The evolution of SARS-CoV-2 seroprevalence in Canada: a time-series study, 2020-2023.

BACKGROUND: During the first year of the COVID-19 pandemic, the proportion of reported cases of COVID-19 among Canadians was under 6%. Although high vaccine coverage was achieved in Canada by fall 2021, the Omicron variant caused unprecedented numbers of infections, overwhelming testing capacity and making it difficult to quantify the trajectory of population immunity. METHODS: Using a time-series approach and data from more than 900 000 samples collected by 7 research studies collaborating with the COVID-19 Immunity Task Force (CITF), we estimated trends in SARS-CoV-2 seroprevalence owing to infection and vaccination for the Canadian population over 3 intervals: prevaccination (March to November 2020), vaccine roll-out (December 2020 to November 2021), and the arrival of the Omicron variant (December 2021 to March 2023). We also estimated seroprevalence by geographical region and age. RESULTS: By November 2021, 9.0% (95% credible interval [CrI] 7.3%-11%) of people in Canada had humoral immunity to SARS-CoV-2 from an infection. Seroprevalence increased rapidly after the arrival of the Omicron variant - by Mar. 15, 2023, 76% (95% CrI 74%-79%) of the population had detectable antibodies from infections. The rapid rise in infection-induced antibodies occurred across Canada and was most pronounced in younger age groups and in the Western provinces: Manitoba, Saskatchewan, Alberta and British Columbia. INTERPRETATION: Data up to March 2023 indicate that most people in Canada had acquired antibodies against SARS-CoV-2 through natural infection and vaccination. However, given variations in population seropositivity by age and geography, the potential for waning antibody levels, and new variants that may escape immunity, public health policy and clinical decisions should be tailored to local patterns of population immunity.

Estimating spatial and temporal trends of dog importation into Canada from 2013 to 2019.

Background and objective: For several years, there has been growing concern over the public and animal health impacts of dog importation, with many Canadian veterinarians reporting increasing diagnoses of exotic pests and pathogens. This study is the first to estimate the number of dogs imported into Canada and describe spatial and temporal trends. Animal and procedure: Commercial and a subset of personal dog importation records, obtained from the Canada Border Services Agency, were used to estimate the total number of dogs imported into Canada from 2013 to 2019. Results: The number of dogs imported annually increased by > 400% over the study period, with > 37 000 dogs imported in 2019. The majority of dogs (72%) were imported from the United States and Eastern Europe, and 23% originated in a country considered high-risk for canine rabies. Conclusion: Dog importation into Canada has increased substantially over time. Moving forward, education and improved tracking will be essential.

Estimation des tendances spatiales et temporelles de l'importation de chiens au Canada de 2013 à 2019. Contexte et objectif: Depuis plusieurs années, les impacts de l'importation de chiens sur la santé publique et animale suscitent de plus en plus d'inquiétudes, de nombreux vétérinaires canadiens signalant une augmentation des diagnostics de vermines et d'agents pathogènes exotiques. Cette étude est la première à estimer le nombre de chiens importés au Canada et à décrire les tendances spatiales et temporelles. Animal et procédure: Des dossiers d'importation de chiens commerciaux et personnels, obtenus auprès de l'Agence des services frontaliers du Canada, ont été utilisés pour estimer le nombre total de chiens importés au Canada de 2013 à 2019. Résultats: Le nombre de chiens importés chaque année a augmenté de > 400 % au cours de la période d'étude, avec > 37 000 chiens importés en 2019. La majorité des chiens (72 %) ont été importés des États-Unis et d'Europe de l'Est, et 23 % sont originaires d'un pays considéré comme à haut risque de rage canine. Conclusion: L'importation de chiens au Canada a considérablement augmenté au fil du temps. À l'avenir, l'éducation et un meilleur suivi seront essentiels.(Traduit par Dr Serge Messier).

Brucella canis in Commercial Dog Breeding Kennels, Ontario, Canada.

We evaluated the prevalence of Brucella canis seropositivity in a convenience sample of dogs from commercial breeding kennels in Ontario, Canada. Overall, 127/1,080 (11.8%) dogs from 23/63 (37%) kennels were seropositive. The prevalence of positive dogs within kennels with >1 positive dog ranged from 3.9% to 100% (median 33%).

Emergence and Containment of Canine Influenza Virus A(H3N2), Ontario, Canada, 2017-2018.

