1
|
Nantel S, Sheikh-Mohamed S, Chao GYC, Kurtesi A, Hu Q, Wood H, Colwill K, Li Z, Liu Y, Seifried L, Bourdin B, McGeer A, Hardy WR, Rojas OL, Al-Aubodah TA, Liu Z, Ostrowski MA, Brockman MA, Piccirillo CA, Quach C, Rini JM, Gingras AC, Decaluwe H, Gommerman JL. Comparison of Omicron breakthrough infection versus monovalent SARS-CoV-2 intramuscular booster reveals differences in mucosal and systemic humoral immunity. Mucosal Immunol 2024; 17:201-210. [PMID: 38278415 DOI: 10.1016/j.mucimm.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 01/17/2024] [Accepted: 01/20/2024] [Indexed: 01/28/2024]
Abstract
Our understanding of the quality of cellular and humoral immunity conferred by COVID-19 vaccination alone versus vaccination plus SARS-CoV-2 breakthrough (BT) infection remains incomplete. While the current (2023) SARS-CoV-2 immune landscape of Canadians is complex, in late 2021 most Canadians had either just received a third dose of COVID-19 vaccine, or had received their two-dose primary series and then experienced an Omicron BT. Herein we took advantage of this coincident timing to contrast cellular and humoral immunity conferred by three doses of vaccine versus two doses plus BT. Our results show thatBT infection induces cell-mediated immune responses to variants comparable to an intramuscular vaccine booster dose. In contrast, BT subjects had higher salivary immunoglobulin (Ig)G and IgA levels against the Omicron spike and enhanced reactivity to the ancestral spike for the IgA isotype, which also reacted with SARS-CoV-1. Serumneutralizing antibody levels against the ancestral strain and the variants were also higher after BT infection. Our results support the need for the development of intranasal vaccines that could emulate the enhanced mucosal and humoral immunity induced by Omicron BT without exposing individuals to the risks associated with SARS-CoV-2 infection.
Collapse
Affiliation(s)
- Sabryna Nantel
- Sainte-Justine University Hospital and Research Center, Montréal, Québec, Canada; Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | | | - Gary Y C Chao
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Kurtesi
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Queenie Hu
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Heidi Wood
- One Health Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Zhijie Li
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Ying Liu
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Laurie Seifried
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada; Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Benoîte Bourdin
- Sainte-Justine University Hospital and Research Center, Montréal, Québec, Canada
| | - Allison McGeer
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - William R Hardy
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada
| | - Olga L Rojas
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada; Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Tho-Alfakar Al-Aubodah
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Zhiyang Liu
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Mario A Ostrowski
- Department of Immunology, University of Toronto, Toronto, Ontario, Canada
| | - Mark A Brockman
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ciriaco A Piccirillo
- Department of Microbiology and Immunology, Faculty of Medicine and Health Sciences, McGill University, Montréal, Québec, Canada; Infectious Diseases and Immunity in Global Health Program, Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Caroline Quach
- Sainte-Justine University Hospital and Research Center, Montréal, Québec, Canada; Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada
| | - James M Rini
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada; Department of Biochemistry, University of Toronto, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute at Mount Sinai Hospital, Sinai Health, Toronto, Ontario, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Hélène Decaluwe
- Sainte-Justine University Hospital and Research Center, Montréal, Québec, Canada; Microbiology, Infectiology and Immunology Department, Faculty of Medicine, University of Montréal, Montréal, Québec, Canada; Pediatric Immunology and Rheumatology Division, Department of Pediatrics, University of Montréal, Montréal, Québec, Canada.
| | | |
Collapse
|
2
|
Volling C, Mataseje L, Graña-Miraglia L, Hu X, Anceva-Sami S, Coleman BL, Downing M, Hota S, Jamal AJ, Johnstone J, Katz K, Leis JA, Li A, Mahesh V, Melano R, Muller M, Nayani S, Patel S, Paterson A, Pejkovska M, Ricciuto D, Sultana A, Vikulova T, Zhong Z, McGeer A, Guttman DS, Mulvey MR. Epidemiology of healthcare-associated Pseudomonas aeruginosa in intensive care units: Are sink drains to blame? J Hosp Infect 2024:S0195-6701(24)00103-8. [PMID: 38554807 DOI: 10.1016/j.jhin.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 02/23/2024] [Accepted: 03/04/2024] [Indexed: 04/02/2024]
Abstract
BACKGROUND Pseudomonas aeruginosa (PA) is a common cause of healthcare-associated infections (PA-HAI) in the intensive care unit (ICU). We aimed to describe the epidemiology of PA-HAI in ICUs in Ontario, Canada, and determine whether we could identify episodes of sink-to-patient PA transmission. METHODS This was a prospective cohort study of patients in six ICUs from 2018-2019, with retrieval of PA clinical isolates, and PA-screening of antimicrobial resistant organism surveillance rectal swabs, and of sink drain, air, and faucet samples. All PA isolates underwent whole genome sequencing. PA-HAI was defined using US National Healthcare Safety Network criteria. ICU-acquired PA was defined as PA isolated from specimens obtained >48 hours after ICU admission in those with prior negative rectal swabs. Sink-to-patient PA transmission was defined as ICU-acquired PA with close genomic relationship to isolate(s) previously recovered from sinks in a room/bedspace occupied 3-14 days prior to the relevant patient isolate. RESULTS Over ten months, 72 PA-HAI occurred among 60/4263 admissions. The rate of PA-HAI was 2.40 per 1000 patient-ICU days; higher in patients who were PA-colonized on admission. PA-HAI was associated with longer stay (median 26 vs 3 days uninfected, p<0.001) and contributed to death in 22/60 cases (36.7%). Fifty-eight admissions with ICU-acquired PA were identified, contributing 35/72 (48.6%) PA-HAI. Four patients with five PA-HAI (6.9%) had closely related isolates previously recovered from their room/bedspace sinks. CONCLUSIONS Nearly half of PA causing HAI appeared to be acquired in ICUs, and 7% of PA-HAI were associated with sink-to-patient transmission. Sinks may be an underrecognized reservoir for HAIs.
