145 results on '"Marchand‐Austin, Alex"'
Search Results
2. Divergent SARS-CoV-2 variant emerges in white-tailed deer with deer-to-human transmission
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Pickering, Bradley, Lung, Oliver, Maguire, Finlay, Kruczkiewicz, Peter, Kotwa, Jonathon D., Buchanan, Tore, Gagnier, Marianne, Guthrie, Jennifer L., Jardine, Claire M., Marchand-Austin, Alex, Massé, Ariane, McClinchey, Heather, Nirmalarajah, Kuganya, Aftanas, Patryk, Blais-Savoie, Juliette, Chee, Hsien-Yao, Chien, Emily, Yim, Winfield, Banete, Andra, Griffin, Bryan D., Yip, Lily, Goolia, Melissa, Suderman, Matthew, Pinette, Mathieu, Smith, Greg, Sullivan, Daniel, Rudar, Josip, Vernygora, Oksana, Adey, Elizabeth, Nebroski, Michelle, Goyette, Guillaume, Finzi, Andrés, Laroche, Geneviève, Ariana, Ardeshir, Vahkal, Brett, Côté, Marceline, McGeer, Allison J., Nituch, Larissa, Mubareka, Samira, and Bowman, Jeff
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- 2022
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3. Large scale analysis of the SARS-CoV-2 main protease reveals marginal presence of nirmatrelvir-resistant SARS-CoV-2 Omicron mutants in Ontario, Canada, December 2021-September 2023.
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Duvvuri, Venkata, Shire, Fatima, Isabel, Sandra, Braukmann, Thomas, Clark, Shawn, Marchand-Austin, Alex, Eshaghi, Alireza, Bandukwala, Hina, Varghese, Nobish, Ye Li, Sivaraman, Karthikeyan, Hussain, Hadia, Cronin, Kirby, Sullivan, Ashleigh, Aimin Li, Zygmunt, Austin, Ramotar, Karam, Kus, Julianne, Hasso, Maan, and Corbeil, Antoine
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SARS-CoV-2 Omicron variant ,SARS-CoV-2 ,COVID-19 pandemic ,COVID-19 treatment ,DATABASES - Abstract
Background: In response to the COVID-19 pandemic, a new oral antiviral called nirmatrelvirritonavir (PaxlovidTM) was authorized for use in Canada in January 2022. In vitro studies have reported mutations in Mpro protein that may be associated with the development of nirmatrelvir resistance. Objectives: To survey the prevalence, relevance and temporal patterns of Mpro mutations among SARS-CoV-2 Omicron lineages in Ontario, Canada. Methods: A total of 93,082 Mpro gene sequences from December 2021 to September 2023 were analyzed. Reported in vitro Mpro mutations were screened against our database using in-house data science pipelines to determine the nirmatrelvir resistance. Negative binomial regression was conducted to analyze the temporal trends in Mpro mutation counts over the study time period. Results: A declining trend was observed in non-synonymous mutations of Mpro sequences, showing a 7.9% reduction (95% CI: 6.5%--9.4%; p<0.001) every 30 days. The P132H was the most prevalent mutation (higher than 95%) in all Omicron lineages. In vitro nirmatrelvir-resistant mutations were found in 3.12% (n=29/929) Omicron lineages with very low counts, ranging from one to 19. Only two mutations, A7T (n=19) and M82I (n=9), showed temporal presence among the BA.1.1 in 2022 and the BQ.1.2.3 in 2022, respectively. Conclusion: The observations suggest that, as of September 2023, no significant or widespread resistance to nirmatrelvir has developed among SARS-CoV-2 Omicron variants in Ontario. This study highlights the importance of creating automated monitoring systems to track the emergence of nirmatrelvir-resistant mutations within the SARS-CoV-2 virus, utilizing genomic data generated in real-time. [ABSTRACT FROM AUTHOR]
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- 2024
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4. Exploring the reasons for low pertussis vaccine effectiveness in Ontario, Canada, 2006–2008: a Canadian Immunization Research Network study
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Hughes, Stephanie L., Kwong, Jeffrey C., Schwartz, Kevin L., Chen, Cynthia, Johnson, Caitlin, Li, Ye, Marchand-Austin, Alex, Bolotin, Shelly, Jamieson, Frances B., Drews, Steven J., Russell, Margaret L., Svenson, Lawrence W., Mahmud, Salaheddin M., and Crowcroft, Natasha S.
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- 2022
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5. Patient and provider determinants of breast cancer screening among Ontario women aged 40–49: a population-based retrospective cohort study
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Nadler, Michelle B., Ivers, Noah, Marchand-Austin, Alex, Lofters, Aisha, Austin, Peter C., Wilson, Brooke E., Desnoyers, Alexandra, and Amir, Eitan
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- 2021
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6. Antibiotic susceptibility reporting and association with antibiotic prescribing: a cohort study
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Langford, Bradley J., Daneman, Nick, Diong, Christina, Marchand-Austin, Alex, Adomako, Kwaku, Saedi, Arezou, Schwartz, Kevin L., Johnstone, Jennie, MacFadden, Derek R., Matukas, Larissa M., Patel, Samir N., Garber, Gary, and Brown, Kevin A.
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- 2021
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7. Publisher Correction: Divergent SARS-CoV-2 variant emerges in white-tailed deer with deer-to-human transmission
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Pickering, Bradley, Lung, Oliver, Maguire, Finlay, Kruczkiewicz, Peter, Kotwa, Jonathon D., Buchanan, Tore, Gagnier, Marianne, Guthrie, Jennifer L., Jardine, Claire M., Marchand-Austin, Alex, Massé, Ariane, McClinchey, Heather, Nirmalarajah, Kuganya, Aftanas, Patryk, Blais-Savoie, Juliette, Chee, Hsien-Yao, Chien, Emily, Yim, Winfield, Banete, Andra, Griffin, Bryan D., Yip, Lily, Goolia, Melissa, Suderman, Matthew, Pinette, Mathieu, Smith, Greg, Sullivan, Daniel, Rudar, Josip, Vernygora, Oksana, Adey, Elizabeth, Nebroski, Michelle, Goyette, Guillaume, Finzi, Andrés, Laroche, Geneviève, Ariana, Ardeshir, Vahkal, Brett, Côté, Marceline, McGeer, Allison J., Nituch, Larissa, Mubareka, Samira, and Bowman, Jeff
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- 2023
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8. Limitations of administrative data to identify measles cases in Ontario, Canada : a cautionary tale
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Johnson, Caitlin, Chen, Cynthia, Rosella, Laura, Rilkoff, Heather, Marchand-Austin, Alex, Gubbay, Jonathan B., Kozlowski, Tina, Deeks, Shelley L., Mazzulli, Tony, and Crowcroft, Natasha
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- 2018
9. Prenatal hepatitis B screening, and hepatitis B burden among children, in Ontario: a descriptive study
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Biondi, Mia J., Marchand-Austin, Alex, Cronin, Kirby, Nanwa, Natasha, Ravirajan, Vithusha, Mandel, Erin, Goneau, Lee W., Mazzulli, Tony, Shah, Hemant, Capraru, Camelia, Janssen, Harry L.A., Sander, Beate, and Feld, Jordan J.
