Jan Fehr

Introduction: Human papillomavirus (HPV) is a major cause of cervical cancer and other related diseases. Switzerland has implemented a national HPV immunisation strategy since 2007. This study examined trends in HPV vaccination coverage and valid schedule completion among adolescents in Switzerland between 2008 and 2022 and assessed differences in vaccination outcomes by delivery through school health services. Methods: We analysed data from the Swiss National Vaccination Coverage Survey, including 46 914 sampled adolescents, of whom 32 554 provided vaccination documentation. The analysis included 16-year-old girls (2008–2022) and 16-year-old boys (2017–2022). Vaccination uptake (≥1, ≥2 and ≥3 doses) and valid schedule completion (valid two-dose, valid three-dose and valid total) were estimated using weighted proportions with 95% CIs. Differences between cantons with and without HPV vaccination delivered through school health services were assessed for the 2017–2019 survey period. Multivariable logistic regression was used to evaluate factors associated with valid total schedule completion among girls (2011–2019). Results: Vaccination coverage among 16-year-old girls increased from 28.8% (95% CI 24.4% to 33.2%) in the survey period 2008–2010 to 74.6% (95% CI 72.2% to 77%) in the survey period 2020–2022 for ≥1 dose. Valid schedule completion rose substantially, particularly for the two-dose regimen after the 2012 recommendation change. Among boys, coverage reached 51.2% (95% CI 48.4% to 54%) for ≥1 dose in the survey period 2020–2022. In 2017–2019, completion of a valid HPV schedule among girls was 51.8% (95% CI 48.6% to 54.9%) in cantons with school health services versus 40.8% (95% CI 37.2% to 44.5%) in those without such services. In multivariable analyses, school health services, urban residence and French-speaking region were associated with higher odds of valid schedule completion. Conclusion: HPV vaccination coverage in Switzerland has improved over time, particularly following the introduction of the two-dose schedule. Delivery through school health services was associated with higher coverage and completion, highlighting the importance of organised vaccination delivery strategies.

Background: Free voluntary counselling and testing (VCT) interventions improve access to HIV and sexually transmitted infections (STI) prevention, particularly for underserved populations. In 2023, Zurich (Switzerland) introduced a pilot programme offering free VCT for young people and low-income residents. This study explores healthcare professionals’ (HCPs) experiences implementing the programme, focusing on perceived benefits, barriers, and opportunities for improvement. Methods: We conducted a qualitative descriptive study with 12 HCPs from two participating clinics. Data collection included semi-structured interviews and semi-quantitative ranking activities to prioritise perceived barriers and hardly reached population groups were analysed using inductive thematic analysis and data frame comparison. Standards for reporting qualitative research guidelines (SRQR) informed reporting. Results: HCPs viewed the programme as an effective entry point into sexual healthcare for young people and first-time testers, particularly due to the removal of financial barriers. Counselling was seen as its most important component, promoting knowledge-sharing and early engagement in preventative healthcare. The programme successfully reached well-informed, highly educated individuals. However, key high-risk groups - including vocational students, conservative individuals, asylum seekers, and those under 18 – were not well reached. Reported barriers included stigma, misinformation, and long appointment waiting times. HCPs recommended improved outreach to vocational schools, more inclusive educational materials, and mobile testing initiatives to improve accessibility. Conclusion: HCPs consider free VCT programmes a critical tool for equitable access to sexual healthcare. However, to maximise their reach and impact, targeted, context-sensitive strategies are needed to engage underserved and high-risk populations more effectively. WHAT IS ALREADY KNOWN ON THIS TOPIC: Financial barriers reduce uptake of HIV and STI testing, particularly among young and low-income populations in high-income countries. WHAT THIS STUDY ADDS: Removing cost improves uptake and visibility of voluntary counselling and testing (VCT) services, especially among socially connected youth. However, high-need groups such as vocational students, asylum seekers, and individuals from conservative backgrounds remain underreached without targeted outreach. HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY: Findings highlight the need for policies that combine free testing initiatives with inclusive sexual health education and outreach to improve equity and programme effectiveness.