Collapse
Affiliation(s)
- Cheryl Volling
- Department of Microbiology, Sinai Health, Toronto, Canada.
| | - Laura Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| | | | - Xiaoyi Hu
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada
| | | | | | | | - Susy Hota
- Department of Medicine, University Health Network, Toronto, Canada
| | | | | | - Kevin Katz
- Department of Medicine, North York General Hospital, Toronto, Canada
| | - Jerome A Leis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Angel Li
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Vinaya Mahesh
- Department of Microbiology, Sinai Health, Toronto, Canada
| | | | - Matthew Muller
- Department of Medicine, Unity Health Toronto, Toronto, Canada
| | - Sarah Nayani
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Samir Patel
- Public Health Ontario Laboratory, Toronto, Canada
| | - Aimee Paterson
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Mare Pejkovska
- Department of Microbiology, Sinai Health, Toronto, Canada
| | | | - Asfia Sultana
- Department of Microbiology, Sinai Health, Toronto, Canada
| | | | - Zoe Zhong
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health, Toronto, Canada
| | - David S Guttman
- Department of Cell & Systems Biology, University of Toronto, Toronto, Canada; Centre for the Analysis of Genome Evolution and Function, Department of Cell and Systems Biology, University of Toronto, Toronto, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada
| |
Collapse
|
3
|
Nasreen S, Wang J, Marra F, Kwong JC, McGeer A, Sadarangani M, Wilson SE, Fadel SA. Indirect impact of childhood 13-valent pneumococcal conjugate vaccine (PCV13) in Canadian older adults: a Canadian Immunization Research Network (CIRN) retrospective observational study. Thorax 2024:thorax-2023-220377. [PMID: 38359926 DOI: 10.1136/thorax-2023-220377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
BACKGROUND 13-valent pneumococcal conjugate vaccine (PCV13) has been part of publicly funded childhood immunisation programmes in Ontario and British Columbia (BC) since 2010. We assessed the indirect impact of infant PCV13 programmes on invasive pneumococcal disease (IPD) and all-cause pneumonia hospitalisation in older adults (aged ≥65 years) using a retrospective observational study. METHODS We extracted monthly IPD and all-cause pneumonia cases from laboratory and health administrative databases between January 2005 and December 2018. Using a quasi-experimental difference-in-differences design, we calculated the ratio of risk ratios (RRRs) using incidence rates of IPD or all-cause pneumonia cases before (pre-PCV13 period) and after (PCV13 period) 2010 with rates of fractures as controls. RESULTS The rates of all IPD or PCV serotype-specific IPD for older adults in both Ontario and BC did not change in 8 years after childhood PCV13 programme implementation. All-cause pneumonia increased in Ontario (RRR 1.38, 95% CI 1.11 to 1.71) but remained unchanged in BC. CONCLUSIONS Indirect community protection of older adults from hospitalisation with pneumococcal disease stalled despite maturation of childhood PCV13 vaccination programmes in two Canadian provinces.
