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Using behavioural science to improve antibiotic stewardship in Canadian long-term care homes: Protocol for a multi-center cluster randomized quality improvement study. 使用行为科学改善加拿大长期护理院的抗生素管理:一项多中心集群随机质量改进研究的协议。
Pub Date : 2025-01-02 eCollection Date: 2025-01-01 DOI: 10.14745/ccdr.v51i01a06
Tyler Good, Jorida Cila, Rhiannon Mosher, Klajdi Puka, Shaghig Reynolds, Barbara Catt, Aboubakar Mounchili, Denise Gravel-Tropper, Patrick Quail, Allison McGeer, Andrea Moser, Madeleine Ashcroft, Peter Daley, Katrina Piggott, Jerome Leis, Mark Morrissey

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.

背景:抗菌素耐药性(AMR)与巨大的人力和财务成本相关,特别是在弱势人群中,如生活在长期护理之家(LTCHs)的老年人中。尿路感染(UTI)是这一人群使用抗生素的主要指征,一些估计表明,多达70%的此类处方是可以避免的。目的:本研究的目的是在加拿大LTCHs中开发和测试新的基于行为科学的抗菌药物管理(AMS)质量改进策略,旨在减少对缺乏尿路感染最低临床体征和症状的居民不必要的检测和治疗。干预:质量改进策略是一个双管齐下的方法,包括1)对基本护理提供者(LTCH居民的家人和朋友)进行针对性的教育,了解尿路感染和AMS的好处,努力概述该群体在尿路感染管理中的积极作用;2)每月向LTCH工作人员反馈其设施的尿液培养定诊率。结果:该方案在单个LTCH中试点;试点实施的过程评估有助于完善研究方案,该方案正在加拿大的八个ltch中实施,采用八个月的阶梯楔形随机聚类设计。结论:该方案代表了一种行为科学知情的干预措施,以改善ltch的AMS。如果成功,这种护理模式可以在加拿大的LTCHs中推广,提供一种包容性的方法,旨在使临床医生、不受监管的医疗保健人员、居民及其家人和朋友能够作为抗生素管理员改善健康结果。
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引用次数: 0
Popularity of HIV self-tests may say more about the state of our primary care system than about the device itself. 艾滋病毒自检的普及可能更多地说明了我们初级保健系统的状况,而不是设备本身。
Pub Date : 2024-12-05 eCollection Date: 2024-12-01 DOI: 10.14745/ccdr.v50i12da04
Alexandra Musten, Patrick O'Byrne

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.

背景:在加拿大,艾滋病毒传播继续不成比例地影响同一社区的男同性恋、双性恋和男男性行为者(gbMSM);非洲、加勒比或黑人社区成员;使用注射毒品的人;原住民;以及属于上述群体的女性。虽然初级保健是这些群体成员进行艾滋病毒检测的理想场所,但许多人无法获得此类卫生保健服务。作为回应,我们启动了GetaKit,分发艾滋病毒自检。方法:鉴于大流行导致获得保健服务的机会减少,并预期加拿大卫生部将批准艾滋病毒自我检测,渥太华大学的一个临床科学家研究小组开发了GetaKit:一个提供性健康服务的在线平台。2020年7月,在安大略省卫生部的资助下,GetaKit首次在渥太华推出时,其目标是确保获得新批准的设备保持1)临床适宜,2)可获得,3)与护理相关。结果:在研究过程中,有稳定数量的人报告说他们以前从未接受过艾滋病毒检测。这些人往往更年轻,更有可能是种族化的少数群体的成员;与那些在获得初级保健方面也面临最大障碍的人具有相似的特征。结论:新的报告表明,近600万加拿大人没有初级保健提供者,有人提出,艾滋病毒自检的普及可能更多地说明了这种缺乏途径,而不是设备本身的效用。虽然GetaKit等项目应成为更广泛战略的一部分,以克服地理距离和门诊时间不方便等历史检测障碍,但重要的是,这是在一个强大的初级保健卫生系统能够根据需要支持治疗、随访和专家转诊的环境中进行的。
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引用次数: 0
Mycobacterium tuberculosis pseudo-outbreak due to laboratory cross-contamination: A molecular epidemiology outbreak investigation. 实验室交叉污染引起的结核分枝杆菌伪暴发:一次分子流行病学暴发调查。
Pub Date : 2024-12-05 eCollection Date: 2024-12-01 DOI: 10.14745/ccdr.v50i12da03
Nayla Léveillé, Floriane Point, Josée Houde, Michael Hall, Hafid Souhaline, Marie-Andrée Leblanc, Pierre-Marie Akochy, Simon Grandjean Lapierre

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.

