Hepatitis C virus therapy is associated with lower health care costs not only in noncirrhotic patients but also in patients with end-stage liver disease.

BACKGROUND: The effect of anti-viral treatment on downstream costs for hepatitis C virus (HCV)-infected patients is unknown. AIM: To evaluate follow-up costs in patients with chronic HCV, stratified by liver disease severity. METHODS: Using a US private insurance database, mean all-cause per-patient-per-month (PPPM) US (2010) medical costs were calculated for HCV-infected persons who did and did not receive anti-HCV treatment between January 2002 and August 2010. Analysis was stratified by liver disease severity [noncirrhotic disease (NCD), compensated cirrhosis (CC) or end-stage liver disease (ESLD)] defined by ICD-9 and CPT codes. RESULTS: A total of 33 309 patients were included (78% NCD, 7% CC and 15% ESLD); 4111 individuals (12%) received anti-HCV treatment during the 2-year baseline period. Mean PPPM follow-up health care costs were significantly lower among treated patients with NCD ($900 vs. $1378 in untreated patients, P < 0.001) and ESLD ($3634 vs. $5071, P < 0.001) groups but not in the CC group ($1404 vs. $1795, P < 0.071; t-test). In a multivariable model adjusted for demographic characteristics, comorbidities, index date and geographical region, incremental cost ratios for total health care costs differed significantly (P < 0.001) between treated and untreated patients in the NCD and ESLD groups but not in the CC group. From this model, mean PPPM total health care costs between treated and untreated patients were $885 and $1370 in the NCD, $1369 and $1802 in the CC, and $3547 and $5137 in the ESLD groups, respectively. CONCLUSIONS: Anti-HCV therapy was associated with lower follow-up US health care costs, and these savings were independent of baseline patient comorbidities and stage of disease.

Absolute and relative contraindications to pegylated-interferon or ribavirin in the US general patient population with chronic hepatitis C: results from a US database of over 45 000 HCV-infected, evaluated patients.

BACKGROUND: Chronic hepatitis C (HCV) treatment with pegylated-interferon (PEG-IFN)/ribavirin (RBV) is often limited by preexisting medical, psychiatric and psychosocial contraindications. However, limited data exist in general patient populations. AIM: To evaluate the percentage of HCV-infected patients in the general US population who may have contraindications to PEG-IFN/RBV. METHODS: The General Electric (GE) Centricity dataset was used to screen the US population between 2004 and 2009 for HCV infection and contraindications to PEG-IFN/RBV. HCV diagnosis and contraindications were identified using ICD-9-CM codes or laboratory values. Only patients with an encounter 180 days prior to HCV diagnosis were included. Demographic differences were calculated using Pearson's chi-squared test. Frequencies and percentages for absolute and relative contraindications to PEG-IFN and/or RBV were determined and proportions and rates/1000 person-months were calculated. RESULTS: A total of 15 561 021 patients were screened, and 45 690 (0.3%) were HCV-positive and were evaluated. Those with contraindications were significantly younger, female, White, not currently married and receiving Medicare or Medicaid coverage (all P < 0.0001). 17.3% had at least one contraindication to PEG-IFN/RBV (5.5 events/1000 person-months); bipolar disorder (6.5%), anaemia (Hgb < 10 g/dL; 5.9%), pregnancy (1.9%) and neutropenia (neutrophils <750 cells/mm(3) ; 1.2%) were most frequently cited. CONCLUSIONS: Approximately, 17% of HCV-infected patients in the general US population had at least one contraindication to PEG-IFN/RBV. Most contraindications were relative and potentially modifiable. Clinical assessment of contraindications as relative and/or modifiable should be considered and used to determine if patients could benefit from current PEG-IFN-containing triple therapy or future PEG-IFN- or RBV-free regimens.

Antimicrobial resistance in Swiss laying hens, prevalence and risk factors.

