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Introduction
Skills and Expertise
Current institution
Publications
Publications (514)
Background
New vaccines with broader protection against SARS-CoV-2 are needed to reduce the risk of immune escape and provide broad and long-lasting cellular immunity. The objectives of the naNO-COVID trial were to evaluate the safety and immunogenicity of a CD8 + T cell, gold nanoparticle-based, peptide COVID-19 vaccine.
Methods
A randomized, dou...
Background: Inappropriate antibiotic use drives antimicrobial resistance and remains a global concern. Evidence suggests antibiotic use may be higher among malaria-negative patients compared to malaria-positive ones, but uncertainty persists, particularly in regions with varying malaria prevalence. This study measured antibiotic residuals in three...
Introduction: Inappropriate antibiotic use is a big driver of bacterial antimicrobial resistance, and an increasing problem worldwide. Antibiotic use has sometimes been found to be more frequent by patients without malaria than patients with malaria. However, much uncertainty still exists, especially in places with varying malaria prevalence. In th...
Background New vaccines with broader protection against SARS-CoV-2 are needed to reduce the risk of immune escape and provide broad and long-lasting cellular immunity. The objectives of the naNO-COVID trial were to evaluate the safety and immunogenicity of a CD8+ T cell, gold nanoparticle-based, peptide COVID-19 vaccine. Methods A randomized, doubl...
Background
Parasitic infectious agents rarely occur in isolation. Epidemiological evidence is mostly lacking, and little is known on how the two common parasites Plasmodium and soil transmitted helminths (STH) interact. There are contradictory findings in different studies. Synergism, antagonism and neutral effect have been documented between Plasm...
BACKGROUND
Early diagnosis is key to reducing the morbi-mortality associated with P. falciparum malaria among international travellers. However, access to microbiological tests can be challenging for some healthcare settings. Artificial Intelligence could improve the management of febrile travellers.
METHODS
Data from a multicentric prospective st...
Background
Up to 45% of febrile returning travellers remain undiagnosed after a thorough diagnostic work-up, even at referral centres. Although metagenomic next-generation sequencing (mNGS) has emerged as a promising tool, evidence of its usefulness in imported fever is very limited.
Methods
Travellers returning with fever were prospectively recru...
Background
Vaccines that minimize the risk of vaccine-induced antibody-dependent enhancement and severe dengue are needed to address the global health threat posed by dengue. This study assessed the safety and immunogenicity of a gold nanoparticle (GNP)-based, multi-valent, synthetic peptide dengue vaccine candidate (PepGNP-Dengue), designed to pro...
Highlight
A potential breakthrough in the fight against malaria is the availability of a new promising tool, the R21/Matrix-M™ malaria vaccine that has shown an efficacy of 75% to protect young children against clinical malaria in different epidemiological settings. WHO recommends its deployment in addition to RTS,S/ASO1 and other effective interve...
Background:
Tropical infectious diseases and vaccine-preventable emergencies are the mainstay of pre-travel consultations. However, non-communicable diseases, injuries, and accidents that occur during travel are not emphasized enough in these settings.
Methods:
We performed a narrative review based on a literature search of PubMed, Google Schola...
Background:
Malaria infections during pregnancy can cause adverse birth outcomes, yet many infections are undetected by microscopy. We aimed to describe the epidemiology of submicroscopic malaria infections in pregnant women in Asia, the Americas, and Africa using aggregated and individual participant data (IPD).
Methods:
For this systematic rev...
Background:
Identifying the causes of Acute Undifferentiated Febrile Illness(AUFI) is key to improve the management of returning travellers with fever. We evaluated a BioFire®FilmArray® prototype panel of multiplex nucleic acid amplification tests(NAAT) targeting different relevant pathogens in travellers returning with fever.
Methods:
Prospecti...
Background
Nasopharyngeal antigen Rapid Diagnostic Tests (RDTs), saliva RT-PCR and nasopharyngeal (NP) RT-PCR have shown different performance characteristics to detect patients infected by SARS-CoV-2, according to the viral load (VL)—and thus transmissibility.