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Child health -- Management ,Medical care utilization -- Evaluation ,Hepatitis B -- Diagnosis -- Care and treatment ,Company business management ,Health - Abstract
BACKGROUND: Ontario is 1 of 5 provinces that immunize adolescents for hepatitis B virus (HBV), despite the World Health Organization recommendation for universal birth dose vaccination. One rationale for not vaccinating at birth is that universal prenatal screening and related interventions prevent vertical transmission. The aims of our study were to evaluate the uptake and epidemiology of prenatal HBV screening, and to determine the number of children in Ontario with a diagnosis of HBV before adolescent vaccination. METHODS: We extracted data from ICES, Public Health Ontario and Better Outcomes & Registry Network (BORN) Ontario databases. We assessed prenatal screening uptake and prevalence of prenatal hepatitis B surface antigen (HBsAg) from 2012 to 2016, as well as subsequent hepatitis B e-antigen (HBeAg) and HBV DNA testing and percent positivity. We used age and region to subcategorize the results. In a separate unlinked analysis, we evaluated the number of children positive for HBV aged 0-11 years who were born in Ontario from 2003 to 2013. RESULTS: From 2012 to 2016, 93% of pregnant women were screened for HBV, with an HBsAg prevalence of 0.6%. Prevalence of HBsAg increased with age, peaking at older than 45 years at 3%. North Toronto had the highest overall prevalence of 1.5%, whereas northern Ontario had the lowest. Of women who were HBsAg positive, HBeAg and HBV DNA tests were subsequently ordered in 13% and 38%, respectively. Of children born in Ontario between 2003 and 2013, 139 of 23759 tested positive for HBV. INTERPRETATION: Prenatal HBV screening is not universal and subsequent evaluation is poor, limiting optimal intervention and possibly contributing to some Ontario-born children being given a diagnosis of HBV before age 12 years. These findings underscore the limitations of the province's adolescent vaccination strategy., An estimated 257 million people are chronically infected with hepatitis B virus (HBV) worldwide. (1) Hepatitis B ranks fourth on the list of most burdensome infectious diseases in Ontario, (2) [...]
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- 2020
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10. Prescribing Patterns for Treatment of Mycobacterium avium Complex and M. xenopi Pulmonary Disease in Ontario, Canada, 2001-2013
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Brode, Sarah K., Chung, Hannah, Campitelli, Michael A., Kwong, Jeffrey C., Marchand-Austin, Alex, Winthrop, Kevin L., Jamieson, Frances B., and Marras, Theodore K.
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Evidence-based medicine -- Surveys ,Mycobacterium avium complex -- Surveys ,Prescription writing -- Surveys ,Rifamycins -- Surveys ,Microbial drug resistance -- Care and treatment ,Lung diseases -- Care and treatment ,Ethambutol -- Surveys ,Health - Abstract
Nontuberculous mycobacteria (NTM) pulmonary disease (PD) is increasing in North America (1-3). The 2 most common causes of NTM PD in Ontario, Canada, are Mycobacterium avium complex (MAC) and M. [...]
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- 2019
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11. Mycobacterium xenopi Genotype Associated with Clinical Phenotype in Lung Disease
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Hirama, Takashi, Marchand-Austin, Alex, Ma, Jennifer, Alexander, David C., Brode, Sarah K., Marras, Theodore K., and Jamieson, Frances B.
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Lung diseases -- Causes of -- Development and progression -- Genetic aspects -- Research ,Mycobacteria -- Physiological aspects -- Genetic aspects -- Research ,Health - Abstract
Mycobacterium xenopi is responsible for pulmonary disease (PD) in Europe and Canada. Despite its high prevalence and increasing clinical importance, little is known about the genetic diversity of M. xenopi. Through a prospective study for M. xenopi strain type and the relation to clinical phenotype, 39 patients with M. xenopi PD were analyzed. Our study demonstrated that sequence type (ST) 5 was dominant in Ontario among 15 distinct STs and caused PD in people even without underlying lung disease, whereas disease due to non-ST5 was found almost exclusively in patients with underlying lung disease., Author(s): Takashi Hirama [sup.1] [sup.2] [sup.3] , Alex Marchand-Austin [sup.4] [sup.5] , Jennifer Ma [sup.5] , David C. Alexander [sup.6] , Sarah K. Brode [sup.1] [sup.2] [sup.3] , Theodore K. [...]
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- 2018
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12. Data-driven approach of CUSUM algorithm in temporal aberrant event detection using interactive web applications
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Li, Ye, Whelan, Michael, Hobbs, Leigh, Fan, Wen Qi, Fung, Cecilia, Wong, Kenny, Marchand-Austin, Alex, Badiani, Tina, and Johnson, Ian
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- 2016
13. The direct healthcare costs attributable to West Nile virus illness in Ontario, Canada: a population-based cohort study using laboratory and health administrative data
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Shing, Emily, Wang, John, Nelder, Mark P., Parpia, Camilla, Gubbay, Jonathan B., Loeb, Mark, Kristjanson, Erik, Marchand-Austin, Alex, Moore, Stephen, Russell, Curtis, Sider, Doug, and Sander, Beate
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- 2019
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14. Pulmonary versus Nonpulmonary Nontuberculous Mycobacteria, Ontario, Canada
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Brode, Sarah K., Marchand-Austin, Alex, Jamieson, Frances B., and Marras, Theodore K.
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High performance liquid chromatography -- Usage ,Public health -- Health aspects ,Bronchoscopy -- Usage ,Mycobacteria -- Analysis ,Health - Abstract
Nontuberculous mycobacteria (NTM) cause pulmonary and nonpulmonary disease, but most isolates and disease cases are pulmonary (1). Studies have demonstrated temporal increases in pulmonary NTM isolation and disease (2,3). To [...]
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- 2017
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15. Pulmonary nontuberculous mycobacteria-associated deaths, Ontario, Canada, 2001-2013
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Marras, Theodore K., Campitelli, Michael A., Lu, Hong, Chung, Hannah, Brode, Sarah K., Marchand-Austin, Alex, Winthrop, Kevin L., Gershon, Andrea S., Kwong, Jeffrey C., and Jamieson, Frances B.
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Ontario. Ministry of Health and Long-Term Care -- Analysis ,Mortality -- Ontario -- Canada -- Analysis ,Lung diseases -- Analysis ,Health - Abstract
Nontuberculous mycobacterial pulmonary disease (NTM-PD) is an increasingly common problem (1-3) that is associated with substantially impaired quality of life (4) and is difficult and costly to treat (5,6). At [...]
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- 2017
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16. Coxsackieviruses in Ontario, January 2005 to December 2011
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Peci, Adriana, Winter, Anne-Luise, Eshaghi, Alireza, Marchand-Austin, Alex, Olsha, Romy, Lombardi, Nino, and Gubbay, Jonathan B.
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- 2014
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17. Antimicrobial susceptibility of clinical isolates of anaerobic bacteria in Ontario, 2010–2011
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Marchand-Austin, Alex, Rawte, Prasad, Toye, Baldwin, Jamieson, Frances B., Farrell, David J., and Patel, Samir N.
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- 2014
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18. High Incidence of Invasive Group A Streptococcal Infections in Remote Indigenous Communities in Northwestern Ontario, Canada
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Bocking, Natalie, Matsumoto, Cai-lei, Loewen, Kassandra, Teatero, Sarah, Marchand-Austin, Alex, Gordon, Janet, Fittipaldi, Nahuel, and McGeer, Allison
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- 2017
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19. Potential T cell epitopes within swine-origin triple reassortant influenza A (H3N2) variant virus which emerged in 2011: An immunoinformatics study
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Duvvuri, Venkata R., Marchand-Austin, Alex, Eshaghi, Alireza, Patel, Samir N., Low, Donald E., and Gubbay, Jonathan B.
