Invasive Bacterial Diseases in Northern Canada, 2006-2013.

BACKGROUND: Northern populations were at a high risk of developing invasive bacterial diseases (IBDs). Since the last published study that described IBDs in Northern Canada, a number of vaccines against some bacterial pathogens have been introduced into the routine childhood immunization schedule. OBJECTIVE: To describe the epidemiology of IBDs in Northern Canada from 2006 to 2013. METHODS: Data for 5 IBDs (invasive pneumococcal disease (IPD), invasive Haemophilus influenzae disease (Hi), invasive Group A streptococcal disease (iGAS), invasive meningococcal disease (IMD) and invasive Group B streptococcal disease (GBS)) were extracted from the International Circumpolar Surveillance (ICS) program and the Canadian Notifiable Diseases Surveillance System. Incidence rates were calculated per 100,000 population per year. RESULTS: During the study period, the incidence rates of IPD ranged from 16.84-30.97, iGAS 2.70-17.06, Hi serotype b 0-2.78, Hi non-b type 2.73-8.53, and IMD 0-3.47. Except for IMD and GBS, the age-standardized incidence rates of other diseases in Northern Canada were 2.6-10 times higher than in the rest of Canada. Over the study period, rates decreased for IPD (p=0.04), and iGAS (p=0.01), and increased for Hi type a (Hia) (p=0.004). Among IPD cases, the proportion of pneumococcal conjugate vaccine (PCV)7 serotypes decreased (p=0.0004) over the study period. Among Hi cases, 69.8% were Hia and 71.6% of these were in children under than 5 years. Of 13 IMD cases, 8 were serogroup B and 2 of them died. CONCLUSION: Northern population in Canada, especially infants and seniors among First Nations and Inuit, are at a high risk of IPD, Hi and iGAS. Hia is the predominant serotype in Northern Canada.

Evaluation of the Enhanced Invasive Pneumococcal Disease Surveillance System (eIPDSS) Pilot Project.

BACKGROUND: Invasive pneumococcal disease (IPD) causes significant morbidity in Canada, yet even with routine surveillance, it is difficult to interpret current IPD trends in serotype distribution and antimicrobial resistance. The enhanced Invasive Pneumococcal Disease Surveillance System (eIPDSS) pilot project was designed to facilitate a better understanding of IPD trends at the national level by linking epidemiologic and laboratory (epi-lab) data. OBJECTIVES: To evaluate the eIPDSS by assessing five attributes (usefulness, data quality, simplicity, acceptability and timeliness) and to develop recommendations for future national IPD surveillance. METHODS: An evaluation was developed that assessed the five key attributes through a qualitative survey sent to eight eIPDSS users as well as a quantitative analysis of the eIPDSS database. Recommendations were based on the results of both the survey and the analysis. RESULTS: The response rate to the survey was 100%. The majority of the survey respondents found the eIPDSS to be useful (75%), simple (100%) and acceptable (86%). Analysis of the eIPDSS database revealed that the majority of IPD cases (61%) were assessed as timely. Data quality and data management mechanisms were identified as issues by both survey respondents and the analysis of the database. Consultation with public health, regular audits and upgrades to the platform are recommended to address data quality and management issues. CONCLUSION: The epi-lab linked data of the eIPDSS enables the detection and analysis of IPD serotype distribution and antimicrobial resistance trends. This web-based system facilitates data collection and is simple, acceptable and timely. With improvements that address data quality and management issues, it is feasible to develop a national surveillance system that links epi-lab data.

Measles surveillance in Canada: Trends for 2014.

BACKGROUND: Measles elimination status was achieved in Canada in 1998. The Public Health Agency of Canada compiles evidence for the Pan American Health Organization to confirm that criteria for the verification of measles elimination continue to be met. OBJECTIVE: To describe measles activity in Canada for 2014 in order to support Canada's ongoing measles elimination status. METHODS: Using data captured by the Canadian Measles and Rubella Surveillance System and the Measles and Rubella Surveillance pilot project during 2014, the distribution of measles cases by demographics, immunization status and hospitalization were assessed, outbreak characteristics were summarized and genotypic and phylogenetic analyses were conducted and described. RESULTS: During 2014, 418 measles cases were reported by five provinces and territories for an overall incidence rate of 11.8 cases per 1,000,000 population. Case counts and incidence rates were highest among those five to 14 years of age and the majority of cases were not immunized. Overall, five percent of cases were hospitalized, most frequently the youngest and oldest age groups. Eighteen outbreaks were reported, the largest of which occurred in a non-immunizing religious community in British Columbia. Genotype information was available for 98% of measles events (18/18 outbreaks and 31/32 sporadic cases). Canada continued to meet or partially meet all four of PAHO's criteria for verification of measles elimination. CONCLUSION: Despite significant measles activity in 2014, Canada continues to provide strong evidence that measles elimination status is being maintained.

Maintaining measles elimination in Canada: Moving forward.

