[COVID-19 screening strategy in workplaces in the canton of Vaud: what lessons?] / Stratégie de dépistage du Covid-19 dans les entreprises vaudoises : quels enseignements ?

Repetitive screening in enterprises was one of the measures recommended in Switzerland in the fight against COVID-19. In the canton of Vaud, 70 companies participated in the program, 73 % of which were small and medium-sized enterprises. The SARS-CoV-2 positivity rate was 0.07 % out of 70'105 tests performed. The impossibility of teleworking and the reduction of transmission were the main motivations for joining the program. The facilitating elements were the availability of the Cantonal Medical Office, the existence of a starter kit and the support of the hierarchy within the companies. The main obstacles were the arrival of vaccination, the multiplicity of screening providers and the workload. The program was a pragmatic action tool for companies rather than a population-based strategy.

Le dépistage en entreprise était une des mesures de lutte contre l'épidémie de Covid-19 promues par la Confédération. Dans le canton de Vaud, 70 entreprises ont participé au programme, dont 73 % de petites et moyennes entreprises. Le taux de positivité au SARS-CoV-2 a été de 0,07 % sur 70 105 tests réalisés. L'impossibilité du télétravail et la réduction de la transmission ont été les principales motivations d'adhésion. Les éléments facilitateurs ont été la disponibilité de l'Office du médecin cantonal, l'existence d'un starter kit et le soutien de la hiérarchie au sein des entreprises. Les freins principaux ont été l'arrivée de la vaccination, la multiplicité des prestataires de dépistage et la charge de travail. Le programme a représenté un outil d'action pragmatique pour les entreprises plutôt qu'une stratégie à visée populationnelle.

Trends in COVID-Related Activity in Sentinel Family Medicine Practices: An Observational Study.

Objectives: During the COVID pandemic, data collected in family medicine were scarce. The COVID-FM project aimed to monitor trends of COVID-related activity in family medicine practices of the canton of Vaud, Switzerland, during the year 2021. Methods: Practitioners were invited to join an ad hoc sentinel surveillance system. Online data collection was based on daily activity reports and monthly questionnaires. Participants categorized daily counts of consultations and phone calls into predefined categories. Data were reported and discussed on a weekly basis with public health authorities. Results: On the target of 50 physicians, 37 general physicians from 32 practices finally constituted the COVID-FM sentinel network, contributing to 901 practice-weeks of surveillance in family medicine and 604 in paediatrics. In paediatrics, COVID-related activity corresponded mostly to COVID-19 diagnostic consultations (2911/25990 face-to-face consultations = 11.2%) while in family medicine, other COVID-related topics-such as questions on vaccination-predominated (4143/42221 = 9.8%). Conclusion: COVID-related consultations constituted an important part of primary care practices' activity in 2021. Monitoring COVID-related activity in primary care provided health authorities with valuable information to guide public health action.

Prevalence of SARS-CoV-2 in Household Members and Other Close Contacts of COVID-19 Cases: A Serologic Study in Canton of Vaud, Switzerland.

BACKGROUND: Research on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission within households and other close settings using serological testing is scarce. METHODS: We invited coronavirus disease 2019 (COVID-19) cases diagnosed between February 27 and April 1, 2020, in Canton of Vaud, Switzerland, to participate, along with household members and other close contacts. Anti-SARS-CoV-2 immunoglobulin G antibodies were measured using a Luminex immunoassay. We estimated factors associated with serological status using generalized estimating equations. RESULTS: Overall, 219 cases, 302 household members, and 69 other close contacts participated between May 4 and June 27, 2020. More than half of household members (57.2%; 95% CI, 49.7%-64.3%) had developed a serologic response to SARS-CoV-2, while 19.0% (95% CI, 10.0%-33.2%) of other close contacts were seropositive. After adjusting for individual and household characteristics, infection risk was higher in household members aged ≥65 years than in younger adults (adjusted odds ratio [aOR], 3.63; 95% CI, 1.05-12.60) and in those not strictly adhering to simple hygiene rules like hand washing (aOR, 1.80; 95% CI, 1.02-3.17). The risk was lower when more than 5 people outside home were met during semiconfinement, compared with none (aOR, 0.35; 95% CI, 0.16-0.74). Individual risk of household members to be seropositive was lower in large households (22% less per each additional person). CONCLUSIONS: During semiconfinement, household members of a COVID-19 case were at very high risk of getting infected, 3 times more than close contacts outside home. This highlights the need to provide clear messages on protective measures applicable at home. For elderly couples, who were especially at risk, providing external support for daily basic activities is essential.

