RESUMEN
We describe a human papillomavirus (HPV) vaccination program implemented since 2007 in Geneva Canton, Switzerland, that used school services, a public hospital, and private physicians as vaccination providers. We assessed program performance with the evolution of immunization coverage during the first four years of program implementation. We measured vaccination coverage of the target population using individual records of vaccination status collected by service providers and transmitted to the Geneva Canton Medical Office. The target population was 20,541 adolescent girls aged 11-19 years as of September 1, 2008, who resided in the canton when the program began. As of June 30, 2012, HPV vaccination coverage was 72.6% and 74.8% in targeted cohorts for three and two doses, respectively. The global coverage for three doses increased by 27 percentage points from December 2009 to June 2012. Coverage for girls aged 16-18 years at the beginning of the program reached 80% or more four years into the program. High coverage by this HPV vaccination program in Geneva was likely related to free vaccination and easy access to the vaccine using a combination of delivery services, including school health services, a public hospital, and private physicians, covering most eligible adolescent girls.
Asunto(s)
Programas de Inmunización/organización & administración , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Atención Primaria de Salud/organización & administración , Servicios de Salud Escolar/organización & administración , Adolescente , Femenino , Humanos , SuizaRESUMEN
Bedbugs are hematophagic arthropods spread in the entire world and in all socio cultural environment. An augmentation of isolated or grouped cases (hotels, hostels, retirement homes) is observed in Geneva since 2012. Clinical manifestations can be various, however a psychological impact exists. To get rid of bedbugs, eradication of the insect from the contaminated room, can be made by different chemical or mechanical ways. These different ways are discussed in this article.
Asunto(s)
Chinches , Infestaciones Ectoparasitarias/prevención & control , Mordeduras y Picaduras de Insectos/epidemiología , Animales , Infestaciones Ectoparasitarias/diagnóstico , Infestaciones Ectoparasitarias/epidemiología , Humanos , Mordeduras y Picaduras de Insectos/diagnóstico , Mordeduras y Picaduras de Insectos/etiología , Suiza/epidemiologíaRESUMEN
BACKGROUND: An increase in new HIV cases among men who have sex with men (MSM) has been reported in Switzerland since 2001. A rapid result HIV testing for MSM through voluntary counselling and testing (VCT) facility ("Checkpoint") was opened in Geneva in 2005. This gay-friendly facility, the first to open in Switzerland, provides testing for sexually transmitted infections (STI) and rapid result HIV testing and counselling. Our objective was to analyze Checkpoint's activity over its first five years of activity and its ability to attract at-risk MSM. METHODS: We used routine data collected anonymously about the facility activity (number of clients, number of tests, and test results) and about the characteristics of the clientele (sociodemographic data, sexual risk behaviour, and reasons for testing) from 2005 to 2009. RESULTS: The yearly number of HIV tests performed increased from 249 in 2005 to 561 in 2009. The annual proportion of positive tests among tests performed varied between 2% and 3%. Among MSM clients, the median annual number of anal intercourse (AI) partners was three. Roughly 30% of all MSM clients had at least one unprotected anal intercourse (UAI) experience in the previous 12 months with a partner of different/unknown HIV status.The main reason for testing in 2007, 2008, and 2009 was "sexual risk exposure" (~40%), followed by "routine" testing (~30%) and "condom stopping in the beginning of a new steady relationship" (~10%). Clients who came to the facility after a sexual risk exposure, compared to clients who came for "routine testing" or "condom stopping" reasons, had the highest number of AI partners in the previous 12 months, were more likely to have had UAI with a partner of different/unknown HIV status in the previous 12 months (respectively 57.3%, 12.5%, 23.5%), more likely to have had an STI diagnosed in the past (41.6%, 32.2%, 22.9%), and more likely to report recent feelings of sadness or depression (42.6%; 32.8%, 18.5%). CONCLUSION: Many of Checkpoint's clients reported elevated sexual risk exposure and risk factors, and the annual proportion of new HIV cases in the facility is stable. This VCT facility attracts the intended population and appears to be a useful tool contributing to the fight against the HIV epidemic among MSM in Switzerland.
