[Update of the 2019 Swiss immunization schedule 7 new recommendations and review of practical implications for health professionals]. / Nouveautés du Plan vaccinal suisse 2019 - Sept nouvelles recommandations et implications pratiques pour les praticiens.

The Swiss 2019 immunization schedule published includes 7 news clauses: 1) DTPa-IPV-Hib-HBV vaccination in newborns with the simplified dosing schedule "2+1"; 2) recommendation for vaccination against measles, mumps and rubella administered at 9 and 12 months of age; 3) pneumococcal immunization in children under 5 years of age as a basic recommendation; 4) replacement of the monovalent capsular group C meningococcal conjugate vaccine by the quadrivalent ACWY conjugate vaccine (Menveo); 5) extension of vaccination against tick-borne encephalitis virus to the entire Swiss territory - with the exception of the cantons of Geneva and Tessin - in people with risk factors for contagion; 6) replacement of Gardasil® with Gardasil 9® since January 2019; 7) recommendation for vaccination against hepatitis B in newborns.

Le Plan de vaccination 2019 comprend sept nouveautés: 1) la vaccination DTPa-IPV-Hib-HBV chez le nourrisson avec le schéma simplifié à « 2+1 ¼ doses; 2) la recommandation de la vaccination contre la rougeole, les oreillons et la rubéole (ROR) à 9 et 12 mois; 3) la vaccination contre les pneumocoques chez les enfants de moins de 5 ans comme recommandation de base; 4) le remplacement du vaccin conjugué monovalent contre le méningocoque C par le vaccin conjugué quadrivalent ACWY (Menveo); 5) l'élargissement de la vaccination contre l'encéphalite à tique verno-estivale (FSME) à tout le territoire suisse, à l'exception des cantons de Genève et du Tessin, chez les sujets présentant un facteur de risque d'exposition; 6) le remplacement de Gardasil par Gardasil 9 depuis janvier 2019 et 7) la recommandation de la vaccination contre l'hépatite B pour les nourrissons.

Successful treatment of severe disruptive disorder featuring symptoms of the Klüver-Bucy Syndrome following a massive right temporal-parietal hemorrhage.

We know little about effective treatment for patients suffering from partial or complete Klüver-Bucy Syndrome (KBS) and other disruptive behaviors following a stroke. Reported cases have shown that certain medication, given alone or combined, can be partially effective. In this specific case study, we will try to demonstrate the effectiveness of a combination of carbamazepine, clonidine, quetiapine and methylphenidate in the alleviating of these symptoms. The wide range of symptoms found in KBS led us to use several kinds of psychotropic medication in spite of the inherent risks associated to polypharmacy.

[Vaccination of asylum seekers in the canton Vaud, Switzerland]. / Vaccination des requérants d'asile dans le canton de Vaud.

Even if only a small proportion of asylum seekers obtains a permanent resident permit, a significant number of them stay for a prolonged or indefinite period in Switzerland in a legal or illegal way. The asylum seekers can be either vectors or victims of infectious diseases. Some of these diseases can be prevented by vaccination. This article summarizes the recent decisions which have been taken in the canton Vaud concerning the vaccination of asylum seekers. These new recommendations privilege a large coverage of a maximum number of asylum seekers. Vaccinations against varicella and human papillomavirus will be proposed in addition to the already previously recommended vaccines. Finally the medical visits for the vaccinations will also be an opportunity to screen for chronic hepatitis B which has been neglected until now.

Rabies postexposure prophylaxis in routine practice in view of the new Centers for Disease Control and Prevention and World Health Organization recommendations.

BACKGROUND: New recommendations for rabies postexposure prophylaxis (PEP) were published by the Centers for Disease Control and Prevention and the World Health Organization in 2010. In view of these new recommendations, we investigated the adequacy of rabies PEP among patients consulting our travel clinic. METHODS: A retrospective analysis of the files of all patients who consulted for rabies PEP at the Travel Clinic of the University Hospital in Lausanne, Switzerland, between January 2005 and August 2011 was conducted. RESULTS: A total of 110 patients who received rabies PEP were identified. The median age of the patients was 34 years (range, 2-79 years), and 53% were women. Ninety subjects were potentially exposed to rabies while travelling abroad. Shortcomings in the management of these patients were (1) late initiation of rabies PEP in travelers who waited to seek medical care until returning to Switzerland, (2) administration of human rabies immunoglobulin (HRIG) to only 7 of 50 travelers (14%) who sought care abroad and for whom HRIG was indicated, and (3) antibody levels <0.5 IU/mL in 6 of 90 patients (6.7%) after 4 doses of vaccine. CONCLUSIONS: Patients do not always receive optimal rabies PEP under real-life conditions. A significant proportion of patients did not develop adequate antibody levels after 4 doses of vaccine. These data indicate that the measurement of antibody levels on day 21 of the Essen PEP regimen is useful in order to verify an adequate immune response.

