Emergency department presentations for hoverboard-related injuries: the electronic Canadian Hospitals Injury Reporting and Prevention Program, 2015 to 2016. / Blessures associées aux planches gyroscopiques traitées dans les services d'urgence au Canada : plate-forme électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2015-2016.

TITRE: Blessures associées aux planches gyroscopiques traitées dans les services d'urgence au Canada : plate forme électronique du Système canadien hospitalier d'information et de recherche en prévention des traumatismes, 2015-2016.

Surveillance of the emerging enterovirus D68 in Canada: An evaluation.

BACKGROUND: In the fall of 2014, in response to outbreaks of an emerging respiratory pathogen enterovirus D68 (EV-D68) which affected mostly children, a rapid time-limited surveillance pilot for hospitalized cases was conducted in seven Canadian jurisdictions. OBJECTIVE: To evaluate whether the goals of the EV-D68 pilot were met and to determine the benefits of and lessons learned from a rapid-response surveillance system for emerging pathogens. METHODS: An evaluation survey was created and administered via a secure online link. All provinces and territories (PTs) and federal partners involved in the pilot were invited to complete one survey per jurisdiction (N=17). Proportions were calculated for responses to closed-ended questions and recurring themes were identified for open-ended questions. RESULTS: Fifty four percent (7/13) of PTs and 50% (2/4) of federal partners completed the survey. All four goals of the pilot were met to some degree. All respondents agreed that there were important benefits to rapid surveillance initiatives for emerging pathogens including the capacity to: better understand the epidemiological and clinical features as well as the public health risk of emerging pathogens (66.7%); inform public health action (66.7%); collaborate and avoid duplication of work (11.1%); test and develop jurisdictional capacity (11.1%); and inform future response efforts (11.1%). Receiving timely case summaries (preferably weekly) was identified as important for 88% of respondents. In terms of lessons learned, more than half of respondents (66.7%) indicated that current processes needed to be improved in order to facilitate rapid surveillance initiatives within and across jurisdictions including the need to develop data-sharing agreements and have pre-existing protocols. Important factors identified for a surveillance data reporting platform included: ease of functionality, data security, jurisdictional control, web-based and flexibility to meet changing surveillance needs. CONCLUSION: Evaluation results from the EV-D68 surveillance pilot will assist with future rapid surveillance initiatives. It is important that lessons learned be addressed prior to the emergence of the next emerging pathogen.

Epidemiological features of influenza in Canadian adult intensive care unit patients.

To identify predictive factors and mortality of patients with influenza admitted to intensive care units (ICU) we carried out a prospective cohort study of patients hospitalized with laboratory-confirmed influenza in adult ICUs in a network of Canadian hospitals between 2006 and 2012. There were 626 influenza-positive patients admitted to ICUs over the six influenza seasons, representing 17·9% of hospitalized influenza patients, 3·1/10,000 hospital admissions. Variability occurred in admission rate and proportion of hospital influenza patients who were admitted to ICUs (proportion range by year: 11·7-29·4%; 21·3% in the 2009-2010 pandemic). In logistic regression models ICU patients were younger during the pandemic and post-pandemic period, and more likely to be obese than hospital non-ICU patients. Influenza B accounted for 14·2% of all ICU cases and had a similar ICU admission rate as influenza A. Influenza-related mortality was 17·8% in ICU patients compared to 2·0% in non-ICU patients.

Surveillance summary of hospitalized pediatric enterovirus D68 cases in Canada, September 2014.

BACKGROUND: Enterovirus D68 (EV-D68) has been detected infrequently and has not been associated with severe disease in Canada. In the early fall of 2014, following an unusual case increase in the United States, clusters of EV-D68 among children and some adults manifesting severe symptoms were reported in Canada. OBJECTIVE: To provide an initial epidemiological summary of pediatric cases hospitalized with EV-D68 in Canada. METHODS: A time-limited surveillance pilot was conducted collecting information on pediatric cases (less than 18 years of age) hospitalized with EV-D68 between September 1 and 30, 2014. RESULTS: In total, 268 cases were reported from Ontario (n=210), Alberta (n=45), and British Columbia (n=13). Of the 268 reported cases, 64.9% (n=174) were male; the sex difference was statistically significant (p<0.01). Age was reported for 255 cases, with a mean age for males of 5.4 years and for females of 5.3 years. For cases with data available, 6.8% (18/266) were admitted to an intensive care unit. Of those where clinical illness was recorded, respiratory illness alone was present in 98.3% (227/231), neurologic illness alone was present in 0.4% (n=1), and both illnesses were present in 0.9% of cases (n=2); cases with neither respiratory nor neurologic illness were rare (n=1). Of the 90 cases with additional clinical information available, 43.3% were reported as having asthma. No deaths were reported among the 268 cases. CONCLUSION: The EV-D68 outbreak in Canada in September 2014 represents the beginning of a novel outbreak associated with severe illness in children. These findings provide the first epidemiological summary of severe cases of EV-D68 as an emergent respiratory pathogen in Canada. The continued investigation of this pathogen is necessary to build on these results and capture the full spectrum of associated illness.

FluWatch summary: February 8-14, 2015 (Week 6).

