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

Over the past 20 years, Trichophyton mentagrophytes (T. mentagrophytes) infections affecting the genital and pubic regions, with suspected sexual transmission, have been increasingly reported in South Asia and Europe. The first case in the United States was reported in 2024. We describe the first confirmed case of T. mentagrophytes genotype VII infection causing Majocchi granuloma in a Canadian male who had recently travelled to Mexico, with suspected sexual transmission. Raising awareness among healthcare professionals is critical for early diagnosis and preventing long-term sequelae. Tinea corporis presenting with deep lesions in the pubogenital region and not responding to topical medications should prompt consideration of sexually transmitted fungal infection and extended testing including molecular identification by DNA sequencing of fungal cultures.

Background: Antimicrobial resistance (AMR) is one of the major public health threats of our time. Human activities across the One Health spectrum, such as the misuse and overuse of antimicrobials, can accelerate the resistance threat. A variety of antimicrobials used in veterinary medicine are also important in human medicine. As part of Canada's commitment to address AMR and antimicrobial use (AMU), and to align with international best practices aimed to minimize the impacts of AMR and preserve the effectiveness of existing antimicrobials, regulatory controls and enhanced surveillance initiatives have been implemented in veterinary medicine and animal health to improve intelligence on the quantities of antimicrobials available for use in animals. These efforts include the implementation of the national Veterinary Antimicrobial Sales Reporting (VASR) system in Canada, in 2018. The focus of this article is to describe the VASR data collection system and platform.

Methods: A custom-built data collection and analytical system was developed to enhance understanding of the volume of antimicrobials available for use in animals and contribute to the broader surveillance of trends in AMU and AMR in an effort to support stewardship. Partners from Health Canada's Veterinary Drugs Directorate, the Public Health Agency of Canada's Centre for Food-borne, Environmental and Zoonotic Infectious Diseases, and the Canadian Network for Public Health Intelligence worked together to envision, develop, and implement the national-scale, purpose-built technological intervention, the VASR system.

Results: The VASR surveillance system provides a robust data collection and analytical informatics platform to improve intelligence on antimicrobial sales available for veterinary use in Canada.

Conclusion: An innovative, purpose-built national antimicrobial sales reporting system was developed. This web-based platform is effective for data submission by the participants and facilitates analysis to provide a comprehensive picture of medically important antimicrobials available for use in animals in Canada, thereby supporting AMR and AMU surveillance and stewardship.

Background: The COVID-19 antiviral Nirmatrelvir/Ritonavir (Paxlovid^TM, N/R) was approved for use in Canada in January 2022, with the Government of Canada assuming a procurement role and provinces, territories, and federal departments implementing usage within their respective healthcare systems. The objective of this analysis is to describe how N/R was implemented across various jurisdictions in the first six months after it was available for use and identify promising implementation practices.

Methods: Fourteen semi-structured discussions in small group settings were conducted with jurisdictional representatives involved in the implementation of N/R. A descriptive analysis of the eligibility criteria and service delivery model was conducted. A thematic analysis using the Consolidated Framework for Implementation Research and cluster analysis of the codes were then undertaken on NVivo 12 to identify key themes.

Results: Overall, the eligibility criteria were similar across jurisdictions, and three types of service delivery models were identified. Ten main themes emerged as facilitators and eight as challenges to the implementation. Partnership, collaboration, communication and flexibility were among the facilitators identified, while the complexity of the intervention (e.g., drug-drug interactions), perceived evidence gaps in effectiveness by prescribers, and resource limitations were identified as key implementation challenges.

Conclusion: While there were jurisdictional variations in the implementation of N/R, communication and collaboration, and the availability of rapid testing for COVID-19 emerged as key facilitators. Drug-drug interactions, resource pressures and limited evidence were some of the key challenges. Overall, these facilitators and challenges were similar across jurisdictions and may help inform future therapeutic implementation plans for pandemic preparedness.

Background: In Canada, the burden of gonorrhea has been increasing steadily over the last decade with emerging multi-drug-resistant strains. There is a high genomic similarity between Neisseria meningitidis and Neisseria gonorrhoea.

Methods: Review of published studies and on-going trials with the four-component meningococcal serogroup B vaccine (4CMenB-Bexsero®).

Results: Observational studies have shown protection against gonorrhea infection ranging from 35% to 59% for up to three years after the administration of 4CMenB. Several randomized clinical trials are also under way. Results from the DOXYVAC trial have been published but the sample size was too small to exclude a protective effect in the 30%-50% range. Recommendations on the use of 4CMenB for individuals at high risk of gonorrhea infection have been issued in the United Kingdom and New York state based on results of observational studies.

