatomy and Physiology at Berlin University. The campus of Charité is now named Campus Virchow Klinikum.

Virchow was the first to precisely describe and give names of diseases such as leukemia, chordoma, ochronosis, embolism, and thrombosis. He coined scientific terms, chromatin, agenesis, parenchyma, osteoid, amyloid degeneration, and spina bifida. His description of the transmission cycle of a roundworm Trichinella spiralis established the importance of meat inspection, which was started in Berlin. He developed the first systematic method of autopsy involving surgery of all body parts and microscopic examination. A number of medical terms are named after him, including Virchow's node, Virchow–Robin spaces, Virchow–Seckel syndrome, and Virchow's triad. He was the first to use hair analysis in criminal investigation, and recognised its limitations. His laborious analyses of the hair, skin, and eye colour of school children made him criticise the Aryan race concept as a myth.

He was an ardent anti-evolutionist. He referred to Charles Darwin as an "ignoramus" and his own student Ernst Haeckel, the leading advocate of Darwinism in Germany, as a "fool". He discredited the original specimen of Neanderthal man as nothing but that of a deformed human, and not an ancestral species. He was an agnostic. [1]

Anti-germ theory of diseases

Virchow did not believe in the germ theory of diseases, as advocated by Louis Pasteur and Robert Koch. He proposed that diseases came from abnormal activities inside the cells, not from outside pathogens. He believed that epidemics were social in origin, and the way to combat epidemics was political, not medical. He regarded germ theory as hindrance to prevention and cure. He considered social factors such as poverty as major cause of diseases. He even attacked Koch's and Ignaz Semmelweis' policy of hand-washing as an antiseptic practice. He postulated that germs were only using infected organs as habitats, but they were not the cause, and stated,

"If I could live my life over again, I would devote it to proving that germs seek their natural habitat: diseased tissue, rather than being the cause of diseased tissue".Virchow said. [1]

In hindsight, he may be glad that he did not embark on such path.


Virchow broke his thigh bone on 4 January 1902, jumping off a running streetcar while exiting the electric tramway. Although he anticipated full recovery, the fractured femur never healed, and restricted his physical activity. His health gradually deteriorated and he died of heart failure after eight months, on 5 September 1902, in Berlin. A state funeral was held on 9 September in the Assembly Room of the Magistracy in the Berlin Town Hall, which was decorated with laurels, palms and flowers. He was buried in the Alter St.-Matthäus-Kirchhof in Schöneberg, Berlin. His tomb was shared by his wife on 21 February 1913. [1]

"At his death Germany would complain of having lost four great men in one: her leading pathologist, her leading anthropologist, her leading sanitarian, and her leading liberal."
Erwin Ackerknecht [2]


  1. Rudolf Virchow, in: Wikipedia, accessed 13 October 2017
  2. Silver GA. Virchow, the heroic model in medicine: health policy by accolade. American Journal of Public Health. 1987;77(1):82-88.
  3. Virchow RC. Report on the Typhus Epidemic in Upper Silesia. American Journal of Public Health. 2006;96(12):2102-2105.

A day to remember - Alexander D. Langmuir

It was 107 years ago today..

..when Alexander Duncan Langmuir was born in Santa Monica, California. He spent his youth in New Jersey. His uncle, Irving Langmuir won the Nobel Prize in Chemistry in 1932. At Harvard College, Alex Langmuir received his AB (cum laude) in 1931 and his MD in 1935 from Cornell University Medical College.[3]

From 1942 to 1946, he served as an epidemiologist with the Armed Forces Epidemiologic Board’s Commission on Acute Respiratory Diseases, stimulating his lifelong interest in influenza. In 1946, Langmuir returned to Johns Hopkins University as an associate professor of epidemiology. By 1949 he was attracted to the challenge of becoming the first chief epidemiologist of the newly established Communicable Disease Center (now the Centers for Disease Control and Prevention [CDC]) in Atlanta, Georgia, a position he held for over 20 years.[3]

He wrote extensively on all phases of epidemiology on a global basis and was recognized internationally as a leading contributor in epidemiology. Langmuir was a visiting professor at the Johns Hopkins School of Hygiene and Public Health from 1988 until his death in 1993.[1]

In 1951, following the start of the Korean War, Langmuir established the EIS program as an early warning system against biologic warfare. EIS officers then and now are physicians, veterinarians, nurses, and health scientists who serve 2-year assignments. In an obituary written for the New York Times, Lawrence Altman said Langmuir “taught what he called ‘shoe leather epidemiology,’ stressing that investigators go into the field to collect their own data and view directly the locale of the public health problem they were investigating.” Langmuir said:

“Each epidemic aid call was an adventure and a training experience, even the false alarms.”

He stressed that field epidemiology should be taught in the field, not in the classroom. Admission into the EIS program was highly selective. Langmuir believed that when competent persons were thrust into challenging circumstances with supportive supervision, excellent results were certain. He regarded the EIS officers as members of his extended family, backing them firmly when they found themselves in difficulty and joining them for the roasts of CDC leaders during the officers’ annual skit night—often at his own expense.

In 1955, Langmuir and his young staff achieved early recognition due to the “Cutter Incident.” The new inactivated (Salk) polio vaccine was causing cases of polio. Surgeon General Leonard Scheele asked Langmuir to develop a surveillance system to determine the extent of the problem. Langmuir deployed his staff, and within days they determined that the cases were caused by vaccine from a single manufacturer: Cutter Laboratories.

“Langmuir was able to predict with great accuracy the expected size of the epidemic and the number of secondary cases that would occur,”
(William Foege, former CDC director).

Langmuir's vision of surveillance

The idea of effective national disease surveillance captured Alex Langmuir’s imagination throughout his career. He believed that surveillance is the foundation for evidence-based public health action. Langmuir preached the importance of the systematic collection of pertinent data, the consolidation and analysis of these data into useful information, and the dissemination of the results to all who need to know so that they can take action. His goal was to use surveillance systems to define populations at risk for disease, determine interventions, and monitor their impact. Langmuir and his staff developed novel national surveillance programs for an array of communicable diseases and for chronic diseases, injuries, and reproductive health. Indeed, he considered the population explosion to be the most serious epidemic of all. [3]

Altman described Langmuir as “a tall man who could command immediate attention when he stood to speak to audiences in his deep voice. He thrived on controversy and took pride in overcoming local political pressures to crusade for preventive medicine and other measures to safeguard public health.” Philip Brachman, who succeeded Langmuir as EIS director, described Langmuir as “visionary, clairvoyant, tenacious, well prepared, scientifically honest, and optimistic.” Langmuir enjoyed being a civil servant and working to benefit the public. “His concerns were to control and prevent disease by applying the principles of epidemiology to the identification of causes and solutions,” Brachman wrote. Foege described Langmuir as someone with a public health message who arrived at the right time and place in history to be able to broadly disseminate his message. [3]

In 1979, when Alex Langmuir was interviewed by D.A. Henderson about being recruited to work at CDC in 1949, Langmuir said,

“As I looked it over and saw the vision, there was no question, [former CDC director] Justin Andrews took me to the mountain and showed me the Promised Land.”