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- 2012
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20. Transmission of Influenza A Pandemic (H1N1) 2009 Virus in a Long‐Term Care Facility in Ontario, Canada
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Alexander, David C., Winter, Anne‐Luise, Eshaghi, AliReza, Dooling, Kathleen, Frenette, Crystal, de Villa, Eileen, Varia, Monali, Marchand‐Austin, Alex, Jamieson, Frances, and Gubbay, Jonathan B.
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- 2010
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21. Effectiveness of pertussis vaccination and duration of immunity
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Schwartz, Kevin L., Kwong, Jeffrey C., Deeks, Shelley L., Campitelli, Michael A., Jamieson, Frances B., Marchand-Austin, Alex, Stukel, Therese A., Rosella, Laura, Daneman, Nick, Bolotin, Shelly, Drews, Steven J., Rilkoff, Heather, and Crowcroft, Natasha S.
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Immune response -- Testing ,Vaccines -- Testing ,Whooping-cough -- Prevention ,Health - Abstract
Background: A resurgence of pertussis cases among both vaccinated and unvaccinated people raises questions about vaccine effectiveness over time. Our objective was to study the effectiveness of the pertussis vaccine and characterize the effect of waning immunity and whole-cell vaccine priming. Methods: We used the test-negative design, a nested case-control study with test-negative individuals as controls. We constructed multivariable logistic regression models to estimate odds ratios (ORs). Vaccine effectiveness was calculated as (1 - OR) x 100. We assessed waning immunity by calculating the odds of developing pertussis per year since last vaccination and evaluated the relative effectiveness of priming with acellular versus whole-cell vaccine. Results: Between Dec. 7, 2009, and Mar. 31, 2013, data on 5867 individuals (486 test-positive cases and 5381 test-negative controls) were available for analysis. Adjusted vaccine effectiveness was 80% (95% confidence interval [CI] 71% to 86%) at 15-364 days, 84% (95% CI 77% to 89%) at 1-3 years, 62% (95% CI 42% to 75%) at 4-7 years and 41% (95% CI 0% to 66%) at 8 or more years since last vaccination. We observed waning immunity with the acellular vaccine, with an adjusted OR for pertussis infection of 1.27 (95% CI 1.20 to 1.34) per year since last vaccination. Acellular, versus whole-cell, vaccine priming was associated with an increased odds of pertussis (adjusted OR 2.15, 95% CI 1.30 to 3.57). Interpretation: We observed high early effectiveness of the pertussis vaccine that rapidly declined as time since last vaccination surpassed 4 years, particularly with acellular vaccine priming. Considering whole-cell vaccine priming and/or boosters in pregnancy to optimize pertussis control may be prudent., Whooping cough, or pertussis, is a highly contagious respiratory infection that has been inadequately controlled compared with other vaccine-preventable diseases. The incidence of pertussis in Canada decreased from 156 cases [...]
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- 2016
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22. Increased risk of mycobacterial infections associated with anti-rheumatic medications
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Brode, Sarah K, Jamieson, Frances B, Ng, Ryan, Campitelli, Michael A, Kwong, Jeffrey C, Paterson, J Michael, Li, Ping, Marchand-Austin, Alex, Bombardier, Claire, and Marras, Theodore K
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- 2015
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23. Human metapneumovirus prevalence and molecular epidemiology in respiratory outbreaks in Ontario, Canada
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Neemuchwala, Alefiya, Duvvuri, Venkata R., Marchand-Austin, Alex, Li, Aimin, and Gubbay, Jonathan B.
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- 2015
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24. Acute respiratory infections in travelers returning from MERS-CoV-affected areas
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German, Matthew, Olsha, Romy, Kristjanson, Erik, Marchand-Austin, Alex, Peci, Adriana, Winter, Anne-Luise, and Gubbay, Jonathan B.
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Travelers -- Health aspects -- Research ,Health - Abstract
Middle East respiratory syndrome coronavirus (MERS-CoV) was originally described in 2012 in a patient with severe pneumonia in Saudi Arabia (1). The virus has been detected in several countries of [...]
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- 2015
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25. Respiratory viral infections in institutions from late stage of the first and second waves of pandemic influenza A (H1N1) 2009, Ontario, Canada
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Asner, Sandra, Peci, Adriana, Marchand-Austin, Alex, Winter, Anne-Luise, Olsha, Romy, Kristjanson, Erik, Low, Donald E., and Gubbay, Jonathan B.
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- 2012
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26. SEVERE HUMAN RHINOVIRUS OUTBREAK ASSOCIATED WITH FATALITIES IN A LONG-TERM CARE FACILITY IN ONTARIO, CANADA
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Longtin, Jean, Winter, Anne-Luise, Heng, Denis, Marchand-Austin, Alex, Eshaghi, Alireza, Patel, Samir, Jamieson, Frances, Weir, Erica, Low, Donald E., and Gubbay, Jonathan B.
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- 2010
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27. Pulmonary nontuberculous mycobacterial disease, Ontario, Canada, 1998-2010
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Marras, Theodore K., Mendelson, David, Marchand-Austin, Alex, May, Kevin, and Jamieson, Frances B.
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Mycobacterial infections -- Research -- Demographic aspects ,Bacterial infections -- Diagnosis -- Demographic aspects ,Prevalence studies (Epidemiology) -- Analysis ,Health - Abstract
Pulmonary nontuberculous mycobacterial (pNTM) disease is clinically challenging. Therapy entails complex antimycobacterial drug combinations, typically for 18 months (1), often with poor tolerability (2) and limited success (3). pNTM disease [...]
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- 2013
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28. Rhinovirus outbreaks in long-term care facilities, Ontario, Canada
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Longtin, Jean, Marchand-Austin, Alex, Winter, Anne-Luise, Patel, Samir, Eshaghi, Alireza, Jamieson, Frances, Low, Donald E., and Gubbay, Jonathan B.
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Epidemics -- Canada -- Research ,Rhinoviruses -- Health aspects -- Distribution -- Research ,Respiratory tract infections -- Causes of -- Distribution -- Research -- Health aspects ,Long-term care facilities -- Health aspects -- Distribution ,Company distribution practices ,Health - Abstract
Respiratory tract illnesses are a major cause of illness and death among elderly persons, especially those in long-term care facilities. Although the most commonly identified viruses have been influenza virus [...]
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- 2010
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29. Respiratory infection in institutions during early stages of pandemic (H1N1) 2009, Canada
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Marchand-Austin, Alex, Farrell, David J., Jamieson, Frances B., Lombardi, Nino, Lombos, Ernesto, Narang, Sunita, Akwar, Holy, Low, Donald E., and Gubbay, Jonathan B.
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Long-term care facilities -- Health aspects ,Epidemics -- Canada ,Epidemics -- Risk factors ,Epidemics -- Development and progression ,Epidemics -- Health aspects ,Long-term care of the sick -- Health aspects ,Public health -- Health aspects ,Medical research -- Health aspects ,Medicine, Experimental -- Health aspects ,Influenza viruses -- Health aspects ,Influenza -- Risk factors ,Influenza -- Development and progression ,Influenza -- Health aspects ,Lung diseases -- Risk factors ,Lung diseases -- Development and progression ,Lung diseases -- Health aspects ,Diseases -- Canada ,Diseases -- Risk factors ,Diseases -- Development and progression ,Diseases -- Health aspects - Abstract
Respiratory infection outbreaks in institutions housing large numbers of residents create an ideal environment for disease transmission (1). Patients in long-term care facilities (LTCFs) for the elderly are more susceptible [...]
