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Les residents des etablissements de soins de longue duree (ESLD) sont surrepresentes dans la repartition des cas de COVID-19 et de SRAS-CoV-2 au Canada et ailleurs dans le monde (1-3). [...], CONTEXTE : Le deploiement de mesures de gestion des eclosions de SRAS-CoV-2 dans les etablissements de soins de longue duree en Ontario a permis d'en reduire la frequence et la gravite. Nous decrivons ici les donnees epidemiologiques et de laboratoire d'une de ces premieres eclosions en Ontario afin de determiner les facteurs associes a son importance et les impacts des interventions progressives de lutte contre les infections appliquees pendant la duree de l'eclosion. METHODES : Nous avons obtenu du bureau de sante la liste des cas et les donnees de l'eclosion afin de decrire les cas chez les residents et le personnel, leur gravite et leur distribution dans le temps et a l'interieur de l'etablissement touche. Quand elles etaient disponibles, nous avons obtenu des donnees concernant les echantillons soumis au laboratoire de Sante publique Ontario et effectue un sequenqage complet et une analyse phylogenetique des echantillons viraux de l'eclosion. RESULTATS : Sur les 65 residents de l'etablissement de soins de longue duree, 61 (94 %) ont contracte le SRAS-CoV-2, le taux de letalite etant de 45 % (28/61). Parmi les 67 employes initiaux, 34 (51 [degrees]%) ont contracte le virus, et aucun n'est decede. Lorsque l'eclosion a ete declaree, 12 employes, 2 visiteurs et 9 residents presentaient des symptomes. Parmi les residents, les cas se trouvaient dans 3 des 4 secteurs de l'etablissement. L'analyse phylogenetique a montre une forte similitude des sequences; une seule autre souche de SRAS-CoV-2 genetiquement distincte a ete identifiee chez un employe a la troisieme semaine de l'eclosion. Apres le deploiement de toutes les mesures de gestion de l'eclosion, aucun cas n'a ete identifie parmi les 26 nouveaux employes appeles en renfort. INTERPRETATION : La propagation rapide et non detectee du virus dans un etablissement de soins de longue duree a donne lieu a des taux eleves d'infection chez les residents et le personnel. L'application progressive de mesures de gestion apres le pic de l'eclosion a permis d'eviter la contamination du personnel appele en renfort et fait desormais partie des politiques a long terme de prevention des eclosions en Ontario.

Residents of long-term care (LTC) homes have been disproportionately represented in overall cases of SARS-CoV-2 and COVID-19 both in Canada and internationally. (1-3) Older adults in LTC are vulnerable to [...], BACKGROUND: The implementation of outbreak management measures has decreased the frequency and severity of SARS-CoV-2 outbreaks in Ontario longterm care homes. We describe the epidemiological and laboratory data from one of the first such outbreaks in Ontario to assess factors associated with its severity, and the impact of progressive interventions for infection control over the course of the outbreak. METHODS: We obtained line list and outbreak data from the public health unit to describe resident and staff cases, severity and distribution of cases over time and within the outbreak facility. Where available, we obtained data on laboratory specimens from the Public Health Ontario Laboratory and performed whole genome sequencing and phylogenetic analysis of viral specimens from the outbreak. RESULTS: Among 65 residents of the long-term care home, 61 (94%) contracted SARS-CoV-2, with a case fatality rate of 45% (28/61). Among 67 initial staff, 34 (51%) contracted the virus and none died. When the outbreak was declared, 12 staff, 2 visitors and 9 residents had symptoms. Resident cases were located in 3 of 4 areas of the home. Phylogenetic analysis showed tight clustering of cases, with only 1 additional strain of genetically distinct SARS-CoV-2 identified from a staff case in the third week of the outbreak. No cases were identified among 26 new staff brought into the home after full outbreak measures were implemented. INTERPRETATION: Rapid and undetected viral spread in a long-term care home led to high rates of infection among residents and staff. Progressive implementation of outbreak measures after the peak of cases prevented subsequent staff cases and are now part of long-term care outbreak policy in Ontario.