At CDC, Alex Langmuir changed the way epidemiology is used in public health practice, first in the United States and then throughout the world. In the 65 years since Langmuir’s arrival at CDC, his disciples—EIS and field epidemiology training program officers—have played pivotal roles in combating the root causes of major public health problems. In addition, EIS inspired Field Epidemiology Training Programmes (FETP) all around the world. At present, 69 FETP's worldwide train field epidemiologists after the example that Langmuir set. Millions of persons live longer and healthier lives because of the accomplishments of Langmuir and his progeny in controlling and preventing disease.

This is Alex Langmuir’s grand legacy. [3]


  1. Alexander Langmuir, in: Wikipedia, accessed on 12 september 2017
  2. Alexander Langmuir, in: Heroes of Public Health. Johns Hopkins School website. Accessed on 12 September 2017
  3. Schultz MG, Schaffner W. Alexander Duncan Langmuir. Emerging Infectious Diseases. 2015;21(9):1635-1637. doi:10.3201/eid2109.141445.

A day to remember - Thomas Sydenham

It was 393 years ago when....

Thomas Sydenham was born on 10 September 1624 at Wynford Eagle in Dorset. He was an English physician and the author of Observationes Medicae which became a standard textbook of medicine for two centuries. This earned him the predicate 'The English Hippocrates'. Among his many achievements was the discovery of a disease, Sydenham's Chorea, also known as St Vitus Dance. [1]

Much to describe on infectious diseases.

His first book, Methodus curandi febres (The Method of Curing Fevers), was published in 1666; a second edition, with an additional chapter on the plague, in 1668; and a third edition, further enlarged and bearing the better-known title of Observationes mediciae (Observations of Medicine), in 1676. His next publication was in 1680 in the form of two Epistolae responsoriae (Letters & Replies), the one, "On Epidemics," addressed to Robert Brady, Regius Professor of Physic at Cambridge, and the other "On the Lues venerea," (On Venereal Diseases) to Henry Paman, public orator at Cambridge and Gresham Professor of Physic in London.

In 1679, Sydenham gave Whooping cough the name pertussis, meaning a 'violent cough of any type'.

In 1682 he published another Dissertatio epistolaris (Dissertation on the Letters), on the treatment of confluent smallpox and on hysteria, addressed to Dr William Cole of Worcester. The Tractatus de podagra et hydrope (The Management of Arthritis and Dropsy) came out in 1683, and the Schedula monitoria de novae febris ingressu (The Schedule of Symptoms of the Newly Arrived Fever) in 1686. [1]

Dance, Dance, Dance
All night long
(Steve Miller Band)

Among other things Sydenham is credited with the first diagnosis of scarlatina and with the modern definition, of chorea, also known as St Vitus Dance.

Sydenham's chorea (SC) or chorea minor (historically referred to as St Vitus's dance) is a disorder characterized by rapid, uncoordinated jerking movements primarily affecting the face, hands and feet. Sydenham's chorea results from childhood infection with Group A beta-haemolytic Streptococcus and is reported to occur in 20–30% of patients with acute rheumatic fever (ARF). The disease is usually latent, occurring up to 6 months after the acute infection, but may occasionally be the presenting symptom of rheumatic fever. Sydenham's chorea is more common in females than males and most patients are children, below 18 years of age. Adult onset of Sydenham's chorea is comparatively rare and the majority of the adult cases are associated with exacerbation of chorea following childhood Sydenham's chorea.

The disorder is a result of an autoimmune response that occurs following infection by group A β-hemolytic streptococci that destroys cells in the corpus striatum of the basal ganglia. Molecular mimicry to streptococcal antigens leading to an autoantibody production against the basal ganglia has long been thought to be the main mechanism by which chorea occurs in this condition. [2]



Hardly anything is known of Sydenham's personal history in London. He died at his house in Pall Mall on 29 December 1689, aged 65. He is buried in St James's Churchyard, Piccadilly, where a mural slab was put up by the College of Physicians in 1810.

A memorial stone dedicated to Thomas can be found halfway up the staircase of St James's Church, Pall Mall. It was put there by the now defunct 'Sydenham Society’. [1]



  1. Thomas Sydenham, in: Wikipedia, accessed 8 September 2017
  2. Sydenham's Chorea, in: Wikipedia, accessed 8 September 2017

A day to remember - Donald Henderson, smallpox eradicator.

It was 89 years ago today ...

Donald Ainslie Henderson was born in Lakewood, Ohio on September 7, 1928, of Scots-Canadian immigrant parents. Henderson was an American physician, educator, and epidemiologist who directed a 10-year international effort (1967–77) that eradicated smallpox throughout the world and launched international childhood vaccination programs. From 1977 to 1990, he was Dean of the Johns Hopkins School of Public Health. Later, he played a leading role in instigating national programs for public health preparedness and response following biological attacks and national disasters. At the time of his death, he was Professor and Dean Emeritus of the Johns Hopkins Bloomberg School of Public Health, and Professor of Medicine and Public Health at the University of Pittsburgh, as well as Distinguished Scholar at the UPMC Center for Health Security. [1]

Eradication of smallpox.

Henderson served as Chief of the CDC virus disease surveillance programs from 1960 to 1965, working closely with the inspirational epidemiologist Dr. Alexander Langmuir. During this period, he and his unit developed a proposal for a United States Agency for International Development (USAID) program to eliminate smallpox and control measles during a 5-year period in 18 contiguous countries in western and central Africa.

The USAID initiative provided an important impetus to a World Health Organization (WHO) program to eradicate smallpox throughout the world within a 10-year period. In 1966, Henderson moved to Geneva to become director of the campaign. At that time, smallpox was occurring widely throughout Brazil and in 30 countries in Africa and South Asia. More than 10 million cases and 2 million deaths were occurring annually. Vaccination brought some control, but the key strategy was "surveillance-containment". This technique entailed rapid reporting of cases from all health units and prompt vaccination of household members and close contacts of confirmed cases. WHO staff and advisors from some 73 countries worked closely with national staff. The last case occurred in Somalia on October 26, 1977, only 10 years after the program began. Three years later, the World Health Assembly recommended that smallpox vaccination could cease. Smallpox is the first human disease ever to be eradicated. [1]


Not without a fight

What seems such an obvious effort now, looking back, was far from obvious at the time. Eradicating the virus from the planet was not merely an epidemiological and microbiological activity. It was mainly about overcoming huge political resistance. At that level, public health might as well be called 'political health'.

