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Banholzer N, Jent P, Bittel P, Zürcher K, Furrer L, Bertschinger S, Weingartner E, Ramette A, Egger M, Hascher T, Fenner L. Air Cleaners and Respiratory Infections in Schools: A Modeling Study Based on Epidemiologic, Environmental, and Molecular Data. Open Forum Infect Dis 2024; 11:ofae169. [PMID: 38665173 PMCID: PMC11045022 DOI: 10.1093/ofid/ofae169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 03/19/2024] [Indexed: 04/28/2024] Open
Abstract
Background Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA air filtration devices (air cleaners) in a school setting. Methods We collected data over 7 weeks during winter 2022/2023 in 2 Swiss secondary school classes: environmental (CO2, particle concentrations), epidemiologic (absences related to respiratory infections), audio (coughing), and molecular (bioaerosol and saliva samples). Using a crossover design, we compared particle concentrations, coughing, and risk of infection with and without air cleaners. Results All 38 students participated (age, 13-15 years). With air cleaners, mean particle concentration decreased by 77% (95% credible interval, 63%-86%). There were no differences in CO2 levels. Absences related to respiratory infections were 22 without air cleaners vs 13 with them. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval, 0.44-1.18). Coughing also tended to be less frequent (posterior probability, 93%), indicating that fewer symptomatic students were in class. Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive) but not in bioaerosols (2/105) or on the HEPA filters of the air cleaners (4/160). The molecular detection rate in saliva was similar with and without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions. Conclusions Air cleaners improved air quality and showed potential benefits in reducing respiratory infections. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission and the cost-effectiveness of using air cleaners.
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Affiliation(s)
- Nicolas Banholzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Bittel
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Lavinia Furrer
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Simon Bertschinger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ernest Weingartner
- Institute for Sensors and Electronics, University of Applied Sciences and Arts Northwestern Switzerland, Windisch, Switzerland
| | - Alban Ramette
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Tina Hascher
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute of Educational Science, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
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Banholzer N, Bittel P, Jent P, Furrer L, Zürcher K, Egger M, Hascher T, Fenner L. Molecular detection of SARS-CoV-2 and other respiratory viruses in saliva and classroom air: a two winters tale. Clin Microbiol Infect 2024:S1198-743X(24)00114-9. [PMID: 38467247 DOI: 10.1016/j.cmi.2024.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/26/2024] [Accepted: 03/04/2024] [Indexed: 03/13/2024]
Abstract
OBJECTIVES To compare the prevalence of SARS-CoV-2 and other respiratory viruses in saliva and bioaerosols between two winters and to model the probability of virus detection in classroom air for different viruses. METHODS We analysed saliva, air, and air cleaner filter samples from studies conducted in two Swiss secondary schools (students aged 14-17 years) over 7 weeks during the winters of 2021/22 and 2022/23. Two bioaerosol sampling devices and high efficiency particulate air (HEPA) filters from air cleaners were used to collect airborne virus particles in four classrooms. Daily bioaerosol samples were pooled for each sampling device before PCR analysis of a panel of 19 respiratory viruses and viral subtypes. The probability of detection of airborne viruses was modelled using an adjusted Bayesian logistic regression model. RESULTS Three classes (58 students) participated in 2021/22, and two classes (38 students) in 2022/23. During winter 2021/22, SARS-CoV-2 dominated in saliva (19 of 21 positive samples) and bioaerosols (9 of 10). One year later, there were 50 positive saliva samples, mostly influenza B, rhinovirus, and adenovirus, and two positive bioaerosol samples, one rhinovirus and one adenovirus. The weekly probability of airborne detection was 34% (95% credible interval [CrI] 22-47%) for SARS-CoV-2 and 10% (95% CrI 5-16%) for other respiratory viruses. DISCUSSION There was a distinct shift in the distribution of respiratory viruses from SARS-CoV-2 during the omicron wave to other respiratory viruses one year later. SARS-CoV-2 is more likely to be detected in the air than other endemic respiratory viruses, possibly reflecting differences in viral characteristics and the composition of virus-carrying particles that facilitate airborne long-range transmission.
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Affiliation(s)
- Nicolas Banholzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Pascal Bittel
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland; Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland; Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Lavinia Furrer
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Population Health Sciences, University of Bristol, Bristol, UK; Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Tina Hascher
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland; Institute of Educational Science, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland.
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Banholzer N, Jent P, Bittel P, Zürcher K, Furrer L, Bertschinger S, Weingartner E, Ramette A, Egger M, Hascher T, Fenner L. Air cleaners and respiratory infections in schools: A modeling study using epidemiological, environmental, and molecular data. medRxiv 2023:2023.12.29.23300635. [PMID: 38234723 PMCID: PMC10793541 DOI: 10.1101/2023.12.29.23300635] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2024]
Abstract
Background Using a multiple-measurement approach, we examined the real-world effectiveness of portable HEPA-air filtration devices (air cleaners) in a school setting. Methods We collected environmental (CO2, particle concentrations), epidemiological (absences related to respiratory infections), audio (coughing), and molecular data (bioaerosol and saliva samples) over seven weeks during winter 2022/2023 in two Swiss secondary school classes. Using a cross-over study design, we compared particle concentrations, coughing, and the risk of infection with vs without air cleaners. Results All 38 students (age 13-15 years) participated. With air cleaners, mean particle concentration decreased by 77% (95% credible interval 63%-86%). There were no differences in CO2 levels. Absences related to respiratory infections were 22 without vs 13 with air cleaners. Bayesian modeling suggested a reduced risk of infection, with a posterior probability of 91% and a relative risk of 0.73 (95% credible interval 0.44-1.18). Coughing also tended to be less frequent (posterior probability 93%). Molecular analysis detected mainly non-SARS-CoV-2 viruses in saliva (50/448 positive), but not in bioaerosols (2/105 positive) or HEPA-filters (4/160). The detection rate was similar with vs without air cleaners. Spatiotemporal analysis of positive saliva samples identified several likely transmissions. Conclusions Air cleaners improved air quality, showed a potential benefit in reducing respiratory infections, and were associated with less coughing. Airborne detection of non-SARS-CoV-2 viruses was rare, suggesting that these viruses may be more difficult to detect in the air. Future studies should examine the importance of close contact and long-range transmission, and the cost-effectiveness of using air cleaners.
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Affiliation(s)
- Nicolas Banholzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Bittel
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lavinia Furrer
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Simon Bertschinger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Ernest Weingartner
- Institute for Sensors and Electronics, University of Applied Sciences and Arts Northwestern Switzerland, Windisch, Switzerland
| | - Alban Ramette
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, University of Bristol, Bristol, UK
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
| | - Tina Hascher
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
- Institute of Educational Science, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Multidisciplinary Center for Infectious Diseases, University of Bern, Bern, Switzerland
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Perrig L, Abela IA, Banholzer N, Audigé A, Epp S, Mugglin C, Zürcher K, Egger M, Trkola A, Fenner L. Long-term course of neutralising antibodies against SARS-CoV-2 in vaccinated and unvaccinated staff and residents in a Swiss nursing home: a cohort study 2021-2022. Swiss Med Wkly 2023; 153:3502. [PMID: 38579325 DOI: 10.57187/s.3502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Given their high-risk resident population, nursing homes were critical institutions in the COVID-19 pandemic, calling for continued monitoring and vaccine administration to healthcare workers and residents. Here, we studied long-term severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) immunity in vaccinated and unvaccinated healthcare workers and residents of a nursing home in Switzerland between February 2021 and June 2022. METHODS Our study comprised 45 participants, of which 39 were healthcare workers and six were residents. All participants were offered a maximum of three mRNA vaccine doses (Pfizer/BioNTech, BNT162b2) in December 2020, January 2021, and November/December 2021. Thirty-five participants received three vaccinations, seven either one or two, and three remained unvaccinated. We collected four blood samples: one in March 2021 and three during follow-ups in November 2021, February 2022, and June 2022. We performed a multifactorial serological SARS-CoV-2 assay (ABCORA) for immunoglobulin G, A, and M responses to spike (receptor-binding domain, S1, and S2) and nucleocapsid (N) proteins. Furthermore, we assessed predicted neutralisation activity based on signal over cutoff in ABCORA. We collected epidemiological data from participants via a standardised questionnaire. RESULTS Thirty-two (71%) of the 45 participants showed hybrid immunity from combined vaccination and previous infection; 10 (22%) had only vaccine-induced immunity; and three (7%) had only post-infection immunity. Participants with hybrid immunity showed the highest predicted neutralisation activity at the end of the study period (median Sum S1 = 273), and unvaccinated participants showed the lowest (median Sum S1 = 41). Amongst participants who reported a SARS-CoV-2 infection, median Sum S1 levels increased with the number of vaccinations (p = 0.077). The healthcare worker group showed a significant time-dependent decrease in median Sum S1 after base immunisation (93% decrease, p = 0.0005) and the booster dose (26% decrease, p = 0.010). Predicted neutralisation activity was lower amongst residents (adjusted ratio of means [AM] = 0.7, 95% confidence interval [CI] = 0.3-1.0) and amongst smokers (AM = 0.5, 95% CI 0.3-0.8). Activity increased with the number of vaccinations (booster: AM = 3.6, 95% CI 1.5-8.8; no booster: AM = 2.3, 95% CI 0.9-2.5). Positive SARS-CoV-2 infection status tended to confer higher predicted neutralisation levels (AM = 1.5, 95% CI 0.9-2.5). CONCLUSIONS Our study of the long-term serological course of SARS-CoV-2 in a nursing home showed that the first SARS-CoV-2 booster vaccine was essential for maintaining antiviral antibody levels. Hybrid immunity sustained SARS-CoV-2 immunity at the highest level. In critical settings such as nursing homes, monitoring the SARS-CoV-2 immune status may guide booster vaccinations.