Methods
In October 2020, we conducted a prospective trial involving patients presenting...
Background
Plasmodium falciparum malaria is associated with anaemia-related morbidity, attributable to host, parasite and drug factors. We quantified the haematological response following treatment of uncomplicated P. falciparum malaria to identify the factors associated with malarial anaemia.
Methods
Individual patient data from eligible antimala...
Background:
Blastocystis sp. is a worldwide-distributed protist colonizing the guts of humans and a great variety of animals. It is unclear whether it is just a commensal or an infectious parasite that prompts eradication.The main objective of this study was to evaluate the usefulness of metronidazole in patients with gastrointestinal symptoms har...
Background
Diagnosis of undifferentiated non-malaria fevers (NMF) in returning travellers is a great challenge. Currently, there is no consensus about the use of empirical antibiotics in returning travellers with undifferentiated non-malaria fevers (NMF). Although studies in endemic areas showed that a wide range of pathogens implicated in undiffer...
While no vaccine is on the horizon to prevent traveler's diarrhea, progress has been made in the field of malaria and dengue fever. In both cases, the objective is not primarily the prevention among travelers but rather the reduction of morbidity and mortality in populations living in endemic areas. The immune mechanisms protecting against parasito...
At the time of the assessment of the sanitary measures taken to fight the crisis, we have analysed the testing and vaccination following the grid well known in health economics: the law of diminishing returns. In the first phase, the returns are positive and increasing, the increase in benefits being faster than the increase in costs. In the second...
Which recommendations family doctors and travel health practitioners can provide to their patients, to reduce their environmental footprint when travelling? Avoiding flying is the biggest action a traveler can take to reduce their greenhouse gas emissions. Staying at eco-lodges, or carbon offsetting, may help, but one must be aware of false or exag...
Background
Etiological diagnosis of febrile illnesses in returning travelers is a great challenge, particularly when presenting with no focal symptoms (acute undifferentiated febrile illnesses (AUFI)), but is crucial to guide clinical decisions and public health policies. In this study, we describe the frequencies and predictors of the main causes...
Background
Inappropriate antibiotics use in lower respiratory tract infections (LRTI) is a major contributor to resistance. We aimed to design an algorithm based on clinical signs and host biomarkers to identify bacterial community-acquired pneumonia (CAP) among patients with LRTI.
Methods
Participants with LRTI were selected in a prospective coho...
This paper summarizes the main knowledge on mRNA vaccines in September 2021. The only contraindication for a 1st dose of vaccine is an allergy to one of the components of the vaccine, but a specialized consultation is possible for an eventual split vaccination under medical supervision. Serious side effects are rare and consist mainly of myocarditi...
Background and aim:
Vaccines providing protection against COVID-19 are a core tool for ending the pandemic. Though international organisations created guidance in 2020 for vaccine deployment, this had to be adapted for each country's situation and values. We aimed to assist public health decision makers by identifying areas of consensus among Swis...
Introduction
The use of personal protective equipment, especially medical masks, increased dramatically during the COVID-19 crisis. Medical masks are made of synthetic materials, mainly polypropylene, and a majority of them are produced in China and imported to the European market. The urgency of the need has so far prevailed over environmental con...
Background.
Inappropriate antibiotics in lower respiratory tract infections (LRTI) is a major contributor to resistance. We aimed to design an algorithm based on clinical signs and host biomarkers to identify bacterial community-acquired pneumonia (CAP) among patients with LRTI.
Methods.
Participants with LRTI were selected in a prospective cohort...
Background:
Saliva reverse transcriptase-Polymerase chain reaction (RT-PCR) is an attractive alternative for the detection of severe acute respiratory syndrome coronavirus 2 in adults with less known in children.
Methods:
Children with coronavirus disease 2019 symptoms were prospectively enrolled in a 1-month comparative clinical trial of saliva...
