A tradition and an epidemic: determinants of the campylobacteriosis winter peak in Switzerland

Campylobacteriosis is the most frequently reported food borne infection in Switzerland. We investigated determinants of infections and illness experience in wintertime. A case-control study was conducted in Switzerland between December 2012 and February 2013. Cases were recruited among laboratory-confirmed campylobacteriosis patients. Population-based controls were matched according to age group, sex and canton of residence. We determined risk factors associated with campylobacteriosis, and help seeking behaviour and illness perception. The multivariable analysis identified two factors associated with an increased risk for campylobacteriosis: consumption of meat fondue (matched odds ratio [mOR] 4.0, 95% confidence interval [CI] 2.3-7.1) and travelling abroad (mOR 2.7, 95% CI 1.1-6.4). Univariable analysis among meat fondue consumers revealed chicken as the type of meat with the highest risk of disease (mOR 3.8, 95% CI 1.1-13.5). Most frequently reported signs and symptoms among patients were diarrhoea (98%), abdominal pain (81%), fever (66%), nausea (44%) and vomiting (34%). The median perceived disease severity was 8 on a 1-to-10 rating scale. Patients reported a median duration of illness of 7days and 14% were hospitalised. Meat fondues, mostly "Fondue chinoise”, traditionally consumed during the festive season in Switzerland, are the major driver of the epidemic campylobacteriosis peak in wintertime. At these meals, individual handling and consumption of chicken meat may play an important role in disease transmission. Laboratory-confirmed patients are severely ill and hospitalisation rate is considerable. Public health measures such as decontamination of chicken meat and improved food handling behaviour at the individual level are urgently needed

A tradition and an epidemic : determinants of the campylobacteriosis winter peak in Switzerland

Campylobacteriosis is the most frequently reported food borne infection in Switzerland. We investigated determinants of infections and illness experience in wintertime. A case-control study was conducted in Switzerland between December 2012 and February 2013. Cases were recruited among laboratory-confirmed campylobacteriosis patients. Population-based controls were matched according to age group, sex and canton of residence. We determined risk factors associated with campylobacteriosis, and help seeking behaviour and illness perception. The multivariable analysis identified two factors associated with an increased risk for campylobacteriosis: consumption of meat fondue (matched odds ratio [mOR] 4.0, 95 % confidence interval [CI] 2.3-7.1) and travelling abroad (mOR 2.7, 95 % CI 1.1-6.4). Univariable analysis among meat fondue consumers revealed chicken as the type of meat with the highest risk of disease (mOR 3.8, 95 % CI 1.1-13.5). Most frequently reported signs and symptoms among patients were diarrhoea (98 %), abdominal pain (81 %), fever (66 %), nausea (44 %) and vomiting (34 %). The median perceived disease severity was 8 on a 1-to-10 rating scale. Patients reported a median duration of illness of 7 days and 14 % were hospitalised. Meat fondues, mostly "Fondue chinoise", traditionally consumed during the festive season in Switzerland, are the major driver of the epidemic campylobacteriosis peak in wintertime. At these meals, individual handling and consumption of chicken meat may play an important role in disease transmission. Laboratory-confirmed patients are severely ill and hospitalisation rate is considerable. Public health measures such as decontamination of chicken meat and improved food handling behaviour at the individual level are urgently needed

Acute gastroenteritis in primary care : a longitudinal study in the Swiss Sentinel Surveillance Network, Sentinella

Acute gastroenteritis (AG) leads to considerable burden of disease, health care costs and socio-economic impact worldwide. We assessed the frequency of medical consultations and work absenteeism due to AG at primary care level, and physicians' case management using the Swiss Sentinel Surveillance Network "Sentinella".; During the 1-year, longitudinal study in 2014, 172 physicians participating in "Sentinella" reported consultations due to AG including information on clinical presentation, stool diagnostics, treatment, and work absenteeism.; An incidence of 2146 first consultations due to AG at primary care level per 100,000 inhabitants in Switzerland was calculated for 2014 based on reported 3.9 thousand cases. Physicians classified patients' general condition at first consultation with a median score of 7 (1 = poor, 10 = good). The majority (92%) of patients received dietary recommendations and/or medical prescriptions; antibiotics were prescribed in 8.5%. Stool testing was initiated in 12.3% of cases; more frequently in patients reporting recent travel. Among employees (15-64 years), 86.3% were on sick leave. Median duration of sick leave was 4 days.; The burden of AG in primary care is high and comparable with that of influenza-like illness (ILI) in Switzerland. Work absenteeism is substantial, leading to considerable socio-economic impact. Mandatory infectious disease surveillance underestimates the burden of AG considering that stool testing is not conducted routinely. While a national strategy to reduce the burden of ILI exists, similar comprehensive prevention efforts should be considered for AG