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- 2009
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30. The Benefits and Harms of Antibiotic Prophylaxis for Urinary Tract Infection in Older Adults.
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Langford, Bradley J, Brown, Kevin A, Diong, Christina, Marchand-Austin, Alex, Adomako, Kwaku, Saedi, Arezou, Schwartz, Kevin L, Johnstone, Jennie, MacFadden, Derek R, Matukas, Larissa M, Patel, Samir N, Garber, Gary, and Daneman, Nick
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URINARY tract infection prevention ,CONFIDENCE intervals ,URINARY tract infections ,CASE-control method ,RETROSPECTIVE studies ,CLOSTRIDIOIDES difficile ,ANTIBIOTIC prophylaxis ,TREATMENT effectiveness ,SEPSIS ,DESCRIPTIVE statistics ,HOSPITAL care ,DRUG resistance in microorganisms ,DRUG side effects ,LONGITUDINAL method ,OLD age - Abstract
Background The role of antibiotics in preventing urinary tract infection (UTI) in older adults is unknown. We sought to quantify the benefits and risks of antibiotic prophylaxis among older adults. Methods We conducted a matched cohort study comparing older adults (≥66 years) receiving antibiotic prophylaxis, defined as antibiotic treatment for ≥30 days starting within 30 days of a positive culture, with patients with positive urine cultures who received antibiotic treatment but did not receive prophylaxis. We matched each prophylaxis recipient to 10 nonrecipients based on organism, number of positive cultures, and propensity score. Outcomes included (1) emergency department (ED) visit or hospitalization for UTI, sepsis, or bloodstream infection within 1 year; (2) acquisition of antibiotic resistance in urinary tract pathogens; and (3) antibiotic-related complications. Results Overall, 4.7% (151/3190) of UTI prophylaxis patients and 3.6% (n = 1092/30 542) of controls required an ED visit or hospitalization for UTI, sepsis, or bloodstream infection (hazard ratio [HR], 1.33; 95% confidence interval [CI], 1.12–1.57). Acquisition of antibiotic resistance to any urinary antibiotic (HR, 1.31; 95% CI, 1.18–1.44) and to the specific prophylaxis agent (HR, 2.01; 95% CI, 1.80–2.24) was higher in patients receiving prophylaxis. While the overall risk of antibiotic-related complications was similar between groups (HR, 1.08; 95% CI,.94–1.22), the risk of Clostridioides difficile and general medication adverse events was higher in prophylaxis recipients (HR [95% CI], 1.56 [1.05–2.23] and 1.62 [1.11–2.29], respectively). Conclusions Among older adults with UTI, the harms of long-term antibiotic prophylaxis may outweigh their benefits. [ABSTRACT FROM AUTHOR]
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- 2021
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31. A Call for Caution in Use of Pertussis Vaccine Effectiveness Studies to Estimate Waning Immunity: A Canadian Immunization Research Network Study.
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Crowcroft, Natasha S, Schwartz, Kevin L, Savage, Rachel D, Chen, Cynthia, Johnson, Caitlin, Li, Ye, Marchand-Austin, Alex, Bolotin, Shelly, Deeks, Shelley L, Jamieson, Frances B, Drews, Steven J, Russell, Margaret L, Svenson, Lawrence W, Simmonds, Kimberley, Righolt, Christiaan H, Bell, Christopher, Mahmud, Salaheddin M, and Kwong, Jeffrey C
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IMMUNIZATION ,WHOOPING cough ,IMMUNITY ,WHOOPING cough vaccines - Abstract
Background Vaccine effectiveness (VE) studies provide essential evidence on waning vaccine-derived immunity, a major threat to pertussis control. We evaluated how study design affects estimates by comparing 2 case-control studies conducted in Ontario, Canada. Methods We compared results from a test-negative design (TND) with a frequency-matched design (FMD) case-control study using pertussis cases from 2005–2015. In the first study, we identified test-negative controls from the public health laboratory that diagnosed cases and, in the second, randomly selected controls from patients attending the same physicians that reported cases, frequency matched on age and year. We compared characteristics of cases and controls using standardized differences. Results In both designs, VE estimates for the early years postimmunization were consistent with clinical trials (TND, 84%; FMD, 89% at 1–3 years postvaccination) but diverged as time since last vaccination increased (TND, 41%; FMD, 74% by 8 years postvaccination). Overall, we observed lower VE and faster waning in the TND than the FMD. In the TND but not FMD, controls differed from cases in important confounders, being younger, having more comorbidities, and higher healthcare use. Differences between the controls of each design were greater than differences between cases. TND controls were more likely to be unvaccinated or incompletely vaccinated than FMD controls (P < .001). Conclusions The FMD adjusted better for healthcare-seeking behavior than the TND. Duration of protection from pertussis vaccines is unclear because estimates vary by study design. Caution should be exercised by experts, researchers, and decision makers when evaluating evidence on optimal timing of boosters. [ABSTRACT FROM AUTHOR]
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- 2021
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32. Underutilization of nontuberculous mycobacterial drug susceptibility testing in Ontario, Canada, 2010-2015.
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Andrews, Elizabeth R., Marchand-Austin, Alex, Ma, Jennifer, Cronin, Kirby, Sharma, Meenu, Brode, Sarah K., Marras, Theodore K., and Jamieson, Frances B.
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- 2020
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33. The evolving nature of Bordetella pertussis in Ontario, Canada, 2009–2017: strains with shifting genotypes and pertactin deficiency.
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Tsang, Raymond S.W., Shuel, Michelle, Cronin, Kirby, Deng, Saul, Whyte, Kathleen, Marchand-Austin, Alex, Ma, Jennifer, Bolotin, Shelly, Crowcroft, Natasha, Schwartz, Kevin, Van Domselaar, Gary, Graham, Morag, and Jamieson, Frances B.
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BORDETELLA pertussis ,PERTUSSIS toxin ,GENOTYPES ,NATURE ,WHOOPING cough - Abstract
Copyright of Canadian Journal of Microbiology is the property of Canadian Science Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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- 2019
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34. Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort).
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Juan Liu, Wilton, James, Sullivan, Ashleigh, Marchand-Austin, Alex, Rachlis, Beth, Giles, Madison, Light, Lucia, Sider, Doug, Kroch, Abigail E., and Gilbert, Mark
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Purpose Population-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada. Participants A datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985-2015) or VL test (1996-2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration. Findings to date As of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with =1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort--contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged =45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015. Future plans We plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities. [ABSTRACT FROM AUTHOR]
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- 2019
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35. Universal genotyping reveals province-level differences in the molecular epidemiology of tuberculosis.
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Guthrie, Jennifer L., Marchand-Austin, Alex, Cronin, Kirby, Lam, Karen, Pyskir, Daria, Kong, Clare, Jorgensen, Danielle, Rodrigues, Mabel, Roth, David, Tang, Patrick, Cook, Victoria J., Johnston, James, Jamieson, Frances B., and Gardy, Jennifer L.
