ABSTRACT
Context: Environmental changes will foster the spread of Ixodes scapularis ticks and increase the incidence of Lyme disease in Québec in the coming years. The objective of this study is to estimate the epidemiological and clinical burden and part of the current economic burden of Lyme disease in Québec and to estimate the number of cases expected by 2050. Methods: Cases of Lyme disease reported in Québec from 2015 to 2019 were used to describe their demographic, geographical and clinical characteristics and the cost of their initial care. Three incidence rate scenarios were then developed to estimate the number of cases expected by 2050, based on demographic and climate projections. Results: From 2016 to 2019, 1,473 cases of Lyme disease were reported in Québec. Over 90% of those cases were acquired in two regions of southern Québec (Estrie and Montérégie), while the individuals infected were residents from all over Québec. The average age of cases is 44 years and 66% of infections were at the localized stage, the first stage of Lyme disease. The cost of initial care is estimated at an average of $182 CAN per patient ($47 CAN at the localized stage and $443 CAN at the disseminated stage). According to projections, over 95% of the Québec population will live in a climate zone conducive to the establishment of ticks by 2050, with a number of cases acquired in Québec being 1.3 to 14.5 times higher than in 2019, depending on the incidence rate scenario used. Conclusion: The epidemiological burden is concentrated primarily in southern Québec, but the clinical and economic burden is already distributed throughout the province. The projections for 2050 should help the regions of Québec adapt and optimize public health protection measures.
ABSTRACT
Multidrug-resistant (MDR) Shigella sonnei have become prevalent among men who have sex with men and have become a global public health concern. From June 2017 to April 2019, 32 men were infected with MDR S. sonnei acquired locally, in Montréal, which was suggestive of an outbreak. Antimicrobial susceptibility testing, whole-genome sequencing (WGS), phylogenetic analysis, antimicrobial resistance and virulence characterization, and association to international clusters were performed. The outbreak strain was ceftriaxone- and azithromycin-resistant due to the acquisition of blaCTX-M-27, and mphA and ermB genes, respectively, with reduced susceptibility to ciprofloxacin due to a single point mutation (gyrA S83L). One out of 27 patients treated with a fluoroquinolone experienced microbiological failure. Epidemiological evidence first supported by a rare unique MDR Shigella sonnei documented only in men in 2017 followed by similar pulsed-field gel electrophoresis profiles was confirmed by WGS. A core genome high-quality single-nucleotide variant (hqSNV)-based phylogeny found a median of 6 hqSNV differences among isolates. Virulence gene content was investigated, but no Shiga toxins were detected. An international cluster of highly related isolates was identified (PDS000019750.208) and belonged to the 3.7.29.1.4.1 S. sonnei genotype (Global III VN2.KH1.Aus). Genomic analysis revealed that this Montréal cluster was connected to other documented outbreaks in Australia, the United States, and the United Kingdom. This study highlights the urgent need for public health measures to focus on the prevention and the early detection of S. sonnei, since global transmission patterns of MDR strains is concerning and few antimicrobial treatment options are available. IMPORTANCE Shigella sonnei, an important foodborne pathogen, recently became a frequent sexually transmitted agent involved in large and persistent outbreaks globally among men who have sex with men. Most strains also harbor several multidrug-resistant (MDR) determinants of particular concern. This study characterizes an outbreak strain at the source of an important MDR cluster identified in Montréal in 2017. Associations were made to many high-profile international outbreaks, and the causative S. sonnei lineage of these clusters was identified, which was not evident in past reports. The worldwide occurrence of this strain is of concern since treatment with antimicrobials like ceftriaxone and azithromycin may not be effective, and rare microbiological failures have been documented in patients treated with ciprofloxacin. Our investigation highlights the threats of Shigella spp. infection and the necessity for antimicrobial susceptibility monitoring in order to mitigate S. sonnei's impact on public health and to avoid transmission to other at-risk communities.
Subject(s)
Dysentery, Bacillary , Sexual and Gender Minorities , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Azithromycin/pharmacology , Ceftriaxone/pharmacology , Ceftriaxone/therapeutic use , Ciprofloxacin/pharmacology , Ciprofloxacin/therapeutic use , Drug Resistance, Bacterial/genetics , Dysentery, Bacillary/drug therapy , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/microbiology , Genomics , Homosexuality, Male , Humans , Male , Microbial Sensitivity Tests , Phylogeny , Shigella sonnei/geneticsABSTRACT
We analyzed 254 Shigella species isolates collected in Québec, Canada, during 2013 and 2014. Overall, 23.6% of isolates showed reduced susceptibility to azithromycin (RSA) encoded by mphA (11.6%), ermB (1.7%), or both genes (86.7%). Shigella strains with RSA were mostly isolated from men who have sex with men (68.8% or higher) from the Montreal region. A complete sequence analysis of six selected plasmids from Shigella sonnei and different serotypes of Shigella flexneri emphasized the role of IS26 in the dissemination of RSA.