Collapse
Affiliation(s)
- Sharifa Nasreen
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- SUNY Downstate Health Sciences University School of Public Health, Brooklyn, New York, USA
| | - Jun Wang
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Allison McGeer
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- Sinai Health System, Toronto, Ontario, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sarah E Wilson
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
| | - Shaza A Fadel
- University of Toronto Dalla Lana School of Public Health, Toronto, Ontario, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
4
|
Ismail S, Unger S, Budylowski P, Poutanen S, Yau Y, Jenkins C, Anwer S, Christie-Holmes N, Kiss A, Mazzulli T, Johnstone J, McGeer A, Whittle W, Parvez B, Gray-Owen SD, Stone D, O'Connor DL. SARS-CoV-2 antibodies and their neutralizing capacity against live virus in human milk after COVID-19 infection and vaccination: prospective cohort studies. Am J Clin Nutr 2024; 119:485-495. [PMID: 38309831 DOI: 10.1016/j.ajcnut.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/29/2023] [Accepted: 10/02/2023] [Indexed: 02/05/2024] Open
Abstract
BACKGROUND There is limited understanding of the impact of coronavirus disease 2019 (COVID-19) infection and vaccination type and interval on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human milk antibodies and their neutralizing capacity. OBJECTIVES These cohort studies aimed to determine the presence of antibodies and live virus neutralizing capacity in milk from females infected with COVID-19, unexposed milk bank donors, and vaccinated females and examine impacts of vaccine interval and type. METHODS Milk was collected from participants infected with COVID-19 during pregnancy or lactation (Cohort-1) and milk bank donors (Cohort-2) from March 2020-July 2021 at 3 sequential 4-wk intervals and COVID-19 vaccinated participants with varying dose intervals (Cohort-3) (January-October 2021). Cohort-1 and Cohort-3 were recruited from Sinai Health (patients) and through social media. Cohort-2 included Ontario Milk Bank donors. Milk was examined for SARS-CoV-2 antibodies and live virus neutralization. RESULTS Of females with COVID-19, 53% (Cohort-1, n = 55) had anti-SARS-CoV-2 IgA antibodies in ≥1 milk sample. IgA+ samples (40%) were more likely neutralizing than IgA- samples (odds ratio [OR]: 2.18; 95% confidence interval [CI]: 1.03, 4.60; P = 0.04); however, 25% of IgA- samples were neutralizing. Both IgA positivity and neutralization decreased ∼6 mo after symptom onset (0-100 compared with 201+ d: IgA OR: 14.30; 95% CI: 1.08, 189.89; P = 0.04; neutralizing OR: 4.30; 95% CI: 1.55, 11.89; P = 0.005). Among milk bank donors (Cohort-2, n = 373), 4.3% had IgA antibodies; 23% of IgA+ samples were neutralizing. Vaccination (Cohort-3, n = 60) with mRNA-1273 and shorter vaccine intervals (3 to <6 wk) resulted in higher IgA and IgG than BNT162b2 (P < 0.04) and longer intervals (6 to <16 wk) (P≤0.02), respectively. Neutralizing capacity increased postvaccination (P = 0.04) but was not associated with antibody positivity. CONCLUSIONS SARS-CoV-2 infection and vaccination (type and interval) impacted milk antibodies; however, antibody presence did not consistently predict live virus neutralization. Although human milk is unequivocally the best way to nourish infants, guidance on protection to infants following maternal infection/vaccination may require more nuanced messaging. This study was registered at clinicaltrials.gov as NCT04453969 and NCT04453982.
Collapse
Affiliation(s)
- Samantha Ismail
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Sharon Unger
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada; Paediatrics, Sinai Health System, Toronto, Canada
| | - Patrick Budylowski
- Combined Containment Level 3 Unit, University of Toronto, Toronto, Canada; Institute of Medical Sciences, University of Toronto, Toronto, Canada
| | - Susan Poutanen
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Yvonne Yau
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada; Department of Paediatric Laboratory Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Carleigh Jenkins
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada
| | - Shaista Anwer
- Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | | | - Alex Kiss
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada; Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Jennie Johnstone
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada; Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Wendy Whittle
- Obstetrics and Gynecology, Sinai Health System, Toronto, Canada
| | | | - Scott D Gray-Owen
- Combined Containment Level 3 Unit, University of Toronto, Toronto, Canada; Department of Molecular Genetics, University of Toronto, Toronto, Canada
| | - Debbie Stone
- Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada
| | - Deborah L O'Connor
- Department of Nutritional Sciences, University of Toronto, Toronto, Canada; Rogers Hixon Ontario Human Milk Bank, Sinai Health System, Toronto, Canada; Paediatrics, Sinai Health System, Toronto, Canada; The Hospital for Sick Children Research Institute, Toronto, Canada.
| |
Collapse
|
5
|
Muller MP, Navarro C, Wilson SE, Shulha HP, Naus M, Lim G, Padhi S, McGeer A, Finkelstein M, Liddy A, Bettinger JA. Prospective monitoring of adverse events following vaccination with Modified vaccinia Ankara - Bavarian Nordic (MVA-BN) administered to a Canadian population at risk of Mpox: A Canadian Immunization Research Network study. Vaccine 2024; 42:535-540. [PMID: 38199921 DOI: 10.1016/j.vaccine.2023.12.068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 12/04/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024]
Abstract
MVA-BN is an orthopoxvirus vaccine that provides protection against both smallpox and mpox. In June 2022, Canada launched a publicly-funded vaccination campaign to offer MVA-BN to at-risk populations including men who have sex with men (MSM) and sex workers. The safety of MVA-BN has not been assessed in this context. To address this, the Canadian National Vaccine Safety Network (CANVAS) conducted prospective safety surveillance during public health vaccination campaigns in Toronto, Ontario and in Vancouver, British Columbia. Vaccinated participants received a survey 7 and 30 days after each MVA-BN dose to elicit adverse health events. Unvaccinated individuals from a concurrent vaccine safety project evaluating COVID-19 vaccine safety were used as controls. Vaccinated and unvaccinated participants that reported a medically attended visit on their 7-day survey were interviewed. Vaccinated participants and unvaccinated controls were matched 1:1 based on age group, gender, sex and provincial study site. Overall, 1,173 vaccinated participants completed a 7-day survey, of whom 75 % (n = 878) also completed a 30-day survey. Mild to moderate injection site pain was reported by 60 % of vaccinated participants. Among vaccinated participants 8.4 % were HIV positive and when compared to HIV negative vaccinated individuals, local injection sites were less frequent in those with HIV (48 % vs 61 %, p = 0.021), but health events preventing work/school or requiring medical assessment were more frequent (7.1 % vs 3.1 %, p = 0.040). Health events interfering with work/school, or requiring medical assessment were less common in the vaccinated group than controls (3.3 % vs. 7.1 %, p < 0.010). No participants were hospitalized within 7 or 30 days of vaccination. No cases of severe neurological disease, skin disease, or myocarditis were identified. Our results demonstrate that the MVA-BN vaccine appears safe when used for mpox prevention, with a low frequency of severe adverse events and no hospitalizations observed.