BACKGROUND: Pregnant and lactating women were systematically excluded from the first SARS-CoV-2 vaccine trials, leading to great uncertainty in those women and their treating clinicians concerning the safety of the SARS-CoV-2 vaccine [1]. Detailed information about the immune response in blood and breast milk of lactating women and the transmission to infants after mRNA vaccination against SARS-CoV-2 is still scarce. STUDY AIMS: We aimed to characterise the antibody responses and neutralising antibody responses against different variants of SARS-CoV-2 after mRNA vaccination in blood and breast milk of lactating women. We further aimed to compare the antibody responses to a matched cohort of non-lactating women, and to identify factors associated with antibody responses. Additionally, we assessed the occurrence of post-vaccination symptoms, health status trajectories and SARS-CoV-2 infections among participants and their infants after vaccination. METHODS: We conducted a single-centre prospective cohort study recruiting participants between October 2021 and February 2022. The study participants were recruited directly on-site at the reference vaccination centre of the Canton of Zurich, or referred to the study centre by external healthcare providers. Eligible participants were aged >18 years and had not previously been vaccinated against SARS-CoV-2 with an mRNA vaccine. The primary outcome was the antibody response (anti-S IgA, anti-S IgG, anti-N IgG) in blood plasma and breast milk in lactating women at baseline, 4 weeks and 6 weeks. Secondary outcomes were neutralising antibody responses in blood plasma at 6 weeks, as well as self-reported post-vaccination symptoms, health status (assessed using the EuroQol visual analogue scale [EQ VAS]) and SARS-CoV-2 infections in mothers and infants over the study follow-up. Antibody responses in plasma were compared with a propensity score-matched sample of non-lactating women from the population-based Zurich SARS-CoV-2 Vaccination Cohort. Descriptive statistical analyses were conducted for all outcomes, and associations between demographic and clinical factors with antibody responses were evaluated using multivariable mixed linear regression models. RESULTS: Of 45 eligible study participants, 40 lactating women completed at least two immunological assessments and were included in analyses. Study participants had a mean age of 34.9 years and 5 (12.8%, 5/39) participants reported a prior SARS-CoV-2 infection.Two weeks after the second vaccination (at 6 weeks), all study participants tested seropositive in blood plasma for anti-S IgG and anti-S IgA, with 3 (7.7%, 3/39) testing seropositive for anti-N IgG. Neutralising antibodies against the wildtype, delta and omicron variants were detected in blood plasma of 100% (40/40), 97.4% (39/40) and 64.1% (26/40) of participants, respectively. All breast milk samples tested positive for anti-S IgG, but only 15.6% (6/40) showed detectable anti-S IgA levels. Antibody responses were similar in the matched cohort of non-lactating women. Of the 136 post-vaccination symptoms reported in mothers and the 37 reported in infants (173 post-vaccination symptoms in total), the majority were reported to be of very mild to medium severity (87.1%, 108/124 in mothers; 93.5%, 29/31 in infants) and resolved spontaneously (70.7%, 70/99 in lactating women; 42.3%, 11/26 in infants). EQ VAS scores were high at baseline (median: 85, interquartile range [IQR]: 75.5–92) and showed a minimal decrease at weeks 4 and 6 (medians: 82 and 81), with self-reported wellbeing returning to baseline levels by month 6. Over six months, 52% of the study participants reached for full follow-up (13/25) reported an infection with SARS-CoV-2, all of mild severity. CONCLUSIONS: Antibody responses against SARS-CoV-2 in blood plasma and breast milk were found to be anti-S IgG-dominant, and neutralisation assays at 6 months showed high neutralisation capacity for the wildtype and delta variants in plasma. No difference between lactating and non-lactating women was found. Self-reported post-vaccination symptoms were mostly of medium severity, and health status returned to baseline levels by 6 months after a short-term decrease around 4–6 weeks. Mild infections were reported after vaccination.

Background: The rise of online dating apps (ODAs) has raised concerns about potential mental and sexual health risks, particularly among emerging adults. However, limited research exists on how problematic ODA use and health outcomes are associated during this sensitive transition phase of early adulthood. Methods: Data were collected in an anonymous online survey from 923 Swiss university students (64% female) who had actively used ODA in the past 12 months. The Problematic Online Dating Apps Use Scale (PODAUS) and a variety of mental health, substance use and sexual health outcomes were assessed. Regression models were applied to examine associations between problematic ODA use and health outcomes. Measurement invariance (MI) of the PODAUS was tested across females and males. In a subsample ( N =275), the PODAUS was retested at a 14-day follow-up. Results: Higher intensity of problematic ODA use was significantly associated with more symptoms of depression, impulsivity and a higher number of sexual partners. Furthermore, a higher PODAUS score was associated with higher lifetime and 12-month prevalence rates of sexually transmitted infections. PODAUS demonstrated good internal consistency (α=0.73) and acceptable retest reliability (r _s =0.54**), while MI was confirmed across genders. Conclusions: We identified significant associations between problematic ODA use and adverse health outcomes in a student population. Our findings highlight the necessity for targeted mental health interventions and sexual health education for university students, especially for those students exhibiting problematic ODA use patterns.

