Tularemia on the rise in Switzerland? A one health approach is needed!

In the last 10 years, an increase in tularemia cases has been observed in both humans and animals in Switzerland. In these, infection with Francisella tularensis, the causative agent of the zoonotic disease tularemia, can occur through arthropod vectors or contact to infected animals or exposure to contaminated environmental sources. Currently, we are only able to postulate potential aetiologies: (i) behavioral changes of humans with more exposure to endemic habitats of infected arthropod vectors; (ii) an increased rate of tularemia infected ticks; (iii) increasing number and geographical regions of tick biotopes; (iv) increasing and/or more diverse reservoir populations; (v) increasing presence of bacteria in the environment; (vi) raised awareness and increased testing among physicians; (vii) improved laboratory techniques including molecular testing. To approach these questions, a one-health strategy is necessary. A functioning collaboration between public health, human medicine, and diagnostic and veterinary units for the control of tularemia must be established. Furthermore, the public should be included within citizen-supported-science-projects.

A combined cross-sectional analysis and case-control study evaluating tick-borne encephalitis vaccination coverage, disease and vaccine effectiveness in children and adolescents, Switzerland, 2005 to 2022.

BackgroundTick-borne encephalitis (TBE) is a severe, vaccine-preventable viral infection of the central nervous system. Symptoms are generally milder in children and adolescents than in adults, though severe disease does occur. A better understanding of the disease burden and duration of vaccine-mediated protection is important for vaccination recommendations.AimTo estimate TBE vaccination coverage, disease severity and vaccine effectiveness (VE) among individuals aged 0-17 years in Switzerland.MethodsVaccination coverage between 2005 and 2022 was estimated using the Swiss National Vaccination Coverage Survey (SNVCS), a nationwide, repeated cross-sectional study assessing vaccine uptake. Incidence and severity of TBE between 2005 and 2022 were determined using data from the Swiss disease surveillance system and VE was calculated using a case-control analysis, matching TBE cases with SNVCS controls.ResultsOver the study period, vaccination coverage increased substantially, from 4.8% (95% confidence interval (CI): 4.1-5.5%) to 50.1% (95% CI: 48.3-52.0%). Reported clinical symptoms in TBE cases were similar irrespective of age. Neurological involvement was less likely in incompletely (1-2 doses) and completely (≥ 3 doses) vaccinated cases compared with unvaccinated ones. For incomplete vaccination, VE was 66.2% (95% CI: 42.3-80.2), whereas VE for complete vaccination was 90.8% (95% CI: 87.7-96.4). Vaccine effectiveness remained high, 83.9% (95% CI: 69.0-91.7) up to 10 years since last vaccination.ConclusionsEven children younger than 5 years can experience severe TBE. Incomplete and complete vaccination protect against neurological manifestations of the disease. Complete vaccination offers durable protection up to 10 years against TBE.

Tuberculosis incidence in foreign-born people residing in European countries in 2020.

BackgroundEuropean-specific policies for tuberculosis (TB) elimination require identification of key populations that benefit from TB screening.AimWe aimed to identify groups of foreign-born individuals residing in European countries that benefit most from targeted TB prevention screening.MethodsThe Tuberculosis Network European Trials group collected, by cross-sectional survey, numbers of foreign-born TB patients residing in European Union (EU) countries, Iceland, Norway, Switzerland and the United Kingdom (UK) in 2020 from the 10 highest ranked countries of origin in terms of TB cases in each country of residence. Tuberculosis incidence rates (IRs) in countries of residence were compared with countries of origin.ResultsData on 9,116 foreign-born TB patients in 30 countries of residence were collected. Main countries of origin were Eritrea, India, Pakistan, Morocco, Romania and Somalia. Tuberculosis IRs were highest in patients of Eritrean and Somali origin in Greece and Malta (both > 1,000/100,000) and lowest among Ukrainian patients in Poland (3.6/100,000). They were mainly lower in countries of residence than countries of origin. However, IRs among Eritreans and Somalis in Greece and Malta were five times higher than in Eritrea and Somalia. Similarly, IRs among Eritreans in Germany, the Netherlands and the UK were four times higher than in Eritrea.ConclusionsCountry of origin TB IR is an insufficient indicator when targeting foreign-born populations for active case finding or TB prevention policies in the countries covered here. Elimination strategies should be informed by regularly collected country-specific data to address rapidly changing epidemiology and associated risks.