Collapse
Affiliation(s)
- M P Muller
- Canadian National Vaccine Safety Network (CANVAS); Department of Medicine, St. Michael's Hospital, Toronto, Canada.
| | - C Navarro
- Public Health Ontario, Ontario, Canada
| | | | - H P Shulha
- Canadian National Vaccine Safety Network (CANVAS)
| | - M Naus
- British Columbia Centre for Disease Control, British Columbia, Canada
| | - G Lim
- Public Health Ontario, Ontario, Canada
| | - S Padhi
- Toronto Public Health, Toronto, Canada
| | - A McGeer
- Canadian National Vaccine Safety Network (CANVAS); Department of Laboratory Medicine, Sinai Health Systems, Toronto, Canada
| | | | - A Liddy
- Toronto Public Health, Toronto, Canada
| | - J A Bettinger
- Canadian National Vaccine Safety Network (CANVAS); Vaccine Evaluation Center, BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, Canada
| |
Collapse
|
6
|
Mohammed Y, Tran K, Carlsten C, Ryerson C, Wong A, Lee T, Cheng MP, Vinh DC, Lee TC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Murthy S, Jain F, Borchers CH, Goodlett DR, Levin A, Russell JA. Proteomic Evolution from Acute to Post-COVID-19 Conditions. J Proteome Res 2024; 23:52-70. [PMID: 38048423 PMCID: PMC10775146 DOI: 10.1021/acs.jproteome.3c00324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/30/2023] [Accepted: 11/13/2023] [Indexed: 12/06/2023]
Abstract
Many COVID-19 survivors have post-COVID-19 conditions, and females are at a higher risk. We sought to determine (1) how protein levels change from acute to post-COVID-19 conditions, (2) whether females have a plasma protein signature different from that of males, and (3) which biological pathways are associated with COVID-19 when compared to restrictive lung disease. We measured protein levels in 74 patients on the day of admission and at 3 and 6 months after diagnosis. We determined protein concentrations by multiple reaction monitoring (MRM) using a panel of 269 heavy-labeled peptides. The predicted forced vital capacity (FVC) and diffusing capacity of the lungs for carbon monoxide (DLCO) were measured by routine pulmonary function testing. Proteins associated with six key lipid-related pathways increased from admission to 3 and 6 months; conversely, proteins related to innate immune responses and vasoconstriction-related proteins decreased. Multiple biological functions were regulated differentially between females and males. Concentrations of eight proteins were associated with FVC, %, and they together had c-statistics of 0.751 (CI:0.732-0.779); similarly, concentrations of five proteins had c-statistics of 0.707 (CI:0.676-0.737) for DLCO, %. Lipid biology may drive evolution from acute to post-COVID-19 conditions, while activation of innate immunity and vascular regulation pathways decreased over that period. (ProteomeXchange identifiers: PXD041762, PXD029437).
Collapse
Affiliation(s)
- Yassene Mohammed
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
| | - Karen Tran
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - Chris Carlsten
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Christopher Ryerson
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Alyson Wong
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Terry Lee
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew P. Cheng
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Donald C. Vinh
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Todd C. Lee
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
| | - Brent W. Winston
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
| | - David Sweet
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
| | - John H. Boyd
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Keith R. Walley
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - Greg Haljan
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
| | - Allison McGeer
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
| | | | - Robert Fowler
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
| | - David Maslove
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
| | - Joel Singer
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - David M. Patrick
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
| | - John C. Marshall
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
| | - Srinivas Murthy
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
| | - Fagun Jain
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
| | - Christoph H. Borchers
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
| | - David R. Goodlett
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
| | - Adeera Levin
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - James A. Russell
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| | - ARBs CORONA I Consortium
- Center
for Proteomics and Metabolomics, Leiden
University Medical Center, Leiden 2333 ZA, The Netherlands
- UVic-Genome
BC Proteomics Centre, University of Victoria, Victoria V8Z 5N3, BC Canada
- Gerald
Bronfman Department of Oncology, McGill
University, Montreal, QC H3A 0G4, Canada
- Division
of General Internal Medicine, Vancouver
General Hospital and University of British Columbia, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Division
of Respiratory Medicine, Vancouver General Hospital, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
- Centre for
Health Evaluation and Outcome Science (CHEOS), St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division
of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montreal, PQ H4A 3J1, Canada
- Departments
of Critical Care Medicine, Medicine and Biochemistry and Molecular
Biology, Foothills Medical Centre and University
of Calgary, 1403 29 Street
NW, Calgary, Alberta T2N 4N1, Canada
- Division
of Critical Care Medicine, Vancouver General
Hospital, 2775 Laurel St, Vancouver, BC V5Z 1M9, Canada
- Centre
for Heart Lung Innovation, St. Paul’s Hospital, University of British Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Division of Critical Care Medicine, St.