1 L'immunite collective procure une protection indirecte aux personnes vulnerables face a une maladie infectieuse Le seuil d'immunite collective est la proportion minimum de la population qui doit etre immunisee [...]

1 Herd immunity provides indirect protection to people who are susceptible to an infectious disease The herd immunity threshold is the minimum proportion of the population that must be immune [...]

AbstractObjectiveIn August 2023, 68% (n=25,900) of the Northwest Territories, Canada, evacuated from wildfires, including the never previously evacuated capital, Yellowknife. Official evacuation orders extended from August 16 to September 6 for this region, impacting health protection services (HPS) in the Territory for remaining residents, and risks on return.MethodsThe Office of the Chief Public Health Officer (OCPHO) reviewed and implemented priorities over a three-day period prior to the evacuation order for time critical HPS to continue remotely or transfer to receiving jurisdictions. On return to community, OCPHO implemented processes for reviewing surveillance objectives to assess for impacts to affected populations.ResultsDuring evacuation, over 15 reports of animal exposures were assessed remotely for rabies prophylaxis. Individuals requiring sexually transmitted infection (STI) follow-up were referred to receiving jurisdictions. One patient with infectious tuberculosis was transferred to another province. Water plant operators were supported with new communication and out-of-Territory testing protocols. On return, enhanced surveillance included: respiratory viruses, STI and blood borne infections, gastrointestinal illness, and toxic drug supplies.ConclusionsWhile some HPS continued to mitigate risks, future surveillance will assess the scale of impacts. Updates to continuity of operations plans need to include considerations for remote and local services.

Group B Streptococcus(GBS) significantly contributes to neonatal sepsis and meningitis, with varying disease rates reported globally and limited population-based data. We estimated infant GBS disease burden in Ontario, Canada and assessed the association of maternal GBS screening (35–37 weeks' gestation) and intrapartum antibiotic prophylaxis (IAP) provision with infant disease rates.

AbstractObjectives:Performance characteristics of SARS-CoV-2 nucleic acid detection assays are understudied within contexts of low pre-test probability, including screening asymptomatic persons without epidemiological links to confirmed cases, or asymptomatic surveillance testing. SARS-CoV-2 detection without symptoms may represent presymptomatic or asymptomatic infection, resolved infection with persistent RNA shedding, or a false-positive test. This study assessed the positive predictive value of SARS-CoV-2 real-time reverse transcription polymerase chain reaction (rRT-PCR) assays by retesting positive specimens from 5 pre-test probability groups ranging from high to low with an alternate assay.Methods:In total, 122 rRT-PCR positive specimens collected from unique patients between March and July 2020 were retested using a laboratory-developed nested RT-PCR assay targeting the RNA-dependent RNA polymerase (RdRp) gene followed by Sanger sequencing.Results:Significantly fewer (15.6%) positive results in the lowest pre-test probability group (facilities with institution-wide screening having ≤3 positive asymptomatic cases) were reproduced with the nested RdRp gene RT-PCR assay than in each of the 4 groups with higher pre-test probability (individual group range, 50.0%–85.0%).Conclusions:Large-scale SARS-CoV-2 screening testing initiatives among low pre-test probability populations should be evaluated thoroughly prior to implementation given the risk of false-positive results and consequent potential for harm at the individual and population level.