The Denominator problem: estimating the size of local populations of men-who-have-sex-with-men and rates of HIV and other STIs in Switzerland.

OBJECTIVES: There is no estimate of the current number of men who have sex with men (MSM) in Switzerland, or of their geographical distribution. We aimed to (1) estimate MSM concentration factors and population sizes for 83 Swiss postal code areas (PCA), including the nine largest Swiss cities, and (2) calculate MSM-specific local HIV prevalence and yearly rates of diagnosed HIV, hepatitis C virus (HCV), syphilis and gonorrhoea. METHODS: We triangulated data from general population estimates, MSM online surveys, published data on HIV prevalence and Swiss notification data for HIV and STDs. We compared two different formulae for the estimation of local MSM populations and calculated Bayesian 95%-credible-intervals (CrI) for each PCA. RESULTS: Across Switzerland, we estimate the MSM population aged 15-64 at roughly 80 000 men (95% CrI 64 000-96 000). (1) MSM in Switzerland were most concentrated in the five largest cities of Zurich, Geneva, Lausanne, Bern and Basel. (2) We estimate that in 2012, 6300 MSM, or 8.0%, were living with HIV, both diagnosed and undiagnosed and 1700 MSM, or 2.2%, had non-suppressed HIV infection. Between 2010 and 2013, average yearly rates of diagnosed HIV, HCV, syphilis and gonorrhoea were 0.3%, 0.02%, 0.4 % and 0.4 %, respectively. CONCLUSIONS: Combining general population data, MSM online surveys and notification data allows the calculation of realistic estimates of local MSM populations and thus proportions of MSM with diagnosed HIV and other STIs, with implications for prevention planning, commissioning of health services and counselling MSM on HIV/STI risk. Our methodology for Switzerland is transferable to other countries with similar data sources.

Standard Genotyping Overestimates Transmission of Mycobacterium tuberculosis among Immigrants in a Low-Incidence Country.

Immigrants from regions with a high incidence of tuberculosis (TB) are a risk group for TB in low-incidence countries such as Switzerland. In a previous analysis of a nationwide collection of 520 Mycobacterium tuberculosis isolates from 2000 to 2008, we identified 35 clusters comprising 90 patients based on standard genotyping (24-locus mycobacterial interspersed repetitive-unit-variable-number tandem-repeat [MIRU-VNTR] typing and spoligotyping). Here, we used whole-genome sequencing (WGS) to revisit these transmission clusters. Genome-based transmission clusters were defined as isolate pairs separated by ≤12 single nucleotide polymorphisms (SNPs). WGS confirmed 17/35 (49%) MIRU-VNTR typing clusters; the other 18 clusters contained pairs separated by >12 SNPs. Most transmission clusters (3/4) of Swiss-born patients were confirmed by WGS, as opposed to 25% (4/16) of the clusters involving only foreign-born patients. The overall clustering proportion was 17% (90 patients; 95% confidence interval [CI], 14 to 21%) by standard genotyping but only 8% (43 patients; 95% CI, 6 to 11%) by WGS. The clustering proportion was 17% (67/401; 95% CI, 13 to 21%) by standard genotyping and 7% (26/401; 95% CI, 4 to 9%) by WGS among foreign-born patients and 19% (23/119; 95% CI, 13 to 28%) and 14% (17/119; 95% CI, 9 to 22%), respectively, among Swiss-born patients. Using weighted logistic regression, we found weak evidence of an association between birth origin and transmission (adjusted odds ratio of 2.2 and 95% CI of 0.9 to 5.5 comparing Swiss-born patients to others). In conclusion, standard genotyping overestimated recent TB transmission in Switzerland compared to WGS, particularly among immigrants from regions with a high TB incidence, where genetically closely related strains often predominate. We recommend the use of WGS to identify transmission clusters in settings with a low incidence of TB.