Due to the success of immunization and timely surveillance, Canada has not reported any cases of endemic measles since 1998. However, recent large outbreaks of imported-related measles have highlighted the risks of reintroduction of disease through travel and immunization coverage gaps in sub-populations. Building on its 2011 Elimination Report and in collaboration with provincial and territorial partners, the Public Health Agency of Canada has been promoting immunization, expanding the information gathered in immunization coverage surveys, piloting enhanced surveillance with real-time notifications of suspected and confirmed cases to enable early detection of outbreaks and strengthening its laboratory capacity. As these efforts are consolidated, this approach may become a model for other countries around the world as they seek to achieve measles elimination goals.

Comparative efficacy of flubendazole and a commercially available herbal wormer against natural infections of Ascaridia galli, Heterakis gallinarum and intestinal Capillaria spp. in chickens.

The efficacy of a commercially available flubendazole-based product and a commercially available herbal product were compared against three species of helminth parasites of chickens: Ascaridia galli, Heterakis gallinarum and Capillaria spp. A total of 48 naturally infected chickens were used in the study with 16 birds in each of three treatment groups (untreated control; flubendazole; and a herbal product). One bird from each treatment group was necropsied on Day 0 prior to first treatment to confirm the parasite species present in the birds. Treatments were administered as labelled and the 45 remaining birds were necropsied on Day 12 and worm counts performed. Average worm counts in the two treated groups were compared to the untreated controls to calculate efficacy. Flubendazole (Group A) achieved an overall efficacy of 99.4% for the three parasite species. The herbal product (Group B) achieved efficacies ranging from less than zero to 11.6% for the three parasites, with worm counts not significantly different to the untreated controls. At present, commercially available herbal products claiming anthelmintic properties do not require licencing as veterinary medicinal products (Directive 2004/28/EC: see Article 17 and 33-38) and thus are not required to meet specific efficacy thresholds. Products which do not appear to deliver acceptable anthelmintic efficacy, are obviously a concern from many aspects but specifically from an animal welfare perspective.

Psychosocial and functional correlates of nutrition among community-dwelling older adults in Ireland.

OBJECTIVES: To examine psychosocial and functional correlates of nutrition in a nonrandom sample of Irish community-dwelling older adults. DESIGN: Cross-sectional observational study. SETTING: Technology Research for Independent Living (TRIL) Clinic, a comprehensive geriatric assessment facility in St James's Hospital, Dublin. Data were collected from participants by medical personnel (physical assessments) and psychologists (questionnaires), between August 2007 and May 2009. PARTICIPANTS: 556 participants (388 females; 168 males) ranging in age from 60-92 years (Mean 72.5 years, SD 7.1). All were community-dwelling and provided informed consent. MEASUREMENTS: The Nestlé Mini-Nutritional Assessment (MNA®), Time to get up and go (TUG) and the Lubben Social Network Scale-18 (LSNS-18) were used to assess nutrition, functional mobility and social support. METHODS: Multivariate binary logistic regression was used to examine the association between social support or mobility and nutritional status, whilst controlling for possible confounders (age, gender, living alone and material deprivation). RESULTS: The strongest predictors of abnormal nutritional status were mobility (p < 0.001) and social support (p = 0.005). Other significant predictors of nutritional risk were age (p = 0.032) and deprivation (p = 0.018). CONCLUSION: The results emphasise the importance of mobility and social supports in mediating nutritional outcomes in Irish community-dwelling older adults.

Bacterial meningitis among cochlear implant recipients--Canada, 2002.

INTRODUCTION: In July 2002, a cluster of bacterial meningitis (BM) cases was identified among European cochlear implant recipients (CIRs), prompting Health Canada to conduct a retrospective cohort study to determine the rate of BM infection among Canadian CIRs and to identify risk factors for acquiring BM. METHODS: A survey was mailed to 1,432 Canadian CIRs who had received implants during January 1995-July 2002 to assess occurrence of postimplant BM infection. Data collection included demographics, episodes of meningitis, and vaccination status. RESULTS: A total of 1,024 (72%) surveys were completed. Median age of CIRs at implantation was 16 years (range: 7 months-81 years). Five (0.5%) cases of BM infection were reported (two pneumococcal, one meningococcal, and two of unknown etiology); one CIR died. Four cases occurred among children aged <18 years. Time between implantation and BM infection varied (range: 7 months-7.7 years; median: 11 months). The rate of BM infection per 1,000 person-years was 0.7 among CIRs aged > or =18 years and 2.9 among those aged <18 years. The proportion of CIRs vaccinated against pneumococcal and meningococcal disease was low (46% and 41%, respectively). Preimplant meningitis was identified as a risk factor for postimplant BM (p = 0.002). No other risk factors evaluated were associated with an increased risk for BM infection. CONCLUSION: CIRs have a high rate of postimplant BM infection. Preimplant BM infection was identified as a risk factor. Cases of BM infection might have been prevented through vaccination.

Characterization of Neisseria meningitidis strains isolated from invasive meningococcal disease cases in Canada in 2001.

