Adapting response to a measles outbreak in a context of high vaccination and breakthrough cases: an example from Vaud, Switzerland, January to March 2024.

A measles outbreak with 51 cases occurred in the canton of Vaud, Switzerland, between January and March 2024. The outbreak was triggered by an imported case, and 37 (72.5%) subsequent cases were previously vaccinated individuals. Epidemiological investigations showed that vaccinated measles cases were symptomatic and infectious. In a highly vaccinated population, it is important to raise awareness among healthcare professionals to suspect and test for measles virus when an outbreak is declared, irrespective of the vaccination status of the patients.

Transfer of antiretroviral drugs into breastmilk: a prospective study from the Swiss Mother and Child HIV Cohort Study.

INTRODUCTION: In 2018, Switzerland changed its guidelines to support women living with HIV wishing to breastfeed. The exposure of antiretroviral drugs (ARVs) in breastmilk and the ingested daily dose by the breastfed infant are understudied, notably for newer ARVs. This study aimed to quantify ARV concentrations in maternal plasma and breastmilk to determine the milk/plasma ratio, to estimate daily infant ARV dose from breastfeeding and to measure ARV concentrations in infants. METHODS: All women wishing to breastfeed were included, regardless of their ARV treatment. Breastmilk and maternal plasma samples were mostly collected at mid-dosing interval. RESULTS: Twenty-one mother/child pairs were enrolled; of those several were on newer ARVs including 10 raltegravir, 1 bictegravir, 2 rilpivirine, 2 darunavir/ritonavir and 3 tenofovir alafenamide. No vertical HIV transmission was detected (one infant still breastfed). The median milk/plasma ratios were 0.96/0.39 for raltegravir once/twice daily, 0.01 for bictegravir, 1.08 for rilpivirine, 0.12 for darunavir/ritonavir and 4.09 for tenofovir alafenamide. The median estimated infant daily dose (mg/kg) from breastfeeding was 0.02/0.25 for raltegravir once/twice daily, 0.01 for bictegravir, 0.02 for rilpivirine, 0.05 for darunavir/ritonavir and 0.007 for tenofovir alafenamide, resulting in relative infant dose <10% exposure index for all ARVs. CONCLUSIONS: ARVs were transferred to a variable extent in breastmilk. Nevertheless, the estimated daily ARV dose from breastfeeding remained low. Differential ARV exposure was observed in breastfed infants with some ARVs being below/above their effective concentrations raising the concern of resistance development if HIV infection occurs. More data on this potential risk are warranted to better support breastfeeding.

[Vaccination in adult patients: shingles vaccines and vaccination in case of anatomical or functional asplenia]. / Vaccination chez l'adulte: vaccins contre le zona et vaccination en cas d'asplénie anatomique ou fonctionnelle.

Shingles vaccination and pneumococcal vaccination of patients with celiac disease are among the most recent updates for the vaccination of vulnerable adults, in Switzerland. Shingles and especially post-herpes zoster pain remain an unresolved public health issue. The only vaccine available in Switzerland is very little administered because it is not reimbursed by health insurance companies. A second shingles vaccine is announced for 2022 and should help to reduce the burden of this disease. It has been known for many years that celiac disease is accompanied by hyposplenism in adults. The resulting increased risk of invasive pneumococcal infections justifies, since 2020, a recommendation for vaccination against these encapsulated bacteria.

La vaccination contre le zona et la vaccination contre les pneumocoques des patients souffrant de maladie cœliaque font partie des mises à jour les plus récentes pour la vaccination de l'adulte vulnérable, en Suisse. Le zona et surtout les douleurs postzostériennes restent un problème de santé publique non résolu. Le seul vaccin disponible en Suisse est très peu administré en raison de son non-remboursement par les caisses-maladie. Un deuxième vaccin contre le zona est annoncé pour 2022 et devrait contribuer à alléger le fardeau de cette maladie. On sait depuis de nombreuses années que la maladie cœliaque s'accompagne d'un hyposplénisme chez l'adulte. Le risque accru d'infections invasives à pneumocoques qui en découle justifie, depuis 2020, une recommandation de vaccination contre ces bactéries encapsulées.