Background: Post-COVID-19 condition (PCC) remains a public health challenge with limited treatment options. Objective: To evaluate the effects of Pycnogenol ^® , a French maritime pine bark extract with anti-inflammatory and antioxidative properties, versus placebo on patient-reported health status in individuals with PCC. Design: Single-center, placebo-controlled, quadruple-blind, randomized trial. ClinicalTrials.gov, NCT05890534 Setting: German-speaking Switzerland. Participants: Adults with PCC with at least one of the following symptoms: fatigue, post-exertional malaise, dyspnea, or brain fog. Intervention: Daily dose of 200 mg Pycnogenol ^® (50 mg capsules four times daily) or placebo for 12 weeks. Measurements: The primary outcome was self-reported health status (EQ-VAS). Secondary outcomes included symptoms, quality of life, exercise capacity, physical activity and blood biomarkers. Results: Between June 14, 2023, and July 5, 2024, 153 participants were randomized to receive Pycnogenol ^® (n=75) or placebo (n=78). Participants reported persisting symptoms for a median duration of 101 weeks. Unadjusted median EQ-VAS increased by 5.4 units and 7.9 units in the in the Pycnogenol ^® and placebo groups, respectively, with no difference observed between the groups (β=0.54, 95% CI -3.45 to 4.54, p=0.79). 31 adverse events occurred in the Pycnogenol ^® group (11 probably related) and 18 in the placebo group (9 probably related). Three serious adverse events were reported, all unrelated to the study products. No between group differences were observed in secondary endpoints. Limitation: The results may not be generalizable to individuals newly experiencing PCC. Conclusion: Pycnogenol ^® (200 mg daily) did not improve health status compared to placebo over 12 weeks in PCC. Both groups showed clinically relevant improvements, suggesting non-therapeutic effects. Primary funding source: Horphag Research, Switzerland.

Background and aims: Online dating applications (ODAs) are gaining popularity, raising concerns about their potential addictive effects on users' health. The main objective of this study was to investigate the association between problematic ODA use and mental health, substance use, and sexual behavior outcomes in men-who-have-sex-with-men (MSM). To achieve this, we first validated a German version of the Problematic ODA Use Scale (PODAUS), which assesses problematic ODA usage patterns.Methods: Problematic ODA use was assessed in 226 HIV-negative MSM counseling for HIV pre-exposure prophylaxis at baseline and 6-month follow-up (n = 164, M_age = 42, SD = 11). The German PODAUS was validated using confirmatory factor analyses (CFA) and correlational analysis. Multiple linear regression analyses were performed to investigate associations of PODAUS with mental, sexual health, and substance use outcomes.Results: CFA supported PODAUS’ 6-item unidimensional structure, demonstrating excellent fit indices. Reliability analyses indicated good internal consistency (α = 0.79) and high test-retest reliability (r_s = 0.68). Regarding mental health, significant positive associations were found between PODAUS and symptoms of depression, loneliness, anxiety, Attention Deficit Hyperactivity Disorder (ADHD), and impulsivity, with medium to large effect sizes. Regarding sexual health, significant negative associations of small to medium effect sizes were found between PODAUS and lifetime prevalence of sexually transmitted infections, body acceptance, and sexual fulfillment, while a significant positive association with trait sex motivation occurred.Discussion and Conclusion: The German version of PODAUS emerges as a valid, reliable tool to assess problematic ODA use. In an MSM sample, problematic ODA use was associated with lower mental and sexual health.

Chagas disease is a parasitic infection found mainly in continental Latin America. However, it is now present globally due to increasing international mobility and its lifelong persistence in the absence of timely treatment. In Switzerland, this neglected tropical disease presents a significant challenge because of its high potential for transmission, severe clinical manifestations and complications, and a lack of medical and public health programs at both the cantonal and national levels. This paper reviews the medical and public health interventions addressing Chagas disease in countries outside Latin America. It provides a specific perspective on the challenges, opportunities, and strategies for the elimination of Chagas disease as a public health problem within the Swiss context. This article concludes with the introduction of the newly created Swiss Chagas Network, which aims to develop strategies for improving the management of Chagas disease in Switzerland.