Conclusion: If results of observational studies are confirmed by randomized trials with an acceptable cost-effectiveness profile in the Canadian context, a targeted immunization program using 4CMenB could be implemented.

Background: In Canada in 2020, the indication for use of Imvamune was expanded to include immunization against smallpox, mpox and related Orthopoxvirus infection and disease in adults who are 18 years of age and older and determined to be at high risk for exposure.

Methods: Since the introduction of this new use for the vaccine and throughout the 2022 mpox outbreaks, the Public Health Agency of Canada (PHAC) has closely monitored the safety of the Imvamune vaccine through the Canadian Adverse Events Following Immunization Surveillance System (CAEFISS).

Results: This article describes reports of adverse events following immunization (AEFI) after administration of Imvamune, submitted to the CAEFISS database between May 24, 2022 and December 11, 2022, during the activation of Canada's emergency response.

Conclusion: Monitoring of AEFI reports following immunization with Imvamune submitted to CAEFISS has not identified any new or unexpected safety concerns in the Canadian adult population. The Public Health Agency of Canada continues to monitor for potential vaccine safety signals.

Background: Respiratory syncytial virus (RSV) surged in the 2022-2023 respiratory season after low activity during the pandemic. To monitor the RSV season in real time and support healthcare planning, Ontario introduced daily hospital bed census reporting of RSV hospitalizations by age group (0-17, 18-64, 65 years and older).

Objectives: To assess the completeness and quality of the newly introduced real-time surveillance compared to end-of-season ICD-10 coded hospitalization discharge abstract data (DAD) from November 22, 2022, to March 31, 2023.

Methods: Respiratory syncytial virus hospitalizations from both data sources were compared to RSV laboratory positivity to assess concordance with overall RSV activity. A longitudinal comparison by age group was assessed by time-lagged cross-correlation of the daily submission data versus DAD data, including cross correlation coefficients for each time lag, confidence bound and the highest correlation value.

Results: Both data sources followed trends in RSV positivity. Data by age groups showed an early peak of paediatric admissions followed by a peak in adult and older adult hospitalizations. Daily surveillance consistently underestimated hospitalizations with a peak of 430 beds by DAD on January 7, 2023, versus 322 beds (75%) for daily reporting on the same day. The maximum correlation coefficient values were 0.67 (all ages), 0.57 (0-17 years), 0.66 (18-64 years) and 0.63 (65 years and older).

Conclusion: Implementation of daily hospital reporting provided accurate trending in RSV hospitalizations by age group to inform within season healthcare and public health planning.

Background: Respiratory syncytial virus (RSV) is a common respiratory virus. In addition to infants, older adults are at higher risk of severe outcomes due to RSV, particularly advanced-age older adults and those with chronic medical conditions. The authorization of three vaccines, one for adults 50 years of age and older (Arexvy) and two for adults 60 years of age and older (Abrysvo and mRESVIA), offers the opportunity to protect older Canadians from RSV disease. This article summarizes guidance from the National Advisory Committee on Immunization (NACI) on the prevention of RSV in older adults.

Methods: NACI established key policy questions and performed an evidence review and synthesis for three new vaccines. In consideration of the burden of illness to be prevented, safety and efficacy of the new immunizing products, economic evidence and ethics, equity, feasibility and acceptability considerations, NACI made evidence-based recommendations.

Results: The three RSV vaccines may provide similar reductions in hospitalizations associated with RSV and medically attended RSV respiratory tract infection for adults 60 years of age and older. However, evidence is limited for other outcomes. These vaccines were well-tolerated in clinical studies, with an acceptable safety profile among older adults. The duration of protection of the RSV vaccine is not yet known, and it is unclear if the protection offered by vaccination can be boosted by subsequent doses of vaccine.

Conclusion: Based on available evidence, NACI recommends RSV immunization programs for adults 75 years of age and older, particularly for older adults with chronic health conditions who are at increased risk of severe RSV disease. NACI also recommends RSV immunization programs for adults 60 years of age and older who are residents of nursing homes and other chronic care facilities. NACI recommends that receiving an RSV vaccine may be considered as an individual decision by adults 50 to 74 years of age, in consultation with their healthcare provider.

Background: Enteric illnesses are a preventable cause of morbidity and healthcare utilization in Canada. To support public health and epidemiological activities, Foodbook was launched in 2014 by the Public Health Agency of Canada to collect representative information on food, water, and animal exposures, food safety knowledge, burden of gastrointestinal illnesses, and sociodemographic information. The aim of this overview was to identify how this valuable data source has been used in the past decade since its launch.

