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

Background: This case report describes a young male with multidrug-resistant Neisseria gonorrhoeae infection acquired in Ontario, Canada with no travel history.

Methods: Case follow-up was conducted following routine public health practice in Ontario. Antimicrobial susceptibility testing of the isolate was done by agar dilution. Strain typing and other molecular characterization was done by whole genome sequencing.

Results: The patient was treated successfully with intramuscular ceftriaxone and oral azithromycin. Agar dilution testing demonstrated reduced susceptibility to all tested agents, except for azithromycin and spectinomycin, including non-susceptibility to ceftriaxone (minimum inhibitory concentration [MIC]=0.5 mg/L) and cefixime (MIC=2 mg/L), resistance to tetracycline (MIC=2 mg/mL) and ciprofloxacin (MIC=32 mg/L), and testing intermediate to penicillin (MIC=1 mg/L). Whole-genome sequencing revealed the isolate was closely related to the FC428 clone, which harbours the mosaic penA60 allele responsible for elevated MICs to extended-spectrum cephalosporins, such as ceftriaxone or cefixime, both currently recommended as first-line or alternative treatment options for uncomplicated anogenital gonorrhea infections in Ontario.

Conclusion: Identification of this case suggests previously unrecognized local transmission of this multidrug-resistant N. gonorrhoeae strain is occurring in Ontario and highlights the need for ongoing surveillance to monitor trends and inform treatment recommendations.

Background: The domestic tuberculosis (TB) disease burden in high-income, low TB-incidence countries is largely driven by the reactivation of remotely acquired TB infections (TBIs) in people born outside the country (PBOC). In Canada, PBOC now accounts for more than three quarters of annual active TB diagnoses. To prevent some of this disease experience, Immigration, Refugees and Citizenship Canada (IRCC) rolled out a new TBI screening initiative in 2019.

Objective: An evaluation of TB outcomes among individuals referred through this initiative between May 2019 and May 2023 in Alberta, Canada.

Methods: Inclusion criteria for this initiative are migrants who are required to undergo an immigration medical exam with at least one of HIV/AIDS, solid organ transplant, end-stage renal disease, recent close TB contact (within five years), and past head and neck cancer. Those with a positive screening test for TBI are referred directly to TB services in the stated province/territory of landing for assessment and treatment.

Results: Over four years, 179 referrals were made to Alberta. No one referred through the program and offered treatment developed active TB. Overall, 95 individuals were considered suitable candidates for prevention, among whom 87% accepted. Completion was high at nearly 95%. Inefficiencies included 113 individuals undergoing repeated TBI testing locally, 39 (21.8%) referrals not meeting the inclusion criteria, and 61 (34.1%) individuals being rereferred despite being past patients of Alberta TB services.

Conclusion: Our findings highlight that, in Alberta, IRCC's new TBI screening initiative was highly successful in connecting referred individuals to TB services. The initiative experienced some inefficiencies and we describe areas where it could be improved.

Background: Public health models often lack comprehensive behavioural data, leading to inaccurate predictions about the spread of disease and insufficient information about how to effectively build and sustain adherence to changing public health protocols.

Objective: The current study addresses this lack of comprehensive behavioural data by examining the role of trust as a predictor of adherence to public health measures.

Methods: Data were collected from an online Web intercept survey of 3,021 randomly engaged Canadians aged 16 years and older, analyzing factors such as gender, education and sources of COVID-19 information in relation to adherence to public health guidelines.

Results: Trust, respecting someone's expertise sufficiently to be willing to accept their counsel, emerged as a potent predictor of adherence to public health measures, highlighting the significance of trust in shaping community engagement; further, community-level adherence was found to predict anticipated future adherence.

Conclusion: This study emphasizes the critical role of trust, especially at the community level, in the success of public health measures, and proposes integrating trust measurement into public health models of compliance and resistance.

Background: Exposure incidents to human pathogens and toxins (HPTs) in licensed facilities in Canada are monitored by Laboratory Incident Notification Canada (LINC), a surveillance system that describes and identifies trends among exposure incidents in Canada using quantitative and qualitative data.

Methods: Confirmed exposure incidents reported to LINC in 2024 were analyzed. The exposure incident rate was calculated and compared to previous years. A seasonality analysis compared monthly trends. Exposure incidents were described by sector, implicated HPTs, main activity, occurrence types, root causes, affected individuals and reporting delay. Text-based descriptions of exposure incidents underwent qualitative analysis.

