Surveillance is critical for improving population health. Public health surveillance systems generate information that drives action, and the data must be of sufficient quality and with a resolution ...and timeliness that matches objectives. In the context of scientific advances in public health surveillance, changing health care and public health environments, and rapidly evolving technologies, the aim of this article is to review public health surveillance systems. We consider their current use to increase the efficiency and effectiveness of the public health system, the role of system stakeholders, the analysis and interpretation of surveillance data, approaches to system monitoring and evaluation, and opportunities for future advances in terms of increased scientific rigor, outcomes-focused research, and health informatics.
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.
Healthcare-associated infections (HAIs) are a significant healthcare burden in Canada. National surveillance of HAIs at sentinel acute care hospitals is conducted by the Canadian Nosocomial Infection ...Surveillance Program. This article describes device and surgical procedure-related HAI epidemiology in Canada from 2017 to 2021.
Data were collected from over 60 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for central line-associated bloodstream infections (CLABSIs), hip and knee surgical site infections (SSIs), cerebrospinal fluid shunt SSIs and paediatric cardiac SSIs. Case counts, rates, patient and hospital characteristics, pathogen distributions and antimicrobial resistance data are presented.
Between 2017 and 2021, 2,898 device and surgical procedure-related infections were reported, with CLABSIs in intensive care units representing 69% (n=2,002) of all reported infections under surveillance. Significant rate increases were observed in adult mixed intensive care unit CLABSIs (1.08-2.11 infections per 1,000 line days,
=0.014) while decreases were observed in SSIs following knee arthroplasty (0.34-0.27 infections per 100 surgeries,
=0.05). No changes in trends were observed in the other reported HAIs. Of the 3,089 pathogens identified, the majority were gram-positive (66%), followed by gram negative (23%) and fungi (11%). Coagulase-negative staphylococci (22%) and
(17%) were the most frequently isolated pathogens.
Epidemiological and microbiological trends among select device and surgical procedure-related HAIs are essential for benchmarking infection rates nationally and internationally, identifying any changes in infection rates or antimicrobial resistance patterns and helping inform hospital infection prevention and control and antimicrobial stewardship policies and programs.
Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. This report describes epidemiologic and laboratory ...characteristics and trends of HAIs and AMR from 2017 to 2021 (
2012-2021) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial laboratories to the National Microbiology Laboratory (NML).
Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2017, and December 31, 2021, for
infections (CDI), carbapenemase-producing
(CPE), methicillin-resistant
(MRSA) bloodstream infections (BSIs) and vancomycin-resistant
(VRE) BSIs.
(
) surveillance was initiated in 2019 by CNISP and in 2012 by the NML. Case counts, rates, outcomes, molecular characterization and antimicrobial resistance profiles are presented.
From 2017 to 2021, increased rates per 10,000 patient days were observed for MRSA BSIs (35%; 0.84-1.13), VRE BSIs (43%; 0.23-0.33) and CPE infections (166%, 0.03-0.08). CDI rates decreased 11% (5.68-5.05). Thirty-one
isolates were identified in Canada from 2012 to 2021, with the majority from Western Canada (68%).
From 2017 to 2021, the incidence of MRSA and VRE BSIs, and CPE infections increased in Canadian acute care hospitals participating in a national sentinel network (CNISP) while CDI decreased. Few
isolates were identified from 2012 to 2021. Reporting standardized surveillance data and the consistent application of infection prevention and control practises in acute care hospitals are critical to help decrease the burden of HAIs and AMR in Canada.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants of concern are associated with increased infectivity, severity, and mortality of coronavirus disease 2019 (COVID-19) and have ...been increasingly detected in clinical and wastewater surveillance in Canada and internationally. In this study, we present a real-time quantitative reverse transcription polymerase chain reaction (RT-qPCR) assay for detection of the N gene D377Y mutation associated with the SARS-CoV-2 Delta variant in wastewater.
Wastewater samples (n=980) were collected from six cities and 17 rural communities across Canada from July to November 2021 and screened for the D377Y mutation.
The Delta variant was detected in all major Canadian cities and northern remote regions, and half of the southern rural communities. The sensitivity and specificity of this assay were sufficient for detection and quantitation of the Delta variant in wastewater to aid in rapid population-level screening and surveillance.
This study demonstrates a novel cost-effective RT-qPCR assay for tracking the spread of the SARS-CoV-2 Delta variant. This rapid assay can be easily integrated into current wastewater surveillance programs to aid in population-level variant tracking.
Neste trabalho é analisado o Sistema Nacional de Inspeção e Vigilância Sanitária - SNIVS, por meio do conjunto de normas que o constitui, assim como, de sua operacionalização enquanto instrumentos de ...regulação das atividades de produção, distribuição e consumo de alimentos de origem agrícola e pecuária no Brasil. O objetivo desta pesquisa é compreender o funcionamento do Sistema Nacional de Inspeção e de Vigilância Sanitária–SNIVS, suas vinculações institucionais e sua atuação na agricultura familiar e empresarial no Brasil, no contexto da discussão da concentração fundiária. O método utilizado foi à análise documental. Nos resultados da pesquisa identificam-se dois períodos distintos que caracterizam a atuação dos órgãos e entidades que compõem o SNIVS: num primeiro momento, suas atuações são favoráveis a Agricultura Empresarial, num segundo momento, as ações daqueles órgãos e entidades favorecem aos interesses da Agricultura Familiar. A pesquisa mostrou também que o SNIVS está operando um cuidadoso processo de harmonização institucional e operacional de acordo com os tratados bilaterais de comércio firmados com a Organização Mundial do Comércio – OMC e com a Organização Mundial da Saúde – OMS.
