François Chappuis

Background: Chikungunya virus (CHIKV) infection is an emerging disease of growing concern to international travelers due to the expanding geographic distribution of competent vectors, climate change, and frequent outbreaks in endemic and previously unaffected regions. Until recently, prevention relied exclusively on vector control and bite prevention; however, the recent approval of chikungunya vaccines has introduced a new preventive strategy. Methods: We conducted a narrative review of currently licensed chikungunya vaccines and candidates in clinical development, focusing on immunogenicity, safety, regulatory status, and implications for travel medicine practice. Results: Two vaccines have recently received regulatory approval: the live-attenuated vaccine IXCHIQ^® and the virus-like particle vaccine Vimkunya^®. Both demonstrated high immunogenicity based on neutralizing antibody thresholds accepted as surrogate markers of protection. Post-marketing safety signals associated with IXCHIQ^®, particularly in older adults, have led to divergent regulatory decisions between authorities. The indication of vaccination in national recommendations varies somewhat depending on age, duration of travel, and individual risk factors. Several additional vaccine platforms remain under investigation, although some candidates have been discontinued. Conclusions: The recent approval of chikungunya vaccines marks a significant milestone in the field of travel medicine. However, uncertainties regarding long-term protection, safety in specific populations, and optimal targeting of travelers remain. Individualized risk–benefit assessment is essential, and further data are needed to refine vaccination strategies for travelers and populations at risk.

BACKGROUND: Alveolar echinococcosis is a rare but potentially severe parasitic disease caused by the larval stage of Echinococcus multilocularis, endemic in many countries in the northern hemisphere, including Switzerland. While the liver is most commonly affected, other organs can also be involved either by contiguity or haematogenous spread. To date, there is no epidemiological or clinical data on alveolar echinococcosis in the canton of Geneva. OBJECTIVES: To describe the demographic, epidemiological, clinical and therapeutic characteristics of alveolar echinococcosis in the canton of Geneva between 2010 and 2021. METHODS: An investigation was conducted among physicians from Geneva University Hospitals (HUG) and the private sector likely to encounter patients diagnosed with alveolar echinococcosis between 2010 and 2021. All patients being treated in the canton of Geneva were included. After obtaining their consent, an epidemiological questionnaire was completed by patients, and a clinical questionnaire by their referring physicians. Demographic, epidemiological and clinical data were entered into REDCap, then extracted and analysed. RESULTS: Of a total of 27 patients diagnosed with alveolar echinococcosis, 25 were included in the study; one patient did not provide his consent and one patient could not be contacted. The annual incidence of alveolar echinococcosis in the canton of Geneva was calculated at 0.24 cases per 100,000 inhabitants based on the subset (n = 14) domiciled in Geneva. The vast majority of patients (n = 24; 96%) were followed at HUG. The median age of patients was 55 years (range: 17–79) with a slight predominance of women (56%). Reported risk factors for alveolar echinococcosis included owning a vegetable garden (70.8%), often unfenced, practicing composting (69.6%), and owning a dog (58.3%) or a cat (58.3%). Four patients (16%) had an immunosuppressive condition. Only 52% of patients were symptomatic at the time of diagnosis. The liver was affected in most cases (n = 24; 96%), but one patient had a primary splenic location. Surgical resection for curative purposes was performed in 13 patients (52%). All patients received parasitostatic treatment with albendazole, discontinued in 5 patients (20%) due to drug-induced hepatitis. Three patients died (12%), of which two directly related to alveolar echinococcosis. CONCLUSION: Alveolar echinococcosis, a rare but severe disease, is endemic in the canton of Geneva. The establishment of mandatory reporting of this disease in Switzerland would allow monitoring of its epidemiological evolution. Primary and secondary prevention measures, currently non-existent, could potentially lower the incidence and severity of the disease.

