RESUMEN
A measles outbreak with 51 cases occurred in the canton of Vaud, Switzerland, between January and March 2024. The outbreak was triggered by an imported case, and 37 (72.5%) subsequent cases were previously vaccinated individuals. Epidemiological investigations showed that vaccinated measles cases were symptomatic and infectious. In a highly vaccinated population, it is important to raise awareness among healthcare professionals to suspect and test for measles virus when an outbreak is declared, irrespective of the vaccination status of the patients.
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Brotes de Enfermedades , Vacuna Antisarampión , Virus del Sarampión , Sarampión , Vacunación , Humanos , Sarampión/prevención & control , Sarampión/epidemiología , Suiza/epidemiología , Brotes de Enfermedades/prevención & control , Vacuna Antisarampión/administración & dosificación , Vacunación/estadística & datos numéricos , Masculino , Femenino , Adulto , Adolescente , Niño , Virus del Sarampión/inmunología , Virus del Sarampión/aislamiento & purificación , Preescolar , Adulto Joven , LactanteRESUMEN
Civil involuntary outpatient treatment authorises the provision to unwilling psychiatric patients of continuing ambulatory treatment. There is an absence of convincing international evidence for their effectiveness. From 2013 and after the Swiss Civil Code was amended, all cantonal governments enacted legislation for this new form of coercion. In canton Vaud, a working group including jurists, psychiatrists and civil judges has been set up by the Department of health in order to propose involuntary outpatient treatments respectful of patients' rights and proportional to patients' and network's needs. This article describes how involuntary outpatient treatments are locally implemented and assessed in the context of a pilot project limited to one year.
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Atención Ambulatoria/métodos , Internamiento Obligatorio del Enfermo Mental , Implementación de Plan de Salud , Enfermos Mentales , Atención Ambulatoria/psicología , Implementación de Plan de Salud/métodos , Implementación de Plan de Salud/organización & administración , Humanos , Enfermos Mentales/psicología , Pacientes Ambulatorios , Proyectos Piloto , SuizaRESUMEN
OBJECTIVE: To assess the overall burden of healthcare-associated infections (HAIs) in patients exposed and nonexposed to surgery. BACKGROUND: Targeted HAI surveillance is common in healthcare institutions, but may underestimate the overall burden of disease. METHODS: Prevalence study among patients hospitalized in 50 acute care hospitals participating in the Swiss Nosocomial Infection Prevalence surveillance program. RESULTS: Of 8273 patients, 3377 (40.8%) had recent surgery. Overall, HAI was present in 358 (10.6%) patients exposed to surgery, but only in 206 (4.2%) of 4896 nonexposed (P < 0.001). Prevalence of surgical site infection (SSI) was 5.4%. Healthcare-associated infections prevalence excluding SSI was 6.5% in patients with surgery and 4.7% in those without (P < 0.0001). Patients exposed to surgery carried less intrinsic risk factors for infection (age >60 years, 55.6% vs 63.0%; American Society of Anesthesiologists score >3,5.9% vs 9.3%; McCabe for rapidly fatal disease, 3.9% vs 6.6%; Charlson comorbidity index >2, 12.3% vs 20.9%, respectively; all P < 0.001) than those nonexposed, but more extrinsic risk factors (urinary catheters, 39.6%vs 14.1%; central venous catheters, 17.8% vs 7.1%; mechanical ventilation, 4.7% vs 1.3%; intensive care stay, 18.3% vs 8.8%, respectively; all P<0.001). Exposure to surgery independently predicted an increased risk of HAI (odds ratio 2.43; 95% CI 2.03.0). CONCLUSIONS: Despite a lower intrinsic risk, patients exposed to surgery carried more than twice the overall HAI burden than those nonexposed; almost half was accountable to SSI. Extending infection control efforts beyond SSI prevention in these patients might be rewarding, especially because of the extrinsic nature of risk factors.