Human papillomavirus vaccine uptake in adolescence and adherence to cervical cancer screening in Switzerland: a national cross-sectional survey.

OBJECTIVES The objectives were to measure uptake of and factors associated with human papillomavirus (HPV) vaccination initiation and to determine whether HPV vaccination reduced the uptake of cervical cancer screening. METHODS We conducted a cross-sectional survey in a random sample of Swiss women aged 18-49 years in 2014 (N = 3588). RESULTS Vaccination initiation was 69.3% and full coverage (three doses) 54.1% for 18-20-year olds, respectively, 42.4% and 33.9% for 21-24-year olds. Women with ≥ 10 lifetime sexual partners were less likely to have received any HPV vaccination than women with ≤ 2 partners (18-20 years OR 0.2, 21-24 years OR 0.5). Amongst 1000 unvaccinated women (18-24 years), reasons for not having initiated vaccination were lack of information (22.5%) and fear of vaccine side effects (18.1%). Vaccination status was not associated with adherence to cervical cancer screening recommendations (OR 1.3). 95.4% of all vaccinated participants knew about the continued need for screening. CONCLUSIONS Our data suggest that HPV vaccination is not associated with reduced uptake of cervical cancer screening. This study provides information that can be used to improve HPV vaccination uptake in Switzerland

How can patients and their physicians contribute to an outbreak investigation? Experiences from a nationwide listeriosis outbreak in Switzerland

QUESTIONS UNDER STUDY/PRINCIPLES: Gathering patient information to contain an outbreak of Listeria monocytogenes is difficult because of the patients' severe illness or death. Extending the range of interviewees to acquire epidemiological data can thus be important to maximise information. METHODS: We built the current analysis on a case-case outbreak investigation conducted during a Swiss listeriosis outbreak between 30 January and 11 May 2014, including 31 patients with confirmed L. monocytogenes infection. We interviewed treating physicians and patients or their next of kin to gather information on clinical aspects, eating habits and food consumption. We compared the different information sources with regards to their potential to provide specific, complete and rapid information on the affected population and their food consumption history. RESULTS: We obtained a 100% response rate among physicians, providing detailed information on the affected population by describing health status, underlying conditions, and signs and symptoms. Detailed information on food history could not be obtained from physicians, making the information vague and unspecific. Less than 50% of patients could be interviewed, limiting our information base. Nevertheless, patient information on the food history was sufficiently detailed and helped to identify the outbreak source CONCLUSIONS: Outbreak investigation teams confronted with limited information from patients and with small numbers of cases can enhance information on the affected population and the outbreak source by combining information from physicians and patients. Physicians provided comprehensive information on signs and symptoms, underlying conditions and the general health status. Patients remain vital to provide detailed information on the food consumption history

Foodborne transmission of Listeria monocytogenes via ready-to-eat salad: a nationwide outbreak in Switzerland, 2013-2014

From 26 October 2013 to 23 April 2014, 32 cases of listeriosis infected with an Listeria monocytogenes strain serovar 4b, sequence type 4 and belonging to a single distinct PFGE pulsotype were registered in patients from several cantons of Switzerland. L. monocytogenes was detected in blood (75%), CSF (16%), ascites (6%) and in joint fluid (3%) samples. By the end of March 2014, a food producing company reported an L. monocytogenes contamination of ready-to-eat salads to the authorities after detecting the pathogen through its in-house routine quality control. Product and environmental samples collected during subsequent investigations yielded isolates, matching the outbreak strain, thus confirming that ready-to-eat salad from this company was most likely the outbreak source. The cause for the product contamination was related to a design-inherent hygienic problem of one specific product-feeding belt. Complementary patient interviews also identified ready-to-eat green salads bought at one retailer as the likely outbreak sourc