Performance of acute flaccid paralysis surveillance compared with World Health Organization standards.

AIM: To compare acute flaccid paralysis (AFP) surveillance systems used by members of the International Network of Paediatric Surveillance Units (INoPSU) across the five AFP surveillance performance indicators recommended by the World Health Organization (WHO) for the maintenance of polio-free certification. METHODS: A survey was administered to AFP surveillance co-ordinators in five INoPSU member countries (Australia, Belgium, Canada, New Zealand and Switzerland). Data collected included information on surveillance system processes, WHO-recommended performance indicators, investigative practices and final diagnoses of cases from 2006 to 2010. RESULTS: All countries contacted completed the survey. Each country used similar case definitions and processes for collecting AFP data. All countries used at least one of the WHO indicators for surveillance. No country consistently met the performance indicator for incidence or stool sampling. In all countries, at least one form of neurological testing was used to diagnose cases of AFP. Guillain-Barré syndrome was the most common final diagnosis in all countries for all years examined. CONCLUSIONS: Industrialised countries surveyed do not consistently meet the WHO-recommended AFP surveillance performance indicators. An opportunity exists for INoPSU to suggest a standard way for member countries to collect AFP data in order to examine the potential for strengthening the current systems or introducing additional enterovirus surveillance or alternative/complementary neurological performance measures suitable for countries that have eliminated polio. INoPSU member countries are evaluating these possibilities.

Epidemiology of childhood tuberculosis in Switzerland between 1996 and 2011.

Approximately 9 million cases of tuberculosis (TB) are reported annually and half a million occur in children <15 years of age. Globally, TB notifications in children have been neglected for decades although childhood TB may represent a sentinel for ongoing transmission. Data included in this study were collected from the TB database of the Swiss Federal Office of Public Health, which includes culture-confirmed TB and/or cases treated with ≥3 anti-mycobacterial drugs. Data from all children <15 years of age reported between 1996 and 2011 were analyzed. A total of 320 cases of TB (166 cultures confirmed, 5 confirmed by nucleic acid amplification, 149 other than definite cases) were reported with an overall incidence rate of 1.6 per 100,000 children (range 1.2-2.2). A total of 154 (48 %) children were younger than 5 years of age and 141 (44 %) were born in Switzerland. Children below 5 years of age were more likely to be Swiss-born compared to children aged 10 to 14 years (74 % versus 26 %). When analyzing the country of origin, only 55 children (17 %) were of Swiss origin. Of all children with foreign origin, 117 (47 %) were from a country within the WHO European Region. In 288 (90 %) of all notified cases, the site of disease was the lung. Mycobacterial culture was positive in 166 cases (51.9 %) with 1.8 % multi-drug-resistance. The overall incidence of childhood TB disease reported in Switzerland remained stable over a 16-year period with a remarkable high rate of very young patients of foreign origin. Only half of the reported cases were culture confirmed, highlighting the need for better diagnostic tests in childhood TB.

Rapid detection of the source of a Listeria monocytogenes outbreak in Switzerland through routine interviewing of patients and whole-genome sequencing.