[SARS-CoV-2 in children: epidemiology, clinical presentation and contagiosity]. / SARS-CoV-2 et enfants : épidémiologie, présentation clinique et contagiosité.

Children are under-represented in terms of the frequency and severity of COVID-19 disease. Although the proportion of children tested positive remains much lower than that of adults suggesting that they are less susceptible to SARS-CoV-2 infection, seroprevalence studies are contradictory in this regard. With respect to the role of children in transmission of the virus, no biological reason for reduced infectivity has been found. However, in the community, children rarely seem to be the vectors of this infection. With regard to adolescents, epidemiological data and their behavior similar to that of young adults suggest that they contribute to the spread of the virus more effectively than younger children.

Les enfants sont sous-représentés en termes de fréquence et de sévérité de la maladie Covid-19. Même si la proportion des enfants testés positifs reste bien inférieure à celle des adultes, suggérant qu'ils sont moins susceptibles à l'infection par le SARS-CoV-2, les études de séroprévalence sont contradictoires à ce sujet. En ce qui concerne le rôle des enfants dans la transmission du virus, aucune raison biologique expliquant une moindre contagiosité n'a pu être mise en évidence. Cependant, dans la communauté, les enfants ne semblent que rarement être les vecteurs de cette infection. En ce qui concerne les adolescents, les données épidémiologiques et leurs comportements similaires aux jeunes adultes laissent supposer qu'ils contribuent à la propagation du virus de manière plus efficace que les enfants plus jeunes.

[Congenital Toxoplasmosis and CMV in Switzerland in 2019]. / Toxoplasmose et cytomégalovirus congénitaux en Suisse en 2019.

Epidemiological trends in congenital toxoplasmosis and CMV are extremely divergent. While there were only 39 cases of congenital toxoplasmosis in Switzerland between 1982 and 2015, there was an equivalent number of cases of congenital CMV, 38 in total, in 2017 alone. Serological screening for toxoplasmosis was logically abandoned in Switzerland in 2008. Regarding CMV, there is no recommendation for serological screening or neonatal screening in Switzerland, whereas early diagnosis can improve prognosis through the rapid initiation of antiviral treatment. The epidemiological data generated by sentinel surveillance of congenital CMV infections in Switzerland may or may not justify such a measure in our country in the future.

Les évolutions épidémiologiques de la toxoplasmose et du cytomégalovirus (CMV) congénitaux sont extrêmement divergentes. Alors qu'on a recensé seulement 39 cas de toxoplasmose congénitale en Suisse entre 1982 et 2015, on a comptabilisé un nombre équivalent de cas de CMV congénital, 38 au total, pendant la seule année 2017. Le dépistage sérologique de la toxoplasmose a été logiquement abandonné en Suisse à partir de 2008. En ce qui concerne le CMV, il n'existe pas de recommandation de dépistage néonatal en Suisse, alors qu'un diagnostic précoce peut améliorer le pronostic par l'instauration rapide d'un traitement antiviral. Les données épidémiologiques générées par la surveillance sentinelle des infections congénitales à CMV en Suisse devraient permettre de justifier ou non une telle mesure dans notre pays à l'avenir.

[MMR vaccination at UNIL and EPFL†: Lausanne medical students get involved]. / Vaccination ROR à l'UNIL et à l'EPFL†: les étudiant·e·s en médecine de Lausanne se mobilisent.

In recent years, several cases of measles have appeared on the campuses of the University of Lausanne (UNIL) and the Swiss Federal Institute of Technology in Lausanne (EPFL). In response to this, several medical students have mobilized in collaboration with various cantonal authorities in order to set up a free measles, mumps and rubella vaccination campaign on the UNIL/EPFL campuses, in 2019. This first edition was a success and will be repeated in the future. Such an approach having shown its feasibility, it could be applied to other public health issues. The involvement of medical students could thus be extremely valuable if a generalized vaccination against SARS-CoV-2 were to take place.