背景:在加拿大,分枝杆菌培养是诊断结核病的常规方法。在全球范围内,荟萃分析表明,由于实验室交叉污染,高达2%的阳性培养物为结核分枝杆菌假阳性。在集中的分枝杆菌实验室处理临床样本时,来自montracimal不同临床机构的5名患者被诊断为培养阳性结核。由于一名器官供体培养阳性,且结核病检测前概率低,因此怀疑存在交叉污染。我们描述了一起由实验室交叉污染引起的结核病伪暴发,并评估了传统分型(即分枝杆菌穿插重复单位可变数目串联重复序列[MIRU-VNTR])和全基因组测序(WGS)在支持调查中的作用。方法:回顾性分析患者的流行病学危险因素及临床表现。分析前和分析后样品的轨迹被追溯,以确定潜在的交叉污染事件。采用牛津纳米孔技术(ONT)对结核分离株进行MIRU-VNTR和WGS鉴定。采用生物信息学管道tbpore (v0.7.1)聚类进行系统发育分析。结果:两名患者曾接触过地方性环境,临床症状与结核病相符。四名患者的培养基接种时间重叠,包括一名疑似肺腔疾病患者和一名器官捐赠者,他的器官被移植给了三个不同的接受者。MIRU-VNTR和WGS分型证实这4例患者的分离株是相同的。结论:临床、实验室和分子分型数据,包括ONT测序结果,被认为足够可靠,可以确认实验室交叉污染,并停止结核病治疗,包括所有器官移植受者。
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引用次数: 0
Summary of the National Advisory Committee on Immunization (NACI) Statement: Updated guidance on human papillomavirus (HPV) vaccines. 国家免疫咨询委员会(NACI)声明摘要:关于人乳头瘤病毒(HPV)疫苗的最新指南。
Pub Date : 2024-12-05 eCollection Date: 2024-12-01 DOI: 10.14745/ccdr.v50i12da01
Nicole Forbes, Josh Montroy, Marina I Salvadori, Vinita Dubey

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.

背景:如果不接种疫苗,加拿大大约75%的人一生中会感染人乳头瘤病毒(HPV)。人乳头瘤病毒疫苗接种率继续低于国家目标,即到17岁时接种两剂或两剂以上疫苗的接种率达到90%。最近的证据和世界卫生组织(世卫组织)指南现在支持针对较年轻年龄组的1剂或2剂计划,与多剂免疫规划相比,这可以简化疫苗接种工作并提高覆盖率。方法:国家免疫咨询委员会(NACI)审查了1剂HPV疫苗接种计划的临床获益和风险的现有证据,以及其他因素,包括伦理、公平性、可行性和可接受性。证据和方案考虑是通过建议分级评估、发展和评估(GRADE)框架来组织的,所有信息都用于促进NACI指南的制定。结果:根据现有证据,接种1剂疫苗对年轻女性人群的HPV感染非常有效,目前接种后随访时间长达11年。传染病模型表明,与两次剂量相比,加拿大男性和女性的一次剂量战略预计在短期和长期内产生类似的健康结果。结论:NACI更新了9至20岁个体接种一剂9vHPV (Gardasil-9,默克)疫苗的建议。对于21岁及以上的个体,应按2次剂量服用。被认为免疫功能低下和感染艾滋病毒的个体应接受3剂系列疫苗。NACI还发布了针对27岁及以上个体接种HPV疫苗的酌情建议,并更新了允许在怀孕期间接种HPV疫苗的指南。
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引用次数: 0
Popularity of HIV self-tests may say more about the state of our primary care system than about the device itself. 艾滋病毒自检的普及可能更多地说明了我们初级保健系统的状况,而不是设备本身。
Pub Date : 2024-12-05 eCollection Date: 2024-12-01 DOI: 10.14745/ccdr.v50i12da02
Alexandra Musten, Patrick O'Byrne

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.

