The coronavirus disease 2019 (COVID-19) pandemic has highlighted the need for robust surveillance of respiratory viruses. Syndromic surveillance continues to be an important surveillance component ...recommended by the World Health Organization (WHO). While FluWatchers, Canada's syndromic surveillance system, has been in place since 2015, the COVID-19 pandemic provided a valuable opportunity to expand the program's scope and underlying technology infrastructure. Following some structural changes to FluWatchers syndromic questionnaire, participants are now able to contribute valuable data to the non-specific surveillance of respiratory virus activity across Canada. This article examines the performance of FluWatchers' syndromic surveillance over the three years of the COVID-19 pandemic in Canada. More specifically, this article examines FluWatchers' performance with respect to the correlation between the FluWatchers influenza-like illness (ILI) and acute respiratory infection (ARI) indicators and total respiratory virus detections (RVDs) in Canada, including influenza, respiratory syncytial virus (RSV), severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and other respiratory viruses.
Coinciding with the beginning of the coronavirus disease 2019 (COVID-19) pandemic in March 2020, Canadian seasonal influenza circulation was suppressed, which was a trend reported globally. Canada ...saw a brief and delayed return of community influenza circulation during the spring of the 2021-2022 influenza season. Surveillance for Canada's 2022-2023 seasonal influenza epidemic began in epidemiological week 35 (week starting August 28, 2022) and ended in epidemiological week 34 (week ending August 26, 2023). The 2022-2023 season marked the return to pre-pandemic-like influenza circulation. The epidemic began in epidemiological week 43 (week ending October 29, 2022) and lasted 10 weeks. Driven by influenza A(H3N2), the epidemic was relatively early, extraordinary in intensity, and short in length. This season, a total of 74,344 laboratory-confirmed influenza detections were reported out of 1,188,962 total laboratory tests. A total of 93% of detections were influenza A (n=68,923). Influenza A(H3N2) accounted for 89% of the subtyped specimens (n=17,638/19,876). Late-season, Canada saw community circulation of influenza B for the first time since the 2019-2020 season. The 2022-2023 influenza season in Canada had an extraordinary impact on children and youth; nearly half (n=6,194/13,729, 45%) of reported influenza A(H3N2) detections were in the paediatric (younger than 19 years) population. Weekly paediatric influenza-associated hospital admissions were persistently above historical peak levels for several weeks. The total number of influenza-associated paediatric hospitalizations (n=1,792) far exceeded historical averages (n=1,091). With the return of seasonal influenza circulation and endemic co-circulation of multiple high burden respiratory viruses, sustained vigilance is warranted. Annual seasonal influenza vaccination is a key public health intervention available to protect Canadians.
In Canada, gonorrhea is the second most prevalent bacterial sexually transmitted infection. The Gonococcal Antimicrobial Surveillance Programme (GASP - Canada), a passive surveillance system ...monitoring antimicrobial resistance in
in Canada since 1985, is the source for this summary of demographics, antimicrobial resistance and
multi-antigen sequence typing (NG-MAST) of gonococcal isolates collected in Canada in 2021.
Provincial and territorial public health laboratories submitted
cultures and data to the National Microbiology Laboratory in Winnipeg as part of the surveillance system. The antimicrobial resistance and molecular type of each isolate received were determined.
In total, 3,439
cultures were received from laboratories across Canada in 2021, a 9.9% increase since 2020 (n=3,130). Decreased susceptibility to cefixime increased significantly (
<0.001) in 2021 (1.5%) compared to 2017 (0.6%). No significant change in decreased susceptibility to ceftriaxone was detected between 2017 and 2021 (0.6%) (
>0.001); however, one ceftriaxone-resistant isolate was identified. Azithromycin resistance decreased significantly (
<0.001) in 2021 (7.6%) compared to 2017 (11.7%); however, there was a significant increase (
<0.001) in the proportion of cultures with an azithromycin minimum inhibitory concentration of at least 1 mg/L (2017=22.2% to 2021=28.1%). In 2021, NG-MAST-19875 (15.3%) was the most prevalent sequence type in Canada; 20.3% of isolates with this sequence type were resistant to azithromycin.
The spread of antimicrobial-resistant gonorrhea is a significant public health concern. The continued regional and national surveillance of antimicrobial resistance in
is essential in ensuring effective treatment therapies are recommended.
The Laboratory Incident Notification Canada (LINC) surveillance system was launched in 2015 to monitor the mandated national reporting of laboratory incidents. This report describes the laboratory ...exposures reported in 2022.
Exposure incidents were analyzed by activity, occurrence, sector, root cause and pathogens/toxins implicated, while affected individuals were analyzed by education, exposure route, role and years of laboratory experience. An analysis of the median number of exposures per month was conducted, and time between the exposure incident date and the date the incident was reported to LINC was examined.
Forty confirmed laboratory exposure incident reports were received, with two suspected laboratory-acquired infections. The exposure incident rate per 100 active licences was 3.8, and the number of exposure incidents was highest in September. The majority of exposure incidents involved risk group 2 pathogens (n=27; 63%) and non-security sensitive biological agents (n=36; 84%). Microbiology was the most cited activity occurring during the exposure event (n=20; 50%), and sharps and procedure-related issues were the most common occurrences (n=15; 24.2% each). Most incidents were reported by the academic sector (n=16; 40%). Human interaction was the most common root cause (n=20; 23.8%) and most affected individuals were technicians/technologists (n=68; 73.1%). The median time delay between the incident date and reporting date was 5.5 days.
The exposure incident rate was lower in 2022 than in 2021. Incidents related to sharps and standard operating procedures remained the most common occurrence types. The most cited root cause of exposure incidents involved human interaction.
