Outcome of treatment of pulmonary tuberculosis in Switzerland in 1996.

Adequate treatment of pulmonary tuberculosis cures patients and reduces transmission. The study assesses treatment outcomes under current conditions in Switzerland. Retrospective cohort study including all TB cases with positive sputum cultures notified to the national surveillance system between July 1996 and June 1997. Ten months after notification, treating physicians reported the outcomes using WHO categories. Of 265 patients, 209 (79%) completed at least 6 months' treatment, 3 (1%) were treatment failures, 23 (9%) died, 8 (3%) defaulted from treatment and 22 (8%) left the country. The proportion of successful treatments did not significantly differ between the 103 Swiss-born (80%) and the 162 foreign-born (78%) patients. There were 19 deaths (18%) in the Swiss-born and 4 (2%) in the foreign-born groups; death was caused by TB in two patients, 10 died of other causes (cause unknown in 11). In the foreign-born group there were 31 (19%) potentially unsatisfactory outcomes (treatment failure, default from treatment, transfer abroad) and in the Swiss-born group 2 (2%). Default from treatment involved 8 patients, 6 of whom were asylum seekers. In a multivariate analysis potentially unsatisfactory outcomes were not significantly associated with foreign origin but with status as a foreigner of irregular or unknown legal status (adj. OR 8.8; 95% CI 1.4 to 53.7). Overall treatment success rates are satisfactory and similar to those of other western European countries. Potentially unsatisfactory outcomes are more common in foreign-born persons of irregular legal status. Tracking of non-adherent patients by health workers could further improve outcomes

Faut-il vacciner les sujets âgés [Should elderly persons be vaccinated?]

The susceptibility to infectious diseases in the elderly may be explained by the age-related physiological immune deficiency. Influenza and pneumococcal infections are the most frequent ones in this age. These infections can be efficiently prevented by vaccination, a fact that is often not considered. Other vaccinations should be considered in risk circumstances, such as travel to foreign countries. The lack of vaccination programs for the elderly constitutes a problem which should be resolved

Enquête sur les recommandations prodiguées aux voyageurs en zone tropicale [Survey of the recommendations given to travelers to tropical zones]

This inquiry, conducted with the collaboration of 250 doctors, 150 pharmacists and 76 travel agencies in the Canton de Vaud was set up to assess the prophylactic advice given against tropical diseases. Replies concerning major affections are discussed. It appears that in a high proportion of cases the recommendations available to travellers are inadequate, due in part to lack of precise, standardised and up to date information

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

Prophylaxe für Tropenreisen [Prevention for travel to the tropics]

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

Impfungen für Auslandreisen [Vaccinations for travel abroad]

Travel to the developing world by Swiss citizens has been increasing. Vaccine-preventable diseases challenges the physician to provide pre-travel advice. Each traveler's itinerary, duration of stay and medical history, including previous immunization, should be reviewed. Vaccinations are required or recommended according to the requirements and the epidemiology of countries being visited. This article summarizes updated recommendations to individual vaccines and immunoglobulins