Ther Umsch [journal]
- [The benefits prevail – why electronic immunization records are advantageous to the general practitioner and his patients]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):297-300.
Immunization coverage throughout the Swiss population is still not optimal and therefore preventable diseases such as measles have not been eliminated in Switzerland yet. In addition, new vaccination protocols are available and official recommendations are becoming increasingly complex. The website www.myvaccines.ch has been in use since 2011 with the primary goal to increase immunization coverage. This service was established by Vaccinologist Professor Claire-Anne Siegrist from the University of Geneva and is free of charge for all Swiss doctors and pharmacists. It enables general practitioners and pediatricians to document the vaccination history of their patients in a new electronic immunization record. After a simple and quick process, the web-based software proposes up-to-date recommendations of new or follow-up vaccinations following the current Swiss Immunization Plan by the Federal Department of Health. Within this single practice, 1446 files have been recorded within the past three years. As a consequence, a total of 4378 immunizations have been administered, leading to a mean of 3.03 immunizations per patient. After introducing the electronic immunization record, the rates of immunizations have increased dramatically for all antigens (factor 2.1 to 41.5). Overall, patient acceptance was high – the doctor’s investment was positively recognized and his approach to patient care was perceived as modern. As a result, the practice has become competent in immunization. In summary, the positive outcome of using the electronic record highly supports the free program www.myvaccines.ch to all general practitioners and pediatricians in Switzerland.
- [Understanding and Handling Vaccine Hesitancy]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):291-6.
Vaccine hesitancy is a growing concern to experts around the world and could increasingly jeopardize the success of vaccination campaigns. Ambivalence in questions of vaccination is promoted through mistrust of vaccines and providers, furthermore through the plethora of unfiltered and often contradictory information leading to uncertainty as to whom one shall believe. Individuals are also in a dilemma in issues of vaccination, having to decide if they will accept vaccines regarding only their own wellbeing or also as an act of solidarity to maintain a high level of vaccination rates in order to eradicate diseases. Finally vaccine hesitancy is also maintained by the success of vaccination. Vaccine preventable diseases have become so seldom that many individuals perceive them as negligible. The risk of vaccination then surpasses the risk of disease thus leading to the rejection of vaccination. Although those opposing vaccination comprise only a small minority of the population, their arguments seem to be heard disproportionately, influencing vaccine hesitants very strongly. On the other hand family doctors are still highly appreciated as advisors in health related issues. These health providers can play an important role in stimulating vaccine acceptance. Delivering transparent and evidence-based information on vaccination through competent communication skills helps to rebuild the dwindling trust in vaccines. Sufficient time is required for an enriching dialogue.
- [Vaccinations for immunocompromised hosts – focussing on patients after a hematological stem cell or organ transplantation, with HIV or with functional or anatomical asplenia]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):281-9.
Patients with an acquired immune deficiency, for example due to HIV-infection, after a solid organ or haematological stem cell transplantation or due to functional or anatomical asplenia, have a greater risk to experience severe complications or a chronic course of infection compared to healthy individuals. Vaccinations would pose an ideal primary preventive method. However, their efficacy is reduced if applied during the immunosuppressed period. Therefore, whenever possible, vaccinations should be administered before the period of immunosuppression starts – or caught up later during the period of minimal possible immunosuppression. Nevertheless, the benefit conveyed through vaccines is undisputed, particularly if indications regarding dosing of vaccines (amount and frequency of doses) are optimized according to the given state of immunosuppression. Live attenuated vaccines are contraindicated during severe immunosuppression. Serologies should still be analysed and documented however, since these vulnerable patients require passive immunization through specific or standard intravenous immunoglobulins in case of relevant exposure to the respective antigens. For all patients therefore, careful documentation and communication of previous vaccinations and serologies (protective or not) among the various medical specialties is required to optimize patient management. For all immunosuppressed patients the efficacy of polysaccharide vaccines (such as the pneumococcal and meningococcal vaccines PSV-23 and MPV-ACWY) is strongly reduced compared to the conjugated ones (PCV13 and MCV-ACWY). Therefore, contrary to most other national guidelines, the Swiss guidelines recommend to use only the conjugated versions in primary vaccination series as well as in boosters – this applies strongly for immunosuppressed patients, but is recommended also for the general population in Switzerland. Another common management recommendation specific for transplant patients is the indication to control vaccine efficacy by measuring titers. This is also indicated for hepatitis B in HIV-positive patients, but not required for any vaccine in asplenic patients. In summary, vaccines pose an important opportunity for primary and secondary prevention for vulnerable patients at highest risk of experiencing the worst forms of the diseases to be prevented.
- [Vaccinations in patients with autoimmune diseases]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):275-80.
The number of individuals with autoimmune diseases treated with immunosuppressive drugs is increasing steadily. The variety of immunosuppressive drugs and in particular biological therapies is also rising. The autoimmune disease itself as well as the immunosuppressive therapy increases the risk of infection in this population. Particularly the risk of vaccine-preventable infections is elevated. Thus, preventing infections by the means of vaccination is of utmost importance. The Division of Infectious Diseases of the Epidemiology, Biostatistics and Prevention Institute, University of Zurich, performed a literature search on the topic of vaccinations in patients with autoimmune diseases upon request by the Swiss Federal Commission for Vaccination Issues. Overall, data are scarce. The following main points were retrieved from the literature: Inactivated vaccines are safe, but their immunogenicity may be reduced under immunosuppressive therapy. In addition to the generally recommended basic vaccinations, specific vaccinations, such as influenza and pneumococcal vaccination are indicated in these patient groups. Live vaccines are generally contraindicated under immunosuppressive therapy due to safety concerns. However, specific exceptions apply. Furthermore, certain time intervals for the administration of live vaccines after pausing or ceasing an immunosuppressive therapy should be respected.