Detection of cognitive impairment and dementia using the animal fluency test: the DECIDE study.

OBJECTIVES: To evaluate the performance of a one-minute screening test measured against a validated 10-minute screening test for mild cognitive impairment (MCI) in detecting CI in patients aged > or = 65 years with two or more vascular risk factors (VRF). METHODS: Patients (n=1523) aged 65 years or older without documented CI symptoms or dementia with two or more VRF participated in this study set in Canadian primary care practice. Baseline data was collected, followed by the 1-minute animal fluency (AF) test and the 10-minute Montreal Cognitive Assessment (MoCA). Physicians (n=122) completed case reports during patient interviews and reported their diagnostic impression. AF test sensitivity, specificity, and accuracy in predicting a positive MoCA was assessed. RESULTS: Study sample mean age was 79.7 years, 55% were female, 97.6% were Caucasian and 75% had < or = 12 years of education. The AF test and MoCA detected CI in 52 and 56 percent of the study population, respectively. The AF test demonstrated sensitivity, specificity, and accuracy in predicting a positive MoCA of 67 percent each. Physicians diagnostic impression of MCI was reported for 37% of patients, and of dementia for 6%. CONCLUSION: In an elderly population with at least two VRF, using AF can be useful in detecting previously unknown symptoms of CI or dementia. Screening for CI in this high risk population is warranted to assist physician recognition of early CI. The short AF administration time favours its incorporation into clinical practice.

Cognitive-behavioural, pharmacological and psychosocial predictors of outcome during tapered discontinuation of benzodiazepine.

Eighty-six participants wishing to stop benzodiazepine and who met DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th ed. American Psychological Association, 1994) criteria for anxiety disorder or insomnia were assessed pre- and post-taper on clinical, pharmacological and psychosocial measures. An initial cohort of 41 participants received treatment as usual (taper only) plus physician counselling in the same clinic setting. A second cohort of 45 participants were randomly allocated to group cognitive-behavioural therapy (CBT) plus taper, or group support (GS) plus taper. At 3 months follow-up, the outcomes in both the CBT and the GS subgroups were equivalent. Intention to treat analysis revealed a slight advantage to the CBT over the GS group and the CBT group showed higher self-efficacy post-taper.Over all 86 participants, a high-baseline level of psychological distress, anxiety and dosage predicted a poor outcome, but increase in self-efficacy contributed to a successful outcome particularly in those with initially poor baseline predictors. Although there was a decrease in positive affect during preliminary stages of tapered discontinuation compared to baseline, there was no significant overall increase in negative affect.

[Pilgimage and other mass gatherings: epidemiology and prevention]. / Pèlerinages et grands rassemblements: épidémiologie et prévention.

Hajj is the typical example of a mass gathering. Pilgrims should receive appropriate counselling. Following the late 20th century epidemics, meningococcal ACWY vaccination is obligatory for Saudi Arabia. Respiratory illnesses are frequent and influenza vaccination recommended. Elderly and ill travellers should be aware of the physical constrains during the pilgrimage and the risk of trauma. No epidemic was detected during big sports events, but surveillance is warranted and recommendations need to take local factors into account. Epidemics of influenza and norovirus infections are frequently reported during cruises. Elderly or ill people should be immunized against flu and all tourists should receive adequate counselling on measures of hygiene.

Malaria chemoprophylaxis: what do the travelers choose, and how does pretravel consultation influence their final decision.

Three different drugs (mefloquine, atovaquone/proguanil, doxycycline) are recommended for malaria chemoprophylaxis, each with approximately the same efficacy but various adverse event profiles, regimens, and prices. We investigated which medication the travelers would have chosen on the basis of written evidence-based information and the impact that pretravel consultation had on their decision. A prospective study was performed in a travel clinic and private practice, and 1073 travelers were included; 45% chose mefloquine (Lariam or Mephaquine), 21% atovaquone/proguanil (Malarone), 18% doxycycline (Supracycline), 5% "no prophylaxis," and 11% "do not know." Lariam was principally chosen because of prior experience (38%), Mephaquine because of low price (34%), and doxycycline and Malarone because of the profile of adverse events (55% and 43%, respectively). Based on objective written information, travelers most frequently chose mefloquine for chemoprophylaxis. This suggests that evidence-based information weighs more heavily than negative publicity. Taking into account the perspective of the user should improve appropriateness of the pretravel advice.

