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There is a need for more information on the relationship between diseases and fluctuations of wild populations of marine animals. In the case of Callinectes sapidus reovirus 1 ( Cs RV1, also known as RLV), there is a lack of baseline information on range, prevalence and outbreaks, from which to develop an understanding of population-level impacts. An RT- qPCR assay was developed that is capable of detecting 10 copies of the Cs RV1 genome. In collaboration with state, federal and academic partners, blue crabs were collected from sites throughout the north-eastern United States to assess the northern range of this pathogen. In addition, archived crab samples from the Chesapeake Bay were assessed for Cs RV1 by RT- qPCR and histology. PCR-based assessments indicate that Cs RV1 was present at all but one site. Prevalence of Cs RV1 as assessed by RT- qPCR was highly variable between locations, and Cs RV1 prevalence varied between years at a given location. Mean Cs RV1 prevalence as assessed by RT- qPCR was >15% each year, and peak prevalence was 79%. The wide geographic range and highly variable prevalence of Cs RV1 indicate that more study is needed to understand Cs RV1 dynamics and the role the virus plays in blue crab natural mortality. [ABSTRACT FROM AUTHOR]

Objectives: To summarize the first four years of national surveillance for Lyme disease in Canada from 2009 to 2012 and to conduct a preliminary comparison of presenting clinical manifestations in Canada and the United States.Methods: The numbers and incidence of reported cases by province, month, year, age and sex were calculated. Logistic regression was used to examine trends over time. Acquisition locations were mapped and presenting clinical manifestations reported for jurisdictions where data was available. Variations by province, year, age and sex as well as presenting clinical symptoms were explored by logistic regression. An initial comparative analysis was made of presenting symptoms in Canada and the United States.Results: The numbers of reported cases rose significantly from 144 in 2009 to 338 in 2012 (coefficient = 0.34, standard error = 0.07, P <0.05), mostly due to an increased incidence of infections acquired in Canada. More cases were classified as 'confirmed' (71.5%) than 'probable' (28.5%). Most cases occurred in locations where vector tick populations were known to be present. More men than women were affected (53.4% versus 46.6%), incidence was highest in adults aged 55 to 74 years and in children aged five to 14 years. Most cases (95%) were acquired from April to November. Of cases acquired in endemic areas, 39.7% presented with manifestations of early Lyme disease, while 60.3% had manifestations of disseminated Lyme disease. There were significant differences among age groups, sexes and provinces in the frequencies of reported clinical manifestations. The proportion of cases acquired in endemic areas presenting with early Lyme disease was lower than that reported in the US.Conclusion: Lyme disease incidence is increasing in Canada. Most cases are acquired where vector tick populations are spreading and this varies geographically within and among provinces. There is also variation in the frequency of age, season and presenting manifestations. The lower proportion of cases presenting with early Lyme disease in Canada compared with the US suggests lower awareness of early Lyme disease in Canada, but this requires further study. [ABSTRACT FROM AUTHOR]

Background: Enterovirus D68 (EV-D68) has been detected infrequently and has not been associated with severe disease in Canada. In the early fall of 2014, following an unusual case increase in the United States, clusters of EV-D68 among children and some adults manifesting severe symptoms were reported in Canada. Objective: To provide an initial epidemiological summary of pediatric cases hospitalized with EV-D68 in Canada. Methods: A time-limited surveillance pilot was conducted collecting information on pediatric cases (less than 18 years of age) hospitalized with EV-D68 between September 1 and 30, 2014. Results: In total, 268 cases were reported from Ontario (n=210), Alberta (n=45), and British Columbia (n=13). Of the 268 reported cases, 64.9% (n=174) were male; the sex difference was statistically significant (p<0.01). Age was reported for 255 cases, with a mean age for males of 5.4 years and for females of 5.3 years. For cases with data available, 6.8% (18/266) were admitted to an intensive care unit. Of those where clinical illness was recorded, respiratory illness alone was present in 98.3% (227/231), neurologic illness alone was present in 0.4% (n=1), and both illnesses were present in 0.9% of cases (n=2); cases with neither respiratory nor neurologic illness were rare (n=1). Of the 90 cases with additional clinical information available, 43.3% were reported as having asthma. No deaths were reported among the 268 cases. Conclusion: The EV-D68 outbreak in Canada in September 2014 represents the beginning of a novel outbreak associated with severe illness in children. These findings provide the first epidemiological summary of severe cases of EV-D68 as an emergent respiratory pathogen in Canada. The continued investigation of this pathogen is necessary to build on these results and capture the full spectrum of associated illness. [ABSTRACT FROM AUTHOR]

