What might the future bring? COVID-19 planning considerations for faculty and universities.

This paper applies a scenario planning approach, to outline some current uncertainties related to COVID-19 and what they might mean for plausible futures for which we should prepare, and to identify factors that we as individual faculty members and university institutions should be considering now, when planning for the future under COVID-19. Although the contextual focus of this paper is Canada, the content is likely applicable to other places where the COVID-19 epidemic curve is in its initial rising stage, and where universities are predominantly publicly funded institutions.

Associating sporadic, foodborne illness caused by Shiga toxin-producing Escherichia coli with specific foods: a systematic review and meta-analysis of case-control studies.

Shiga toxin-producing Escherichia coli (STEC) infections are a significant public health issue, with foodborne transmission causing >1 million illnesses worldwide each year. We conducted a systematic review and meta-analysis (PROSPERO registry # CRD42017074239), to determine the relative association of different food types with sporadic illnesses caused by STEC. Searches were conducted from 01 August to 30 September 2017, using bibliographic and grey literature databases, websites and expert consultation. We identified 22 case-control studies of sporadic STEC infection in humans, from 10 countries within four World Health Organization subregions, from 1985 to 2012. We extracted data from 21 studies, for 237 individual measures in 11 food categories and across three status types (raw or undercooked, not raw and unknown). Beef was the most significant food item associated with STEC illness in the Americas and Europe, but in the Western Pacific region, chicken was most significant. These findings were not significantly moderated by the raw or cooked status of the food item, nor the publication year of the study. Data from the African, South-East Asian and Eastern Mediterranean subregions were lacking and it is unclear whether our results are relevant to these regions.

Integrated surveillance and potential sources of Salmonella enteritidis in human cases in Canada from 2003 to 2009.

Salmonella enteritidis has emerged as the most prevalent cause of human salmonellosis in Canada. Recent trends of S. enteritidis subtypes and their potential sources were described by integrating Salmonella data from several Canadian surveillance and monitoring programmes. A threefold increase in S. enteritidis cases from 2003 to 2009 was identified to be primarily associated with phage types 13, 8 and 13a. Other common phage types (4, 1, 6a) showed winter seasonality and were more likely to be associated with cases linked to international travel. Conversely, phage types 13, 8 and 13a had summer seasonal peaks and were associated with cases of domestically acquired infections. During agri-food surveillance, S. enteritidis was detected in various commodities, most frequently in chicken (with PT13, PT8 and PT13a predominating). Antimicrobial resistance was low in human and non-human isolates. Continued integrated surveillance and collaborative prevention and control efforts are required to mitigate future illness.

Drinking water consumption patterns in Canadian communities (2001-2007).

A pooled analysis of seven cross-sectional studies from Newfoundland and Labrador, Waterloo and Hamilton Regions, Ontario and Vancouver, East Kootenay and Northern Interior Regions, British Columbia (2001 to 2007) was performed to investigate the drinking water consumption patterns of Canadians and to identify factors associated with the volume of tap water consumed. The mean volume of tap water consumed was 1.2 L/day, with a large range (0.03 to 9.0 L/day). In-home water treatment and interactions between age and gender and age and bottled water use were significantly associated with the volume of tap water consumed in multivariable analyses. Approximately 25% (2,221/8,916) of participants were classified as bottled water users, meaning that 75% or more of their total daily drinking water intake was bottled. Approximately 48.6% (4,307/8,799) of participants used an in-home treatment method to treat their tap water for drinking purposes. This study provides a broader geographic perspective and more current estimates of Canadian water consumption patterns than previous studies. The identified factors associated with daily water consumption could be beneficial for risk assessors to identify individuals who may be at greater risk of waterborne illness.

Hospitalization and deaths for select enteric illnesses and associated sequelae in Canada, 2001-2004.

This paper describes morbidity and mortality parameters for Campylobacter spp., Salmonella spp., enterohaemorrhagic Escherichia coli, Listeria spp., norovirus infections and their primary associated sequelae [Guillain-Barré syndrome (GBS), haemolytic uraemic syndrome, reactive arthropathies and Reiter's syndrome]. Data from a period of 4 years were obtained from three national databases to estimate percentage of reported cases hospitalized, mean annual hospitalization incidence rate, frequency of hospitalization by age and sex, and number of deaths. The length of hospital stay, discharge disposition, hospitalization age, and number of diagnoses per case were also extracted and summarized. In addition, we estimated that each year in Canada, there are between 126 and 251 cases of Campylobacter-associated GBS. This study provides morbidity and mortality estimates for the top enteric pathogens in Canada, including their associated sequelae, which can contribute to the quantification of the burden of illness.

