Systematic community- and hospital-based surveillance for enterovirus-D68 in three Canadian provinces, August to December 2014.

Respiratory specimens collected from outpatients with influenza-like illness in three Canadian provinces (British Columbia (BC), Alberta and Quebec) participating in a community-based sentinel surveillance network were prospectively screened for enterovirus-D68 (EV-D68) from 1 August to 31 December 2014 and compared to specimens collected from 1 October 2013 to 31 July 2014. Eighteen (1%) of 1,894 specimens were EV-D68-positive: 1/348 (0.3%) collected from October to December 2013 and 11/460 (2.4%) from October to December 2014, an eight-fold increase in detection rates (p=0.01), consistent with epidemic circulation in autumn 2014. The remaining EV-D68 detections were in September 2014 (6/37). Enhanced passive surveillance was also conducted on all inpatient and outpatient EV-D68 cases (n=211) detected at the BC provincial reference laboratory from 28 August to 31 December 2014. Incidence of hospitalisations was 3/100,000 overall and 21, 17, 4 and 1/100,000 among those<5, 5-9, 10-19 and ≥20-years-old with male-to-female ratios>1 among paediatric but not adult cases. Three cases in BC with comorbidity or co-infection died and five exhibited neurological features persisting >9 months. Active surveillance in outpatient and inpatient settings is needed from more areas and additional seasons to better understand EV-D68 epidemiology and potential at-risk groups for severe or unusual manifestations.

Urban-rural divide in COVID-19 infection and vaccination rates in healthcare workers in British Columbia, Canada.

Introduction: Healthcare workers (HCWs) play a critical role in responding to the COVID-19 pandemic. Early in the pandemic, urban centres were hit hardest globally; rural areas gradually became more impacted. We compared COVID-19 infection and vaccine uptake in HCWs living in urban versus rural locations within, and between, two health regions in British Columbia (BC), Canada. We also analysed the impact of a vaccine mandate for HCWs. Methods: We tracked laboratory-confirmed SARS-CoV-2 infections, positivity rates and vaccine uptake in all 29,021 HCWs in Interior Health (IH) and all 24,634 HCWs in Vancouver Coastal Health (VCH), by occupation, age and home location, comparing to the general population in that region. We then evaluated the impact of infection rates as well as the mandate on vaccination uptake. Results: While we found an association between vaccine uptake by HCWs and HCW COVID-19 rates in the preceding 2-week period, the higher rates of COVID-19 infection in some occupational groups did not lead to increased vaccination in these groups. By 27 October 2021, the date that unvaccinated HCWs were prohibited from providing healthcare, only 1.6% in VCH compared with 6.5% in IH remained unvaccinated. Rural workers in both areas had significantly higher unvaccinated rates compared with urban dwellers. Over 1800 workers, comprising 6.7% of rural HCWs and 3.6% of urban HCWs, remained unvaccinated and set to be terminated from their employment. While the mandate prompted a significant increase in uptake of second doses, the impact on the unvaccinated was less clear. Conclusions: As rural areas often suffer from under-staffing, loss of HCWs could have serious impacts on healthcare provision as well as on the livelihoods of unvaccinated HCWs. Greater efforts are needed to understand how to better address the drivers of rural-related vaccine hesitancy.

Résumé Introduction: Les travailleurs de la santé (TS) jouent un rôle essentiel dans la réponse à la pandémie de COVID-19. Au début de la pandémie, les centres urbains ont été les plus durement touchés à l'échelle mondiale; les zones rurales ont progressivement été plus touchées. Nous avons comparé l'infection à la COVID-19 et l'adoption du vaccin chez les travailleuses et travailleurs de la santé vivant dans des zones urbaines et rurales au sein de deux régions sanitaires de la Colombie-Britannique (C.-B.), au Canada, et entre ces régions. Nous avons également analysé l'impact d'un mandat de vaccination pour les travailleuses et travailleurs de la santé. Méthodes: Nous avons suivi les infections au SRAS-CoV-2 confirmées en laboratoire, les taux de positivité et l'adoption du vaccin chez les 29 021 TS d'Interior Health (IH) et les 24 634 TS de Vancouver Coastal Health (VCH), par profession, âge et lieu de résidence, en les comparant à la population générale de cette région. Nous avons ensuite évalué l'impact des taux d'infection ainsi que du mandat sur le recours à la vaccination. Résultats: Bien que nous ayons trouvé une association entre l'adoption du vaccin par les TS et les taux de COVID-19 des travailleurs de la santé au cours de la période de deux semaines précédentes, les taux plus élevés d'infection par la COVID-19 dans certains groupes professionnels n'ont pas entraîné une augmentation de la vaccination dans ces groupes. En date du 27 octobre 2021, date à laquelle il était interdit aux travailleuses et travailleurs de santé non vaccinés de fournir des soins de santé, seul 1,6% des travailleuses et travailleurs de la VCH, contre 6,5% des travailleuses et travailleurs de l'IH, n'étaient toujours pas vaccinés. Les travailleuses et travailleurs ruraux des deux zones présentaient des taux de non-vaccination significativement plus élevés que les citadins. Plus de 1 800 travailleuses et travailleurs, soit 6,7% des TS ruraux et 3,6% des TS urbains, n'étaient toujours pas vaccinés et devaient être licenciés. Bien que le mandat ait entraîné une augmentation significative de la prise des deuxièmes doses, l'impact sur les personnes non-vaccinées était moins clair. Conclusions: Comme les zones rurales souffrent souvent d'un manque de personnel, la perte de TS pourrait avoir de graves répercussions sur la prestation des soins de santé ainsi que sur les moyens de subsistance des TS non-vaccinés. Des efforts plus importants sont nécessaires pour comprendre comment mieux aborder les facteurs d'hésitation à SE faire vacciner en milieu rural. Mots-clés: Travailleuses et travailleurs de la santé, COVID-19, vaccination, mandat de vaccination, milieu rural.

