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Genetic variation within and among populations of the threatened lichen Lobaria pulmonaria in Switzerland and implications for its conservation.

The foliose epiphytic lichen Lobaria pulmonaria has suffered a significant decline in European lowlands during the last decades and therefore is considered as endangered throughout Europe. An assessment of the genetic variability is necessary to formulate biologically sound conservation recommendations for this species. We investigated the genetic diversity of the fungal symbiont of L. pulmonaria using 143 specimens sampled from six populations (two small, one medium, three large) in the lowland, the Jura Mountains, the pre-Alps and the Alps of Switzerland. Among all nuclear and mitochondrial regions sequenced for this study, variability was found only in the internal transcribed spacer (ITS I), with three polymorphic sites, and in the nuclear ribosomal large subunit (nrLSU), with four polymorphic sites. The variable sites in the nrLSU are all located within a putative spliceosomal intron. We sequenced these two regions for 81 specimens and detected six genotypes. Two genotypes were common, two were found only in the more diverse populations and two were found only in one population each. There was no correlation between population size and genetic diversity. The highest genetic diversity was found in populations where the fungal symbiont is reproducing sexually. Populations with low genetic diversity included only the two same common genotypes. Our study provides evidence suggesting that L. pulmonaria is self-incompatible and heterothallic. Based on our results we give populations with sexually reproducing individuals a higher rank in terms of conservation priority than strictly asexual populations. The remaining lowland populations are so small, that one single catastrophic event such as a windthrow might destroy the entire population. Hence we suggest augmenting such populations in size and genetic diversity using small thallus fragments or vegetative diaspores collected in other populations. As we did not detect any locally adapted genotypes, these transplants can be taken from any other genetically diverse population in Switzerland.

Base Sequence↗

[5 cases of Mediterranean boutonneuse fever in Switzerland].

The Boutonneuse Fever also called Marseilles or Eruptive Mediterranean Fever is an common disease in mediterranean area, in Africa and Indien. Rickettsia conorii is the microorganism involved and Rhipicephalus sanguineus is the most common vector. In Switzerland, this dog's tick don't exist in the nature, but it may be introduced by a dog contaminated elsewhere outside of the country and remain alive in our houses. It the reason why this disease is very uncommon in Switzerland. However, it may be observed in people coming back from vacation or in patients in contact with imported Rhipicephalus. In this paper, five cases of Boutonneuse Fever diagnosed between 1980 and 1985 are reported. The epidemiological relationships between four of these cases are of special interest. The clinical picture of the disease is presented with the different serological tests useful in confirming the diagnosis. Prevention and treatment are discussed.

Adult↗

Prospective survey of parenteral nutrition in Switzerland: a three-year nation-wide survey.

BACKGROUND AND AIMS: The goals of this national survey were to determine the current PN practices and admixture formulations used in Switzerland. METHODS: During three years, an annual questionnaire was sent to all heads of Swiss hospital pharmacies. RESULTS: 92% of Swiss hospitals with a full-time pharmacist participated. Different PN systems were commonly used for adult patients: 2 commercial formulas in 2 or 3 compartments bags, 2 commercial formulas with/without lipid, 3 formulas compounded by the hospital pharmacy. For hospitalized adults, 83% of PN bags were administered as commercial multicompartment bags. The compounding of individualized PN admixtures takes place primarily in pharmacies of medium to large size hospitals. For pediatric PN, hospital compounding is routine because of individualized PN compositions and absence of commercially available standardized admixtures. Long-term home-PN was mostly delivered by hospital pharmacies (57%) or by private nutrition support home delivery services (37%). Most PN formula compositions complied with European guidelines and represented 2.6+/-2.0% of the hospital drug budget. Multi-disciplinary nutritional support teams were present in 52% of hospitals. CONCLUSION: In Switzerland, most PN for hospitalized adults were administered as commercial multi-compartment bags. The compounding of individualized PN admixtures were still important for pediatric patients and long-term home-PN.

Adult↗

[Ultrasonically established cystic periventricular leukomalacia (PVL): incidence and associated factors in Switzerland 1995-1997].