On 15 August 1975, the Indian government hosted a lavish party. It had good reason to celebrate: not only was it marking 28 years of independence from British rule, but the prime minister, Indira Gandhi, had declared the date “Independence from Smallpox Day”. For decades, India was considered the endemic home of the disease, accounting for some 60% of globally reported cases. Yet in the space of just one year, infections had fallen from 188,000 to zero, thanks to a combination of disease surveillance, vaccination and publicity.

Yet as Donald Henderson left the celebrations in order to catch a flight to Bangladesh, he received word that the borders were closed. The Bangladeshi military had staged a coup; the president and his family were dead.

It was a pivotal moment in the global effort to eradicate smallpox, a disease that had until recently killed some 2 million people each year. To get this far, Henderson and his team had overcome political resistance, ineffective vaccine stocks, floods, famine and civil war.[2]

They had stopped cars in the streets of the former Yugoslavia to vaccinate people, and gone house to house in remote regions of India to nip outbreaks in the bud. Now, eight years into the campaign, Bangladesh was the final refuge for Variola major, the most infectious form of the virus, and the country was threatening to fall apart.

Fearing that a tide of refugees might trigger fresh outbreaks, or even reimport the disease to India, Henderson deployed large numbers of health workers to the border to step up surveillance, and vaccinate as required. Fortunately, the predicted influx never arrived. A few weeks later, the borders reopened and WHO’s teams went back to work. In November 1975, Bangladesh reported its final case of smallpox and, two years later, the world’s last case was identified in Ali Maow Maalin – a Somali cook from the port city of Merca. The world was finally declared smallpox-free in 1979.[2]


“If the Nobel prize in medicine was not so focused on basic science, Henderson and the smallpox team would surely have shared it,”

Chris Beyrer, , Desmond Tutu professor of public health and human rights at the Johns Hopkins Bloomberg School of Public Health in Baltimore

Donald Henderson died in Baltimore, USA, on August 19, 2016



  1. Donald Henderson, in: Wikipedia, accessed 7 September 2017
  2. Obituary, the Guardian, 20 August 2016.

A day to remember - Andrija Štampar's birthday

It was 129 years ago today......

Andrija was born 1 September 1888 in Brodski Drenovac, in modern Požega-Slavonia County.  He enrolled at the Medical School in Vienna in 1906, which was at the time the most important medical center in the world. On 23 December 1911, he was awarded the title of Doctor of Universal Medicine.

In 1919, he attended the Congress of Inter-Allied Countries for Social Hygiene in Paris giving a lecture on children's health. It showed at that time that he had a clear concept of organizing the public health service. Andrija Štampar is universally known as "the man of action".

At the young age of 31 he became principal of the former Yugoslav Health Service in Belgrade (Beograd). Thanks to Štampar's endeavours, a special Institute of Social Medicine was founded affiliated with the University of Zagreb School of Medicine.

From 1931 to 1933, Štampar was permanently employed as the expert of the League of Nation's Health Organization. The Health Organization sent him as an advisor to help the Chinese health administration in the control of the mass infectious diseases that cropped up after devastating floods in 1931.

Dr. Štampar has come to China to help our Government in its work on reconstruction based on the plan of technical cooperation with the League of Nations. He went round several provinces, from Kansu and Shanghai in the West to Kwangtung and Kwangsi in the South, and made a valuable contribution to the reconstruction of our villages, especially in the field of rural health protection services. On his departure we wish to give this to him as a remembrance of his work in China, hoping he will come to visit us again.
-- Ching Feng

During the International Health Conference in New York in the summer of 1946 the draft of the World Health Organization (WHO) was accepted. The First World Health Assembly was called with the ratification of the WHO Constitution. It was in session from 24 June to 24 July 1948. in Geneva, Štampar was elected as the first President of the Assembly unanimously. At the 8th regular session of WHO in Mexico City, in 1955, Štampar was awarded the Leon Bernard Foundation Prize and Medal, the greatest international recognition of merit in the field of social medicine.

Andrija Štampar founded School of Public Health in Zagreb in 1927. He became the Dean of the Medical School of Zagred University for the academic year 1940/41. With the energy so characteristic of him, he set to work on the reform of medical training. During the German occupation of WWII, Stampar was arrested and interned. On his return in May 1945, he resumed his duty as Professor of Hygiene and Social Medicine at the Medical School and became head of the School of Public Health in Zagreb.

Štampar was the Rector of Zagreb University for the academic year 1945/46. In 1952, he was again elected the Dean of the Medical School, for 5 years consecutively. He also had an important role in founding of the Medical School at Rijeka in 1955.


  1. Andrija Stampar, in: Wikipedia. Accessed 27 August 2017

European Antibiotic Awareness Day 2017





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The EAAD is organized each year on 18 November to raise awareness about the threat to public health of antibiotic resistance and the importance of prudent antibiotic use.

The latest data confirm that across the European Union the number of patients infected by resistant bacteria is increasing and that antibiotic resistance is a major threat to public health.

Prudent use of antibiotics can help stop resistant bacteria from developing and help keep antibiotics effective for the use of future generations." revealfx="off" overlay_revealfx="off"]


Joint Transmissible & Trimension workshop for Communicable Disease Control Training

A large group of people gets contaminated with a virulent pathogen, and regular treatment is ineffective. To make matters worse, the control measures are interrupted by increasing civil unrest. The Communicable Disease Control team of the Public Health Service 'Hollands-Midden', dared to engage in this scenario during a training workshop.

As per request of the Public Health Service, communicable disease Control consultant Arnold Bosman (Transmissible) and Trimension trainer Arthur van Lohuijzen got together to organise and animate this workshop. Arnold was responsible for detailing the case finding and epidemiological investigation. Arthur put this in the context of crisis management. The participants showed great engagement to identify the origin of the disease, in order to block further spread. In addition, the participant could use several interim evaluations to review their approach. It turned out a challenge to combine the structured approach according to the principles of crisis management with the required outbreak response.

Both trainers consider this collaboration between Transmissible and Trimension as a clear success and aim for continuing this training offer. Are you interested in to receive more details on this workshop, feel free to contact:

Arthur van Lohuijzen –
Arnold Bosman - Arnold.Bosman@Transmissible.EU


For more Transmissible training, read this page.