AIMS OF THE STUDY: Listeriosis is a notifiable disease in Switzerland. In summer 2022, the Swiss Federal Office of Public Health noticed an increase in reports of listeriosis cases, indicating a possible ongoing outbreak. Here we present the approaches applied for rapidly confirming the outbreak, detecting the underlying source of infection and the measures put in place to eliminate it and contain the outbreak. METHODS: For close surveillance and early detection of outbreak situations with their possible sources, listeriosis patients in Switzerland are systematically interviewed about risk behaviours and foods consumed prior to the infection. Listeria monocytogenes isolates derived from patients in medical laboratories are sent to the National Reference Laboratory for Enteropathogenic Bacteria and Listeria, where they routinely undergo whole-genome sequencing. Interview and whole-genome sequencing data are continuously linked for comparison and analysis. RESULTS: In summer 2022, 20 patient-derived L. monocytogenes serotype 4b sequence type 388 strains were found to belong to an outbreak cluster (≤10 different alleles between neighbouring isolates) based on core genome multilocus sequence typing analysis. Geographically, 18 of 20 outbreak cases occurred in northeastern Switzerland. The median age of patients was 77.4 years (range: 58.1-89.7), with both sexes equally affected. Rolling analysis of the interview data revealed smoked trout from a local producer as a suspected infection source, triggering an on-site investigation of the production facility and sampling of the suspected products by the responsible cantonal food inspection team on 15 July 2022. Seven of ten samples tested positive for L. monocytogenes and the respective cantonal authority ordered a ban on production and distribution as well as a product recall. The Federal Food Safety and Veterinary Office released a nationwide public alert covering the smoked fish products concerned. Whole-genome sequencing analysis confirmed the interrelatedness of the L. monocytogenes smoked trout product isolates and the patient-derived isolates. Following the ban on production and distribution and the product recall, reporting of new outbreak-related cases rapidly dropped to zero. CONCLUSIONS: This listeriosis outbreak could be contained within a relatively short time thanks to identification of the source of contamination through the established combined approach of timely interviewing of every listeriosis patient or a representative and continuous molecular analysis of the patient- and food-derived L. monocytogenes isolates. These findings highlight the effectiveness of this well-established, joint approach involving the federal and cantonal authorities and the research institutions mandated to contain listeriosis outbreaks in Switzerland.

Phylogeography of Francisella tularensis subspecies holarctica and epidemiology of tularemia in Switzerland.

Tularemia, an endemic disease that mainly affects wild animals and humans, is caused by Francisella tularensis subsp. holarctica (Fth) in Switzerland. The Swiss Fth population consist of multiple different subclades which are distributed throughout the country. The aim of this study is to characterize the genetic diversity of Fth in Switzerland and to describe the phylogeographic relationship of isolates by single nucleotide polymorphism (SNP) analysis. This analysis is combined with human surveillance data from reported cases over the last 10 years and in vitro and in silico antibiotic resistance tests to provide insight into the epidemiology of tularemia in Switzerland. We sequenced the whole genomes of 52 Fth strains of human or tick origin collected in Switzerland between 2009 and 2022 and analyzed together with all publicly available sequencing data of Swiss and European Fth. Next, we performed a preliminary classification with the established canonical single nucleotide polymorphism nomenclature. Furthermore, we tested 20 isolates from all main Swiss clades for antimicrobial susceptibility against a panel of antimicrobial agents. All 52 sequenced isolates from Switzerland belong to major clade B.6, specifically subclades B.45 and B.46, previously described in Western Europe. We were able to accurately reconstruct the population structure according to the global phylogenetic framework. No resistance to clinically recommended antibiotics could be identified in vitro or in silico in the western B.6 strains.

Effect of mutation and genetic background on drug resistance in Mycobacterium tuberculosis.

Bacterial factors may contribute to the global emergence and spread of drug-resistant tuberculosis (TB). Only a few studies have reported on the interactions between different bacterial factors. We studied drug-resistant Mycobacterium tuberculosis isolates from a nationwide study conducted from 2000 to 2008 in Switzerland. We determined quantitative drug resistance levels of first-line drugs by using Bactec MGIT-960 and drug resistance genotypes by sequencing the hot-spot regions of the relevant genes. We determined recent transmission by molecular methods and collected clinical data. Overall, we analyzed 158 isolates that were resistant to isoniazid, rifampin, or ethambutol, 48 (30.4%) of which were multidrug resistant. Among 154 isoniazid-resistant strains, katG mutations were associated with high-level and inhA promoter mutations with low-level drug resistance. Only katG(S315T) (65.6% of all isoniazid-resistant strains) and inhA promoter -15C/T (22.7%) were found in molecular clusters. M. tuberculosis lineage 2 (includes Beijing genotype) was associated with any drug resistance (adjusted odds ratio [OR], 3.0; 95% confidence interval [CI], 1.7 to 5.6; P < 0.0001). Lineage 1 was associated with inhA promoter -15C/T mutations (OR, 6.4; 95% CI, 2.0 to 20.7; P = 0.002). We found that the genetic strain background influences the level of isoniazid resistance conveyed by particular mutations (interaction tests of drug resistance mutations across all lineages; P < 0.0001). In conclusion, M. tuberculosis drug resistance mutations were associated with various levels of drug resistance and transmission, and M. tuberculosis lineages were associated with particular drug resistance-conferring mutations and phenotypic drug resistance. Our study also supports a role for epistatic interactions between different drug resistance mutations and strain genetic backgrounds in M. tuberculosis drug resistance.

