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Tuberculosis (TB), caused by Mycobacterium tuberculosis infection, is spread through airborne, aerosolized droplet nuclei produced by persons with pulmonary TB during forceful expiration (e.g., coughing, sneezing). (1) TB disease most [...], OBJECTIVES: Tuberculosis (TB) was a major cause of morbidity and mortality in Canada early in the 20th century. Elderly populations in Canada remain at high risk for TB disease. Elderly patients may present atypically, with the result that many active cases can remain undiagnosed. We present an outbreak of TB that occurred in a Residential and Long-Term Care (LTC) facility in Ontario. METHODS: Case finding was carried out through the conventional concentric circle approach. Three rounds of tuberculin skin testing were conducted at 8-12 week intervals. Laboratory analysis was conducted at the Public Health Ontario Laboratories. An indoor air quality assessment was conducted to determine whether inadequate engineering controls were a transmission risk factor. RESULTS: A case of active pulmonary TB was confirmed in May 2010 in a staff member at the facility. By January 2011, 3 additional active cases and 24 latent tuberculosis infections among residents and staff had been identified. Genotyping methods confirmed that the 4 active cases were infected by an identical strain. Nine of 15 locations tested in the facility had air exchange rates below published guidelines. CONCLUSION: Prompt reporting of the initial case allowed for a quick initiation of the epidemiologic investigation. Given the epidemiology of TB in elderly populations, outbreaks should remain a concern for LTC facilities and physicians, even in jurisdictions of low TB incidence. Baseline and annual TB screening for residents and staff, early diagnosis of active TB, and adequate ventilation are important to reduce the incidence of disease. KEY WORDS: Epidemiology; outbreaks; tuberculosis; long-term care OBJECTIFS : La tuberculose etait l'une des grandes causes de morbidite et de mortalite au Canada au debut du 20e siecle. Les populations agees du Canada presentent encore un risque eleve de contracter la tuberculose-maladie. Ses manifestations peuvent etre atypiques chez les patients ages; de nombreux cas actifs peuvent donc rester non diagnostiques. Nous presentons une eclosion de tuberculose survenue dans une maison de soins infirmiers en Ontario. METHODE : Nous avons procede a la recherche des cas selon l'approche classique des cercles concentriques. Trois cycles de tests cutanes a la tuberculine ont ete menes a intervalles de 8 a 12 semaines. L'analyse a ete faite dans les laboratoires de Sante publique Ontario. Une evaluation de la qualite de l'air a l'interieur a permis de determiner si des mesures d'ingenierie inadequates etaient un facteur de risque dans la transmission de la maladie. RESULTATS : Un cas de tuberculose pulmonaire active a ete confirme en mai 2010 chez un membre du personnel de l'etablissement. En janvier 2011, 3 autres cas actifs et 24 infections latentes a la tuberculose avaient ete detectes parmi les residents et le personnel. Des methodes de genotypage ont confirme que les quatre cas actifs etaient infectes par une souche identique. Neuf des 15 endroits testes dans l'etablissement avaient des taux d'echange d'air inferieurs aux lignes directrices publiees. CONCLUSION : La declaration rapide du cas initial a permis d'amorcer rapidement l'enquete epidemiologique. Etant donne l'epidemiologie de la tuberculose dans les populations agees, les maisons de soins infirmiers et les medecins doivent rester a l'affut des eclosions, meme dans les provinces et les territoires ou l'incidence de la tuberculose est faible. Le depistage initial, puis annuel de la tuberculose chez les residents et le personnel, le diagnostic precoce de la tuberculose active et une ventilation adequate sont d'importants facteurs pour reduire l'incidence de cette maladie. MOTS CLES : epidemiologie; flambees epidemiques; tuberculose; soins longue duree

Shiga toxin-producing Escherichia coli O157:H7/NM (STEC O157) are zoonotic pathogens associated with many food-borne and water-borne outbreaks in North America and elsewhere. (1-3) Most STEC O157 infections have been linked [...], Objectives: To describe an outbreak of Shiga toxin-producing Escherichia coli (STEC) O157:H7 infection following a four-day family gathering in Ontario. This is the first published account of a STEC O157 outbreak in Canada linked to consumption of pork. Methods: The outbreak investigation included interviews with food handlers and other key associated persons, inspection of food preparation premises, traceback investigations, case finding, analysis of data from an outbreak questionnaire, and laboratory analysis of samples collected from various sources associated with the outbreak. Results: Several meals, including pork from a pig roast, were served to the 59 attendees, 29 of whom developed gastrointestinal illness following the event. Six cases developed bloody diarrhoea and seven were hospitalized. Leftover pork served the day after the pig roast was the item most significantly associated with an increased risk of illness (p Conclusion: This outbreak highlights the need for increased awareness of pork as a potential source of STEC O157 infection, and for enhanced education regarding the safe handling, cooking and storage of food, specifically where large cuts of meat are cooked outdoors at events such as pig roasts, a cultural norm in some communities. Key words: Escherichia coli O157; zoonoses; food-borne illnesses; outbreaks; pigs; pork Objectif: Decrire une eclosion d'infections a Escherichia coli producteur de toxine dysenterique (STEC) O157:H7 apres une reunion familiale de quatre jours en Ontario. Il s'agit du premier compte rendu publie d'une eclosion de STEC O157 liee