Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
26 Sep 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The aim of this study was to characterize Swiss children suffering from intestinal
parasites, in order to provide a clinical guidance who should be tested. The study
deals with an important topic, but there are some fundamental issues that
undermines the strength of the study, mainly the methods and discussion section.
REQUESTED REVISIONS: 
The methodology lacks details and there is insufficient data to allow for this
study to be replicated. Some specific comments are provided. Pg 3, line 24: How
was this data collected? What parameters were used to collect the data? More
details are needed to understand the data collection process.
Pg 4, line 1: The data is over 10 years. did the methods remain the same for the
entire 10 yrs period?
Pg 4, line 7: standard wet mount procedures are not sensitive enough to identify
many protozoa such as Dientamoeba and the entamoeba species and smaller
oocysts from protozoa like Cryptosoporidium. 
line 8: More information is needed on the context in which samples were
collected. were all stools from symptomatic children? under what circumstances
would tests have been performed? this detail is needed.
line 13: What qualitative data does this refer to?There is no details about
qualitative data collected in the study. More details are needed on the data
collection process.
pg 5, line 1: More details are needed to understand the multiple samples per
child. Provide details on the type of stools and what proportion of children were
symptomatic? 
page 5, line 10: The word immigrant is used loosely here. Can this word be
defined for better understanding in terms of recently arrived migrants or persons
of immigrant background who have lived in the area for a while? If samples were
taken during screening of people on arrival then this is a very different context to
persons who have lived in the country for some time.
Pg 5, line 20: Were any other non-protozoa organisms identified in those
negative samples? Was any attempt made to identify other pathogens?
Pg 6, line 11: Was any attempt made to identify if these cases were diagnosed
with any other pathogens? What about other parasites? Was the method used
able to identify others and if not, what does this mean for the interpretation of
the results? Limitations of this method must be clearly outlined.
Pg 6, line 14: What are the conclusions from the debate in the previous
manuscript? 
Readers may not have time to read it!
Pg 9, line 13: There is published data on 
manifestations of Blastocystis infection,
and its association with IBD and other chronic gut conditions that could be used
to strengthen this discussion. How do we balance this argument with the fact that
some pathogens could have been missed due to low sensitivity of this method?
This discussion cannot be complete without such an acknowledgement.
Pg 9, lines 7-12: The paragraph on Ascaris lumbricoides seems out of place
except as an FYI. 
Pg 9, line 19: Need to clarify whether immigrants here mean 'recently migrated'
or long standing immigrants because this could have different implications for
prevention and control strategies.
The limitations of the parasite detection method must be clearly underscored in
the interpretation of these results. 
The paper could benefit from the use of an
algorithm to show how the decision making process could be followed by
clinicians. 
Reference 6 nd 25 are the same references. Table 1 & 2 it would be
more useful for comparisons if Table 1 and 2 were together. 
The limited
information provided in the methods make it difficult to assess whether every
effort was made to identify a causative agent for the symptoms. In that case, the
conclusions drawn cannot be adequately assessed.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
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Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
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No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
26 Sep 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The aim of this study was to characterize Swiss children suffering from intestinal
parasites, in order to provide a clinical guidance who should be tested. The study
deals with an important topic, but there are some fundamental issues that
undermines the strength of the study, mainly the methods and discussion section.
REQUESTED REVISIONS: 
The methodology lacks details and there is insufficient data to allow for this
study to be replicated. Some specific comments are provided. Pg 3, line 24: How
was this data collected? What parameters were used to collect the data? More
details are needed to understand the data collection process.
Pg 4, line 1: The data is over 10 years. did the methods remain the same for the
entire 10 yrs period?
Pg 4, line 7: standard wet mount procedures are not sensitive enough to identify
many protozoa such as Dientamoeba and the entamoeba species and smaller
oocysts from protozoa like Cryptosoporidium. 
line 8: More information is needed on the context in which samples were
collected. were all stools from symptomatic children? under what circumstances
would tests have been performed? this detail is needed.
line 13: What qualitative data does this refer to?There is no details about
qualitative data collected in the study. More details are needed on the data
collection process.
pg 5, line 1: More details are needed to understand the multiple samples per
child. Provide details on the type of stools and what proportion of children were
symptomatic? 
page 5, line 10: The word immigrant is used loosely here. Can this word be
defined for better understanding in terms of recently arrived migrants or persons
of immigrant background who have lived in the area for a while? If samples were
taken during screening of people on arrival then this is a very different context to
persons who have lived in the country for some time.