Canine influenza virus (CIV) A(H3N2) was identified in 104 dogs in Ontario, Canada, during December 28, 2017-October 30, 2018, in distinct epidemiologic clusters. High morbidity rates occurred within groups of dogs, and kennels and a veterinary clinic were identified as foci of infection. Death attributable to CIV infection occurred in 2 (2%) of 104 diagnosed cases. A combination of testing of suspected cases, contact tracing and testing, and 28-day isolation of infected dogs was used, and CIV transmission was contained in each outbreak. Dogs recently imported from Asia were implicated as the source of infection. CIV H3N2 spread rapidly within groups in this immunologically naive population; however, containment measures were apparently effective, demonstrating the potential value of prompt diagnosis and implementation of CIV control measures.

Defining 'actionable' high- costhealth care use: results using the Canadian Institute for Health Information population grouping methodology.

BACKGROUND: A small proportion of the population consumes the majority of health care resources. High-cost health care users are a heterogeneous group. We aim to segment a provincial population into relevant homogenous sub-groups to provide actionable information on risk factors associated with high-cost health care use within sub-populations. METHODS: The Canadian Institute for Health Information (CIHI) Population Grouping methodology was used to define mutually exclusive and clinically relevant health profile sub-groups. High-cost users (> = 90th percentile of health care spending) were defined within each sub-group. Univariate analyses explored demographic, socio-economic status, health status and health care utilization variables associated with high-cost use. Multivariable logistic regression models were constructed for the costliest health profile groups. RESULTS: From 2015 to 2017, 1,175,147 individuals were identified for study. High-cost users consumed 41% of total health care resources. Average annual health care spending for individuals not high-cost were $642; high-cost users were $16,316. The costliest health profile groups were 'long-term care', 'palliative', 'major acute', 'major chronic', 'major cancer', 'major newborn', 'major mental health' and 'moderate chronic'. Both 'major acute' and 'major cancer' health profile groups were largely explained by measures of health care utilization and multi-morbidity. In the remaining costliest health profile groups modelled, 'major chronic', 'moderate chronic', 'major newborn' and 'other mental health', a measure of socio-economic status, low neighbourhood income, was statistically significantly associated with high-cost use. INTERPRETATION: Model results point to specific, actionable information within clinically meaningful subgroups to reduce high-cost health care use. Health equity, specifically low socio-economic status, was statistically significantly associated with high-cost use in the majority of health profile sub-groups. Population segmentation methods, and more specifically, the CIHI Population Grouping Methodology, provide specificity to high-cost health care use; informing interventions aimed at reducing health care costs and improving population health.

Integrative medicine and the oncology patient: options and benefits.

Cancer is a major public health problem, and cancer patients and survivors face many physical and emotional challenges after the initial diagnosis, through treatment, and in the post-treatment period. Different integrative medicine (IM) modalities can be used to mitigate some of the physical issues that originate from the cancer itself or the treatment and to promote well-being and emotional health. Here, we discuss how an IM Department can function in a hospital system, particularly with regard to oncology patients, the modalities appropriate for oncology patients, how these modalities can benefit this patient population, and the role of IM in cancer survivorship. A dedicated IM Department that works with oncologists provides support and care for the whole person. These different modalities work together to reduce pain, anxiety, and chemotherapy-induced nausea and peripheral neuropathy, while promoting immune function and improving sleep, range of motion, and an overall sense of well-being. However, each modality has different contraindications for the oncology patient, and proper training is required for safe and effective care. We illustrate how IM can be a valuable component of the care of the oncology patient.

Passive surveillance of antimicrobial resistance in Salmonella and Escherichia coli isolates from Ontario livestock, 2007-2015.

Clinical isolates are important to antimicrobial resistance surveillance efforts because clinically ill animals are the direct targets of antimicrobial treatments. Thus, clinical data may provide a surveillance tool for identifying emerging resistance threats. The purpose of this study was to describe resistance trends in Escherichia coli and Salmonella spp. from clinically ill animals over time and evaluate the utility of these laboratory data as a passive surveillance tool. Susceptibility results of isolates from chickens, swine, and cattle recovered between 2007 and 2015 at a major veterinary diagnostic laboratory in Ontario, Canada were analyzed. Relative to other antimicrobials tested, visible trends highlighted high resistance to ampicillin and tetracycline in chicken E. coli, consistently high resistance to tetracycline, sulfisoxazole, and ampicillin among swine isolates, and an increase in cattle E. coli resistant to ampicillin and cephalothin over time. While the data show potential for use in surveillance, there are limitations of such a clinical dataset for predicting overall trends and guiding empirical treatment decisions.