背景:在加拿大,艾滋病毒传播继续不成比例地影响同一社区的男同性恋、双性恋和男男性行为者(gbMSM);非洲、加勒比或黑人社区成员;使用注射毒品的人;原住民;以及属于上述群体的女性。虽然初级保健是这些群体成员进行艾滋病毒检测的理想场所,但许多人无法获得此类卫生保健服务。作为回应,我们启动了GetaKit,分发艾滋病毒自检。方法:鉴于大流行导致获得保健服务的机会减少,并预期加拿大卫生部将批准艾滋病毒自我检测,渥太华大学的一个临床科学家研究小组开发了GetaKit:一个提供性健康服务的在线平台。2020年7月,在安大略省卫生部的资助下,GetaKit首次在渥太华推出时,其目标是确保获得新批准的设备保持1)临床适宜,2)可获得,3)与护理相关。结果:在研究过程中,有稳定数量的人报告说他们以前从未接受过艾滋病毒检测。这些人往往更年轻,更有可能是种族化的少数群体的成员;与那些在获得初级保健方面也面临最大障碍的人具有相似的特征。结论:新的报告表明,近600万加拿大人没有初级保健提供者,有人提出,艾滋病毒自检的普及可能更多地说明了这种缺乏途径,而不是设备本身的效用。虽然GetaKit等项目应成为更广泛战略的一部分,以克服地理距离和门诊时间不方便等历史检测障碍,但重要的是,这是在一个强大的初级保健卫生系统能够根据需要支持治疗、随访和专家转诊的环境中进行的。
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引用次数: 0
Perspectives on blastomycosis in Canada in the face of climate change. 面对气候变化,加拿大囊霉菌病的前景。
Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI: 10.14745/ccdr.v50i11a04
Amole Khadilkar, Lisa Waddell, Emily S Acheson, Nicholas H Ogden

Blastomycosis is a disease of potentially varied presentations caused by thermally dimorphic fungi that appear as mold at ambient temperatures and transform to yeast at body temperature. Inhalation of aerosolized fungal spores represents the primary mode of transmission. Exposure may follow outdoor activities that disturb soil, which is warm, moist, acidic and rich in organic debris, particularly within forested areas and in proximity to waterways. Blastomycosis is endemic to several parts of Canada, but is only reportable in Ontario and Manitoba, with Northwestern Ontario being considered a hyperendemic area with average annual incidence rates of over 25 cases per 100,000 population. Delays in diagnosis and treatment are frequently observed as the symptoms and imaging findings of blastomycosis may initially be mistaken for community-acquired pneumonia, tuberculosis or malignancy, which can result in interim disease progression and worsening clinical outcomes. Risks from fungal infections such as blastomycosis are likely to increase with climate change-associated shifts in temperature and rainfall, and this may contribute to the geographic expansion of cases, a phenomenon that appears to be already underway. Further research investigating the ecological niche of Blastomyces and its climate sensitivity could help facilitate better modelling of the potential impacts of climate change on risks to Canadians and inform more effective methods of exposure prevention. Early clinical recognition and treatment of blastomycosis remain the key to minimizing morbidity and mortality.

高致病性真菌病是一种表现形式可能多种多样的疾病,由热二态性真菌引起,这种真菌在环境温度下表现为霉菌,在体温下转变为酵母菌。吸入气溶胶状真菌孢子是主要的传播方式。室外活动可能会扰乱温暖、潮湿、酸性和富含有机碎屑的土壤,尤其是在森林地区和水道附近。布氏杆菌病在加拿大多个地区流行,但只有安大略省和马尼托巴省需要报告,安大略省西北部被视为高流行区,年平均发病率超过每 10 万人 25 例。由于囊霉菌病的症状和影像学检查结果最初可能会被误认为是社区获得性肺炎、结核病或恶性肿瘤,这可能会导致疾病的中期发展和临床结果的恶化,因此经常会出现诊断和治疗延误的情况。随着气候变化引起的气温和降雨量的变化,囊霉菌病等真菌感染的风险可能会增加,这可能会导致病例的地理分布扩大,而这一现象似乎已经开始。对囊霉菌的生态位及其气候敏感性的进一步研究有助于更好地模拟气候变化对加拿大人所面临风险的潜在影响,并提供更有效的接触预防方法。在临床上及早识别和治疗布氏杆菌病仍然是最大限度降低发病率和死亡率的关键。
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引用次数: 0
Summary of the National Advisory Committee on Immunization (NACI) Seasonal Influenza Vaccine Statement for 2024-2025. 国家免疫咨询委员会 (NACI) 2024-2025 年季节性流感疫苗声明摘要。
Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI: 10.14745/ccdr.v50i11a01
Anabel Gil, Winnie Siu, Jesse Papenburg

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 Vaccine for 2024-2025 updates the NACI recommendations from the previous year.