Antimicrobial resistance is an emerging concern to public health, and food-producing animals are known to be a potential source for transmission of resistant bacteria to humans. As legislation of the European Union requires to ban conventional cages for the housing of laying hens on the one hand, and a high food safety standard for eggs on the other hand, further investigations about the occurrence of antimicrobial resistance in alternative housing types are required. In this study, we determined antimicrobial resistance in indicator bacteria from 396 cloacal swabs from 99 Swiss laying hen farms among four alternative housing types during a cross-sectional study. On each farm, four hens were sampled and exposure to potential risk factors was identified with a questionnaire. The minimal inhibitory concentration was determined using broth microdilution in Escherichia coli (n=371) for 18 antimicrobials and in Enterococcus faecalis (n=138) and Enterococcus faecium (n=153) for 16 antimicrobials. All antimicrobial classes recommended by the European Food Safety Authority for E. coli and enterococci were included in the resistance profile. Sixty per cent of the E. coli isolates were susceptible to all of the considered antimicrobials and 30% were resistant to at least two antimicrobials. In E. faecalis, 33% of the strains were susceptible to all tested antimicrobials and 40% were resistant to two or more antimicrobials, whereas in E. faecium these figures were 14% and 39% respectively. Risk factor analyses were carried out for bacteria species and antimicrobials with a prevalence of resistance between 15% and 85%. In these analyses, none of the considered housing and management factors showed a consistent association with the prevalence of resistance for more than two combinations of bacteria and antimicrobial. Therefore we conclude that the impact of the considered housing and management practices on the egg producing farms on resistance in laying hens is low.

Diseases in chicks and laying hens during the first 12 years after battery cages were banned in Switzerland.

Between 1992 and 2003, a period of 12 years after the definitive ban on battery cages in Switzerland, more than 10,000 replacement chicks and laying hens were examined postmortem. There was a significant decrease in the incidence of viral diseases, mostly due to a reduction in Marek's disease, but there was a marked increase in bacterial diseases, particularly since 1999, mainly due to colisepticaemia in young laying hens. There was a steady decrease in parasitic infections, but the incidence of non-infectious diseases varied from year to year, with no clear trends. There were no significant emerging diseases or economic losses in the alternative housing systems. Vaccination and hygiene were the most effective precautions against infections, and control strategies brought about a marked decline in notifiable diseases, especially for Salmonella Enteritidis. Fifteen years after the ban on battery cages in Switzerland, the health and egg production of laying hens is good.

Characterization of western European field isolates and vaccine strains of avian infectious laryngotracheitis virus by restriction fragment length polymorphism and sequence analysis.

Infectious laryngotracheitis is a dramatic disease of the upper respiratory tract in poultry caused by a herpesvirus. In this study we investigated the characteristics of western European field isolates of infectious laryngotracheitis virus (ILTV) to gain more information on their diversity. The examined 104 isolates, collected from acute outbreaks during the last 35 years, originated from eight different countries: Switzerland (48), Germany (21), Sweden (14), the United Kingdom (9), Italy (5), Belgium (4), Austria (2), and Norway (1). Two vaccines, a chicken embryo origin product and a tissue culture origin product, were included in the survey. Polymerase chain reaction (PCR) was performed to amplify a 2.1-kb DNA fragment of ILTV using primers generated for the thymidine kinase (TK) gene. After digestion of the resulting PCR products by restriction endonuclease HaeIII, restriction fragment length polymorphism analysis was carried out. PCR amplicons of three field isolates and both vaccine strains were selected for sequencing. Here 98 field isolates showed the same cleavage pattern and were identical to both vaccine strains (clone 1). They differed from five Swiss isolates with identical cleavage pattern (clone 2) and one Swedish isolate (clone 3). The present study demonstrated that at least three clones of ILTV have been circulating in western Europe during the last 35 years. The 104 isolates analyzed showed a high genetic similarity regarding the TK gene, and a large majority of the field isolates (98/104) were genetically related to the vaccine strains.

[Avian influenza: wildbird monitoring in Switzerland between 2003-2006]. / Aviäre Influenza: Wildvogelmonitoring in der Schweiz zwischen 2003-2006.

