Policy and socio-cultural differences between cantons in Switzerland with high and low adolescent vaccination coverage for hepatitis B and HPV.

Vaccination recommendations in Switzerland are national, but vaccine coverage varies greatly from one canton to another, particularly for vaccinations recommended in adolescence. To explain these differences, we studied vaccination practices and socio-cultural views from the vantage points of policy makers, healthcare providers and community adolescents and parents in 4 cantons with low (LVC) and 4 cantons with high (HVC) vaccination coverage for hepatitis B (HBV) and human papillomavirus (HPV) vaccines. In-depth semi-structured interviews were administered to a policy maker, a private practitioner and 4 to 7 community members (adolescents and parents of adolescents) from each of the 8 cantons. LVCs were notable for less government involvement in vaccination issues, more autonomy of municipalities for school health, lower density of pediatricians, less information about these vaccines, greater emphasis on individual rather than government responsibility for vaccinations and for anticipated community hesitancy. Doctors in HVCs more actively advocated for vaccines. Community views in HVCs were more collectivistic and reliant on schools as a source of information than in LVCs. In both groups, hesitancy and concerns about efficacy were greater for HPV than for HBV vaccine. Findings suggest more systematic involvement of health and school authorities will be appreciated by adolescents and their parents, and will improve vaccination coverage. Interventions focused only on community awareness and hesitancy are likely to be inadequate without efforts to reach policy makers and doctors.

Human papillomavirus genotype distribution and socio-behavioural characteristics in women with cervical pre-cancer and cancer at the start of a human papillomavirus vaccination programme: the CIN3+ plus study.

BACKGROUND: The Swiss Federal Office of Public Health has recommended vaccination against human papillomavirus (HPV) to prevent cervical cancer since 2008. To establish monitoring of the future public health impact of vaccination, baseline population-based data are required. The objectives of this study were to examine the distribution of oncogenic HPV genotypes in biopsies with cervical intraepithelial neoplasia stage 3 or more severe lesions (CIN3+) at the beginning of HPV vaccination programmes and to compare sociodemographic and behavioural factors of women with CIN3+ with women in the Swiss general population. METHODS: We conducted a retrospective and prospective cross-sectional study with women diagnosed with CIN3+ in Switzerland. Ten pathology institutes from six cantons and three language regions participated. We conducted HPV typing on formaldehyde fixed-paraffin embedded specimens from 2014 and 2015. Women enrolled in 2015 were asked to complete a questionnaire. We described frequencies of HPV types. We also compared demographic characteristics and socioeconomic status in the CIN3 + plus group with the Swiss National Cohort in 2014 and compared risk factors for HPV infection with the Swiss Health Survey in 2012. RESULTS: We included 768 biopsies from 767 women. Four hundred and seventy-five (61.8%) biopsies were positive for HPV 16 and/or 18, 687 (89.5%) were positive for oncogenic HPV genotypes 16, 18, 31, 33, 45, 52, and/or 58 and five (0.7%) were HPV negative. Twenty-eight (10.3%) of the 273 women who completed the patient questionnaire reported having received at least one dose of an HPV vaccine. When compared with Swiss women in the six study cantons, fewer women in the CIN3+ plus study group were of Swiss nationality, more were born abroad and more were single. The study group also had a higher proportion of women with ≥2 partners in the last year, current smokers and was younger at age of first sexual intercourse. CONCLUSIONS: Introduction of the nonavalent vaccine could cover approximately 90% of CIN3+ lesions in Swiss women compared with around 60% with the quadrivalent vaccine. Surveillance of HPV genotype distribution in CIN3+, together with information about vaccination and CIN3+ incidence will allow monitoring of the public health impact of vaccination programmes. TRIAL REGISTRATION: ClinicalTrials.gov, NCT02323997 . Registered 24 December 2014.

Reduction of acute hepatitis B through vaccina-tion of adolescents with no decrease in chronic hepatitis B due to immigration in a low ende-micity country.