- [Vaccinations in pregnancy – Don’t miss the opportunity!]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):269-73.
Pregnant women and neonates are prone to a variety of infections and often suffer from complicated courses of the disease. The growing knowledge on immunology and vaccinations during pregnancy has led to further development of already known strategies in protecting pregnant women and neonates in the most vulnerable moments of their lives. Vaccination during pregnancy against pertussis and influenza is safe and induces high levels of protecting antibodies in the mother. In addition, these specific antibodies are actively transferred to the fetus, protecting the newborn during the first weeks of life, when infections are often severe and associated with high morbidity and mortality. Viral infections like measles, rubella and varicella also may have devastating effects on mother and child when occurring during pregnancy. Available vaccinations (MMR, VZV) are inducing a stable and durable immunity, but are contraindicated during pregnancy, because of being live-vaccines. Therefore, every woman should be immune either by past infection or by vaccination before becoming pregnant. If susceptibility is only detected during pregnancy, vaccination should be started as soon as possible after birth. In conclusion, vaccinations during pregnancy offer a safe and efficient protection against dangerous infections for mother, fetus and newborn.
- [Which vaccinations for which travel-destination?]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):261-8.
Several vaccinations are recommended to protect international travellers, especially to tropical countries, from diseases in other parts of the world. Firstly, the routine schedule of childhood vaccinations and booster shots according to the Swiss immunisation programme should be checked, updated or even completed. Additional vaccinations against hepatitis A and B, typhoid fever, poliomyelitis, rabies or Japanese encephalitis may be recommended. This will depend on a number of factors including the exact destination and route (developing countries, rural areas), planned activities (backpacker, family visit, business trip), duration of travel, season, age of the traveller and current health status including the current medication and previous vaccinations. Some vaccinations, such as yellow fever, may be required for travellers to certain countries and the international certificate of vaccination may even be required when entering a country from another country where yellow fever is endemic. The international certificate of vaccination (or a letter of exemption when appropriate) is considered valid only if it is administered by an approved vaccination centre. Furthermore, the meningococcal vaccination (A, C, W, Y) is required for pilgrims to Saudi Arabia. It is recommended to start the vaccinations four to six weeks before departure to ensure enough time to administer all the necessary doses for an adequate immune response. All commonly used vaccines can be administered on the same day. The basic health insurance does not usually cover travel vaccines.
- [Rabbies vaccination]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):257-60.
With very few exceptions, rabies is occurring around the globe. The clinical course of this mammal-transmitted infection is almost universally fatal. Thus, the disease is causing more human deaths than any other zoonosis. Due to the lack of effective therapeutic options, pre- or post-exposure vaccination remains the only effective means to avoid development of fatal disease. Save and highly effective cell culture vaccines which have been available for decades provide long-lasting protection. Various vaccination schedules have been tested and are being recommended.
- [Immunization against tick-borne encephalitis]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):253-6.
Tick-borne encephalitis (TBE) is a viral infection that may cause irreversible damage to the brain and even result in death. No specific therapy exists. Active immunization is of major importance in controlling the infection. Vaccination is recommended to all adults and children > 6 years who live in endemic areas. Two inactivated vaccines are available in Switzerland. The vaccination schedule includes a basic immunization composed of 3 injections followed by boosting every 10 years. The efficacy of the vaccines has never been investigated in controlled studies, however, from indirect evidence, the vaccines are thought to cause good protection and to be safe. Local reactions at the injections site may occur in one third and mild systemic side effects in one fifth of vaccinees. Anaphylactic reactions and severe central nervous side effects are very rare.
- [Chickenpox and shingles: one virus, two diseases and current vaccination recommendations in Switzerland]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):247-52.
Adults, pregnant women, premature babies and immunocompromised persons are at increased risk for varicella complications. Therefore the current Swiss vaccination recommendations against varicella include a general recommendation for 11 to 15 year old adolescents with a negative varicella history, as well as a specific recommendation for risk groups. The goal of both recommendations is to reduce varicella complications in persons most at risk. The vaccine is not universally recommended for all toddlers in Switzerland, while this is the case in some countries such as the United States. Pros and cons of different vaccination strategies, as well as possible short- and long-term effects on herpes zoster incidence are taken into account. In the United States, there was a marked decline in incidence and hospitalisations, but an increased herpes zoster incidence in the short term. Finally, public health aspects of herpes zoster, post-herpetic neuralgia and possible vaccination strategies are outlined.
- [HPV vaccination]. [English Abstract, Journal Article]
- Ther Umsch 2016; 73(5):241-6.
Human Papilloma Viruses are associated with genital carcinoma (of the cervix, anus, vulva, vagina and the penis) as well as with non-genital carcinoma (oropharyngeal carcinoma) and genital warts. In Switzerland two highly efficient and safe vaccines are available. The safety of these vaccines has been repeatedly subject of controversial discussions, however so far post marketing surveillance has always been able to confirm the safety. In Switzerland girls and young women have been offered the HPV vaccination within cantonal programmes since 2008. 2015 the recommendation for the HPV-vaccination for boys and young men was issued, and starting July 1, 2016 they as well will be offered vaccination free of charge within the cantonal programmes. This article discusses the burden of disease, efficacy and safety of the vaccines and presents facts which are important for vaccinating these young people. Specifically, aspects of the decisional capacity of adolescents to consent to the vaccination are presented. Finally, the future perspective with a focus on a new vaccine with an enlarged spectrum of HPV-types is discussed.