BACKGROUND: Cystic periventricular leukomalacia (PVL) is an ischemic brain lesion that mainly affects preterm infants and causes severe neurological damage. Diagnosis is made by cranial ultrasonography. Objectives of this study were to determine the incidence, to identify associated factors and to evaluate the frequency of neurological abnormality at discharge. PATIENTS AND METHODS: Infants with PVL in Switzerland were systematically registered (Swiss Pediatric Surveillance Unit, Swiss Neonatal Network) over three years (1995 to 1997). They were compared to a control group matched for gestational age. RESULTS: Over the three year period 40 infants with PVL defined as at least 2 cysts with diameter = 2 mm in the periventricular region were registered (35 of them were preterm babies). In comparison with the matched controls the infants with PVL had received significantly less frequently antenatal corticosteroids (44 vs 78%, Event Rate Ratio 0.57, 95% Confidence Interval 0.38-0.68), they had lower umbilical cord arterial pH and lower Apgar scores; there was a trend to arterial hypotonia and hypocapnia associated with PVL. The infants of the study group needed more often mechanical ventilation or nasal CPAP (92% versus 67%; ERR 1.38, CI 1.07-1.77) and had more often intracranial hemorrhage (39 versus 14%; ERR 2.8, CI 1.13-6.96). 56% of the infants with PVL were considered abnormal at the neurological examination at discharge compared to 28% in the control group (p < 0.02). CONCLUSION: The incidence of PVL in Switzerland is 1.2% for preterm infants with a birth weight less than 1500 g. Cranial ultrasonography on infants at risk for PVL is important because 44% of the infants with PVL didn't show neurologic abnormalities at discharge.

Apgar Score↗

[Social change in the physician's role and medical practice caused by managed care in Switzerland].

Switzerland is the first European country where health maintenance organizations (HMOs) characterised by capitation (per capita lumpsum) and gatekeeping were implemented according to the HMO staff model known in the USA. The development of managed health care in Switzerland relies on the belief that adequate economic incentives and competition result in cost reduction and high quality health care. Whether this is true or not--in any case the deregulation of legally accepted forms of health insurance and managed care result in profound changes in the Swiss health care system. Observations are made by using expert interviews and analysis of documents. The implementation of managed care induces socio-cultural changes of the medical profession which are as profound as the induced economic changes. We discuss conflicts of interests among physicians using four main dimensions of conflict: (1) control, (2) monopolization, (3) valuation, and (4) specialization. In the HMOs we observe pronounced conflicts of the physicians' role. The changes of the physicians' role in HMOs is on the one hand the result of new duties. On the other hand it expresses strategies of coping with the role conflict between the main clinical duties and the new obligation to control cost and to monitor treatment via gatekeeping. In HMOs the teamwork of doctors and the quality control of care promotes the satisfaction of physicians with their work, however, it can also have dysfunctional effects.

Cost Control↗

[Prenatal ultrasonography in Switzerland--a repersentative national survey] .

BACKGROUND: The cost-effectiveness ratio of routine ultrasound during pregnancy has been debated for years. However, there is a lack of population based data concerning both costs and benefit. AIM: Population based survey of ultrasound examinations (US) during pregnancy in Switzerland with respect to quantity, indications and results; estimation of total costs, the proportion paid by health insurance and the costs for routine US. METHOD: During a representative week all certified physicians and obstetrical out-patient departments in Switzerland were asked to participate in an anonymous questionnaire based national survey on the use of ultrasound during pregnancy. RESULTS: With 62.9% of the physicians and 90.6% of the out-patient departments participating a total of 6455 questionnaires were returned. On average, 4.6 US were done per pregnancy or about 520,000 scans per year. At a mean price of $ 50 per scan total costs equalied $ 26 million a year. $ 19.5 million were covered by health insurance and the rest was not billed by the physicians. The indication for the scan was a medical problem in 48%, a routine scan in 36.9% of cases a first and a second trimester scan is paid for and in 15.1% reassurance of either the women or the physician. Abnormal results were found in 40.7% of medical indications, in 15% of routine scans and in 12.6% of reassurance cases. CONCLUSION: The considerable number of scans done for reasons of reassurance and not changed for does support our hypothesis that ultrasound during pregnancy has become a tool to routinely check the general state of the fetus comparable to the stethoscope of the general practitioner. One in seven US yielded a pathological result. Maximal cost savings for the health insurance amount to about 9 million a year. This amount has to be balanced by the health benefit, respectively if routine US were abolished.

Cost-Benefit Analysis↗

[Quality of praenatal diagnostic ultrasound - comparison of sonographically detected foetal anomalies with diagnostic findings verified post-partum in Switzerland].