During various surveillance programs more than 3500 cloacal swabs and organ samples from songbirds, waterbirds and poultry have been tested for avian influenza using real time RT-PCR. Switzerland carried out the first wildbird monitoring between autumn 2003 and spring 2005. 1053 samples, mostly from songbirds, were tested. LPAI-strains were found in two cases. A second intensified surveillance program started in October 2005 along with the first ban on free range poultry farming. Until the end of April 2006 2455 cloacal swabs from dead wildbirds have been analysed. By the end of february H5N1 was for the first time detected in Switzerland and by the end of march 32 waterbirds have been found positive for H5N1. 146 poultry flocks with a special permission for free range management proved to be AI negative.

[Carbofuran poisoning in mallard ducks]. / Carbofuran-Vergiftung bei wildlebenden Stockenten.

Carbofurane, a pesticide from the group of carbamates, has been employed against soil nematodes on a small meadow at the lake of Lugano, Switzerland. On the next morning, the first cases of death involving a total of 19 mallard ducks (Anas platyrhynchos) have been reported. By inhibiting the enzymatic breakdown of the neurotransmitter acetycholine, carbamates lead to excessive activation of the parasympathicus. In addition, paralysis of skeletal muscles is caused by continued stimulation of neuromuscular junctions. Death may occur by asphyxia. In the present case report, the diagnosis of poisoning could be confirmed by the chemical detection of carbofuran in the stomach, blood, muscle and kidney tissue of the affected mallard ducks.

[Wild birds--a reservoir for influenza A virus]. / Aviäre Influenza--die Sicht der Veterinärmedizin.

Influenza A viruses, in particular the H5 and H7 subtypes, have caused epizootic diseases in poultry for a long time. Wild aquatic birds and shorebirds form the natural virus reservoir. All influenza virus subtypes and almost all possible haemagglutinin/neuraminidase combinations have been detected in wild birds, whereas relatively few have been detected in humans and other mammals. In 1997, the emerging and spreading of the highly pathogenic strain H5N1 within Asia was supported by lack of hygiene in commercial poultry units and by the existence of live bird markets. During autumn 2005, migratory birds have been accused for spreading the infection along their flyways to Europe including Switzerland. For early detection of introduction to Europe, many countries have initiated surveillance programs for avian influenza in wild birds. Vaccines against influenza A viruses are existing for birds and are widely used to protect domestic fowl in endemic regions of Asia as well as valuable birds in zoos worldwide. Subtype H5N1 could be the progenitor virus of a new pandemic influenza virus. Therefore, the World Organisation for Animal Health (OIE, Paris) as well as the Food and Agriculture Organisation of the United Nations (FAO, Rome) will need to increase their efforts to assist countries to combat the disease in the field.

[Suckling mortality in fattening rabbits in Switzerland]. / Untersuchung zur Säuglingsmortalität bei Mastkaninchen in der Schweiz.

The aims of this project were to determine mortality rate and aetiology of losses in suckling rabbits during the first 14 days of life. Post-mortem examinations were done on 1096 siblings from 8 conventional farms. Mortality rates varied from 0 to 17.0%. Main death causes were non-infectious and included stillbirth (13.9%), weakness due to reduced birth weight (3.0%), starvation (11.6%), runting (11.6%), cannibalism (0.5%) and scattering (7.9%). The last four causes mainly attributed to insufficient nursing by the doe. Only 21.8% of the losses were of infectious aetiology.

[Avian leukosis subgroup J in broiler breeders in Switzerland]. / Aviäre Leukose Subtyp J bei Mastelterntieren in der Schweiz.

Since a new envelope subgroup (J) of the avian leukosis-sarcomatosis-complex was isolated for the first time from broiler breeders in the United Kingdom in 1989 and was characterized and associated with myeloid leukosis (syn. myelocytomatosis) the emergence of this subgroup was reported from all over the world. Thus the first known case of subgroup J avian leukosis in Switzerland in four imported broiler breeder flocks will be described. A total of 53 broiler breeder birds from four flocks showing reduced performance and increased mortality were submitted for postmortem examination. Approximately 20 blood samples from each flock were monitored serologically for antibodies against avian leukosis virus subgroup J (ALV-J). On necropsy myeloid leukosis (ML) was diagnosed in all four flocks. Furthermore the blood samples of three flocks showed significant ELISA-titres for ALV-J.