In January 2021, the Public Health Agency of Canada launched an outbreak surveillance system, the Canadian COVID-19 Outbreak Surveillance System (CCOSS), with the goal of monitoring incidence and ...severity of coronavirus disease 2019 (COVID-19) outbreaks across various community settings and complementing case surveillance.
Seven provinces were included in this report; these provinces submitted weekly cumulative COVID-19 outbreak line lists to CCOSS in 2021. Data includes administrative variables (e.g. date outbreak declared, date outbreak declared over, outbreak identifier), 24 outbreak settings, and number of confirmed cases and outcomes (hospitalization, death). Descriptive analyses for COVID-19 outbreaks across Canada from January 3, 2021, to January 1, 2022, were performed examining trends over time, severity, and outbreak size.
Incidence of outbreaks followed similar trends to case incidence. Outbreaks were most common in school and childcare settings (39%) and industrial/agricultural settings (21%). Outbreak size ranged from 2 to 639 cases per outbreak; the median size was four cases per outbreak. Correctional facilities had the largest median outbreak size with 18 cases per outbreak, followed by long-term care facilities with 10 cases per outbreak. During periods of high case incidence, outbreaks may be under-ascertained due to limited public health capacity, or reporting may be biased towards high-risk settings prioritized for testing. Outbreaks reported to CCOSS were dominated by jurisdictions with the largest populations.
The trends illustrate that COVID-19 outbreaks in 2021 were reported most frequently in community settings such as schools; however, the largest outbreaks occurred in congregate living settings. The information gathered from outbreak surveillance complemented case incidence trends and furthered understanding of COVID-19 in Canada.
Case underreporting during the coronavirus disease 2019 (COVID-19) pandemic has been a major challenge to the planning and evaluation of public health responses. School children were often considered ...a less vulnerable population and underreporting rates may have been particularly high. In January 2022, the Canadian province of Newfoundland and Labrador (NL) was experiencing an Omicron variant outbreak (BA.1/BA.2 subvariants) and public health officials recommended that all returning students complete two rapid antigen tests (RATs) to be performed three days apart.
To estimate the prevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we asked parents and guardians to report the results of the RATs completed by K-12 students (approximately 59,000 students) using an online survey.
When comparing the survey responses with the number of cases and tests reported by the NL testing system, we found that one out of every 4.3 (95% CI, 3.1-5.3) positive households were captured by provincial case count, with 5.1% positivity estimated from the RAT results and 1.2% positivity reported by the provincial testing system. Of positive test results, 62.9% (95% CI, 44.3-83.0) were reported for elementary school students, and the remaining 37.1% (95% CI, 22.7-52.9) were reported for junior high and high school students. Asymptomatic infections were 59.8% of the positive cases. Given the low survey participation rate (3.5%), our results may suffer from sample selection biases and should be interpreted with caution.
The underreporting ratio is consistent with ratios calculated from serology data and provides insights into infection prevalence and asymptomatic infections in school children; a currently understudied population.
In December 2020, Canada began its coronavirus disease 2019 (COVID-19) vaccine rollout campaign. Canadians were vaccinated with differing time intervals between doses, vaccine products and vaccine ...schedules, based on age, timing of vaccination and jurisdiction. The objective of this study is to describe the epidemiology and association between the incidence of COVID-19 cases following vaccination, time since completion of primary series, time between doses and/or product combination and probability of developing severe outcomes.
The national COVID-19 case data and vaccination coverage data were extracted from the National COVID-19 Surveillance System, and the Canadian COVID-19 Vaccination Coverage Surveillance System. Population estimates from Statistics Canada were used as denominators for rates and for number of people "not fully vaccinated". Two binomial generalized linear models were constructed for analysis.
Within the analysis period, fully vaccinated (i.e. completed primary series) cases (n=17,206) were more commonly female and older, and had fewer reported severe outcomes relative to not fully vaccinated cases (n=615,999). Episode date of fully vaccinated cases most frequently occurred two months after receiving their second dose, and time-between doses of 29-49 and 50-77 days were most common. The probability of becoming a detected COVID-19 case in not fully vaccinated individuals was higher than those fully vaccinated. Those receiving two doses of AstraZeneca and those with shortest time intervals between doses had higher probabilities of becoming COVID-19 cases.
Findings from Canada's national surveillance systems support that being fully vaccinated against COVID-19, having a longer time interval between doses and receiving a messenger ribonucleic acid (mRNA) COVID-19 vaccine schedule compared to other vaccines reduce the probability of becoming a case, using data from January to August 2021.
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