Canada communicable disease report = Releve des maladies transmissibles au Canada最新文献

Background: Availability of new vaccines for adults has increased interest in understanding Canada's respiratory syncytial virus (RSV) burden in older adults and adults considered at high risk of severe infection.

Objective: To characterize the burden of RSV disease in Canada by joint analysis of the published literature and hospitalization data from a healthcare administrative database.

Methods: Electronic databases of published literature were searched to identify studies and systematic reviews reporting data on outpatient visits, hospitalizations, intensive care unit (ICU) admissions and deaths associated with RSV infection in adults. For the hospitalization data analysis, hospital discharge records were extracted from the Canadian Institute of Health Information Discharge Abstract Database for all patients admitted to an acute care facility for RSV infection defined by ICD-10 codes from 2010 to 2020 and 2021 to 2023.

Results: Overall, 26 studies, including seven systematic reviews, were identified and summarized. Evidence suggests that medically attended RSV respiratory tract infections (RTI) are frequently causing 4.7%-7.8% of symptomatic RTI in adults 60 years of age and older. Incidence of RSV RTI increases with age and presence of underlying medical conditions. This trend was consistently observed across all RSV clinical outcomes of interest. Patients who reside in long-term care or other chronic care facilities have a higher likelihood of severe clinical outcomes compared to patients with other living situations upon hospital admission. Approximately 10% of older adults hospitalized with RSV infection require ICU admission. Although data are limited, the case fatality ratio (CFR) among those admitted to hospital varies between 5% and 10%. Some evidence suggests that RSV burden may be close to the influenza burden in older adults. In general, the results from the Canadian hospitalization data support the rapid review findings. Rates of hospitalization, ICU admission and death associated with RSV all increased with age, with 16% of hospitalizations resulting in ICU admission and with an in-hospital CFR of 9%.

Conclusion: In adults, the burden of severe RSV outcomes in general increases with age and presence of comorbidities.

Background: The Public Health Agency of Canada oversees the Human Pathogens and Toxins Act and Human Pathogens and Toxins Regulations, and monitors human pathogen and toxin incidents in licensed facilities to minimize exposure impact at the individual and population level.

Objective: To provide an overview of confirmed laboratory exposure incidents in Canada in 2023.

Methods: Confirmed exposure incident reports in 2023 were analyzed using R 4.2.2, Microsoft Excel and SAS.

Results: In 2023, 207 incident reports were received, including 63 confirmed exposure incidents that affected 85 individuals. The academic sector accounted for 50.8% (n=32) of the reported confirmed exposure incidents. Microbiology (n=33; 52.4%) was the predominant activity being performed, with the most common occurrence types being sharps-related (n=22; 27.2%) and procedure-related (n=16; 19.8%). Human interaction (n=36; 57.1%) and standard operating procedures (n=24; 38.1%) were the most frequent root causes cited, with corrective actions often directly addressing these causes. Most of the 85 affected individuals were technicians/technologists (n=55; 64.7%) and had a median of 11 years of laboratory experience. Sixty-seven human pathogens and toxins (HPTs) were implicated in the confirmed exposure incidents, with bacteria (n=36; 53.7%) being the most common biological agent type. The median time between the incident and the reporting date was six days.

Conclusion: The number of confirmed exposure incidents increased in 2023 compared to 2022. Microbiology was most often the activity being performed at the time of exposure, and occurrence-types, root causes and HPTs implicated in 2023 mirrored those cited in 2022.

Background: Mpox is a viral illness related to smallpox. It can cause flu-like symptoms and a rash, and in severe cases, can lead to hospitalization or death. The Imvamune® vaccine offers protection against mpox. Consistent with global trends, mpox cases in Canada have been reported primarily among men who have sex with men (MSM), with sexual contact as the predominantly reported mode of transmission. While the incidence of mpox in Canada has significantly declined since the fall of 2022, mpox remains an important public health concern with the potential for future resurgence.