[Early detection and treatment of panic disorder with or without agoraphobia: update]. / L'identification et traitement du trouble panique avec ou sans agoraphobie: Mise a jour.

OBJECTIVE: To describe for family physicians screening, diagnosis, and treatment of panic disorder with or without agoraphobia (PD/A). QUALITY OF EVIDENCE: Articles were identified through PsycLIT, PsyINFO, and MEDLINE (1985 to 2006) using the terms panic disorder, psychotherapy, psychosocial treatment, treatment, and pharmacotherapy. Recommendations on treatment choices and guidelines are based on data from high-quality studies only. Information about assessment and diagnosis of PD/A is supported by the most recent epidemiologic studies, as well as expert consensus and opinion. MAIN MESSAGE: Panic disorder with or without agoraphobia is a psychiatric disease frequently encountered in primary care. It appears to be underdiagnosed and undertreated in this medical setting. Early successful screening requires a focus on unexplained symptoms and specific questions aimed at identifying panic attacks and their meaning for patients. The treatment of choice for PD/A is cognitive-behavioral therapy administered by a specialized psychologist or psychiatrist. When such therapy is hard to come by or unavailable, family physicians can prescribe drug therapy. CONCLUSION: Family physicians can contribute greatly to early detection and treatment of PD/A.

Methicillin-resistant Staphylococcus aureus: A public health issue with economic consequences.

BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) has become endemic worldwide in hospitals, and community-associated MRSA is spreading into the community at large. OBJECTIVES: To estimate the current cost of MRSA in Canada and to assess the magnitude of this public health issue. METHODS: An extensive review of the literature was conducted to gather epidemiology, health care resource utilization and cost data for MRSA in Canadian settings. The current MRSA burden was estimated using available cost data and the most recent epidemiology data. RESULTS: The rate of MRSA in Canadian hospitals increased from 0.46 to 5.90 per 1000 admissions between 1995 and 2004, while community-associated MRSA continued to spread into the community. Patients harbouring MRSA required prolonged hospitalization (average 26 days of isolation per patient), special control measures, expensive treatments and extensive surveillance. Total cost per infected MRSA patient averaged $12,216, with hospitalization being the major cost driver (81%), followed by barrier precautions (13%), antimicrobial therapy (4%) and laboratory investigations (2%). The most recent epidemiological data, combined with available cost data, suggest that direct health care cost attributable to MRSA in Canada, including cost for management of MRSA-infected and-colonized patients and MRSA infrastructure, averaged $82 million in 2004 and could reach $129 million in 2010. CONCLUSION: MRSA is a costly public health issue that needs to be tackled if the growing burden of this disease in Canadian hospitals and in the community is to be limited.

Origins and evolution of the Europeans' genome: evidence from multiple microsatellite loci.

There is general agreement that the current European gene pool is mainly derived from Palaeolithic hunting-gathering and Neolithic farming ancestors, but different studies disagree on the relative weight of these contributions. We estimated admixture rates in European populations from data on 377 autosomal microsatellite loci in 235 individuals, using five different numerical methods. On average, the Near Eastern (and presumably Neolithic) contribution was between 46 and 66%, and admixture estimates showed, with all methods, a strong and significant negative correlation with distance from the Near East. If the assumptions of the model are approximately correct, i.e. if the Basques' and Near Easterners' genomes represent a good approximation to the Palaeolithic and Neolithic settlers of Europe, respectively, these results imply that half or more of the Europeans' genes are descended from Near Eastern ancestors who immigrated in Europe 10000 years ago. If these assumptions are incorrect, our results show anyway that clinal variation is the rule in the Europeans' genomes and that lower estimates of Near Eastern admixture obtained from the analysis of single markers do not reflect the patterns observed at the genomic level.

Do travelers really take their mefloquine malaria chemoprophylaxis? Estimation of adherence by an electronic pillbox.