Asunto(s)
Consejo , Infecciones por VIH/diagnóstico , Homosexualidad Masculina/estadística & datos numéricos , Adulto , Consejo/métodos , Consejo/estadística & datos numéricos , Femenino , Humanos , Masculino , Factores de Riesgo , Conducta Sexual , Encuestas y Cuestionarios , Suiza/epidemiologíaRESUMEN
OBJECTIVE: The objective of this study is to assess the HPV vaccination coverage of 11-19-year-old girls during a state-coordinated HPV vaccination program in Geneva, Switzerland, from September 2008 to June 2011. METHODS: State Medical Office coordinated the HPV vaccination program. Each service provider transmitted the list of the persons who had received their first, second, or third shot. RESULTS: The global coverage rates, 3 years after the program had been launched, were 63.72% for one dose, 63.22% for two doses, and 61.40% for three doses of the HPV vaccine. CONCLUSION: This study shows that it is possible to obtain a good coverage rates after 3 years of a state-coordinated HPV vaccination program.
Asunto(s)
Papillomavirus Humano 16/inmunología , Papillomavirus Humano 18/inmunología , Programas de Inmunización/estadística & datos numéricos , Vacunas contra Papillomavirus/uso terapéutico , Adolescente , Niño , Femenino , Humanos , Suiza , Adulto JovenRESUMEN
After the occurrence of a case of chickenpox in Switzerland's largest pre-trial prison, protective measures including post-exposure vaccination were implemented, as chickenpox can cause severe complications in adults. Serology for chickenpox was carried out for all contacts of the index case and rapid post-exposure vaccination proposed to all prisoners with a negative history for chickenpox. Susceptibility was found in 14 out of 110 prisoners (12.7%; 95% confidence interval 6.5-18.9). The positive predictive value of a history of chickenpox was 90%. In this predominantly migrant population, susceptibility to chickenpox was approximately 6 times higher than in the general Swiss adult population. Since the attack rate among susceptible household contacts is usually high, preventive measures such as vaccination and quarantine probably allowed containment of the spread of infection.
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Vacuna contra la Varicela/administración & dosificación , Varicela/diagnóstico , Control de Infecciones/métodos , Prisiones , Vacunación/métodos , Adulto , Anticuerpos Antivirales/sangre , Varicela/prevención & control , Humanos , Masculino , Prisioneros , SuizaRESUMEN
Chlamydia trachomatis infection (CTI) is the most frequent sexually transmitted infection in western countries. Its prevalence in undocumented immigrants, a rapidly growing vulnerable population, remains unknown. We aimed to document the prevalence of CTI and associated factors at the primary health care level. This cross-sectional study included all undocumented immigrants attending a health care facility in Geneva, Switzerland. Participants completed a questionnaire and were tested for CTI by PCR assay. Three-hundred thirteen undocumented immigrants (68.4% female, mean age 32.4 (SD 8) years) agreed to participate. CTI prevalence was 5.8% (95% CI 3.3-8.4). Factors associated with higher prevalence were age ≤25 (OR 3.9, 95% CI 1.3-12.2) and having had two or more sexual partners during the precedent year (OR 4.5, 95% CI 1.5-13.7). Prevalence and associated factors for infection in this vulnerable population were comparable with other populations in Western countries. Our findings support the importance of facilitating access to existing screening opportunities in particular to individuals at higher risk.