ObjectivesThe objective of our study was to estimate the rate of workplace outbreak-associated cases of COVID-19 by industry in labour market participants aged 15–69 years who reported working the majority of hours outside the home in Ontario, Canada.MethodsWe conducted a population-based cross-sectional study of COVID-19 workplace outbreaks and associated cases reported in Ontario between 1 April 2020 and 31 March 2021. All outbreaks were manually classified into two-digit North American Industry Classification System codes. We obtained monthly denominator estimates from the Statistics Canada Labour Force Survey to estimate the incidence of outbreak-associated cases per 100 000 000 hours among individuals who reported the majority of hours were worked outside the home. We performed this analysis across industries and in three distinct time periods.ResultsOverall, 12% of cases were attributed to workplace outbreaks among working-age adults across our study period. While incidence varied across the time periods, the five industries with the highest incidence rates across our study period were agriculture, healthcare and social assistance, food manufacturing, educational services, and transportation and warehousing.ConclusionsCertain industries have consistently increased the incidence of COVID-19 over the course of the pandemic. These results may assist in ongoing efforts to reduce transmission of COVID-19 by prioritising resources, as well as industry-specific guidance, vaccination and public health messaging.

Setting: Syndemics occur when two or more health conditions interact to increase morbidity and mortality and are exacerbated by social, economic, environmental, and political factors. Routine provincial surveillance in Ontario assesses and reports on the epidemiology of single infectious diseases separately. Therefore, we aimed to develop a method that allows disease overlaps to be examined routinely as a path to better understanding and addressing syndemics in Ontario. Intervention: We extracted data for individuals with a record of chlamydia, gonorrhea, infectious syphilis, hepatitis B and C, HIV/AIDS, invasive group A streptococcal disease (iGAS), or tuberculosis in Ontario’s reportable disease database from 1990 to 2018. We transformed the data into a person-based integrated surveillance dataset retaining individuals (clients) with at least one record between 2006 and 2018. Outcomes: The resulting dataset had 659,136 unique disease records among 470,673 unique clients. Of those clients, 23.1% had multiple disease records with 50 being the most for one client. We described the frequency of disease overlaps; for example, 34.7% of clients with a syphilis record had a gonorrhea record. We quantified known overlaps, finding 1274 clients had gonorrhea, infectious syphilis, and HIV/AIDS records, and potentially emerging overlaps, finding 59 clients had HIV/AIDS, hepatitis C, and iGAS records. Implications: Our novel person-based integrated surveillance dataset represents a platform for ongoing in-depth assessment of disease overlaps such as the relative timing of disease records. It enables a more client-focused approach, is a step towards improved characterization of syndemics in Ontario, and could inform other jurisdictions interested in adopting similar approaches.

AbstractThere has been a steady increase in illness incidence of Vibrio parahaemolyticus(Vp). The majority of illnesses are associated with consumption of raw oysters. In the summer of 2015, Canada experienced the largest outbreak associated with the consumption of raw oysters harvested from British Columbia (BC) coastal waters. Case investigation of laboratory-confirmed cases was conducted to collect information on exposures and to assist traceback. Investigations at processors and oyster sampling were conducted. Eighty-two laboratory-confirmed cases of Vp infection were reported between January 1 and October 26, 2015. The majority of the cases were reported in BC, associated with consumption of raw BC oysters in restaurants. Sea surface temperatures were above the historical levels in 2015. This outbreak identified the need to improve surveillance and response to increases in human cases of Vp. This is of particular importance due to the potential for increasing water temperatures and the likelihood of additional outbreaks of Vibrio.

OBJECTIVES: The objectives of the study were to 1) describe the implementation of the “Testing is Healthy” campaign in four locations in British Columbia (BC) and 2) report process evaluation indicators for the campaign.