Burden of acute gastrointestinal illness in the Metropolitan region, Chile, 2008.

The purpose of this study was to determine the magnitude and distribution of acute gastrointestinal illness (GI) in the Chilean population, describe its burden and presentation, identify risk factors associated with GI and assess the differences between a 7-day, 15-day and a 30-day recall period in the population-based burden of illness study design. Face-to-face surveys were conducted on 6047 randomly selected residents in the Metropolitan region, Chile (average response rate 75·8%) in 2008. The age-adjusted monthly prevalence of GI was 9·2%. The 7-day recall period provided annual incidence rate estimates about 2·2 times those of the 30-day recall period. Age, occupation, healthcare system, sewer system, antibiotic use and cat ownership were all found to be significant predictors for being a case. This study expands on the discussion of recall bias in retrospective population studies and reports the first population-based burden and distribution of GI estimates in Chile.

Respiratory symptoms and the case definition of gastroenteritis: an international analysis of the potential impact on burden estimates.

Estimates of the burden of foodborne disease rely on attributing a proportion of syndromic gastroenteritis to foodborne transmission. Persons with syndromic diarrhoea/vomiting can also present with concurrent respiratory symptoms that could be due to respiratory infections, gastrointestinal infections, or both. This distinction is important when estimating the foodborne disease burden but has rarely been considered. Using data from population surveys from Australia, Canada and the USA we describe the effect of excluding persons with respiratory and associated symptoms from the case definition of gastroenteritis. Excluding persons first with respiratory symptoms, or second with respiratory symptoms plus fever and headache, resulted in a decrease in the weighted estimates of acute gastroenteritis of about 10-50% depending on the exclusion criteria. This has the potential to have a very significant impact on estimates of the burden of foodborne infections using syndromic case definitions of acute gastroenteritis.

Estimation of the costs of acute gastrointestinal illness in British Columbia, Canada.

The costs associated with gastrointestinal infection (GI) in the province of British Columbia, Canada, were estimated using data from a population-based survey in three health service delivery areas, namely Vancouver, East Kootenay and Northern Interior. The number of cases of disease, consequent expenditure of resources and associated economic costs were modeled as probability distributions in a stochastic model. Using 2004 prices, the estimated mean annual cost per capita of gastrointestinal infection was CAN$128.61 (207.96 euros), with a mean annual cost per case of CAN$1,342.57 (2,170.99 euros). The mean estimate of the overall economic burden to British Columbia was CAN$514.2 million (831.5 million euros) (95% CFI CAN$161.0 million to CAN$5.8 billion; 260.3 million euros to 9.38 billion euros). The major element of this cost was the loss of productivity associated with time away from paid employment by both the sick and their caregivers. Sensitivity analysis suggested that the uncertainty associated with the base model assumptions did not significantly affect the estimates. The results are comparable to those obtained in an earlier study using a similar analytical framework and data from the city of Hamilton, Ontario, Canada.

Burden of acute gastrointestinal illness in Canada, 1999-2007: interim summary of NSAGI activities.

INTRODUCTION: The National Studies on Acute Gastrointestinal Illness (NSAGI) initiative was designed to generate baseline period prevalence rates of self-reported AGI in communities across Canada, assess the burden associated with AGI, and quantify the under-reporting of AGI in Canada's national enteric disease reporting systems. METHODS: Methods utilized included population surveys administered randomly via telephone services. Three population surveys in three locations within Canada included over 10,000 residents. Questions pertained to recent symptoms as well as socio-demographic factors, use of the health care system and missed work or school due to illness. RESULTS: In summary of published results, there are an estimated 1.3 episodes of AGI per person-year and an estimated 10-47, 13-37 and 23-49 cases in the community for every case of verotoxigenic Escherichia coli, Salmonella and Campylobacter, respectively, captured within the national surveillance system. AGI represents an annual per capita cost of $115 CAD. DISCUSSION: The work of NSAGI highlights the significant burden and impact of AGI in the Canadian population. These results will also be incorporated into the current work at the World Health Organization (WHO) to estimate the global burden of food related illnesses.

Drinking water consumption patterns in British Columbia: an investigation of associations with demographic factors and acute gastrointestinal illness.

