[Reporting communicable diseases, a choice and an obligation]. / Notifier les maladies transmissibles: un choix et une obligation.

Surveillance means collecting data for action. Local, cantonal and federal actors are critical partners in disease control. There is evidence that the quality of notifications should continuously be improved. The retrieval of missing information increases the workload of the system of notification at all levels and slows down the response. By law, the diagnosing physician and the head of the laboratory are responsible for the transmission of data to the FOPH, while the cantonal health authority oversees their quality. The law on epidemics doesn't leave it up to physicians and laboratories whether to notify or not: notification is mandatory and sanctions are foreseen in the law against violators. However, the quality of the reporting system would preferably remain a matter of professionalism rather than coercion.

[Malaria--chemoprophylaxis 2001]. / Malaria-Chemoprophylaxe 2001.

An estimated 20,000 to 30,000 cases of imported malaria are annually diagnosed in industrialised countries. Some 700 of them concern Swiss travellers and foreign guests. Exposure prophylaxis and chemoprophylaxis for high risk destinations lower the risk of malarial disease. The latter is defined as regular intake of antimalarial drugs in subtherapeutic dosage in order to suppress the development of clinical disease. Drugs are usually taken from one week before travel until four weeks after return from an endemic area. Mefloquine, doxycycline, chloroquine plus proguanil, and presumably soon also atovaquone plus proguanil are available in Switzerland for chemoprophylaxis.

Surveillance of antituberculosis drug resistance in Switzerland 1995-1997: the central link.

The purpose of the present paper is to investigate the usefulness of routine notification of antituberculosis drug susceptibilities. In Switzerland, laboratories have to report susceptibilities to isoniazid, rifampicin, ethambutol, and pyrazinamide to the Federal Office of Public Health. All clinical and laboratory information on every single tuberculosis case is routinely linked. Proportions of drug resistance were calculated and logistic regression was applied to evaluate the role of potential risk factors. Eighty percent (1056) of all culture-positive tuberculosis cases reported between October 1995 and December 1997 were analysed. The strains of 66 (6.3%) patients had resistances to at least one drug. Risk factors identified were previous antituberculosis treatment (adjusted odds ratio 7.3, 95% confidence interval 3.9-13.6), male sex (1.4, 1.1-2.0), and age <65 yrs (1.5, 1.0-2.3). Fourteen cases (1.3%), 13 of them foreign-born, were resistant to at least isoniazid and rifampicin. Reporting of drug susceptibilities allows routine assessment of the proportion of drug resistant tuberculosis and populations at risk. This proportion was found to be small in Switzerland. Risk factors were previous treatment for tuberculosis, male sex, and age <65 yrs. Resistance to at least isoniazid and rifampicin was predominantly found in foreign-born patients.

[National reference centers for surveillance of infectious diseases in Switzerland: results of a delphi study]. / Centres nationaux de référence pour la surveillance des maladies infectieuses en Suisse: résultats d'une étude Delphi.

The national reference laboratories are one of the tools used by public health authorities to control infectious diseases. The Swiss Confederation supports 9 national reference centers (NC), each dealing with a limited number of infectious agents. The purpose of this study was to evaluate if this network meets present day needs, whether it has to be redefined, and how it can be improved. Using the Delphi technique, 34 experts in the field of infectious diseases were questioned to establish a concept for NC in Switzerland. The main result of this study is that official reference laboratories are considered necessary. However, depending on the type of infectious agent, the following types of laboratories should be used: national reference centers, specialized laboratories and laboratories abroad. The study also defined criteria for the designation of NC, their field of action (general objectives, tasks, duration of the mandate, infectious agent to be monitored), evaluation criteria, and the type of funding. Furthermore, possible improvements in the present system were identified and the establishment of good collaborations with reference centers abroad was proposed.

[Asylum seekers and refugees in general practice: problems and possible developments]. / Asylsuchende und Flüchtlinge in der hausärztlichen Praxis: Probleme und Entwicklungsmöglichkeiten.