Durant ces dernières années, plusieurs cas de rougeole sont apparus sur les campus de l'Université de Lausanne (UNIL) et de l'École polytechnique fédérale de Lausanne (EPFL). En réponse à cela, plusieurs étudiant·e·s en médecine se sont mobilisé·e·s en collaboration avec diverses instances cantonales afin de mettre en place en 2019 une campagne de vaccination gratuite contre la rougeole, les oreillons et la rubéole sur les campus UNIL/EPFL. Cette première édition a été un succès et sera reconduite dans le futur. Une telle approche ayant montré sa faisabilité, elle pourrait être appliquée à d'autres enjeux de santé publique. L'implication des étudiant·e·s en médecine pourrait ainsi être extrêmement précieuse si une vaccination généralisée contre le virus SARS-CoV-2 devait avoir lieu.

[Breastfeeding for HIV-positive mothers in Switzerland : are we ready to discuss ?] / Allaitement des femmes vivant avec le VIH : sommes-nous prêts à ouvrir la discussion ?

Mother-to-child transmission (MTCT) is almost inexistent in Switzerland nowadays. This success has been achieved with systematic screening of HIV in pregnant women, provision of antiretroviral treatment (ART), elective cesarean-section (CS), neonatal antiretroviral prophylaxis (ARP) and avoidance of breastfeeding. Elective CS and neonatal ARP are no longer recommended when the viral load (VL) is suppressed. Recent studies have shown that the risk of HIV MTCT through breastfeeding is extremely rare if not zero when the mother is treated, has a suppressed VL and is correctly followed-up. It is time to be open to discuss the risks and benefits of breastfeeding with HIV-infected pregnant women and to enter in a shared decision-making process, as recommended by the new Swiss guidelines. Close monitoring is mandatory in case of breastfeeding.

La transmission verticale du VIH est presque inexistante en Suisse aujourd'hui. Ce succès a été obtenu grâce au dépistage systématique du VIH de la femme enceinte et aux traitements antirétroviraux, à la césarienne élective (CS), à la prophylaxie postexpositionnelle néonatale (PPEn) et à l'évitement de l'allaitement. La CS et la PPEn ne sont plus recommandées en cas de charge virale indétectable. Des études récentes ont montré que le risque de transmission du VIH par l'allaitement est extrêmement faible, voire nul, lorsque la mère est correctement traitée et suivie. Il est temps de peser les risques et les bénéfices de l'allaitement maternel avec les femmes enceintes infectées par le VIH dans un processus de décision partagée, comme le suggèrent les nouvelles recommandations suisses. En cas d'allaitement, un suivi étroit est incontournable.

[Persistent fever in the travelling child]. / Fièvre persistante chez l'enfant de retour de voyage.

Persistent fever or FUO (fever of unknown origin) is defined by a fever of more than 1­2 weeks that remains unexplained, after considerable diagnostic efforts. In the travelling child, in addition to cosmopolitan infectious diseases, tropical pathogens must absolutely be considered according to the regions visited and the activities practiced. A detailed history and a complete clinical examination are essential to decide which supplementary investigations will complete the basic assessment, which must contain the search for malaria in any child who has visited an endemic area. Following the diagnostic strategy proposed in this article, the clinician should be able to diagnose the most common diseases.

La fièvre persistante ou FUO (fever of unknown origin) est définie par une fièvre de plus de 1­2 semaines non expliquée, après des efforts diagnostiques considérables. Chez l'enfant voyageur, en plus des pathologies infectieuses cosmopolites, des pathogènes tropicaux doivent absolument être considérés selon les régions visitées et les activités pratiquées. Une anamnèse détaillée et un examen clinique complet sont primordiaux pour décider quels examens complémentaires viendront compléter le bilan de base, qui doit contenir obligatoirement la recherche d'une malaria chez tout enfant ayant visité une zone endémique. En suivant la stratégie diagnostique proposée dans cet article, le clinicien devrait être en mesure de diagnostiquer les pathologies les plus fréquentes.