With the recent introduction of polysaccharide-protein conjugated vaccines for the control of serogroup C meningococcal disease and the emergence of different variants of serogroup C meningococci, it is likely the epidemiology of meningococcal disease in many countries may be affected. We have therefore analysed and reported the characteristics of Neisseria meningitidis strains collected in 2001 from the Canadian surveillance program on invasive meningococcal disease. Only strains collected from normally sterile clinical sites of patients were studied. Of the 289 isolates obtained from individual patients, 173 (59.9%) were serogroup C, 76 (26.3%) were serogroup B, 30 (10.4%) were serogroup Y, and 10 (3.5%) were serogroup W135. Ninety-six percent of the serogroup C isolates belonged to the ET-15 clone, with an additional 2.3% belonging to other electrophoretic types within the ET-37 clonal complex. Different antigenic variants of the endemic serogroup C ET-15 clone were responsible for localized outbreaks in different parts of the country. One novel variant with the antigenic composition of C:2a:P1.1,7 was reported in two provinces, Quebec and Ontario. Eighteen percent of the meningococci isolated from patients in Ontario belonged to serogroup Y, compared with only 8% in the rest of Canada. The current data highlight the importance of strain characterization by serogroup, serotype, and serosubtype antigens in providing useful information for the surveillance of meningococcal disease in Canada.

Annualized incidence and spectrum of illness from an outbreak investigation of Bell's palsy.

BACKGROUND: There are limited clinical and epidemiological data on patients diagnosed with Bell's palsy. While investigating an apparent clustering of Bell's palsy, we sought to characterize the spectrum of illness in patients with this diagnosis. METHODS: A telephone survey of persons with idiopathic facial (Bell's) palsy in the Greater Toronto Area (GTA, population = 4.99 million) and Nova Scotia (population = 0.93 million) from August 1 to November 15, 1997 collected information on subject demographics, neurological symptoms, constitutional symptoms, medical investigation and management. Information regarding potential risks for exposure to infectious agents, past medical history, and family history of Bell's palsy was also collected. Subjects with other secondary causes of facial palsy were excluded. RESULTS: In the GTA and Nova Scotia, 222 and 36 patients were diagnosed with idiopathic facial (Bell's) palsy, respectively. The crude annualized incidence of Bell's palsy was 15.2 and 13.1 per 100,000 population in the GTA and Nova Scotia, respectively. There was no temporal or geographical clustering, and symptomatology did not differ significantly between the two samples. The mean age was 45 years, with 55% of subjects being female. The most common symptoms accompanying Bell's palsy were increased tearing (63%), pain in or around the ear (63%), and taste abnormalities (52%). A significant number of patients reported neurological symptoms not attributable to the facial nerve. CONCLUSION: No clustering of cases of Bell's palsy was observed to support an infectious etiology for the condition. Misdiagnosis of the etiology of facial weakness is common. Patients diagnosed with Bell's palsy have a variety of neurological symptoms, many of which cannot be attributed to a facial nerve disorder.

Respiratory virus surveillance. FluWatch project, 2000-2001. End of season update.

The 2000-2001 season was a relatively mild season worldwide. In Canada, lower than usual activity was reported for all national indicators of influenza activity, including the rate of influenza-like illness (ILI), the percentage of laboratory-confirmed cases of influenza and provincial/territorial influenza activity levels. However, there were a number of interesting characteristics of this year's influenza season. In contrast to the predominance of influenza A, and in particular the A/Sydney/5/97 (H3N2)-like virus over the past 3 years, influenza B predominated overall this season. Influenza A (H3N2) accounted for < 1% of all characterized isolates (H1N1 accounted for 49% of isolates). Increased laboratory-confirmed influenza activity began in the West (Yukon, prairie provinces and British Columbia) in mid-December, followed by the Atlantic provinces in mid- to late January and Ontario and Quebec in mid- February and March.

Evaluation of the notification of hepatitis C risk to children who received unscreened blood or blood products.

Parents of children who received blood or blood products between 1984 and 1990 were notified about the potential risk of hepatitis C virus (HCV) infection. Data were collected about knowledge, attitudes and intended behaviours to determine the acceptability of the notification process. Demographic variables that may predict responses to notification were also recorded and analysed. Recipients were sent couriered letters explaining HCV risk, and the survey questionnaire. Sera were screened for HCV antibody and reactive samples confirmed with a recombinant immunoblot assay (RIBA). Four letter recipients were RIBA positive for a prevalence of 1.1% (4/358) in the notification group. Thirty-two percent of respondents did not know their child had been transfused and 58% did not know about the potential risk of HCV infection. Although 90% (165/185) felt the notification was valuable, 65% reported emotional distress (fear, worry, anger, very depressed). Responders were similar to non-responders except for HCV testing rate (76.2% v. 59.8%, p < 0.0002). Parents of children at risk of transfusion-acquired HCV virus approved of notification programs, but experienced some emotional distress. Awareness of transfusion history or risk of HCV was not universal, indicating the need to address notification to individuals, rather than through public education campaigns alone.