Background: Southern Alberta is home to many unique homogeneous communities that typically educate their children in private schools. A number of these communities do not promote immunization as a preventive public health measure, although the reasons behind this vary. People within these communities keep themselves somewhat secluded from other populations and thus do not benefit from overall herd immunity. This has led to frequent outbreaks of vaccine-preventable diseases in private schools affiliated with these homogeneous religious communities.Objective: To report on low immunization rates of measles, mumps, rubella (MMR) and MMR-varicella in southern Alberta communities and schools and to compare the epidemiology of immunization rates in certain vulnerable communities with those of same-age cohorts in South Zone communities.Methods: The analysis includes immunization data at the individual level submitted to the provincial immunization repository, Immunization and Adverse Reactions to Immunization, and the Alberta Health Services Meditech module between January 1, 2013, and June 30, 2013.Results: Heterogeneity of immunization status was found among communities and among schools. The status of two year old children up to date on immunizations ranged from 46.6% in Fort Macleod to 71.9% in Oyen, with a mean of 57.3 children in every 100 up to date. By age seven, the mean percentage of immunized children in southern Alberta was 77.6%, ranging from 57.8% in Picture Butte to 94.6% in Oyen. Immunization status among schools ranged from 17% to 100%, with a mean of 89.3% of children fully immunized and a median of 91% immunized.Conclusion: There is heterogeneity of immunization uptake for childhood measles-containing vaccine by community and by school in southern Alberta. This study highlights that the location of the school may not align with geographic community as it pertains to immunization rates. Analysis of childhood immunization data at both community and school level is important in understanding the risks of vaccine-preventable illness spread in a given geographic region, such as Alberta South Zone. Data from this study can be used to inform specific interventions required to improve immunization coverage rates in these unique homogeneous cultural communities and their respective schools, and to decrease the risk of measles transmission in Southern Alberta. [ABSTRACT FROM AUTHOR]

Background: An outbreak of measles was declared in southern Alberta on October 18, 2013, after a case had been reported to the local public health unit in a non-immunized teenager with recent travel to the Netherlands. The teenager had had contact with a large number of unimmunized people while infectious; therefore, the risk of spread was high. The potential for an outbreak of measles in this area had been identified by the lead Medical Officer of Health for South Zone, and planning for an outbreak had begun in August 2013.Methods: Several public health measures were implemented to control the outbreak: mass immunization clinics; an outbreak dose of measles mumps and rubella (MMR) vaccine for infants 6-12 months old; communication within the affected and surrounding communities; a dedicated measles hotline; a Mobile Measles Assessment Team; and a Measles Assessment Centre.Results: A total of 42 confirmed cases were identified during the outbreak between October 16 and November 25. Just over half the cases were male (52.4%). The average age was 12 (range < 1 to 24 years) and the median age 13 years. There was one hospitalization, and no deaths occurred. All cases were unimmunized. Cases were located in five communities immediately surrounding Lethbridge. All but two cases were epidemiologically linked within 10 households.Conclusion: The planning that occurred before the outbreak was essential in containing the outbreak to 10 households. To prevent future outbreaks of measles, exploring strategies for increasing immunization coverage rates in unimmunized populations is essential. When immunization acceptance is not uniform, other public health strategies should be planned for and implemented in order to prevent additional spread. [ABSTRACT FROM AUTHOR]

In September 2000, the U.S. Food and Drug Administration (FDA) approved the use of mifepristone for the provision of medical abortion. Although mifepristone was developed and marketed because of its potential to effect early first-trimester medical abortion, it has additional applications to health care, including the treatment of gynecologic conditions, cancer, and Cushing's disease. The controversial nature of abortion has dominated the publicity about mifepristone. The evidence for the safety and efficacy of mifepristone in medical abortion has been overshadowed, and many clinicians are unaware of the other potential uses of the drug. This article provides a discussion of background information on the pharmacology, development of, and research on mifepristone and an update on current and potential uses in health care today. Information on the FDA-approved regimen and alternative protocols for management of mifepristone in its use in abortion care are presented. [ABSTRACT FROM AUTHOR]

Abstract Between 2002 and 2007, travel related cases of Shigella sonnei and S. flexneri in Alberta, Canada were acquired from Central America, the Indian subcontinent and North America. Of this group, resistance to ciprofloxacin and nalidixic acid was identified in isolates from patients who had travelled to the Indian subcontinent. This study provides a Canadian perspective to a growing body of literature linking ciprofloxacin and nalidixic acid resistance to travel to the Indian subcontinent. Shigella is a common cause of diarrheal illness in North America with a rate of 2.0 per 100,000 in Canada 1 and a rate of 3.2 per 100,000 in the United States 23. Imported cases of Shigella infections have been reported in developed countries following travel to a foreign or developing country 45 and may be impacted by factors including socio-economic factors 6, food distribution networks 5 and microbiologic factors 7. Across multiple geographic regions, high rates of antimicrobial resistance to multiple agents (e.g. sulfonamides, tetracycline, chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) have limited the choices for empiric antimicrobial therapy required to manage Shigella infections and reduce fecal excretion of the bacteria 8910 with descriptions of shifting species dominance and changes in antimicrobial susceptibility 1011. Generally, Shigella flexneri and Shigella sonnei are the dominant species and are heavily impacted by changes in antimicrobial susceptibility 1213. This study identifies the global regions associated with travel-related cases of S. flexneri and S. sonnei in Alberta, Canada and compares antibiotic resistance patterns of these isolates for 2002 to 2007 inclusive. Specimens collected 2002-2007 (inclusive) from S. flexneri and S. sonnei infections in Alberta, Canada were included for study. Data collected at time of specimen submission included: date of specimen collection, outbreak association if present, travel history and antibiogram (data source-ProvLab Information Systems; Communicable Disease Report at Alberta Health and Wellness). Outbreaks were defined by public health officials as ≥ 2 epidemiologically related cases. Each outbreak was assigned a unique incident number. Repeat isolates received within six months of original case infections were excluded. Only one representative case for each outbreak was included, unless the isolates had different antibiotic susceptibility patterns. Based on travel history the origin of an isolate was grouped into corresponding regions and continents. Regions included in the study represented major travel destinations for individuals living in Canada. Domestic exposures were defined as "travel within North America."