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Affiliation(s)
- Lisa Perrig
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Irene A Abela
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Nicolas Banholzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Annette Audigé
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Selina Epp
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zurich, Zurich, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Heron L, Mugglin C, Zürcher K, Brumann E, Keune-Dübi B, Low N, Fenner L. Contact tracing for COVID-19 in a Swiss canton: analysis of key performance indicators. Swiss Med Wkly 2023; 153:40112. [PMID: 37955850 DOI: 10.57187/smw.2023.40112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Contact tracing (CT) has played an important role in strategies to control COVID-19. However, there is limited evidence on the performance of digital tools for CT and no consensus on which indicators to use to monitor their performance. We aimed to describe the system and analyse outcomes of CT with a partially automated workflow in the Swiss canton of Solothurn, using key performance indicators (KPIs). METHODS We describe the process of CT used in the canton of Solothurn between November 2020 and February 2022, including forward and backward CT. We developed 16 KPIs representing CT structure (S1-2), process (P1-11) and outcome (O1-3) based on previous literature to analyse the relative performance of CT. We report the changes in the indicators over waves of SARS-CoV-2 infections caused by several viral variants. RESULTS The CT team in Solothurn processed 57,363 index cases and 71,809 contacts over a 15-month period. The CT team successfully contacted 99% of positive cases within 24 hours (KPI P7) throughout the pandemic and returned almost all test results on the same or next day (KPI P6), before the delta variant emerged. Three-quarters of contacts were notified within 24 hours of the CT interview with the index (KPI P8) before the emergence of the alpha, delta and omicron variants, when the proportions decreased to 64%, 36% and 54%, respectively. The percentage of new symptomatic cases tested and interviewed within 3 days of symptom onset was high at >70% (KPI P10) and contacts started quarantine within a median of 3 days of index case symptom onset (KPI P3). About a fifth of new index cases had already been in quarantine by the time of their positive test (KPI O1), before the delta variant emerged. The percentage of index cases in isolation by day of testing remained at almost 100% throughout the period of analysis (KPI O2). CONCLUSIONS The CT in Solothurn used a partially automated workflow and continued to perform well throughout the pandemic, although the relative performance of the CT system declined at higher caseloads. CT remains an important tool for controlling the spread of infectious diseases, but clearer standards should improve the performance, comparability and monitoring of infection in real time as part of pandemic preparedness efforts.
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Affiliation(s)
- Leonie Heron
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Erich Brumann
- Cantonal Physician's Office, Canton of Solothurn, Solothurn, Switzerland
| | - Bettina Keune-Dübi
- Cantonal Physician's Office, Canton of Solothurn, Solothurn, Switzerland
| | - Nicola Low
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Zürcher K, Abela IA, Stange M, Dupont C, Mugglin C, Egli A, Trkola A, Egger M, Fenner L. Alpha Variant Coronavirus Outbreak in a Nursing Home Despite High Vaccination Coverage: Molecular, Epidemiological, and Immunological Studies. Clin Infect Dis 2023; 77:537-546. [PMID: 35522980 PMCID: PMC9129182 DOI: 10.1093/cid/ciab1005] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Vaccination may control the coronavirus disease 2019 (COVID-19) pandemic, including in nursing homes where many high-risk people live. We conducted extensive outbreak investigations. METHODS We studied an outbreak at a nursing home in Switzerland, where the uptake of messenger RNA vaccines against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 82% among residents as of 21 January 2021. After diagnosis of COVID-19 in a vaccinated symptomatic healthcare worker (HCW) on 22 February, we performed outbreak investigations in house A (47 residents; 37 HCWs), using SARS-CoV-2-specific polymerase chain reaction testing of nasopharyngeal swab samples. We performed whole-genome sequencing of SARS-CoV-2 and serological analyses. RESULTS We identified 17 individuals with positive polymerase chain reaction results, 10 residents (5 vaccinated) and 7 HCWs (3 vaccinated). The median age (interquartile range) was 86 (70-90) years among residents and 49 (29-59) years among HCWs. Of the 5 vaccinated residents, 3 had mild disease and 2 had no symptoms, whereas all 5 unvaccinated residents had mild to severe disease, and 2 died. Vaccine effectiveness for the prevention of infection among residents was 73.0% (95% confidence interval, 24.7%-90.1%). The 12 available genomes were all alpha variants. Neutralizing titers were significantly higher in vaccinated individuals on reexposure (>1 week after diagnosis) than in vaccinated, unexposed HCWs (P = .01). Transmission networks indicated 4 likely or possible transmissions from vaccinated to other individuals and 12 transmission events from unvaccinated individuals. CONCLUSIONS COVID-19 outbreaks can occur in nursing homes, including transmission from vaccinated persons to others. Outbreaks might occur silently, underlining the need for continued testing and basic infection control measures in these high-risk settings.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Irene A Abela
- Institute of Medical Virology, University of Zürich, Zurich, Switzerland
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, Zurich, Switzerland
| | - Madlen Stange
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Carole Dupont
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Kantonsärztlicher Dienst, Gesundheitsamt, Kanton Solothurn, Switzerland
| | - Adrian Egli
- Clinical Bacteriology and Mycology, University Hospital Basel, Basel, Switzerland
- Applied Microbiology Research, Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Alexandra Trkola
- Institute of Medical Virology, University of Zürich, Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Kantonsärztlicher Dienst, Gesundheitsamt, Kanton Solothurn, Switzerland
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Banholzer N, Zürcher K, Jent P, Bittel P, Furrer L, Egger M, Hascher T, Fenner L. SARS-CoV-2 transmission with and without mask wearing or air cleaners in schools in Switzerland: A modeling study of epidemiological, environmental, and molecular data. PLoS Med 2023; 20:e1004226. [PMID: 37200241 PMCID: PMC10194935 DOI: 10.1371/journal.pmed.1004226] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 03/28/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Growing evidence suggests an important contribution of airborne transmission to the overall spread of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), in particular via smaller particles called aerosols. However, the contribution of school children to SARS-CoV-2 transmission remains uncertain. The aim of this study was to assess transmission of airborne respiratory infections and the association with infection control measures in schools using a multiple-measurement approach. METHODS AND FINDINGS We collected epidemiological (cases of Coronavirus Disease 2019 (COVID-19)), environmental (CO2, aerosol and particle concentrations), and molecular data (bioaerosol and saliva samples) over 7 weeks from January to March 2022 (Omicron wave) in 2 secondary schools (n = 90, average 18 students/classroom) in Switzerland. We analyzed changes in environmental and molecular characteristics between different study conditions (no intervention, mask wearing, air cleaners). Analyses of environmental changes were adjusted for different ventilation, the number of students in class, school and weekday effects. We modeled disease transmission using a semi-mechanistic Bayesian hierarchical model, adjusting for absent students and community transmission. Molecular analysis of saliva (21/262 positive) and airborne samples (10/130) detected SARS-CoV-2 throughout the study (weekly average viral concentration 0.6 copies/L) and occasionally other respiratory viruses. Overall daily average CO2 levels were 1,064 ± 232 ppm (± standard deviation). Daily average aerosol number concentrations without interventions were 177 ± 109 1/cm3 and decreased by 69% (95% CrI 42% to 86%) with mask mandates and 39% (95% CrI 4% to 69%) with air cleaners. Compared to no intervention, the transmission risk was lower with mask mandates (adjusted odds ratio 0.19, 95% CrI 0.09 to 0.38) and comparable with air cleaners (1.00, 95% CrI 0.15 to 6.51). Study limitations include possible confounding by period as the number of susceptible students declined over time. Furthermore, airborne detection of pathogens document exposure but not necessarily transmission. CONCLUSIONS Molecular detection of airborne and human SARS-CoV-2 indicated sustained transmission in schools. Mask mandates were associated with greater reductions in aerosol concentrations than air cleaners and with lower transmission. Our multiple-measurement approach could be used to continuously monitor transmission risk of respiratory infections and the effectiveness of infection control measures in schools and other congregate settings.