AbstractIntroductionApproximately 1.2 million persons in Oakland County, Michigan (USA) reside less than 50 miles from the Fermi Nuclear Power Plant, Unit 2, but information is limited regarding how residents might react during a radiation emergency. Community Assessment for Public Health Emergency Response (CASPER) survey methodology has been used in disaster and nondisaster settings to collect reliable and accurate population-based public health information, but it has not been used to assess household-level emergency preparedness for a radiation emergency. To improve emergency preparedness plans in Oakland County, including how residents might respond during a radiation emergency, Oakland County Health Division (OCHD), with assistance from the Centers for Disease Control and Prevention (CDC) and the Michigan Department of Community Health (MDCH), conducted a CASPER survey.MethodsDuring September 2012, a 2-stage cluster sampling design was used to select 210 representative households in Oakland County. By using in-person surveys, the proportion of households with essential needs and supplies, how residents might respond to public health authorities’ instructions, and their main source for obtaining information during a radiation emergency were assessed. Data were weighted to account for the complex sampling design.ResultsOf the goal of 210 households, 192 (91.4%) surveys were completed: 64.7% and 85.4% of respondents indicated having 3-day supplies of water and of nonperishable food, respectively; 62.8% had a 7-day supply of prescription medication for each person who needed it. Additionally, 64.2% had a working carbon monoxide detector; 67.1% had a first-aid kit; and 52% had an alternative heat source. In response to instructions from public health officials during a radiation emergency, 93.3% of all respondents would report to a radiation screening center; 96% would evacuate; and 91.8% would shelter-in-place. During a radiation emergency, 55.8% of respondents indicated their main information source would be television, 18.4% radio, and 13.6% the Internet. The most trusted source for information would be the local public health department (36.5%), local news (23%), a physician (11.2%), and family members (11.1%). Including completed and incomplete interviews, refusals, and nonrespondents, 517 total households were contacted.ConclusionsCASPER data regarding how residents might react during a radiation emergency provided objective and quantifiable information that will be used to develop Oakland County's radiation emergency preparedness plans. Survey information demonstrates the feasibility and usefulness of CASPER methodology for radiation emergency preparedness planning.NyakuMK, WolkinAF, McFaddenJ, CollinsJ, MurtiM, SchnallA, BiesS, StanburyM, BeggsJ, BayleyegnTM. Assessing radiation emergency preparedness planning by using Community Assessment for Public Health Emergency Response (CASPER) methodology. Prehosp Disaster Med. 2014;29(3):1-9.

AbstractObjectivesWe examined the association between housing type and household emergency preparedness among households in Oakland County, Michigan.MethodsWe used interview data on household emergency preparedness from a cluster design survey in Oakland County, Michigan, in 2012. We compared survey-weighted frequencies of household demographics, medical conditions, and preparedness measures in single-detached homes versus multi-unit dwellings, and determined the unadjusted odds ratios (OR) and the income-level adjusted OR for each preparedness measure.ResultsHouseholds had similar demographics and medical conditions between housing types. Unadjusted ORs were statistically significant for single detached homes having a generator (11.1), back-up heat source (10.9), way to cook without utilities (5.8), carbon monoxide (CO) detector (3.8), copies of important documents (3.4), evacuation routes (3.1), and 3-day supply of water (2.5). Income level adjusted ORs remained statistically significant except for owning a CO detector.ConclusionsHouseholds in multi-unit dwellings were less likely to have certain recommended emergency plans and supplies compared to those in single detached homes. Further research is required to explore the feasibility, barriers, and alternatives for households in multi-unit dwellings in terms of complying with these measures. (Disaster Med Public Preparedness. 2014;0:1–8)

Timely surveillance of enteric diseases is necessary to identify and control cases and outbreaks. Our objective was to evaluate the timeliness of enteric disease surveillance in British Columbia, Canada, compare these results to other settings, and recommend improvements. In 2012 and 2013, information was collected from case report forms and laboratory information systems on 2615 Salmonella, shigatoxin-producing E. coli, Shigella, and Listeria infections. Twelve date variables representing the surveillance process from onset of symptoms to case interview and final laboratory results were collected, and intervals were measured. The median time from onset of symptoms to reporting subtyping results to BC epidemiologists was 26–36 days and from onset of symptoms to case interview was 12–14 days. Our findings were comparable to the international literature except for a longer time (up to 29 day difference) to reporting of PFGE results to epidemiologists in BC. Such a delay may impact our ability to identify and solve outbreaks. Several process and system changes were implemented which should improve the timeliness of enteric disease surveillance.