Paul’s Hospital, University of British
Columbia, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
- Department of Medicine, Surrey Memorial
Hospital, 13750 96th
Avenue, Surrey, BC V3V 1Z2, Canada
- Mt. Sinai Hospital and University of Toronto, 600 University Avenue, Toronto, ON M5G 1X5, Canada
- University of Sherbrooke, Sherbrooke, PQ J1K 2R1, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada
- Department
of Critical Care, Kingston General Hospital
and Queen’s University, 76 Stuart Street, Kingston, ON K7L 2V7, Canada
- British Columbia Centre for Disease Control
(BCCDC) and University
of British Columbia, 655 West 12th Avenue, Vancouver, BC V5Z 4R4, Canada
- Department of Surgery, St. Michael’s
Hospital, 30 Bond Street, Toronto, ON M5B
1W8, Canada
- BC Children’s Hospital and University of British Columbia, 4500 Oak Street, Vancouver, BC V6H 3N1, Canada
- Black Tusk Research Group, Vancouver, BC V6Z 2C7, Canada
- Segal Cancer Proteomics, Centre, Lady Davis
Institute
for Medical Research, McGill University, Montreal, QC H3T 1E2, Canada
- Gerald Bronfman Department of Oncology, Jewish General Hospital, Montreal, QC H3T 1E2, Canada
- Division of Experimental Medicine, McGill
University, Montreal, QC H3T 1E2, Canada
- Department of Pathology, McGill
University, Montreal, QC H3T 1E2, Canada
- Division of Nephrology, St.
Paul’s Hospital, 1081 Burrard Street, Vancouver, BC V6Z 1Y6, Canada
| |
Collapse
|
7
|
Lerminiaux N, Mitchell R, Bartoszko J, Davis I, Ellis C, Fakharuddin K, Hota SS, Katz K, Kibsey P, Leis JA, Longtin Y, McGeer A, Minion J, Mulvey M, Musto S, Rajda E, Smith SW, Srigley JA, Suh KN, Thampi N, Tomlinson J, Wong T, Mataseje L. Plasmid genomic epidemiology of blaKPC carbapenemase-producing Enterobacterales in Canada, 2010-2021. Antimicrob Agents Chemother 2023; 67:e0086023. [PMID: 37971242 PMCID: PMC10720558 DOI: 10.1128/aac.00860-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/07/2023] [Indexed: 11/19/2023] Open
Abstract
Carbapenems are considered last-resort antibiotics for the treatment of infections caused by multidrug-resistant Enterobacterales, but carbapenem resistance due to acquisition of carbapenemase genes is a growing threat that has been reported worldwide. Klebsiella pneumoniae carbapenemase (blaKPC) is the most common type of carbapenemase in Canada and elsewhere; it can hydrolyze penicillins, cephalosporins, aztreonam, and carbapenems and is frequently found on mobile plasmids in the Tn4401 transposon. This means that alongside clonal expansion, blaKPC can disseminate through plasmid- and transposon-mediated horizontal gene transfer. We applied whole genome sequencing to characterize the molecular epidemiology of 829 blaKPC carbapenemase-producing isolates collected by the Canadian Nosocomial Infection Surveillance Program from 2010 to 2021. Using a combination of short-read and long-read sequencing, we obtained 202 complete and circular blaKPC-encoding plasmids. Using MOB-suite, 10 major plasmid clusters were identified from this data set which represented 87% (175/202) of the Canadian blaKPC-encoding plasmids. We further estimated the genomic location of incomplete blaKPC-encoding contigs and predicted a plasmid cluster for 95% (603/635) of these. We identified different patterns of carbapenemase mobilization across Canada related to different plasmid clusters, including clonal transmission of IncF-type plasmids (108/829, 13%) in K. pneumoniae clonal complex 258 and novel repE(pEh60-7) plasmids (44/829, 5%) in Enterobacter hormaechei ST316, and horizontal transmission of IncL/M (142/829, 17%) and IncN-type plasmids (149/829, 18%) across multiple genera. Our findings highlight the diversity of blaKPC genomic loci and indicate that multiple, distinct plasmid clusters have contributed to blaKPC spread and persistence in Canada.