Skimmed Milk Applied as a Phytopharmaceutical Product: A Risk for Allergic Populations?

Milk allergy is among the most common food-related allergies. Milk-based products are recognized as plant protection products (PPPs) in several countries as alternatives to synthetic pesticides. The potential health risk for allergic workers, as well as the general population, is yet to be assessed. An investigation was conducted in the Vaud Canton of Switzerland, where milk-based products are sprayed by helicopter over vineyards. Air lactose concentration was measured at 14 locations via 25 mm IOM Multidust samplers. Residual lactose concentration was measured on the surface of leaves over 7 days following spraying. Surface contamination downwind from the treated area was estimated through computer-based modeling using AgDRIFT® software. The average milk protein concentration inside and outside the vineyard was 0.47 and 0.16 µg/m3, respectively. Milk residues persisted on the leaf surface for an average of three days. Modelling results revealed an estimated order of magnitude of 0.1-0.5 µg/m3 in milk proteins within one hour after the treatment in the close vicinity of the treated area. Our results reveal that the potential exposure to milk proteins in and around helicopter-treated vineyards is not negligible and that prevention messages targeted to individuals with severe allergies should be considered.

A hidden side of the COVID-19 pandemic in children: the double burden of undernutrition and overnutrition.

The COVID-19 pandemic has deteriorated key determinants of health and caused major upheavals around the world. Children, although less directly affected by the virus, are paying a heavy price through the indirect effects of the crisis, including poor diet, mental health impact, social isolation, addiction to screens and lack of schooling and health care, particularly among vulnerable groups. This paper is aimed at discussing the potential impact of this pandemic on children's nutrition and lifestyle. Preliminary data from the literature and from our survey show significant disruptions in nutrition and lifestyle habits of children. While undernutrition is expected to worsen in poor countries, obesity rates could increase in middle- and high-income countries especially among precarious groups widening the gap in health and social inequalities.The real impact of the COVID-19 pandemic on children extends well beyond that of a viral infection. This crisis has public health implications that could have life-long consequences on children. It requires effective and targeted measures mainly for vulnerable children and households to guarantee children's basic rights for optimal nutrition, health and development.

Epidemiology of sexually transmitted infections among female sex workers in Switzerland: a local, exploratory, cross-sectional study.

Female sex workers are often considered highly vulnerable to sexually transmitted infections (STIs). However, data on STI epidemiology in female sex workers are lacking in Switzerland. Our main goal was to evaluate the prevalence of six STIs (human immunodeficiency virus [HIV], hepatitis B, hepatitis C, Chlamydia trachomatis, Neisseria gonorrhoeae and syphilis) among local female sex workers in Lausanne. A local, exploratory, cross-sectional study was conducted on a convenience sample of adult (≥18 years) Female sex workers in Lausanne, Switzerland, from 1 April 2015 to 31 December 2016. female sex workers who worked in street sex venues, massage parlours and brothels were approached for recruitment by a local non-governmental organisation. They were then invited to present at the Lausanne University Hospital, where they were offered a free STI screening and hepatitis A and B vaccination. We enrolled 96 female sex workers. They were predominantly undocumented immigrants (60%) from Africa and Eastern Europe with no health insurance; only one participant (1%) was Swiss born. During the study, 15 (16%; 95% confidence interval [CI] 9–23%) participants were newly confirmed to have an STI: six (6%; 95% CI 1–11%) had C. trachomatis, five (5%; 95% CI 0.6-9%) latent syphilis and four (4%; 95% CI 0.1–8%) hepatitis B (three with chronic active infection and one with past exposure). No human immunodeficiency virus (HIV) infections were newly diagnosed among the participants. Nineteen (20%) of the female sex workers were already vaccinated against hepatitis B, and 73 (76%) initiated vaccination against hepatitis A and hepatitis B during the study. Forty-four (46%) of the female sex workers required translation and assistance from social services.

[SICOVID: a cantonal COVID information system for public health decision-making]. / SICOVID: un système cantonal d'information COVID pour la décision en santé publique.

Late 2019 a new coronavirus appeared, creating a pandemic, with the first case in Switzerland detected on the 25th of February 2020. Considering the rapid increase in the number of cases, with the fear of an over-burdening of the sanitary network, the Canton of Vaud created a surveillance system (SICOVID). The objective of the SICOVID was to produce a set of indicators, covering the breadth of the epidemiological impact and response as the epidemic progressed. These indicators where used for monitoring purposes, orienting strategies, operational decision-making, communication and research. The challenges encountered throughout this process underline the importance of anticipation and considering the function of a crisis information system, ideally integrating these elements into pandemic preparedness plans.