Pg 5, line 20: Were any other non-protozoa organisms identified in those
negative samples? Was any attempt made to identify other pathogens?
Pg 6, line 11: Was any attempt made to identify if these cases were diagnosed
with any other pathogens? What about other parasites? Was the method used
able to identify others and if not, what does this mean for the interpretation of
the results? Limitations of this method must be clearly outlined.
Pg 6, line 14: What are the conclusions from the debate in the previous
manuscript? 
Readers may not have time to read it!
Pg 9, line 13: There is published data on 
manifestations of Blastocystis infection,
and its association with IBD and other chronic gut conditions that could be used
to strengthen this discussion. How do we balance this argument with the fact that
some pathogens could have been missed due to low sensitivity of this method?
This discussion cannot be complete without such an acknowledgement.
Pg 9, lines 7-12: The paragraph on Ascaris lumbricoides seems out of place
except as an FYI. 
Pg 9, line 19: Need to clarify whether immigrants here mean 'recently migrated'
or long standing immigrants because this could have different implications for
prevention and control strategies.
The limitations of the parasite detection method must be clearly underscored in
the interpretation of these results. 
The paper could benefit from the use of an
algorithm to show how the decision making process could be followed by
clinicians. 
Reference 6 nd 25 are the same references. Table 1 & 2 it would be
more useful for comparisons if Table 1 and 2 were together. 
The limited
information provided in the methods make it difficult to assess whether every
effort was made to identify a causative agent for the symptoms. In that case, the
conclusions drawn cannot be adequately assessed.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
Please review this paper.
user
Reviewer’s report
Title: 
Parasitic infections in Swiss children – are we overtesting?
Version: 
0 
Date: 
26 Sep 2020
Reviewer's report:
PEER REVIEWER ASSESSMENTS: 
OBJECTIVE - Full research articles: is there a clear objective that addresses a
testable research question(s) (brief or other article types: is there a clear
objective)?
Yes - there is a clear objective
DESIGN - Is the current approach (including controls and analysis protocols)
appropriate for the objective?
No - there are major issues
EXECUTION - Are the experiments and analyses performed with technical rigor
to allow confidence in the results?
No - there are major issues
STATISTICS - Is the use of statistics in the manuscript appropriate?
No - there are issues with the statistics in the study
INTERPRETATION - Is the current interpretation/discussion of the results
reasonable and not overstated?
No - there are major issues
OVERALL MANUSCRIPT POTENTIAL - Is the current version of this work
technically sound? If not, can revisions be made to make the work technically
sound?
No - manuscript has some fundamental flaw(s)
PEER REVIEWER COMMENTS: 
GENERAL COMMENTS: 
The aim of this study was to characterize Swiss children suffering from intestinal
parasites, in order to provide a clinical guidance who should be tested. The study
deals with an important topic, but there are some fundamental issues that
undermines the strength of the study, mainly the methods and discussion section.
REQUESTED REVISIONS: 
The methodology lacks details and there is insufficient data to allow for this
study to be replicated. Some specific comments are provided. Pg 3, line 24: How
was this data collected? What parameters were used to collect the data? More
details are needed to understand the data collection process.
Pg 4, line 1: The data is over 10 years. did the methods remain the same for the
entire 10 yrs period?
Pg 4, line 7: standard wet mount procedures are not sensitive enough to identify
many protozoa such as Dientamoeba and the entamoeba species and smaller
oocysts from protozoa like Cryptosoporidium. 
line 8: More information is needed on the context in which samples were
collected. were all stools from symptomatic children? under what circumstances
would tests have been performed? this detail is needed.
line 13: What qualitative data does this refer to?There is no details about
qualitative data collected in the study. More details are needed on the data
collection process.
pg 5, line 1: More details are needed to understand the multiple samples per
child. Provide details on the type of stools and what proportion of children were
symptomatic? 
page 5, line 10: The word immigrant is used loosely here. Can this word be
defined for better understanding in terms of recently arrived migrants or persons
of immigrant background who have lived in the area for a while? If samples were
taken during screening of people on arrival then this is a very different context to
persons who have lived in the country for some time.
Pg 5, line 20: Were any other non-protozoa organisms identified in those
negative samples? Was any attempt made to identify other pathogens?
Pg 6, line 11: Was any attempt made to identify if these cases were diagnosed
with any other pathogens? What about other parasites? Was the method used
able to identify others and if not, what does this mean for the interpretation of
the results? Limitations of this method must be clearly outlined.