Tick-borne encephalitis (TBE) in Switzerland: does the prolongation of vaccine booster intervals result in an increased risk of breakthroughs?

BACKGROUND: In 2006, the Swiss Federal Office of Public Health (FOPH) decided recommending a prolongation of vaccine booster intervals after the third dose for the prevention of tick-borne encephalitis (TBE) from 3 to 10 years. METHODS: To ascertain whether this amendment resulted in an increased rate of vaccine breakthroughs, we conducted a retrospective analysis of surveillance data collected 2000-19 by mandatory reporting to the Swiss FOPH. Fractions of breakthroughs [with 95% confidence intervals (CIs)]-0-3 years vs >3-10 years after the third vaccination dose-were compared across time periods and age groups. RESULTS: Among 3205 notified TBE cases, known vaccination status was reported in 2562 (79.9%), including 103 patients with ≥3 vaccine doses (4.0%). Among those, there were 39 patients who had received the last dose within 3 years and 48 patients in the >3-10 years group. During the 2010-19 period in which the new booster strategy was implemented there were 23 and 38 breakthroughs, respectively, and the annual breakthrough rate was 7.7 (95% CI 5.0-11.7) cases during the first 3 years after the last dose, and 5.4 (95% CI 3.9-7.5) cases in following 7 years. We observed no significant trend of TBE breakthroughs with increasing age. Increasing numbers of TBE and of vaccine breakthroughs over time have been associated with spreading endemicity and higher vaccination coverage in Switzerland. CONCLUSIONS: There is no indication that extended booster intervals resulted in an increased rate of breakthroughs, but there was a marked public health benefit with respect to increased acceptability of TBE immunization in the general population.

Retrospective, matched case-control analysis of tickborne encephalitis vaccine effectiveness by booster interval, Switzerland 2006-2020.

OBJECTIVE: To estimate effectiveness of tickborne encephalitis (TBE) vaccination by time interval (<5, 5-10 and 10+years) postvaccination. DESIGN: A retrospective, matched case-control study PARTICIPANTS: Cases-all adult (age 18-79) TBE cases in Switzerland reported via the national mandatory disease reporting surveillance system from 2006 to 2020 (final n=1868). Controls-community controls from a database of randomly selected adults (age 18-79) participating in a 2018 cross-sectional study of TBE vaccination in Switzerland (final n=4625). PRIMARY OUTCOME MEASURES: For cases and controls, the number of TBE vaccine doses received and the time since last vaccination were determined. Individuals were classified as being 'unvaccinated' (0 doses), 'incomplete' (1-2 doses) or 'complete' (3+ doses). Individuals with 'complete' vaccination were further classified by time since the last dose was received (<5 years, 5-10 years or 10+ years). A conditional logistic regression model was used to calculate vaccine effectiveness (VE: 100 × [1-OR]) for each vaccination status category. RESULTS: VE for incomplete vaccination was 76.8% (95% CI 69.0% to 82.6%). For complete vaccination, overall VE was 95.0% (95% CI 93.5% to 96.1%). When the most recent dose was received <5 years prior VE was 91.6% (95% CI 88.4% to 94.0%), 95.2% (95% CI 92.4% to 97.0%) when the most recent dose was received 5-10 years prior, and 98.5% (95% CI 96.8% to 99.2%) when the most recent dose was received 10+ years prior. CONCLUSIONS: That VE does not decrease among completely vaccinated individuals over 10+ years since last vaccination supports the longevity of the protective response following complete TBE vaccination. Our findings support the effectiveness of 10-year TBE booster intervals currently used in Switzerland.