Objective: To summarize the 2024-2025 NACI seasonal influenza vaccine recommendations and to highlight new and updated information.

Methods: For the development of the Statement on Seasonal Influenza Vaccine for 2024-2025, the NACI Influenza Working Group applied the NACI evidence-based process to assess available evidence and formulate recommendations. These recommendations underwent a thorough evaluation and were approved by NACI based on the available evidence.

Results: Key updates for the 2024-2025 influenza season include updated immunization recommendations reflecting changes in influenza epidemiology and revised guidance for vaccine administration during pregnancy and in older adults.

Conclusion: The National Advisory Committee on Immunization recommends that any age-appropriate quadrivalent or trivalent influenza vaccine should be used for individuals six months of age and older who do not have contraindications or precautions. NACI reaffirms the importance of influenza vaccination with inactivated or recombinant influenza vaccines in pregnancy. Finally, NACI recommends that inactivated high-dose (IIV-HD), inactivated adjuvanted (IIV-Adj) or recombinant influenza vaccine (RIV) should be offered, when available, over other influenza vaccines for adults 65 years of age and older.

背景:国家免疫咨询委员会(NACI)审查不断变化的流感免疫证据,并就季节性流感疫苗的使用提出年度建议。国家免疫咨询委员会关于 2024-2025 年季节性流感疫苗的声明更新了国家免疫咨询委员会上一年的建议:总结 2024-2025 年 NACI 关于季节性流感疫苗的建议,并强调新信息和更新信息:为制定《2024-2025 年季节性流感疫苗声明》,NACI 流感工作组采用 NACI 循证程序评估现有证据并制定建议。这些建议经过了全面评估,并在现有证据的基础上获得了 NACI 的批准:2024-2025年流感季节的主要更新包括反映流感流行病学变化的最新免疫接种建议,以及对孕期和老年人疫苗接种指南的修订:国家免疫咨询委员会建议,年龄在 6 个月及以上且无禁忌症或预防措施的人应接种任何适龄的四价或三价流感疫苗。NACI 重申妊娠期接种灭活或重组流感疫苗的重要性。最后,NACI 建议,在有条件的情况下,为 65 岁及以上的成年人接种高剂量灭活 (IIV-HD)、佐剂灭活 (IIV-Adj) 或重组流感疫苗 (RIV) 应优于接种其他流感疫苗。
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引用次数: 0
Summary of the National Advisory Committee on Immunization (NACI) Supplemental Guidance on Influenza Vaccination in Adults 65 Years of Age and Older. 国家免疫咨询委员会(NACI)关于 65 岁及以上成人接种流感疫苗的补充指南摘要。
Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI: 10.14745/ccdr.v50i11a02
Pamela Doyon-Plourde, Angela Sinilaite, Jesse Papenburg

Background: Adults 65 years of age and older are at higher risk of influenza complications, such as hospitalization and death. As a result, seasonal influenza immunization is particularly important for this group.

Objective: This supplemental statement provides an evidence summary on the preferential use of one or more of the age-appropriate influenza vaccines for adults 65 years of age and older, over other age-appropriate influenza vaccines.

Methods: The National Advisory Committee on Immunization (NACI)'s Influenza Working Group undertook an overview of existing systematic reviews on the efficacy, effectiveness, safety and cost effectiveness of influenza vaccination in adults 65 years of age and older. Additionally, NACI's evidence-based process was used to assess the quality of eligible studies, summarize and analyze the findings and apply an ethics, feasibility and acceptability lens to develop recommendations.