Subject(s)
Azithromycin/pharmacology , Shigella/drug effects , Shigella/pathogenicity , Anti-Bacterial Agents/pharmacology , Canada , Homosexuality, Male/statistics & numerical data , Humans , Male , Microbial Sensitivity Tests , Quebec , Shigella flexneri/drug effects , Shigella flexneri/pathogenicity , Shigella sonnei/drug effects , Shigella sonnei/pathogenicityABSTRACT
From March 2014 to December 2016, a cluster of 13 cases of Campylobacter fetus intestinal and extraintestinal infections, including 2 patients with an aortic mycotic aneurysm, caused significant morbidity. The cluster likely resulted from sexual transmission between men having sex with men living in the greater Montreal area, Quebec, Canada.
Subject(s)
Campylobacter Infections/epidemiology , Campylobacter fetus/genetics , Disease Outbreaks/statistics & numerical data , Homosexuality, Male/statistics & numerical data , Sexually Transmitted Diseases, Bacterial/epidemiology , Adult , Aged , Anti-Bacterial Agents/pharmacology , Anti-Bacterial Agents/therapeutic use , Campylobacter Infections/drug therapy , Campylobacter Infections/microbiology , Campylobacter Infections/transmission , Campylobacter fetus/classification , Campylobacter fetus/drug effects , Cluster Analysis , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Quebec/epidemiology , Retrospective Studies , Sexually Transmitted Diseases, Bacterial/drug therapy , Sexually Transmitted Diseases, Bacterial/microbiology , Sexually Transmitted Diseases, Bacterial/transmissionSubject(s)
Anti-Bacterial Agents/pharmacology , Azithromycin/pharmacology , Ciprofloxacin/pharmacology , Drug Resistance, Bacterial , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/microbiology , Shigella flexneri/drug effects , Canada/epidemiology , Coinfection , Dysentery, Bacillary/diagnosis , Dysentery, Bacillary/history , HIV Infections/drug therapy , HIV Infections/virology , History, 21st Century , Humans , Microbial Sensitivity Tests , Population Surveillance , Shigella flexneri/geneticsSubject(s)
Anti-Bacterial Agents/pharmacology , Campylobacter Infections/microbiology , Campylobacter Infections/transmission , Campylobacter coli/drug effects , Drug Resistance, Multiple, Bacterial , Homosexuality, Male , Anti-Bacterial Agents/therapeutic use , Campylobacter Infections/drug therapy , Campylobacter Infections/epidemiology , Campylobacter coli/classification , Campylobacter coli/genetics , Disease Outbreaks , Electrophoresis, Gel, Pulsed-Field , Humans , Male , Microbial Sensitivity Tests , Quebec/epidemiology , beta-Lactamases/geneticsABSTRACT
From January 2003 to December 2013, sexual transmission of 2 clades of Campylobacter jejuni subspecies jejuni isolates resulted in a prolonged outbreak among men who have sex with men living in Quebec, Canada. The outbreak isolates were acquired locally and were resistant to erythromycin and ciprofloxacin.
Subject(s)
Anti-Bacterial Agents/pharmacology , Campylobacter Infections/epidemiology , Campylobacter jejuni/isolation & purification , Ciprofloxacin/pharmacology , Disease Outbreaks , Drug Resistance, Multiple, Bacterial , Erythromycin/pharmacology , Adult , Campylobacter Infections/microbiology , Campylobacter Infections/transmission , Campylobacter jejuni/drug effects , DNA, Bacterial/chemistry , DNA, Bacterial/genetics , Genotype , Homosexuality, Male , Humans , Male , Middle Aged , Molecular Epidemiology , Phylogeny , Quebec/epidemiology , Sequence Analysis, DNA , Sexually Transmitted Diseases, Bacterial/epidemiology , Sexually Transmitted Diseases, Bacterial/microbiology , Sexually Transmitted Diseases, Bacterial/transmission , Young AdultABSTRACT
During 2012-2013 in Montreal, Canada, 4 locally acquired Shigella spp. pulse types with the mph(A) gene and reduced susceptibility to azithromycin were identified from 9 men who have sex with men, 7 of whom were HIV infected. Counseling about prevention of enteric sexually transmitted infections might help slow transmission of these organisms.
Subject(s)
Anti-Bacterial Agents/pharmacology , Azithromycin/pharmacology , Drug Resistance, Bacterial , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/microbiology , Shigella/drug effects , Adult , Coinfection/epidemiology , Drug Resistance, Bacterial/genetics , Female , Genes, Bacterial , Homosexuality, Male , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Phosphotransferases (Alcohol Group Acceptor)/genetics , Public Health Surveillance , Quebec/epidemiology , Sexually Transmitted Diseases , Shigella/geneticsABSTRACT
During September 2010-November 2011, a cluster of erythromycin-susceptible, tetracycline- and ciprofloxacin-resistant Campylobacter coli pulsovar 1 infections was documented, involving 10 case-patients, in Montreal, Quebec, Canada. The findings suggested sexual transmission of an enteric infection among men who have sex with men.
