Do changes in STEC diagnostics mislead interpretation of disease surveillance data in Switzerland? Time trends in positivity, 2007 to 2016.

BackgroundLaboratory-confirmed cases of Shiga toxin-producing Escherichia coli (STEC) have been notifiable to the National Notification System for Infectious Diseases in Switzerland since 1999. Since 2015, a large increase in case numbers has been observed. Around the same time, syndromic multiplex PCR started to replace other diagnostic methods in standard laboratory practice for gastrointestinal pathogen testing, suggesting that the increase in notified cases is due to a change in test practices and numbers.AimThis study examined the impact of changes in diagnostic methods, in particular the introduction of multiplex PCR panels, on routine STEC surveillance data in Switzerland.MethodsWe analysed routine laboratory data from 11 laboratories, which reported 61.9% of all STEC cases from 2007 to 2016 to calculate the positivity, i.e. the rate of the number of positive STEC tests divided by the total number of tests performed.ResultsThe introduction of multiplex PCR had a strong impact on STEC test frequency and identified cases, with the number of tests performed increasing sevenfold from 2007 to 2016. Still, age- and sex-standardised positivity increased from 0.8% in 2007 to 1.7% in 2016.ConclusionIncreasing positivity suggests that the increase in case notifications cannot be attributed to an increase in test numbers alone. Therefore, we cannot exclude a real epidemiological trend for the observed increase. Modernising the notification system to address current gaps in information availability, e.g. diagnostic methods, and improved triangulation of clinical presentation, diagnostic and serotype information are needed to deal with emerging disease and technological advances.

Did COVID-19 Policies Have the Same Effect on COVID-19 Incidence Among Women and Men? Evidence From Spain and Switzerland.

Objective: This study aimed to investigate how COVID-19 prevention policies influenced the COVID-19 incidence in men and women. Methods: We conducted a retrospective longitudinal study using the Swiss Federal Office of Public Health and the Spanish Ministry of Health surveillance data for February 2020-June 2021 to explore sex and age differences in COVID-19 cases and testing. The female-male incidence rate ratios (IRR) were estimated for each week of the pandemic. We complemented our analysis with qualitative information on relevant containment measures in each country. Results: In Switzerland and in Spain, there was an excess of cases in women of 20-59 years old and 80+. This excess of cases was significant during the waves of the pandemic in both countries. In Switzerland, the biggest difference was observed for the age group 20-29, reaching an excess of 94% of cases compared to men during the first wave of COVID-19 (March-May 2020). The excess of cases in women was greater in Spain than in Switzerland, where it reached 159% for women aged 20-29 during the first wave (March-June 2020). In both countries, the age groups 60-79 had a significant excess of cases in men during the pandemic. Conclusion: COVID-19 public health policies affect men and women in different ways. Our findings highlight the importance of gender-sensitive responses to address a public health crisis.

From Public Health Policy to Impact for COVID-19: A Multi-Country Case Study in Switzerland, Spain, Iran and Pakistan.

Objectives: With the application of a systems thinking lens, we aimed to assess the national COVID-19 response across health systems components in Switzerland, Spain, Iran, and Pakistan. Methods: We conducted four case studies on the policy response of national health systems to the early phase of the COVID-19 pandemic. Selected countries include different health system typologies. We collected data prospectively for the period of January-July 2020 on 17 measures of the COVID-19 response recommended by the WHO that encompassed all health systems domains (governance, financing, health workforce, information, medicine and technology and service delivery). We further monitored contextual factors influencing their adoption or deployment. Results: The policies enacted coincided with a decrease in the COVID-19 transmission. However, there was inadequate communication and a perception that the measures were adverse to the economy, weakening political support for their continuation and leading to a rapid resurgence in transmission. Conclusion: Social pressure, religious beliefs, governance structure and level of administrative decentralization or global economic sanctions played a major role in how countries' health systems could respond to the pandemic.