Methods: The National Advisory Committee on Immunization (NACI) reviewed available evidence on the clinical benefits and risks of Imvamune. This evidence included studies assessing the vaccine effectiveness estimates from real-world evidence, as well as pre- and post-market licensure safety data. NACI has also considered additional factors including ethics, equity, feasibility and acceptability. Guidance on the use of Imvamune in the context of international travel was developed in collaboration with the Canadian Committee to Advise on Tropical Medicine and Travel (CATMAT).

Results: NACI concluded that available evidence supported the vaccine's effectiveness and safety in preventing mpox infection.

Conclusion: Building on previous interim guidance from NACI recommending the use of Imvamune for pre-exposure vaccination in the context of ongoing mpox outbreaks, NACI now recommends that Imvamune be used in the context of a focused routine immunization program. Individuals at high risk of mpox, including MSM who meet high-risk criteria such as having more than one sexual partner, should receive two doses of Imvamune administered by subcutaneous injection at least 28 days apart.

Background: Ugandan health authorities declared an outbreak of Ebola disease (EBOD), caused by the Sudan virus, in September 2022. A rapid review was conducted to update the Public Health Agency of Canada's guidelines for infection prevention and control measures for EBOD in healthcare settings to prepare for potential introduction of cases.

Objective: Summarize the available evidence on personal protective equipment (PPE) use by healthcare workers (HCWs) to prevent exposure to and transmission of viral hemorrhagic fevers (VHFs), including Ebola virus.

Methods: Electronic databases were searched to identify peer-reviewed evidence published from July 2014-October 2022. Peer-reviewed primary studies and literature reviews, in English or French, reporting on PPE for VHFs and filoviruses in the healthcare context were eligible for inclusion. Literature review processes were conducted by two reviewers using DistillerSR® systematic review software and the Public Health Agency of Canada's Infection Prevention and Control Critical Appraisal Toolkit. An environmental scan of grey literature was also conducted to inform the rapid review.

Results: The database search yielded 417 citations and 29 studies were considered eligible for critical appraisal. In total, 20 studies were included in the narrative synthesis of evidence. The evidence base was limited regarding comparative effectiveness of types of PPE for preventing exposure to and transmission of VHFs to HCWs. Four studies reported on exposure to and transmission of a VHF. Sixteen studies provided data on other relevant topics, such as simulated contamination and lab-based tests of PPE integrity.

Conclusion: There is limited evidence with which to draw conclusions on the comparative effectiveness of PPE to prevent exposure to and transmission of VHFs to HCWs. Additional research is required to determine the optimal PPE to protect HCWs from exposure to and transmission of VHFs.

Background: Measuring trends in HIV pre-exposure prophylaxis (HIV-PrEP) uptake is important to inform planning for prevention programs and policies. The HIV-PrEP-to-need ratio (PnR) is a construct used by public health organizations to explore disparities in the provision of HIV-PrEP across geographic areas and demographic categories (e.g., age, sex).

Methods: This is a retrospective database review study using administrative pharmacy data, containing limited demographic information, from nine Canadian provinces. Annual estimates of persons taking HIV-PrEP and PnR were generated using data from the company IQVIA and the BC Centre for Excellence on HIV/AIDS. Data on new HIV diagnoses were obtained from the National HIV Surveillance System. The PnR was defined as the number of HIV-PrEP users divided by the number of new HIV diagnoses annually and is interpreted as the number of HIV-negative people using HIV-PrEP each year for every person newly diagnosed with HIV.

Results: In 2021, an estimated 23,644 individuals were prescribed HIV-PrEP, corresponding to an HIV-PrEP prevalence of 66.9 per 100,000 persons. This represents a 1.8-fold increase since 2018. The overall PnR was 16.8, meaning that for every person newly diagnosed with HIV, 17 HIV-negative individuals were taking HIV-PrEP. There were disparities between provinces (PnR range: 1.5/100,000-37.7/100,000) and between males and females (PnR 22.6 and 1.2, respectively). Females, individuals aged 0-19 years, and those in Manitoba, Saskatchewan and Prince Edward Island, had lower levels of HIV-PrEP use relative to epidemic need.