A day to remember - Alexander Fleming

Sir Alexander Fleming, (6 August 1881 - 11 March 1955) was a Scottish biologist, pharmacologist and botanist who discovered Penicillin. (Photo by Universal History Archive/UIG via Getty Images)

It was 136 years ago today...

that Alexander Fleming was born, on August 6, 1881, in Ayrshire, Scotland. He was the third of the four children of farmer Hugh Fleming (1816–1888) and his wife Grace Stirling Morton.

After working in a shipping office for four years, the twenty-year-old Fleming inherited some money from an uncle, John Fleming. His elder brother, Tom, was already a physician and suggested to him that he should follow the same career, and so in 1903, the younger Alexander enrolled at St Mary's Hospital Medical School in Paddington; he qualified with an MBBS degree from the school with distinction in 1906. Het joined the research department at St Mary's, where he became assistant bacteriologist to Sir Almroth Wright, a pioneer in vaccine therapy and immunology.

In 1908, he gained a BSc degree with Gold Medal in Bacteriology, and became a lecturer at St Mary's until 1914. Fleming served throughout World War I as a captain in the Royal Army Medical Corps, and was Mentioned in Dispatches. He and many of his colleagues worked in battlefield hospitals at the Western Front in France. In 1918 he returned to St Mary's Hospital, where he was elected Professor of Bacteriology of the University of London in 1928.

Work before penicillin

During World War I, Fleming witnessed the death of many soldiers from sepsis resulting from infected wounds. Antiseptics, which were used at the time to treat infected wounds, often worsened the injuries. In an article he submitted for the medical journal The Lancet during World War I, Fleming described an ingenious experiment, which he was able to conduct as a result of his own glass blowing skills, in which he explained why antiseptics were killing more soldiers than infection itself during World War I. Antiseptics worked well on the surface, but deep wounds tended to shelter anaerobic bacteria from the antiseptic agent, and antiseptics seemed to remove beneficial agents produced that protected the patients in these cases at least as well as they removed bacteria, and did nothing to remove the bacteria that were out of reach. Sir Almroth Wright strongly supported Fleming's findings, but despite this, most army physicians over the course of the war continued to use antiseptics even in cases where this worsened the condition of the patients.

At St Mary’s Hospital Fleming continued his investigations into antibacterial substances. Testing the nasal secretions from a patient with a heavy cold, he found that nasal mucus had an inhibitory effect on bacterial growth. This was the first recorded discovery of lysozyme, an enzyme present in many secretions including tears, saliva, skin, hair and nails as well as mucus. Although he was able to obtain larger amounts of lysozyme from egg whites, the enzyme was only effective against small counts of harmless bacteria, and therefore had little therapeutic potential.

Accidental discovery

When I woke up just after dawn on September 28, 1928, I certainly didn't plan to revolutionise all medicine by discovering the world's first antibiotic, or bacteria killer. But I suppose that was exactly what I did.

— Alexander Fleming

By 1927, Fleming had been investigating the properties of staphylococci. He was already well-known from his earlier work, and had developed a reputation as a brilliant researcher, but his laboratory was often untidy. On 3 September 1928, Fleming returned to his laboratory having spent August on holiday with his family. Before leaving, he had stacked all his cultures of staphylococci on a bench in a corner of his laboratory. On returning, Fleming noticed that one culture was contaminated with a fungus, and that the colonies of staphylococci immediately surrounding the fungus had been destroyed, whereas other staphylococci colonies farther away were normal, famously remarking "That's funny".

Fleming grew the mould in a pure culture and found that it produced a substance that killed a number of disease-causing bacteria. He identified the mould as being from the Penicillium genus, and, after some months of calling it "mould juice", named the substance it released penicillin on 7 March 1929.

He investigated its positive anti-bacterial effect on many organisms, and noticed that it affected bacteria such as staphylococci and many other Gram-positive pathogens that cause scarlet fever, pneumonia, meningitis and diphtheria, but not typhoid fever or paratyphoid fever, which are caused by Gram-negative bacteria, for which he was seeking a cure at the time. It also affected Neisseria gonorrhoeae, which causes gonorrhoea although this bacterium is Gram-negative.

Not much attention...

Fleming published his discovery in 1929, in the British Journal of Experimental Pathology, but little attention was paid to his article. Fleming continued his investigations, and found that cultivating penicillium was quite difficult, and that after having grown the mould, it was even more difficult to isolate the antibiotic agent. Fleming's impression was that because of the problem of producing it in quantity, and because its action appeared to be rather slow, penicillin would not be important in treating infection. Fleming also became convinced that penicillin would not last long enough in the human body (in vivo) to kill bacteria effectively. Many clinical tests were inconclusive, probably because it had been used as a surface antiseptic.

In the 1930s, Fleming’s trials occasionally showed more promise, and he continued, until 1940, to try to interest a chemist skilled enough to further refine usable penicillin. Fleming finally abandoned penicillin, and not long after he did, Howard Florey and Ernst Boris Chain at the Radcliffe Infirmary in Oxford took up researching and mass-producing it, with funds from the U.S. and British governments. They started mass production after the bombing of Pearl Harbor. By D-Day in 1944, enough penicillin had been produced to treat all the wounded in the Allied forces.

Fleming was said to be "a reticent and rather taciturn man, with great independence of mind and strength of character". He was a keen observant of nature and everything around him, always ready to devise and test new methods for studying germs in the lab. He accepted the many honors that were bestowed upon him with modesty. It seemed that simple tributes touched him most, such as the letter of some poor person who had benefitted from penicillin.

Fleming died on 11 March 1955, at his home in London of a heart attack. He was buried in St Paul's Cathedral


  1. Alexander Fleming, in: Wikipedia, accessed 6 August 2017
  2. Robert Cruickshank, Obituary of Alexander Fleming. In: Nature, nr 4459, April 16,1955, P663


A day to remember: Daniel Elmer Salmon

It was 167 years ago today....

when Daniel Elmer Salmon (July 23, 1850 – August 30, 1914) was a veterinary surgeon. He earned the first D.V.M. degree awarded in the United States, and spent his career studying animal diseases for the U.S. Department of Agriculture. He gave his name to the Salmonella genus of bacteria, which was discovered by an assistant, and named in his honor.