Fin 2019 est apparu un nouveau coronavirus, créant une pandémie, avec un premier cas en Suisse le 25 février 2020. Au vu de l'augmentation rapide du nombre de cas, avec une crainte de surcharge du réseau sanitaire, le canton de Vaud a mis en place un système de surveillance (système d'information COVID (SICOVID)). L'objectif du SICOVID était de produire un ensemble d'indicateurs de suivi, couvrant l'entier de l'impact épidémique et du dispositif de réponse en regard de la progression de l'épidémie. Ces indicateurs ont été utilisés à des fins de monitorage, d'orientation stratégique, de prise de décision opérationnelle, de communication et de recherche. Les défis rencontrés au long de ce processus soulignent l'importance d'une réflexion sur l'anticipation et la fonction d'un système d'information de crise, idéalement intégré aux plans de préparation en cas de pandémie.

Improvement in Tuberculosis Outcomes With a Combined Medical and Social Approach.

Setting: Studies performed locally in Switzerland in the late eighties reported unsatisfactory treatment outcomes. Better outcomes were observed since the introduction of directly observed therapy (DOT) in the late nineties and improvement in social support in recent years. Design: retrospective study of treatment outcomes for all tuberculosis (TB) patients notified in Vaud County (VD), Switzerland, between, 1st of January 2010 and 31st of December of 2014. Results: 375 patients were notified in VD during the study period. The global outcome was successful in 90.1% of patients (338/375). In 183 culture and PCR positive pulmonary TB, the documented cure rate was 57.9% (106/183), and the treatment completion was 59/183 (32.2%), i.e., a treatment success of 90.2%. DOT was applied globally in 234/375 (62.4%) and in 64/67 of the asylum seekers (AS) (95.5%) followed at the dispensary. Treatment outcomes were successful in 60/67 (89.6%) AS. Discussion: Improvements in tuberculosis outcomes resulted not only from the introduction of DOT in VD in the nineties but also from a change in the management, with increased attention to the social problems faced by the migrants. Conclusion: A combined medical and social approach of TB care in VD improved treatment outcomes.

[Consensus for the management of infectious diseases among asylum seekers and detainees in the canton of Vaud]. / Consensus vaudois de prise en charge de maladies infectieuses auprès des requérants d'asile et détenus.

Our work develops procedures and useful tools for the screening, assessment and management of prevalent infectious or parasitic diseases (tuberculosis, measles, chickenpox, scabies, bed bugs) among asylum seekers and detainees in the canton of Vaud, populations living in similar closed settings. Its aim is to support health professionals in their work, to maintain the health of the target population and to protect the health of the community. Through a literature review and a focus group with experts, it is proposed to harmonize the existing procedures in asylum seekers centres end prisons of the canton of Vaud. The proposed decision algorithms are coherent with the recommendations of the literature and relevant in terms of public health and ethics, as well as feasible logistically and acceptable by the field health professionals.

Ce travail développe des procédures dans le cadre du dépistage et de la prise en charge de maladies infectieuses ou parasitaires prévalentes (tuberculose, rougeole, varicelle, gale, punaises de lit) chez les requérants d'asile et détenus du canton de Vaud, populations vivant dans des environnements similaires, afin de soutenir le personnel soignant dans son travail de terrain, veiller à la santé des personnes concernées et protéger la population locale. Il s'agit donc d'harmoniser, grâce à une revue de littérature et un focus group d'experts, les procédures existant dans les centres de requérants et de détenus vaudois en s'assurant que celles-ci correspondent aux recommandations de la littérature et soient pertinentes en termes de santé publique et d'éthique, ainsi que réalisables d'un point de vue logistique et acceptables par les équipes de terrain.

Assessment of voluntary HIV screening for asylum seekers in two Swiss cantons.

OBJECTIVE: To evaluate the feasibility of HIV screening, offered to newly arrived asylum seekers in the Swiss cantons of Valais (VS) and Vaud (VD) in order to meet the national and international standards for early detection and effective treatment of HIV infections. METHODS: HIV screening was offered free of charge to every asylum seeker who arrived from June 2015 to November 2016 in VS, and from June to October 2016 in VD. Pregnant women and children <16 were excluded. Written consent was required in VS through multi-language forms, whereas VD required oral consent obtained with the help of interpreters. RESULTS: 807 asylum seekers were offered HIV testing (VS 451, VD 356). Their mean age was 27.6 years, 61.2% were male, 67.4% were single, 60.8% arrived from sub-Saharan Africa. The overall proportion that accepted HIV screening was 72.2% (VS 63.2%, VD 83.7%). Prevalence of HIV infection was 0.87% (two newly and five previously diagnosed persons). Multivariable analysis found that a higher proportion accepted HIV testing among asylum seekers originating from sub-Saharan Africa, men, and those arriving in VD. CONCLUSIONS: the acceptance of HIV screening among asylum seekers was high and appeared to respond to a real demand among this vulnerable population, particularly among those coming from high endemic regions. It may help guaranteeing an equitable access to the local health care system. Ways to reach a high testing rate should still be explored, taking available and necessary resources into account.