[Impact of vaccination on the epidemiology of childhood pneumonia]. / Impact de la vaccination sur l'épidémiologie des pneumonies de L'Enfant.

The impact of vaccination on non-bacteremic Haemophilus influenza pneumonia is difficult to appreciate, in the absence of proper microbiological documentation. It has certainly been largely underestimated. Vaccination has reduced the incidence of pneumococcal pneumonia. However, the increase of incidence of empyema due to nonvaccine serotypes was observed in several countries. The replacement of Prevenar 7 by Prevenar 13 portends a decrease in the occurrence of these infections, but, unfortunately, without eliminating them completely.

Demonstration of the effectiveness of zinc in diarrhoea of children living in Switzerland.

UNLABELLED: We designed a double-blinded randomized clinical trial of zinc (10 or 20 mg of zinc sulphate for 2-5 month-old or 6-59 month-old children, respectively, during 10 days) vs. placebo in otherwise healthy children aged 2 months to 5 years who presented with acute diarrhoea (i.e. ≥3 stools/day for less than 72 h). Eighty-seven patients (median age 14 months; range 3.1-58.3) were analysed in an intention-to-treat approach. Forty-two patients took zinc and 45 placebo. There was no difference in the duration nor in the frequency of diarrhoea, but only 5% of the zinc group still had diarrhoea at 120 h of treatment compared to 20% in the placebo group (P = 0.05). Thirty-one patients (13 zinc and 18 placebo) were available for per-protocol analyses. The median (IQR) duration of diarrhoea in zinc-treated patients was 47.5 h (18.3-72) and differed significantly from the placebo group (median 76.3; IQR 52.8-137) (P = 0.03). The frequency of diarrhoea was also lower in the zinc group (P = 0.02). CONCLUSION: zinc treatment decreases the frequency and severity of diarrhoea in children aged 2 months to 5 years living in Switzerland. However, the intention-to-treat analysis reveals compliance issues that question the proper duration of treatment and the choice of optimal pharmaceutical formulation.

Seizures in Children with Influenza during the 2022-2023 Winter Season, a Case Series.

Influenza is a viral infection presenting with general symptoms such as fever, headache, fatigue, and involvement of airways or the gastrointestinal tract. The nervous system may be involved, but less frequently. These neurological complications remain challenging to diagnose; moreover, no guidelines for management and treatment exist. Therefore, when presenting with neurological symptoms, patients undergo invasive diagnostic procedures and empirical treatments before making the correct diagnosis. During the winter of 2022-2023, four children between nine months and nine years of age were admitted to the Lausanne University Hospital, Switzerland, complaining of influenza and neurological complications. This report presents the symptoms of neurological manifestation and the treatment management of the four patients. All the legally authorized representatives gave their written informed consent before study inclusion.

Risk of cytomegalovirus infection and disease after umbilical cord blood transplantation in children.

BACKGROUND: Pediatric data regarding cytomegalovirus (CMV) infections in pediatric patients receiving umbilical cord blood (UCB) transplantation are sparse. OBJECTIVE: To determine whether UCB transplantation increases the risk of CMV infection and disease compared with other graft sources. METHODS: The medical files of patients who underwent allogeneic hematopoietic stem cell transplantation at CHU Ste-Justine (Montreal, Quebec) from April 2000 to December 2006 were retrospectively reviewed. A Cox proportional hazard model was used to assess the effect of potential predictors of outcomes. RESULTS: A total of 176 patients with a median age of nine years (range 0.1 to 18 years) underwent hematopoietic stem cell transplantation. The source of stem cells were UCB, bone marrow and peripheral blood stem cells in 86, 86 and four of the cases, respectively. CMV infection occurred in 29 patients (16%). At day 100 post-transplantation, the rate of CMV infection was 13% in UCB transplant recipients (11 of 86) versus 20% in those with other sources of graft (18 of 90) (P=0.19). Positive CMV serology of the recipient and leukocyte depletion were two independent variables associated with an increased risk of CMV infection. Among infected patients, six developed CMV disease (20.7%). The rate of CMV disease one year after infection was 49% in patients who received UCB (five of 11) and 6% in others (one of 18). This difference was significant by univariate (P=0.01) but not by multivariate analysis. CONCLUSION: In the setting of the current study, with a moderate CMV infection rate (16.5%), UCB transplantation did not appear to increase the risk of CMV infection and disease.

