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

Background: The Global Public Health Intelligence Network (GPHIN) is an event-based surveillance platform that collects thousands of pieces of open-source information, including international news media, across multiple languages on a daily basis. Analysts have observed that news media reporting in some languages tended to use more sensational wording to describe major health events. There has been minimal research exploring potential differences in sensationalism in international news media reporting to confirm these observations.

Objective: This exploratory study assessed the differences in the level of sensationalism in early international news media reporting of COVID-19 through a mixed-methods analysis.

Methods: Relevant news media articles received in GPHIN seven days following the Public Health Emergency of International Concern declaration of COVID-19 by the World Health Organization were extracted for screening and analysis. An adapted tool was used to measure the sensationalism of pandemic-related health news. Deductive thematic analysis was conducted to examine themes of sensationalism. Differences in prevalence of sensationalism in news media reporting by language and country/territory of publication were assessed. Sentiment analysis assessed the sentiment and emotional tone of the news media articles.

Results: Of 951 news articles that met the eligibility criteria, 155 contained sensationalism. There were significant differences between languages (French, Russian and Spanish) and various domains of sensationalism. This study also found a more negative emotional tone in news media articles with sensationalism.

Conclusion: This exploratory study showed that language has the potential to impact the perception of health events using more sensationalized language.

Background: In July 2024, Health Canada authorized a 21-valent pneumococcal conjugate vaccine (Pneu-C-21) for use in adults.

Objective: To conduct a systematic review of the cost-effectiveness of Pneu-C-21 for preventing pneumococcal disease in adults.

Methods: We conducted a systematic search of the literature and National Immunization Technical Advisory Groups' websites on July 3, 2024. We included economic evaluations that assessed Pneu-C-21 as a vaccination strategy among adults aged 18 years and older. Costs were adjusted to 2023 Canadian dollars.

Results: We identified 10 studies in our search, five of which were summarized in our review. No economic evaluations were conducted in Canada. All economic evaluations used static cohort models and incorporated indirect effects from paediatric pneumococcal conjugate vaccination in primary or sensitivity analyses. Although incremental cost-effectiveness ratios were heterogeneous across included economic evaluations, overall, they qualitatively identified the same vaccination strategies as optimal within the given age and risk groups. Pneu-C-21 is likely to be cost-effective in adults aged 65 years and older and adults under the age of 65 years with specific high risk conditions.

Conclusion: Pneu-C-21 is likely to be cost-effective in adults within specific age and risk groups. The applicability of the included economic evaluations to adults living in Canada is limited because the serotype-specific incidence of pneumococcal disease and the impact of indirect effects from pediatric vaccination varies by region and over time.

Background: Two pneumococcal conjugate vaccines, covering 15 and 20 Streptococcus pneumoniae serotypes (Pneu-C-15 and Pneu-C-20, respectively), were recently approved for use in the Canadian paediatric population.

Objective: To assess the cost-effectiveness of Pneu-C-15 and Pneu-C-20 in unvaccinated infants initiating routine pneumococcal vaccination, compared to the currently used 13-valent conjugate vaccine (Pneu-C-13).

Methods: A static cohort model was used to estimate sequential incremental cost-effectiveness ratios (ICERs in 2022 Canadian dollars per quality-adjusted life year [QALY]) of Pneu-C-13, Pneu-C-15 and Pneu-C-20 in the paediatric population starting their primary series. Costs and outcomes were calculated over a 10-year time horizon at the program level and a lifetime time horizon at the individual level and discounted at a rate of 1.5% per year. We explored the impact of uncertainties in model parameters and assumptions in scenario and sensitivity analyses.

Results: Routine use of Pneu-C-20 and, to a lesser extent, Pneu-C-15 is projected to reduce pneumococcal disease burden, compared to Pneu-C-13. Based on product cost assumptions, sequential ICERs for Pneu-C-15 and Pneu-C-20 were $58,800 and $135,200 per QALY gained from the health system perspective and $18,272 and $93,416 per QALY gained from the societal perspective, excluding indirect effects. A reduction in serotype-attributable disease due to indirect vaccine effects of 5% or greater resulted in ICERs below $30,000 per QALY gained for Pneu-C-15 and Pneu-C-20, with the optimal strategy determined by the magnitude and time to reach a reduction in pneumococcal disease.

Conclusion: Both Pneu-C-15 and Pneu-C-20 are expected to increase QALYs in Canadian children compared to Pneu-C-13 and may be cost-effective interventions.

Background: Mpox is an infectious disease caused by the monkeypox virus (MPXV), closely related to the virus that causes smallpox. In May 2022, cases of mpox were reported in previously non-endemic countries including Canada.

Objective: To summarize the epidemiology of the mpox outbreak in Canada, as well as key public health response activities, between April and December 2022.

Methods: The Public Health Agency of Canada (PHAC) worked closely with local, provincial and territorial public health authorities to develop national case investigation and reporting tools, including national case definitions for confirmed and probable mpox cases. Based on de-identified case data submitted to PHAC, patterns and trends were examined, including the distribution of cases by sociodemographic, clinical and transmission factors.

Results: Overall, 1,474 mpox cases (1,396 confirmed, 78 probable) were reported to PHAC. All reported cases were associated with MPXV clade IIb. Mpox disproportionately affected gay, bisexual and other men who have sex with men (80.0%) and those between 20-49 years of age (86.0%). Available data suggests that the most likely mode of disease acquisition was through sexual contact, with limited evidence on other possible modes of transmission. Some cases were hospitalized (3.0%); however, there were no mpox-related deaths in Canada.

Conclusion: Rapid coordination and surveillance activities supported the timely implementation of tailored interventions, including the procurement and distribution of vaccines. These actions, coupled with vaccination uptake and behavioural changes, contributed to reducing transmission and health impacts of mpox on the Canadian population.

Background: Two respiratory syncytial virus (RSV) vaccines are currently approved for use in adults aged 60 years and older in Canada.

Objective: To conduct a multi-model comparison to explore the impact of alternate model structural and methodological assumptions on the estimated cost-effectiveness of RSV adult vaccination programs.

Methods: We compared three static cost-utility models developed by the Public Health Agency of Canada, GSK and Pfizer using a common set of input parameters. Each model evaluated sequential incremental cost-effectiveness ratios in 2023 Canadian dollars per quality-adjusted life year (QALY) for a set of policy alternatives, with vaccine eligibility determined by combinations of age and chronic medical condition (CMC) status. Results were calculated for each vaccine separately for scenarios assuming two or three years of vaccine protection using the health system perspective and a 1.5% annual discount rate.

Results: The three cost-utility models were broadly concordant across the scenarios modeled. In all scenarios, focusing on vaccination of people with CMCs was preferred over broader age-based policies. Respiratory syncytial virus vaccination for people with CMCs over the age of 70 years was most commonly identified as the optimal policy when using a cost-effectiveness threshold of $50,000/QALY. When only considering policies based on age criteria, vaccinating people over 80 years was cost-effective at this threshold.

Conclusion: A multi-model comparison of Canadian cost-utility models shows that RSV vaccination programs for RSV are likely cost-effective for some groups of older adults in Canada. These findings were consistent across models, despite differences in model structure.

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.