Shifts in mortality during a hot weather event in Vancouver, British Columbia: rapid assessment with case-only analysis.

OBJECTIVES: We assessed shifts in patterns of mortality during a hot weather event in greater Vancouver, British Columbia. METHODS: We used a case-only analysis to compare characteristics of individuals who died during the hottest week of 2009 with those who died (1) during earlier summer weeks in 2009 and (2) during the same calendar weeks in the summers of 2001 through 2008. RESULTS: Compared with the 8 previous weeks of 2009, odds of mortality during the summer's hottest week were highest in the 65 to 74 years age category, compared with the 85 years and older category (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.06, 2.03). The number of deaths at home increased over deaths in hospitals or institutions (OR = 1.43; 95% CI = 1.10, 1.86). Densely populated administrative health areas were more affected. CONCLUSIONS: A shift toward deaths at home suggests that in-home-based protective measures should be part of planning for hot weather events in greater Vancouver. Targeting should be considered for those aged 65 to 74 years. The case-only approach is quick and easy to apply and can provide useful information about localized, time-limited events.

Investigation of a pandemic H1N1 influenza outbreak in a remote First Nations community in northern Manitoba, 2009.

OBJECTIVES: First Nations communities in Manitoba were significantly affected by the pandemic H1N1 influenza virus (pH1N1) in 2009. Our objective was to conduct an epidemiologic investigation of a pH1N1 outbreak in one remote First Nations community (population 3,300) in northern Manitoba to inform a timely public health response and provide recommendations for preventing future outbreaks. METHODS: Chart reviews were conducted at the nursing station for patients meeting the influenza-like illness (ILI) case definition during the study period (April 20 to June 11, 2009). Descriptive analyses examined age, gender, clinical presentation, management, outcomes and risk factors. Comparisons were made for hospitalized versus non-hospitalized cases and laboratory-confirmed versus possible cases using Pearson's chi-square test for gender and symptoms and using a t-test for age. RESULTS: There were 180 ILI cases, including 23 laboratory-confirmed cases of pH1N1. Forty percent of children < 1 year old in the community and 9.4% of pregnant women presented to the nursing station with ILI. Most ILI cases were managed through the community nursing station, although 18.3% of cases (n = 33) were medically evacuated and 16.1% (n = 29) were hospitalized. There were no differences between hospitalized versus non-hospitalized or laboratory-confirmed versus possible cases. Risk factors identified in a subset of cases included exposure to an individual with ILI prior to illness onset, overcrowding and inadequate access to household water. CONCLUSIONS: Early arrival and rapid transmission of pH1N1 rendered usual non-pharmacological control measures largely ineffective. Recommendations for prevention of future outbreaks include an effective communications strategy and daily surveillance for disease detection and monitoring. Key determinants of health should be addressed in remote First Nations communities to prevent disease and protect the health of these populations.

Development and implementation of a Heat Alert and Response System in rural British Columbia.

