141 research outputs found

    Foodborne diseases in Switzerland: understanding the burden of illness pyramid to improve Swiss infectious disease surveillance

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    Background: Infectious diseases cause a considerable burden to population health worldwide. Different types of surveillance systems have been implemented to assess changes in disease frequency, to identify outbreaks, and to detect newly emerging diseases aiming at early detection of epidemics, disease control and prevention. Passive surveillance systems are mostly used, measuring the ‘incidence of notified cases’ rather than the incidence (frequency) of disease at population level. Foodborne pathogens, for example, do not always cause disease in infected individuals. Sick individuals – mostly presenting with acute gastroenteritis (AG) – do not always seek healthcare. Of those approaching a physician, aetiology of disease is investigated only in a fraction of patients. Finally, not all cases with a positive laboratory finding for a notifiable pathogen might be reported to the surveillance system. This “loss” of cases along the so-called burden of illness pyramid – from infection to actual notification in the surveillance system –, or the factor of underestimation, depends on the pathogen and the local health (care) system. Two surveillance systems are implemented in Switzerland which are important for infectious disease surveillance and early detection: the National Notification System for Infectious Diseases (NNSID) and the Swiss Sentinel Surveillance Network (Sentinella). The NNSID is based on the Epidemics Act and is the only mandatory surveillance system in Switzerland covering the entire nation and involving all physicians and diagnostic laboratories. The Epidemics Act defines which observations have to be reported to the NNSID and stipulates the time frame for reporting. Sentinella is a network where information from a subset of voluntarily participating physicians is collected to study diseases and health issues at the primary care level. It was estimated that 31 foodborne hazards caused 33 million Disability Adjusted Life Years (DALYs) and 600 million cases of illness worldwide in 2010. In European countries, the incidence of AG was estimated at 0.3–1.5 disease episodes per person-year. Campylobacter spp. is the most frequent, notifiable, bacterial foodborne disease, both in the European Union (EU) and in Switzerland and showed increasing trends in the past decade. In contrast, Salmonella spp. notifications were decreasing in the EU and in Switzerland while enterohaemorrhagic Escherichia coli (EHEC) notifications were increasing in Switzerland but remained stable in the EU. In Switzerland, information on foodborne diseases is mostly restricted to data obtained through the NNSID. Many factors contribute to underestimation and hence, it is unclear how well notification rates reflect disease incidence. Objectives: This work aimed at contributing to a better understanding of the burden of illness pyramid for foodborne infections in Switzerland and, thus, contributing to improve infectious disease surveillance and control. It sought to investigate the frequency of cases of foodborne disease or AG at different levels of the burden of illness pyramid. Further, it should describe trends and understand factors leading to case registration. Finally, a better understanding of disease epidemiology will lead to improvements in early disease detection and control. Methods: This research work consisted of several projects characterising different levels of the burden of illness pyramid from its tip to the wide (population) base. In a first step, notification data of Campylobacter, Salmonella and hepatitis A were analysed to describe trends since 1988. Considering that the number of tests conducted can strongly) influence the number of cases detected, we studied the trend in the proportion of positive tests out of all tests performed – the positivity rate – for Campylobacter, Salmonella and EHEC over a 10-year period. Personnel of diagnostic laboratories was consulted to assess current laboratory practices, focussing on the diagnosis of EHEC infections. Furthermore, we conducted a qualitative study among Swiss general practitioners (GPs) to understand physicians’ approaches towards anamnesis (including diagnosis) and treatment of AG in general and campylobacteriosis in particular. Subsequently, these findings were complemented by a study within Sentinella, where the number of patient consultations due to AG at primary care level was assessed. Physicians reported all first consultations due to AG including information on hospitalisation, stool diagnostics, treatment and inability to work. Findings of the aforementioned studies, expert consultations and publicly available data were used to explore healthcare costs for AG and campylobacteriosis in Switzerland for the first time. Four distinct patient management models were defined for which frequency and individual case management costs were estimated. Extrapolations of these results were used to assess total direct healthcare costs for Switzerland. Finally, bringing together all study results of the above-mentioned studies, we identified the need to understand the burden of AG at the basis – at the level of the general population. Therefore, a study protocol to investigate the lowest level of the burden of illness pyramid – the incidence and aetiology of AG at population-level – was developed. Results: Campylobacter case notifications increased between 1988 and 2013 while Salmonella case notifications decreased. Highest case numbers for Campylobacter were recorded in 2012 with 8’480 cases. For Salmonella, peak levels were observed in 1992 with 7’806 cases. While showing inverse long-term