A cross-sectional telephone survey was performed in the province of British Columbia, Canada, to investigate drinking water consumption patterns and their associations with various demographic characteristics and acute gastrointestinal illness (AGI). Water consumption included plain water and water used in the preparation of cold beverages. The median amount of water consumed daily was four-250 mL servings (1.0 L), although responses were highly variable (0 to 9.0 L). Alternative water use was common: bottled water was the primary source of drinking water (i.e. >or=75% of the total daily water intake) for 23% of respondents and 47% of households used in-home water treatment methods. Approximately 10% of respondents reported an episode of AGI (vomiting or diarrhea) in the previous 4-week period. Such illness was associated with age (continuous variable in years, OR=-0.98), sex (male vs. female, OR=0.8) and the amount of water consumed (continuous variable in 250-mL servings, OR=1.06); however, a causal relationship with water consumption cannot be established based on this study alone. Overall, the associations of drinking water patterns with age, sex, education, and household income serve as important reminders to researchers and public health professionals of the non-uniform nature of drinking water consumption, and indicate potential differences in exposure to waterborne hazards in this population.

Drinking water consumption patterns of residents in a Canadian community.

A cross-sectional survey using computer-assisted telephone interviewing was performed to assess the drinking water consumption patterns in a Canadian community, and to examine the associations between these patterns and various demographic characteristics. The median amount of water consumed daily was four 250 ml servings (1.01), although responses were highly variable (0 to 8.01). Bottled water consumption was common, and represented the primary source of drinking water for approximately 27% of respondents. Approximately 49% of households used water treatment devices to treat their tap water. The observed associations between some demographic characteristics and drinking water consumption patterns indicated potential differences in risk of exposure to waterborne hazards in the population. Our results lend support to the federal review of the bottled water regulations currently in progress in Canada. Additionally, they may lend support to a provincial/territorial government review of bottled water regulations, and both federal and provincial/territorial level reviews of the water treatment device industry. Further investigation of the use of alternative water sources and the perceptions of drinking water in Canada is also needed to better understand, and subsequently address, concerns among Canadians.

Burden and cost of gastroenteritis in a Canadian community.

This study estimated the health burden and costs associated with gastroenteritis in the City of Hamilton (Ontario, Canada). The number of cases, number of different resource units used, and cost per resource unit were represented by probability distributions and point estimates. These were subsequently integrated in a stochastic model to estimate the overall burden and cost in the population and to depict the uncertainty of the estimates. The estimated mean annual cost per capita was Can dollar 115. The estimated mean annual cost per case was Can dollar 1,089 and was similar to other published figures. Gastroenteritis represented a significant burden in the study population, with costs high enough to justify prevention efforts. These results, currently the most accurate available estimates for a Canadian population, can inform future economic evaluations to determine the most cost effective measures for reducing the burden and cost of gastroenteritis in the community.

Descriptive analysis of endemic cryptosporidiosis cases reported in Ontario, 1996-1997.

Endemic cryptosporidiosis in Ontario was studied using notifiable disease data from the Ontario Ministry of Health for the years 1996-1997 inclusive. For this study period, 451 endemic cases were identified, corresponding to a provincial mean annual age- and sex-adjusted incidence rate of 2.13 cases per 100,000. Children under five years of age had the highest incidence of disease. Males had a higher incidence than females, except for those 15-19 years of age. Five percent of cases were reported as HIV-positive or having AIDS. The proportion of cases occurring between July and November inclusive (63%) was significantly higher than expected (42%) assuming no seasonal variation (p < 0.01). The proportion of rural cases observed (29%) was significantly higher than expected (17%) based on the Ontario population (p < 0.01). Travel to or prior residence in an endemic area was identified in 22% of the cases where a risk setting was reported (n = 265).

A descriptive analysis of giardiasis cases reported in Ontario, 1990-1998.

Cases of giardiasis in Ontario were described using notifiable disease data from the Ontario Ministry of Health for the years 1990-1998 inclusive. The mean annual age- and sex-adjusted incidence rate was 25.77 cases per 100,000 population for the 25,289 cases reported. Children under five years of age had the highest incidence of disease. Males had a higher mean annual incidence in all age groups. Four deaths occurred among cases. The most frequently reported symptoms were loose stools or watery diarrhea (50.1%). A seasonal pattern was noted, peaking in late summer and early autumn. The most frequently reported probable risk settings were the home (40.1%) and travel (39.1%). The study findings suggest that a high proportion of cases occur in urban areas and spatial analysis showed the highest incidence around Lake Huron and Georgian Bay. Unfiltered water and person-to-person contact are believed to be important sources of infection.

