Jordy Vercauteren

Assessment of the contribution from wood burning to the PM10 aerosol in Flanders, Belgium

From February 2010 to February 2011 PM10 aerosol samples were simultaneously taken every 4th day at 7 monitoring sites in Flanders, Belgium. Two of the sites (i.e., Borgerhout and Gent) were urban background sites; one (i.e., Mechelen) a suburban background site, and the other four (i.e., Hamme, Lier, Retie, and Houtem) rural background sites, whereby Hamme and Lier were expected to be particularly impacted by biomass burning. The samplings were done for 24h and 47-mm diameter Pallflex® Tissuquartz™ 2500 QAT-UP filters were used. After sampling the PM10 mass concentration was determined by weighing; organic and elemental carbon (OC and EC) were measured by thermal-optical transmission analysis and the wood burning tracers levoglucosan, mannosan, and galactosan were determined by means of gas chromatography/mass spectrometry. The atmospheric concentrations of levoglucosan and the other two monosaccharide anhydrides showed a very clear seasonal variation at each site, with highest levels in winter, followed by autumn, spring, and summer. The levoglucosan levels for 5 of our 7 sites (i.e., Retie, Lier, Mechelen, Borgerhout, and Gent) were very highly correlated with each other (all between site correlation coefficients r>0.9, except for one value of 0.86) and the levels in the parallel samples of these 5 sites were similar, indicating that wood burning at these 5 sites was a regional phenomenon and that it was taking place in many individual houses on similar occasions (e.g., on cold days, weekends or holidays). The levoglucosan levels at Houtem and the correlation coefficients of the 5 sites with Houtem were lower, which is explained by the fact that the latter site is at less than 20 km from the North Sea so that the air there is often diluted by rather clean westerly maritime air. A peculiar behavior was seen for Hamme, with on many occasions very high levoglucosan levels, which was attributed to the fact that there is wood burning going on in several houses nearby this site. From our levoglucosan/mannosan ratios we derived the relative contributions of softwood and hardwood burning, thereby following the same approach as used by Schmidl et al. (Atmos Environ 2008;38:126-41). It was found that softwood burning accounted, on average, for about 70%, and there was little variation in this percentage with site or with season. The levoglucosan data were used to assess the contribution of wood burning to the OC and to the PM10 mass, again following the approach of Schmidl et al. (2008). The annual average contributions of wood burning OC to the PM10 OC were in the range of 20-25% for 6 of our 7 sites and 36% for Hamme; the averages for summer were 2.0-3.9% for the 6 sites and 14.5% for Hamme; the corresponding data for winter were 36-43% and 60%. As to the contribution from wood burning to the PM10 mass, the annual averages were in the range of 4.8-6.3% for 6 of our 7 sites and 13.3% at Hamme; the averages for summer were 0.51-1.14% for the 6 sites and 5.0% for Hamme; the corresponding data for winter were 8.6-11.3% and 22%. Our finding that wood burning is an important contributor to the OC and the PM10 mass, especially in winter, is in line with published data from various other sites in other European countries.

Higher proportion of G2P[4] rotaviruses in vaccinated hospitalized cases compared with unvaccinated hospitalized cases, despite high vaccine effectiveness against heterotypic G2P[4] rotaviruses

The overall vaccine effectiveness of the monovalent rotavirus vaccine in an observational, prospective, multicentre, hospital-based case-control study in Belgium (RotaBel) was 90%. However, rotavirus genotype and co-infecting pathogens are important parameters to take into account when assessing vaccine effectiveness. In this study we specifically investigated the effect of rotavirus genotypes and co-infecting pathogens on vaccine effectiveness of the monovalent vaccine. In addition, we also investigated the effect of co-infecting pathogens on disease severity. From February 2008 to June 2010 stool samples of rotavirus gastroenteritis cases of a random sample of 39 Belgian hospitals were collected and subsequently genotyped. Fishers exact tests were performed to investigate the relationships between rotavirus genotype, co-infecting pathogens and disease severity. The vaccine effectiveness of a full series of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by G1P[8] rotavirus strains was 95% (95% CI 77.5-98.7). Against G2P[4], the vaccine effectiveness was 85% (95% CI: 63.7-93.8). G4P[8]- and G3P[8]-specific vaccine effectiveness was 90% (95% CI 19.2-98.7) and 87% (95% CI -5.2 to 98.4), respectively. A post-hoc analysis showed that the genotype distribution was significantly related to the vaccination status (p <0.001), whereby G2P[4] strains were proportionally more prevalent in vaccinated cases than in unvaccinated cases. No statistical associations were found between co-infection status and vaccination status, Vesikari severity score or rotavirus genotype. The high vaccine effectiveness against the individual genotypes implies robust protection of the monovalent rotavirus vaccine against hospitalized rotavirus gastroenteritis caused by the major human rotavirus genotypes. The prevalence of G2P[4] requires continued monitoring.