trends, both pathogens follow a similar seasonality pattern with higher case numbers during summer months. In winter, a short but pronounced peak over Christmas and New Year was observed for Campylobacter. Positivity rates for Campylobacter increased from 2003 to 2012 while they decreased for Salmonella. At the same time, the number of tests conducted increased for both pathogens. Hepatitis A case notifications decreased between 1988 and 2016 in Switzerland, similar to Salmonella. The strongest decline was observed in the early 1990’s, starting even before active immunisation was introduced in 1992. At the same time, there was a shift in reported risk exposures for hepatitis A: Intravenous drug use was the most frequently mentioned risk exposure at the beginning of reporting while, more recently, contaminated food and beverages were mentioned predominantly as possible sources of infection. Notification forms and content were changed multiple times during this 29-year period. Laboratory experts unanimously think that the increase in EHEC notifications which is observed in the NNSID can be explained by the introduction of multiplex gastrointestinal PCR panels. Those panels also test for EHEC while traditional culture-based stool testing mostly considered Campylobacter spp., Salmonella spp. and Shigella spp. only. Nevertheless, there was also an increase in positivity rate observed for EHEC from 2007 to 2016 apart from an increase in testing frequency. Preliminary analysis of surveillance data on testing frequency, which was collected since the implementation of the new Epidemics Act in 2016, reveals several issues regarding data quality related to the complex and heterogeneous “laboratory landscape” in Switzerland. AG case management of Swiss GPs is diverse. Nevertheless, four distinct strategies could be identified. The majority of patients is managed with a “wait & see” approach based on the knowledge that AG is usually self-limiting. Two of the four approaches include microbiological investigation (stool testing), with antibiotic treatment started either before or after availability of stool test results. Swiss GPs perceive AG and campylobacteriosis as diseases of minor importance in their daily work but acknowledge that they can be disturbing and debilitating for the individual patient. Surveillance of AG in Sentinella revealed that 8.5% of AG patients received antibiotic therapy, for 12.3% stool testing was initiated and 86.3% of employees were not able to work. Extrapolation of case numbers suggested an incidence of AG at primary care level of 2’146 first consultations per 100’000 inhabitants in Switzerland in 2014. Direct healthcare costs of AG and campylobacteriosis in Switzerland were estimated at €29–45 million in 2012. Of these, €8.3 million were attributed to the 8’480 laboratory-confirmed campylobacteriosis patients registered in the NNSID. It was estimated that 233’000–629’000 patients consulted a physician without further stool testing resulting in healthcare costs of €9.0–24.2 million in 2012. Work-loss and other non-healthcare costs associated with AG and campylobacteriosis were not assessed in this study. However, this socio-economic burden will be explored in more detail in an upcoming study on the burden of gastroenteritis in Switzerland (“BUGS study”). The BUGS study was developed to explore the “true” incidence, burden of disease, aetiology and socio-economic impact of AG in Switzerland; to finally understand the entire burden of AG at population level and the level of underestimation of cases notified to the NNSID. BUGS is a prospective cohort study weekly following up individuals of the general population during a 52-week period. Furthermore, the presence of four pathogenic bacteria (Campylobacter, Salmonella, Shigella and EHEC) and of bacteria harbouring selected antibiotic resistances (fluoroquinolone, extended-spectrum beta-lactamase (ESBL), carbapenemase and mobilised colistin resistance-1 (mcr-1)) is assessed in cohort participants during an asymptomatic period. Conclusions: The NNSID is a useful and stable surveillance system and health system component which is well accepted by stakeholders. Surveillance data from the NNSID suggest increasing trends for Campylobacter and EHEC and decreasing trends for Salmonella and hepatitis A. Our complementary research studies come to the same conclusion even though trends might appear more pronounced (EHEC) or attenuated (Salmonella) in the notification system than the true incidence due to changes in diagnostic procedures. Hence, from what we know we cannot fully explain the increase of Campylobacter and EHEC seen in the notification system. Therefore, an increase in disease incidence or an outbreak must be considered from an epidemiological perspective. Furthermore, underestimation is probably substantial. Cases seen in the NNSID are more likely to be severe, have co-morbidities or present with well-known risk factors. Assessing all factors contributing to underestimation on a regular basis is hardly possible. Instead, complementary research such as the proposed BUGS study are needed. The information on disease trends and individual cases obtained through the NNSID should be restricted to the minimum (with high data quality) rather than expanded to keep the system as simple and responsive as possible, providing reliable information. This enables the system to stay alert to and be prepared for a rapid response in the event of changing case numbers. Maintaining systems like Sentinella and fostering strategic research partnerships for action is important to be able to react immediately once an outbreak or a change in disease epidemiology is suspected. Pathways to provide good evidence for public health policy and distribute information to stakeholders should be established