Surveillance passive de l'antibiorésistance dans les isolats de Salmonella et d'Escherichia coli chez le bétail de l'Ontario, 2007­2015. Les isolats cliniques sont importants pour la surveillance de l'antibiorésistance parce que les animaux cliniquement malades sont les cibles directes des traitements antimicrobiens. Par conséquent, les données cliniques peuvent fournir un outil de surveillance pour identifier les nouvelles menaces de résistance. Le but de cette étude consistait à décrire dans le temps les tendances de résistance d'Escherichia coli et de Salmonella spp. chez les animaux cliniquement malades et d'évaluer l'utilité de ces données de laboratoire en tant qu'outil de surveillance passive. On a analysé les résultats de susceptibilité des isolats récupérés entre 2007 et 2015 auprès de poulets, de porcs et de bovins dans un grand laboratoire de diagnostic vétérinaire en Ontario, au Canada. Pour les antimicrobiens testés, les tendances visibles ont souligné une résistance importante d'E. coli à l'ampicilline et à la tétracycline chez les poulets, une résistance importante constante à la tétracycline, au sulfisoxazole et à l'ampicilline parmi les isolats des porcs et, chez les bovins, une progression d'E. coli résistant à l'ampicilline et à la céphalothine dans le temps. Même si les données montrent un potentiel d'utilisation pour la surveillance, il y a des limitations pour un tel ensemble de données cliniques en vue de la prédiction des tendances générales et de l'orientation des décisions de traitement empiriques.(Traduit par Isabelle Vallières).

Self-reported hand hygiene perceptions and barriers among companion animal veterinary clinic personnel in Ontario, Canada.

The objective of this study was to describe the perceived importance of and barriers to hand hygiene among companion animal clinic staff. An anonymous, voluntary written questionnaire was completed by 356 of approximately 578 individuals (62%) from 49/51 clinics. On a scale of 1 (not important) to 7 (very important), the percentage of respondents who rated hand hygiene as a 5 or higher was at least 82% in all clinical scenarios queried. The most frequently reported reason for not performing hand hygiene was forgetting to do so (40%, 141/353). Specific discussion of hand hygiene practices at work was recalled by 32% (114/354) of respondents. Although veterinary staff seem to recognize the importance of hand hygiene, it should be emphasized more during staff training. Other barriers including time constraints and skin irritation should also be addressed, possibly through increased access to and use of alcohol-based hand sanitizers.

Perceptions et obstacles autodéclarés pour l'hygiène des mains parmi les employés des cliniques vétérinaires pour animaux de compagnie en Ontario, au Canada. L'objectif de cette étude consistait à décrire l'importance perçue des obstacles à l'hygiène des mains, ainsi que les obstacles eux-mêmes, parmi les employés des cliniques pour animaux de compagnie. Un questionnaire écrit volontaire et anonyme a été rempli par 356 personnes parmi un groupe d'environ 578 individus (62 %) provenant de 49/51 cliniques. Sur une échelle de 1 (pas important) à 7 (très important), le pourcentage des répondants qui a évalué l'hygiène des mains avec une cote de 5 ou supérieure était d'au moins 82 % dans tous les scénarios cliniques présentés. La raison la plus fréquente de ne pas effectuer l'hygiène des mains était l'oubli (40 %, 141/353). Signalons que 32 % (114/354) des répondants se sont rappelés d'une discussion spécifique sur les pratiques d'hygiène des mains au travail. Même si le personnel vétérinaire semble reconnaître l'importance de l'hygiène des mains, il faudrait insister plus sur ce sujet lors de la formation des employés. Les autres obstacles, qui incluent les contraintes de temps et l'irritation de la peau, devraient aussi être abordés, potentiellement par l'accès et l'utilisation accrus de désinfectants à base d'alcool.(Traduit par Isabelle Vallières).

Video observation of sharps handling and infection control practices during routine companion animal appointments.