Pg 6, line 14: What are the conclusions from the debate in the previous
manuscript? 
Readers may not have time to read it!
Pg 9, line 13: There is published data on 
manifestations of Blastocystis infection,
and its association with IBD and other chronic gut conditions that could be used
to strengthen this discussion. How do we balance this argument with the fact that
some pathogens could have been missed due to low sensitivity of this method?
This discussion cannot be complete without such an acknowledgement.
Pg 9, lines 7-12: The paragraph on Ascaris lumbricoides seems out of place
except as an FYI. 
Pg 9, line 19: Need to clarify whether immigrants here mean 'recently migrated'
or long standing immigrants because this could have different implications for
prevention and control strategies.
The limitations of the parasite detection method must be clearly underscored in
the interpretation of these results. 
The paper could benefit from the use of an
algorithm to show how the decision making process could be followed by
clinicians. 
Reference 6 nd 25 are the same references. Table 1 & 2 it would be
more useful for comparisons if Table 1 and 2 were together. 
The limited
information provided in the methods make it difficult to assess whether every
effort was made to identify a causative agent for the symptoms. In that case, the
conclusions drawn cannot be adequately assessed.
Publons Reviewer Recognition
. Springer Nature can send verification of this
review directly to Publons (a subsidiary of Clarivate Analytics). If you would
like to take advantage of this service, please click on the “Yes” option below.
Your name, email address, title of the reviewed manuscript, name of the journal,
and date of your review submission (the “Review Data”) will then be transmitted
to Publons upon publication of the manuscript. If you have already registered at
Publons, they will notify you of the receipt of this review and update your profile
as per your settings and their policy. If you are not registered with Publons, you
will receive an email from them asking you to register in order for them to be
able to recognize your review on your new profile page. Publons may use the
Review Data to generate derivative metadata for the benefit of Publons and you
as a reviewer, carefully considering the sensitivity of such information. For
example, Publons may verify your record as a reviewer by updating your profile
published on its webservice if you have registered for such service or help
editors to identify candidate reviewers. Please find the details of processing in
Publons’ privacy policy 
https://publons.com/about/terms
No
Declaration of competing interests
Please complete a declaration of competing interests, considering the following
questions:
1
. 
Have you in the past five years received reimbursements, fees, funding, or
salary from an organisation that may in any way gain or lose financially
from the publication of this manuscript, either now or in the future?
2
. 
Do you hold any stocks or shares in an organisation that may in any way
gain or lose financially from the publication of this manuscript, either now
or in the future?
3
. 
Do you hold or are you currently applying for any patents relating to the
content of the manuscript?
4
. 
Have you received reimbursements, fees, funding, or salary from an
organization that holds or has applied for patents relating to the content of
the manuscript?
5
. 
Do you have any other financial competing interests?
6
. 
Do you have any non-financial competing interests in relation to this
paper?
If you can answer no to all of the above, write 'I declare that I have no competing
interests' below. If your reply is yes to any, please give details below.
This reviewer has been recruited by a partner organization, Research Square.
Reviewers with declared or apparent competing interests are not utilized for
these reviews. This reviewer has agreed to publication of their comments online
under a Creative Commons Attribution License attributed to Research Square
and was paid a small honorarium for completing the review within a specified
timeframe. Honoraria for reviews such as this are paid regardless of the reviewer
recommendation.
Reviewer Publication Consent.
 I agree for my report to be made available
under an Open Access Creative Commons CC-BY License (
http://creativecommons.org/licenses/by/4.0
) if this manuscript is accepted for
publication. Any comments that I do not wish to be included in the published
report have been included as confidential comments to the editor, which will not
be published.
If you are not happy for us to publish this report, please contact the editorial
office before completing the review.
If you wish, you can include your name in your published report. Please note
you must decide whether to include your name at the start of the process and
confirm this decision whenever prompted. If you change your decision later, we
will not be able to publish your name.
I agree to the terms of the CC-BY 4.0 license; please 
do not
 publish my name
with my report. (default)
Is the study design appropriate to answer the research question (including the use
of appropriate controls), and are the conclusions supported by the evidence
presented?
No
Are the methods sufficiently described to allow the study to be repeated?
No
Is the use of statistics and treatment of uncertainties appropriate?
No
Is the presentation of the work clear?
Yes
Are the images in this manuscript (including electrophoretic gels and blots) free
from apparent manipulation?
Yes
assistant