Perceptions of risk and optimistic bias for acute gastrointestinal illness: a population survey.

Optimistic bias refers to the tendency of individuals to believe that they are less likely to experience negative events compared with other people. Individuals who perceive their risk of an adverse health event to be low may not be as receptive to informational messages aimed at disease prevention. Our objective was to estimate the magnitude of optimistic bias for acute gastrointestinal illness, and to describe demographic associations with, and reasons for, individuals' perception of personal risk. Data were obtained by a retrospective, cross-sectional telephone survey of 2057 randomly selected English-speaking residents of Ontario, Canada conducted between May 2005 and April 2006. Data were collected on the occurrence of acute gastrointestinal illness during the 28 days prior to the survey, demographics, respondents' perception of their personal risk of acute gastrointestinal illness compared with the average person, and the reasons for this perception. Associations with perception of illness were evaluated using ordinal logistic regression and reasons for perception of risk were explored qualitatively. Optimistic bias was present among all respondents, but was not statistically significant within the group that had experienced acute gastrointestinal illness in the previous 28 days. Rural residency and not having experienced acute gastrointestinal illness in the previous 28 days were associated with a lower perception of risk compared with the average person. Proportionally fewer individuals who had not completed secondary education saw themselves as at less than average risk. The most common reason given for the perception of lower risk was that the respondent was healthier than the average person, although personal lifestyle choices also were provided as reasons. The presence of optimistic bias may negatively impact compliance with public health initiatives to reduce acute gastrointestinal illness. Therefore, recognizing the demographic characteristics associated with a perception of lower risk and understanding the reasons for this perception may help with targeting effective preventive messaging.

The burden of acute gastrointestinal illness in Ontario, Canada, 2005-2006.

A retrospective, cross-sectional telephone survey (n=2090) was conducted in Ontario, Canada, between May 2005 and April 2006, to determine the burden of acute gastrointestinal illness in the population. The 4-week prevalence was 8.56% (95% CI 7.36-9.76); in households with more than one resident, 35% of cases reported someone else in their household had similar symptoms at the same time. The annual adjusted incidence rate was 1.17 (95% CI 0.99-1.35) episodes per person-year, with higher rates in females, rural residents, and in the winter and spring. Health care was sought by 22% of cases, of which 33% were asked to provide a stool sample. Interestingly, 2.2% of cases who did not visit a health-care provider reported self-administering antibiotics. Overall, acute gastrointestinal illness appears to pose a significant burden in the Ontario population. Further research into the specific aetiologies and risk factors is now needed to better target intervention strategies.

A common, symptom-based case definition for gastroenteritis.

National studies determining the burden of gastroenteritis have defined gastroenteritis by its clinical picture, using symptoms to classify cases and non-cases. The use of different case definitions has complicated inter-country comparisons. We selected four case definitions from the literature, applied these to population data from Australia, Canada, Ireland, Malta and the United States, and evaluated how the epidemiology of illness varied. Based on the results, we developed a standard case definition. The choice of case definition impacted on the observed incidence of gastroenteritis, with a 1.5-2.1 times difference between definitions in a given country. The proportion of cases with bloody diarrhoea, fever, and the proportion who sought medical care and submitted a stool sample also varied. The mean age of cases varied by <5 years under the four definitions. To ensure comparability of results between studies, we recommend a standard symptom-based case definition, and minimum set of results to be reported.

Magnitude and distribution of acute, self-reported gastrointestinal illness in a Canadian community.

To estimate the magnitude and distribution of self-reported, acute gastrointestinal illness in a Canadian-based population, we conducted a retrospective, cross-sectional telephone survey of approximately 3500 randomly selected residents of the city of Hamilton (Ontario, Canada) from February 2001 to February 2002. The observed monthly prevalence was 10% (95 % CI 9.94-10.14) and the incidence rate was 1.3 (95 % CI 1.1-1.4) episodes per person-year; this is within the range of estimates from other developed countries. The prevalence was higher in females and in those aged < 10 years and 20-24 years. Overall, prevalence peaked in April and October, but a different temporal distribution was observed for those aged < 10 years. Although these data were derived from one community, they demonstrate that the epidemiology of acute gastrointestinal illness in a Canadian-based population is similar to that reported for other developed countries.