- Subjects
- *
MOLECULAR epidemiology , *MYCOBACTERIUM tuberculosis , *TUBERCULOSIS , *TANDEM repeats , *DEMOGRAPHIC characteristics , *NUCLEOTIDE sequencing - Abstract
Objectives: Compare the molecular epidemiology of tuberculosis (TB) between two large Canadian provinces–Ontario and British Columbia (BC)–to identify genotypic clusters within and across both provinces, allowing for an improved understanding of genotype data and providing context to more accurately identify clusters representing local transmission. Design: We compared 24-locus Mycobacterial Interspersed Repetitive Units-Variable Number of Tandem Repeats (MIRU-VNTR) genotyping for 3,314 Ontario and 1,602 BC clinical Mycobacterium tuberculosis isolates collected from 2008 through 2014. Laboratory data for each isolate was linked to case-level records to obtain clinical and demographic data. Results: The demographic characteristics of persons with TB varied between provinces, most notably in the proportion of persons born outside Canada, which was reflected in the large number of unique genotypes (n = 3,461). The proportion of clustered isolates was significantly higher in BC. Substantial clustering amongst non-Lineage 4 TB strains was observed within and across the provinces. Only two large clusters (≥10 cases/cluster) representing within province transmission had interprovincial genotype matches. Conclusion: We recommend expanding analysis of shared genotypes to include neighbouring jurisdictions, and implementing whole genome sequencing to improve identification of TB transmission, recognize outbreaks, and monitor changing trends in TB epidemiology. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
36. A method for improved fluorescent staining for acid fast smear microscopy by incorporating an acetone rinse step.
- Author
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May, Kevin, Marchand-Austin, Alex, Peci, Adriana, and Jamieson, Frances B.
- Subjects
- *
ACETONE , *MARINE debris , *STAIRS - Abstract
Abstract Microscopic examination of the specimen smear for acid fast bacilli (AFB) provides a simple and rapid means of detecting AFB using fluorescent stain methods and remains a valuable diagnostic test used worldwide to identify and manage suspect cases of tuberculosis (TB). Methods to improve AFB smear staining protocols could provide better detection of suspect TB cases. In particular, decreasing background debris may improve the detection of smears with low numbers of bacilli. We assessed staining by the standard rack method compared to bulk container staining using an acetone rinse step to decrease background debris. No cross-contamination was observed in the bulk container staining, and higher accuracy with less reading time was achieved with the acetone rinse. Most importantly, more bacilli were detected per positive smear using the acetone rinse method. Highlights • Bulk container staining for acid fast smears did not result in cross-contamination. • Bulk container staining is less laborious and easier to perform than rack staining. • The acetone rinse step decreased background debris and improved slide quality. • Acetone rinsed slides were read more accurately and quickly. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
37. Trends in HIV care cascade engagement among diagnosed people living with HIV in Ontario, Canada: A retrospective, population-based cohort study.
- Author
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Wilton, James, Liu, Juan, Sullivan, Ashleigh, Rachlis, Beth, Marchand-Austin, Alex, Giles, Madison, Light, Lucia, Rank, Claudia, Burchell, Ann N., Gardner, Sandra, Sider, Doug, Gilbert, Mark, Kroch, Abigail E., and null, null
- Subjects
HIV ,DIAGNOSIS of HIV infections ,VIRAL load ,HIV-positive persons ,MICROBIAL virulence - Abstract
Background: The HIV cascade is an important framework for assessing systems of care, but population-based assessment is lacking for most jurisdictions worldwide. We measured cascade indicators over time in a population-based cohort of diagnosed people living with HIV (PLWH) in Ontario, Canada. Methods: We created a retrospective cohort of diagnosed PLWH using a centralized laboratory database with HIV diagnostic and viral load (VL) test records linked at the individual-level. Individuals enter the cohort with record of a nominal HIV-positive diagnostic test or VL test, and remain unless administratively lost to follow-up (LTFU, >2 consecutive years with no VL test and no VL test in later years). We calculated the annual percent of diagnosed PLWH (cohort individuals not LTFU) between 2000 and 2015 who were in care (≥1 VL test), on ART (as documented on VL test requisition) or virally suppressed (<200 copies/ml). We also calculated time from diagnosis to linkage to care and viral suppression among individuals newly diagnosed with HIV. Analyses were stratified by sex and age. Upper/lower bounds were calculated using alternative indicator definitions. Results: The number of diagnosed PLWH increased from 8,859 (8,859–11,389) in 2000 to 16,110 (16,110–17,423) in 2015. Over this 16-year period, the percent of diagnosed PLWH who were: in care increased from 81% (63–81%) to 87% (81–87%), on ART increased from 55% (34–60%) to 81% (70–82%) and virally suppressed increased from 41% (23–46%) to 80% (67–81%). Between 2000 and 2014, the percent of newly diagnosed individuals who linked to care within three months of diagnosis or achieved viral suppression within six months of diagnosis increased from 67% to 82% and from 22% to 42%, respectively. Estimates were generally lower for females and younger individuals. Discussion: HIV cascade indicators among diagnosed PLWH in Ontario improved between 2000 and 2015, but gaps still remain—particularly for younger individuals. [ABSTRACT FROM AUTHOR]
- Published
- 2019
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- View/download PDF
38. Surveillance of antimicrobial resistance in contemporary clinical isolates of Bordetella pertussis in Ontario, Canada
- Author
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Marchand-Austin, Alex, Memari, Nader, Patel, Samir N., Tang, Patrick, Deeks, Shelley L., Jamieson, Frances B., Crowcroft, Natasha S., and Farrell, David J.
- Published
- 2014
- Full Text
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39. Under-reporting of pertussis in Ontario: A Canadian Immunization Research Network (CIRN) study using capture-recapture.
- Author
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Crowcroft, Natasha S., Johnson, Caitlin, Chen, Cynthia, Li, Ye, Marchand-Austin, Alex, Bolotin, Shelly, Schwartz, Kevin, Deeks, Shelley L., Jamieson, Frances, Drews, Steven, Russell, Margaret L., Svenson, Lawrence W., Simmonds, Kimberley, Mahmud, Salaheddin M., and Kwong, Jeffrey C.
- Subjects
WHOOPING cough ,HEALTH services administration ,PUBLIC health ,DATA analysis ,PREVENTION - Abstract
Introduction: Under-reporting of pertussis cases is a longstanding challenge. We estimated the true number of pertussis cases in Ontario using multiple data sources, and evaluated the completeness of each source. Methods: We linked data from multiple sources for the period 2009 to 2015: public health reportable disease surveillance data, public health laboratory data, and health administrative data (hospitalizations, emergency department visits, and physician office visits). To estimate the total number of pertussis cases in Ontario, we used a three-source capture-recapture analysis stratified by age (infants, or aged one year and older) and adjusting for dependency between sources. We used the Bayesian Information Criterion to compare models. Results: Using probable and confirmed reported cases, laboratory data, and combined hospitalizations/emergency department visits, the estimated total number of cases during the six-year period amongst infants was 924, compared with 545 unique observed cases from all sources. Using the same sources, the estimated total for those aged 1 year and older was 12,883, compared with 3,304 observed cases from all sources. Only 37% of infants and 11% for those aged 1 year and over admitted to hospital or seen in an emergency department for pertussis were reported to public health. Public health reporting sensitivity varied from 2% to 68% depending on age group and the combination of data sources included. Sensitivity of combined hospitalizations and emergency department visits varied from 37% to 49% and of laboratory data from 1% to 50%. Conclusions: All data sources contribute cases and are complementary, suggesting that the incidence of pertussis is substantially higher than suggested by routine reports. The sensitivity of different data sources varies. Better case identification is required to improve pertussis control in Ontario. [ABSTRACT FROM AUTHOR]
- Published
- 2018
- Full Text
- View/download PDF
40. <italic>Mycobacterium xenopi</italic> Genotype Associated with Clinical Phenotype in Lung Disease.