SETTING: In 2018, a regional health authority in British Columbia (BC) initiated a multi-year project to support planning and response to extreme heat. Climate projections indicate that temperatures in the southern interior of BC will continue to increase, with concomitant negative impacts on human health. Successful climate change adaptation must include cross-sectoral action, inclusive of the health sector, to plan for and respond to climate-related events, including extreme heat. INTERVENTION: The objective of this project was to support the development and implementation of a Heat Alert and Response System (HARS) in a small, rural community. The health authority facilitated collaboration among provincial and local governments, community organizations, and First Nations partners to assess community assets, draft a plan for extreme heat, and prepare for a community-supported response during heat events. OUTCOMES: Stakeholders expressed the importance of utilizing existing partnerships and community resources, such as physical and procedural infrastructure, in which to embed the HARS. It was imperative that the plan be simple, concise, and considerate of the community's unique context. Educational materials and a tailored method of dissemination were important for collective and individual risk mitigation. IMPLICATIONS: A community-driven approach that utilized existing assets allowed for integration of HARS within municipal response plans and established infrastructure. The result is a sustainable public health intervention that has the potential to mitigate the negative health effects of extreme heat. Knowledge acquired through this initiative is informing similar HARS planning processes in other rural BC communities.

RéSUMé: Lieu En 2018, une régie régionale de la santé de la Colombie-Britannique a lancé un projet pluriannuel de soutien de la planification et des interventions face à la chaleur extrême. Selon les projections climatiques, les températures dans l'intérieur méridional de la province continueront d'augmenter, ce qui aura des effets nuisibles sur la santé humaine. Pour se préparer aux phénomènes climatiques comme la chaleur extrême et pour intervenir efficacement, les mesures d'adaptation doivent être intersectorielles et englober le secteur de la santé.Intervention Le projet visait à soutenir la création et la mise en œuvre d'un système d'alerte et d'intervention à la chaleur (SAIC) dans une petite communauté rurale. La régie de la santé a facilité la collaboration entre le gouvernement provincial, l'administration locale, les organismes associatifs et les partenaires des Premières Nations pour évaluer les actifs communautaires, dresser un plan en cas de chaleur extrême et se préparer à intervenir avec l'aide de la communauté durant les épisodes de chaleur.Résultats Les acteurs ont souligné l'importance d'utiliser les partenariats et les ressources communautaires existants, comme les infrastructures matérielles et administratives, et d'y intégrer le SAIC. Il fallait absolument que le plan soit simple et concis et qu'il tienne compte du contexte particulier de la communauté. Il a été jugé important d'avoir du matériel pédagogique et une méthode de diffusion créés sur mesure pour atténuer les risques individuels et collectifs.Conséquences Une approche communautaire utilisant les actifs existants a permis d'intégrer le SAIC dans les plans d'intervention municipaux et les infrastructures établies. Il en est résulté une intervention sanitaire durable qui peut potentiellement atténuer les effets néfastes de la chaleur extrême sur la santé. Les connaissances acquises grâce à cette initiative éclairent aujourd'hui des processus de planification de SAIC similaires dans d'autres communautés rurales de la Colombie-Britannique.

COVID-19 outbreak in a long-term care facility in Kelowna, British Columbia after rollout of COVID-19 vaccine in March 2021.

BACKGROUND: In March 2021, a coronavirus disease 2019 (COVID-19) outbreak was declared at a large long-term care and short stay facility in British Columbia, Canada-well after introduction of the vaccination program in long-term care facilities that resulted in a dramatic decline in the number of outbreaks in this type of setting. The objective of this study is to provide the descriptive epidemiology of this outbreak, in the context of partial immunization of both residents and staff at the facility. METHODS: The cases' information was extracted from a provincial information system (Panorama). Descriptive analysis was performed using Microsoft Excel and SAS. Outbreak management controls included, but were not limited to, asymptomatic testing and efforts to increase vaccination. RESULTS: Twenty-six cases among the 241 resident and three cases among the 418 staff (corresponding to attack rates of 10% and less than 1%, respectively) were identified. The attack rate in residents was considerably lower than the average attack rate for COVID-19 outbreaks in long-term care facilities before the vaccine rollout. Seventeen resident cases were either partially or fully immunized. Four of the eight hospitalized cases and two of the three deceased cases were partially immunized. Seventeen cases were temporary stay residents. The three staff cases were not vaccinated. Ten cases were identified as part of asymptomatic testing. CONCLUSION: Introduction of vaccination at facilities contributed to lower attack rates and higher numbers of asymptomatic cases in this outbreak. Screening asymptomatic individuals identified additional cases among vaccinated residents. Findings underscore the importance of achieving high vaccine coverage, including among temporary stay residents, to prevent virus introduction and subsequent unrecognized transmission opportunities.

Measuring the impact of influenza vaccination on healthcare worker absenteeism in the context of a province-wide mandatory vaccinate-or-mask policy.