Subject(s)
Campylobacter Infections/epidemiology , Campylobacter coli/genetics , Disease Outbreaks , HIV Infections/epidemiology , HIV/isolation & purification , Homosexuality, Male , Adult , Anti-Bacterial Agents/therapeutic use , Campylobacter Infections/drug therapy , Campylobacter Infections/microbiology , Campylobacter Infections/transmission , Campylobacter coli/isolation & purification , Ciprofloxacin/therapeutic use , Coinfection , Drug Resistance, Multiple, Bacterial , Erythromycin/therapeutic use , HIV Infections/virology , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Quebec/epidemiology , Retrospective Studies , Tetracycline/therapeutic useABSTRACT
In 2010, we observed isolates with matching pulsed-field gel electrophoresis patterns from 13 cases of ciprofloxacin-resistant Shigella sonnei in Montréal. We report on the emergence of this resistance type and a study of resistance mechanisms. The investigation suggested local transmission among men who have sex with men associated with sex venues.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Ciprofloxacin/therapeutic use , Drug Resistance, Bacterial , Dysentery, Bacillary/drug therapy , Homosexuality, Male , Shigella sonnei/drug effects , Adult , Aged , Canada/epidemiology , Disease Outbreaks , Dysentery, Bacillary/epidemiology , Dysentery, Bacillary/transmission , Electrophoresis, Gel, Pulsed-Field , Female , Humans , Male , Microbial Sensitivity Tests , Middle Aged , Molecular Typing , Sexual Behavior , Shigella sonnei/classification , Shigella sonnei/isolation & purification , Young AdultSubject(s)
Child Health Services/organization & administration , Immunization Programs/organization & administration , National Health Programs/organization & administration , Pneumococcal Infections/prevention & control , Pneumococcal Vaccines , Canada/epidemiology , Child , Humans , Immunization Schedule , Pneumococcal Infections/epidemiology , Risk Assessment , Risk FactorsABSTRACT
We identified 306 invasive group A streptococcal infections (IGASI) by passive population-based surveillance in Montreal, Canada, from 1995 to 2001. The average yearly reported incidence was 2.4 per 100,000 persons, with a 14% death rate. Among clinical manifestations, incidence of pneumonia increased from 0.06 per 100,000 in 1995 to 0.50 per 100,000 in 2000. Over a span of 7 years, the odds of developing pneumonia increased (odds ratio [OR] = 1.21, 95% confidence interval [CI] 1.0-1.5), while they decreased for soft-tissue infections (OR = 0.86, 95% CI 0.7-1.0). Serotypes M1 and M3 accounted for 30% of IGASI. However, neither serotype was significantly associated with specific clinical manifestations, which suggests that manifestation development among IGASI might be attributable to host or environmental factors rather than the pathogen. In our study, these factors included age, gender, underlying medical conditions, and living environment, yet none explained temporal changes in risk for pneumonia and soft-tissue infections.
Subject(s)
Population Surveillance , Streptococcal Infections/epidemiology , Streptococcal Infections/physiopathology , Streptococcus pyogenes/pathogenicity , Adolescent , Adult , Aged , Bacteremia/epidemiology , Canada/epidemiology , Child , Child, Preschool , Female , Humans , Incidence , Infant , Male , Middle Aged , Pneumonia, Bacterial/epidemiology , Pneumonia, Bacterial/microbiology , Risk Factors , Severity of Illness Index , Shock, Septic/epidemiology , Soft Tissue Infections/epidemiology , Soft Tissue Infections/microbiology , Streptococcal Infections/microbiology , Streptococcal Infections/mortalityABSTRACT
BACKGROUND: In the fall of 2000, a nine-year-old child living in Montreal (Québec) died of rabies encephalitis. Cases of human rabies had not been reported in Canada for 15 years. The molecular characterization of viral nucleic acid implicated the Ln/Ps variant associated with the silver-haired bat and the eastern pipistrelle. This article describes and analyzes the intervention carried out by public health. INTERVENTION AND DISCUSSION: The investigation revealed that contact with the bat must have occurred while the child was sleeping. Following the search for close contacts of the reference case, rabies postexposure prophylaxis (RPEP) was recommended to 59 people (3 household contacts, 12 playmates and 44 health care workers). Discussion with other public health departments in the province was important because of the media coverage of this case, which led to a considerable increase in the number of reported exposures to bats and in RPEP administration. CONCLUSION: Lessons learned from this event are that rapid and coordinated action with all stakeholders is essential to the success of this type of public health intervention and that the population must be informed of the risk of rabies transmission from bats.