- Author
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Hirama, Takashi, Marchand-Austin, Alex, Ma, Jennifer, Alexander, David C., Brode, Sarah K., Marras, Theodore K., and Jamieson, Frances B.
- Subjects
- *
MYCOBACTERIUM , *OBSTRUCTIVE lung diseases , *HEALTH equity , *PUBLIC health , *MEDICAL screening - Abstract
Mycobacterium xenopi is responsible for pulmonary disease (PD) in Europe and Canada. Despite its high prevalence and increasing clinical importance, little is known about the genetic diversity ofM. xenopi . Through a prospective study forM. xenopi strain type and the relation to clinical phenotype, 39 patients withM. xenopi PD were analyzed. Our study demonstrated that sequence type (ST) 5 was dominant in Ontario among 15 distinct STs and caused PD in people even without underlying lung disease, whereas disease due to non-ST5 was found almost exclusively in patients with underlying lung disease. [ABSTRACT FROM AUTHOR]- Published
- 2018
- Full Text
- View/download PDF
41. Technology and tuberculosis control: the OUT-TB Web experience.
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Guthrie, Jennifer L., Alexander, David C., Marchand-Austin, Alex, Lam, Karen, Whelan, Michael, Lee, Brenda, Furness, Colin, Rea, Elizabeth, Stuart, Rebecca, Lechner, Julia, Varia, Monali, McLean, Jennifer, and Jamieson, Frances B.
- Abstract
Objective: Develop a tool to disseminate integrated laboratory, clinical, and demographic case data necessary for improved contact tracing and outbreak detection of tuberculosis (TB).Methods: In 2007, the Public Health Ontario Laboratories implemented a universal genotyping program to monitor the spread of TB strains within Ontario. Ontario Universal Typing of TB (OUT-TB) Web utilizes geographic information system (GIS) technology with a relational database platform, allowing TB control staff to visualize genotyping matches and microbiological data within the context of relevant epidemiological and demographic data.Results: OUT-TB Web is currently available to the 8 health units responsible for >85% of Ontario's TB cases and is a valuable tool for TB case investigation. Users identified key features to implement for application enhancements, including an e-mail alert function, customizable heat maps for visualizing TB and drug-resistant cases, socioeconomic map layers, a dashboard providing TB surveillance metrics, and a feature for animating the geographic spread of strains over time.Conclusion: OUT-TB Web has proven to be an award-winning application and a useful tool. Developed and enhanced using regular user feedback, future versions will include additional data sources, enhanced map and line-list filter capabilities, and development of a mobile app. [ABSTRACT FROM AUTHOR]- Published
- 2017
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42. Epidemiology of Enterovirus D68 in Ontario.
- Author
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Peci, Adriana, Winter, Anne-Luise, Warshawsky, Bryna, Booth, Tim F., Eshaghi, AliReza, Li, Aimin, Perusini, Stephen, Olsha, Romy, Marchand-Austin, Alex, Kristjanson, Erik, and Gubbay, Jonathan B.
- Subjects
EPIDEMIOLOGY ,ENTEROVIRUS diseases ,VIRAL diseases in children ,CHILDREN'S hospitals ,HOSPITAL patients ,DIAGNOSIS - Abstract
In August 2014, children’s hospitals in Kansas City, Missouri and Chicago, Illinois notified the Centers for Disease Control and Prevention (CDC) about increased numbers of pediatric patients hospitalized with severe respiratory illness (SRI). In response to CDC reports, Public Health Ontario Laboratories (PHOL) launched an investigation of patients being tested for enterovirus D-68 (EV-D68) in Ontario, Canada. The purpose of this investigation was to enhance our understanding of EV-D68 epidemiology and clinical features. Data for this study included specimens submitted for EV-D68 testing at PHOL from September 1, 2014 to October 31, 2014. Comparisons were made between patients who tested positive for the virus (cases) and those testing negative (controls). EV-D68 was identified in 153/907 (16.8%) of patients tested. In the logistic regression model adjusting for age, sex, setting and time to specimen collection, individuals younger than 20 years of age were more likely to be diagnosed with EV-D68 compared to those 20 and over, with peak positivity at ages 5–9 years. Cases were not more likely to be hospitalized than controls. Cases were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). Routine viral culture and multiplex PCR were inadequate methods to identify EV-D68 due to poor sensitivity and inability to differentiate EV-D68 from other enterovirus serotypes or rhinovirus. Testing for EV-D68 in Ontario from July to December, 2014 detected the presence of EV-D68 virus among young children during September-October, 2014, with most cases detected in September. There was no difference in hospitalization status between cases and controls. In order to better understand the epidemiology of this virus, surveillance for EV-D68 should include testing of symptomatic individuals from all treatment settings and patient age groups, with collection and analysis of comprehensive clinical and epidemiological data. [ABSTRACT FROM AUTHOR]
- Published
- 2015
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- View/download PDF
43. Correlation of Real Time PCR Cycle Threshold Cut-Off with Bordetella pertussis Clinical Severity.
- Author
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Bolotin, Shelly, Deeks, Shelley L., Marchand-Austin, Alex, Rilkoff, Heather, Dang, Vica, Walton, Ryan, Hashim, Ahmed, Farrell, David, and Crowcroft, Natasha S.
- Subjects
BORDETELLA pertussis ,POLYMERASE chain reaction ,SEVERITY of illness index ,SYMPTOMS ,PUBLIC health ,EPIDEMIOLOGY ,DIAGNOSIS - Abstract
Bordetella pertussis testing performed using real-time polymerase chain reaction (RT-PCR) is interpreted based on a cycle threshold (Ct) value. At Public Health Ontario Laboratories (PHOL), a Ct value <36 is reported as positive, and Ct values ≥36 and <40 are reported as indeterminate. PHOL reported indeterminate results to physicians and public health units until May 2012, after which these results were only reported to physicians. We investigated the association between Ct value and disease symptom and severity to examine the significance of indeterminate results clinically, epidemiologically and for public health reporting. B. pertussis positive and indeterminate RT-PCR results were linked to pertussis cases reported in the provincial Integrated Public Health Information System (iPHIS), using deterministic linkage. Patients with positive RT-PCR results had a lower median age of 10.8 years compared to 12.0 years for patients with indeterminate results (p = 0.24). Hospitalized patients had significantly lower Ct values than non-hospitalized patients (median Ct values of 20.7 vs. 31.6, p<0.001). The proportion of patients reporting the most indicative symptoms of pertussis did not differ between patients with positive vs. indeterminate RT-PCR results. Taking the most indicative symptoms of pertussis as the gold-standard, the positive predictive value of the RT-PCR test was 68.1%. RT-PCR test results should be interpreted in the context of the clinical symptoms, age, vaccination status, prevalence, and other factors. Further information on interpretation of indeterminate RT-PCR results may be needed, and the utility of reporting to public health practitioners should be re-evaluated. [ABSTRACT FROM AUTHOR]
- Published
- 2015
- Full Text
- View/download PDF
44. Pertussis vaccine effectiveness in a frequency matched population-based case-control Canadian Immunization Research Network study in Ontario, Canada 2009–2015.
- Author
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Crowcroft, Natasha S., Schwartz, Kevin L., Chen, Cynthia, Johnson, Caitlin, Li, Ye, Marchand-Austin, Alex, Bolotin, Shelly, Jamieson, Frances B., Drews, Steven J., Russell, Margaret L., Svenson, Lawrence W., Simmonds, Kimberley, Mahmud, Salaheddin M, and Kwong, Jeffrey C.