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Infección Hospitalaria/epidemiología , Infección de la Herida Quirúrgica/epidemiología , Anciano , Infección Hospitalaria/microbiología , Femenino , Unidades Hospitalarias , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Infección de la Herida Quirúrgica/microbiología , Suiza/epidemiologíaRESUMEN
PURPOSE: Community treatment orders (CTOs) are legal procedures that authorise compulsory community mental health care to people affected by severe mental disorders. Nowadays, CTOs are regulated in 75 countries, with important variations in terms of legal criteria and practices. In Switzerland CTOs were introduced on the 1st January 2013, following the amendment of the Swiss Civil Code. The aim of this study was to provide a first understanding of the use of CTOs in Western Switzerland in terms of incidence and prevalence rates, population profile, orders duration and reasons for discharge. METHODS: Incidence and prevalence rates of CTOs between 2013 and 2017 were estimated. Survival analysis was used to investigate time to CTO discharge and associated factors. Logistic regression was performed to identify factors associated with CTOs' success as reason for discharge. RESULTS: CTOs' incidence rates per 100'000 inhabitants ranged between 4.8 for 2013 and 9.6 for 2017, while their prevalence raised from 4.8 to 19.5. People placed under CTO were mainly male, in their forties, of Swiss origin, single and living independently. Primarily affected by Schizophrenia, schizotypal and delusional disorders (F20-F29), they frequently presented substance use problems, and severe danger for themselves. CTOs were mainly ordered by the guardianship authority as a form of conditional release. The estimated mean time to discharge was almost three years. Not being of Swiss origin and being prescribed to take a medication were associated with longer CTO while living in hospital, as a consequence of a long-lasting hospitalisation, and having a non-medical professional in charge of the order were associated with shorter time to discharge. Neither clinical factors nor legal criteria predicted time to discharge. Moreover, spending more days under CTO increased the likelihood of success at discharge, whereas not being of Swiss origin reduced it. CONCLUSIONS: To the best of our knowledge, no previous studies have examined the CTOs' implementation in Switzerland. CTOs prevalence increased rapidly despite the lack of evidence on positive outcomes. Our results suggested that once under CTO, it takes a long time for a patient to be released, in case of both positive and negative outcomes.
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Servicios Comunitarios de Salud Mental/legislación & jurisprudencia , Programas Obligatorios/legislación & jurisprudencia , Trastornos Mentales/terapia , Pacientes Ambulatorios/legislación & jurisprudencia , Adulto , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Programas Obligatorios/estadística & datos numéricos , Persona de Mediana Edad , Pacientes Ambulatorios/estadística & datos numéricos , Prevalencia , Estudios Retrospectivos , Suiza/epidemiologíaRESUMEN
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.
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Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/epidemiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Humanos , Lactante , Persona de Mediana Edad , Suiza/epidemiología , Tuberculosis Pulmonar/diagnósticoRESUMEN
BACKGROUND: Exposure to urinary catheters is considered the most important risk factor for healthcare-associated urinary tract infection (UTI) and is associated with significant morbidity and substantial extra-costs. In this study, we assessed the impact of urinary catheterisation (UC) on symptomatic healthcare-associated UTI among hospitalized patients. METHODS: A nationwide period prevalence survey of healthcare-associated infections was conducted during 1 May to 30 June 2004 in 49 Swiss hospitals and included 8169 adult patients (4313 female; 52.8%) hospitalised in medical, surgical, intermediate, and intensive care wards. Additional data were collected on exposure to UC to investigate factors associated with UTI among hospitalised adult patients exposed and non-exposed to UC. RESULTS: 1917 (23.5%) patients were exposed to UC within the week prior to survey day; 126 (126/8169; 1.5%) developed UTI. Exposure to UC preceded UTI only in 73 cases (58%). By multivariate logistic regression analysis, UTI was independently associated with exposure to UC (odds ratio [OR], 3.9 [95% CI, 2.6-5.9]), female gender (OR, 2.1 [95% CI, 1.4-3.1]), an American Society of Anesthesiologists' score > 2 points (OR, 3.2 [95% CI, 1.1-9.4], and prolonged hospital stay >20 days (OR, 1.9 [95% CI, 1.4-3.2]. Further analysis showed that the only significant factor for UTI with exposure to UC use was prolonged hospital stay >40 days (OR, 2.9 [95% CI, 1.3-6.1], while female gender only showed a tendency (OR, 1.6 [95% CI, 1.0-2.7]. In the absence of exposure to UC, the only significant risk factor for UTI was female gender (OR, 3.3 [95% CI, 1.7-6.5]). CONCLUSIONS: Exposure to UC was the most important risk factor for symptomatic healthcare-associated UTI, but only concerned about half of all patients with UTI. Further investigation is warranted to improve overall infection control strategies for UTI.