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Affiliation(s)
- Nicolas Banholzer
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Philipp Jent
- Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Pascal Bittel
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Lavinia Furrer
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Tina Hascher
- Institute of Educational Science, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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Marti M, Zürcher K, Enane LA, Diero L, Marcy O, Tiendrebeogo T, Yotebieng M, Twizere C, Khusuwan S, Yunihastuti E, Reubenson G, Shah NS, Egger M, Ballif M, Fenner L. Impact of the COVID-19 pandemic on TB services at ART programmes in low- and middle-income countries: a multi-cohort survey. J Int AIDS Soc 2022; 25:e26018. [PMID: 36285602 PMCID: PMC9597377 DOI: 10.1002/jia2.26018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/21/2022] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION COVID-19 stretched healthcare systems to their limits, particularly in settings with a pre-existing high burden of infectious diseases, including HIV and tuberculosis (TB). We studied the impact of COVID-19 on TB services at antiretroviral therapy (ART) clinics in low- and middle-income countries. METHODS We surveyed ART clinics providing TB services in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in Africa and the Asia-Pacific until July 2021 (TB diagnoses until the end of 2021). We collected site-level data using standardized questionnaires. RESULTS Of 46 participating ART clinics, 32 (70%) were in Africa and 14 (30%) in the Asia-Pacific; 52% provided tertiary care. Most clinics (85%) reported disrupted routine HIV care services during the pandemic, both in Africa (84%) and the Asia-Pacific (86%). The most frequently reported impacts were on staff (52%) and resource shortages (37%; protective clothing, face masks and disinfectants). Restrictions in TB health services were observed in 12 clinics (26%), mainly reduced access to TB diagnosis and postponed follow-up visits (6/12, 50% each), and restrictions in TB laboratory services (22%). Restrictions of TB services were addressed by dispensing TB drugs for longer periods than usual (7/12, 58%), providing telehealth services (3/12, 25%) and with changes in directly observed therapy (DOT) (e.g. virtual DOT, 3/12). The number of TB diagnoses at participating clinics decreased by 21% in 2020 compared to 2019; the decline was more pronounced in tertiary than primary/secondary clinics (24% vs. 12%) and in sites from the Asia-Pacific compared to Africa (46% vs. 14%). In 2021, TB diagnoses continued to decline in Africa (-8%) but not in the Asia-Pacific (+62%) compared to 2020. During the pandemic, new infection control measures were introduced or intensified at the clinics, including wearing face masks, hand sanitation and patient triage. CONCLUSIONS The COVID-19 pandemic led to staff shortages, reduced access to TB care and delays in follow-up visits for people with TB across IeDEA sites in Africa and the Asia-Pacific. Increased efforts are needed to restore and secure ongoing access to essential TB services in these contexts.
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Affiliation(s)
- Mariana Marti
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global HealthDepartment of PediatricsIndiana University School of MedicineIndianapolisIndianaUSA
| | - Lameck Diero
- Department of MedicineMoi University School of MedicineEldoretKenya
- Department of MedicineMoi Teaching and Referral HospitalEldoretKenya
| | - Olivier Marcy
- University of Bordeaux, Inserm U1219IRD EMR271BordeauxFrance
| | | | - Marcel Yotebieng
- Division of General Internal MedicineDepartment of MedicineAlbert Einstein College of MedicineBronxNew YorkUSA
| | - Christelle Twizere
- Centre National de Référence en matière de VIH/SIDA Burundi (CNR)BujumburaBurundi
| | | | - Evy Yunihastuti
- Faculty of Medicine Universitas IndonesiaDr. Cipto Mangunkusumo General HospitalJakartaIndonesia
| | - Gary Reubenson
- Rahima Moosa Mother and Child HospitalDepartment of Paediatrics and Child HealthFaculty of Health SciencesUniversity of the WitwatersrandJohannesburgSouth Africa
| | - N. Sarita Shah
- Emory Rollins School of Public HealthEmory UniversityAtlantaGeorgiaUSA
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchFaculty of Health SciencesUniversity of Cape TownCape TownSouth Africa
- Population Health SciencesBristol Medical SchoolUniversity of BristolBristolUK
| | - Marie Ballif
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
| | - Lukas Fenner
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
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9
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Zürcher K, Cox SR, Ballif M, Enane LA, Marcy O, Yotebieng M, Reubenson G, Imsanguan W, Otero L, Suryavanshi N, Duda SN, Egger M, Tornheim JA, Fenner L. Integrating services for HIV and multidrug-resistant tuberculosis: A global cross-sectional survey among ART clinics in low- and middle-income countries. PLOS Glob Public Health 2022; 2:e0000180. [PMID: 36778080 PMCID: PMC9910322 DOI: 10.1371/journal.pgph.0000180] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 01/19/2022] [Indexed: 04/21/2023]
Abstract
Tuberculosis (TB) is the leading cause of death among PLHIV and multidrug-resistant-TB (MDR-TB) is associated with high mortality. We examined the management for adult PLHIV coinfected with MDR-TB at ART clinics in lower income countries. Between 2019 and 2020, we conducted a cross-sectional survey at 29 ART clinics in high TB burden countries within the global IeDEA network. We used structured questionnaires to collect clinic-level data on the TB and HIV services and the availability of diagnostic tools and treatment for MDR-TB. Of 29 ART clinics, 25 (86%) were in urban areas and 19 (66%) were tertiary care clinics. Integrated HIV-TB services were reported at 25 (86%) ART clinics for pan-susceptible TB, and 14 (48%) clinics reported full MDR-TB services on-site, i.e. drug susceptibility testing [DST] and MDR-TB treatment. Some form of DST was available on-site at 22 (76%) clinics, while the remainder referred testing off-site. On-site DST for second-line drugs was available at 9 (31%) clinics. MDR-TB treatment was delivered on-site at 15 (52%) clinics, with 10 individualizing treatment based on DST results and five using standardized regimens alone. Bedaquiline was routinely available at 5 (17%) clinics and delamanid at 3 (10%) clinics. Although most ART clinics reported having integrated HIV and TB services, few had fully integrated MDR-TB services. There is a continued need for increased access to diagnostic and treatment options for MDR-TB patients and better integration of MDR-TB services into the HIV care continuum.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Samyra R. Cox
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Leslie A. Enane
- The Ryan White Center for Pediatric Infectious Disease and Global Health, Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, United States of America
| | - Olivier Marcy
- U1219 Bordeaux Population Health Research Center, University of Bordeaux, Inserm, IRD, Bordeaux, France
| | - Marcel Yotebieng
- Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, NY, United States of America
| | - Gary Reubenson
- Faculty of Health Sciences, Department of Paediatrics and Child Health, University of the Witwatersrand, Rahima Moosa Mother and Child Hospital, Johannesburg, South Africa
| | | | - Larissa Otero
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Nishi Suryavanshi
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
- Johns Hopkins India, Pune, India
| | - Stephany N. Duda
- Department of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, TN, United States of America
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Jeffrey A. Tornheim
- Division of Infectious Diseases, Center for Clinical Global Health Education, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
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10
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Zürcher K, Riou J, Morrow C, Ballif M, Koch A, Bertschinger S, Warner DF, Middelkoop K, Wood R, Egger M, Fenner L. Estimating Tuberculosis Transmission Risks in a Primary Care Clinic in South Africa: Modeling of Environmental and Clinical Data. J Infect Dis 2022; 225:1642-1652. [PMID: 35039860 PMCID: PMC9071349 DOI: 10.1093/infdis/jiab534] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 11/09/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Congregate settings, such as healthcare clinics, may play an essential role in Mycobacterium tuberculosis (Mtb) transmission. Using patient and environmental data, we studied transmission at a primary care clinic in South Africa. METHODS We collected patient movements, cough frequency, and clinical data, and measured indoor carbon dioxide (CO2) levels, relative humidity, and Mtb genomes in the air. We used negative binomial regression model to investigate associations. RESULTS We analyzed 978 unique patients who contributed 14 795 data points. The median patient age was 33 (interquartile range [IQR], 26-41) years, and 757 (77.4%) were female. Overall, median CO2 levels were 564 (IQR 495-646) parts per million and were highest in the morning. Median number of coughs per day was 466 (IQR, 368-503), and overall median Mtb DNA copies/μL/day was 4.2 (IQR, 1.2-9.5). We found an increased presence of Mtb DNA in the air of 32% (95% credible interval, 7%-63%) per 100 additional young adults (aged 15-29 years) and 1% (0-2%) more Mtb DNA per 10% increase of relative humidity. Estimated cumulative transmission risks for patients attending the clinic monthly for at least 1 hour range between 9% and 29%. CONCLUSIONS We identified young adults and relative humidity as potentially important factors for transmission risks in healthcare clinics. Our approach should be used to detect transmission and evaluate infection control interventions.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Julien Riou
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Carl Morrow
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anastasia Koch
- South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Simon Bertschinger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Institute for Medical Informatics, Bern University of Applied Sciences, Bern, Switzerland