OBJECTIVE: To provide a summary of the weekly FluWatch report on influenza activity in Canada for the week of February 8-14, 2015. METHODS: The FluWatch programs consists of a network of sentinel laboratories, sentinel primary care practices, provincial and territorial ministries of health, and sentinel hospitals that report on the seven main influenza indictors on a weekly basis across Canada. Information is aggregated by the FluWatch program and disseminated through weekly reports during the activity influenza season and bi-weekly reports during the low season. RESULTS: In week 6, influenza activity levels declined for six surveillance indicators. Seven regions reported widespread activity: Ontario (2), Quebec (2), Manitoba (1), Prince Edward Island (1) and Newfoundland (1). Twenty-one regions reported localized activity: New Brunswick (7), Nova Scotia (5), Ontario (5), Alberta (1) and Manitoba (1), and 22 regions reported sporadic activity. The national influenza-like-illness (ILI) consultation rate decreased from the previous week to 44.5 consultations per 1,000, which is higher than expected levels for week 6. A total of 74 outbreaks have been reported this week and the majority of outbreaks this season have been reported in long-term care facilities (LTCF). Laboratory detections of influenza decreased from the previous week from 1,884 in week 5 to 1,625 in week 6. The number of positive respiratory syncytial virus (RSV) tests decreased to 914 RSV detections down from 1,110 RSV detections in week 5 and remains the second most frequently detected virus after influenza. To date, 4,817 influenza hospitalizations and 342 deaths have been reported through the national severe outcome surveillance system; with the majority reported in adults aged 65 and over. In the 2014-15 season, the National Microbiology Laboratory (NML) has characterized 194 influenza viruses and found that the majority of influenza A (H3N2) specimens tested to date was not optimally matched to the vaccine strain; but all those tested for resistance were all found to be sensitive to oseltamivir and zanamivir. Two Canadian studies, one by the Sentinel Physician Surveillance Network (SPSN) and the other by the Canadian Immunization Research Network (CIRN), examined mid-season data on the current influenza vaccine's effectiveness and both studies observed little to no vaccine protection against the A(H3N2) virus. (See ID News). CONCLUSION: Influenza A (H3N2) continues to be the most common type of influenza affecting Canadians. In laboratory detections, hospitalizations and deaths, the majority of cases have been among seniors greater than 65 years of age. The patterns of many indicators such as laboratory detections and outbreaks have been similar to the 2012-13 season when influenza A (H3N2) also predominated. The NML and the SPSN study have found that the majority of the circulating influenza A (H3N2) specimens are not optimally matched to the vaccine strain. Several indicators have been continuously declining since week 1, indicating that the peak of the 2014-15 influenza season has passed. The FluWatch surveillance system will continue to monitor influenza activity throughout the remainder of the 2014-15 season and publish findings in the FluWatch report.

MERS-CoV- Low risk to Canadians.

Middle East respiratory syndrome - Coronavirus (MERS-CoV) -- is a novel coronavirus that has caused a number of community-acquired cases and health care associated outbreaks in Saudi Arabia and the United Arab Emirates (UAE) as well as sporadic cases in other countries, especially in the Middle East. The evidence to date links MERS-CoV cases with exposure to camels, including camel products or to probable or confirmed human cases of MERS-CoV. It typically presents as an acute respiratory illness and is associated with a 35% mortality rate. Based on available information at this time, the current risk to Canadians for acquiring MERS-CoV infections is considered low. However, the International Health Regulations Committee concerning MERS-CoV has cautioned that the upsurge of cases seen this past spring (2014) may be predictive of an increase in cases related to the Hajj - an annual pilgrimage to Mecca in Saudi Arabia that took place in early October 2014. Although the overall risk is low, the Public Health Agency of Canada and its National Microbiology Laboratory (NML) in close collaboration with provincial and territorial partners, the Canadian Public Health Laboratory Network (CPHLN) and infection prevention and control experts have developed a number of preparedness guidance documents and protocols to address the risk of an imported case of MERS-CoV in Canada.

Influenza in Canada, 2012-2013 season.

OBJECTIVE: This report summarizes influenza activity in Canada during the 2012-13 influenza season (August 26, 2012-August 24, 2013) from data obtained through the FluWatch surveillance program. METHODS: FluWatch collected information from six primary indicators of influenza activity that describe the epidemiologic and virologic behaviour of influenza in Canada: sentinel laboratory-based influenza detections; strain characterization and antiviral resistance for circulating influenza viruses; primary care consultation rates of influenza-like illness; regional influenza activity levels; influenza-associated severe outcomes; and pharmacy surveillance. RESULTS: The influenza season peaked nationally between late December 2012 and early January 2013 with influenza A(H3N2) identified as the predominant circulating influenza strain until early March, when influenza B became the predominant circulating strain. The cumulative reported hospitalization rates for all age groups were 25.0 per 100,000. Influenza A most greatly affected adults ≥65 years of age and influenza B most greatly affected children ≤19 years of age. CONCLUSION: The influenza season was moderately severe. When compared to the previous two seasons, which were considered relatively mild, there was a significant increase in laboratory detections for influenza, as well as hospitalizations associated with influenza in 2012-13.

An observational study of sun and heat protection during Canada Day outdoor celebration, 2003.

Attendance at summer outdoor mass gatherings may lead to heat- and sun-related illness. The purposes of this study were: (1) to estimate the proportion of people in attendance at the 2003 Canada Day celebration in the National Capital Region who used sun and heat protective items; (2) to identify factors associated with the utilization of these protective items; and (3) to provide research data to public outdoor event organizers when developing evidence-based plans for safer events. A naturalistic observational cross-sectional method was used to gather information at the 2003 Canada Day celebration in the National Capital Region on attendees' demographics, the sun and heat protective items they used and the protective resources available at the event sites. Of the 398 observed attendees, the proportion using any one of the protective items ranged from 3 percent (an open umbrella) to 51.5 percent (sunglasses). Females were more likely to use protective items more than males, and adults more likely than children. Planners of public outdoor events should consider the factors that influence the utilization of sun and heat protective behaviours and the environmental modifications that would allow participants to make safe choices.