Conclusion: In Canada, the use of HIV-PrEP increased from 2018 to 2021 and uptake varied by age, sex and province. HIV-PrEP-to-need ratio is a useful measure to assess uptake of HIV-PrEP as a prevention strategy and could be used to explore disparities in provision across provinces and available demographic categories. However, PnR could be improved with more information on key populations and other attributes, such as race/ethnicity, socioeconomic status and residence of city/rural area.

Background: Antimicrobial resistance (AMR) is associated with significant human and financial costs, particularly among vulnerable populations like older adults living in long-term care homes (LTCHs). Urinary tract infection (UTI) is the leading indication for antibiotic use in this population, with some estimates suggesting that up to 70% of these prescriptions may be avoidable.

Objective: The purpose of this study is to develop and test novel behavioural science-informed antimicrobial stewardship (AMS) quality improvement strategies in Canadian LTCHs, which aim to decrease unnecessary testing and treatment for residents who lack the minimum clinical signs and symptoms of UTI.

Intervention: The quality improvement strategy is a two-pronged approach that includes 1) targeted education for essential care providers (family and friends of LTCH residents) about UTI and benefits of AMS, which strives to outline a positive role for this group in UTI management, and 2) monthly feedback to LTCH staff on their facility's urine culture ordering rates.

Outcomes: The protocol was piloted in a single LTCH; a process evaluation of the pilot implementation served to refine the research protocol, which is being implemented in eight LTCHs across Canada using an eight-month stepped wedge randomized cluster design.

Conclusion: This protocol represents a behavioural science-informed intervention to improve AMS across LTCHs. If successful, this model of care could be scalable across Canadian LTCHs, offering an inclusive approach that aims to empower clinicians, non-regulated healthcare staff, residents and their family and friends to improve health outcomes as antibiotic stewards.

Background: In Canada, HIV transmission continues to disproportionately affect the same communities of gay men, bisexual men and men who have sex with men (gbMSM); members of African, Caribbean or Black communities (ACB); people who use injection drugs; Indigenous people; and women who belong to the aforementioned groups. While primary care is an ideal location for HIV testing for members of these groups, many people do not have access to such healthcare services. In response, we launched GetaKit to distribute HIV self-tests.

Methods: In light of reduced access to healthcare services as a result of the pandemic and in anticipation of Health Canada's approval of an HIV self-test, a clinician-scientist research team at the University of Ottawa developed GetaKit: an online platform to provide access to sexual health services. When GetaKit first launched in Ottawa in July 2020 with funding from the Ontario Ministry of Health, its objectives were to ensure that access to the newly approved device remained 1) clinically appropriate, 2) accessible and 3) linked to care.

Results: Over the course of the study, there were a stable number of individuals who reported having never been tested for HIV before. These individuals tended to be younger and more likely to be members of racialized minority groups; similar characteristics to those who also face the most barriers to primary care access.

Conclusion: With new reports indicating that nearly six million Canadians are without a primary care provider, it was proposed that the popularity of the HIV self-test may tell more about this lack of access than about the utility of the device itself. While projects like GetaKit should be part of the broader strategy to overcome historic testing barriers, such as geographic distance and inconvenient clinic hours, it is important that this occurs in an environment where a strong primary care health system can support treatment, follow-up and specialist referrals, as required.

Background: Mycobacterial culture is routinely performed to diagnose tuberculosis (TB) in Canada. Globally, meta-analyses suggest that up to 2% of positive cultures are falsely positive for Mycobacterium tuberculosis due to laboratory cross-contamination. Five patients from distinct clinical institutions in Montréal were diagnosed with culture-positive TB as their clinical samples were processed in a centralized mycobacteria laboratory. Cross-contamination was suspected due to culture positivity in an organ donor with low TB pre-test probability. We describe a TB pseudo-outbreak due to laboratory cross-contamination and assess the role of conventional typing (i.e., mycobacterial interspersed repetitive unit variable number of tandem repeats [MIRU-VNTR]) and whole-genome sequencing (WGS) in supporting the investigation.