| | - Digby F Warner
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,South African Medical Research Council/National Health Laboratory Service/University of Cape Town Molecular Mycobacteriology Research Unit and Department of Science and Innovation/National Research Foundation Centre of Excellence for Biomedical TB Research, Department of Pathology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Keren Middelkoop
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Robin Wood
- Institute of Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa,Desmond Tutu HIV Centre, Department of Medicine, University of Cape Town, University of Cape Town, Cape Town, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa,Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland,Correspondence: Lukas Fenner, MD, MSc, Institute of Social and Preventive Medicine, University of Bern (ISPM), Mittelstrasse 43, 3012 Bern, Switzerland ()
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11
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Zürcher K, Mugglin C, Egger M, Müller S, Fluri M, Bolick L, Piso RJ, Hoffmann M, Fenner L. Vaccination willingness for COVID-19 among healthcare workers: a cross-sectional survey in a Swiss canton. Swiss Med Wkly 2021; 151:w30061. [PMID: 34546016 DOI: 10.4414/smw.2021.w30061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
AIMS OF THE STUDY Vaccination is regarded as the most promising response to the COVID-19 pandemic. We assessed opinions about COVID-19 vaccination, willingness to be vaccinated, and reasons for vaccination hesitancy among healthcare workers. METHODS We conducted a cross-sectional, web-based survey among 3,793 healthcare workers in December 2020 in the Canton of Solothurn, Switzerland, before the start of the national COVID-19 vaccination campaign. RESULTS Median age was 43 years (interquartile range [IQR] 31-53), 2,841 were female (74.9%). A total of 1,511 healthcare workers (39.8%) reported willingness to accept vaccination, whereas 1,114 (29.4%) were unsure and 1,168 (30.8%) would decline vaccination. Among medical doctors, 76.1% were willing, whereas only 27.8% of nurses expressed willingness. Among the 1,168 healthcare workers who would decline vaccination, 1,073 (91.9%) expressed concerns about vaccine safety and side effects. The willingness of healthcare workers to be vaccinated was associated with older age (adjusted odds ratio [aOR] 1.97, 95% confidence interval [Cl] 1.71-2.27) and having been vaccinated for influenza this year (aOR 2.70, 95% Cl 2.20-3.31). Healthcare workers who reported a lack of confidence in government were less likely to be willing to be vaccinated (aOR 0.58, 95% Cl 0.40-0.84), and women were less willing to be vaccinated than men (OR 0.33, 95% CI 0.28-0.38). CONCLUSION Less than half of healthcare workers reported willingness to be vaccinated before the campaign start, but proportions varied greatly depending on profession and workplace. Strategies with clear and objective messages that particularly address the concerns of healthcare workers are needed if their willingness to be vaccinated against COVID-19 is to be further increased.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Kantonsärztlicher Dienst, Gesundheitsamt, Kanton Solothurn, Switzerland.,Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Sandro Müller
- Amt für soziale Sicherheit, Kanton Solothurn, Switzerland
| | - Michael Fluri
- Hausarztpraxis Weissenstein, Langendorf, Switzerland
| | - Laurence Bolick
- Department of Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Switzerland
| | - Rein Jan Piso
- Department of Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Switzerland
| | - Matthias Hoffmann
- Department of Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Kantonsärztlicher Dienst, Gesundheitsamt, Kanton Solothurn, Switzerland
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12
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Zürcher K, Mugglin C, Suter-Riniker F, Keller PM, Egger M, Müller S, Fluri M, Hoffmann M, Fenner L. Seroprevalence of SARS-CoV-2 in healthcare workers from outpatient facilities and retirement or nursing homes in a Swiss canton. Swiss Med Wkly 2021; 151:w30021. [PMID: 34495604 DOI: 10.4414/smw.2021.w30021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Healthcare workers are more frequently exposed to SARS-CoV-2 than the general population. Little is known about healthcare settings outside of hospitals. We studied the seroprevalence of SARS-CoV-2 among healthcare workers in outpatient facilities and retirement or nursing homes in the Canton of Solothurn, Switzerland in the first wave of the COVID-19 pandemic. METHODS Longitudinal seroprevalence study among healthcare workers with examinations at baseline and 2 months between June and September 2020. The Abbott SARS-CoV-2 IgG and Liaison/Diasorin SARS-CoV-2 S1/S2 IgG assay were used to detect antibodies against SARS-CoV-2. All participants provided demographic information. We report descriptive statistics and calculated the seroprevalence with 95% confidence intervals. RESULTS We included 357 healthcare workers; their median age was 43 years (interquartile range 29-54), and 315 (88.2%) were female. Forty-nine (13.7%) were physicians, 87 (24.4%) practice assistants and 221 (61.9%) nurses. Overall seroprevalence among healthcare workers in outpatient facilities and retirement or nursing homes was 3.4% (12/357). The 12 seropositive healthcare workers were all nurses (12/221, 5.5%); 11 worked at retirement or nursing homes and one at the hospital's outpatient clinic. Symptoms such as loss of smell or taste, shortness of breath, and fever were more prevalent among seropositive healthcare workers than seronegative healthcare workers. No close contact had detectable antibodies against SARS-CoV-2. CONCLUSIONS Seroprevalence among healthcare workers was low, but higher among nursing staff of retirement or nursing homes. Healthcare workers at private practices were able to protect themselves well during the first wave of the COVID-19 pandemic.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Catrina Mugglin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Gesundheitsamt, Kanton Solothurn, Switzerland.,Department of Infectious Diseases, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | | | - Peter M Keller
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Sandro Müller
- Amt für soziale Sicherheit, Kanton Solothurn, Switzerland
| | - Michael Fluri
- Hausarztpraxis Weissenstein, Langendorf, Switzerland
| | - Matthias Hoffmann
- Department of Internal Medicine, Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Olten, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Switzerland.,Gesundheitsamt, Kanton Solothurn, Switzerland
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13
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Abstract
OBJECTIVES We studied time trends in seasonal influenza vaccination and associations with socioeconomic and health-related determinants in Switzerland, overall and in people aged ≥65 years. DESIGN Three cross-sectional surveys. PARTICIPANTS Individuals who participated in the Swiss Health Surveys 2007, 2012 and 2017. We calculated the proportion reporting influenza vaccination in the last 12 months, and performed multivariable logistic regression analyses. RESULTS We included 51 582 individuals in this analysis. The median age was 49 years (IQR 25-64), and 27 518 were women (53.3%). The proportion of reporting a history of influenza vaccination overall was 31.9% (95% CI 31.4 to 32.4); and dropped from 34.5% in 2007 to 28.8% in 2017. The uptake of vaccination within the past 12 months was 16% in 2007 and similar in 2012 and 2017 (around 14%). In people with chronic disease, uptake dropped from 43.8% in 2007 to 37.1% in 2012 and to 31.6% in 2017 (p<0.001). In people aged ≥65 years, uptake dropped from 47.8% in 2007 to 38.5% in 2012 to 36.2% in 2017 (p<0.001). In logistic regression, self-reported vaccination coverage decreased in the 65-75 years old (adjusted OR (aOR) 0.56, 95% CI 0.48 to 0.66 between 2007 and 2012; aOR 0.89, 95% CI 0.77 to 1.03 between 2012 and 2017). Uptake was positively associated with the ≥65 age group, living in French-speaking and urban areas, history of smoking, bad self-reported health status, private/semiprivate health insurance, having a medical profession and having any underlying chronic disease. CONCLUSION Influenza vaccination coverage was low in older and chronically ill persons. Significant efforts are required in preparing for the influenza season 2020/2021 to reduce the double burden of COVID-19 and seasonal influenza. These efforts should include campaigns but also novel approaches using social media.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Claudia Berlin
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
| | - Matthias Egger
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Population Health Sciences, Bristol Medical School, University of Bristol, BristolUK
| | - Lukas Fenner
- Institute of Social & Preventive Medicine, University of Bern, Bern, Switzerland
- Kanton Solothurn Gesundheitsamt, Solothurn, Switzerland
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14
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Reichmuth ML, Hömke R, Zürcher K, Sander P, Avihingsanon A, Collantes J, Loiseau C, Borrell S, Reinhard M, Wilkinson RJ, Yotebieng M, Fenner L, Böttger EC, Gagneux S, Egger M, Keller PM. Natural Polymorphisms in Mycobacterium tuberculosis Conferring Resistance to Delamanid in Drug-Naive Patients. Antimicrob Agents Chemother 2020; 64:e00513-20. [PMID: 32868333 PMCID: PMC7577131 DOI: 10.1128/aac.00513-20] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 08/19/2020] [Indexed: 02/06/2023] Open
Abstract
Mutations in the genes of the F420 signaling pathway of Mycobacterium tuberculosis complex, including dnn, fgd1, fbiA, fbiB, fbiC, and fbiD, can lead to delamanid resistance. We searched for such mutations among 129 M. tuberculosis strains from Asia, South America, and Africa using whole-genome sequencing; 70 (54%) strains had at least one mutation in one of the genes. For 10 strains with mutations, we determined the MIC of delamanid. We found one strain from a delamanid-naive patient carrying the natural polymorphism Tyr29del (ddn) that was associated with a critical delamanid MIC.