Background: The emergence of COVID-19 disrupted several global health partnerships, with people unable to travel, meetings and conferences cancelled, and many forced to work remotely. The aim of this study was to explore the impact of COVID-19 on global health partnerships learning from the activities of the Division of Tropical and Humanitarian Medicine (DTHM) at the Geneva University Hospitals (HUG). Methods: Five members of the DTHM team as well as five local partners from ongoing projects within the DTHM in Bosnia-Herzegovina, Kyrgyzstan, Nepal, Peru and Ukraine were interviewed. A qualitative approach was chosen employing an interpretive approach using Grounded Theory involving the application of inductive reasoning for the analysis. Results: Interviewees describe both positive and negative impacts of COVID-19 for the existing partnerships. The use of on-site visits was disrupted and replaced by extra remote monitoring. Digital tools enabled the continuity of interactions ensuring that the partnership could continue to operate. Online tools allowed access to a wider audience and advantages with regards to time, cost and the environment. However, going online was unable to fully replace human interactions and exchanges which are core components of any partnership. Conclusions: COVID-19 resulted in the DTHM and its partners needing to redefine and improve how partnerships were established and maintained. This change in how partnerships operated and adapted during the pandemic will require ongoing assessment to see the long-term impact of these changes in the ways partnerships function in a post-COVID-19 environment.

Reactivation of latent tuberculosis infection (LTBI) or latent parasitic infection (LPI) during drug-induced immunosuppression can have serious consequences. The Division of tropical and humanitarian medicine of the Geneva University Hospitals runs a specific consultation for parasitic screening of immunosuppressed or pre-immunosuppressed patients. We sought to determine the seroprevalence of LTBI and LPI in such patients and explore its relationship with country of origin or previous travel in a retrospective, single-centre observational study from 2016 to 2019. Demographic data, travel history, ongoing treatments and results of the parasitological (Strongyloides stercoralis, Trypanosoma cruzi, Echinococcus multilocularis, Entamoeba histolytica and Leishmania spp.) and TB screening were collected to calculate LPI or LTBI prevalence. Risk factors for LTBI and strongyloidiasis were analysed using Poisson regression with robust variance. Among 406 eligible patients, 24/353 (6.8%) had LTBI, 8/368 (2.2%) were positive for Strongyloides stercoralis infection, 1/32 (3.1%) was positive for Entamoeba histolytica and 1/299 (0.3%) was positive for Leishmaniasis. No cases of Trypanosoma cruzi (0/274) or Echinococcus multilocularis (0/56) infection were detected. Previous travel to or originating from high-prevalence countries was a risk factor for LTBI (PR = 3.4, CI 95%: 1.4–8.2 and 4.0, CI 95%: 1.8–8.9, respectively). The prevalence of serological Strongyloidiasis in immunosuppressed patients is lower in comparison to those without immunosuppression (PR = 0.1, CI 95%: 0.01–0.8). In conclusion, screening before immunosuppression needs to be individualized, and LTBI and LPI need to be ruled out in patients who originate from or have travelled to high-prevalence countries. The sensitivity of strongyloidiasis serology is reduced following immunosuppression, so an algorithm combining different tests or presumptive treatment should be considered.