Good communication between healthcare professionals and their patients is essential to enlighten the benefits and risks of vaccination. Despite the availability of effective vaccines, reluctance ...prevails, sometimes fuelled by sub-optimal communication leading to a lack of trust. An evaluation of the effectiveness of a communication strategy for which healthcare professionals are trained has yet to be carried out.
Systematic review of studies with a randomized controlled trial (RCT) to define and evaluate the impact of healthcare professionals' communication on patients' vaccine adherence.
We performed a structured search on Medline, Embase, CENTRAL, PsycINFO and CINAHL. The studies selected include those involving healthcare professionals authorized to administer vaccines according to Canadian guidelines. Primary outcomes include vaccination rate or vaccine hesitancy rate.
Nine articles were included. Five studies (n=5) reported intervention effectiveness according to vaccine adherence. The results are largely represented by parental vaccine hesitancy for human papillomavirus (HPV) or childhood vaccination, while three studies (n=3) target the general population. The risk of bias relative to the studies is either low (n=7) or of some concern (n=2).
The effectiveness of communication varies according to the studies and knowledge acquired through training. Future studies will need to examine communication with healthcare professionals in order to establish a consensus on optimal and appropriate training.
Recent studies have demonstrated the effectiveness of nirmatrelvir-ritonavir in reducing the risk of progression to severe disease among outpatients with mild to moderate coronavirus disease 2019 ...(COVID-19); however, data are limited regarding the use and role of nirmatrelvir-ritonavir among hospitalized patients. This study describes the use and outcomes of nirmatrelvir-ritonavir among adults hospitalized with COVID-19 in a sentinel network of Canadian acute care hospitals during the Omicron variant phase of the pandemic.
The Canadian Nosocomial Infection Surveillance Program conducts surveillance of hospitalized patients with COVID-19 in acute care hospitals across Canada. Demographic, clinical, treatment and 30-day outcome data were collected by chart review by trained infection control professionals using standardized questionnaires.
From January 1 to December 31, 2022, 13% (n=490/3,731) of adult patients (18 years of age and older) hospitalized with COVID-19 in 40 acute care hospitals received nirmatrelvir-ritonavir either at admission or during hospitalization. Most inpatients who received nirmatrelvir-ritonavir, 79% of whom were fully vaccinated, had at least one pre-existing comorbidity (97%) and were of advanced age (median=79 years). Few were admitted to an intensive care unit (2.3%) and among the 490 nirmatrelvir-ritonavir treated inpatients, there were 13 (2.7%) deaths attributable to COVID-19.
These findings from a large sentinel network of Canadian acute-care hospitals suggest that nirmatrelvir-ritonavir is being used to treat adult COVID-19 patients at admission who are at risk of progression to severe disease or those who acquired COVID-19 in hospital. Additional research on the efficacy and indications for nirmatrelvir-ritonavir use in hospitalized patients is warranted to inform future policies and guidelines.
Invasive group A streptococcal disease (iGAS) is caused by
group A bacteria. In 2022, multiple disease alerts for iGAS in the Island Health region, in the context of increased infections in the ...paediatric population in Europe and the United States, prompted further investigation into local trends. This surveillance study summarizes epidemiological trends of iGAS in the region covered by Island Health, a regional health authority in British Columbia, in 2022.
In British Columbia, iGAS is a reportable disease; all confirmed cases are reported to the regional authority and the provincial health authority (BC Centre for Disease Control). Island Health's iGAS surveillance system is passive and collects information on cases that are identified through laboratory testing. Surveillance data were summarized for 2022 and compared with historical data from 2017-2021.
In 2022, the incidence rate was 11.4 cases per 100,000 population (n=101), the highest observed rate in the last six years. The median age of cases was 53 years, with a range of 0-96 years, and 64% of cases were male. The highest risk of infection was reported in men 40-59 years of age, with an incidence rate of 21.3 cases per 100,000 population. The most common
types were
92 (n=14),
49 (n=13), and
83 (n=12). Overall, 85% (n=86) of cases were hospitalized, 21% (n=21) were admitted to the intensive care unit, and 6% (n=6) died.
This study highlights that the incidence of iGAS in the Island Health region continued to increase throughout the coronavirus disease 2019 (COVID-19) pandemic, reaching its highest annual rate in 2022. In contrast to reports from Europe and the United States, there was no notable increase in infections in the paediatric population. Given the sustained increase in iGAS activity, continued monitoring and description of the epidemiology of these cases on a regular basis is imperative.
and
ticks are the principal vectors of the agent of Lyme disease and several other tick-borne diseases in Canada. Tick surveillance data can be used to identify local tick-borne disease risk areas ...and direct public health interventions. The objective of this article is to describe the seasonal and spatial characteristics of the main Lyme disease vectors in Canada, and the tick-borne pathogens they carry, using passive and active surveillance data from 2020.
Passive and active surveillance data were compiled from the National Microbiology Laboratory Branch (Public Health Agency of Canada), provincial and local public health authorities, and eTick (an online, image-based platform). Seasonal and spatial analyses of ticks and their associated pathogens are presented, including infection prevalence estimates.
In passive surveillance,
(n=7,534) were submitted from all provinces except Manitoba and British Columbia, while
(n=718) were submitted only from British Columbia. No ticks were submitted from the Territories. The seasonal distribution of
submissions was bimodal, but unimodal for
. Four tick-borne pathogens were identified in
(
,
,
and
) and one in
(
). In active surveillance,
(n=688) were collected in Ontario, Québec and New Brunswick. Five tick-borne pathogens were identified:
,
,
and Powassan virus.
This article provides a snapshot of the distribution of
and
and their associated human pathogens in Canada in 2020, which can help assess the risk of exposure to tick-borne pathogens in different provinces.
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