Travel-related Zika virus cases in Canada: October 2015-June 2017.

BACKGROUND: Zika virus (ZIKV) is an emerging mosquito-borne disease that can cause severe birth defects if contracted congenitally. Since late 2015, there has been a large increase in the number of travel-related cases of Zika virus infection in Canada. OBJECTIVE: The objective of this study was to describe the epidemiology of travel-related Zika cases in Canada from October 2015 to June 2017 and review them in the context of the international outbreak in the Americas. METHODS: Zika virus infections were confirmed by polymerase chain reaction (PCR) detection of viral RNA and/or the serological identification of ZIKV-specific antibodies in serum. Cases of ZIKV infection were identified by provincial and territorial health authorities, and reported on a regular basis to the Public Health Agency of Canada (PHAC). Case information requested included date of illness onset, age category, sex, pregnancy status, and location(s) and dates of travel. Estimates for the monthly number of Canadians travelling outside of Canada to other countries in the Americas were obtained from Statistics Canada and the International Air Transport Association (IATA). Data to produce the epidemic curves of autochthonous cases for each region of the Americas were extracted from country-specific epidemic curves on the Pan American Health Organization website. RESULTS: As of June 7, 2017, 513 laboratory confirmed cases and two Zika-related birth/fetal anomalies were reported across all 10 provinces. Illness in Canadian travellers generally coincided with outbreak intensity in the country of exposure rather than travel volume. There has been no evidence of autochthonous (local) transmission in Canada. Currently, cases are on the decline both in Canada and internationally. CONCLUSION: The surge in Canadian ZIKV infections in 2016 was directly related to the incursion and spread of ZIKV into the Americas. Although cases are now on the decline worldwide, it remains to be seen whether a resurgence of cases in previously affected or new areas will occur. Both outbreak intensity and seasonality of ZIKV transmission should be monitored over time in order to inform the timing of public health education campaigns, as some may turn out to be more effective in the off-peak travel season when the risk of disease transmission may be higher. Ongoing education and awareness among travellers, particularly for pregnant women and those planning pregnancies, is still indicated.

Outbreak of Salmonella Typhimurium associated with feeder rodents.

In December 2012, an increase in human Salmonella Typhimurium cases was identified in the province of Ontario, Canada launching an outbreak investigation. The outbreak spanned 3 years (2012-2014), with 134 cases reported from five Canadian provinces. There was a substantial burden of illness among children: 45% of cases were children 12 years old or under, and 23% of cases were under 5 years old. Epidemiologic, traceback and laboratory findings linked this outbreak to feeder rodents (used to feed snakes) supplied by a network of rodent breeders in Ontario. Cases likely acquired their illness through either direct or indirect contact with feeder rodents. This investigation not only contributes to the weight of evidence on the risk that feeder rodents pose, but also underscores the importance of investigating indirect animal contact and associated risks, especially for high-risk individuals.

Estimates of the burden of illness for eight enteric pathogens associated with animal contact in Canada.

Enteric pathogens are commonly known to be transmitted through food or water; however, contact with animals is another important transmission route. This study estimated the annual burden of illness attributable to animal contact for eight enteric pathogens in Canada. Using data from a Canadian expert elicitation on transmission routes, the proportion of enteric illnesses attributable to animal contact was estimated for each pathogen to estimate the annual number of illnesses, hospitalizations and deaths in Canada. For each estimate, a mean and probability intervals were generated. Of all illnesses caused by these eight pathogens, 16% were estimated attributable to animal contact. This estimate translates to 86 000 (31 000-166 000) illnesses, 488 (186-890) hospitalizations and 12 (2-28) deaths annually for the eight pathogens combined. Campylobacter spp. is the leading cause of illnesses annually, with an estimated 38 000 (14 000-71 000) illnesses occurring each year, followed by non-typhoidal Salmonella spp. (17 000, 6000-32 000). The majority of hospitalizations were attributable to non-typhoidal Salmonella spp. (36%) and Campylobacter spp. (31%). Non-typhoidal Salmonella spp. (28%) and Listeria monocytogenes (31%) were responsible for the majority of the estimated deaths. These results identify farm animal and pet/pet food exposure as key pathways of transmission for several pathogens. The estimated burden of illness associated with animal contact is substantial.

International outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder - USA and Canada, 2013-2014.

Salmonella is a leading cause of bacterial foodborne illness. We report the collaborative investigative efforts of US and Canadian public health officials during the 2013-2014 international outbreak of multiple Salmonella serotype infections linked to sprouted chia seed powder. The investigation included open-ended interviews of ill persons, traceback, product testing, facility inspections, and trace forward. Ninety-four persons infected with outbreak strains from 16 states and four provinces were identified; 21% were hospitalized and none died. Fifty-four (96%) of 56 persons who consumed chia seed powder, reported 13 different brands that traced back to a single Canadian firm, distributed by four US and eight Canadian companies. Laboratory testing yielded outbreak strains from leftover and intact product. Contaminated product was recalled. Although chia seed powder is a novel outbreak vehicle, sprouted seeds are recognized as an important cause of foodborne illness; firms should follow available guidance to reduce the risk of bacterial contamination during sprouting.