A comparative examination of tuberculosis immigration medical screening programs from selected countries with high immigration and low tuberculosis incidence rates.

BACKGROUND: Tuberculosis (TB) in migrants is an ongoing challenge in several low TB incidence countries since a large proportion of TB in these countries occurs in migrants from high incidence countries. To meet these challenges, several countries utilize TB screening programs. The programs attempt to identify and treat those with active and/or infectious stages of the disease. In addition, screening is used to identify and manage those with latent or inactive disease after arrival. Between nations, considerable variation exists in the methods used in migration-associated TB screening. The present study aimed to compare the TB immigration medical examination requirements in selected countries of high immigration and low TB incidence rates. METHODS: Descriptive study of immigration TB screening programs. RESULTS: 16 out of 18 eligible countries responded to the written standardized survey and phone interview. Comparisons in specific areas of TB immigration screening programs included authorities responsible for TB screening, the primary objectives of the TB screening program, the yield of detection of active TB disease, screening details and aspects of follow up for inactive pulmonary TB. No two countries had the same approach to TB screening among migrants. Important differences, common practices, common problems, evidence or lack of evidence for program specifics were noted. CONCLUSIONS: In spite of common goals, there is great diversity in the processes and practices designed to mitigate the impact of migration-associated TB among nations that screen migrants for the disease. The long-term goal in decreasing migration-related introduction of TB from high to low incidence countries remains diminishing the prevalence of the disease in those high incidence locations. In the meantime, existing or planned migration screening programs for TB can be made more efficient and evidenced based. Cooperation among countries doing research in the areas outlined in this study should facilitate the development of improved screening programs.

Surveillance of tuberculosis in Switzerland and the Principality of Liechtenstein, 2009 to 2019.

OBJECTIVE: To describe the epidemiology of tuberculosis in Switzerland from 2009 to 2019.METHODS: Analysis of Swiss notification data. RESULTS: Tuberculosis cases declined from 553 (7.1/100,000) in 2009 to 437 (5.1/100,000) in 2019. The male-to-female ratio was 3:2. Although the number of tuberculosis cases of Swiss origin has steadily declined, the number of tuberculosis cases of foreign origin was rather stable but peaked in 2016. Overall, three quarters of tuberculosis cases were among people of foreign origin; of these, around half were from East Africa, Southern East Europe, and Southern Asia. Forty-nine percent had extrapulmonary manifestations. Every year, with little variation, 7-16 cases with rifampicin resistance were reported (2.9% overall). Independent risk factors for rifampicin resistance were prior anti-tuberculosis treatment, with an adjusted odds ratio (aOR) of 5.5 and a 95% confidence interval (CI) from 3.7 to 8.1, and foreign origin (aOR 3.6, 95% CI 2.0-7.0), particularly Georgia (aOR 10.0, 95% CI 4.0-23.1), Ethiopia (aOR 9.4, 95% CI 3.5-24.2), Tibet (aOR 6.9; 95% CI 2.9-16.6) and Somalia (aOR 8.1, 95% CI 4.0-17.2), together with Eritrea (aOR 2.6, 95% CI 1.1-5.9), accounting for more than half of all 134 cases . From 2016 to 2018, applying the World Health Organization definitions, overall treatment success in culture-confirmed pulmonary cases was 78%, and thus below the target of 85%. Since most cases with unsuccessful outcome are due to missing information, the proportion of unsuccessful outcome are overestimated. CONCLUSION: Autochthonous tuberculosis has become rare in Switzerland and the new diagnoses are increasingly attributable to immigration. Rifampicin resistance remains rare. Switzerland currently fails to achieve international targets for treatment success.