BACKGROUND: Infection control in veterinary clinics is important for preventing pathogen spread between patients, staff and the public. There has been no direct evaluation of the use of many basic infection control practices, including sharps handling, environmental cleaning, and personal protective clothing (PPC), in companion animal clinics. The objective of this study was to describe these and other infection control practices associated with routine companion animal appointments in veterinary clinics in Ontario. RESULTS: Video observation of practices was performed in 51 clinics for approximately 3 weeks each as part of another study evaluating the effect of a poster campaign on hand hygiene compliance. Two small wireless surveillance cameras were used: one in an exam room, one in what was considered the most likely location for hand hygiene to be performed outside the exam room following an appointment. Video footage was coded and analyzed for 47 clinics, including 2713 appointments and 4903 individual staff-animal contacts. Recapping of a needle was seen in 84% (1137/1353) of appointments in which use was observed. Only one apparent needlestick injury (NSI) was seen, during recapping. Exam tables were cleaned and floors were mopped following 76% (2015/2646) and 7% (174/2643) of appointments, respectively. Contact time with spray used to clean the exam table ranged from 0-4611 s (mean 39 s, median 9 s). Appropriate PPC was worn for 72% (3518/4903) of staff-animal contacts. CONCLUSIONS: Although there was significant room for improvement in sharps handling behaviours in participating clinics, the number of observed NSIs was low. Contact time with environmental disinfectants and use of PPC could also be improved, as well as other basic infection control practices. Education and motivation of veterinary staff to use these simple measures more effectively could potentially have a significant impact on infection control in veterinary clinics for relatively little cost.

Video observation of hand hygiene practices during routine companion animal appointments and the effect of a poster intervention on hand hygiene compliance.

BACKGROUND: Hand hygiene is considered one of the most important infection control measures in human healthcare settings, but there is little information available regarding hand hygiene frequency and technique used in veterinary clinics. The objectives of this study were to describe hand hygiene practices associated with routine appointments in companion animal clinics in Ontario, and the effectiveness of a poster campaign to improve hand hygiene compliance. RESULTS: Observation of hand hygiene practices was performed in 51 clinics for approximately 3 weeks each using 2 small wireless surveillance cameras: one in an exam room, and one in the most likely location for hand hygiene to be performed outside the exam room following an appointment. Data from 38 clinics were included in the final analysis, including 449 individuals, 1139 appointments before and after the poster intervention, and 10894 hand hygiene opportunities. Overall hand hygiene compliance was 14% (1473/10894), while before and after patient contact compliance was 3% (123/4377) and 26% (1145/4377), respectively. Soap and water was used for 87% (1182/1353) of observed hand hygiene attempts with a mean contact time of 4 s (median 2 s, range 1-49 s), while alcohol-based hand rub (ABHR) was used for 7% (98/1353) of attempts with a mean contact time of 8 s (median 7 s, range 1-30 s). The presence of the posters had no significant effect on compliance, although some staff reported that they felt the posters did increase their personal awareness of the need to perform hand hygiene, and the posters had some effect on product contact times. CONCLUSIONS: Overall hand hygiene compliance in veterinary clinics in this study was low, and contact time with hand hygiene products was frequently below current recommendations. Use of ABHR was low despite its advantages over hand washing and availability in the majority of clinics. The poster campaign had a limited effect on its own, but could still be used as a component of a multimodal hand hygiene campaign. Improving the infection control culture in veterinary medicine would facilitate future campaigns and studies in this area, as well as overall patient and staff safety.

Observational study of patient and surgeon preoperative preparation in ten companion animal clinics in Ontario, Canada.

BACKGROUND: Surgical site infections (SSIs) are a recognized risk of any surgical procedure in veterinary medicine. One of the keys to prevention of SSIs is reducing exposure of the surgical site to endogenous and exogenous microbes, beginning in the preoperative period. While guidelines are available for preoperative preparation procedures, there has been no objective investigation of compliance with these recommendations in veterinary practices. The objectives of this pilot study were to describe preoperative patient and surgeon preparation practices in a sample of non-equine companion animal veterinary clinics, and to determine if there were any areas that consistently did not meet current guidelines. RESULTS: Observation of preparation practices was performed in 10 clinics over 9-14 days each using up to 3 small wireless surveillance cameras. Data were coded for 148 surgical patients, and 31 surgeons performing 190 preoperative preparations. When patient hair removal was observed, it was most commonly done using clippers (117/133, 88%), and in only one case was it performed prior to anesthetic induction. Patient contact time with soap ranged from 10-462 s (average of clinic means 75 s, average of clinic medians 67 s), and with alcohol from 3-220 s (average of clinic means 44 s, average of clinic medians 37 s). Alcohol-based hand rub (AHR) was used preoperatively in 2/10 facilities, but soap-and-water hand scrub was most commonly used at all clinics. Proximal-to-distal scrubbing was noted in 95/142 (67%) of soap-and-water scrubs. Contact time during surgeon hand preparation ranged from 7-529 s (average mean 121 s, average median 122 s) for soap-and-water and from 4-123 s (average mean 25 s, average median 19 s) for AHR. No significant changes in practices were identified over time during the observation period. Practices that did not conform to guidelines available in major companion animal surgical textbooks were commonly observed. CONCLUSIONS: Some preoperative preparation practices were relatively consistent between clinics in this study, while others were quite variable. Contact times with preoperative preparatory solutions for both patients and surgeons were often shorter than recommended. Evidence-based guidelines for these procedures in veterinary medicine should be established and implemented in order to help reduce preventable SSIs, while maintaining efficiency and cost-effectiveness.