The Canadian Rabies Management Plan: An integrated approach to the coordination of rabies activities in Canada.

Although human cases of rabies are exceptionally rare in Canada, rabies remains endemic in some animal populations thus creating the need for ongoing vigilance. Rabies has always been a shared responsibility among local, provincial/territorial and federal authorities, as reflected in the 2009 Canadian Rabies Management Plan. Since 2009, a number of changes in rabies management have occurred, including the development of new tests, an oral rabies vaccine for wildlife, lessons learned from recent animal cases and changes in federal, provincial and territorial responsibilities in 2014. Federal departments and agencies continue to support rabies management through a number of activities. As the rabies landscape continues to evolve, so too must the strategies and frameworks required to manage this disease. As a result, the Canadian Rabies Management Plan and the North American Rabies Management Plan are being revised.

Outbreak of E. coli O157:H7 associated with lettuce served at fast food chains in the Maritimes and Ontario, Canada, Dec 2012.

BACKGROUND: Identification and control of multi-jurisdictional foodborne illness outbreaks can be complex because of their multidisciplinary nature and the number of investigative partners involved. OBJECTIVE: To describe the multi-jurisdictional outbreak response to an E. coli O157:H7 outbreak in Canada that highlights the importance of early notification and collaboration and the value of centralized interviewing. METHODS: Investigators from local, provincial and federal jurisdictions, using a national outbreak response protocol to clarify roles and responsibilities and facilitate collaboration, conducted a rapid investigation that included centralized re-interview of cases, descriptive methods, binomial probability, and traceback findings to identify the source of the outbreak. RESULTS: There were 31 laboratory confirmed cases identified in New Brunswick, Nova Scotia, and Ontario. Thirteen cases (42%) were hospitalized and one case (3%) developed hemolytic uremic syndrome; there were no deaths. Due to early notification a coordinated investigation was initiated before laboratory subtyping was available. Re-interview of cases identified 10 cases who had not initially reported exposure to the source of the outbreak. Less than one week after the Outbreak Investigation Coordinating Committee was formed, consumption of shredded lettuce from a fast food chain was identified as the likely source of the illnesses and the implicated importer/processor initiated a precautionary recall the same day. CONCLUSION: This outbreak investigation highlights the importance of early notification, prompt re-interviewing and collaboration to rapidly identify the source of an outbreak.

The effect of nitrous oxide on halothane, isoflurane and sevoflurane requirements in ventilated dogs undergoing ovariohysterectomy.

OBJECTIVE: To examine the effect of 64% nitrous oxide (N2O) on halothane (HAL), isoflurane (ISO) or sevoflurane (SEV) requirements in dogs undergoing ovariohysterectomy. STUDY DESIGN: Prospective, randomized, clinical trial. ANIMALS: Ninety, healthy dogs of (mean +/- SD) body weight 21.2 +/- 10.0 kg and age 17.8 +/- 22.8 months. MATERIALS AND METHODS: After premedication with acepromazine, hydromorphone and glycopyrrolate, anesthesia was induced with thiopental administered to effect. Dogs received one of six inhalant protocols (n = 15 group): HAL; HAL/N2O; ISO; ISO/N2O; SEV; or SEV/N2O. End-tidal CO2 was maintained at 40 +/- 2 mmHg with intermittent positive pressure ventilation (IPPV). Body temperature, heart rate, indirect systemic arterial blood pressures, inspired and end-tidal CO2, volatile agent, N2O and O2 were recorded every 5 minutes. The vaporizer setting was decreased in 0.25-0.5% decrements to elicit a palpebral reflex, and this level maintained. Statistical analysis included two-way anova for repeated measures with Bonferroni's correction factor and statistical significance assumed when p < 0.05. Percentage reduction in end-tidal volatile agent was calculated at 60 minutes after starting study. RESULTS: End-tidal HAL, ISO and SEV decreased when N2O was administered. Percentage reduction: HAL (12.4%); ISO (37.1%) and SEV (21.4%). Diastolic, mean and systolic blood pressures increased in ISO/N2O compared with ISO. Heart rate increased in ISO/N2O and SEV/N2O compared with ISO and SEV, respectively. Systolic, mean and diastolic blood pressures increased in SEV compared with HAL and ISO. Systolic, mean, diastolic blood pressures and heart rate increased in SEV/N2O and ISO/N2O compared with HAL/N2O. CONCLUSIONS: N2O reduces HAL, ISO and SEV requirements in dogs undergoing ovariohysterectomy. Cardiovascular stimulation occurred when N2O was used with ISO, less so with SEV and not with HAL