HISTORIQUE: Il existe peu de données pédiatriques sur les infections à cytomégalovirus (CMV) chez les patients pédiatriques qui reçoivent une greffe de sang du cordon ombilical (SCO). OBJECTIF: Déterminer si la greffe de SCO accroît le risque d'infection à CMV par rapport à d'autres greffes. MÉTHODOLOGIE: Les chercheurs ont procédé à une analyse rétrospective des dossiers médicaux de patients qui ont subi une greffe de cellules souches hématopoïétiques au CHU Sainte-Justine de Montréal, au Québec, entre avril 2000 et décembre 2006. Ils ont utilisé un modèle de risque proportionnel de Cox pour évaluer l'effet des prédicteurs potentiels d'issues. RÉSULTATS: Au total, 176 patients ayant un âge médian de neuf ans (plage de 0,1 à 18 ans) ont subi une greffe de cellules souches hématopoïétiques. Les cellules souches provenaient du SCO, de la moelle épinière et du sang périphérique dans 86, 86 et quatre cas, respectivement. Une infection à CMV s'est manifestée chez 29 patients (16 %). Au 100e jour après la greffe, le taux d'infection à CMV s'élevait à 13 % chez les greffés de SCO (11 sur 86) par rapport à 20 % chez ceux dont la greffe provenait d'autres sources (18 sur 90) (P=0,19). La sérologie positive au CMV du receveur et la déplétion leucocytaire étaient deux variables indépendantes associées à un risque plus élevé d'infection à CMV. Chez les patients infectés, six ont contracté la maladie à CMV (20,7 %). Le taux de maladie à CMV un an après l'infection s'élevait à 49 % chez les patients qui avaient reçu du SCO (cinq sur 11) et 6 % chez les autres (un sur 18). Cette différence était significative selon l'analyse univariée (P=0,01), mais pas selon l'analyse multivariée. CONCLUSION: Dans le cadre de la présente étude, où le taux d'infection à CMV était modéré (16,5 %), la greffe de SCO ne semblait pas accroître le risque d'infection et de maladie à CMV.

School-based HPV Vaccination: Variation in Inter-school Vaccine Uptake not Influenced by the Introduction of a New Information Brochure.

BACKGROUND: Switzerland, with an adolescent HPV vaccination coverage at 59%, remains far from reaching the crucial swiss national goal of 80% coverage. Our objective was to implement a new information brochure in schools to increase HPV vaccination uptake. METHODS: We designed a public health quality project. A new information brochure was produced and was distributed to a test group of 9th grade students from the Canton of Vaud, in Switzerland during the 2019-2020 school year. Vaccine uptake of the test group was compared to those of all other students in 2019-2020 and of students in the same schools in 2017-2018. RESULTS: 12,143 electronic records were analyzed. 713 students were enrolled in 6 schools where the new brochure was distributed. Median age was 13 years (IQR 12-13), and 6,031 (49.7%) were female. Vaccine uptake was 52% (6,299/12,143). The new brochure did not result in increased uptake. Age ≥ 13 years (aOR 1.39, 95% CI 1.22-1.58) was significantly associated with uptake. Uptake increased between 2017-2018 (51%, 3,216/6,307) and 2019-2020 (52.8%, 3,083/5,836, p=0.04) due to increased acceptance among boys. The only determinant of uptake in 2019-2020 was uptake in the same schools in 2017-2018. CONCLUSION: The introduction of a new information brochure was insufficient to increase HPV vaccination coverage. More innovative strategies are needed.