Tuberculous sacroiliitis with secondary psoas abscess in an older patient: a case report.

BACKGROUND: Tuberculosis is the leading infectious cause of death worldwide. Among native Swiss people, tuberculosis is more common in older people than in younger people. Approximately 25-30% of reported cases of tuberculosis are purely extrapulmonary; skeletal tuberculosis is reported in 3-5% of cases. The purpose of this case report is to draw attention to the diagnostic challenge of tuberculous sacroiliitis with secondary psoas abscess, as this clinical picture is very rare. CASE PRESENTATION: A magnetic resonance imaging scan of an 85-year-old (Swiss-German) Caucasian woman with chronic left-sided hip pain and limitation of hip joint movement showed a progressive destruction of her sacroiliac joint and a large collection in her left iliopsoas muscle. Drainage of the abscess revealed pus; a polymerase chain reaction assay was positive for Mycobacterium tuberculosis complex. Tuberculous sacroiliitis with secondary iliopsoas abscess was diagnosed 9 months after the start of the symptoms. Combination treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol was started. CONCLUSIONS: Sacroiliitis with secondary psoas abscess is an unusual cause of hip pain and is likely to be overlooked since joint pain of the lower extremity and lumbar pain are some of the most common complaints in older individuals. A high level of suspicion and invasive diagnostic procedures are needed for timely diagnosis of tuberculous sacroiliitis not only in immunocompromised patients living in or originating from endemic areas.

Marked increase in measles vaccination coverage among young adults in Switzerland: a campaign or cohort effect?

OBJECTIVES: To evaluate the impact of the Swiss measles elimination strategy-including a mass media campaign-on vaccination coverage and awareness among young adults aged 20-29 years. METHODS: Comparison of the results of two cross-sectional population surveys in 2012 and 2015. RESULTS: Documented vaccination coverage increased from 77 to 88% for two doses of measles vaccine. Major determinants of complete vaccination were survey year, birth cohort, sex and the absence of prior measles disease. If birth cohort and prior history of measles disease are included as factors in a multivariate model, the difference between 2012 and 2015 vanishes. CONCLUSIONS: The marked increase in complete measles vaccination coverage is due to a cohort effect, owing to the introduction of the second dose of vaccine in 1996. Most of the vaccinations were administered before the national strategy was implemented and vaccination catch-ups did not increase during the campaign in young adults. Nevertheless, this study provides evidence of an improvement in the awareness of measles and measles vaccination in young adults, which may result in an impact on measles vaccination coverage in the near future.

Human papillomavirus vaccine uptake in adolescence and adherence to cervical cancer screening in Switzerland: a national cross-sectional survey.

OBJECTIVES: The objectives were to measure uptake of and factors associated with human papillomavirus (HPV) vaccination initiation and to determine whether HPV vaccination reduced the uptake of cervical cancer screening. METHODS: We conducted a cross-sectional survey in a random sample of Swiss women aged 18-49 years in 2014 (N = 3588). RESULTS: Vaccination initiation was 69.3% and full coverage (three doses) 54.1% for 18-20-year olds, respectively, 42.4% and 33.9% for 21-24-year olds. Women with ≥ 10 lifetime sexual partners were less likely to have received any HPV vaccination than women with ≤ 2 partners (18-20 years OR 0.2, 21-24 years OR 0.5). Amongst 1000 unvaccinated women (18-24 years), reasons for not having initiated vaccination were lack of information (22.5%) and fear of vaccine side effects (18.1%). Vaccination status was not associated with adherence to cervical cancer screening recommendations (OR 1.3). 95.4% of all vaccinated participants knew about the continued need for screening. CONCLUSIONS: Our data suggest that HPV vaccination is not associated with reduced uptake of cervical cancer screening. This study provides information that can be used to improve HPV vaccination uptake in Switzerland.

Health-seeking behaviour and treatment delay in patients with pulmonary tuberculosis in Switzerland: some slip through the net.

