Pneumococcal Vaccination Coverage and Uptake Among Adults in Switzerland: A Nationwide Cross-Sectional Study of Vaccination Records

Streptococcus pneumoniae, or pneumococcus, is a common, opportunistic pathogen which can cause severe disease, particularly in adults 65+. In Switzerland, vaccination is recommended for children under 5 and for adults with health predispositions; vaccination of healthy adults 65+ is not recommended. In 2020 we conducted a nationwide, cross-sectional survey of vaccination records to evaluate pneumococcal vaccination coverage and factors affecting uptake among adults 18-85. We found that nationwide coverage was 4.5% without significant regional differences. Coverage was comparable between men and women and between those aged 18-39 (3.0%) and 40-64 (3.2%). Coverage was significantly higher among those 65-85 (9.6%). While 2.7% of individuals reporting no health predisposition were vaccinated, 14.8% with asthma or chronic pulmonary disease, 27.1% with immunosuppression, 12.9% with diabetes, 11.6% with heart, liver, or kidney disease, and 25.9% with >1 health risk were vaccinated. Adjusted odds of vaccination for all health predispositions except heart, liver, or kidney disease were significantly increased. Among unvaccinated individuals "not enough information about the topic" and "not suggested by a doctor/healthcare provider" were the major reasons for abstaining from vaccination. Respondents reporting a health predisposition were significantly less likely to report "not at increased risk due to chronic health conditions or age" as a reason for not being vaccinated (3.7% vs. 29.1%) and were more likely to report willingness to be vaccinated in the future compared to those not-at-risk (54.2% vs. 39.9%). Our results indicate that pneumococcal vaccination coverage in Switzerland is low among both individuals 65-85 and among those with predisposing health risks. It appears that at-risk individuals are aware of their increased risk, but feel they do not have enough information on the topic to seek vaccination, or have not been recommended a vaccination by their physician

National and regional variations in timely adherence to recommended measles vaccination scheme in 2-years old in Switzerland, 2005–2019

BACKGROUND Although monitoring of vaccination program performance is usually evaluated by measurement of vaccine coverage, timely uptake is rarely part of this assessment. This study aims to examine the timeliness of the administration of a measles-containing-vaccine (MCV) for 2-year-old children between 2005 and 2019. METHODS We used data from the Swiss National Vaccination Coverage Survey 2005-2019 for the study. We defined timely vaccinated as a vaccination administered within the recommended age specified in the Swiss National Vaccination Schedule, with an added tolerance period of 30.4 days for both MCV 1 and 2 doses. The median delay time was estimated by Kaplan-Meier survival curve and examined using log-rank test. A Cox hazard ratio was used to identify factors associated with delay. RESULTS 81% (95% CI:79-82%) of toddlers were timely vaccinated for MCV1 and 82% (95% CI:81-83%) for MCV2 in survey period 2017-2019. Between 2005 and 2019, the median age of vaccinated children ranged between 12.2 and 12.5 and 18.3-22.0 months for MCV1 and MCV2 with median delay of 44 and 38 days, respectively, at the national level. Children in the French-, Italian- and German-speaking regions were vaccinated earlier between 2005 and 2019 for MCV1 (vaccination coverage range before 10 months of age: 1.7-45.9%, 1.2-35.3% and 1.4-15.0%, respectively). Nationality, linguistic regions, and survey periods were the strongest predictive factors related to prolonged delay time. CONCLUSION Overall adherence to recommendations has improved over time, as MCV coverage has significantly increased over the years with differences across linguistic regions. Vaccinations were administered earlier and with shorter delay time

Risk factors for Entamoeba histolytica infection in an agricultural community in Hanam province, Vietnam

