Economic Burden of West Nile Virus Disease, Quebec, Canada, 2012-2013.

The economic burden of West Nile virus (WNV) infection is not known for Canada. We sought to describe the direct and indirect costs of WNV infection in the province of Quebec, Canada, up to 2 years after onset of signs and symptoms. We conducted a retrospective cohort study that included WNV cases reported during 2012 and 2013. For 90 persons infected with WNV, persons with encephalitis accounted for the largest proportion of total cost: a median cost of $21,332 per patient compared with $8,124 for West Nile meningitis (p = 0.0004) and $192 for West Nile fever (p<0.0001). When results were extrapolated to all reported WNV patients, the estimated total cost for 124 symptomatic cases was ≈$1.7 million for 2012 and that for 31 symptomatic cases was ≈$430,000 for 2013. Our study provides information for the government to make informed decisions regarding public health policies and infectious diseases prevention and control programs.

Lyme disease: Knowledge and practices of family practitioners in southern Quebec.

BACKGROUND: Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management. OBJECTIVES: To describe FPs' clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie). METHODS: In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans). RESULTS: A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%). CONCLUSION: The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.

HISTORIQUE: Les autorités en santé publique du Québec ont répondu à l'émergence progressive de la maladie de Lyme (ML) par des activités de surveillance et des formations pour les médecins de famille (MF), qui sont des acteurs majeurs en matière de vigilance et de prise en charge. OBJECTIFS: Décrire l'expérience clinique des MF à l'égard de la ML, leur degré de connaissances et leurs pratiques dans deux régions, l'une comptant des populations connues de tiques infectées (Montérégie) et l'autre n'en comptant pas (régions à proximité de la Montérégie). MÉTHODOLOGIE: Dans la présente étude transversale descriptive, les MF ont été recrutés pendant des séances de formation. Ils ont été invités à remplir un questionnaire visant à évaluer leur expérience clinique de la ML, leurs connaissances des signes et symptômes de cette maladie et leurs connaissances des directives acceptées pour diagnostiquer et traiter la ML pour deux scénarios cliniques (piqûre de tique et érythème migrant). RÉSULTATS: Au total, 201 MF ont participé, la plupart provenant de la Montérégie (n=151). Dans l'ensemble, les résultats ont révélé un manque modéré de connaissances et des pratiques sous-optimales plutôt que des connaissances systématiquement insuffisantes ou des pratiques inadéquates. La majorité des participants ont convenu avoir besoin de plus de formation sur la ML. Comme prévu, les MF de la Montérégie avaient une plus grande expérience clinique des piqûres de tique (57 % par rapport à 25 %), connaissaient mieux les régions endémiques de la ML au Canada et les caractéristiques de l'érythème migrant et prenaient mieux en charge l'érythème migrant (72 % par rapport à 50 %). CONCLUSION: La présente étude a permis de constater l'intention inappropriée de demander des tests sérologiques après une piqûre de tique et d'analyser les tiques pour corroborer le diagnostic de ML. Il faut décourager ces pratiques, car elles sont inutiles et favorisent la surutilisation collective des laboratoires et des ressources médicales. Par ailleurs, les autorités en santé publique doivent poursuivre leurs efforts de formation auprès des MF pour optimiser la prise en charge des cas.

A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality.

BACKGROUND: In March 2003, several hospitals in Quebec, Canada, noted a marked increase in the incidence of Clostridium difficile-associated diarrhea. METHODS: In 2004 we conducted a prospective study at 12 Quebec hospitals to determine the incidence of nosocomial C. difficile-associated diarrhea and its complications and a case-control study to identify risk factors for the disease. Isolates of C. difficile were typed by pulsed-field gel electrophoresis and analyzed for binary toxin genes and partial deletions in the toxin A and B repressor gene tcdC. Antimicrobial susceptibility was evaluated in a subgroup of isolates. RESULTS: A total of 1703 patients with 1719 episodes of nosocomial C. difficile-associated diarrhea were identified. The incidence was 22.5 per 1000 admissions. The 30-day attributable mortality rate was 6.9 percent. Case patients were more likely than matched controls to have received fluoroquinolones (odds ratio, 3.9; 95 percent confidence interval, 2.3 to 6.6) or cephalosporins (odds ratio, 3.8; 95 percent confidence interval, 2.2 to 6.6). A predominant strain, resistant to fluoroquinolones, was found in 129 of 157 isolates (82.2 percent), and the binary toxin genes and partial deletions in the tcdC gene were present in 132 isolates (84.1 percent). CONCLUSIONS: A strain of C. difficile that was resistant to fluoroquinolones and had binary toxin and a partial deletion of the tcdC gene was responsible for this outbreak of C. difficile-associated diarrhea. Exposure to fluoroquinolones or cephalosporins was a risk factor.