    Gesteinsmehl gegen den RapsglanzkÀfer: Jetzt anmelden

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    Gesteinsmehlbehandlungen reduzieren den Befallsdruck mit RapsglanzkÀfer

    Long time behavior of an age and leaky memory-structured neuronal population equation

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    We study the asymptotic stability of a two-dimensional mean-field equation, which takes the form of a nonlocal transport equation and generalizes the time-elapsed neuron network model by the inclusion of a leaky memory variable. This additional variable can represent a slow fatigue mechanism, like spike frequency adaptation or short-term synaptic depression. Even though two-dimensional models are known to have emergent behaviors, like population bursts, which are not observed in standard one-dimensional models, we show that in the weak connectivity regime, two-dimensional models behave like one-dimensional models, i.e. they relax to a unique stationary state. The proof is based on an application of Harris' ergodic theorem and a perturbation argument, adapted to the case of a multidimensional equation with delays

    Rape pollen beetle

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    Organic rapeseed oils is in demand. But the organic rape cultivation is difficult. Especially the pollen beetle causes big yield losses. As there is currently no allowed direct control measure, preventive measures have to be used. The leaflet provides some information about the biology of the pollen beetle and about methods of identifying it. It also provides some information about monitoring and possible preventive measures. Since pollen beetles affect closed buds, supporting fast growth and flowering is an important measure. Finally, the current research is discussed

    Time trends of positivity rates from foodborne pathogen testing in Switzerland, 2003 to 2012

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    Campylobacteriosis and salmonellosis are important foodborne diseases in Europe, including in Switzerland. In 2014, notification rates for Switzerland were 92.9 per 100 000 population for campylobacteriosis and 15.2 per 100 000 population for salmonellosis. These notification rates originate from laboratory-based surveillance whereby positive test results are reported to the National Notification System for Infectious Diseases. Consequently, notification rates do not directly correspond to the disease burden among the population as the number of positive tests depends on patients' healthcare-seeking behaviour, stool sampling rates and other factors.; We assessed laboratory positivity rates (proportion of positive tests among all tests performed) of diagnostic tests for Campylobacter and Salmonella from five private laboratories in Switzerland between 2003 and 2012. We analysed demographic characteristics, temporal and spatial distribution of test numbers and positivity rates. Predictors for a positive test and disease seasonality were assessed with logistic regression analyses.; A total of 135 122 (13 095 positive) Campylobacter tests and 136 997 (2832 positive) Salmonella tests were obtained with positive tests corresponding to 20.4% and 17.2% of notified campylobacteriosis and salmonellosis cases, respectively. The number of tests conducted annually increased for both pathogens by 51% from 2003 to 2012. Annual positivity rates of Campylobacter increased from 7.6 to 11.1% and rates of Salmonella decreased from 2.7 to 1.5%. The largest increases in annual Campylobacter positivity rates were observed for patients older than 85 years (+193.7%), followed by children aged 5-9 years (+131.9%). Positivity rates and test numbers for both diseases by month or calendar week showed a distinct seasonality, with peak rates for Salmonella occurring in autumn and for Campylobacter in summer and at the turn of the year. These findings were independent of patients' age and sex.; Both positivity rates and notification rates showed increasing trends for Campylobacter and decreasing trends for Salmonella, suggesting that these trends reflect changes in disease epidemiology at population level. The continuous assessment of positivity rates remains important to appropriately interpret changes observed in the notification system especially considering the increasing use of multiplex polymerase chain reaction test panels where multiple pathogens are tested simultaneously

    Do changes in STEC diagnostics mislead interpretation of disease surveillance data in Switzerland? Time trends in positivity, 2007 to 2016

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    BackgroundLaboratory-confirmed cases of Shiga toxin-producing; Escherichia coli; (STEC) have been notifiable to the National Notification System for Infectious Diseases in Switzerland since 1999. Since 2015, a large increase in case numbers has been observed. Around the same time, syndromic multiplex PCR started to replace other diagnostic methods in standard laboratory practice for gastrointestinal pathogen testing, suggesting that the increase in notified cases is due to a change in test practices and numbers.AimThis study examined the impact of changes in diagnostic methods, in particular the introduction of multiplex PCR panels, on routine STEC surveillance data in Switzerland.MethodsWe analysed routine laboratory data from 11 laboratories, which reported 61.9% of all STEC cases from 2007 to 2016 to calculate the positivity, i.e. the rate of the number of positive STEC tests divided by the total number of tests performed.ResultsThe introduction of multiplex PCR had a strong impact on STEC test frequency and identified cases, with the number of tests performed increasing sevenfold from 2007 to 2016. Still, age- and sex-standardised positivity increased from 0.8% in 2007 to 1.7% in 2016.ConclusionIncreasing positivity suggests that the increase in case notifications cannot be attributed to an increase in test numbers alone. Therefore, we cannot exclude a real epidemiological trend for the observed increase. Modernising the notification system to address current gaps in information availability, e.g. diagnostic methods, and improved triangulation of clinical presentation, diagnostic and serotype information are needed to deal with emerging disease and technological advances