- Subjects
- *
WHOOPING cough vaccines , *VACCINE effectiveness , *IMMUNIZATION , *WHOOPING cough , *HIGH-income countries - Abstract
Highlights • Immunization provides highly effective protection from pertussis. • Children are most protected from pertussis in the first few years after immunization. • Protection is sustained for the first decade after the last dose of vaccine, but subsequently falls rapidly. • Method of control selection affects estimates of vaccine effectiveness. Abstract Background Resurgences of pertussis have occurred in several high-income countries, often linked to waning of immunity from acellular pertussis vaccines. The degree of waning observed has varied by study design and setting. In Ontario, pertussis has not shown a substantial resurgence in the past decade. The routine immunization schedule comprises three priming doses in infancy, toddler and pre-school doses, and an adolescent dose at 14–16 years of age. Methods We estimated pertussis vaccine effectiveness (VE) through a case-control study of 1335 cases statutorily reported to public health in Ontario and occurring between January 1, 2009 and March 31, 2015, compared with 5340 randomly selected population controls, frequency-matched by age, primary-care provider and year of diagnosis. Pertussis cases met provincial confirmed or probable case definitions. We used multivariable logistic regression to estimate crude and adjusted odds ratios (aOR). Results VE against pertussis was sustained between 92% (95% confidence interval (95%CI) 88–95%) in 2–3 year olds and 90% (95%CI: 80–95%) in 8–9 year olds, but fell rapidly to 49% (95%CI: 2–73%) in children 12–13 years of age. VE following the teenage booster given at 14–16 years in Ontario reached 76% (95%CI: 52–88%) in 14–16 year olds and 78% (95%CI: −31 to 96%) in those 16–22 years old. For children who were up-to-date with the immunization schedule, VE declined from 87% (95%CI: 84–90%) during the first year to 74% (95%CI: 63–82%) after 8 or more years following their last dose of immunization. Conclusions VE is high during the first decade of life but then falls rapidly. Protection is not fully restored by the teenage booster. Our findings are consistent with the localized outbreaks we observe in high school children and underline the importance of additional policies to protect infants. [ABSTRACT FROM AUTHOR]
- Published
- 2019
- Full Text
- View/download PDF
45. Antibiotic susceptibility of urine culture specimens in Ontario: a population-based cohort study.
- Author
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Marchand-Austin A, Lee SM, Langford BJ, Daneman N, MacFadden DR, Diong C, Schwartz KL, Allen VG, Johnstone J, Patel SN, Garber GE, and Brown KA
- Subjects
- Humans, Cohort Studies, Ontario epidemiology, Nitrofurantoin therapeutic use, Escherichia coli, Anti-Bacterial Agents pharmacology, Anti-Bacterial Agents therapeutic use
- Abstract
Background: Surveillance of antimicrobial resistance is essential to mitigate its impact on population health and inform local empiric treatment practices. Our aims were to evaluate urine culture specimen susceptibility from a range of diverse settings and describe antibiotic susceptibility across all organisms and compare susceptibilities to that of Escherichia coli alone., Methods: In this descriptive cohort study, we measured the prevalence of organisms in urine culture specimens using linked province-wide administrative databases. Using positive urine cultures collected in Ontario between Jan. 1, 2016, and Dec. 31, 2017, we measured susceptibility to 6 classes of antibiotics using a weighted antibiogram for all organisms compared with E. coli alone., Results: We included 689 497 cultures derived from 569 399 patients and 879 778 test orders for specimens. For all organisms, the rates of susceptibility in the outpatient, inpatient and long-term care settings were 49.3%, 42.8% and 39.2%, respectively, for ampicillin; 83.1%, 72.7% and 69.7%, respectively, for nitrofurantoin; 80.3%, 64.8% and 73.1%, respectively, for trimethoprim-sulfamethoxazole; 87.2%, 74.1% and 66.2%, respectively, for ciprofloxacin; 90.6%, 73.6% and 85.1%, respectively, for aminoglycosides; and 82.6%, 57.5% and 73.5%, respectively, for cefazolin. We found resistance to 3 or more antibiotic classes in 20.6% of episodes for all organisms compared with 14.0% for E. coli alone. The average absolute difference in antibiotic susceptibility between all organisms and E. coli across all drugs was lowest in the outpatient setting (6.2%) and highest in the inpatient setting (14.6%)., Interpretation: In this study, urinary organism prevalence and antimicrobial susceptibility varied across health care settings and patient populations, with implications for both antimicrobial resistance surveillance and clinical decision-making. Weighted antibiograms may be most useful for guiding empiric treatment of urinary infections in inpatient settings where the diversity of infectious organisms is higher than in the community., Competing Interests: Competing interests: None declared., (© 2022 CMA Impact Inc. or its licensors.)
- Published
- 2022
- Full Text
- View/download PDF
46. Prevalence and Mortality Associated with Bloodstream Organisms: a Population-Wide Retrospective Cohort Study.
- Author
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Verway M, Brown KA, Marchand-Austin A, Diong C, Lee S, Langford B, Schwartz KL, MacFadden DR, Patel SN, Sander B, Johnstone J, Garber G, and Daneman N
- Subjects
- Escherichia coli, Humans, Prevalence, Retrospective Studies, Staphylococcus aureus, Bacteremia microbiology, Cross Infection epidemiology, Sepsis, Staphylococcal Infections epidemiology
- Abstract
Bloodstream infections (BSIs) represent a substantial mortality risk, yet most studies are limited to select pathogens or populations. The aim of this study was to describe the population-wide prevalence of BSIs and examine the associated mortality risk for the responsible microorganisms. We conducted a population-wide retrospective cohort study of BSIs in Ontario in 2017. Blood culture data was collected from almost all microbiology laboratories in Ontario and linked to data sets of patient characteristics. For each organism, we determined the prevalence and crude mortality risk, and using logistic regression models, the adjusted odds of 30-day mortality was calculated relative to patients with negative blood cultures and matched patients without blood culture testing. From 531,065 blood cultures, we identified 22,935 positive BSI episodes in 19,326 patients, for an incidence of 150 per 100,000 population. The most frequently isolated organisms were Escherichia coli, Staphylococcus aureus, coagulase-negative staphylococci, Klebsiella species, and Enterococcus species with 40.2, 22.4, 12.1, 11.1, and 7.1 episodes per 100,000 population respectively. BSI episodes were associated with 17.0% mortality at 30 days. Compared to patients with negative cultures, the adjusted 30-day mortality risk for positive BSIs was 1.47 (95% confidence interval (CI), 1.41 to 1.54) and compared to matched patients without blood culture testing was 2.62 (95% CI, 2.52 to 2.73). Clostridium species were associated with the highest adjusted odds of mortality compared to that of negative cultures (adjusted odds ratio, 5.81; 95% CI, 4.00 to 8.44). Among high incidence pathogens, Staphylococcus aureus had the highest odds ratio of mortality (adjusted odds ratio, 2.14; 95% CI, 1.94 to 2.36). BSIs are associated with increased mortality risk, varying across organisms.
- Published
- 2022
- Full Text
- View/download PDF
47. The impact of different antibiotic treatment regimens on mortality in Mycobacterium avium complex pulmonary disease: a population-based cohort study.