Background: The use of process evaluations is a growing area of interest in research groups working on complex interventions. This methodology tries to understand how the intervention was implemented to inform policy and practice. A recent systematic review by Liu et al. on process evaluations of complex interventions addressing non-communicable diseases found few studies in low- and middle- income countries (LMIC) because it was restricted to randomized controlled trials, primary healthcare level and non-communicable diseases. Yet, LMICs face different barriers to implement interventions in comparison to high-income countries such as limited human resources, access to health care and skills of health workers to treat chronic conditions especially at primary health care level. Therefore, understanding the challenges of interventions for non-communicable diseases and neglected tropical diseases (diseases that affect poor populations and have chronic sequelae) will be important to improve how process evaluation is designed, conducted and used in research projects in LMICs. For these reasons, in comparison to the study of Liu et al., the current study will expand the search strategy to include different study designs, languages and settings. Objective: Map research using process evaluation in the areas of non-communicable diseases and neglected tropical diseases to inform the gaps in the design and conduct of this type of research in LMICs. Methods: Scoping review of process evaluation studies of randomized controlled trials (RCTs) and non-RCTs of complex interventions implemented in LMICs including participants with non-communicable diseases or neglected tropical diseases and their health care providers (physicians, nurses, technicians and others) related to achieve better health for all through reforms in universal coverage, public policy, service delivery and leadership. The aspects that will be evaluated are as follows: (i) available evidence of process evaluation in the areas of non-communicable diseases and neglected tropical diseases such as frameworks and theories, (ii) methods applied to conduct process evaluations and (iii) gaps between the design of the intervention and its implementation that were identified through the process evaluation. Studies published from January 2008. Exclusion criteria are as follows: not peer reviewed articles, not a report based on empirical research, not reported in English or Spanish or Portuguese or French, reviews and non-human research. Discussion: This scoping review will map the evidence of process evaluations conducted in LMICs. It will also identify the methods they used to collect and interpret data, how different theories and frameworks were used and lessons from the implementation of complex interventions. This information will allow researchers to conduct better process evaluations considering special characteristics from countries with limited human resources, scarce data available and limited access to health care.

Coronavirus disease 2019 (COVID-19) can lead to long-term health effects. This article systematically characterizes the prevalence and longitudinal evolution of COVID-19 symptoms more than 7 months... Visual Prevalence of Symptoms More Than 7 Months After Symptomatic COVID-19. Coronavirus disease 2019 (COVID-19) can lead to long-term health effects. This article systematically character... Background: With millions of SARS-CoV-2 infections worldwide, increasing numbers of patients are coming forward with long-term clinical effects of the disease lasting several weeks to months. Objec...

Objectives This cohort study including essential workers, assessed the□risk and incidence of SARS-CoV-2□infection during the second surge of COVID-19 according to baseline serostatus and occupational sector. Methods Essential workers were selected from a seroprevalence survey cohort in Geneva, Switzerland and were linked to a state centralized registry compiling SARS-CoV-2 infections. Primary outcome was the number of virologically-confirmed infections from serological assessment (between May and September 2020) to January 25, 2021, according to baseline antibody status and stratified by three pre-defined occupational groups (occupations requiring sustained physical proximity, involving brief regular contact or others). Secondary outcomes included the incidence of infection. Results 10457 essential workers were included (occupations requiring sustained physical proximity accounted for 3057 individuals, those involving regular brief contact, 3645, and 3755 workers were classified under “Other essential occupations”). After a follow-up period of over 27 weeks, 5 (0.6%) seropositive and 830 (8.5%) seronegative individuals had a positive SARS-CoV-2 test, with an incidence rate of 0.2 (95% CI 0.1 to 0.6) and 3.2 (95% CI 2.9 to 3.4) cases per person-week, respectively. Incidences were similar across occupational groups. Seropositive essential workers had a 93% reduction in the hazard (HR of 0.07, 95% CI 0.03 to 0.17) of having a positive test during follow-up with no significant between-occupational group difference. Conclusions A ten-fold reduction in the hazard of being virologically tested positive was observed among anti-SARS-CoV-2 seropositive essential workers regardless of their sector of occupation, confirming the seroprotective effect of a previous SARS-CoV2 exposure at least six months after infection. What is already known about this subject?Risk of SARS-CoV-2 reinfection is low in the general population and among healthcare workers. What are the new findings?A ten-fold reduction of risk of being virologically tested positive reinfection is observed among anti-SARS-CoV-2 seropositive essential workers of different activity sectors, regardless of their occupation-related risk of exposure. How might this impact on policy or clinical practice in the foreseeable future?Vaccination could be delayed in individuals with previous history of SARS-CoV-2 infection with serologic confirmation, regardless of their occupational exposure. These observations need to be confirmed for new SARS-CoV-2 variants.