Methods: Peer-reviewed and grey literature were identified by applying the search term "Foodbook" to two academic databases and two grey literature sources, respectively. Citations were screened against eligibility criteria. Study information, including study characteristics, module of Foodbook data used, and how Foodbook data was used was extracted and synthesized in tabular format.

Results: A total of 27 articles were identified in the published literature that utilized Foodbook survey data in their analyses. The most common use was for outbreak investigations. In addition, Foodbook has been used to describe food, water, and animal exposures, determine food safety knowledge and practices of Canadians, estimate the burden of acute gastrointestinal illness, and evaluate data collection methods for foodborne illnesses.

Conclusion: By summarizing its use, the authors aim to encourage broader use of this publicly available data source to inform health protection and promotion activities to reduce the burden of enteric illnesses in Canada.

Background: Canada's Sexually Transmitted and Blood-borne Infections (STBBI) Action Plan and the Global Health Sector Strategies on STBBI highlight the importance of putting people at the centre of the health system response. Several key populations are disproportionately affected by viral hepatitis, including immigrants. However, there is a limited body of evidence on the burden of viral hepatitis among immigrants in Canada. We seek to address this gap by estimating the prevalence of hepatitis B (HBV) and C (HCV) infections among immigrants in Canada.

Methods: Using country- and region-specific publicly available data on the prevalence of HBV and HCV, we estimated the number of immigrants with chronic HBV (CHB), HCV antibodies, and chronic HCV (CHC) by multiplying the number of immigrants from Statistics Canada's 2021 census of population data by the corresponding publicly available country or region-of-origin prevalence, including lower and upper bounds. Each country was categorized as low (<2%) or intermediate-to-high (≥2%) based on published prevalence. To capture changes over time, estimates were stratified by time-period, where possible.

Results: In 2021, the estimated prevalence of viral hepatitis among all immigrants was 4.03% for CHB, 1.43% for HCV antibodies, and 0.78% for CHC. The estimated prevalence of CHB, HCV antibodies, and CHC was 0.91%, 0.96% and 0.52%, respectively, among immigrants from low-prevalence countries (<2%). It was 5.57%, 4.04%, and 2.20%, respectively, among immigrants from intermediate-to-high-prevalence countries (≥2%).

Conclusion: This is the first study to estimate the burden of HBV and HCV among immigrants at the national level in Canada. The results show that the prevalence of viral hepatitis among immigrants is higher than the general Canadian population. However, grouping all immigrants into one category masks important variation, and potentially over-estimates the burden of HBV and HCV among immigrants. Strengthening our understanding of hepatitis prevalence among immigrants can improve our ability to connect those in need to care and treatment services.

Background: Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are major causes of morbidity and mortality worldwide. Measuring the epidemiological burden of HCV and HBV in Canada is essential to measure progress towards global elimination targets and to ultimately eliminate viral hepatitis as a public health concern.

Objective: This study aimed to provide the first national estimates of HBV prevalence and unawareness, and to update estimates of HCV incidence, prevalence, and unawareness in the general population and key populations in Canada for 2021. Progress towards elimination targets for 2025, namely incidence, awareness, mortality, and HBV vaccination, was also assessed.

Methods: A combination workbook method and mathematical modelling was used to estimate the prevalence and unawareness of chronic hepatitis B (CHB), prevalence and incidence of anti-HCV antibodies, and the prevalence and unawareness of chronic hepatitis C (CHC).

Results: The estimated prevalence of CHB was 0.68% (plausible range: 0.40%-0.97%) or 262,000 (152,000-371,000) people in the general population, of whom 42.5% (33.9%-51.0%) were unaware of their infection. Immigrants from countries where HBV is common had the highest prevalence at 4.2% (1.9%-5.6%). An estimated 8,212 new HCV infections occurred in 2021, and the estimated prevalence of CHC was 0.56% (0.15%-0.97%) or 214,000 (58,500-369,000) people, of whom 41.5% (34.3%-48.8%) were unaware of their infection. People who inject drugs had the highest prevalence and largest proportion who were unaware at 36.9% (12.6%-55.1%) and 49.9% (29.0%-70.2%), respectively.

Conclusion: While the overall viral hepatitis burden is low in the general Canadian population, these estimates indicate that certain populations and communities remain disproportionately affected. Although Canada has met some of the 2025 targets, more work is needed. To this end, efforts to obtain and standardize provincial and national data will be required to measure progress towards all elimination targets.