Health and health services provided to asylum seekers and refugees by the Swiss National Health System have so far not been systematically investigated. The aim of this cross-sectional study was to describe the attending asylum seekers and refugees demographically and clinically, to identify main problem areas as perceived by general practitioners and to highlight options and venues for improvements. 272 questionnaires have been filled in by GPs of eight "federal districts" (Kantone) and the consultations of 1477 asylum seekers and refugees have been documented during one month in 193 surgeries. The documented asylum seekers and refugees reflected the distribution of this population in Switzerland. Low consultation rates of asylum seekers and refugees in the majority of surgeries and high diversity of this population in respect to places of origin, education and proficiency in languages appear to be the major determinants of the difficulties in providing adequate health services to them. Readily available information on the past medical history and on the ethnic background of these patients and continuing education on specific topics concerning health care for asylum seekers and refugees were thought to be particularly useful. This needs to be considered in the planning of services for this group. General practitioners specialized in health care for asylum seekers and refugees is an option for providing improved specific services (interpreters, institutional links, culturally adapted medical care).

[Human echinococcosis in Switzerland, 1984-1992]. / Echinokokkose des Menschen in der Schweiz, 1984-1992.

In a retrospective study (1984-1992), new cases of human echinococcosis were registered in Switzerland based on information obtained from (a) questionnaires sent to 294 of the 300 acute hospitals in all parts of the country and to 17 institutes of pathology (268 answers form hospitals: 91%), and (b) from tracing back cases reported under the official notification system since 1 January 1988 by laboratories to the Federal Health Office or recorded at the Institute of Parasitology in Zurich. Cases were regarded as verified if the diagnosis was documented by unequivocal findings (by radiology, ultrasonography, pathomorphology etc. and often by additional detection of anti-Echinococcus antibodies). Patients with antibodies but without reports on further findings were classified as suspected cases. From 1984 to 1992 (9 years), 302 new cases of human echinococcosis were diagnosed in Switzerland and verified in this study, corresponding to an annual average of 34 new cases and a range between 26 and 43 cases. The total number of 302 cases included 228 (75%) of cystic echinococcosis (CE) (Echinococcus granulosus), 65 (22%) of alveolar echinococcosis (AE) (E. multilocularis), and 9 (3%) of non-specified echinococcosis (NSE) (Echinococcus sp.). Among 185 patients with CE and 60 patients with AE and known geographic origin, the ratio of Swiss nationals to foreigners was 25%:75% and 88%:12% respectively. Based on a total population (Swiss nationals and foreigners) of 6.62 million in 1988 and the case numbers of 1984-1992, the following average annual incidence rates per 100,000 inhabitants were calculated: 0.51 for all new cases, 0.38 for CE, 0.11 for AE and 0.01 for NSE. In the 37 years since 1956 there has been steady increase in new cases of CE due to the importation of such cases by foreigners, whereas the case numbers of AE have remained nearly constant with a range between 7 and 10 new cases per year. In our study 258 suspected seropositive patients were registered but not added to the total number of cases, due to the lack of further findings.

[The traveler returning from the tropics in clinical practice]. / Der Tropenrückkehrer in der Praxis.

Travellers returning from the tropics frequently consult a physician even if they have no actual symptoms. Physical check-ups in asymptomatic returnees rarely detect dangerous conditions. The most common laboratory finding is intestinal parasites. Blood eosinophilia may indicate helminthic infections, such as strongyloidosis, filariasis, schistosomiasis and others. If there are no diagnostically suggestive symptoms a systematic, step-by-step workup is recommended (stool parasitology, serology, and special methods to demonstrate parasites in blood or tissues). The most common symptom of returnees from the tropics is diarrhea, or other disorders of intestinal motility. Appropriate investigations include parasitological and bacteriological tests, and--if the course is more chronic--endoscopy. If diarrhea is associated with fever, systemic infections (e.g. falciparum malaria) must be considered. Fever as a leading sign may mask a number of potentially dangerous infections. If there are no other obvious signs or symptoms indicating a particular etiology, the diagnostic approach should consider first of all those systemic infections, which are potentially life-threatening and can be cured by specific therapy, i.e. bacterial meningitis, falciparum malaria, septicemia (including typhoid fever), extraintestinal amebiasis, and African trypanosomiasis.