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Affiliation(s)
- Martina L Reichmuth
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Rico Hömke
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Peter Sander
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Anchalee Avihingsanon
- The HIV Netherlands Australia Thailand (HIV-NAT) Research Collaboration, Thai Red Cross AIDS Research Centre and Tuberculosis Research Unit, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Jimena Collantes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Chloé Loiseau
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Sonia Borrell
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Miriam Reinhard
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, Republic of South Africa
- Department of Infectious Diseases, Imperial College, London, United Kingdom
- The Francis Crick Institute, London, United Kingdom
| | - Marcel Yotebieng
- National TB Lab, Kinshasa, Democratic Republic of the Congo
- Albert Einstein College of Medicine, New York, New York, USA
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Erik C Böttger
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology and Research, Faculty of Health Sciences, University of Cape Town, Cape Town, Republic of South Africa
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland
- Swiss National Center for Mycobacteria, Zurich, Switzerland
- Institute for Infectious Diseases, University of Bern, Bern, Switzerland
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15
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Lutz A, Pasche M, Zürcher K. Integrating sustainability in professionals’ training in the field of health promotion and prevention. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa165.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Climate change poses a number of threats and challenges to our societies and has direct impacts on human health. Raising awareness and training health professionals to sustainable development represents a major strategy in order to respond to climate challenges. This article describes a teaching experience conducted in the context of a Certificate of Advanced Studies (CAS) in public health at the University of Lausanne, where students have been trained to sustainable development, through theoretical lessons and practical exercises.
Objectives
The integration of the topic of sustainable development in the teaching of health promotion and prevention to the students of the CAS in public health aimed to foster students' knowledge and competences in relation to this emerging topic. The main objective was to transmit concepts, methods and practical resources allowing them to incorporate sustainability into everyday health promotion and prevention practices.
Results
Health promotion and sustainable development share common goals and methodologies. The experience of teaching sustainability to public health students shows that these two topics can be easily integrated within a public health training, if teachers provide students with a clear theoretical and methodological framework, allowing them to make the appropriate connections between the two fields. Social determinants of health, intersectorial action and multilevel governance represent key topics that teachers can address with students in order to show the connections between public health and sustainability.
Conclusions
As stated in the 2019 Lancet Countdown on health and climate change, climate change is both a threat and an opportunity for our societies. While it puts health systems and professionals under considerable pressure, it also represents an opportunity to innovate and transform professional training and practices, and generate new knowledge and know-how.
Key messages
Training health professionals to sustainable development represents a major strategy to respond to climate change and its health impacts. In order to integrate sustainable development in public health training, teachers should provide students with a clear theoretical and methodological framework.
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Affiliation(s)
- A Lutz
- Unisanté, Lausanne, Switzerland
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16
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Zürcher K, Morrow C, Riou J, Ballif M, Koch AS, Bertschinger S, Liu X, Sharma M, Middelkoop K, Warner D, Wood R, Egger M, Fenner L. Novel approach to estimate tuberculosis transmission in primary care clinics in sub-Saharan Africa: protocol of a prospective study. BMJ Open 2020; 10:e036214. [PMID: 32847906 PMCID: PMC7451471 DOI: 10.1136/bmjopen-2019-036214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION Tuberculosis (TB) transmission is difficult to measure, and its drivers are not well understood. The effectiveness of infection control measures at healthcare clinics and the most appropriate intervention strategies to interrupt transmission are unclear. We propose a novel approach using clinical, environmental and position-tracking data to study the risk of TB transmission at primary care clinics in TB and HIV high burden settings in sub-Saharan Africa. METHODS AND ANALYSIS We describe a novel and rapid study design to assess risk factors for airborne TB transmission at primary care clinics in high-burden settings. The study protocol combines a range of different measurements. We will collect anonymous data on the number of patients, waiting times and patient movements using video sensors. Also, we will collect acoustic sound recordings to determine the frequency and intensity of coughing. Environmental data will include indoor carbon dioxide levels (CO2 in parts per million) and relative humidity. We will also extract routinely collected clinical data from the clinic records. The number of Mycobacterium tuberculosis particles in the air will be ascertained from dried filter units using highly sensitive digital droplet PCR. We will calculate rebreathed air volume based on people density and CO2 levels and develop a mathematical model to estimate the risk of TB transmission. The mathematical model can then be used to estimate the effect of possible interventions such as separating patient flows or improving ventilation in reducing transmission. The feasibility of our approach was recently demonstrated in a pilot study in a primary care clinic in Cape Town, South Africa. ETHICS AND DISSEMINATION The study was approved by the University of Cape Town (HREC/REF no. 228/2019), the City of Cape Town (ID-8139) and the Ethics Committee of the Canton Bern (2019-02131), Switzerland. The results will be disseminated in international peer-reviewed journals.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Carl Morrow
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Julien Riou
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Anastasia Sideris Koch
- Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Molecular Mycobacteriology Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Simon Bertschinger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Medical Informatics, Berne University of Applied Sciences, Bern, Switzerland
| | - Xin Liu
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington, USA
| | - Manuja Sharma
- Paul G. Allen School of Computer Science & Engineering, University of Washington, Seattle, Washington, USA
| | - Keren Middelkoop
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Digby Warner
- Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Molecular Mycobacteriology Research Unit, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Robin Wood
- Desmond Tutu HIV Centre, Institute of Infectious Disease and Molecular Medicine (IDM), University of Cape Town, Cape Town, South Africa
- Institute of Infectious Disease and Molecular Medicine and the Department of Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
- Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Rondebosch, Western Cape, South Africa
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
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17
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Chammartin F, Zürcher K, Keiser O, Weigel R, Chu K, Kiragga AN, Ardura-Garcia C, Anderegg N, Laurent C, Cornell M, Tweya H, Haas AD, Rice BD, Geng EH, Fox MP, Hargreaves JR, Egger M. Outcomes of Patients Lost to Follow-up in African Antiretroviral Therapy Programs: Individual Patient Data Meta-analysis. Clin Infect Dis 2019; 67:1643-1652. [PMID: 29889240 PMCID: PMC6233676 DOI: 10.1093/cid/ciy347] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 05/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background Low retention on combination antiretroviral therapy (cART) has emerged as a threat to the Joint United Nations Programme on human immunodeficiency virus (HIV)/AIDS (UNAIDS) 90-90-90 targets. We examined outcomes of patients who started cART but were subsequently lost to follow-up (LTFU) in African treatment programs. Methods This was a systematic review and individual patient data meta-analysis of studies that traced patients who were LTFU. Outcomes were analyzed using cumulative incidence functions and proportional hazards models for the competing risks of (i) death, (ii) alive but stopped cART, (iii) silent transfer to other clinics, and (iv) retention on cART. Results Nine studies contributed data on 7377 patients who started cART and were subsequently LTFU in sub-Saharan Africa. The median CD4 count at the start of cART was 129 cells/μL. At 4 years after the last clinic visit, 21.8% (95% confidence interval [CI], 20.8%-22.7%) were known to have died, 22.6% (95% CI, 21.6%-23.6%) were alive but had stopped cART, 14.8% (95% CI, 14.0%-15.6%) had transferred to another clinic, 9.2% (95% CI, 8.5%-9.8%) were retained on cART, and 31.6% (95% CI, 30.6%-32.7%) could not been found. Mortality was associated with male sex, more advanced disease, and shorter cART duration; stopping cART with less advanced disease andlonger cART duration; and silent transfer with female sex and less advanced disease. Conclusions Mortality in patients LTFU must be considered for unbiased assessments of program outcomes and UNAIDS targets in sub-Saharan Africa. Immediate start of cART and early tracing of patients LTFU should be priorities.