Universal screening and decolonization for control of MRSA in nursing homes: a cluster randomized controlled study.

OBJECTIVE: The risk of carrying methicillin-resistant Staphylococcus aureus (MRSA) is higher among nursing home (NH) residents than in the general population. However, control strategies are not clearly defined in this setting. In this study, we compared the impact of standard precautions either alone (control) or combined with screening of residents and decolonization of carriers (intervention) to control MRSA in NHs. DESIGN: Cluster randomized controlled trial. SETTING: NHs of the state of Vaud, Switzerland. PARTICIPANTS: Of 157 total NHs in Vaud, 104 (67%) participated in the study. INTERVENTION: Standard precautions were enforced in all participating NHs, and residents underwent MRSA screening at baseline and 12 months thereafter. All carriers identified in intervention NHs, either at study entry or among newly admitted residents, underwent topical decolonization combined with environmental disinfection, except in cases of MRSA infection, MRSA bacteriuria, or deep skin ulcers. RESULTS: NHs were randomly allocated to a control group (51 NHs, 2,412 residents) or an intervention group (53 NHs, 2,338 residents). Characteristics of NHs and residents were similar in both groups. The mean screening rates were 86% (range, 27%-100%) in control NHs and 87% (20%-100%) in intervention NHs. Prevalence of MRSA carriage averaged 8.9% in both control NHs (range, 0%-43%) and intervention NHs (range, 0%-38%) at baseline, and this rate significantly declined to 6.6% in control NHs and to 5.8% in intervention NHs after 12 months. However, the decline did not differ between groups (P=.66). CONCLUSION: Universal screening followed by decolonization of carriers did not significantly reduce the prevalence of the MRSA carriage rate at 1 year compared with standard precautions.

[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.

A cross-sectional survey of attitudes to HIV risk and rapid HIV testing among clients of sex workers in Switzerland.

OBJECTIVES: To assess attitudes to HIV risk and acceptability of rapid HIV testing among clients of street-based female sex workers (FSW) in Lausanne, Switzerland, where HIV prevalence in the general population is 0.4%. METHODS: The authors conducted a cross-sectional study in the red light district of Lausanne for five nights in September of 2008, 2009 and 2010. Clients of FSW were invited to complete a questionnaire in the street assessing demographic characteristics, attitudes to HIV risk and HIV testing history. All clients interviewed were then offered anonymous finger stick rapid HIV testing in a van parked on-site. RESULTS: The authors interviewed 112, 127 and 79 clients in 2008, 2009 and 2010, respectively. All were men, average age 32-37 years old; 40-60% were in a stable relationship. History of unprotected sex was higher with non-commercial partners (33-50%) than with FSW (6-11%); 29-46% of clients had never undergone an HIV test. Anonymous rapid HIV testing was accepted by 45-50% of clients. Out of 109 HIV tests conducted during the three study periods, none was reactive. CONCLUSIONS: On-site HIV counselling and testing is acceptable among clients of FSW in this urban setting. These individuals represent an unquantified population, a proportion of which has an incomplete understanding of HIV risk in the face of high-risk behaviour, with implications for potential onward transmission to non-commercial sexual partners.

Comparison of two strategies to prevent varicella outbreaks in housing facilities for asylum seekers.

BACKGROUND: The proportion of adults with positive varicella serology is lower in populations from tropical countries. Therefore immigrants to countries with a temperate climate are at risk of acquiring varicella infection during adulthood. METHODS: We tested two different strategies to prevent varicella outbreaks in housing facilities for asylum seekers arriving in the Canton of Vaud, Switzerland. The first strategy consisted of a rapid response with isolation of the affected individuals and vaccination of the susceptible contacts. The second strategy consisted of a general vaccination upon arrival of all asylum seekers aged 15-39 years with no history of chickenpox. RESULTS: From May 2008 to January 2009 we applied the rapid response strategy. Eight hundred and fifty-eight asylum seekers arrived in the Canton and an attack rate of 2.8% (seven cases among 248 exposed asylum seekers) was observed. The mean cost was US$ 31.35 per asylum seeker. The general vaccination strategy was applied from February 2009 to May 2010, a period during which 966 asylum seekers were registered. This second strategy completely prevented any outbreak at a mean cost of US$ 83.85 per asylum seeker. CONCLUSIONS: Of the two analyzed interventions to prevent varicella outbreaks in housing facilities for asylum seekers, the general vaccination strategy was more effective, more sustainable, and ethically preferable, although more costly.