AIMS OF THE STUDY: To assess the health-seeking behaviour, the patient delay (onset of symptoms to first consultation) and the health system delay (first consultation to start of tuberculosis treatment) among patients with pulmonary tuberculosis (TB) diagnosed in Switzerland, and to assess the predictors of the various types of delay. METHODS: A survey among pulmonary TB patients was carried out in six cantons, covering 42% of all pulmonary adult TB cases notified in Switzerland. Data were collected by collaborators of the cantonal lung associations in charge of the follow-up of TB patients to investigate treatment seeking behaviour and to establish various delays and its predictors. Predictors of percentiles of delay (median and 75th percentile) were assessed using quantile regression. RESULTS: Among 252 eligible patients, 162 patients could be interviewed. Of these, 20.4% were born in Switzerland. Cough as a symptom was mentioned by 76% of the interviewed patients. Almost half of the 162 patients (46%) consulted first a general practitioner in an ambulatory care setting and 26% approached a hospital first. The median delay between symptom onset and first healthcare contact (patient delay) was 5.2 weeks, which is slightly longer than findings in other low prevalence countries. The interquartile range was 1.6 to 14.2 weeks. The median delay between first consultation in Switzerland and the start of TB treatment (health system delay) was 2 weeks. The interquartile range was 0.6 to 7.1 weeks. There were no clear predictors of patient delay. The main predictors of a longer median health system delay were the presence of fever (1.6 weeks, 95% confidence interval [CI] 0.5 to 2.6 weeks), having visited first a general practitioner or a paediatrician (1 week, 95% CI 0.1 to 1.9 weeks) and having seen three or four doctors before beginning TB treatment (2.9 weeks, 95% CI 0.7 to 5.1 weeks). A clear predictor of a shorter median health system delay was having undergone an X-ray at the first consultation (-2.9 weeks, 95% CI -4.8 to -0.9 weeks). Marginally significant for shorter delay was male sex (-2.6 weeks, 95% CI -5.4 to 0.1 weeks). CONCLUSIONS: No predictor of patient delay was found among the variables collected. For one fourth of the patients, the health system delay was longer than 7 weeks. General practitioners are commonly approached first, and they have to consider TB, also for patients not considered at high-risk for TB.

Mycobacterium avium subspecies paratuberculosis and Crohn's disease: a systematic review and meta-analysis.

This systematic review assesses the evidence for an association between Mycobacterium avium subspecies paratuberculosis (MAP) and Crohn's disease. We analysed 28 case-control studies comparing MAP in patients with Crohn's disease with individuals free of inflammatory bowel disease (IBD) or patients with ulcerative colitis. Compared with individuals free of IBD, the pooled odds ratio (OR) from studies using PCR in tissue samples was 7.01 (95% CI 3.95-12.4) and was 1.72 (1.02-2.90) in studies using ELISA in serum. ORs were similar for comparisons with ulcerative colitis patients (PCR, 4.13 [1.57-10.9]; ELISA, 1.88 [1.26-2.81]). The association of MAP with Crohn's disease seems to be specific, but its role in the aetiology of Crohn's disease remains to be defined.

[Epidemiogy and treatment of tuberculosis in Switzerland]. / Epidémiologie et prise en charge de la tuberculose en Suisse.

Problems in tuberculosis are its rarity, drug-resistant strains, and patients' social aspects. Knowing the epidemiology helps to "think tuberculosis" when some anamnestic and clinical findings are present. In a not too seriously ill patient, the emergency consists of excluding infectious tuberculosis by sputum smear examinations. A positive result will lead to the patient's isolation and the initiation of treatment. Negative smears allow to wait for culture results, while following the patient and repeating smears after a non-specific antibiotic treatment. In case of strong suspicion of tuberculosis or risk for a rapid progression, the treatment should begin without delay. Discussion with a specialist is often warranted. A follow-up by the Swiss Pulmonary Association is recommended to prevent the patient from defaulting from treatment.