Salmon was born in Mount Olive Township, New Jersey.[1] Dr. Salmon's father, Daniel L. Salmon, died in 1851 and his mother, Eleanor Flock Salmon, died in 1859, leaving him an orphan at the age of 8. He was then raised by his second cousin, Aaron Howell Salmon and spent time working both on Aaron's farm and as a clerk in a country store. His early education was at the Mount Olive District School, Chester Institute, and Eastman Business College. He then attended Cornell University and graduated with the degree of Bachelor of Veterinary Medicine in 1872. After an additional four years of study, in veterinary health and science, he was awarded the professional degree of Doctor of Veterinary Medicine from Cornell in 1876, the first D.V.M. degree granted in the United States. Toward the end of his career at Cornell, he studied at the Alfort Veterinary School in Paris, France.

Dr. Salmon opened a veterinary practice in Newark, New Jersey in 1872 and subsequently moved to Asheville, North Carolina in 1875 due to his health. In 1877 he gave a series of lectures at the University of Georgia on the topic of veterinary science. He worked for the State of New York, studying diseases in swine and for the United States Department of Agriculture studying animal diseases in the southern states. In 1883 he was asked to establish a veterinary division within the Department of Agriculture. It became the Bureau of Animal Industry and he served as its chief from 1884 to December 1, 1905. Under his leadership, the Bureau eradicated contagious pleural-pneumonia of cattle in the United States, studied and controlled Texas fever (Babesia), put in place the federal meat inspection program, began inspecting exported livestock and the ships carrying them, began inspecting and quarantining imported livestock, and studied the effect of animal diseases on public health. In 1906 he established the veterinary department at the University of Montevideo, Uruguay and was its head for five years. He returned to the United States in 1911 and concentrated on veterinary work in the western region of the country.

Salmonella is a genus of microorganisms named after him in Modern Latin in 1900 by J. Lignières, although the man who actually discovered and named the first strain, Salmonella cholerae suis, was Theobald Smith, Dr. Salmon's research assistant, who isolated the bacterium in 1885.

Since that time, more than 2,000 subtypes have been identified.

Daniel Salmon died of pneumonia August 30, 1914, in Butte, Montana and is buried in Washington, D.C.


  1. Daniel Elmer Salmon, in: Wikipedia, accessed 23 July 2017


A day to remember: Austin Bradford Hill - father of causation viewpoints

It was 120 years ago, today

When Austin Bradford Hill (8 July 1897 – 18 April 1991) was born in London. He was an English epidemiologist and statistician, pioneered the randomized clinical trial and, together with Richard Doll, demonstrated the connection between cigarette smoking and lung cancer. Hill is widely known for pioneering the "Bradford Hill criteria" for determining a causal association; however, that seems to be a falsification from his personal views. He never seems to have seen these as 'criteria', yet merely 'viewpoints'.

As a child, he lived at the family home, Osborne House, Loughton, Essex; he was educated at Chigwell School, Essex, and later served as a pilot in the First World War but was invalided out when he contracted tuberculosis. Two years in hospital and two years of convalescence put a medical qualification out of the question and he took a degree in economics by correspondence at London University.

In 1922 Hill went to work for the Industry Fatigue Research Board. He was associated with the medical statistician Major Greenwood and, to improve his statistical knowledge, Hill attended lectures by Karl Pearson. When Greenwood accepted a chair at the newly formed London School of Hygiene and Tropical Medicine, Hill moved with him, becoming Reader in Epidemiology and Vital Statistics in 1933 and Professor of Medical Statistics in 1947.

Hill had a distinguished career in research and teaching and as author of a very successful textbook, Principles of Medical Statistics, but he is famous for two landmark studies. He was the statistician on the Medical Research Council Streptomycin in Tuberculosis Trials Committee and their study evaluating the use of streptomycin in treating tuberculosis, is generally accepted as the first randomised clinical trial. The use of randomisation in agricultural experiments had been pioneered by Ronald Aylmer Fisher. The second study was rather a series of studies with Richard Doll on smoking and lung cancer. The first paper, published in 1950, was a case-control study comparing lung cancer patients with matched controls. Doll and Hill also started a long-term prospective study of smoking and health. This was an investigation of the smoking habits and health of 40,701 British doctors for several years (British doctors study). Fisher was in profound disagreement with the conclusions and procedures of the smoking/cancer work and from 1957 he criticised the work in the press and in academic publications.

Hill was made a fellow of the Royal Society in 1954. Fisher was actually one of the proposers. The certificate of election read:

Has, by the application of statistical methods, made valuable contributions to our knowledge of the incidence and aetiology of industrial diseases, of the effects of internal migration upon mortality rates, and of the natural and experimental epidemiology of various infections, for example of the risks of an attack of poliomyelitis following inoculation procedures and of the risk of congenital abnormalities being precipitated by maternal rubella in the pregnant woman. Since the war he has demonstrated in an exact and controlled field survey the association between cigarette smoking and the incidence of cancer of the lung, and has been the leader in the development in medicine of the precise experimental methods now used nationally and internationally in the evaluation of new therapeutic and prophylactic agents.

In 1950–52 Hill was president of the Royal Statistical Society and was awarded its Guy Medal in Gold in 1953. He was knighted in 1961. On Hill's death Peter Armitage wrote,

"to anyone involved in medical statistics, epidemiology or public health, Bradford Hill was quite simply the world’s leading medical statistician."

Work on Causation

Bradford Hill set out nine viewpoint on causality:  strength of association,  consistency, specificity, temporality,  biological gradient, plausibility,  coherence, experimental evidence, and analogy. While these viewpoints are helpful when considering cause and effect, he insisted that

“none of [his] nine viewpoints can bring indisputable evidence for or against the cause-and effect hypothesis”.

What they can do, with greater or lesser strength, is to help epidemiologists make up their minds on the fundamental question - Is there any other way of explaining the set of facts before them? Is there any other answer equally, or more, likely than cause and effect?

It is important to keep in mind that most judgments of cause in epidemiology are tentative and should remain open to change with new evidence. It is important to be remain critical, to aim always for stronger evidence, and to keep an open mind. Checklists of causal criteria should not replace critical thinking.

 "The world is richer in associations than meanings, and it is the part of wisdom to differentiate the two." 

John Barth, novelist.


  1. Austin Bradford Hill, in: Wikipedia, accessed 8 July 2017. 
  2. Causal Inference, in: FemWiki, accessed 8 July 2017

Day 2 - Digital Health Conference notes

Digital support to humanitarian aid

Day 2 started with a keynote presentation by professor Tina Gomes of Delft Technical University. Information systems need to address decision makers needs, which is easier said than done. Because: who are they? The taxonomy map of decision makers in humanitarian aid is extremely complex, and covers levels from grass roots (field) level, up to international organisations. Understanding this mapping is a key starting point in system design.