BACKGROUND: Entamoeba histolytica is an important protozoan intestinal infection in resource-poor settings, including Vietnam. The study objective was to assess risk factors of E. histolytica infection in a community in Vietnam, where wastewater and human excreta are used in agriculture. A case-control study was conducted among residents of Hanam province, Northern Vietnam. Cases (n=46) infected with E. histolytica and non-infected controls (n=138) were identified in a cross-sectional survey among 794 randomly selected individuals and matched for age, sex and place of residence. Potential risk factors including exposure to human and animal excreta and household wastewater were assessed with a questionnaire. RESULTS: People from households with an average socio-economic status had a 4.3 times higher risk of E. histolytica infection (95% confidence interval [CI] 1.3-14.0) compared with those from households with a good socioeconomic status. Those individuals who never or rarely used soap for hand washing had a 3.4 times higher risk for infection (95% CI 1.1-10.0), compared to those who used always soap. In contrast, none of the factors related to use of human or animal excreta was statistically significant associated with E. histolytica infection. People having close contact with domestic animals presented a greater risk of E. histolytica infection (odds ratio [OR]=5.9, 95% CI 1.8-19.0) than those without animal contact. E. histolytica infection was not associated with direct contact with Nhue river water, pond water and household's sanitary conditions, type of latrine or water source used. CONCLUSIONS: Our study suggests that in settings where human and animal excreta and Nhue River water are intensively used in agriculture, socio-economic and personal hygiene factors determine infection with E. histolytica, rather than exposure to human and animal excreta in agricultural activitie

Retrospective, matched case-control analysis of tickborne encephalitis vaccine effectiveness by booster interval, Switzerland 2006-2020

Objective: To estimate effectiveness of tickborne encephalitis (TBE) vaccination by time interval (<5, 5-10 and 10+years) postvaccination. Design: A retrospective, matched case-control study PARTICIPANTS: Cases-all adult (age 18-79) TBE cases in Switzerland reported via the national mandatory disease reporting surveillance system from 2006 to 2020 (final n=1868). Controls-community controls from a database of randomly selected adults (age 18-79) participating in a 2018 cross-sectional study of TBE vaccination in Switzerland (final n=4625). Primary outcome measures: For cases and controls, the number of TBE vaccine doses received and the time since last vaccination were determined. Individuals were classified as being 'unvaccinated' (0 doses), 'incomplete' (1-2 doses) or 'complete' (3+ doses). Individuals with 'complete' vaccination were further classified by time since the last dose was received (<5 years, 5-10 years or 10+ years). A conditional logistic regression model was used to calculate vaccine effectiveness (VE: 100 × [1-OR]) for each vaccination status category. Results: VE for incomplete vaccination was 76.8% (95% CI 69.0% to 82.6%). For complete vaccination, overall VE was 95.0% (95% CI 93.5% to 96.1%). When the most recent dose was received <5 years prior VE was 91.6% (95% CI 88.4% to 94.0%), 95.2% (95% CI 92.4% to 97.0%) when the most recent dose was received 5-10 years prior, and 98.5% (95% CI 96.8% to 99.2%) when the most recent dose was received 10+ years prior. Conclusions: That VE does not decrease among completely vaccinated individuals over 10+ years since last vaccination supports the longevity of the protective response following complete TBE vaccination. Our findings support the effectiveness of 10-year TBE booster intervals currently used in Switzerland. Keywords: Breakthrough Infection; Duration; Prevention; Protection; TBE

Early psychosocial intervention in Alzheimer’s disease:Cost utility evaluation alongside the Danish Alzheimer’s Intervention Study (DAISY)