Results: In 2024, there were 71 confirmed exposure incidents affecting 132 individuals. There were 67.5 incidents per 1,000 active licences. Bacteria was the most commonly implicated HPT (64%). Microbiology (67.6%) was the primary activity during confirmed exposures. The public health sector had the highest incident rate and mean number of affected persons per active licence. The most frequently reported occurrence type and root cause was procedure-related (21.4%) and human factors (62%), respectively. Most affected individuals were technicians/technologists (76.5%). The median time between incident and reporting was five days.

Conclusion: The exposure incident rate was higher in 2024 compared to the previous year. The public health sector had the highest incident rate between 2016-2024. Qualitative analysis revealed that working with cultures outside the biological safety cabinet and insufficient face-related personal protective equipment were common factors involved in confirmed exposure incidents.

Background: Treating individuals with tuberculosis (TB) infection (TBI) is an important aspect of the global strategy to eliminate TB as a public health problem, as it would help reduce the pool of individuals with TBI who are at risk of developing TB disease (TBD). Understanding factors that impact effective management of patients with TBI is helpful in informing policy.

Objective: To assess the proportion of immigrants with TBI accepting and completing TB preventive treatment (TPT), variables potentially related to accepting and completing TPT were examined and healthcare provider (HCP)-related factors that impact TBI management were identified.

Methods: Tuberculosis preventive treatment was offered to TBI-positive immigrants without a history or treatment of TBD from a pilot TBI screening study conducted in southern New Brunswick, Canada between November 2021 and November 2023. Tuberculosis preventive treatment acceptance and completion rates were calculated, and the HCP completed a questionnaire to identify factors that affected TBI management. Participant characteristics were summarized using descriptive statistics, while Fisher's exact tests were conducted to test for independence between demographics and treatment acceptance and completion. The HCP questionnaire data were analyzed using thematic analysis.

Results: Of the 49 participants who screened positive for TBI, 11 (22.4%) were lost to follow-up prior to being assessed and offered TPT and 38 (77.6%) were offered TPT, of whom 3 (7.9%) declined, 35 (92.1%) accepted and initiated TPT, and 30 (85.7%) completed treatment. Treatment acceptance and completion were found to be independent from the participant demographics examined. Thematic analysis revealed five emerging themes regarding the management of TBI participants (i.e., supports, collaboration, communication, time, and satisfaction).

Conclusion: This study demonstrates the feasibility of treating TBI in immigrants and highlights HCP-related factors that impact the management of TBI among immigrants in southern New Brunswick. Our findings may assist programs aimed at improving TBI screening and treatment.

Background: Pneumococcal disease in adults includes invasive pneumococcal disease (IPD), an acute and serious communicable disease with manifestations such as meningitis, bacteremia and bacteremic pneumococcal pneumonia. There are more than 100 different serotypes, and the extent of protection provided by a pneumococcal vaccine depends on the vaccine formulation. In July 2024, Health Canada authorized a 21-valent pneumococcal conjugate vaccine (Pneu-C-21), which followed the recent introduction of a 20-valent vaccine (Pneu-C-20) authorized in 2022.

Methods: The National Advisory Committee on Immunization (NACI) reviewed evidence on the epidemiology of IPD in Canada, immunogenicity and safety of Pneu-C-21, and the cost-effectiveness of different pneumococcal vaccines in adult immunization programs. NACI has also considered additional factors, including ethics, equity, feasibility, and acceptability (EEFA).

Results: Differences in the distribution of serotypes causing IPD have been observed before and after the COVID-19 pandemic. The Pneu-C-21 demonstrated comparable immunogenicity to Pneu-C-20 for shared serotypes and higher responses for unique serotypes. The safety profiles of both vaccines are expected to be similar to other pneumococcal vaccines, and the cost-effectiveness of Pneu-C-21 and Pneu-C-20 will depend on regional serotype distribution. The overall impact of Pneu-C-21 compared to Pneu-C-20 is uncertain, but likely to vary over time with age, risk factors, and geography.

Conclusion: NACI now recommends including at least one of Pneu-C-20 or Pneu-C-21 in adult pneumococcal immunization programs. One dose should be given to adults 65 years and older and those 18 to under 65 years at increased IPD risk, regardless of previous pneumococcal vaccination history.

Background: The National Advisory Committee on Immunization (NACI) reviews the evolving evidence on influenza immunization and provides annual recommendations regarding the use of seasonal influenza vaccines. The NACI Statement on seasonal influenza vaccines for 2025-2026 updates the NACI recommendations from the previous year.

Objective: To summarize the 2025-2026 NACI seasonal influenza vaccine recommendations and to highlight new and updated information.

Methods: For the development of the Statement on seasonal influenza vaccines for 2025-2026, the NACI Influenza Working Group applied the NACI evidence-based process to assess available evidence and formulate recommendations. These recommendations were evaluated and approved by NACI based on the available evidence.