AIM: Comparison of all praenatally detected cases of foetal anomalies to actual diagnostic findings post partum during a one year period in Switzerland. METHODS: A retrospective questionnaire-based evaluation including the 5 university hospitals and 6 large hospitals in Switzerland as a population-based study. Analysis of all foetal anomalies detected praenatally by ultrasound in the year of 1995 in these centres. RESULTS: 347 cases have been included in the study. 89 % of cases were detected using screening methods. (2/3) were referred by obstetrical practitioners and GPs. 62 % of the pregnancies were completed and 33 % terminated, while the rest resulted in abortion or stillbirth. In terminated pregnancies there was a 82 % agreement between praenatal and postmortem findings. Sonographic results and clinical/post-mortem diagnosis were in agreement about the presence of major foetal anomalies in 18 % of cases. Additional minor anomalies unperceived by sonography, however, were seen post mortem. There was no false positive case. CONCLUSIONS: Without ultrasound screening almost 90 % of anomalies would have been missed due to the absence of clinical symptoms. The Swiss two-step system for praenatal ultrasound screening, based on screening scans done by the obstetrician and GP in practice, or residents in the public outpatient clinics respectively, and the detailed scan done by a subspecialized perinatologist shows excellent results especially in the subgroup of terminated pregnancies.

Abortion, Eugenic↗

[Ophthalmology "Made in Switzerland" -- Swiss papers listed in Medline].

BACKGROUND: Publications are one of the most important tools to measure scientific production in a particular sphere. Hence, the aim of this study was to identify the quantitative and (through Journal Impact Factor) qualitative amount of ophthalmological articles coming from Switzerland. MATERIALS AND METHODS: With a specifically developed software we searched 70 ophthalmological Journals indexed by Medline for articles from Switzerland. RESULTS: Not counting the publications related to the annual meeting of the Swiss Ophthalmological Society, the amount of Swiss papers in ophthalmological journals indexed by Medline, increased between 1988 and 1999 by a factor of four. In proportion to the global amount of ophthalmological publications we calculated an increase by a factor of 2.6. The amount of publications grew particularly during the analysed time period in journals with high impact factors. In 1999 a total of 1.8 % of the indexed ophthalmological articles originated from Swiss research institutes and hospitals. The average amount of authors of Swiss publications increased, thereby following an international trend. CONCLUSIONS: The increased amount of publications may rely on the growing role of Swiss research in ophthalmology as well as on a broadened and deepened international orientation of Swiss ophthalmology. The increased number of authors can be explained by the growing complexity and interdisciplinary nature of research projects. Both, the amount of publications and the number of authors, can be linked to the "publish or perish" paradigm.

Forecasting↗

[Heroin-assisted treatment of opioid addicts in Switzerland from 1994-2001--utilisation and characteristics of admissions and discharges].

BACKGROUND OBJECTIVES: Since the beginning of the 1990 s the number of treated opioid addicts has markedly increased in Switzerland. This study examines the cause of health service utilisation of one specific type of treatment--heroin-assisted maintenance--the length of stay in this kind of treatment, and characteristics of admissions and discharges. METHODS AND SAMPLE: Data on all admissions into and discharges from heroin-assisted treatment were collected from the start of this treatment modality on January 1, 1994 to December 31, 2001. These data were used to calculate length of stay, and number of patients at the end of each calendar year. Data were analysed according to sex and age and the Kaplan-Meier survival statistics were calculated. Finally, the discharges from 1994 to 1998 were compared to the discharges of 1999 up to December 2001. RESULTS: Since the introduction of heroin-assisted treatment, the number of patients in this form of treatment has markedly increased. Simultaneously, the average age of the patients entering treatment increased, whereas the proportion of women decreased continually. Compared to the earlier phase (1994-1998), in the last three years fewer patients terminated treatment at an early stage (within the first 4 months). CONCLUSIONS: Substitution programmes are the most common form of treatment for opioid dependence in Switzerland. The increase in the average age of patients in this treatment modality as well as in the abstinence-oriented treatment at admission may be interpreted favourably as an indicator that fewer less young people are opioid dependent than at the beginning of the 1990 s. The decrease in the proportion of females may be an indicator that females were overrepresented in heroin-assisted treatment at the beginning of this treatment modality and that the proportion gradually became more similar to the proportion in the opioid-dependent population as a whole. The decrease of early treatment terminations can be seen as positive, since with longer length of stay the probability of changing into abstinence-oriented treatment is becoming more probable.