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Affiliation(s)
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern
| | - Olivia Keiser
- Institute of Global Health, University of Geneva, Switzerland
| | - Ralf Weigel
- Faculty of Health, Witten/Herdecke University, Witten, Germany.,Lighthouse Trust, Lilongwe, Malawi
| | - Kathryn Chu
- Department of Surgery, University of Cape Town, South Africa
| | - Agnes N Kiragga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | | | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern
| | - Christian Laurent
- Institut de Recherche pour le Développement, Inserm, Univ Montpellier, Recherches Translationnelles sur le VIH et les Maladies Infectieuses, Montpellier, France
| | - Morna Cornell
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
| | | | - Andreas D Haas
- Institute of Social and Preventive Medicine, University of Bern
| | - Brian D Rice
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Elvin H Geng
- Division of Infectious Diseases, HIV and Global Medicine, Department of Medicine, University of California, San Francisco
| | - Matthew P Fox
- Health Economics and Epidemiology Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,Departments of Epidemiology and Global Health, Boston University School of Public Health, Massachusetts
| | - James R Hargreaves
- Department of Social and Environmental Health Research, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern.,Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, South Africa
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18
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Zürcher K, Ballif M, Kiertiburanakul S, Chenal H, Yotebieng M, Grinsztejn B, Michael D, Sterling TR, Ngonyani KM, Mandalakas AM, Egger M, Pettit AC, Fenner L. Diagnosis and clinical outcomes of extrapulmonary tuberculosis in antiretroviral therapy programmes in low- and middle-income countries: a multicohort study. J Int AIDS Soc 2019; 22:e25392. [PMID: 31507083 PMCID: PMC6737289 DOI: 10.1002/jia2.25392] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022] Open
Abstract
INTRODUCTION Extrapulmonary tuberculosis (EPTB) is difficult to confirm bacteriologically and requires specific diagnostic capacities. Diagnosis can be especially challenging in under-resourced settings. We studied diagnostic modalities and clinical outcomes of EPTB compared to pulmonary tuberculosis (PTB) among HIV-positive adults in antiretroviral therapy (ART) programmes in low- and middle-income countries (LMIC). METHODS We collected data from HIV-positive TB patients (≥16 years) in 22 ART programmes participating in the International Epidemiology Databases to Evaluate AIDS (IeDEA) consortium in sub-Saharan Africa, Asia-Pacific, and Caribbean, Central and South America regions between 2012 and 2014. We categorized TB as PTB or EPTB (EPTB included mixed PTB/EPTB). We used multivariable logistic regression to assess associations with clinical outcomes. RESULTS AND DISCUSSION We analysed 2695 HIV-positive TB patients. Median age was 36 years (interquartile range (IQR) 30 to 43), 1102 were female (41%), and the median CD4 count at TB treatment start was 114 cells/μL (IQR 40 to 248). Overall, 1930 had PTB (72%), and 765 EPTB (28%). Among EPTB patients, the most frequently involved sites were the lymph nodes (24%), pleura (15%), abdomen (11%) and meninges (6%). The majority of PTB (1123 of 1930, 58%) and EPTB (582 of 765, 76%) patients were diagnosed based on clinical criteria. Bacteriological confirmation (using positive smear microscopy, culture, Xpert MTB/RIF, or other nucleic acid amplification tests result) was obtained in 897 of 1557 PTB (52%) and 183 of 438 EPTB (42%) patients. EPTB was not associated with higher mortality compared to PTB (adjusted odd ratio (aOR) 1.0, 95% CI 0.8 to 1.3), but TB meningitis was (aOR 1.9, 95% CI 1.0 to 3.1). Bacteriological confirmation was associated with reduced mortality among PTB patients (aOR 0.7, 95% CI 0.6 to 0.8) and EPTB patients (aOR 0.3 95% CI 0.1 to 0.8) compared to TB patients with a negative test result. CONCLUSIONS Diagnosis of EPTB and PTB at ART programmes in LMIC was mainly based on clinical criteria. Greater availability and usage of TB diagnostic tests would improve the diagnosis and clinical outcomes of both EPTB and PTB.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
| | | | - Henri Chenal
- Centre Intégré de Recherches Biocliniques d'Abidjan (CIRBA)AbidjanCôte d'Ivoire
| | | | - Beatriz Grinsztejn
- Instituto Nacional de Infectologia Evandro ChagasFundação Oswaldo CruzRio de JaneiroBrazil
| | - Denna Michael
- National Institute for Medical ResearchKisesa HDSSMwanzaTanzania
| | - Timothy R Sterling
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | | | - Anna M Mandalakas
- The Global Tuberculosis ProgramTexas Children’s Hospital and Baylor College of MedicineHoustonTXUSA
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology & ResearchSchool of Public Health & Family MedicineUniversity of Cape TownSouth Africa
| | - April C Pettit
- Vanderbilt Tuberculosis CenterNashvilleTNUSA
- Division of Infectious DiseasesVanderbilt University Medical CenterNashvilleTNUSA
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM)University of BernBernSwitzerland
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19
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Zürcher K, Ballif M, Fenner L, Borrell S, Keller PM, Gnokoro J, Marcy O, Yotebieng M, Diero L, Carter EJ, Rockwood N, Wilkinson RJ, Cox H, Ezati N, Abimiku AG, Collantes J, Avihingsanon A, Kawkitinarong K, Reinhard M, Hömke R, Huebner R, Gagneux S, Böttger EC, Egger M. Drug susceptibility testing and mortality in patients treated for tuberculosis in high-burden countries: a multicentre cohort study. Lancet Infect Dis 2019; 19:298-307. [PMID: 30744962 DOI: 10.1016/s1473-3099(18)30673-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 10/07/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Drug resistance is a challenge for the global control of tuberculosis. We examined mortality in patients with tuberculosis from high-burden countries, according to concordance or discordance of results from drug susceptibility testing done locally and in a reference laboratory. METHODS This multicentre cohort study was done in Côte d'Ivoire, Democratic Republic of the Congo, Kenya, Nigeria, South Africa, Peru, and Thailand. We collected Mycobacterium tuberculosis isolates and clinical data from adult patients aged 16 years or older. Patients were stratified by HIV status and tuberculosis drug resistance. Molecular or phenotypic drug susceptibility testing was done locally and at the Swiss National Center for Mycobacteria, Zurich, Switzerland. We examined mortality during treatment according to drug susceptibility test results and treatment adequacy in multivariable logistic regression models adjusting for sex, age, sputum microscopy, and HIV status. FINDINGS We obtained M tuberculosis isolates from 871 patients diagnosed between 2013 and 2016. After exclusion of 237 patients, 634 patients with tuberculosis were included in this analysis; the median age was 33·2 years (IQR 26·9-42·5), 239 (38%) were women, 272 (43%) were HIV-positive, and 69 (11%) patients died. Based on the reference laboratory drug susceptibility test, 394 (62%) strains were pan-susceptible, 45 (7%) monoresistant, 163 (26%) multidrug-resistant (MDR), and 30 (5%) had pre-extensively or extensively drug resistant (pre-XDR or XDR) tuberculosis. Results of reference and local laboratories were concordant for 513 (81%) of 634 patients and discordant for 121 (19%) of 634. Overall, sensitivity to detect any resistance was 90·8% (95% CI 86·5-94·2) and specificity 84·3% (80·3-87·7). Mortality ranged from 6% (20 of 336) in patients with pan-susceptible tuberculosis treated according to WHO guidelines to 57% (eight of 14) in patients with resistant strains who were under-treated. In logistic regression models, compared with concordant drug susceptibility test results, the adjusted odds ratio of death was 7·33 (95% CI 2·70-19·95) for patients with discordant results potentially leading to under-treatment. INTERPRETATION Inaccurate drug susceptibility testing by comparison with a reference standard leads to under-treatment of drug-resistant tuberculosis and increased mortality. Rapid molecular drug susceptibility test of first-line and second-line drugs at diagnosis is required to improve outcomes in patients with MDR tuberculosis and pre-XDR or XDR tuberculosis. FUNDING National Institutes of Allergy and Infectious Diseases, Swiss National Science Foundation, Swiss National Center for Mycobacteria.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland
| | - Sonia Borrell
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Peter M Keller
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Joachim Gnokoro
- Centre de Prise en Charge de Recherche et de Formation, Yopougon, Abidjan, Côte d'Ivoire
| | - Olivier Marcy
- Bordeaux Population Health Research Center, Inserm U1219, University of Bordeaux, Bordeaux, France
| | - Marcel Yotebieng
- Ohio State University, College of Public Health, Columbus, OH, USA
| | - Lameck Diero
- Department of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - E Jane Carter
- Department of Medicine, Moi University School of Medicine, and Moi Teaching and Referral Hospital, Eldoret, Kenya
| | - Neesha Rockwood
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK
| | - Robert J Wilkinson
- Wellcome Centre for Infectious Diseases Research in Africa, University of Cape Town, Cape Town, South Africa; Department of Medicine, Imperial College London, London, UK; Francis Crick Institute, London, UK
| | - Helen Cox
- Division of Medical Microbiology and the Institute for Infectious Disease and Molecular Medicine, University of Cape Town, Cape Town, South Africa
| | - Nicholas Ezati
- Institute of Human Virology, Abuja, Nigeria; National Tuberculosis and Leprosy Training Center, Saye, Zaria, Kaduna State, Nigeria
| | | | - Jimena Collantes
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | - Kamon Kawkitinarong
- HIV-NAT/Thai Red Cross AIDS Research Centre, Bangkok, Thailand; Tuberculosis Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Miriam Reinhard
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Rico Hömke
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Robin Huebner
- National Institutes of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Sebastien Gagneux
- Swiss Tropical and Public Health Institute, Basel, Switzerland; University of Basel, Basel, Switzerland
| | - Erik C Böttger
- Institute of Medical Microbiology, University of Zurich, Zurich, Switzerland; Swiss National Center for Mycobacteria, Zurich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine (ISPM), University of Bern, Bern, Switzerland; Centre for Infectious Disease Epidemiology & Research, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa.