Swiss Evaluation Registry for Pediatric Infective Endocarditis (SERPIE) - Risk factors for complications in children and adolescents with infective endocarditis.

BACKGROUND: Infective endocarditis (IE) in pediatric patients is a severe cardiac disease and its actual epidemiology and clinical outcome in Switzerland is scarcely studied. METHODS: Retrospective nationwide multicenter data analysis of pediatric IE in children (<18 years) between 2011 and 2020. RESULTS: 69 patients were treated for definite (40/69;58%) or possible IE (29/69;42%). 61% (42/69) were male. Diagnosis was made at median 6.4 years (IQR 0.8-12.6) of age with 19 patients (28%) during the first year of life. 84% (58/69) had congenital heart defects. IE was located on pulmonary (25/69;35%), mitral (10/69;14%), tricuspid (8/69;12%) and aortic valve (6/69;9%), and rarely on ventricular septal defect (VSD;4/69;6%) and atrial septal defect (ASD;1/69;1%). In 22% (16/69) localization was unknown. 70% (48/69) had postoperative IE, with prosthetic material involved in 60% (29/48; right ventricular to pulmonary artery conduit (24), VSD (4), ASD (1)). Causative organisms were mostly Staphylococci spp. (25;36%) including Staphylococcus aureus (19;28%), and Streptococci spp. (13;19%). 51% (35/69) suffered from severe complications including congestive heart failure (16;23%), sepsis (17;25%) and embolism (19;28%). Staphylococcus aureus was found as a predictor of severe complications in univariate and multivariate analysis (p = 0.02 and p = 0.033). In 46% (32/69) cardiac surgery was performed. 7% (5/69) died. CONCLUSIONS: IE in childhood remains a severe cardiac disease with relevant mortality. The high morbidity and high rate of complications is associated with Staphylococcus aureus infections. Congenital heart defects act as a risk factor for IE, in particular the high number of cases associated with prosthetic pulmonary valve needs further evaluation and therapeutic alternatives.

Successful implementation of new Swiss recommendations on breastfeeding of infants born to women living with HIV.

INTRODUCTION: Swiss national recommendations advise, since end of 2018, supporting women with HIV who wish to breastfeed. Our objective is to describe the motivational factors and the outcome of these women and of their infants. METHODS: mothers included in MoCHiV with a delivery between January 2019 and February 2021 who fulfilled the criteria of the "optimal scenario" (adherence to cART, regular clinical care, and suppressed HIV plasma viral load (pVL) of <50 RNA copies/ml) and who decided to breastfeed after a shared decision-making process, were approached to participate in this nested study and asked to fill-in a questionnaire exploring the main motivating factors for breastfeeding. RESULTS: Between January 9, 2019 and February 7, 2021, 41 women gave birth, and 25 decided to breastfeed of which 20 accepted to participate in the nested study. The three main motivational factors of these women were bonding, neonatal and maternal health benefits. They breastfed for a median duration of 6.3 months (range 0.7-25.7, IQR 2.5-11.1). None of the breastfed neonates received HIV post-exposure prophylaxis. There was no HIV transmission: 24 infants tested negative for HIV at least 3 months after weaning; one mother was still breastfeeding when we analyzed the data. CONCLUSIONS: As a result of a shared decision-making process, a high proportion of mothers expressed a desire to breastfeed. No breastfed infant acquired HIV. The surveillance of breastfeeding mother-infant pairs in high resource settings should be continued to help update guidelines and recommendations.

Viral suppression and retention in HIV care during the postpartum period among women living with HIV: a longitudinal multicenter cohort study.