Collapse
Affiliation(s)
| | | | | | - Ian Davis
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Chelsey Ellis
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Ken Fakharuddin
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Susy S. Hota
- University Health Network, Toronto, Ontario, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Jerome A. Leis
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Yves Longtin
- Jewish General Hospital, Montréal, Québec, Canada
| | | | - Jessica Minion
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Michael Mulvey
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Sonja Musto
- Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Ewa Rajda
- McGill University Health Centre, Montréal, Québec, Canada
| | | | - Jocelyn A. Srigley
- BC Women’s and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | | | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | | | - Titus Wong
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| | - Laura Mataseje
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - on behalf of the Canadian Nosocomial Infection Surveillance Program
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
- Public Health Agency of Canada, Ottawa, Ontario, Canada
- QEII Health Sciences Centre, Halifax, Nova Scotia, Canada
- The Moncton Hospital, Moncton, New Brunswick, Canada
- University Health Network, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Jewish General Hospital, Montréal, Québec, Canada
- Sinai Health, Toronto, Ontario, Canada
- Saskatchewan Health Authority, Regina, Saskatchewan, Canada
- Health Sciences Centre, Winnipeg, Manitoba, Canada
- McGill University Health Centre, Montréal, Québec, Canada
- University of Alberta Hospital, Edmonton, Alberta, Canada
- BC Women’s and BC Children’s Hospital, Vancouver, British Columbia, Canada
- The Ottawa Hospital, Ottawa, Ontario, Canada
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Vancouver Coastal Health Research Institute, Vancouver, British Columbia, Canada
| |
Collapse
|
8
|
Fell DB, Russell M, Fung SG, Swayze S, Chung H, Buchan SA, Roda W, Smolarchuk C, Wilson K, Crowcroft N, Schwartz KL, Gubbay JB, McGeer A, Smieja M, Richardson DC, Katz K, Zahariadis G, Campigotto A, Mubareka S, McNally D, Karnauchow T, Zelyas N, Svenson LW, Kwong JC. Effectiveness of maternal influenza vaccination during pregnancy against laboratory-confirmed seasonal influenza among infants under 6 months of age in Ontario, Canada. J Infect Dis 2023:jiad539. [PMID: 38029414 DOI: 10.1093/infdis/jiad539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 10/30/2023] [Accepted: 11/28/2023] [Indexed: 12/01/2023] Open
Abstract
BACKGROUND Randomized trials conducted in low- and middle-income settings demonstrated efficacy of influenza vaccination during pregnancy against influenza infection among infants <6 months of age. However, vaccine effectiveness (VE) estimates from settings with different population characteristics and influenza seasonality remain limited. METHODS We conducted a test-negative study in Ontario, Canada. All influenza virus tests among infants <6 months from 2010-2019 were identified and linked with health databases to ascertain information on maternal-infant dyads. VE was estimated from the odds ratio for influenza vaccination during pregnancy among cases versus controls, computed using logistic regression with adjustment for potential confounders. RESULTS Among 23,806 infants tested for influenza, 1,783 (7.5%) were positive and 1,708 (7.2%) were born to mothers vaccinated against influenza during pregnancy. VE against laboratory-confirmed infant influenza infection was 64% (95% confidence interval [CI]: 50%-74%). VE was similar by trimester of vaccination (1st/2nd: 66%, 40%-80%; 3rd: 63%, 46%-74%), infant age at testing (0-<2 months: 63%, 46%-75%; 2-<6 months: 64%, 36%-79%), and gestational age at birth (≥37 weeks: 64%, 50%-75%; < 37 weeks: 61%, 4%-86%). VE against influenza hospitalization was 67% (95%CI: 50%-78%). CONCLUSIONS Influenza vaccination during pregnancy offers effective protection to infants <6 months, for whom vaccines are not currently available.
Collapse
Affiliation(s)
- Deshayne B Fell
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
- ICES, Toronto and Ottawa, ON, Canada
| | - Margaret Russell
- Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen G Fung
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, ON, Canada
| | | | | | - Sarah A Buchan
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, ON, Canada
| | - Weston Roda
- Mathematical & Statistical Sciences, University of Alberta, Edmonton, AB, Canada
| | | | - Kumanan Wilson
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Ottawa Hospital Research Institute, Ottawa, ON, Canada
- Bruyère Research Institute, Ottawa, ON, Canada
| | - Natasha Crowcroft
- Department of Immunization, Vaccines, and Biologicals, World Health Organization, Geneva, Switzerland
| | - Kevin L Schwartz
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Unity Health Toronto, Toronto, ON, Canada
| | - Jonathan B Gubbay
- Public Health Ontario, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Department of Pediatrics, The Hospital for Sick Children, Toronto, ON, Canada
| | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Department of Microbiology, Sinai Health System, Toronto, ON, Canada
| | - Marek Smieja
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, Canada
| | - David C Richardson
- Department of Pathology and Laboratory Medicine, William Osler Health System, Brampton, ON, Canada
- Department of Medicine, William Osler Health System, Brampton, ON, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
- Shared Hospital Laboratory, Toronto, Ontario, Canada
| | - George Zahariadis
- Newfoundland and Labrador Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Aaron Campigotto
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Division of Microbiology, Department of Paediatric Laboratory Medicine, Hospital for Sick Children, Toronto, ON, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Dayre McNally
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Timothy Karnauchow
- Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Nathan Zelyas
- Alberta Public Health Laboratory, Alberta Precision Laboratories, Edmonton, AB, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Lawrence W Svenson
- Alberta Health, Edmonton, AB, Canada
- Division of Preventive Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
- School of Public Health, University of Alberta, Edmonton, AB, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Jeffrey C Kwong
- ICES, Toronto and Ottawa, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
- University Health Network, Toronto, ON, Canada
| |
Collapse
|
9
|
Kain DC, Isabel S, Abdulnoor M, Boissinot K, De Borja R, Filkin A, Lam B, Li J, Lungu I, McCreight L, McGeer A, Mazzulli T, Paterson A, Zuzarte P, Vincelli F, Bergwerff C, Fattouh R, Simpson JT, Johnstone J. Coronavirus disease 2019 (COVID-19) outbreak on an in-patient medical unit associated with unrecognized exposures in common areas-Epidemiological and whole-genome sequencing investigation. Infect Control Hosp Epidemiol 2023; 44:1829-1833. [PMID: 36912329 PMCID: PMC10665866 DOI: 10.1017/ice.2023.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/04/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVE Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) hospital outbreaks have been common and devastating during the coronavirus disease 2019 (COVID-19) pandemic. Understanding SARS-CoV-2 transmission in these environments is critical for preventing and managing outbreaks. DESIGN Outbreak investigation through epidemiological mapping and whole-genome sequencing phylogeny. SETTING Hospital in-patient medical unit outbreak in Toronto, Canada, from November 2020 to January 2021. PARTICIPANTS The outbreak involved 8 patients and 10 staff and was associated with 3 patient deaths. RESULTS Patients being cared for in geriatric chairs at the nursing station were at high risk for both acquiring and transmitting SARS-CoV-2 to other patients and staff. Furthermore, given the informal nature of these transmissions, they were not initially recognized, which led to further transmission and missing the opportunity for preventative COVID-19 therapies. CONCLUSIONS During outbreak prevention and management, the risk of informal patient care settings, such as geriatric chairs, should be considered. During high-risk periods or during outbreaks, efforts should be made to care for patients in their rooms when possible.