With a hepatitis B prevalence of 0.3%, Switzerland is a country with low endemicity. Unlike most other countries, Switzerland's recommendation for vaccination against hepatitis B has since 1998 focused on adolescents aged 11 to 15 years rather than on infants, in addition to risk groups since 1982. This paper describes the evolution of the incidence of acute hepatitis B virus (HBV) infection and newly reported chronic cases in Switzerland, as well as their epidemiological features, in order to discuss the implications for the control of hepatitis B through vaccination. Data from mandatory notifications by physicians and laboratories between 1988 and 2015 were analysed for acute and chronic HBV infection. Crude and stratified incidence and notification rates (IR, NR), and incidence and notification rate ratios (NRR, IRR) by year were calculated by means of a Poisson regression. Acute HBV incidence peaked in 1992 at 7.5 cases per 100 000 population and subsequently declined by 11% annually (IRR 0.89, p <0.001) to the lowest rate of 0.4/100 000 in 2015. The decrease in incidence accelerated after the introduction of vaccination for adolescents (IRR 0.93, p <0.001 vs 0.91, p <0.001), and was more pronounced in the targeted age groups (IRR 0.90, p <0.001 vs 0.84, p <0.001 for age 15-19 years and IRR 0.92, p <0.001 vs 0.83, p <0.001 for age 20-24). The use of injectable drugs as an assumed source of exposure decreased from 58.1% to 1.9% of all exposures between 1988-1991 and 2012-2015, while sexual contact with an infected person increased from 10.3% to 67.9%. The NR of chronic cases increased until 1995, then stabilised at around 15/100 000. A growing majority of the chronic cases originated abroad (58.4% in 1988-1991 and 82.2% in 2012-2015), and the NR was significantly higher for foreigners than for Swiss nationals (NRR 7.92, p <0.001), especially when compared with the IRR of 1.55 (p <0.001) for acute cases. The introduction of universal vaccination of adolescents combined with vaccination of risk groups and other nonvaccine-related measures has brought acute HBV infection under control in Switzerland. However, the rate of new notifications of chronic HBV infection has remained stable, largely as a result of the immigration of people chronically infected prior to arrival. The burden of disease is thus likely to increase, requiring the strengthening of secondary prevention of chronic HBV infection, in addition to renewed efforts to vaccinate people and their families originating from countries with high endemicity, and persons who frequently change sexual partners.

[Chickenpox and shingles: one virus, two diseases and current vaccination recommendations in Switzerland]. / Varizellen und Herpes Zoster.

Adults, pregnant women, premature babies and immunocompromised persons are at increased risk for varicella complications. Therefore the current Swiss vaccination recommendations against varicella include a general recommendation for 11 to 15 year old adolescents with a negative varicella history, as well as a specific recommendation for risk groups. The goal of both recommendations is to reduce varicella complications in persons most at risk. The vaccine is not universally recommended for all toddlers in Switzerland, while this is the case in some countries such as the United States. Pros and cons of different vaccination strategies, as well as possible short- and long-term effects on herpes zoster incidence are taken into account. In the United States, there was a marked decline in incidence and hospitalisations, but an increased herpes zoster incidence in the short term. Finally, public health aspects of herpes zoster, post-herpetic neuralgia and possible vaccination strategies are outlined.

Hepatitis B and C in Switzerland - healthcare provider initiated testing for chronic hepatitis B and C infection.

Hepatitis B and hepatitis C are contagious liver diseases caused by the hepatitis B virus (HBV) and the hepatitis C virus (HCV), respectively. In particular, chronic infection with HBV or HCV is a major public health problem throughout Europe. The majority of persons chronically infected (65%-75%) are not aware of their infection status until symptoms of advanced liver disease appear. In addition, the peak in the number of patients suffering from advanced stages of the disease, such as cirrhosis and hepatocellular carcinoma, has not yet been reached. In order to reduce the current and future morbidity and mortality associated with chronic HBV or HCV infection, the timely detection of chronically infected persons, with follow-up and case management, is crucial. However, the current screening strategies in Europe and Switzerland have to be considered as inadequate to detect the majority of chronically infected persons. Hence, we emphasise the importance of an alternative approach: the healthcare provider initiated identification of HBV or HCV infection in defined risk groups. This entails determining whether a person is not only at risk of being chronically infected, but also at risk of becoming infected with HBV or HCV and, if necessary, testing for HBV or HCV infection.

Early onset and rapidly progressive subacute sclerosing panencephalitis after congenital measles infection.

UNLABELLED: We report an 18-month-old girl with rapidly progressive subacute sclerosing panencephalitis, whose non immunised mother had measles at the time of delivery. The patient presented with repetitive episodes of myoclonic jerks of the head and arms, followed by a drop of head and trunk with frequent falls. EEG, CSF studies and MRI confirmed the diagnosis. Despite therapy with isoprinosine and valproate, seizure activity continued and she became vegetative within 2 months, with severe spasticity and swallowing difficulties, and died at the age of 28 months. Early age of onset and rapid progression were most likely related to haematogenous in utero acquisition of the measles virus prior to delivery, as well as immaturity of neuronal and immune systems. CONCLUSION: this case emphasises the importance of a high measles vaccine coverage in the population in order to prevent the risk of disease in general and, in particular, gestational measles.