[Should a preventive congenital toxoplasmosis program be established in Switzerland?]. / Faut-il introduire un programme de prévention de la toxoplasmose congénitale en Suisse?

The Swiss Federal Office of Public Health established a multidisciplinary working group whose objectives were to review the subject of congenital toxoplasmosis (CT), to strengthen, as far as possible, the level of knowledge concerning congenital toxoplasmosis in Switzerland (particularly the epidemiological and economic aspects) and to propose a CT prevention programme acceptable to all concerned medical disciplines. Two main questions were considered: (1.) Does the size of the congenital toxoplasmosis problem justify the cost of a systematic screening programme for pregnant women? (2.) How secure is laboratory diagnosis? Neither the national system of reporting by laboratories and physicians, mortality statistics nor insurance records are adequate to estimate the incidence of congenital toxoplasmosis. A study carried out at the main hospital departments of neonatology and pediatrics in Switzerland provides a more accurate estimate but does not match the number of cases predicted by mathematical models. The discrepancy does not put the seroprevalence studies in doubt but rather the estimate of the rate of transmission of T. gondii to the fetus and its degree of virulence. The implementation of a better surveillance system would provide information for adoption and funding of a prevention programme based on facts rather than estimations. Those who support a generalized screening programme for pregnant women must also make an effort to convince the community of its importance. A prenatal screening programme for pregnant women should resolve problems rather than create new ones. The security of the diagnosis of an infection and the effects to the fetus are of vital importance for the principle primum nil nocere.(ABSTRACT TRUNCATED AT 250 WORDS)

[Prevention of congenital toxoplasmosis in Europe]. / Die Prävention der kongenitalen Toxoplasmose in Europa.

To sound out prevalent opinions among health authorities in Europe concerning the control and prevention of congenital toxoplasmosis (CT), a questionnaire was sent to the 28 WHO member countries in Europe. The questionnaire was returned by 23 countries. Only 7 countries recommend systematic screening of pregnant women. The reasons given by the 14 countries which do not recommend systematic screening are diverse: recommendations are in preparation, unfavourable cost-benefit return, absence of satisfactory treatment, programme not possible, incidence level too low, etc. 11 countries have a surveillance system for CT, of which only 3 are among the countries which recommend systematic screening. However, the absence of a multidisciplinary approach does not permit proper surveillance of cases. It appears from this survey that control of CT is undertaken in a very heterogeneous manner in Europe and no country has a programme whose impact on CT can be measured. So far, the European experience does not permit conclusions either in favour of or against a programme for the systematic screening of CT. However, cost-benefit analysis plays a very important role in determining whether such a programme should be implemented. Parameters such as the security of diagnosis (standardization of methods, quality and experience of the laboratories) and the monitoring of cases (definition, multidisciplinary approach to the surveillance and long-term treatment of patients, national collection of case reports, evaluation of the programme) are indispensable for the implementation of an effective surveillance system.

Infection control in Switzerland.

Infection control in hospitals is not mandatory in Switzerland as in the United States. There are more than 300 acute-care hospitals in Switzerland. Hospitals are reimbursed by patient-days rather than diagnosis-related group. However, all five Swiss university hospitals have developed an infection control program. The major criteria for setting up and running these programs are reviewed; data are based on a questionnaire and personal interviewing of each institution. Most of the major criteria exist in all five institutions. Resources allocated to infection control differ markedly. The number of infection control nurses per 250 beds varies between 0.2 and 0.75 for the five hospitals; the activity of those in charge of infection control differs between hospitals. A comparison is made between the Swiss and U.S. programs with regard to some aspects of healthcare and infection control.

[Prevention for travel to the tropics]. / Prophylaxe für Tropenreisen.

The Swiss Working Group for Health Advice to Travellers regularly publishes its recommendations for malaria prophylaxis and vaccination as supplement to the 'Bulletin' of the Federal Office of Public Health. In this review the strategy with respect to information, to clever behavior abroad, to chemoprophylaxis and immunization prophylaxis is analyzed. A critical evaluation of emergency self-therapy describes remaining questions in particular.