Methods: Patients' epidemiological risk factors and clinical presentations were reviewed. The trajectories of pre- and per-analytic samples were retraced to identify potential cross-contamination events. Tuberculosis isolates were characterized by MIRU-VNTR and WGS using Oxford Nanopore Technology (ONT). The bioinformatic pipeline tbpore (v0.7.1) cluster was used for phylogenetic analyses.

Results: Two patients had previous exposure to endemic settings and clinical symptoms compatible with TB. Culture media inoculation overlapped in time for four patients, including one with suspected pulmonary cavitary disease and an organ donor whose organs had been transplanted in three different receivers. The MIRU-VNTR and WGS typing confirmed isolates from those four patients to be identical.

Conclusion: Clinical, laboratory and molecular typing data, including results from ONT sequencing, were considered sufficiently robust to confirm laboratory cross-contamination and TB therapy was discontinued including in all organ transplant recipients.

Background: Without vaccination, approximately 75% of people in Canada will acquire a human papillomavirus (HPV) infection in their lifetime. HPV vaccine coverage rates continue to fall short of the national goal of 90% coverage for two or more doses by 17 years of age. Recent evidence and World Health Organization (WHO) guidance now support a 1- or 2-dose schedule for younger age groups, which can simplify vaccination efforts and improve coverage rates compared to a multi-dose immunization program.

Methods: The National Advisory Committee on Immunization (NACI) reviewed available evidence on the clinical benefits and risks of a 1-dose HPV vaccine schedule, as well as additional factors, including ethics, equity, feasibility and acceptability. The evidence and programmatic considerations were organized using a process informed by the Grading of Recommendations Assessment, Development and Evaluations (GRADE) framework and all of the information was used to facilitate NACI guidance development.

Results: A 1-dose schedule is highly effective against HPV infection based on available evidence in younger female populations, with current follow-up of up to 11 years following vaccination. Infectious disease modelling shows that a 1-dose strategy in males and females in Canada is expected to have similar health outcomes over the short and long term compared to two doses.

Conclusion: NACI updated recommendations for individuals 9 to 20 years of age to receive one dose of 9vHPV (Gardasil-9, Merck) vaccine. For individuals 21 years of age and older, a 2-dose schedule should be administered. Individuals considered immunocompromised and individuals infected with HIV should receive a 3-dose series. NACI also issued a discretionary recommendation for HPV vaccination for individuals 27 years and older, and updated guidance to allow HPV vaccine during pregnancy.

Background: In Canada, HIV transmission continues to disproportionately affect the same communities of gay men, bisexual men and men who have sex with men (gbMSM); members of African, Caribbean or Black communities (ACB); people who use injection drugs; Indigenous people; and women who belong to the aforementioned groups. While primary care is an ideal location for HIV testing for members of these groups, many people do not have access to such healthcare services. In response, we launched GetaKit to distribute HIV self-tests.

Methods: In light of reduced access to healthcare services as a result of the pandemic and in anticipation of Health Canada's approval of an HIV self-test, a clinician-scientist research team at the University of Ottawa developed GetaKit: an online platform to provide access to sexual health services. When GetaKit first launched in Ottawa in July 2020 with funding from the Ontario Ministry of Health, its objectives were to ensure that access to the newly approved device remained 1) clinically appropriate, 2) accessible and 3) linked to care.

Results: Over the course of the study, there were a stable number of individuals who reported having never been tested for HIV before. These individuals tended to be younger and more likely to be members of racialized minority groups; similar characteristics to those who also face the most barriers to primary care access.

Conclusion: With new reports indicating that nearly six million Canadians are without a primary care provider, it was proposed that the popularity of the HIV self-test may tell more about this lack of access than about the utility of the device itself. While projects like GetaKit should be part of the broader strategy to overcome historic testing barriers, such as geographic distance and inconvenient clinic hours, it is important that this occurs in an environment where a strong primary care health system can support treatment, follow-up and specialist referrals, as required.