OBJECTIVE: To assess the cost utility of early psychosocial intervention for patients with Alzheimer's disease and their primary caregivers. DESIGN: Cost utility evaluation alongside a multicentre, randomised controlled trial with 3 years of follow-up. SETTING: Primary care and memory clinics in five Danish districts. PARTICIPANTS: 330 community-dwelling patients and their primary caregivers. INTERVENTION: Psychosocial counselling and support lasting 8–12 months after diagnosis and follow-up at 3, 6, 12 and 36 months in the intervention group or follow-up only in the control group. MAIN OUTCOME MEASURES: The primary outcome measure was the cost of additional quality-adjusted life years (QALYs). Costs were measured from a societal perspective, including the costs of healthcare, social care, informal care and production loss. QALYs were estimated separately for the patient and the caregiver before aggregation for the main analysis. RESULTS: None of the observed cost and QALY measures were significantly different between the intervention and control groups, although a tendency was noted for psychosocial care leading to cost increases with informal care that was not outweighed by the tendency for cost savings with formal care. The probability of psychosocial intervention being cost-effective did not exceed 36% for any threshold value. The alternative scenario analysis showed that the probability of cost-effectiveness increased over the range of threshold values used if the cost perspective was restricted to formal healthcare. CONCLUSIONS: A multifaceted, psychosocial intervention programme was found unlikely to be cost-effective from a societal perspective. The recommendation for practice in settings that are similar to the Danish setting is to provide follow-up with referral to available local support programmes when needed, and to restrict large multifaceted intervention programmes to patients and caregivers with special needs until further evidence for cost-effectiveness emerges. TRIAL REGISTRATION: The study was registered in the Clinical Trial Database as ISRCTN74848736

Regulation of Apoptosis in Myeloid Cells by Interferon Consensus Sequence–Binding Protein

Mice with a null mutation of the gene encoding interferon consensus sequence–binding protein (ICSBP) develop a disease with marked expansion of granulocytes and macrophages that frequently progresses to a fatal blast crisis, thus resembling human chronic myelogenous leukemia (CML). One important feature of CML is decreased responsiveness of myeloid cells to apoptotic stimuli. Here we show that myeloid cells from mice deficient in ICSBP exhibit reduced spontaneous apoptosis and a significant decrease in sensitivity to apoptosis induced by DNA damage. In contrast, apoptosis in thymocytes from ICSBP-deficient mice is unaffected. We also show that overexpression of ICSBP in the human U937 monocytic cell line enhances the rate of spontaneous apoptosis and the sensitivity to apoptosis induced by etoposide, lipopolysaccharide plus ATP, or rapamycin. Programmed cell death induced by etoposide was specifically blocked by peptides inhibitory for the caspase-1 or caspase-3 subfamilies of caspases. Studies of proapoptotic genes showed that cells overexpressing ICSBP have enhanced expression of caspase-3 precursor protein. In addition, analyses of antiapoptotic genes showed that overexpression of ICSBP results in decreased expression of Bcl-XL. These data suggest that ICSBP modulates survival of myeloid cells by regulating expression of apoptosis-related genes

Scaling up the 454 Titanium Library Construction and Pooling of Barcoded Libraries

We have been developing a high throughput 454 library construction process at the Joint Genome Institute to meet the needs of de novo sequencing a large number of microbial and eukaryote genomes, EST, and metagenome projects. We have been focusing efforts in three areas: (1) modifying the current process to allow the construction of 454 standard libraries on a 96-well format; (2) developing a robotic platform to perform the 454 library construction; and (3) designing molecular barcodes to allow pooling and sorting of many different samples. In the development of a high throughput process to scale up the number of libraries by adapting the process to a 96-well plate format, the key process change involves the replacement of gel electrophoresis for size selection with Solid Phase Reversible Immobilization (SPRI) beads. Although the standard deviation of the insert sizes increases, the overall quality sequence and distribution of the reads in the genome has not changed. The manual process of constructing 454 shotgun libraries on 96-well plates is a time-consuming, labor-intensive, and ergonomically hazardous process; we have been experimenting to program a BioMek robot to perform the library construction. This will not only enable library construction to be completed in a single day, but will also minimize any ergonomic risk. In addition, we have implemented a set of molecular barcodes (AKA Multiple Identifiers or MID) and a pooling process that allows us to sequence many targets simultaneously. Here we will present the testing of pooling a set of selected fosmids derived from the endomycorrhizal fungus Glomus intraradices. By combining the robotic library construction process and the use of molecular barcodes, it is now possible to sequence hundreds of fosmids that represent a minimal tiling path of this genome. Here we present the progress and the challenges of developing these scaled-up processes

Experts by experience in mental health nursing education: What have we learned from the COMMUNE project?