Severe gastric impaction secondary to a gastric polyp in a horse.

A 13-year-old Percheron gelding was presented for refractory gastric impaction. At necropsy a pedunculated 10 cm × 11 cm × 14 cm mass, histologically identified as an inflammatory polyp, was suspected to have been partly obstructing the pylorus. This is the first report of a polyp resulting in gastric outflow obstruction in a horse.

Surcharge gastrique grave secondaire à un polype gastrique chez un cheval. Un hongre Percheron âgé de 13 ans a été présenté pour une surcharge gastrique réfractaire. À la nécropsie, une masse pédonculée de 10 cm × 11 cm × 14 cm, identifiée à l'histologie comme un polype inflammatoire, a été soupçonnée d'avoir partiellement bloqué le pylore. Il s'agit du premier rapport d'un polype qui se traduit par l'obstruction de l'écoulement gastrique chez un cheval.(Traduit par Isabelle Vallières).

Rabies in an imported dog, Ontario, Canada, 2022.

Importation of rabies-infected dogs results in significant and costly public and animal health risks. In January 2022, a dog in Ontario, Canada, which was imported from Iran in June 2021, developed rabies, leading to an extensive public health investigation and administration of rabies post-exposure prophylaxis to 37 individuals. The dog was infected with a rabies virus variant known to circulate in Iran. This is the second reported case of a rabies-infected dog imported into Canada in 2021 from a high-risk country for canine mediated rabies. This case emphasizes the need for public education regarding the risks associated with importing dogs from high-risk countries for canine-mediated rabies and the benefits of establishing a public health team specializing in rabies exposure investigations.

In-person learning low risk for COVID-19 acquisition: Findings from a population-based analysis of the 2020-2021 school year in Saskatchewan, Canada.

Background: The coronavirus disease 2019 (COVID-19) pandemic has caused substantial disruption to in-person learning, often interfering with the social and educational experience of children and youth across North America, and frequently impacting the greater community by limiting the ability of parents and caregivers to work outside the home. Real-world evidence related to the risk of COVID-19 transmission in school settings can help inform decisions around initiating, continuing, or suspending in-person learning. Methods: We analyzed routinely collected case-based surveillance data from Saskatchewan's electronic integrated public health system, Panorama, from the 2020-2021 school year, spanning various phases of the pandemic (including the Alpha variant wave), to better understand the risk of in-school transmission of COVID-19 in Saskatchewan schools. Results: The majority (over 80%) of school-associated COVID-19 infections were acquired outside the school setting. This finding suggests that the non-pharmaceutical measures in place (including masking, distancing, enhanced hygiene, and cohorting) worked to limit viral spread in schools. Conclusion: Implementation of such control measures may play an essential role in allowing children and youth to safely maintain in-person learning during the pandemic.

A survey of multidisciplinary healthcare providers utilizing the KNOWintegrativeoncology.org educational platform.