BACKGROUND: Nonadherence to chemoprophylaxis could explain why some travelers get malaria. Adherence is notoriously difficult to assess, and most studies have been conducted using questionnaires. This study aims at assessing continuous adherence more accurately with the help of an electronic pillbox. METHODS: Adult travelers to sub-Saharan Africa had to fill a questionnaire on demographic and travel data, drug intake, and adverse events. They received oral and written information about malaria and mefloquine prophylaxis and a Medication Event Monitoring System (MEMS, Aardex, Zug, Switzerland), ie, a bottle closed with a cap containing a microprocessor recording date and time of all openings, filled with the exact number of mefloquine 250 mg tablets (Lariam, Roche Reinach, Switzerland). The MEMS) was returned with the questionnaire after completion of chemoprophylaxis. RESULTS: According to the MEMS, only 26 of 81 travelers (32.1%) took all the doses at the expected date, another 8 (9.9%) did so but starting late with the first dose, and 19 others (23.5%) took all the pills but with intervals of +/-1 day from the right date. Another eight (9.9%) took all the pills but in a random way. The remaining 20 travelers (24.7%) missed some doses, mainly after return. Strict adherence as assessed by electronic monitoring was therefore lower than adherence measured by questionnaire (32.1% vs 48% in taking all the tablets on the right day). There was no difference between the two methods when a broader definition of adherence was applied [taking all the tablets on the right day (+/-1 day); 53/81 (65.4%)], but the MEMS showed that some answers to the questionnaire were not reliable. CONCLUSION: The use of electronic pillboxes confirms the low adherence of travelers to mefloquine chemoprophylaxis in spite of extensive information about the disease and its prevention. Electronic assessment of pill taking, for the first time applied to malaria chemoprophylaxis, gives new insights into the real adherence of travelers.

Deriving evolutionary relationships among populations using microsatellites and (deltamu)(2): all loci are equal, but some are more equal than others...

Numerous studies have relied on microsatellite DNA data to assess the relationships among populations in a phylogenetic framework, converting microsatellite allelic composition of populations into evolutionary distances. Among other coefficients, (deltamu)(2) and R(st) are often employed because they make use of the differences in allele sizes on the basis of the stepwise mutation model. While it has been recognized that some microsatellites can yield disproportionate interpopulation distance estimates, no formal investigation has been conducted to evaluate to what extent such loci could affect the topology of the corresponding dendrograms. Here we show that single loci, displaying extremely large among-population variance, can greatly bias the topology of the phylogenetic tree, using data from European grayling (Thymallus thymallus, Salmonidae) populations. Importantly, we also demonstrate that the inclusion of a single disproportionate locus will lead to an overestimation of the stability of trees assessed using bootstrapping. To avoid this bias, we introduce a simple statistical test for detecting loci with significantly disproportionate variance prior to phylogenetic analyses and further show that exclusion of offending loci eliminates the false increase in phylogram stability.

Urbanization and Mental Health in China: Linking the 2010 Population Census with a Cross-Sectional Survey.

Along with the rapid urbanization in China, the state of mental health also receives growing attention. Empirical measures, however, have not been developed to assess the impact of urbanization on mental health and the dramatic spatial variations. Innovatively linking the 2010 Chinese Population Census with a 2011 national survey of urban residents, we first assess the impact of urbanization on depressive symptoms measured by the Center of Epidemiological Studies Depression Scale (CES-D) of 1288 survey respondents. We then retrieve county-level characteristics from the 2010 Chinese Population Census that match the individual characteristics in the survey, so as to create a profile of the "average person" for each of the 2869 counties or city districts, and predict a county-specific CES-D score. We use this county-specific CES-D score to compute the CES-D score for the urban population at the prefectural level, and to demonstrate the dramatic spatial variations in urbanization and mental health across China: highly populated cities along the eastern coast such as Shenyang and Shanghai show high CES-D scores, as do cities in western China with high population density and a high proportion of educated ethnic minorities.

Mefloquine at the crossroads? Implications for malaria chemoprophylaxis in Europe.

Since its introduction to the market in 1985, mefloquine has been used for malaria chemoprophylaxis by more than 35 million travellers. In Europe, in 2014, the European Medicines Agency (EMA) issued recommendations on strengthened warnings, prescribing checklists and updates to the product information of mefloquine. Some malaria prevention advisors question the scientific basis for the restrictions and suggest that this cost-effective, anti-malarial drug will be displaced as a first-line anti-malaria medication with the result that vulnerable groups such as VFR and long-term travellers, pregnant travellers and young children are left without a suitable alternative chemoprophylaxis. This commentary looks at the current position of mefloquine prescribing and the rationale of the new EMA recommendations and restrictions. It also describes the new recommendations for malaria prophylaxis that have been adapted by Switzerland, Germany, Austria and Italy where chemoprophylaxis use is restricted to high-risk malaria-endemic areas.