The need to curb the circulation of SARS-CoV-2 virus in the community and to diagnose those at risk of developing complications implies that an appropriate test should be chosen according to the epidemiological and clinical context. Rapid antigen tests, either nasopharyngeal or nasal, have the advantage of reflecting contagiousness better than PCR...
Background: Although tick-borne pathogens have been reported as an important cause of imported fever, the incidence of Anaplasma phagocytophilum, the causative agent of human granulocytic anaplasmosis (HGA), in travelers is unknown.
Methods: We conducted a prospective cohort study to investigate the aetiologies of fever in returning travelers (Nove...
Background
Saliva RT-PCR is an attractive alternative for the detection of SARS-CoV-2 in adults with much less known in children.
Methods
Children and adolescents with symptoms suggestive of COVID-19 were prospectively enrolled in a comparative clinical trial of saliva and nasopharyngeal (NP) RT-PCR between November and December 2020. Detection ra...
In this multicentre cohort study, we evaluated the risks of maternal ZIKV infections and adverse pregnancy outcomes among exposed travellers compared to women living in areas with ZIKV circulation (residents). The risk of maternal infection was lower among travellers compared to residents: 25.0% (n = 36/144) versus 42.9% (n = 309/721); aRR 0.6; 95%...
Background
Nasopharyngeal antigen Rapid Diagnostic Tests (RDTs) and saliva RT-PCR have shown variable performance to detect SARS-CoV-2.
Methods
In October 2020, we conducted a prospective trial involving patients presenting at testing centers with symptoms of COVID-19. We compared detection rates and performance of RDT, saliva PCR and nasopharynge...
Background
Numerous publications focus on fever in returning travelers, but there is no known systematic review considering all diseases, or all tropical diseases causing fever. Such a review is necessary in order to develop appropriate practice guidelines.
Objectives
Primary objectives of this review were i) to determine the etiology of fever in...
Background
Safety of live vaccines in patients treated with immunosuppressive therapies is not well known, resulting in contradictory vaccination recommendations. We describe here the first case of vaccine-associated measles in a patient on natalizumab treatment.
Case presentation
A young female patient with relapsing-remitting multiple sclerosis...
Background
Low-density (LD) Plasmodium infections are missed by standard malaria rapid diagnostic tests (standard mRDT) when the blood antigen concentration is below the detection threshold. The clinical impact of these LD infections is unknown. This study investigates the clinical presentation and outcome of untreated febrile children with LD infe...
Objectives:
Exploring fever etiologies improves patient management. While most febrile adults are outpatients, all studies were conducted in inpatients. This study describes the spectrum of diseases in adults attending outpatient clinics in urban Tanzania.
Methods:
We recruited consecutive adults with >38°C in a prospective cohort study. We coll...
Background
Malaria in pregnancy, including asymptomatic infection, has a detrimental impact on foetal development. Individual patient data (IPD) meta-analysis was conducted to compare the association between antimalarial treatments and adverse pregnancy outcomes, including placental malaria, accompanied with the gestational age at diagnosis of unco...
Background
Malaria in pregnancy affects both the mother and the fetus. However, evidence supporting treatment guidelines for uncomplicated (including asymptomatic) falciparum malaria in pregnant women is scarce and assessed in varied ways. We did a systematic literature review and individual patient data (IPD) meta-analysis to compare the efficacy...
Children with malnutrition compared with those without are at higher risk of infection, with more severe outcomes. How clinicians assess nutritional risk factors in febrile children in primary care varies. We conducted a post hoc subgroup analysis of febrile children with severe malnutrition enrolled in a randomized, controlled trial in primary car...
Background:
The safety and efficacy of using C-reactive protein (CRP) to decide on antibiotic prescription among febrile children at risk of pneumonia has not been tested.
Methods:
This was a randomized (1:1) controlled noninferiority trial in 9 primary care centers in Tanzania (substudy of the ePOCT trial evaluating a novel electronic decision...