Background: Low rates of postnatal retention in HIV care and viral suppression have been reported in women living with HIV (WLWH) despite viral suppression at delivery. At the same time, postpartum follow-up is of crucial importance in light of the increasing support offered in many resource-rich countries including Switzerland to WLWH choosing to breastfeed their infant, if optimal scenario criteria are met. Methods: We longitudinally investigated retention in HIV care, viral suppression, and infant follow-up in a prospective multicentre HIV cohort study of WLWH in the optimal scenario who had a live birth between January 2000 and December 2018. Risk factors for adverse outcomes in the first year postpartum were assessed using logistic and proportional hazard models. Findings: Overall, WLWH were retained in HIV care for at least six months after 94.2% of the deliveries (694/737). Late start of combination antiretroviral therapy (cART) during the third trimester was found to be the main risk factor for failure of retention in HIV care (crude odds ratio [OR] 3.91; 95% confidence interval [CI], 1.50-10.22; p = 0.005). Among mothers on cART until at least one year after delivery, 4.4% (26/591) experienced viral failure, with illicit drugs use being the most important risk factor (hazard ratio [HR], 13.2; 95% CI, 2.35-73.6; p = 0.003). The main risk factors for not following the recommendations regarding infant follow-up was maternal depression (OR, 3.52; 95% CI, 1.18-10.52; p = 0.024). Interpretation: Although the results are reassuring, several modifiable risk factors for adverse postpartum outcome, such as late treatment initiation and depression, were identified. These factors should be addressed in HIV care of all WLWH, especially those opting to breastfeed in resource-rich countries. Funding: This study has been financed within the framework of the Swiss HIV Cohort Study, supported by the Swiss National Science Foundation (grant #201369), by SHCS project 850 and by the SHCS research foundation.

Comparison of clinical presentation of respiratory tract infections in H1N1/09-positive and H1N1/09-negative patients.

UNLABELLED: The true burden of influenza in children is difficult to assess and is probably underestimated as clinical signs are usually nonspecific, and formal viral identification is rarely searched. In this study, we compare the clinical features of infections related to the new H1N1/09 influenza virus with infections due to other respiratory viruses in children consulting in a tertiary care pediatric hospital in Geneva. Between October 1, 2009 and February 10, 2010, 109 patients were recruited, with a median of age of 7 years (range 0.1-18). There were 75 H1N1/09-positive patients (69%), and 32 (43%) had identified risk factors such as asthma or a history of wheezing. Fever (87%), cough (92%), and rhinitis (85%) were the most frequent reported presenting symptoms in both patient groups. H1N1/09-positive patients were significantly older (median of 8.2 vs. 4.6 years) and were more likely to have risk factors (43% vs. 24%) and myalgias (41% vs. 20%). H1N1/09-negative patients had more wheezing episodes (29% vs. 9%), higher rates of dyspnea (28% vs. 20%) and of hospital admissions (35% vs. 16%). CONCLUSION: Clinical signs cannot reliably differentiate H1N1/09-positive and H1N1/09-negative patients, although we found a higher proportion of myalgias in H1N1/09-positive patients. Severity of disease was lower in H1N1/09-positive than in H1N1/09-negative patients, mostly because of a higher proportion of asthma/wheezing episodes among H1N1/09-negative patients.

[Zinc and diarrhea in children under 5 years: WHO recommendations implemented in Switzerland]. / Zinc et diarrhées chez les enfants de moins de cinq ans: les recommandations de l'OMS applicables en Suisse?

In Europe, acute diarrhea, particularly caused by rotavirus are frequently the cause of epidemics in nurseries, schools, and even hospitals. Studies in many developing countries show that taking 10 to 20 mg per day of zinc for 10 to 14 days, during and after diarrhea, decreases the severity and reduces the number of episodes of diarrhea occurring within 2 to 3 months following the intake of zinc. However, the few studies conducted in developed countries do not confirm or deny its effectiveness in these countries, thereby limiting the global implementation of WHO recommendations for acute diarrhea. The ongoing study at the HEL (Children hospital - Lausanne) aims to promote this additional therapy in children under 5 years of age, perhaps allowing the helvetic application of the new WHO recommendations.