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20
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Zürcher K, Zwahlen M, Berlin C, Egger M, Fenner L. Trends in influenza vaccination uptake in Switzerland: Swiss Health Survey 2007 and 2012. Swiss Med Wkly 2019; 149:w14705. [PMID: 30673116 DOI: 10.4414/smw.2019.14705] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
AIMS We studied time trends in seasonal influenza vaccination and assessed associations with socioeconomic and health-related determinants in Switzerland (overall and people aged ≥65 years). METHODS We used data from the Swiss Health Surveys of 2007 and 2012. We calculated the proportion of the population (overall and those ≥65 years old) reporting influenza vaccination in the last 12 months, and performed multivariate logistic regression analyses, presented as adjusted odds ratios (aORs). RESULTS The average overall frequency of people reporting having been vaccinated for influenza in the previous 12 months was 15.2% (95% confidence interval [CI] 14.7–15.7); frequency decreased from 16.4% in 2007 to 14.1% in 2012 (p <0.001). In elderly people (≥65 years) the frequency declined from 47.8 to 38.5% (p <0.001). The decline was more pronounced in both the 15 to 19 age group (aOR 0.5, 95% CI 0.3–1.0) and those 65 to 75 years old (aOR 0.6, 95% CI 0.5–0.7), and in those with less education (aOR 0.6, 95% CI 0.4–0.7). Pregnant women had the lowest frequency for influenza vaccination (2.3%, 95% CI 0.6–7.9), but the frequency increased between 2007 and 2012 (aOR 4.5, 95% CI 1.0–20.5). Influenza vaccination in the last 12 months was positively associated with the ≥65 age group, living in French-speaking and urban areas, history of smoking, bad self-reported health status, health insurance for private/semiprivate hospital stays and working in healthcare professions. CONCLUSIONS Influenza vaccination coverage was low overall and declined over time. To increase influenza vaccine uptake and reach the European target of 75% in people aged ≥65 years, more efforts should be put into novel intervention approaches.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Claudia Berlin
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Switzerland / Gesundheitsamt, Kanton Solothurn, Switzerland
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21
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Fenner L, Zürcher K, Egger M. Contagion and Public Health in Switzerland: Wilhelm Ost, MD (1853–1922), Polizeiarzt. Am J Public Health 2018; 108:629-630. [DOI: 10.2105/ajph.2018.304344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Lukas Fenner
- All of the authors are with the Institute of Social and Preventive Medicine, University of Bern, Switzerland. Lukas Fenner is also with the Cantonal Health Office, Canton of Solothurn, Switzerland
| | - Kathrin Zürcher
- All of the authors are with the Institute of Social and Preventive Medicine, University of Bern, Switzerland. Lukas Fenner is also with the Cantonal Health Office, Canton of Solothurn, Switzerland
| | - Matthias Egger
- All of the authors are with the Institute of Social and Preventive Medicine, University of Bern, Switzerland. Lukas Fenner is also with the Cantonal Health Office, Canton of Solothurn, Switzerland
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22
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Ballif M, Zürcher K, Reid SE, Boulle A, Fox MP, Prozesky HW, Chimbetete C, Zwahlen M, Egger M, Fenner L. Seasonal variations in tuberculosis diagnosis among HIV-positive individuals in Southern Africa: analysis of cohort studies at antiretroviral treatment programmes. BMJ Open 2018; 8:e017405. [PMID: 29330173 PMCID: PMC5780693 DOI: 10.1136/bmjopen-2017-017405] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Seasonal variations in tuberculosis diagnoses have been attributed to seasonal climatic changes and indoor crowding during colder winter months. We investigated trends in pulmonary tuberculosis (PTB) diagnosis at antiretroviral therapy (ART) programmes in Southern Africa. SETTING Five ART programmes participating in the International Epidemiology Database to Evaluate AIDS in South Africa, Zambia and Zimbabwe. PARTICIPANTS We analysed data of 331 634 HIV-positive adults (>15 years), who initiated ART between January 2004 and December 2014. PRIMARY OUTCOME MEASURE We calculated aggregated averages in monthly counts of PTB diagnoses and ART initiations. To account for time trends, we compared deviations of monthly event counts to yearly averages, and calculated correlation coefficients. We used multivariable regressions to assess associations between deviations of monthly ART initiation and PTB diagnosis counts from yearly averages, adjusted for monthly air temperatures and geographical latitude. As controls, we used Kaposi sarcoma and extrapulmonary tuberculosis (EPTB) diagnoses. RESULTS All programmes showed monthly variations in PTB diagnoses that paralleled fluctuations in ART initiations, with recurrent patterns across 2004-2014. The strongest drops in PTB diagnoses occurred in December, followed by April-May in Zimbabwe and South Africa. This corresponded to holiday seasons, when clinical activities are reduced. We observed little monthly variation in ART initiations and PTB diagnoses in Zambia. Correlation coefficients supported parallel trends in ART initiations and PTB diagnoses (correlation coefficient: 0.28, 95% CI 0.21 to 0.35, P<0.001). Monthly temperatures and latitude did not substantially change regression coefficients between ART initiations and PTB diagnoses. Trends in Kaposi sarcoma and EPTB diagnoses similarly followed changes in ART initiations throughout the year. CONCLUSIONS Monthly variations in PTB diagnosis at ART programmes in Southern Africa likely occurred regardless of seasonal variations in temperatures or latitude and reflected fluctuations in clinical activities and changes in health-seeking behaviour throughout the year, rather than climatic factors.