Dr. Gomes made the point that the cycle starts with preparedness, where issues of interoperability, sustainability and accessibility are key to emergency aid system design. At the development stage as well as in the stage of monitor and control, the issues of timeliness and relevance need to guide the functionality. Reliability and verifiability come into view at this stage.

When actions are taken, these need to follow the humanitarian principles of impartiality, humanity, inclusiveness, reciprocity, accountability and confidentiality. System designers will have to take these principles into the system design as well.

When you provide information to decision makers, then YOU become part of the decision making process.

This is a point that Dr. Gomes communicated clearly to the audience, with the view that technology does have an impact.

Developing new systems for humanitarian aid is a complex matter, and the worst thing one could do, is rolling out a new system during a crisis. Gomes illustrated this with an example from the 2014-2015 Ebola response.

Implementing new information technology in low and middle income countries for response to humanitarian crisis is complicated by many factors, not in the least the inverse relationship of ID-address density and vulnerability of populations.


Innovation awards

The second part of the morning included a series of elevator pitches of candidates for the innovation awards. More about that in an update of this post

Digital Health Conference 2017 - Day 1

From 3-5 July 2017, the 11th International Digital Health Conference is held in London, hosted by UCL. This year is the first 'independent' year, and therefore exciting to see how this event performs without being embedded in a larger IT conference.

The conference covers a wide spectrum of subjects, including communities of practice and social networks, analytics and engagement with tracking and monitoring wearable devices, big data, public health surveillance, persuasive technologies, epidemic intelligence, participatory surveillance, disaster and emergency medicine, serious games for public health interventions, and automated early identification of health threats and response.

The aim of the conference is to bring together public health agencies (WHO, ECDC, CDC, PHE) and computer science and IT and MedTech industry to cross-fertilize ideas and drive this growing interdisciplinary discipline.

The theme of this year is 'emergency and humanitarian medicine'.

The first day was opened by Oliver Morgan (WHO) with a presentation on the new Health Emergencies structure, and how this links to digital health. In less than one hour, Dr. Morgan gave an impressive overview of the global activities of the WHO in this area, and how IT tools and infrastructure play a vital role. The role of WHO in developing new global digital tools for core functions such as surveillance, early warning, epidemic intelligence and field investigations was very well illustrated.

Other parts of the programme on day 1 included a session on Digital Tools in Practice (which I had the privilege to moderate), poster presentations, a debate session on funding and impact on digital health, parallel sessions on online communities and modeling.

Looking back on Day 1, we see a rich diversity of digital health topics that illustrates how much this field is alive, even though the theme of this year may not have been that obvious in all sessions.

Follow tweets on this conference:



Fanny Hesse - the woman who made microbiology possible

Fanny Hesse

Fanny Hesse (Born Angelina Fanny Elishemius, June 22, 1850 – December 1, 1934) is best known for her work in microbiology alongside her husband, Walther Hesse. Together they were instrumental in developing Agar as a medium for culturing microorganisms. She was born in 1850 in New York City to Gottfried Elishemius, a wealthy import merchant, and his wife, Cecile Elise. Fanny met her husband and research partner Walther Hesse in 1872 while in Germany. They were engaged in 1873 and married in 1874 in Geneva.[1]

Fanny and Walter Hesse

In 1881, she worked for her husband as a technician in the laboratory of German physician and microbiologist Robert Koch. Hesse, working unpaid, would make drawings for her husband's publications.[1] At the time, Koch was desperately searching for a suitable medium to grow bacterial cultures. He originally used potato slices, yet not all bacteria would grow on that surface. Then he used gelatin broths, yet during warm weather, these would liquefy and become all gooey. Besides, several bacteria used enzymes to break down the gelatin.[2]

One day in 1881, while eating lunch, Walter asked Fanny about the jellies and puddings that she made and how they managed to stay gelled even in warm weather. Fannie told him about how she learned about the seaweed product, agar-agar, from a Dutch neighbor of hers while she was growing up in New York City. Her neighbor had emigrated from Indonesia, where it was the local custom to use agar in their cooking. Fannie suggested that they try this out in their laboratory. The rest is history. Agar turned out to be an ideal gelling agent that stayed firm even in the incubator and could not be digested by any bacterial enzymes. Walter Hesse notified Koch of this new technique, who immediately added agar to his nutrient broths. [2]

Lab work can be a lot like cooking. You have to follow directions to measure, mix, and heat different chemicals to the right temperature to get the desired result.[3]

This led to Koch using agar to cultivate the bacteria that cause tuberculosis.  While Koch, in an 1882 paper on tuberculosis bacilli, mentioned he used agar instead of gelatin, he did not credit Fanny or Walther Hesse or mention why he made the switch. Fanny Hesse's suggestion never resulted in financial benefit for the Hesse family.[1]


  1. Fanny Hesse, in Wikipedia. Accessed 8 March 2017.
  2. Jay Hardy, in 'Agar and the quest to isolate pure cultures'.
  3. Angeline Fanny Hesse - the woman who made microbiology possible. In: Rejected Princesses, accessed on March 8, 2017.

A day to remember: William M. Haenszel

It was 106 years ago today when William Haenszel was born in Rochester, New York.

William Manning Haenszel (June 19, 1910 – March 13, 1998) was an American epidemiologist who developed the first national system to track cancer cases and their possible causes (Surveillance, Epidemiology, and End Results or SEER). He was an elected fellow of the American Statistical Association, the American Public Health Association, and the American Association For the Advancement of Science. He worked at the National Cancer Institute from 1952 to 1976, when he became a Professor of Epidemiology at the University of Illinois. With Nathan Mantel, he co-authored the Mantel-Haenszel statistical test for omitted variables.[1]

In the 1970's, when the Nixon Administration declared a ''war on cancer,'' William Haenszel, as chief of biometry -- the statistical analysis of biological data -- set out to record individual cases, to track them from diagnosis to death, and to synthesize the data at the N.C.I., in Bethesda, Md., to learn about potential causes. SEER -- which he started in 1973 -- is probably the largest registry for any one disease in the world, said Dr. Earl S. Pollack, who was chief of biometry at the institute after Haenszel. [2]

"Mr. Haenszel provided the intellectual foundation for what epidemiologists do on a day-to-day basis in the study of causes of disease,''

''We can make the right inferences today because of his insights.''