Adult↗

[Fever after a tick bite: clinical manifestations and diagnosis of acute tick bite-associated infections in northeastern Switzerland].

BACKGROUND: Different tick-borne infections can cause an acute febrile illness. The study objectives were to investigate the clinical manifestations and diagnosis of infections among patients who presented with fever after a tick-bite, and to detect newly described pathogens, including Ehrlichia, Babesia and Rickettsia helvetica, in North-Eastern Switzerland. PATIENTS AND METHODS: : We studied 75 patients (41 male, 34 female, median age 38 years, among them 10 children) who had fever within 3 weeks after a tick-bite. Paired sera were tested for antibodies to Borrelia burgdorferi, tick-borne encephalitis virus, Anaplasma (Ehrlichia) phagocytophila, Babesia microti, B. divergens, and Rickettsia helvetica. In addition, microscopy and polymerase chain reaction was used to detect Ehrlichia. Clinical data were obtained at baseline and at 1 and 2 year follow-up. RESULTS: Tick-borne infections were confirmed or possible in 36 (48 %) patients: 7 (9 %) Erythema migrans, 6 (8 %) other specific manifestations of Lyme borreliosis, 6 (8 %) Lyme borreliosis presenting as non-specific febrile illness, 8 (11 %) tick-borne encephalitis, 7 (10 %) granulocytic ehrlichiosis, 1 B. microti infection in a traveler from the US and 6 (8 %) dual infections. In 8 (11 %) patients serological findings were suggesting possible acute or past R. helvetica infection. CONCLUSION: Among patients with fever after a tick-bite, Lyme borreliosis was most frequently found. There was no evidence for babesiosis among the resident population. Serologic data suggest that human granulocytic ehrlichiosis and R. helvetica infections may be endemic in Switzerland. Among 50 % of the patients no tick-borne infections could be diagnosed.

Acute Disease↗

[Increased stigma through a former stay in a mental hospital? Results of a public survey in Switzerland].

OBJECTIVE: The perception of how most people stigmatize mentally ill persons has consequences for the affected. Is a former stay in a mental hospital connected with an additional stigma? METHOD: In three linguistic areas of Switzerland we conducted a representative opinion survey (N = 1737) on public attitude towards mental illness, psychiatric treatment, and the institutions involved. Using Link's "devaluation-discrimination-scale" a randomly selected sample was asked on the telephone about the perceived stigma concerning (1) a currently mentally ill person or (2) a former mentally ill person or (3) a former mental inpatient. RESULTS: In all three linguistic areas of Switzerland we found in the case of current illness a lower social acceptance or a higher discrimination, respectively. Also in all linguistic areas those who were asked about "former mental illness" or "former stay in a mental hospital" did not differ regarding perceived acceptance or discrimination. DISCUSSION: Our data does not confirm the assumption of increased stigma because of a former stay in a mental hospital. An inquiry of subjective experience of a hospital stay, however, would probably lead to other results than that of a public survey.

Adolescent↗

[Forgoing life-sustaining measures in patients at the end of life in the German-speaking part of Switzerland: results of a death certificate study].

BACKGROUND AND OBJECTIVE: There have not been any comprehensive data from German-speaking countries on the medical practice of withholding or withdrawing treatment at the end of life. This study from the German-speaking part of Switzerland provides the first in-depth analysis in this field. This study is based on data from this region and is a contribution to a large empirical research project on medical end-of-life decisions in 6 European countries (EURELD). METHODS: Continuous random samples (n = 4991) were taken from all deaths in the German-speaking part of Switzerland that had been reported to the Swiss Federal Office of Statistics between June and October 2001. Doctors who had been attending the deceased person were asked to complete mailed questionnaires, their replies being kept strictly anonymous. RESULTS: The response rate was 67 %. Medications were withheld or withdrawn in 48 % of all treatments forgone: among these, antibiotics accounted for 17 %. Other potentially life-sustaining medical measures forgone included artificial hydration (12 %), surgery (7 %), artificial feeding (6 %), chemotherapy (6 %), diagnostic tests (4 %), hospital admissions (3 %), renal dialysis (2 %), blood product infusions (2 %), intubation (2 %), ventilation (2 %), resuscitation (2 %), and radiotherapy (1 %). 43 % of all treatments were forgone in patients who died in hospital, 42 % in nursing homes, and 15 % at home. In almost three-quarters (73 %) of the treatments forgone, a primary-care doctor had ordered the treatment to be withheld or withdrawn. On average, forgoing treatment led to a life-shortening effect of more than one month in 8 % of all cases. The proportion was higher for renal dialysis (25 %), blood products infusion (18 %), and diagnostic tests (16 %). CONCLUSIONS: Forgoing life-sustaining medical treatment comprises a wide range of decisions taken in many different clinical settings. In most cases the likely lifespan is only slightly shortened.