Collapse
Affiliation(s)
- Dylan C. Kain
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sandra Isabel
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Mariana Abdulnoor
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Sick Kids Hospital, Department of Infectious Disease, Toronto, Ontario, Canada
| | - Karel Boissinot
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | | | - Amanda Filkin
- Occupational Health, Sinai Health, Toronto, Ontario, Canada
| | - Bernard Lam
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jason Li
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ilinca Lungu
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Liz McCreight
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System/University Health Network, Toronto, Ontario, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Microbiology, Sinai Health System/University Health Network, Toronto, Ontario, Canada
| | - Aimee Paterson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, Ontario, Canada
| | - Philip Zuzarte
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | | | | | - Ramzi Fattouh
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, St. Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jared T. Simpson
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
10
|
Pott H, Andrew MK, Shaffelburg Z, Nichols MK, Ye L, ElSherif M, Hatchette TF, LeBlanc J, Ambrose A, Boivin G, Bowie W, Johnstone J, Katz K, Lagacé-Wiens P, Loeb M, McCarthy A, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Vaccine Effectiveness of non-adjuvanted and adjuvanted trivalent inactivated influenza vaccines in the prevention of influenza-related hospitalization in older adults: A pooled analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN). Vaccine 2023; 41:6359-6365. [PMID: 37696717 DOI: 10.1016/j.vaccine.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Influenza vaccines prevent influenza-related morbidity and mortality; however, suboptimal vaccine effectiveness (VE) of non-adjuvanted trivalent inactivated influenza vaccine (naTIV) or quadrivalent formulations in older adults prompted the use of enhanced products such as adjuvanted TIV (aTIV). Here, the VE of aTIV is compared to naTIV for preventing influenza-associated hospitalization among older adults. METHODS A test-negative design study was used with pooled data from the 2012 to 2015 influenza seasons. An inverse probability of treatment (IPT)-weighted logistic regression estimated the Odds Ratio (OR) for laboratory-confirmed influenza-associated hospitalization. VE was calculated as (1-OR)*100% with accompanying 95% confidence intervals (CI). RESULTS Of 7,101 adults aged ≥ 65, 3,364 received naTIV and 526 received aTIV. The overall VE against influenza hospitalization was 45.9% (95% CI: 40.2%-51.1%) for naTIV and 53.5% (42.8%-62.3%) for aTIV. No statistically significant differences in VE were found between aTIV and naTIV by age group or influenza season, though a trend favoring aTIV over naTIV was noted. Frailty may have impacted VE in aTIV recipients compared to those receiving naTIV, according to an exploratory analysis; VE adjusted by frailty was 59.1% (49.6%-66.8%) for aTIV and 44.8% (39.1%-50.0%) for naTIV. The overall relative VE of aTIV to naTIV against laboratory-confirmed influenza hospital admission was 25% (OR 0.75; 0.61-0.92), demonstrating statistically significant benefit favoring aTIV. CONCLUSIONS Adjusting for frailty, aTIV showed statistically significantly better protection than naTIV against influenza-associated hospitalizations in older adults. In future studies, it is important to consider frailty as a significant confounder of VE.
Collapse
Affiliation(s)
- Henrique Pott
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Melissa K Andrew
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Zachary Shaffelburg
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Michaela K Nichols
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Public Health Agency of Canada, Halifax, Canada
| | - Lingyun Ye
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - May ElSherif
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Jason LeBlanc
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Pathology, Dalhousie University, Halifax, Canada
| | - Ardith Ambrose
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Guy Boivin
- CHU de Québec-Université Laval, Québec, Québec
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andre Poirier
- Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Grant Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | | | | | - Shelly A McNeil
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada.