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Affiliation(s)
- Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Stewart E Reid
- Division of Infection Diseases, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Tuberculosis Department Unit, Centre for Infectious Disease Research in Zambia (CIDRZ), Lusaka, Zambia
| | - Andrew Boulle
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Médecins Sans Frontières, Khayelitsha, South Africa
| | - Matthew P Fox
- Departments of Epidemiology and Global Health, Boston University, Boston, USA
- Department of Internal Medicine, Health Economics and Epidemiology Research Office, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Hans W Prozesky
- Division of Infectious Diseases, Department of Medicine, University of Stellenbosch & Tygerberg Academic Hospital, Cape Town, South Africa
| | | | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
- Centre for Infectious Disease Epidemiology and Research (CIDER), School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, BE, Switzerland
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23
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Zürcher K, Mooser A, Anderegg N, Tymejczyk O, Couvillon MJ, Nash D, Egger M. Outcomes of HIV-positive patients lost to follow-up in African treatment programmes. Trop Med Int Health 2017; 22:375-387. [PMID: 28102610 DOI: 10.1111/tmi.12843] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE The retention of patients on antiretroviral therapy (ART) is key to achieving global targets in response to the HIV epidemic. Loss to follow-up (LTFU) can be substantial, with unknown outcomes for patients lost to ART programmes. We examined changes in outcomes of patients LTFU over calendar time, assessed associations with other study and programme characteristics and investigated the relative success of different tracing methods. METHODS We performed a systematic review and logistic random-effects meta-regression analysis of studies that traced adults or children who started ART and were LTFU in sub-Saharan African treatment programmes. The primary outcome was mortality, and secondary outcomes were undocumented transfer to another programme, treatment interruption and the success of tracing attempts. RESULTS We included 32 eligible studies from 12 countries in sub-Saharan Africa: 20 365 patients LTFU were traced, and 15 708 patients (77.1%) were found. Compared to telephone calls, tracing that included home visits increased the probability of success: the adjusted odds ratio (aOR) was 9.35 (95% confidence interval [CI] 1.85-47.31). The risk of death declined over calendar time (aOR per 1-year increase 0.86, 95% CI 0.78-0.95), whereas undocumented transfers (aOR 1.13, 95% CI 0.96-1.34) and treatment interruptions (aOR 1.31, 95% CI 1.18-1.45) tended to increase. Mortality was lower in urban than in rural areas (aOR 0.59, 95% CI 0.36-0.98), but there was no difference in mortality between adults and children. The CD4 cell count at the start of ART increased over time. CONCLUSIONS Mortality among HIV-positive patients who started ART in sub-Saharan Africa, were lost to programmes and were successfully traced has declined substantially during the scale-up of ART, probably driven by less severe immunodeficiency at the start of therapy.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Anne Mooser
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Nanina Anderegg
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Olga Tymejczyk
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA
| | - Margaret J Couvillon
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Denis Nash
- Institute for Implementation Science in Population Health, City University of New York, New York, NY, USA.,Department of Epidemiology and Biostatistics, City University of New York School of Public Health, New York, NY, USA
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.,Centre for Infectious Disease Epidemiology and Research, University of Cape Town, Cape Town, South Africa
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24
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Zürcher K, Ballif M, Zwahlen M, Rieder HL, Egger M, Fenner L. Tuberculosis Mortality and Living Conditions in Bern, Switzerland, 1856-1950. PLoS One 2016; 11:e0149195. [PMID: 26881850 PMCID: PMC4755532 DOI: 10.1371/journal.pone.0149195] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 01/28/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) is a poverty-related disease that is associated with poor living conditions. We studied TB mortality and living conditions in Bern between 1856 and 1950. METHODS We analysed cause-specific mortality based on mortality registers certified by autopsies, and public health reports 1856 to 1950 from the city council of Bern. RESULTS TB mortality was higher in the Black Quarter (550 per 100,000) and in the city centre (327 per 100,000), compared to the outskirts (209 per 100,000 in 1911-1915). TB mortality correlated positively with the number of persons per room (r = 0.69, p = 0.026), the percentage of rooms without sunlight (r = 0.72, p = 0.020), and negatively with the number of windows per apartment (r = -0.79, p = 0.007). TB mortality decreased 10-fold from 330 per 100,000 in 1856 to 33 per 100,000 in 1950, as housing conditions improved, indoor crowding decreased, and open-air schools, sanatoria, systematic tuberculin skin testing of school children and chest radiography screening were introduced. CONCLUSIONS Improved living conditions and public health measures may have contributed to the massive decline of the TB epidemic in the city of Bern even before effective antibiotic treatment became finally available in the 1950s.
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Affiliation(s)
- Kathrin Zürcher
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marie Ballif
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Marcel Zwahlen
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Hans L. Rieder
- Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland
| | - Matthias Egger
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Lukas Fenner
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
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25
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Abstract
In der vorliegenden Arbeit wird untersucht, ob die sich physiologisch unterschiedlich verhaltenden stereoisomeren Formen der essentiellen Linol- und Linolensäure auch ein unterschiedliches Grenzflächenverhalten zeigen. Zu diesem Zwecke wurden die α-Monoglyceride der all-cis-, cis-trans-, und all-trans-Linolsäure sowie der all-cis- und all-trans-Linolensäure dargestellt und auf ihre grenzflächenspannungserniedrigende Wirkung, ihr Assoziations-Verhalten sowie die Strukturviskosität und Stabilität mit ihnen hergestellter Emulsionen geprüft. Es ergab sich, daß in jedem Fall die trans-Verbindungen stärkere Grenzflächeneigenschaften besitzen als die korrespondierenden cis-Formen.
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Affiliation(s)
- W. Wachs
- Aus dem Institut für Lebensmittelchemie und Lebensmitteltechnologie der Technischen Universität Berlin-Charlottenburg
| | - H. Schwarz
- Aus dem Institut für Lebensmittelchemie und Lebensmitteltechnologie der Technischen Universität Berlin-Charlottenburg
| | - K. Zürcher
- Aus dem Institut für Lebensmittelchemie und Lebensmitteltechnologie der Technischen Universität Berlin-Charlottenburg
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Peitsch W, Zürcher K, Becker H. Das Verhalten der freien Aminosäuren im Serum und ihre Urinausscheidung nach ausgedehnten abdominellen Operationen. Transfus Med Hemother 2009. [DOI: 10.1159/000220257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Steurer J, Zürcher K. [Check-up: general aspects]. Praxis (Bern 1994) 2006; 95:55-9. [PMID: 16459734 DOI: 10.1024/0369-8394.95.3.55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
A Check-up is characterized as a medical examination and a counselling of asymptomatic persons. The aim of such a Check-up is the identification of modifiable risk factors for different illnesses and/or the detection of a treatable, latent disease. The value and the cost-effectiveness of regular Check-up examinations can be assessed in scientific enquiries. However, the question whether regular Check-up examinations are or are not of value from an individual or societal point of view cannot be answered by the results of evaluative studies alone. This question should be discussed between an individual person and a physician or, in general, on a societal level. In addition, in this paper we discuss various tests recommended for a patient who requires a Check-up examination.
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Affiliation(s)
- J Steurer
- Horten-Zentrum für praxisorientierte Forschung und Wissenstransfer, Universität Zürich.
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Zürcher K, Müller B. [Comment on: Burchert A, Schmassman A. Evaluation of various screening and surveillance strategies in colorectal carcinoma]. Schweiz Med Wochenschr 1998; 128:2004-5. [PMID: 9888173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
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Zürcher K. [Uncomplicated second pregnancy following acute pregnancy fatty liver]. Schweiz Med Wochenschr 1996; 126:1224. [PMID: 8787107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Zürcher K. [Uncomplicated second pregnancy following acute fatty liver of pregnancy]. Schweiz Med Wochenschr 1995; 125:1003-5. [PMID: 7770754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Acute fatty liver is a rare but usually severe and frightening complication of the last trimester of pregnancy. Many patients therefore do not want or are warned against having another child. This report adds another case of successful consecutive pregnancy to the 28 documented cases in 24 patients. On the other hand, only 2 recurrences have been reported. Therefore, the wish for another pregnancy may be supported, provided the gravida is well informed and the necessary (bi)weekly clinical and laboratory checks are carried out in the last trimester (liver tests, uric acid, prothrombin time and, in case of doubt, further coagulation tests including antithrombin III).
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Stanković P, Zürcher K, Stuhler T, Heise A. [X-ray diagnosis of capsular ligament injuries to the knee joint]. Chirurg 1979; 50:658-60. [PMID: 510067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Peitsch W, Zürcher K, Becker HD. [Calorie requirement after major abdominal surgery (author's transl)]. Langenbecks Arch Chir 1979; 348:211-20. [PMID: 113634 DOI: 10.1007/bf01239449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
After major abdominal surgery 32 patients received a parenteral nutrition for 6 days with 360 g of a carbohydrate mixture (levulose:glucose:xylitol = 2:1:1) and 100 g of an L-amino acid mixture/24 h. 16 patients with benign disease showed positive nitrogen balances, 16 patients with malignant diseases balanced or slightly negative nitrogen balances. Postoperatively, blood glucose levels did not require insulin. Less than 1.5% of the infused levulose, 2.0% of glucose and 2.4-4.1% of xylitol were found in urine. C3- and C4- complement levels in serum were below normal, transferrin showed a pathological decrease in carcinoma patients.
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Zech R, Grote M, Zürcher K, Schlaeger R. [The phosphorylation of diethanolamine by alkaline phosphatase (author's transl)]. Z Klin Chem Klin Biochem 1973; 11:461-4. [PMID: 4804151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Zech R, Zürcher K. [Substrate specificity and the stability of a phosphoryl phosphatase from rabbit serum]. Hoppe Seylers Z Physiol Chem 1973; 354:583-6. [PMID: 4372150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
An attempt has been made to give an up-to-date summary of published data of cutaneous manifestations due to the systemic administration of drugs. The information is presented in tables and is meant as a diagnostic aid to dermatologists as well as other physicians. In this first part of a wider review analgesics, antipyretics and drugs used in the treatment of gout have been considered. The authors invite information about cutaneous side effects of modern drugs.
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