Background: Travellers frequently visit popular destinations like Brazil, India, Peru, Thailand and Tanzania, each presenting varying malaria risks. The extent to which travellers enter high-risk malaria-endemic areas in destinations with heterogeneous malaria risk remains unclear. We used geo-location via a smartphone application to (i) describe where travellers go within countries with heterogeneous malaria risk (Brazil, India, Peru, Thailand) and (ii) compare mosquito bite prevention behaviours between these destinations and Tanzania, considered entirely high risk for malaria. Methods: This analysis is a sub-study of the Tracking of Urgent Risks in Swiss Travellers (TOURIST2) cohort, which prospectively recruited 1000 travellers (≥18 years, travelling ≤4 weeks) from Swiss travel clinics (Zurich and Basel) between September 2017 and April 2019. We included 734 travellers to Brazil, India, Peru, Thailand and Tanzania who provided geo-location data. Daily health and geo-location data were collected using a smartphone application. Malaria risk was categorized using 2022 malaria maps from the Swiss Expert Committee for Travel Medicine. Results: Of the 734 travellers, 525 travelled to Brazil, India, Peru and Thailand and 225 to Tanzania. In Brazil, India, Peru and Thailand, only 2% (n = 13) visited high-risk malaria areas. In Peru, 4% (n = 4) visited a high-risk area; in Brazil, 3% (n = 6); in Thailand, 2% when crossing the border into Myanmar (n = 3); and in India, 0%. Travellers to high-risk areas were more often male (62%), slightly older (median age 42.0) and planned longer trips (median 23.0 days) than other travellers. No participants were diagnosed with malaria. Travellers to Brazil, India, Peru and Thailand used mosquito bite prevention measures less frequently than travellers to Tanzania. Those in Tanzania had higher, but still suboptimal, use of insect spray (65% of travel days). Conclusions: Travellers to Brazil, India, Peru and Thailand rarely visited high-risk malaria areas, and their adherence to mosquito bite prevention measures was generally low. In Tanzania, adherence was higher but still suboptimal.

Background: A significant proportion of the global population has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) at some point since the onset of the pandemic. Although most individuals who develop coronavirus disease 2019 (COVID-19) recover without complications, about 6% have persistent symptoms, referred to as post-COVID-19 condition (PCC). Intervention studies investigating treatments that potentially alleviate PCC-related symptoms and thus aim to mitigate the global public health burden and healthcare costs linked to PCC are desperately needed. The PYCNOVID trial investigates the effects of Pycnogenol®, a French maritime pine bark extract with anti-inflammatory and antioxidative properties, versus placebo on patient-reported health status in people with PCC. Methods: This is a single-center, placebo-controlled, quadruple blind, randomized trial. We aim to randomly assign 150 individuals with PCC (1:1 ratio) to receive either 200 mg Pycnogenol® or placebo daily for 12 weeks. Randomization is stratified for duration of PCC symptoms (≤ 6 months versus > 6 months) and presence of symptomatic chronic disease(s). The primary endpoint is perceived health status at 12 weeks (EuroQol—Visual Analogue Scale) adjusted for baseline values and stratification factors. Secondary endpoints include change in self-reported PCC symptoms, health-related quality of life, symptoms of depression and anxiety, cognitive function, functional exercise capacity, physical activity measured with accelerometry, and blood biomarkers for endothelial health, inflammation, coagulation, platelet function, and oxidative stress. Investigators, study participants, outcome assessors, and data analysts are blinded regarding the intervention assignment. Individuals with PCC were involved in the design of this study. Discussion: This is the first trial to investigate the effects of Pycnogenol® versus placebo on patient-reported health status in people with PCC. Should the trial proof clinical effectiveness, Pycnogenol® may serve as a therapeutic approach to mitigate symptoms associated with PCC. Trial registration: The study is registered at ClinicalTrials.gov. :NCT05890534, June 6, 2023.

Background: Tick-borne encephalitis (TBE) is a severe, vaccine-preventable viral infection of the central nervous system. Symptoms are generally milder in children and adolescents than in adults, though severe disease does occur. A better understanding of the disease burden and duration of vaccine-mediated protection is important for vaccination recommendations. Aim: To estimate TBE vaccination coverage, disease severity and vaccine effectiveness (VE) among individuals aged 0–17 years in Switzerland. Methods: Vaccination coverage between 2005 and 2022 was estimated using the Swiss National Vaccination Coverage Survey (SNVCS), a nationwide, repeated cross-sectional study assessing vaccine uptake. Incidence and severity of TBE between 2005 and 2022 were determined using data from the Swiss disease surveillance system and VE was calculated using a case–control analysis, matching TBE cases with SNVCS controls. Results: Over the study period, vaccination coverage increased substantially, from 4.8% (95% confidence interval (CI): 4.1–5.5%) to 50.1% (95% CI: 48.3–52.0%). Reported clinical symptoms in TBE cases were similar irrespective of age. Neurological involvement was less likely in incompletely (1–2 doses) and completely (≥ 3 doses) vaccinated cases compared with unvaccinated ones. For incomplete vaccination, VE was 66.2% (95% CI: 42.3–80.2), whereas VE for complete vaccination was 90.8% (95% CI: 87.7–96.4). Vaccine effectiveness remained high, 83.9% (95% CI: 69.0–91.7) up to 10 years since last vaccination. Conclusions: Even children younger than 5 years can experience severe TBE. Incomplete and complete vaccination protect against neurological manifestations of the disease. Complete vaccination offers durable protection up to 10 years against TBE.