Asunto(s)
Infecciones por Chlamydia/epidemiología , Chlamydia trachomatis/aislamiento & purificación , Emigrantes e Inmigrantes , Atención Primaria de Salud , Adolescente , Adulto , Infecciones por Chlamydia/etnología , Estudios Transversales , Femenino , Hospitales Universitarios , Humanos , Masculino , Persona de Mediana Edad , Suiza/epidemiología , Adulto JovenRESUMEN
PRINCIPLES: Neisseria gonorrhoeae (NG) resistant to ciprofloxacin (CR) was documented for the first time in Geneva in 2002 and increased from 7% that year to 47% in 2005. We describe NG cases during this period and compare characteristics of CR and ciprofloxacin susceptible (CS) cases. METHOD: Geneva microbiological laboratories identified NG cases. Antimicrobial susceptibility testing (AST) was performed on a sample of reported cases. The attending physicians completed questionnaires on demographic and epidemiological characteristics. Risk exposures were assessed by comparing CR and CS cases using logistic regression. RESULTS: 238 NG cases were reported. Of 91 on which AST was performed, 23 (25%) were CR; 91% of these were male vs 87% of CS patients. Men having sex with men (MSM) represented 38% of CR cases compared with 31% of CS cases (p>0.05). Among CR cases 65% were Swiss compared with 56% of CS cases. Median age was 35 years for both. Casual sexual contacts were reported for 88% of CR cases and 72% of CS cases (p>0.05). The difference between CR and CS cases in terms of sexual activity outside Switzerland (50% and 19% respectively) remained significant after adjusting for sexual preference and nationality (OR: 7.0, CI 95: 1.99-24.6). CONCLUSION: Although CR infection was more common among Swiss MSM, only sexual activity outside Switzerland was independently associated with CR. Physicians should request AST before treatment and reconsider first-line use of ciprofloxacin. Surveillance of gonococcal antimicrobial resistance is essential in monitoring epidemiologic trends and updating recommendations on first-line treatment.
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Antibacterianos/farmacología , Ciprofloxacina/farmacología , Farmacorresistencia Bacteriana , Gonorrea/tratamiento farmacológico , Neisseria gonorrhoeae , Adulto , Antibacterianos/uso terapéutico , Ciprofloxacina/uso terapéutico , Femenino , Gonorrea/epidemiología , Humanos , Masculino , Pruebas de Sensibilidad Microbiana , Factores de Riesgo , Conducta Sexual , Suiza/epidemiologíaRESUMEN
A new pandemic influenza will most probably occur in the future. As the avian flu caused by Influenza A H5N 1 has a clear potential to cause a pandemic, it stimulates ongoing efforts towards a preparedness plan. The involvement of primary care physicians is pivotal in the response to pandemic because of the expected burden and because of these physicians' key role in outpatients management. The aims of this article is to describe what the primary care physicians' contribution would be in case of pandemic and to show two possible organisation models: one involving the practitioners in a dedicated healthcare network specifically set up for pandemic influenza, the other taking advantage of the existing practices.
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Brotes de Enfermedades/prevención & control , Gripe Humana/prevención & control , Rol del Médico , Atención Primaria de Salud , Control de Enfermedades Transmisibles , Humanos , Subtipo H5N1 del Virus de la Influenza ARESUMEN
OBJECTIVES: Trend in immunization coverage of 28 months old children in Geneva, 1995-2000. METHODS: Comprehensive analysis of routinely collected child immunization cards. Sample survey of non-responding parents. RESULTS: Among 25,288 children (response rate, 91%) immunization coverage (three doses) was 96% for diphtheria and tetanus, 94% for whooping-cough and poliomyelitis and 84% for Haemophilus influenzae. Immunization coverage was 88% for measles (one dose). There was no significant change over time. CONCLUSIONS: Immunization coverage can be monitored by routinely collecting data from child immunization cards. Measles vaccination coverage is too low to prevent epidemics in Geneva.