OBJECTIVES: In 2012, British Columbia (BC) implemented a province-wide vaccinate-or-mask influenza prevention policy for healthcare workers (HCWs) with the aim of improving HCW coverage, and reducing illness in patients and staff. We assess post-policy impacts of HCW vaccination status on their absenteeism. METHODS: We matched individual HCW payroll data from December 1, 2012 to March 31, 2017 with annually self-reported vaccination status for BC health authority employees to assess sick rates (sick time as a proportion of sick time and productive time). We modelled adjusted odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates by vaccination status in influenza (December 1-March 31) and non-influenza seasons (April 1 to November 30). We used two methods to assess changes in influenza season sick rates for HCWs who had a change in their vaccination status over the five years. RESULTS: HCWs who reported 'early' vaccination (before December 1 when the policy is in effect) were less likely to take sick time (OR 0.874, 95%CI: 0.866-0.881) and took less sick time (RR 0.907, 95%CI: 0.901-0.912) in influenza season compared to HCWs who did not report vaccination; whereas HCWs who reported 'late' (between December 1 and March 31, and subject to masking until vaccinated) had similar sick rates to HCWs who did not report vaccination. These trends were also observed in non-influenza season. Influenza season sick rates were similar for HCWs that had at least one year of 'early' vaccination and one year where vaccination was not reported over the five year period. CONCLUSIONS: Overall absenteeism is lower among HCWs who report vaccination versus those who do not report. However, absenteeism behaviours appear to be influenced by individual level factors other than vaccination status.

Measuring the impact of a mandatory province-wide vaccinate-or-mask policy on healthcare worker absenteeism in British Columbia, Canada.

OBJECTIVES: Vaccinate-or-mask (VOM) policies aim to improve influenza vaccine coverage among healthcare workers (HCW) and reduce influenza-related illness among patients and staff. In 2012, British Columbia (BC) implemented a province-wide VOM influenza prevention policy. This study describes an evaluation of policy impacts on HCW absenteeism rates from before to after policy implementation. METHODS: Using payroll data from regional and provincial Health Authorities (HA), we assessed all-cause sick rates (sick time as a proportion of sick time and productive time) before (2007-2011, excluding 2009-2010) and after (2012-2017) policy implementation, and during influenza season (December 1-March 31) and non-influenza season (April 1-November 30). We used a two-part negative binomial hurdle model to calculate odds ratios (OR) of taking any sick time, relative rates (RR) of sick time taken, and predicted mean sick rates, adjusting for age group, sex, job type, job classification, HA, year and vaccine effectiveness. RESULTS: During influenza season, HCWs in the post-policy period were less likely to take any sick time (OR 0.989, 95%CI: 0.979-0.999) but had higher rates of sick time (RR 1.038, 95%CI: 1.030-1.045). However, during non-influenza season, HCWs in the post-policy period were more likely to take any sick time (OR 1.015, 95%CI: 1.008-1.022) but had lower rates of sick time (RR 0.971, 95%CI: 0.966-0.976). There was an overall increase in predicted mean sick rate from pre to post-policy in influenza season (4.392% to 4.508%) and non-influenza season (3.815% to 3.901%). CONCLUSIONS: The observed year-round increase in sick rates from pre-to-post policy was likely influenced by other factors; however, opposite trends in how HCWs took sick time in the influenza and non-influenza seasons may reflect policy influences and need further research to explore reasons for these differences.

Declaring a tuberculosis outbreak over with genomic epidemiology.

We report an updated method for inferring the time at which an infectious disease was transmitted between persons from a time-labelled pathogen genome phylogeny. We applied the method to 48 Mycobacterium tuberculosis genomes as part of a real-time public health outbreak investigation, demonstrating that although active tuberculosis (TB) cases were diagnosed through 2013, no transmission events took place beyond mid-2012. Subsequent cases were the result of progression from latent TB infection to active disease, and not recent transmission. This evolutionary genomic approach was used to declare the outbreak over in January 2015.

Incarcerated women develop a nutrition and fitness program: participatory research.

PURPOSE: Women in prison throughout the world experience higher rates of mental and physical illness compared with the general population and compared with men in prison. The paper finds no published studies that report on men or women in prison engaging in participatory health research to address their concerns about nutrition and fitness. The purpose of this paper is to describe a pilot nutrition and fitness program, which resulted from a unique prison participatory health research project. DESIGN/METHODOLOGY/APPROACH: Women in prison designed, led, and evaluated a six-week pilot fitness program in a minimum/medium security women's prison. Pre- and post-program assessments included a self-administered questionnaire and body measures. Open-ended questionnaire responses illuminated the quantitative findings. FINDINGS: Sixteen women in prison completed the program evaluation. Weight, body mass index, waist-to-hip ratio, and chest measurements decreased, and energy, sleep, and stress levels improved by the end of the program. RESEARCH LIMITATIONS/IMPLICATIONS: As a component of a participatory research project, incarcerated women designed and led a nutrition and fitness program, which resulted in improved body measures and self-reported health benefits. ORIGINALITY VALUE: Incarceration provides opportunities to engage women in designing their own health programs with consequent potential long-term "healing" benefits.