Adolescent↗

Benzotriazoles, alkylphenols and bisphenol A in municipal wastewaters and in the Glatt River, Switzerland.

BACKGROUND: Many organic micropollutants occur at trace concentrations in municipal wastewater effluents and in the aquatic environment. Some of these xenobiotic chemicals can be considered as 'emerging' contaminants and some are suspect to have endocrine disrupting effects. Among the latter are nonylphenol (NP), octylphenol (OP) and bisphenol A (BPA), which deserve special attention due to their ubiquitous occurrence in the aquatic environment. The complexing agents benzotriazole (BT) and tolyltriazole (TT) are applied as anticorrosive agents (e.g. in cooling and hydraulic fluids, in antifreezing fluids, in aircraft deicing fluids, in dish washing liquids for silver protection), as antifogging agents and as intermediates for the synthesis of various chemicals. The environmental occurrence of NP and OP is caused by the fact that they are intermediate products (metabolites) in the biodegradation of alkylphenol polyethoxylate surfactants. BPA is globally used for the production of polycarbonate and epoxy resins. METHODS: BT, TT, NP, OP and BPA were quantitatively determined in municipal wastewater effluents in Switzerland and in the Glatt River. The analytes were enriched by solid-phase enrichment. BT and TT were determined underivatized by electrospray LC/tandem MS. Reversed-phase LC was performed on octylsilica columns with isocratic water/methanol elution. Multiple reaction monitoring of the positive ions provided selective and sensitive detection for reliable quantifications. NP, OP and BPA were determined by GC/MS after derivatization with N-methyl-N-(trimethylsilyl)-trifluoroacetamide. RESULTS AND DISCUSSION: BT and TT concentrations in primary and secondary effluents of municipal wastewater treatment plants varied from below 10 to 100 microg/L. The ranges of the concentrations in the Glatt River in ng/L were 636-3,690 for BT, 122-628 for TT, 68-326 for NP, 6-22 for OP and 9-76 for BPA. The corresponding mass flows in g/d were 93-1,870 for BT, 18-360 for TT, 24-183 for NP, 1-16 for OP and 2-72 for BPA. The concentrations and mass flows of NP in the River Glatt were drastically lower than the analogous values found 15 years ago. Thus, a substantially decreased environmental exposure can be observed due to the reduction of the use of alkyphenol polyethoxylate surfactants in Switzerland. The current concentrations of NP, OP and BPA are within the ranges reported for weakly impacted surface waters. CONCLUSION: The investigated contaminants occur at quantitatively measurable but varying concentrations in municipal wastewaters and in the Glatt River reflecting their ubiquitous input into wastewaters and their different behaviour during biological wastewater treatment.

Benzhydryl Compounds↗

MYOC mutation frequency in primary open-angle glaucoma patients from Western Switzerland.

PURPOSE: To determine MYOC gene mutation frequency in patients with primary open-angle glaucoma (POAG) from Western Switzerland. METHODS: A total of 117 unselected index patients with primary open-angle glaucoma were submitted to a full eye examination. DNA was extracted from blood and PCR amplicons of MYOC exon 3 were screened for mutations by single-strand conformation polymorphism (SSCP) analysis. Abnormal conformers were analyzed both by direct bidirectional sequencing and by enzymatic mutation detection (EMD) assay. RESULTS: Ten occurrences of four different sequence changes were detected, including: 1) five times the same disease-causing mutation (Q368X) in five unrelated POAG patients and 2) three distinct polymorphisms in five patients. The patients carrying an MYOC mutant allele were characterized by a broad clinical variability in terms of age of onset (34-77 years) and highest intraocular pressure (IOP) values (23-47 mmHg). CONCLUSIONS: A pathogenic MYOC mutation (Q368X) was identified in 4.27% (5/117) of the studied population from Western Switzerland, which corresponds to the highest frequency yet reported for this mutation.

Adult↗

[State of measures of quality assurance for radiotherapy units in Switzerland].