- Author
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Brode SK, Chung H, Campitelli MA, Kwong JC, Sutradhar R, Marchand-Austin A, Winthrop KL, Jamieson FB, and Marras TK
- Subjects
- Anti-Bacterial Agents therapeutic use, Cohort Studies, Humans, Mycobacterium avium Complex, Lung Diseases drug therapy, Mycobacterium avium-intracellulare Infection drug therapy
- Abstract
Competing Interests: Conflict of interest: S.K. Brode reports grants from Insmed Pharmaceuticals and Canadian Institutes of Health Research (CIHR), personal fees for educational activities from Boehringer Ingelheim and AstraZeneca, outside the submitted work. Conflict of interest: H. Chung has nothing to disclose. Conflict of interest: M.A. Campitelli has nothing to disclose. Conflict of interest: J.C. Kwong has nothing to disclose. Conflict of interest: R. Sutradhar has nothing to disclose. Conflict of interest: A. Marchand-Austin has nothing to disclose. Conflict of interest: K.L. Winthrop reports grants and personal fees from Insmed, personal fees from Johnson & Johnson, Paratek, Red Hill Biopharma and Horizon, outside the submitted work. Conflict of interest: F.B. Jamieson has nothing to disclose. Conflict of interest: T.K. Marras reports grants and personal fees for consultancy from Insmed, personal fees for educational activities from AstraZeneca, France Foundation and Novartis, personal fees for consultancy from Horizon and RedHill, outside the submitted work.
- Published
- 2020
- Full Text
- View/download PDF
48. Underutilization of nontuberculous mycobacterial drug susceptibility testing in Ontario, Canada, 2010-2015.
- Author
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Andrews ER, Marchand-Austin A, Ma J, Cronin K, Sharma M, Brode SK, Marras TK, and Jamieson FB
- Abstract
Background: Drug susceptibility testing (DST) in nontuberculous mycobacterial pulmonary disease (NTM-PD) is useful for some Mycobacterium species. International guidelines recommend routine use of DST for clinically relevant mycobacteria. DST use and results are poorly studied at the population level. We sought to identify the frequency of DST utilization for nontuberculous mycobacteria (NTMs) and describe the potential relevance of these results in Ontario., Methods: Using public health laboratory data, we performed a population-based retrospective analysis of NTM DST utilization in Ontario from May 2010 to June 2015. We determined the proportion of incident NTM-PD infections for which DST was performed and analyzed minimum inhibitory concentration (MIC) distributions from NTM testing overall, using thresholds recommended by the Clinical and Laboratory Standards Institute., Results: The proportion of incident cases of NTM-PD tested for DST was 6.3% (240/3,806) for Mycobacterium avium complex (MAC), 36.2% (67/185) for M. abscessus, and 1.8% (19/1,057) for M. xenopi. Among specimens from all body sites, MAC resistance to clarithromycin occurred in 8.0% of specimens (21/262) and MAC resistance to amikacin (intravenous, MIC > 64 µg/mL) occurred in 22.6% (19/84). M. abscessus resistance occurred as follows: to amikacin, 3.8% (3/79); cefoxitin, 14.0% (11/79); imipenem, 30.4% (14/46); linezolid, 39.2% (31/79); clarithromycin, 54.2% (13/24); ciprofloxacin, 92.4% (73/79); and moxifloxacin, 91.1% (51/56). M. xenopi analysis was limited by few DST requests and a lack of DST clinical correlation., Conclusions: We found that NTM DST is underutilized in Ontario and observed a very high frequency of amikacin resistance among MAC isolates., (Copyright © 2020, Association of Medical Microbiology and Infectious Disease Canada (AMMI Canada).)
- Published
- 2020
- Full Text
- View/download PDF
49. Cohort profile: Development and profile of a population-based, retrospective cohort of diagnosed people living with HIV in Ontario, Canada (Ontario HIV Laboratory Cohort).
- Author
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Liu J, Wilton J, Sullivan A, Marchand-Austin A, Rachlis B, Giles M, Light L, Sider D, Kroch AE, and Gilbert M
- Subjects
- Adult, Age Distribution, Aged, Cohort Studies, Databases, Factual statistics & numerical data, Female, Humans, Male, Middle Aged, Ontario epidemiology, Retrospective Studies, Sex Distribution, Socioeconomic Factors, Viral Load statistics & numerical data, Young Adult, HIV Infections epidemiology
- Abstract
Purpose: Population-based cohorts of diagnosed people living with HIV (PLWH) are limited worldwide. In Ontario, linked HIV diagnostic and viral load (VL) test databases are centralised and contain laboratory data commonly used to measure engagement in HIV care. We used these linked databases to create a population-based, retrospective cohort of diagnosed PLWH in Ontario, Canada., Participants: A datamart was created by integrating diagnostic and VL databases and linking records at the individual level. These databases contain information on laboratory test results and sociodemographic/clinical information collected on requisition/surveillance forms. Datamart individuals enter our cohort with the first record of a nominal HIV-positive diagnostic test (1985-2015) or VL test (1996-2015), and remain unless administratively lost to follow-up (LTFU; no VL test for >2 years and no VL test in later years). Non-nominal diagnostic tests are excluded as they lack identifying information to permit linkage to other tests. However, individuals diagnosed non-nominally are included in the cohort with record of a VL test. The LTFU rule is applied to indirectly censor for death/out-migration., Findings to Date: As of the end of 2015, the datamart contained 40 372 HIV-positive diagnostic tests and 23 851 individuals with ≥1 VL test. Almost half (46.3%) of the diagnostic tests were non-nominal and excluded, although this was lower (~15%) in recent years. Overall, 29 587 individuals have entered the cohort-contributing 229 302 person-years of follow-up since 1996. Between 2000 and 2015, the number of diagnosed PLWH (cohort individuals not LTFU) increased from 8859 to 16 110, and the percent who were aged ≥45 years increased from 29.1% to 62.6%. The percent of diagnosed PLWH who were virally suppressed (<200 copies/mL) increased from 40.7% in 2000 to 79.5% in 2015., Future Plans: We plan to conduct further analyses of HIV care engagement and link to administrative databases with information on death, migration, physician billing claims and prescriptions. Linkage to other data sources will address cohort limitations and expand research opportunities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2019
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50. In Vitro Antibiotic Susceptibility Pattern of Non-diphtheriae Corynebacterium Isolates in Ontario, Canada, from 2011 to 2016.
- Author
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Neemuchwala A, Soares D, Ravirajan V, Marchand-Austin A, Kus JV, and Patel SN
- Subjects
- Erythromycin pharmacology, Microbial Sensitivity Tests, Penicillin G pharmacology, Penicillins pharmacology, Anti-Bacterial Agents pharmacology, Corynebacterium drug effects
- Abstract
Non- diphtheriae Corynebacterium -associated disease has been increasingly observed and often presents a conundrum to the treating physician. Analysis of antibiotic susceptibility testing data for 1,970 clinical Corynebacterium isolates received between 2011 and 2016 revealed that empirical drug treatment options are limited to vancomycin and linezolid. Corynebacterium striatum was the most frequently observed species during this study period, along with C. amycolatum and C. pseudodiphtheriticum/C. propinquum Low levels of susceptibility to penicillin (14.5%), erythromycin (15.1%), and clindamycin (8.7%) were observed for non- diphtheriae Corynebacterium species, while 3.0% of isolates were not susceptible to daptomycin. Similarly, 26.9% and 38.1% of Corynebacterium isolates were susceptible to ciprofloxacin and trimethoprim-sulfamethoxazole, respectively. Our data show much lower susceptibility to penicillin than previously reported in the literature and an increasing number of isolates resistant to daptomycin, highlighting the need for continued antibiotic surveillance studies for appropriate patient management and treatment success., (© Crown copyright 2018.)
- Published
- 2018
- Full Text
- View/download PDF
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