Rational for review:
Young adults of childbearing age and pregnant women are travelling more frequently to tropical areas, exposing them to specific arboviral infections such as Dengue, Zika and Chikungunya viruses, which may impact ongoing and future pregnancies. In this narrative review, we analyse their potential consequences on pregnancy outco...
Background:
Health-workers in developing countries rely on clinical algorithms, such as the Integrated Management of Childhood Illnesses (IMCI), for the management of patients, including diagnosis of serious bacterial infections (SBI). The diagnostic accuracy of IMCI in detecting children with SBI is unknown. Prediction rules and guidelines for SB...
The study aimed to assess the capacity of AEFI surveillance during vaccination campaigns with the new conjugate meningitis vaccine (MenAfrivac).
A systematic review of studies on MenAfrivac™ published in English during 2001-2016 was done.AEFIs incidence (I) were estimated and compared between MenAfrivac™ clinical trials and immunization campaigns u...
Objective
This secondary analysis of data of a randomized controlled trial (RCT) retrospectively investigated the performance of pulse oximetry in identifying children with severe illnesses, with and without respiratory signs/symptoms, in a cohort of children followed for morbid episodes in an intervention trial assessing the efficacy of Intermitte...
Severe pneumonia among all pneumonia episodes.
Se: sensitivity, Sp: specificity, PPV: positive predictive value, NPV: negative predictive value, LR +: positive likelihood ratio, LR-: negative likelihood ratio, OR: odd ratio.
(TIF)
Hospitalization among all illness episodes.
Se: sensitivity, Sp: specificity, PPV: positive predictive value, NPV: negative predictive value, LR +: positive likelihood ratio, LR-: negative likelihood ratio, OR: odd ratio.
(TIF)
Danger signs among all illness episodes.
Se: sensitivity, Sp: specificity, PPV: positive predictive value, NPV: negative predictive value, LR +: positive likelihood ratio, LR-: negative likelihood ratio, OR: odd ratio.
(TIF)
Background
The intermittent preventive treatment in infants (IPTi) trial that took place in Papua New Guinea showed an overall reduction of 29% of the risk of malaria when delivering single-dose sulfadoxine-pyrimethamine (SP) associated to 3 days of amodiaquine (AQ) every three months to children during the first year of life. The aim of the presen...
Observed vs model-predicted concentrations by Hietala et al. (9) under the four tested adherence patterns.
(DOCX)
Observed vs model-predicted concentrations by Stepniewska et al. (11) under the four tested adherence patterns.
(DOCX)
Abstract Background Although the incidence of dengue across Africa is high, severe dengue is reported infrequently. We describe the clinical features and the outcome of dengue according to raceduring an outbreak in Dar es Salaam, Tanzania that occurred in both native and expatriate populations. Methods Adults with confirmed dengue (NS1 and/or IgM o...
Background:
A novel ultra-sensitive malaria RDT (us-RDT) has been developed for improved active P.falciparum case detection. The utility of this us-RDT in clinical diagnosis and fever management has not been evaluated to date.
Methods:
Diagnostic performance of us-RDT was compared retrospectively to conventional RDT (co-RDT) in 3000 children and...
Background
Understanding pattern of antimalarials use at large scale helps ensuring appropriate use of treatments and preventing the spread of resistant parasites. We estimated the proportion of individuals in community surveys with residual antimalarials in their blood and identified the factors associated with the presence of the most commonly de...
Logistic regression including interaction terms.
(DOCX)
Background:
P27A is an unstructured 104mer synthetic peptide from P. falciparum TEX1 blood-stage protein found to be the target of human antibodies inhibiting parasite growth. The present project aimed at evaluating the safety and immunogenicity of P27A peptide vaccine in malaria non-exposed European and exposed African adults.
Methods:
This stu...