RESUMEN
BACKGROUND: In Switzerland (population 7.4 million), 3 different systems contribute to surveillance for sexually transmitted infections. GOAL: The goal of this study was to compare time trends from surveillance systems for chlamydia, gonorrhea, and syphilis. STUDY DESIGN: We studied surveillance data (1997-2003) from laboratory reports in women and men, men attending dermatology clinics, and women attending gynecologists. RESULTS: Laboratory reports of episodes of Chlamydia trachomatis and Neisseria gonorrhoeae increased by 31% (from 2573 to 3449 cases) and 104% (from 259 to 528 cases), respectively. Over the same period, chlamydia reports from men attending dermatology clinics and women attending gynecologists did not change and dermatology clinic-based reports of gonorrhea in men increased only slightly. Syphilis reports from dermatology clinics increased by 127% (from 22 to 50 cases). CONCLUSIONS: Increases in laboratory reports of chlamydia and gonorrhea were not consistently detected in sentinel populations. Numbers of cases reported to all 3 systems were low. The performance of surveillance systems for sexually transmitted infections should be evaluated regularly.
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Infecciones por Chlamydia/epidemiología , Gonorrea/epidemiología , Vigilancia de la Población , Sífilis/epidemiología , Adolescente , Adulto , Infecciones por Chlamydia/microbiología , Chlamydia trachomatis/aislamiento & purificación , Femenino , Gonorrea/microbiología , Humanos , Masculino , Persona de Mediana Edad , Neisseria gonorrhoeae/aislamiento & purificación , Prevalencia , Suiza/epidemiología , Sífilis/microbiología , Treponema pallidum/aislamiento & purificaciónRESUMEN
The Panton-Valentine leukocidin is associated with staphylococcal skin and pulmonary infections. We describe a school outbreak of skin infections and the public health response to it. Nasal carriage of a Panton-Valentine leukocidin-positive Staphylococcus aureus clone was detected only in previously ill classmates and their family members.
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Brotes de Enfermedades , Leucocidinas/aislamiento & purificación , Enfermedades de la Piel/epidemiología , Staphylococcus aureus/genética , Antibacterianos/uso terapéutico , Toxinas Bacterianas , Portador Sano , Niño , Clorhexidina/uso terapéutico , Electroforesis en Gel de Campo Pulsado , Exotoxinas , Humanos , Mupirocina/uso terapéutico , Mucosa Nasal/microbiología , Reacción en Cadena de la Polimerasa , Enfermedades de la Piel/microbiología , Enfermedades de la Piel/prevención & control , Staphylococcus aureus/aislamiento & purificación , Suiza/epidemiologíaRESUMEN
We prospectively assessed the 1-month prevalence of abnormal body fat distribution in HIV-infected individuals. Of 1,359 patients treated with antiretroviral drugs, 578 (43%) had signs of abnormal fat distribution. Peripheral fat loss was observed in 382 patients (28%), whereas 412 (30%) had signs of fat accumulation. The presence of lipodystrophy (peripheral fat loss with or without fat accumulation) was found to be independently associated with increasing age (less than 35 years of age as a reference group: 35 to 41 years of age, OR = 1.5 [95% CI, 1.1-2.3]; and older than 41 years of age, OR = 2.4 [95% CI, 1.7-3.5]), current use of stavudine (OR = 2.4 [95% CI, 1.8-3.3]), current use of abacavir (OR = 2.1 [95% CI, 1.3-3.4]), and elevated lactate level (OR = 1.6 [95% CI, 1.1-2.4]). The prevalence of lipodystrophy was higher among patients who had received stavudine for a longer period (no stavudine in the current combination as a reference group: <6 months, OR = 1.1 [95% CI, 0.6-1.8]; 6-24 months, OR = 2.4 [95% CI, 1.7-3.5]; and >24 months, OR = 3.2 [95% CI, 2.4-4.3]). This study confirms the association between the use of stavudine and lipodystrophy.