In Switzerland 57 X-ray therapy units are in operation at present. According to the Swiss Ordinance on Radiation Protection, a quality-assurance program must regularly be applied in to these units. However, as the Swiss X-ray Ordinance gives explicit control parameters only for diagnostic units, the present article issues proposals for the realization of a quality-assurance program for the therapy units. In this regard, it is distinguished between checks performed by technical personnel of the X-ray manufacturers and checks performed by a medical physicist with corresponding qualification, or under his supervision. The so-called mentor project for the performance of annual constancy checks in institutes without medical physicists is also taken into account. These proposals should be helpful for the discussion and clarification of competencies, hence contributing to standardization of control practices in Switzerland.

Hospital Departments↗

Isonymy and the genetic structure of Switzerland. I. The distributions of surnames.

The surname distribution of the population of Switzerland was studied using a sample of 1,702,000 private users registered for the year 1994 in the Helvetic Telephone Directory. These users were distributed in four linguistic areas, in 26 Cantons and 271 Communes of the Confederation. Estimates of unbiased random isonymy, of Fisher's alpha, an indicator of abundance of surnames converging to the allele effective number in standard genetic polymorphisms, and of Karlin-McGregor's v, an indicator of immigration rates, were calculated for each Commune, each Canton, each linguistic area and for the whole Confederation. The Commune with the highest value of alpha was Geneva (alpha = 5312) followed by Versoix (3713) and by the Communes of Vaud on the north shore of Lake Leman, Chavannes (3381), Montreux (3200), Nyon (3114) and Lausanne (3109). The Italian-speaking Communes of the Ticino were next. The lowest value (alpha = 29) was observed in Poschiavo, south of the Berninapass; alpha = 39 was observed in Einsiedeln (Schwyz); then Mels and Widnau (62 and 67, Canton of St Gallen), Frutingen in Bern (72), and Appenzell (80). Accordingly, the highest consanguinity values were observed in the Grisons and in the nucleus of the founding Cantons, while the lowest were observed in the Cantons of Geneva and Vaud, preferential areas of immigration to Switzerland from abroad. The effect of subdivision on isonymy is large at the Commune level, and decreases in Cantons and linguistic groups. French and Italian languages indicate minor, German and Romanisch major inbreeding.

Data Collection↗

Isonymy and the genetic structure of Switzerland. II. Isolation by distance.

Isolation by distance in Switzerland was detected comparing the surname distributions between Cantons. The decay of isonymy with geographic distance between Cantons was consistent with Malecot's exponential decay of kinship. Lasker's distance was defined as the negative value of the logarithm of isonymy between localities, and it was found that it is linearly and significantly correlated with the log of geographic distance, both within and between languages. The peculiar geographic and linguistic structure of the Confederation, where mountain barriers exist at short distances separating different languages, might explain the rapid changes in surname similarity. It was predicted that the frequency of markers linked to the Y chromosome would show a similar association with distance in Switzerland.

Genetics, Population↗

Vaccination rate and age of premature infants weighing <1500 g: a pilot study in north-western Switzerland.

UNLABELLED: In Switzerland, there are no special vaccination recommendations for premature and low-birthweight infants with respect to a particular target vaccination age. Incomplete and delayed vaccination bears the inherent risk of preventable infections. Therefore, the vaccination rate and age of 60 premature infants in north-western Switzerland born in 1994/95 were investigated in a retrospective case-control study. For this group of patients these are the first data ever available for this region. At the age of 4-5 y, the vaccination rates for polio and diphtheria, tetanus, pertussis (DTP acellular) as well as Haemophilus influenzae b (Hib) were similar in both preterm and full-term infants. In both groups, the fourth dose of vaccine against DTP, Hib and polio was far less frequently administered than the first three. The vaccination age in preterm infants for most vaccinations was significantly higher than in age-matched full-term controls. This was particularly obvious for the first dose of vaccine against polio and DTP. In preterm infants, the median age (5th; 95th percentile) at the date of the first polio vaccination was 131 (89; 270) d and 82 (60; 182) in full-term controls (p < 0.00001). The age difference was even larger for the first DTP vaccination (62 d, p < 0.00001). The main reasons for delayed vaccination may include insufficient information given to parents as well as prolonged hospitalization. CONCLUSION: Vaccination of preterm infants should be discussed in every discharge communication, with emphasis on vaccine administration at the appropriate chronological age.

Age Factors↗