Background
Quick Sequential Organ Failure Assessment (qSOFA) is a three-item clinical instrument for bedside identification of sepsis patients at risk of poor outcome. qSOFA could be a valuable triage tool in emergency departments of low-income countries, yet its performance in resource-limited settings remains unknown. The prognostic accuracy of q...
Diagnostic tests performed in the study population.
(DOCX)
Receiver operating characteristic (ROC) curves for 28-day mortality in (A) HIV negative and (B) HIV positive patients.
SOFA indicates Sequential (Sepsis-related) Organ Failure Assessment; qSOFA, quick SOFA; SIRS, systemic inflammatory response syndrome. In HIV negative patients, the area under the ROC curves (AUROC) for qSOFA is 0.85 (95% CI 0.76–0...
Background:
Monitoring the impact of case management strategies at large scale is essential to evaluate the public health benefit they confer. The use of methodologies relying on objective and standardized endpoints, such as drug levels in the blood, should be encouraged. Population drug use, diagnosis and treatment appropriateness in case of feve...
Advancements in technology have led to the development of medical applications (Apps) and websites. Their use is especially relevant in the field of travel medicine, be it for travelers before their trip to get specific information on how to best prevent diseases and medical emergencies, or during their trip on what to do in case of health problem...
In Switzerland, 20 % of the population travel to the tropics every year and many have unprotected sexual practices during their stay. A third of newly diagnosed HIV infections among Swiss citizens are acquired abroad. Travel clinics are probably important partners in the fight against sexually transmitted infections and HIV. People living with HIV...
Background:
Telemedicine is emerging as a useful tool to provide expert medical advice to individuals facing health issues while travelling in remote areas. Before embarking on the development of a telemedicine system, we conducted a survey to assess the needs and expectations of travellers for such a service, and evaluate opinions about the impor...
In epidemiological studies, antimalarials measurements in blood represent the best available marker of drugs exposure at population level, an important driver for the emergence of drug resistance. We have developed a liquid chromatography-tandem mass spectrometry method (LC–MS/MS) for the simultaneous quantification of 7 frequently used antimalaria...
Background
The WHO recommends that all suspect malaria cases be tested before receiving treatment. Rapid diagnostic tests (RDT) for malaria can be performed reliably by community health workers with no formal medical background and thus, RDTs could also be provided to travellers for self-diagnosis during visits to endemic regions.
Methods
RDTs wer...
Background
The management of childhood infections remains inadequate in resource-limited countries, resulting in high mortality and irrational use of antimicrobials. Current disease management tools, such as the Integrated Management of Childhood Illness (IMCI) algorithm, rely solely on clinical signs and have not made use of available point-of-car...
Statistical analysis plan.
(PDF)
Flowchart of literature search results and included publications.
(PDF)
Literature search terms.
(DOCX)
Mantel–Haenszel estimates of the effect of clinician and health center on primary and secondary outcome measures (randomized study).
(DOCX)
Detailed description and discussion of the methods and evidence used for the development of the e-POCT algorithm.
(DOCX)
Schematic representation of ALMANACH algorithm.
(PDF)
Days to resolution of fever (e-POCT arm and routine care cohort).
(TIF)
Primary and secondary study outcomes for randomized study (intention-to-treat population).
(DOCX)
Mixed effects logistic regression (randomized study).
(DOCX)
Primary and secondary study outcome comparisons between the e-POCT arm and the routine care cohort (intention-to-treat population).
(DOCX)
Background:
There are several possible malaria prevention strategies for travellers. In Switzerland, chemoprophylaxis (CP) is recommended for persons visiting areas highly endemic for malaria and stand-by emergency treatment (SBET) for areas with moderate to low risk.
Objective:
To describe the type of malaria prevention prescribed to travel cli...
Abstract Background The criteria for defining severe malaria have evolved over the last 20 years. We aimed to assess the strength of association of death with features currently characterizing severe malaria through a systematic review and meta-analysis. Method Electronic databases (Medline, Embase, Cochrane Database of Systematic Reviews, Thomson...