Results: The evidence suggests that high-dose inactivated influenza vaccine (IIV-HD), adjuvanted inactivated influenza vaccine (IIV-Adj) and recombinant influenza vaccine (RIV) offer increased benefits for adults 65 years of age and older when compared to standard dose influenza vaccines. The IIV-HD had the most supporting evidence, followed by IIV-Adj and then RIV. Evidence comparing these enhanced vaccines was limited.

Conclusion: Following a thorough review of the complete body of evidence, NACI recommends that IIV-HD, IIV-Adj or RIV should be offered over other influenza vaccines for adults 65 years of age and older. NACI also continues to strongly recommend the inclusion of adults 65 years of age and older among those for whom it is particularly important to receive influenza vaccination.

背景:65 岁及以上的成年人出现流感并发症(如住院和死亡)的风险较高。因此,季节性流感免疫接种对这一群体尤为重要:本补充声明提供了有关 65 岁及以上成人优先使用一种或多种适龄流感疫苗,而非其他适龄流感疫苗的证据摘要:国家免疫咨询委员会 (NACI) 的流感工作组对现有的关于 65 岁及以上成年人接种流感疫苗的效力、有效性、安全性和成本效益的系统性综述进行了概述。此外,NACI 的循证程序还用于评估符合条件的研究质量、总结和分析研究结果,并从伦理、可行性和可接受性的角度提出建议:证据表明,与标准剂量流感疫苗相比,高剂量灭活流感疫苗(IIV-HD)、佐剂灭活流感疫苗(IIV-Adj)和重组流感疫苗(RIV)可为 65 岁及以上的成年人带来更多益处。IIV-HD 的支持证据最多,其次是 IIV-Adj,然后是 RIV。比较这些强化疫苗的证据有限:在对全部证据进行彻底审查后,NACI 建议为 65 岁及以上的成年人接种 IIV-HD、IIV-Adj 或 RIV,而不是其他流感疫苗。NACI 还继续强烈建议将 65 岁及以上的成年人纳入特别需要接种流感疫苗的人群。
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引用次数: 0
National Influenza Annual Report 2023-2024: A focus on influenza B and public health implications. 2023-2024 年全国流感年度报告:关注乙型流感及其对公共卫生的影响。
Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI: 10.14745/ccdr.v50i11a03
Myriam Ben Moussa, Andrea Nwosu, Kara Schmidt, Steven Buckrell, Abbas Rahal, Liza Lee, Amanda Shane, Nathalie Bastien

The 2023-2024 influenza epidemic saw the return of typical late-season influenza B circulation. The epidemic was declared in week 45 (week ending November 11, 2023) due to the predominant circulation of influenza A(H1N1) and peaked in week 52 (week ending December 30, 2023); however, as influenza A circulation decreased, influenza B detections and the percentage of tests positive increased, reaching its peak in week 14 (week ending April 6, 2024). Influenza B/Victoria dominated this wave of activity, contributing to the ongoing discussion about the apparent disappearance of influenza B/Yamagata. With the recommendation for the removal of influenza B/Yamagata lineages from the recommended seasonal influenza vaccine components, the influenza surveillance community is preparing for the possibility of a new seasonal pattern dominated by influenza B/Victoria circulation. This season, as a result of influenza B/Victoria's overwhelming predominance, younger age groups were primarily affected by the wave of influenza B activity. Over the course of the season, among all influenza B detections, 52% occurred in children aged 0-19 years. Among all influenza B-associated hospitalizations, 46.4% were in children aged 0-19 years, and the highest cumulative hospitalization rates for influenza B were among children younger than five years (n=37 per 100,000 population) and children between the ages of 5-19 years (n=15 per 100,000 population). Continued vigilance and surveillance around influenza B trends and epidemiology is required to contribute to effective epidemic preparedness.