    Induction of general anaesthesia by blowpipe darting in a fractious companion horse

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    a fractious nine-year-old, 520-kg, neutered Swiss Warmblood was presented with a history of anorexia, progressive weight loss and mild hindlimb lameness. Because of its temperament, standard physical examination was considered to be only feasible under general anaesthesia. For safety reasons, general anaesthesia was planned to be induced by blowpipe darting. two attempts are described and discussed in the present report. the first attempt, using a combination of medetomidine and tiletamine-zolazepam, was unsuccessful. Conversely, detomidine combined with butorphanol, followed by a second dart of detomidine and tiletamine-zolazepam, proved to be adequate to induce anaesthesia. Factors that could have influenced the outcome, such as different therapeutic approach, drug protocol and dosages, stress level, or genetic mutations, are presented and discussed

    The Organic Market in Europe. Overview and Market Access Information for Producers and International Trading Companies. Fourteen Country Examples in the European Free Trade Association and the European Union, with a Special Focus on Switzerland

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    From the Foreword by Luks Kilcher, FiBL More than thirty-seven million hectares of agricultural land are managed organically by nearly 1.8 million producers. About one-third of the world’s organic land – 13.4 million hectares – is located in emerging markets and markets in transition. Global sales reached 55 billion USD in 2009, more than doubling in value from 25 billion USD in 2003. Europe is after the USA the second largest organic market in the world with a turnover of 26 billion USD in 2009. These figures increase year by year and such facts impressively illustrate the powerful development of the organic production and market all over the world. Behind these figures lie a large number of benefits and impacts, which are the motor for this development: organic agriculture is the choice of millions of farmers, as it aims to produce healthy food while establishing an ecological balance to prevent soil fertility and pest problems. With this edition, FiBL and SIPPO are presenting The Organic Market in Europe for the third time. Compared to the previous editions, this edition expanded considerably in geographical scope, now including the EFTA countries Iceland, Liechtenstein and Norway and the new EU countries Czech Republic and Poland. The information on regulations, the statistics and market trends collected and compiled in this manual provide a guide with the most important information to successful market access in EFTA and EU countries. However, it can’t claim to be complete in all aspects, as especially market data are still scarce. The market data of this manual are therefore based on a mixture of statistics, estimations and experts opinions. This manual has three parts: Part A provides an overview on the organic market in Europe. Part B includes the four EFTA member states Iceland, Liechtenstein, Norway and Switzerland, giving Switzerland a more detailed look as it is one of the most developed organic markets in the world and also the home-base of the manual editors. Part C includes ten EU member countries: Austria, Czech Republic, Denmark, France, Germany, Italy, Poland, Sweden, the Netherlands and the United Kingdom. The annex contains a comparison of the European and Swiss organic regulations, including Bio Suisse standards. Useful links, addresses and references are listed at the end of each chapter

    Hepatitis A in Switzerland : an analysis of 29 years of surveillance data and contemporary challenges

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    Hepatitis A (HA) incidence declined in most European countries in the past decades. We analysed HA notification data for Switzerland of 29 years looking for disease- and notification system-related factors possibly contributing to observed trends.; Notification data were descriptively analysed using five time intervals (1988-1993, 1994-1999, 2000-2005, 2006-2011, 2012-2016); and notification rates were calculated.; From 1988 to 2016, the HA notification rate decreased from 9.5 to 0.5 per 100'000 population in Switzerland. Median age and the proportion of hospitalised cases increased over time. In the 1988-1993-time period, intravenous drug use was the most frequently mentioned risk exposure while consumption of contaminated food/beverages was most frequently mentioned in the 2012-2016-time period.; Notification data does not allow reliably identifying current risk groups (e.g. travellers) due to low case numbers, limited availability and reliability of information. It is important to document changes in the surveillance system for later analyses and interpretation of long-term trends. Population susceptibility likely increases underlining the importance of continued and continuous surveillance and prevention efforts despite decreasing case numbers. Operational research is recommended to further investigate observed trends of HA and to enhance the abilities for decision making from Swiss HA surveillance data
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