Outbreak of Mycobacterium haemophilum infections after permanent makeup of the eyebrows.

We report a Mycobacterium haemophilum outbreak after permanent make-up of the eyebrows performed by the same freelance artist. Twelve patients presented an eyebrow lesion and cervical lymphadenitis. All were treated with antibiotics. Surgery was required in 10 cases. M. haemophilum DNA was identified in the make-up ink.

Clients of sex workers in Switzerland: it makes sense to counsel and propose rapid test for HIV on the street, a preliminary report.

BACKGROUND: Clients of street sex workers may be at higher risk for HIV infection than the general population. Furthermore, there is a lack of knowledge regarding HIV testing of clients of sex workers in developed countries. METHOD: This pilot study assessed the feasibility and acceptance of rapid HIV testing by the clients of street-based sex workers in Lausanne, Switzerland. For 5 evenings, clients in cars were stopped by trained field staff for face-to-face interviews focusing on sex-related HIV risk behaviors and HIV testing history. The clients were then offered a free anonymous rapid HIV test in a bus parked nearby. Rapid HIV testing and counselling were performed by experienced nurse practitioners. Clients with reactive tests were offered confirmatory testing, medical evaluation, and care in our HIV clinic. RESULT: We intercepted 144 men, 112 (77.8%) agreed to be interviewed. Among them, 50 (46.6%) had never been tested for HIV. A total of 31 (27.7%) rapid HIV tests were performed, 16 (51.6%) in clients who had not previously been tested. None were reactive. Initially, 19 (16.9%) additional clients agreed to HIV testing but later declined due to the 40-minute queue for testing. CONCLUSION: This pilot study showed that rapid HIV testing in the red light district of Lausanne was feasible, and that the clients of sex workers accepted testing at an unexpectedly high rate. This setting seems particularly appropriate for targeted HIV screening, since more than 40% of the clients had not previously been tested for HIV even though they engaged in sex-related HIV risk behaviour.

Screening for latent tuberculosis infection among undocumented immigrants in Swiss healthcare centres; a descriptive exploratory study.

BACKGROUND: Migration is one of the major causes of tuberculosis in developed countries. Undocumented patients are usually not screened at the border and are not covered by a health insurance increasing their risk of developing the disease unnoticed. Urban health centres could help identify this population at risk. The objective of this study is to assess the prevalence of latent tuberculosis infection (LTBI) and adherence to preventive treatment in a population of undocumented immigrant patients. METHODS: All consecutive undocumented patients that visited two urban healthcare centres for vulnerable populations in Lausanne, Switzerland for the first time were offered tuberculosis screening with an interferon-gamma assay. Preventive treatment was offered if indicated. Adherence to treatment was evaluated monthly over a nine month period. RESULTS: Of the 161 participants, 131 (81.4%) agreed to screening and 125 had complete examinations. Twenty-four of the 125 patients (19.2%; CI95% 12.7;27.2) had positive interferon-gamma assay results, two of which had active tuberculosis. Only five patients with LTBI completed full preventive treatments. Five others initiated the treatment but did not follow through. CONCLUSION: Screening for tuberculosis infection in this hard-to-reach population is feasible in dedicated urban clinics, and the prevalence of LTBI is high in this vulnerable population. However, the low adherence to treatment is an important public health concern, and new strategies are needed to address this problem.

[Role of primary care physicians in the influenza pandemic]. / Pandémie de grippe: quel rôle pour les médecins de premier recours?

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.

[Ambulatory parenteral antibiotics in the treatment of severe pediatric infections]. / L'antibiothérapie parentérale ambulatoire dans le traitement des infections pédiatriques sévères.

The indications to parenteral antibiotic treatment in paediatrics are frequent. Antibiotic agents with antimicrobial spectrums and pharmacodynamic properties allowing effective and secure outpatient parenteral therapy are now widely available. Outpatient treatment has a number of advantages including important economic benefits. The physician responsible for conducting such treatment should select patients according to strict criteria and never neglect security and quality issues. In this article, the authors discuss different aspects (general, medical, psychosocial, economic and practical) related to outpatient parenteral antibiotic treatment of severe paediatric infections.