Efficacy of tenofovir and efavirenz in combination with lamivudine or emtricitabine in antiretroviral-naive patients in Europe

BACKGROUND The combination of tenofovir and efavirenz with either lamivudine or emtricitabine (TELE) has proved to be highly effective in clinical trials for first-line treatment of HIV-1 infection. However, limited data are available on its efficacy in routine clinical practice. METHODS A multicentre cohort study was performed in therapy-naive patients initiating ART with TELE before July 2009. Efficacy was studied using ITT (missing or switch = failure) and on-treatment (OT) analyses. Genotypic susceptibility scores (GSSs) were determined using the Stanford HIVdb algorithm. RESULTS Efficacy analysis of 1608 patients showed virological suppression to <50 copies/mL at 48 weeks in 91.5% (OT) and 70.6% (ITT). Almost a quarter of all patients (22.9%) had discontinued TELE at week 48, mainly due to CNS toxicity. Virological failure within 48 weeks was rarely observed (3.3%, n = 53). In multilevel, multivariate analysis, infection with subtype B (P = 0.011), baseline CD4 count <200 cells/mm³ (P < 0.001), GSS <3 (P = 0.002) and use of lamivudine (P < 0.001) were associated with a higher risk of virological failure. After exclusion of patients using co-formulated compounds, virological failure was still more often observed with lamivudine. Following virological failure, three-quarters of patients switched to a PI-based regimen with GSS <3. After 1 year of second-line therapy, viral load was suppressed to <50 copies/mL in 73.5% (OT). CONCLUSIONS In clinical practice, treatment failure on TELE regimens is relatively frequent due to toxicity. Virological failure is rare and more often observed with lamivudine than with emtricitabine. Following virological failure on TELE, PI-based second-line therapy was often successful despite GSS <3.

The Effect of Wood Burning on Particulate Matter Concentrations in Flanders, Belgium

Since 2010, new estimations of the particulate matter emissions in Flanders have been made by using a tier-II approach. By means of a survey, the quantity of the wood by households, buildings (services sector), industry and agricultural sector consumption in Flanders has been estimated. A survey is necessary as not all consumed wood is purchased, e.g. some of the wood is sourced locally or waste wood is used. These surveys also provided data on the installation stock in Flanders, such as the type (fireplaces, pellet stoves, …) and age of the heating installation. Besides the wood consumption and use patterns, emission factors of particulate matter per type of wood and per type and age of heating installation were also updated based on international, recent literature on emission factors. Both new estimations resulted in an actualization of the particulate matter emissions of the residential wood burning in Flanders. Overall, the estimations were a factor 13 higher than the old estimations. This factor 13 is due to a factor 4 increase in the average emission factor and a factor of 3.4 in the wood consumption. As a result, heating in residential sector is estimated to be the most important emission source for primary particulate matter (37 % of all primary emissions) in Flanders. To confirm these results a comparison was carried out with the estimates of the contribution of wood burning to ambient PM10 concentrations based on measurements of levoglucosan. It was shown that about 10 % of the particulate matter concentrations in winter were due to wood burning, while in summer this amounted only 2–3 %. In the next step, a dispersion model has been used in order to check the consistency of both results. It is shown that the increased emissions are consistent with the measured particulate matter concentrations due to wood burning. Indeed, the increase in emissions by a factor 13 is needed to understand the high levoglucosan concentrations in ambient air in Flanders. Finally, the large changes that have been made to the Belgian SNAP-2 emission inventory due to the results of this study, raise questions about the homogeneity (both spatial and temporal) of the European emission inventory for this sector. Adjustments to this sector could possibly decrease the modelled PM-gap quite substantially.