The COMMUNE (co-produced mental health nursing education) was an international project established to embed EBE perspectives in mental health nursing education by developing and delivering a specific mental health nursing module. The underlying intention of this project was to go well beyond ad hoc implementation and tokenistic approaches to EBE involvement. Standards for co-production of Education (Mental Health Nursing) (SCo-PE [MHN]) was developed to provide guidance to the increasing number of academics seeking genuine and meaningful involvement of Experts by Experience in the education of health professionals. These standards were recently published in the Journal of Mental Health and Psychiatric Nursing (Horgan et al., 2020): https://onlinelibrary.wiley.com/doi/abs/10.1111/jpm.12605 and prompted this Editorial to discuss the COMMUNE project more fully, including the lessons learned

Practice Guidelines for Co-Production of Mental Health Nursing Education

COMMUNE (Co-production of Mental Health Nursing Education) is an Erasmus+ Strategic Partnership Project based on the collaboration of experts by experience (EBE) and mental health nursing academics from six European universities and the University of Canberra in Australia. Its purpose was to advance the involvement of those who have experiences of mental health service use (EBE) in mental health nursing education. The project combined experiential and academic knowledge, with the aim of co-producing a module on ‘mental health recovery’ for undergraduate nursing students; a module that was taught to the students by EBE. Principles of co-production where followed as much as possible, involving EBE in all stages of the process, from grant application to dissemination. The project tried to move beyond typical service user involvement and towards co-creation of knowledge, where power differentials are acknowledged and equity issues addressed. Barriers to meeting these goals were experienced and will be discussed in this Guidelines. We hope that these Practice Guidelines will be useful for those who intend to co-produce learning programs or modules in mental health nursing and inspire others to follow similar paths and learn from our experiences, positive or otherwise. These Guidelines provide an overview of our experiences, learnings, limitations and barriers.The Commune team decided on the term ‘Expert by Experience’ (EBE) to describe the members of the team and other collaborators who has lived experience of mental distress. Other more commonly used terms are ‘service user’, ‘consumer’ and ‘people with mental illness.’ As not all experts by experience are mental health care users, and what constitutes an illness is highly debated, the team decided on a term that more correctly describes and value lived experience.Erasmus

EMPOWERED trial: protocol for a randomised control trial of digitally supported, highly personalised and measurement-based care to improve functional outcomes in young people with mood disorders

Objectives: Many adolescents and young adults with emerging mood disorders do not achieve substantial improvements in education, employment, or social function after receiving standard youth mental health care. We have developed a new model of care referred to as ‘highly personalised and measurement-based care’ (HP&MBC). HP&MBC involves repeated assessment of multidimensional domains of morbidity to enable continuous and personalised clinical decision-making. Although measurement-based care is common in medical disease management, it is not a standard practice in mental health. This clinical effectiveness trial tests whether HP&MBC, supported by continuous digital feedback, delivers better functional improvements than standard care and digital support. Method and analysis: This controlled implementation trial is a PROBE study (Prospective, Randomised, Open, Blinded End-point) that comprises a multisite 24-month, assessor-blinded, follow-up study of 1500 individuals aged 15–25 years who present for mental health treatment. Eligible participants will be individually randomised (1:1) to 12 months of HP&MBC or standardised clinical care. The primary outcome measure is social and occupational functioning 12 months after trial entry, assessed by the Social and Occupational Functioning Assessment Scale. Clinical and social outcomes for all participants will be monitored for a further 12 months after cessation of active care. Ethics and dissemination: This clinical trial has been reviewed and approved by the Human Research Ethics Committee of the Sydney Local Health District (HREC Approval Number: X22-0042 & 2022/ETH00725, Protocol ID: BMC-YMH-003-2018, protocol version: V.3, 03/08/2022). Research findings will be disseminated through peer-reviewed journals, presentations at scientific conferences, and to user and advocacy groups. Participant data will be deidentified. Trial registration number: ACTRN12622000882729