Serum concentrations of 17beta-estradiol and estrone after multiple-dose administration of percutaneous estradiol gel in symptomatic menopausal women.

In two multicenter phase III efficacy studies, blood samples were obtained to evaluate the serum concentrations of 17beta-estradiol (E2) and unconjugated estrone (E1) after administration of a percutaneous gel or transdermal patch containing estradiol. In postmenopausal women, normal laboratory E2 and E1 serum concentrations range from 10-30 pg/mL and 20-40 pg/mL, respectively. Study subjects were healthy postmenopausal women with moderate to severe hot flushes occurring at least seven times daily or 60 times per week. Study 1 was a randomized, double-blind, multicenter study of percutaneous E2 gel 1.25 or 2.5 g (0.75 and 1.5 mg E2, respectively) versus placebo gel. Study 2 was a double-blind (blinded to E2 gel dose), randomized, active-controlled, multicenter, 12-week phase 3 study of E2 gel 0.625, 1.25, or 2.5 g (0.375, 0.75, or 1.5 mg E2, respectively) versus a transdermal E2 patch delivering 0.05 mg E2 per day. Serum E2 and E1 concentrations were evaluated at baseline and at week 12 for study 1 and at baseline and weeks 4, 8, and 12 for study 2 using radioimmunoassay. Median serum concentrations of E2 after 1.25- and 2.5-g gel administration appeared to be dose-proportional throughout both studies. In study 1, the median serum concentrations of E2 at week 12 were 33.5 and 65.0 pg/mL for 1.25- and 2.5-g gel dose, respectively. The corresponding E1 values were 49.0 and 58.0 pg/mL. In study 2, both E2 and E1 concentrations were relatively stable at weeks 4, 8, and 12. E2 values at week 12 for 0.625-, 1.25-, and 2.5-g gel doses and E2 patch were 25.0, 32.0, 60.0, and 38.5 pg/mL, respectively. The corresponding E1 values were 39.0, 41.0, 62.5, and 40.0 pg/mL. Application of the 1.25-g gel dose and a transdermal patch delivering 50 microg per day of E2 resulted in comparable median E2 and E1 concentrations. However, the 0.625-g gel dose did not produce E2 levels in a range expected to be consistently therapeutic in most postmenopausal women.

Experimental enteric infection of gnotobiotic piglets with a Chlamydia psittaci strain of avian origin.

The pathogenicity of a Chlamydia psittaci isolate of pigeon origin was assessed using a litter of gnotobiotic piglets. At 3 days of age, six piglets were inoculated intragastrically with egg-grown chlamydiae, the remaining six pigs were sham-inoculated. The animals were observed for clinical signs, and they were killed and necropsied sequentially between 4 and 15 days of age. Clinical manifestations consisted of slight softening of the faeces between 6 and 10 days post-inoculation (DPI). Immunohistochemistry revealed chlamydial replication predominantly in the small intestine, initially within villous enterocytes, after 4 DPI mostly in the lamina propria. Histopathology showed villous atrophy and increased numbers of inflammatory cells in the gut up to 6 DPI. Chlamydial stages of normal morphology were identified within enterocytes using transmission electron microscopy. An enzyme-linked immunosorbent assay (ELISA) run on faecal samples revealed shedding of chlamydial antigen from 3 until 11 DPI. Systemic dissemination of Chlamydia occurred to a limited extent according to polymerase chain reaction and immunohistochemistry results of several extraintestinal organs. Corresponding histopathological changes were minimal. Sera of all pigs were negative for anti-chlamydial antibodies using a complement fixation test. In conclusion, inoculation of this isolate in gnotobiotic piglets resulted in a productive enteric infection with mild lesions, weak systemic dissemination, and faecal shedding, indicating the pig as a potential host for avian chlamydiae.