Clinical and laboratory predictors of imported malaria in an outpatient setting: an aid to medical decision making in returning travelers with fever.

No evidence-based information exists to guide clinicians for giving presumptive treatment to returning travelers when malaria is strongly suspected on clinical grounds but laboratory confirmation is not immediately available or is negative. A prospective study was conducted in travelers or migrants who sought care for fever to identify clinical and laboratory predictors of Plasmodium parasitemia. A total of 336 questionnaires were collected (97 malaria case patients and 239 controls). Multivariate regression analysis showed inadequate prophylaxis, sweating, no abdominal pain, temperature > or = 38 degrees C, poor general health, enlarged spleen, leucocytes < or = 10 x 10(3)/L, platelets < 150 x 10(3)/L, hemoglobin < 12 g/dL, and eosinophils < or = 5% to be associated with parasitemia. Enlarged spleen had the highest positive likelihood ratio for a diagnosis of malaria (13.6), followed by thrombopenia (11.0). Posttest probabilities for malaria were 85% with enlarged spleen and 82% with thrombopenia. A rapid assessment can thus help to decide whether a presumptive treatment should be given or not, especially when the results of the parasitological examination are not immediately available or are uncertain.

Increased use of antibiotics in clozapine-treated patients.

A retrospective chart review of hospitalized patients was completed to verify whether there were differences in the prescription rate of antibiotics to patients treated with clozapine. Subjects were inpatients with a diagnosis of schizophrenia or schizoaffective disorder. Charts of all patients who received clozapine for 24 consecutive months during a period of 48 consecutive months of hospitalization were selected for the study. For each patient, we compared the number of infections treated with an antibiotic during the 24 months pre-clozapine versus the period when they were treated with clozapine. Our study suggests that the number of antibiotic prescriptions is significantly increased in patients treated with clozapine.

Prevalence rate and reasons for refusals of influenza vaccine in elderly.

More knowledge on the reasons for refusal of the influenza vaccine in elderly patients is essential to target groups for additional information, and hence improve coverage rate. The objective of the present study was to describe precisely the true motives for refusal. All patients aged over 64 who attended the Medical Outpatient Clinic, University of Lausanne, or their private practitioner's office during the 1999 and 2000 vaccination periods were included. Each patient was informed on influenza and its complications, as well as on the need for vaccination, its efficacy and adverse events. The vaccination was then proposed. In case of refusal, the reasons were investigated with an open question. Out of 1398 patients, 148 (12%) refused the vaccination. The main reasons for refusal were the perception of being in good health (16%), of not being susceptible to influenza (15%), of not having had the influenza vaccine in the past (15%), of having had a bad experience either personally or a relative (15%), and the uselessness of the vaccine (10%). Seventeen percent gave miscellaneous reasons and 12% no reason at all for refusal. Little epidemiological knowledge and resistance to change appear to be the major obstacles for wide acceptance of the vaccine by the elderly.

Psychological distress and adaptational problems associated with benzodiazepine withdrawal and outcome: a replication.

The aim of this study was to replicate and extend the findings of O'Connor, Bélanger, Marchand, Dupuis, Elie, and Boyer [Addict. Behav. 24 (1999) 537], which had established a psychosocial profile associated with psychological distress in benzodiazepine (BZD) use. Forty-one participants with anxiety or insomnia, receiving maintenance therapy of BZD for at least 8 weeks, participated in a 20-week, tapered discontinuation protocol with physician counselling. Drug type and use was monitored throughout. Questionnaire measures of anxiety, behavioural inhibition, neuroticism, withdrawal complaints, social support, psychological distress, self-efficacy in coping without BZD, quality of life, positive and negative life events, were completed at baseline, postdiscontinuation, and at 3-month follow-up. Measures of baseline psychological distress and anxiety inhibition were consistently associated with both discontinuation and the emergence of withdrawal complaints. Successful withdrawal was characterized by low baseline neuroticism, low behavioural inhibition, higher number of positive events, and higher level of social support satisfaction. Higher dosage (in diazepam equivalent dose) was associated with both poorer outcome and the emergence of withdrawal symptoms. Self-efficacy in coping was negatively associated with relapse but not with outcome. Psychosocial factors play a role at different stages of the BZD withdrawal process and could be targeted in treatment.