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Vacuna Antisarampión/administración & dosificación , Sarampión/prevención & control , Vacunación/tendencias , Factores de Edad , Recolección de Datos , Difteria/prevención & control , Vacuna contra Difteria, Tétanos y Tos Ferina/administración & dosificación , Vacunas contra Haemophilus/administración & dosificación , Humanos , Sarampión/epidemiología , Vacuna contra el Sarampión-Parotiditis-Rubéola/administración & dosificación , Padres , Vacunas contra Poliovirus/administración & dosificación , Factores de Riesgo , Suiza/epidemiología , Factores de Tiempo , Vacunación/estadística & datos numéricos , Organización Mundial de la SaludRESUMEN
We conducted a randomized clinical trial to assess the effectiveness of a newly established education program for adults with asthma. The program was designed to improve patients' health and functional status. Hospitalized patients with asthma were randomly assigned to immediate education or a 6-month waiting list. The education program consisted of three group sessions, delivered by trained educators, and focused on improving patients' self-management skills. Of 253 eligible patients, 131 agreed to participate (66 assigned to immediate education, 65 controls) and 115 (88%) completed the follow-up assessment at 6 months. At follow-up, most indicators of self-management skills and health and functional status had improved significantly among educated patients, but similar improvements were also seen among controls. The trial arms differed significantly on only four variables: patients in the immediate-education group were more likely to develop confidence in their asthma treatment (odds ratio adjusted for baseline [OR] = 2.9; 95% confidence interval [CI]: 1.0 to 8.1), to improve their knowledge of correct inhalation technique (OR = 2.4; 95% CI: 1.0 to 5.7), and to improve knowledge of the peak flow reading that warrants calling a physician (OR = 3.1; 95% CI: 1.4 to 6.7), but they improved less on the Asthma Quality of Life Questionnaire "activity" score (difference: -0.4 on a 1 to 7 scale; 95% CI: -0.8 to 0.0). Use of health services during follow-up was similar in the two groups. The education program did not enhance patients' health and functional status, despite improving a few self-management skills. These results underscore the need for controlled evaluations of education programs.
Asunto(s)
Albuterol/uso terapéutico , Asma/tratamiento farmacológico , Actitud Frente a la Salud , Broncodilatadores/uso terapéutico , Educación del Paciente como Asunto , Autocuidado/psicología , Terbutalina/uso terapéutico , Adulto , Albuterol/administración & dosificación , Asma/clasificación , Broncodilatadores/administración & dosificación , Femenino , Hospitalización , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud , Calidad de Vida , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios , Terbutalina/administración & dosificaciónRESUMEN
OBJECTIVES AND DESIGN: To investigate the clinical consequences of occasional and short (
Asunto(s)
Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/fisiopatología , Adulto , Terapia Antirretroviral Altamente Activa , Recuento de Linfocito CD4 , Estudios de Cohortes , Progresión de la Enfermedad , Esquema de Medicación , Femenino , Infecciones por VIH/inmunología , Infecciones por VIH/virología , Humanos , Masculino , Estudios Prospectivos , ViremiaRESUMEN
OBJECTIVE: To compare the clinical efficacy and tolerance of didanosine (ddl) monotherapy with low-dose zidovudine/didanosine (AZT/ddl) therapy among HIV-infected patients previously treated with AZT. METHODS: A randomized controlled trial was carried out of ddl 400 mg daily versus AZT/ddl 300/200 mg daily among patients with CD4 cell counts =350 mm3 and prior AZT treatment for at least 16 weeks. Fifty eight patients received ddl monotherapy and 66 combined treatment. RESULTS: Patients were similar with respect to demographic, clinical and laboratory characteristics, and prior AZT treatment. Median duration of follow-up was 17.3 months. In the ddl group, 20 patients (34%) discontinued treatment because of toxicity, compared to 19 (29%) in the AZT/ddl group (p=0.38). There was no statistically significant difference in CD4 change between the two groups. In the ddl group, 16 patients (28%) developed a clinical endpoint (death or AIDS-defining opportunistic infection), compared to 33 (50%) in the combined therapy group (relative risk 1.8; 95% confidence interval 1.1-2.9; p=0.01). CONCLUSIONS: For fairly advanced AZT-pretreated patients, monotherapy with ddl was clinically and statistically superior to the low-dose AZT/ddl combination in preventing AIDS-defining illness and death. When access to drugs is limited, e.g. in under-resourced countries, combining available drugs and reducing dosage may be less effective than a single drug at the conventional dosage.