BACKGROUND: Although the vast majority of cancer patients use natural health products (NHPs), 59% of oncology healthcare providers (HCP) report not receiving any education on NHPs. KNOWintegrativeoncology.org (KNOW) is a web-based educational platform that provides up-to-date evidence on NHPs used in cancer care with a user-friendly interface. KNOW is a database of human studies systematically gathered from MEDLINE and EMBASE. We surveyed HCPs before and after accessing KNOW to identify their information needs regarding NHPs in cancer care, their preferred way to receive information, barriers they face accessing NHP information, and to obtain feedback on the website. METHODS: Recruitment was done through Beaumont Health Systems, the Society for Integrative Oncology, and the Andrew Weil Centre for Integrative Medicine, University of Arizona. HCPs who consented completed an initial survey and then a follow-up survey after being given access to KNOW for 4-6 weeks. Participants were required to access KNOW at least three times before completion of the follow-up survey. RESULTS: A total of 65 participants completed the initial survey, with 60% (n = 39) from the conventional medical community, 33% (n = 21) from the integrative medicine community, and 7% (n = 5) from the research community. The majority of participants (82%; n = 53) preferred educational websites to email updates, podcasts/webinars, in-house experts, PubMed searches and smartphone apps. The most common barriers identified to accessing information on NHPs were time, accessibility at point-of-care, and credibility of sources. A high number of participants were lost to follow up, with 18 participants demographically representative of the initial sample of 65 completing the follow-up survey. Half (n = 9) of participants stated accessing the KNOW website changed their clinical practice. Close to 90% (n = 16) reported they would recommend KNOW to a colleague. CONCLUSION: Oncology HCPs reported preferring to use, and already relying on, numerous web-based educational platforms to gather information on NHPs, with time, accessibility, and credibility being common barriers to obtaining information. Our study findings highlight the promise of the KNOW web-based educational platform in reducing barriers to accessing up-to-date information on NHPs in busy cancer care settings.

Canadian Collaboration to Identify a Minimum Dataset for Antimicrobial Use Surveillance for Policy and Intervention Development across Food Animal Sectors.

Surveillance of antimicrobial use (AMU) and antimicrobial resistance (AMR) is a core component of the 2017 Pan-Canadian Framework for Action. There are existing AMU and AMR surveillance systems in Canada, but some stakeholders are interested in developing their own AMU monitoring/surveillance systems. It was recognized that the establishment of core (minimum) AMU data elements, as is necessary for policy or intervention development, would inform the development of practical and sustainable AMU surveillance capacity across food animal sectors in Canada. The Canadian Animal Health Surveillance System (CAHSS) AMU Network was established as a multisectoral working group to explore the possibility of harmonizing data inputs and outputs. There was a consensus that a minimum AMU dataset for AMU surveillance (MDS-AMU-surv) should be developed to guide interested parties in initiating AMU data collection. This multisectoral collaboration is an example of how consultative consensus building across relevant sectors can contribute to the development of harmonized approaches to AMU data collection and reporting and ultimately improve AMU stewardship. The MDS-AMU-surv could be used as a starting point for the progressive development or strengthening of AMU surveillance programs, and the collaborative work could serve as a model for addressing AMR and other shared threats at the human-animal-environment interface.

Rabies in an imported dog, Ontario, 2021.

In July 2021, a dog was imported into Canada from Iran and subsequently developed clinical signs of rabies within 11 days of arrival. Following laboratory confirmation of the diagnosis of rabies, local, provincial and federal inter-agency collaboration was required to complete contact tracing to identify all persons and domestic animals that may have been exposed to the rabid dog during the potential virus shedding period. This case highlights the risks of importing animals from known canine rabies-endemic areas, identifies gaps in current dog importation policies that pose potential risk to human and animal health and prompts ongoing vigilance for this deadly disease among human and animal health partners, as well as members of the public who adopt imported dogs.

Mumps virus detection during an outbreak in a highly unvaccinated population in British Columbia.

OBJECTIVES: Control measures of mumps involve isolation of those symptomatic or potentially exposed. Recent guidelines have recommended shortening the isolation period from 9 days to 5 days after the onset of parotitis, despite using mainly historical evidence. In British Columbia, mumps circulated in a predominantly unvaccinated population in 2008. We compared laboratory findings between the different vaccination groups and assessed the period of mumps viral detection after onset of parotitis. METHODS: Demographic and clinical data were collected according to guidelines during the course of the outbreak. Clinical specimens, including buccal swabs, urine, CSF and sera, were collected on a single visit upon presentation for diagnosis. Laboratory diagnosis of mumps was confirmed by either virus detection by PCR and/or isolation in cell culture from clinical specimens, or by serology. RESULTS: Laboratory testing confirmed mumps on 85 (74%) of 115 cases by virus detection and/or serology. Thirty-nine (78%) of 50 cases had virus detected within the first 5 days after onset of parotitis, with the rate highest in specimens collected early. However, virus could be detected in 5 (56%) of 9 cases after day 5 and up to day 9. CONCLUSION: Our study questions whether a 5-day isolation period is sufficient to prevent mumps transmission in a susceptible population. Our observations are based on single specimen submission, whereas an optimal study design would entail serial collection after presentation of parotitis, as this reflects true viral shedding. Further investigations are warranted to validate patient isolation guidelines.