Dr. Jack H. Goldberg

Haenszel was widely known for migrant studies in the 1950's and 1960's. In one project, he showed that the high stomach cancer rates in Japan were no longer found in the Japanese who migrated to Hawaii. He identified the role of diet as a possible cause of stomach cancer. In a 1959 paper, written with Nathan Mantel, also of the cancer institute, Mr. Haenszel described what is now known as the Mantel-Haenszel Method for analysis to assess the relationship between exposure to a hazard and disease rates. [2]

Dealing with things that are not there

The Cochran-Mantel-Haenszel method is a technique that generates an estimate of an association between an exposure and an outcome after adjusting for or taking into account confounding. The method is used with a dichotomous outcome variable and a dichotomous risk factor. We stratify the data into two or more levels of the confounding factor (as we did in the example above). In essence, we create a series of two-by-two tables showing the association between the risk factor and outcome at two or more levels of the confounding factor, and we then compute a weighted average of the risk ratios or odds ratios across the strata (i.e., across subgroups or levels of the confounder).[3]


  1. William M. Haenszel, in: Wikipedia.
  2. Obituary William Haenszel, New York Times, 22 March 1998.
  3. The Cochran-Mantel-Haenszel Method, in: Confounding and Effect Measure Modification

Transmissible Party: 1st Anniversary

Yes, Time Flies !

It is already a year ago that Transmissible was established in the Netherlands. And since June 1, 2016, the little boy has learned to walk.

Do you remember how good it felt, to be on your own two feet for the first time? Exhilarating!

Meanwhile, we have engaged in exciting public health projects, got connected to a growing group of great clients, developed partnerships with inspiring colleagues, and most of all: had fun doing it.


Reasons to be cheerful. And to party obviously 🙂


A day to remember: Lady Mary Wortley Montagu

Lady Montagu in Turkish dress by Jean-Étienne Liotard, ca. 1756, Palace on the Water in Warsaw

It is 328 years ago today, that Lady Mary Wortley Montagu (born Mary Pierrepont) was baptized in London (Nottinghamshire) on 26 May 1689. She was an English aristocrat, letter writer and poet. Lady Mary is today chiefly remembered for her letters, particularly her letters from travels to the Ottoman Empire, as wife to the British ambassador to Turkey, which have been described by Billie Melman as "the very first example of a secular work by a woman about the Muslim Orient". Aside from her writing, Lady Mary is also known for introducing and advocating for smallpox inoculation to Britain after her return from Turkey. [1]

The Encyclopedia Brittanica describes her as colourful. The daughter of the 5th Earl of Kingston and Lady Mary Fielding (a cousin of the novelist Henry Fielding), she eloped with Edward Wortley Montagu, a Whig member of Parliament, rather than accept a marriage that had been arranged by her father. In 1714 the Whigs came to power, and Edward Wortley Montagu was in 1716 appointed ambassador to Turkey, taking up residence with his wife in Constantinople (now Istanbul). After his recall in 1718, they bought a house in Twickenham, west of London. For reasons not wholly clear, Lady Mary’s relationship with her husband was by this time merely formal and impersonal. [2]

Life in Turkey

In 1716, Edward Wortley Montagu was appointed Ambassador at Istanbul. In August 1716, Lady Mary accompanied him to Vienna, and thence to Adrianople and Istanbul. He was recalled in 1717, but they remained at Istanbul until 1718. While away from England, the Wortley Montagu's had a daughter on 19 January 1718, who would grow up to be Mary, Countess of Bute. After an unsuccessful delegation between Austria and Turkey/Ottoman Empire, they set sail for England via the Mediterranean, and reached London on 2 October 1718.

The story of this voyage and of her observations of Eastern life is told in Letters from Turkey, a series of lively letters full of graphic descriptions; Letters is often credited as being an inspiration for subsequent female travellers/writers, as well as for much Orientalist art. During her visit she was sincerely charmed by the beauty and hospitality of the Ottoman women she encountered, and she recorded her experiences in a Turkish bath. She also recorded a particularly amusing incident in which a group of Turkish women at a bath in Sofia, horrified by the sight of the stays she was wearing, exclaimed that

"the husbands in England were much worse than in the East, for [they] tied up their wives in little boxes, the shape of their bodies".

Lady Mary wrote about misconceptions previous travellers, specifically male travellers, had recorded about the religion, traditions and the treatment of women in the Ottoman Empire. Her gender and class status provided her with access to female spaces, that were closed off to males. Her personal interactions with Ottoman women enabled her to provide, in her view, a more accurate account of Turkish women, their dress, habits, traditions, limitations and liberties, at times irrefutably more a critique of the Occident than a praise of the Orient.

Lady Mary returned to the West with knowledge of the Ottoman practice of inoculation against smallpox, known as variolation.

Immigrating the concept of variolation

Lady Mary Wortley Montagu defied convention most memorably by introducing smallpox inoculation to Western medicine after witnessing it during her travels and stay in the Ottoman Empire. In the Ottoman Empire, she visited the women in their segregated zenanas, making friends and learning about Turkish customs. There she witnessed the practice of inoculation against smallpox—variolation—which she called engrafting, and wrote home about it a number of her letters, the most famous being her 1 April 1 1717 "Letter to a Friend". Variolation used live smallpox virus in the pus taken from a smallpox blister in a mild case of the disease and introduced it into scratched skin of a previously uninfected person to promote immunity to the disease. Lady Mary's brother had died of smallpox in 1713 and her own famous beauty had been marred by a bout with the disease in 1715.

Lady Mary was eager to spare her children, thus, in March 1718 she had her nearly five-year-old son, Edward, inoculated with the help of Embassy surgeon Charles Maitland. On her return to London, she enthusiastically promoted the procedure, but encountered a great deal of resistance from the medical establishment, because it was an Oriental folk treatment process.

In April 1721, when a smallpox epidemic struck England, she had her daughter inoculated by Maitland, the same physician who had inoculated her son at the Embassy in Turkey, and publicised the event. This was the first such operation done in Britain. She persuaded Princess Caroline to test the treatment. In August 1721, seven prisoners at Newgate Prison awaiting execution were offered the chance to undergo variolation instead of execution: they all survived and were released. [3] Controversy over smallpox inoculation intensified, however, Caroline, Princess of Wales was convinced. The Princess's two daughters were successfully inoculated in April 1722 by French-born surgeon Claudiius Amyand. In response to the general fear of inoculation, Lady Mary, under a pseudonym, wrote and published an article describing and advocating in favor of inoculation in September 1722.

In later years, Edward Jenner, who was 13 years old when Lady Mary died, developed the much safer technique of vaccination using cowpox instead of smallpox. As vaccination gained acceptance, variolation gradually fell out of favour.


  1. Lady Mary Wortley Montagu, in: Wikipedia. Accessed on 26 May 2017
  2. Lady Mary Wortley Montague, in: The Encyclopedia Brittanica, Accessed on 26 May 2017
  3. Art Boylston. The Newgate Guinea Pigs.