在 2023-2024 年的流感疫情中,典型的晚季乙型流感再次流行。由于甲型 H1N1 流感的流行占主导地位,疫情在第 45 周(2023 年 11 月 11 日结束的一周)宣布爆发,并在第 52 周(2023 年 12 月 30 日结束的一周)达到高峰;然而,随着甲型流感流行的减少,乙型流感的检测结果和检测呈阳性的百分比都在增加,并在第 14 周(2024 年 4 月 6 日结束的一周)达到高峰。在这波活动中,乙型流感/维多利亚流感占主导地位,从而引发了有关乙型流感/山形流感明显消失的持续讨论。由于建议从推荐的季节性流感疫苗成分中剔除乙型/山形流感病毒系,流感监测界正在为可能出现以乙型/维多利亚流感病毒流行为主的新季节模式做准备。本季度,由于乙型流感/维多利亚型流感占压倒性优势,乙型流感活动浪潮主要影响了年轻群体。在本季所有检测到的乙型流感中,52%发生在 0-19 岁的儿童身上。在所有乙型流感相关住院病例中,0-19 岁儿童占 46.4%,乙型流感累计住院率最高的是 5 岁以下儿童(每 10 万人中有 37 例)和 5-19 岁儿童(每 10 万人中有 15 例)。需要继续对乙型流感趋势和流行病学保持警惕并进行监测,以促进有效的流行病防备工作。
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引用次数: 0
Locally acquired typhoid fever outbreak linked to chronic carriage in Ottawa, Canada, 2018-2022. 2018-2022年加拿大渥太华与慢性携带有关的地方性伤寒疫情。
Pub Date : 2024-11-07 eCollection Date: 2024-11-01 DOI: 10.14745/ccdr.v50i11a05
Janice Zhang, Ann Jolly, Tram Nguyen, Monir Taha, Christina Lee, Antoine Corbeil, Esther Dapaah, Jeff Walker, Curtis Cooper, Jacqueline Willmore

Background: In Canada, Salmonella enterica serovar Typhi infections are uncommon and typically travel-related. In November 2021, Ottawa Public Health identified a link between two typhoid fever cases, with no recent history of international travel, to the same grocery store ready-to-eat counter.

Objective: This report describes the outbreak response to a rare occurrence of chronic S. Typhi carriage in Ottawa, Ontario, Canada and provides recommendations for investigations of small-scale protracted outbreaks.

Methods: We administered exposure questionnaires using a single interviewer approach, tested stool samples of contacts and food handlers, inspected food premises, collected food samples and reviewed takeout receipts. Social network, spatial and whole genome sequencing analyses were used to investigate additional possible links between cases.

Results: Seven people with typhoid fever and onset from October 2018 to May 2022 were linked to an asymptomatic chronic S. Typhi carrier. Whole-genome sequencing confirmed that all eight isolates matched the outbreak cluster. All cases and carrier resided within an eight km radius in Ottawa. The chronic carrier worked as a food handler at various locations of a grocery store chain, including the implicated ready-to-eat counter. Transmission occurred via food handling, shared workspaces and social and household networks.

Conclusion: The chronic carrier was excluded from food handling until successful completion of treatment and clearance testing. We overcame the challenges of a small but prolonged outbreak by identifying an asymptomatic carrier using a multi-method approach including whole genome sequencing and social network analysis.

背景:在加拿大,肠炎沙门氏菌(Salmonella enterica serovar Typhi)感染并不常见,通常与旅行有关。2021 年 11 月,渥太华公共卫生部门发现两例伤寒病例与同一家杂货店即食柜台有关,而这两例病例近期并无国际旅行史:本报告介绍了加拿大安大略省渥太华市对罕见的慢性伤寒杆菌携带事件的疫情应对措施,并为小规模长期疫情调查提供了建议:方法:我们采用单一访问者方法发放接触调查问卷,检测接触者和食品处理者的粪便样本,检查食品经营场所,收集食品样本并审查外卖收据。我们还利用社会网络、空间和全基因组测序分析来调查病例之间可能存在的其他联系:2018年10月至2022年5月期间发病的7名伤寒患者与一名无症状的慢性伤寒杆菌携带者有关。全基因组测序证实,所有八个分离株都与疫情集群相匹配。所有病例和带菌者都居住在渥太华方圆八公里范围内。慢性带菌者曾在一家连锁杂货店的多个地点从事食品处理工作,包括涉事的即食柜台。传播途径包括食物处理、共用工作场所以及社会和家庭网络:结论:在成功完成治疗和清除测试之前,该慢性携带者不得从事食品处理工作。我们采用包括全基因组测序和社会网络分析在内的多种方法确定了一名无症状的带菌者,从而克服了小规模但持续时间长的疫情所带来的挑战。
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引用次数: 0
期刊
Canada communicable disease report = Releve des maladies transmissibles au Canada
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