Results: Key updates for the 2025-2026 influenza season include: 1) removal of the preferential recommendation for quadrivalent influenza vaccines in children; 2) reiteration of the safety of concurrent administration of seasonal influenza vaccines and other vaccines, including COVID-19, based on updated evidence; 3) new evidence on the protective effects of influenza vaccination on cardiovascular events; 4) updated language for Indigenous populations; and 5) addition of individuals at higher risk of avian influenza A(H5N1) exposure as a group for whom influenza vaccination is particularly important.

Conclusion: NACI recommends that seasonal influenza vaccine should be offered annually to anyone six months of age and older who does not have a contraindication to the vaccine. Influenza vaccination is particularly important for people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk, and others as outlined in the Statement.

Background: Outcome surveillance is an important component of infection prevention and control (IPAC) programs to guide healthcare decisions. It is crucial that the reported data are of the highest quality. Reviewing completeness, accuracy and timeliness of the data is important to reduce data inconsistencies. However, many IPAC staff do not have training in data cleaning or data quality activities.

Methods: Expert epidemiologists across Canada have created best practice guidance for data quality activities to provide sufficient detail to improve this important patient safety activity. Most of these activities are simple checks to review the accuracy of the data without requiring additional review of the patient record or linkage to other datasets.

Results: Based on consensus by surveillance experts across jurisdictions, comprehensive recommendations for data quality in IPAC surveillance programs were developed to improve completeness (22%), accuracy (68%), and timeliness (10%) of the data.

Conclusion: The data quality activities list may be used in Canadian IPAC surveillance activities to support or improve existing surveillance data quality activities for IPAC programs.

Background: People who inject drugs are disproportionately affected by HIV and hepatitis C infections. Estimating the size and distribution of this population is essential in monitoring infectious diseases rates and progress towards elimination.

Objective: This study aims to estimate the population sizes of people in Canada who have ever injected drugs, stratified by sex (assigned at birth), province/region and steroid injection, and those who have recently injected drugs (past 12 months), stratified by sex and steroid injection. While a previous national study reported estimates of recent injection by province, this study provides the first estimates of people who have ever injected drugs at both the national and provincial/regional levels. It is also the first to incorporate stratification by sex and steroid injection, using the most currently available data.

Methods: Using combined cycles (2017-2021) of the Canadian Community Health Survey (CCHS), a nationally representative population-based survey, we applied the weighted prevalence of injection drug use to the 2021 Statistics Canada national population size estimate of individuals aged 15 years or more. To this, further adjustments were made using additional data to account for populations not sampled in the CCHS and under-reporting of injection drug use in surveys.

Results: In 2021, an estimated 388,400 (95% CI: 338,900-436,500) people in Canada had ever injected drugs, representing 1.22% of the Canadian population 15 years of age and older. Among these, 75% were male and 25% were female. These estimates varied across regions, ranging from 0.92% to 2.47%. The estimated number of people who have recently injected drugs was 100,300 (95% CI: 82,300-119,200) or 0.31% of the population, of which 74% were male and 26% were female.

Conclusion: Estimates of people who inject drugs at the national and provincial/regional levels can be used to track key epidemiological metrics that inform public health policy and programming.

Background: There is a growing body of evidence on the potential benefit of influenza vaccination against the occurrence of cardiovascular (CV) events.

Objective: This umbrella review of systematic reviews and meta-analyses (SRMAs) aims to summarize the available evidence on the risk of CV events in adults after receipt of influenza vaccine.

Methods: Four electronic databases were searched (CINAHL, PubMed, SYSVAC and Cochrane Library) for SRMAs published in English or French, between January 1, 2000, and January 14, 2025. Eligible SRMAs included those with a quantitative synthesis of data examining the association between influenza vaccination and the risk of CV events in adults. Data from the included SRMAs were extracted using predefined variables. The quality of each SRMA was assessed by two independent reviewers using the AMSTAR 2 tool.

Results: The review included 25 SRMAs published between 2012 and 2024. Overall, 15 SRMAs were deemed to be of moderate or high quality and were further considered in the evidence synthesis. The most frequently evaluated clinical outcomes were myocardial infarction (MI), all-cause and CV mortality, and major adverse cardiovascular events (MACE). In vaccinated individuals at high-risk for CV events, the risk of CV death was significantly reduced by 23% to 47%, MACE by 26% to 37%, MI by 29% to 34%, and stroke by 13% to 19% compared to unvaccinated individuals.

Conclusion: High-quality evidence from the existing literature supports influenza vaccination as an effective preventive measure for reducing CV disease burden. Highlighting this benefit to patients could increase vaccine uptake and improve both influenza and CV outcomes, especially where coverage remains suboptimal.