a la consommation de porc au Canada. Methode: L'enquete sur l'eclosion a compris des entretiens avec les manipulateurs d'aliments et autres personnes liees, l'inspection des installations de preparation des aliments, des enquetes de retracage, la recherche des cas, l'analyse des donnees d'un questionnaire sur l'eclosion et des analyses de laboratoire sur des echantillons preleves de diverses sources associees a l'eclosion. Resultats: Plusieurs repas, y compris du cochon cuit a la broche, ont ete servis aux 59 participants, dont 29 ont contracte une maladie gastrointestinale apres la fete. Six cas ont eu une diarrhee sanglante et sept ont ete hospitalises. Les restes de porc servis le lendemain de la cuisson a la broche ont presente la correlation la plus significative avec le risque accru de maladie (p Conclusion: Cette eclosion montre qu'il faut davantage surveiller le porc comme source d'infection potentielle par le pathogene STEC O157 et sensibiliser la population aux techniques de manipulation, de cuisson et d'entreposage sans danger des aliments, en particulier lorsque de grandes coupes de viande, comme le porc, sont cuites a l'exterieur a la broche (ce qui fait partie de la culture de certaines collectivites). Mots cles: Escherichia coli O157; zoonoses; toxi-infections alimentaires; flambees epidemiques; cochon; porc

Each fall in Ontario, public health delivers, promotes and provides the annual influenza vaccination program to the residents of Ontario. Although public health is the distribution point for all seasonal [...], Objective: Public health in Ontario delivers, promotes and provides each fall the universal influenza immunization program. This paper addresses the question of whether Ontario public health agencies are able to provide the influenza immunization program within the Ministry of Health fiscal funding envelope of $5 per dose. Methods: Actual program delivery data from the 2006 influenza season of Wellington-Dufferin-Guelph Public Health (WDGPH) were used to create a model template for influenza clinics capturing all variable costs. Promotional and administrative costs were separated from clinic costs. Maximum staff workloads were estimated. Vaccine clinics were delivered by public health staff in accordance with standard vaccine administration practices. Results: The most significant economic variables for influenza clinics are labour costs and number of vaccines given per nurse per hour. The cost of facility rental was the only other significant cost driver. The ability of influenza clinics to break even depended on the ability to manage these cost drivers. At WDGPH, weekday flu clinics required the number of vaccines per nurse per hour to exceed 15, and for weekend flu clinics this number was greater than 21. We estimate that 20 vaccines per hour is at the limit of a safe workload over several hours. Managing cost then depends on minimizing hourly labour costs. Discussion: The results of this analysis suggest that by managing the labour costs along with planning the volume of patients and avoiding expensive facilities, flu clinics can just break even. However, any increased costs, including negotiated wage increases or the move to safety needles, with a fixed revenue of $5.00 per dose will negate this conclusion. Key words: Immunization programs/economics; delivery of health care/economics; influenza vaccine/economics; direct service costs La traduction du resume se trouve a la fin de l'article. Objectif : Chaque automne, la Sante publique de l'Ontario assure la prestation, la promotion et l'administration d'un programme universel de vaccination contre la grippe. Nous avons cherche a savoir si les organismes de sante publique ontariens parviennent a offrir ce programme sans depasser l'enveloppe budgetaire accordee par le ministere de la Sante, soit 5 $ la dose. Methode : A l'aide des donnees reelles de prestation du programme dans la circonscription sanitaire de Wellington-Dufferin-Guelph (CSWDG) pendant la saison grippale 2006, nous avons cree un modele pour saisir les couts variables des cliniques de vaccination contre la grippe. Les frais promotionnels et les charges administratives ont ete separes des couts des cliniques. Les charges de travail maximales du personnel sont estimatives. Les cliniques de vaccination ont ete offertes par les effectifs de sante publique conformement aux normes administratives en vigueur. Resultats : Les variables economiques les plus importantes des cliniques de vaccination contre la grippe sont les couts en main-d'oeuvre et le nombre de vaccins administres par infirmiere par heure. Les frais de location des installations etaient le seul autre element de cout significatif. L'equilibre budgetaire des cliniques de vaccination contre la grippe depend de leur capacite de gerer ces elements de cout. Dans la CSWDG, pour les cliniques tenues les jours de semaine, le nombre de vaccinations par infirmiere par heure etait superieur a 15, et pour les cliniques de fin de semaine, ce nombre etait superieur a 21. Nous estimons que 20 vaccinations a l'heure est le maximum pour accomplir le travail en toute securite pendant plusieurs heures. La gestion des couts depend ensuite de la reduction des couts horaires en main-d'oeuvre. Discussion : Selon les resultats de l'analyse, en gerant les couts de main-d'oeuvre, en planifiant le volume de patients et en evitant les installations trop cheres, les cliniques de vaccination contre la grippe font tout juste leurs frais. Le budget fixe de 5 $ la dose devient insuffisant des que les couts augmentent (p. ex., s'il y a des hausses salariales negociees par convention collective ou si l'on opte pour des aiguilles de securite). Mots cles : programmes de vaccination/aspects economiques; prestation des soins de sante/aspects economiques; vaccin contre la grippe/aspects economiques; couts directs des services