A day to remember: Edward Jenner, father of immunization, was born

Edward Jenner. Pastel by John Raphael Smith.

It was 268 years ago today, on 17 May 1749, that Edward Anthony Jenner was born in Berkeley, Gloucestershire, as the eighth of nine children. His father, the Reverend Stephen Jenner, was the vicar of Berkeley, so Jenner received a strong basic education.

He went to school in Wotton-under-Edge and Cirencester. During this time, he was inoculated for smallpox, no doubt by a method close to the one propagated by Lady Mary Wortley Montagu.

At the age of 14, he was apprenticed for seven years to Daniel Ludlow, a surgeon of Chipping Sodbury, South Gloucestershire, where he gained most of the experience needed to become a surgeon himself. In 1770, Jenner became apprenticed in surgery and anatomy under surgeon John Hunter and others at St George's Hospital. William Osler records that Hunter gave Jenner William Harvey's advice, very famous in medical circles (and characteristic of the Age of Enlightenment):

Don't think; try.

Hunter remained in correspondence with Jenner over natural history and proposed him for the Royal Society. Returning to his native countryside by 1773, Jenner became a successful family doctor and surgeon, practising on dedicated premises at Berkeley. He also became a master mason on 30 December 1802, in Lodge of Faith and Friendship #449.[1]

Like any other doctor of the time, Edward Jenner carried out variolation to protect his patients from smallpox. However, from the early days of his career Edward Jenner had been intrigued by country-lore which said that people who caught cowpox from their cows could not catch smallpox. This and his own experience of variolation as a boy and the risks that accompanied it led him to undertake the most important research of his life. Cowpox is a mild viral infection of cows. It causes a few weeping spots (pocks) on their udders, but little discomfort. Milkmaids occasionally caught cowpox from the cows. Although they felt rather off-colour for a few days and developed a small number of pocks, usually on the hand, the disease did not trouble them.[3]

Working on protection against smallpox

By 1768, English physician John Fewster had realised that prior infection with cowpox rendered a person immune to smallpox.[22] A similar observation had also been made in France by Jacques Antoine Rabaut-Pommier. In the years following 1770, at least five investigators in England and Germany successfully tested a cowpox vaccine in humans against smallpox. For example, Dorset farmer Benjamin Jesty successfully vaccinated and presumably induced immunity with cowpox in his wife and two children during a smallpox epidemic in 1774, but it was not until Jenner's work that the procedure became widely understood. Jenner may have been aware of Jesty's procedures and success.

Noting the common observation that milkmaids were generally immune to smallpox, Jenner postulated that the pus in the blisters that milkmaids received from cowpox (a disease similar to smallpox, but much less virulent) protected them from smallpox.[1]

In May 1796 a dairymaid, Sarah Nelmes, consulted Jenner about a rash on her hand. He diagnosed cowpox rather than smallpox and Sarah confirmed that one of her cows, a Gloucester cow called Blossom, had recently had cowpox. Edward Jenner realised that this was his opportunity to test the protective properties of cowpox by giving it to someone who had not yet suffered smallpox.

Hide from the cow named 'Blossom'

He chose James Phipps, the eight-year old son of his gardener. On 14th May he made a few scratches on one of James' arms and rubbed into them some material from one of the pocks on Sarah's hand. A few days later James became mildly ill with cowpox but was well again a week later. So Jenner knew that cowpox could pass from person to person as well as from cow to person. The next step was to test whether the cowpox would now protect James from smallpox. On 1st July Jenner variolated the boy. As Jenner anticipated, and undoubtedly to his great relief, James did not develop smallpox, either on this occasion or on the many subsequent ones when his immunity was tested again.[3] So, in addition to the name of Edward Jenner,  we also need to acknowledge the following names for their contribution to this success: Sarah Nelmes (the milkmaid), James Phipps (the child - guinea pig), The gardner Mr Phipps (for allowing this experiment on his son), and Blossom, the Gloucester Cow, for donating the virus. You can still have a look at Blossom, by the way. Her hide is on display at Saint George's University. [2]

Phipps was the 17th case described in Jenner's first paper on vaccination. Donald Hopkins has written,

"Jenner's unique contribution was not that he inoculated a few persons with cowpox, but that he then proved [by subsequent challenges] that they were immune to smallpox. Moreover, he demonstrated that the protective cowpox pus could be effectively inoculated from person to person, not just directly from cattle.

Jenner successfully tested his hypothesis on 23 additional subjects.[1]

Edward Jenner, vaccinating his son.

Convincing establishment and translation into legal acts

Jenner continued his research and reported it to the Royal Society, which did not publish the initial paper. After revisions and further investigations, he published his findings on the 23 cases. Some of his conclusions were correct, some erroneous; modern microbiological and microscopic methods would make his studies easier to reproduce. The medical establishment deliberated at length over his findings before accepting them. Eventually, vaccination was accepted, and in 1840, the British government banned variolation – the use of smallpox to induce immunity – and provided vaccination using cowpox free of charge.[1]

Later life and death

In 1803 in London, he became president of the Jennerian Society, concerned with promoting vaccination to eradicate smallpox. The Jennerian ceased operations in 1809. In 1808, with government aid, the National Vaccine Establishment was founded, but Jenner felt dishonoured by the men selected to run it and resigned his directorship. Jenner became a member of the Medical and Chirurgical Society on its founding in 1805 (now the Royal Society of Medicine) and presented several papers there. Jenner was also elected a foreign honorary member of the American Academy of Arts and Sciences in 1802, and a foreign member of the Royal Swedish Academy of Sciences in 1806. Returning to London in 1811, Jenner observed a significant number of cases of smallpox after vaccination. He found that in these cases the severity of the illness was notably diminished by previous vaccination. In 1821, he was appointed physician extraordinary to King George IV, and was also made mayor of Berkeley and justice of the peace. He continued to investigate natural history, and in 1823, the last year of his life, he presented his "Observations on the Migration of Birds" to the Royal Society.

Jenner was found in a state of apoplexy on 25 January 1823, with his right side paralysed. He never fully recovered and eventually died of an apparent stroke, his second, on 26 January 1823, aged 73. He was buried in the Jenner family vault at the Church of St. Mary's, Berkeley, Gloucestershire. Jenner was survived by one son and one daughter, his elder son having died of tuberculosis aged 21.[1]


  1. Edward Jenner, in Wikipedia (accessed 17 May 2017)
  2. Saint George's, University of London Alumni Magazine. Issue 17, July 3, 2014. 
  3. About Edward Jenner. The Jenner Institute Webpages. Accesses 17 May 2017
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