An outbreak of COVID-19 associated with a fitness centre in Saskatchewan: Lessons for prevention.

Background: An outbreak of the coronavirus disease 2019 (COVID-19) occurred in Saskatchewan from September 12 to October 20, 2020. The index event, attendance at a local gym, seeded six additional clusters/outbreaks in multiple settings. These included a high school, a hospital, three workplaces (A, B and C) and several households. The overall cluster comprised 63 cases, 27 gym members and an additional 36 second, third and fourth generation cases. Methods: All outbreak-related, laboratory-confirmed cases of COVID-19 were included in the analysis. Local public health authorities interviewed all cases and contacts and conducted environmental investigations of the fitness facility. We used descriptive epidemiological methods to understand transmission dynamics of the gym-associated cluster using case investigation, contact investigation and laboratory data, including whole genome sequencing. Results: Sequencing data confirmed the unique lineage of cluster-related cases (n=32 sequenced; severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] lineage B.1.1.72). In addition to gym attendance, infectious cases attended high school and were involved in other activities. Despite ongoing transmission in the fitness facility, no secondary cases were identified in the high school where four student belonging to the cluster attended class during their infectious period. Conclusion: We describe an outbreak of COVID-19 where the index case(s) attended a fitness facility, and further spread occurred for 38 days despite active-case finding and isolation of positive cases over this period. Due to gym attendance over time, short-term closing and cleaning may not interrupt chains of transmission. Targeted, preventive public health action in fitness facilities may be warranted. Control measures worked to limit in-school acquisition.

A population-based evaluation of a publicly funded, school-based HPV vaccine program in British Columbia, Canada: parental factors associated with HPV vaccine receipt.

BACKGROUND: Information on factors that influence parental decisions for actual human papillomavirus (HPV) vaccine receipt in publicly funded, school-based HPV vaccine programs for girls is limited. We report on the level of uptake of the first dose of the HPV vaccine, and determine parental factors associated with receipt of the HPV vaccine, in a publicly funded school-based HPV vaccine program in British Columbia, Canada. METHODS AND FINDINGS: All parents of girls enrolled in grade 6 during the academic year of September 2008-June 2009 in the province of British Columbia were eligible to participate. Eligible households identified through the provincial public health information system were randomly selected and those who consented completed a validated survey exploring factors associated with HPV vaccine uptake. Bivariate and multivariate analyses were conducted to calculate adjusted odds ratios to identify the factors that were associated with parents' decision to vaccinate their daughter(s) against HPV. 2,025 parents agreed to complete the survey, and 65.1% (95% confidence interval [CI] 63.1-67.1) of parents in the survey reported that their daughters received the first dose of the HPV vaccine. In the same school-based vaccine program, 88.4% (95% CI 87.1-89.7) consented to the hepatitis B vaccine, and 86.5% (95% CI 85.1-87.9) consented to the meningococcal C vaccine. The main reasons for having a daughter receive the HPV vaccine were the effectiveness of the vaccine (47.9%), advice from a physician (8.7%), and concerns about daughter's health (8.4%). The main reasons for not having a daughter receive the HPV vaccine were concerns about HPV vaccine safety (29.2%), preference to wait until the daughter is older (15.6%), and not enough information to make an informed decision (12.6%). In multivariate analysis, overall attitudes to vaccines, the impact of the HPV vaccine on sexual practices, and childhood vaccine history were predictive of parents having a daughter receive the HPV vaccine in a publicly funded school-based HPV vaccine program. By contrast, having a family with two parents, having three or more children, and having more education was associated with a decreased likelihood of having a daughter receive the HPV vaccine. CONCLUSIONS: This study is, to our knowledge, one of the first population-based assessments of factors associated with HPV vaccine uptake in a publicly funded school-based program worldwide. Policy makers need to consider that even with the removal of financial and health care barriers, parents, who are key decision makers in the uptake of this vaccine, are still hesitant to have their daughters receive the HPV vaccine, and strategies to ensure optimal HPV vaccine uptake need to be employed.