| |
Collapse
|
11
|
Maunder RG, Kiss A, Heeney N, Wallwork E, Hunter JJ, Johnstone J, Wiesenfeld L, Jeffs L, McGeer A, Lee K, Loftus C, Ginty L, Wilkinson K, Merkley J. Randomized trial of personalized psychological feedback from a longitudinal online survey and simultaneous evaluation of randomized stepped wedge availability of in-person peer support for hospital staff during the COVID-19 pandemic. Gen Hosp Psychiatry 2023; 84:31-38. [PMID: 37327633 PMCID: PMC10250283 DOI: 10.1016/j.genhosppsych.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 05/29/2023] [Accepted: 06/08/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE We tested if automated Personalized Self-Awareness Feedback (PSAF) from an online survey or in-person Peer Resilience Champion support (PRC) reduced emotional exhaustion among hospital workers during the COVID-19 pandemic. METHOD Among a single cohort of participating staff from one hospital organization, each intervention was evaluated against a control condition with repeated measures of emotional exhaustion at quarterly intervals for 18 months. PSAF was tested in a randomized controlled trial compared to a no-feedback condition. PRC was tested in a group-randomized stepped-wedge design, comparing individual-level emotional exhaustion before and after availability of the intervention. Main and interactive effects on emotional exhaustion were tested in a linear mixed model. RESULTS Among 538 staff, there was a small but significant beneficial effect of PSAF over time (p = .01); the difference at individual timepoints was only significant at timepoint three (month six). The effect of PRC over time was non-significant with a trend in the opposite direction to a treatment effect (p = .06). CONCLUSIONS In a longitudinal assessment, automated feedback about psychological characteristics buffered emotional exhaustion significantly at six months, whereas in-person peer support did not. Providing automated feedback is not resource-intensive and merits further investigation as a method of support.
Collapse
Affiliation(s)
| | - Alex Kiss
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Canada
| | | | | | | | | | | | - Lianne Jeffs
- Lunenfeld-Tannenbaum Research Institute, Sinai Health, Canada
| | - Allison McGeer
- Microbiology and Lunenfeld-Tannenbaum Research Institute, Sinai Health, Canada
| | - Kyla Lee
- Psychiatry, Sinai Health, Canada
| | | | - Leanne Ginty
- Nursing Education and Academic Affairs, Sinai Health, Canada
| | | | | |
Collapse
|
12
|
MacFadden DR, Maxwell C, Bowdish D, Bronskill S, Brooks J, Brown K, Burrows LL, Clarke A, Langford B, Leung E, Leung V, Manuel D, McGeer A, Mishra S, Morris AM, Nott C, Raybardhan S, Sapin M, Schwartz KL, So M, Soucy JPR, Daneman N. Coronavirus Disease 2019 Vaccination Is Associated With Reduced Outpatient Antibiotic Prescribing in Older Adults With Confirmed Severe Acute Respiratory Syndrome Coronavirus 2: A Population-Wide Cohort Study. Clin Infect Dis 2023; 77:362-370. [PMID: 36999314 PMCID: PMC10425187 DOI: 10.1093/cid/ciad190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/23/2023] [Accepted: 03/29/2023] [Indexed: 04/01/2023] Open
Abstract
BACKGROUND Antibiotics are frequently prescribed unnecessarily in outpatients with coronavirus disease 2019 (COVID-19). We sought to evaluate factors associated with antibiotic prescribing in outpatients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. METHODS We performed a population-wide cohort study of outpatients aged ≥66 years with polymerase chain reaction-confirmed SARS-CoV-2 from 1 January 2020 to 31 December 2021 in Ontario, Canada. We determined rates of antibiotic prescribing within 1 week before (prediagnosis) and 1 week after (postdiagnosis) reporting of the positive SARS-CoV-2 result, compared to a self-controlled period (baseline). We evaluated predictors of prescribing, including a primary-series COVID-19 vaccination, in univariate and multivariable analyses. RESULTS We identified 13 529 eligible nursing home residents and 50 885 eligible community-dwelling adults with SARS-CoV-2 infection. Of the nursing home and community residents, 3020 (22%) and 6372 (13%), respectively, received at least 1 antibiotic prescription within 1 week of a SARS-CoV-2 positive result. Antibiotic prescribing in nursing home and community residents occurred, respectively, at 15.0 and 10.5 prescriptions per 1000 person-days prediagnosis and 20.9 and 9.8 per 1000 person-days postdiagnosis, higher than the baseline rates of 4.3 and 2.5 prescriptions per 1000 person-days. COVID-19 vaccination was associated with reduced prescribing in nursing home and community residents, with adjusted postdiagnosis incidence rate ratios (95% confidence interval) of 0.7 (0.4-1) and 0.3 (0.3-0.4), respectively. CONCLUSIONS Antibiotic prescribing was high and with little or no decline following SARS-CoV-2 diagnosis but was reduced in COVID-19-vaccinated individuals, highlighting the importance of vaccination and antibiotic stewardship in older adults with COVID-19.
Collapse
Affiliation(s)
- Derek R MacFadden
- Clinical Epidemiology Program, The Ottawa Hospital Research Institute, Ottawa, Canada
- ICES, Toronto, Canada
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Colleen Maxwell
- ICES, Toronto, Canada
- Schools of Pharmacy and Public Health Sciences, University of Waterloo, Waterloo, Canada
| | - Dawn Bowdish
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - James Brooks
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Kevin Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Lori L Burrows
- Faculty of Health Sciences, McMaster University, Hamilton, Canada
| | | | - Bradley Langford
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
| | - Elizabeth Leung
- Unity Health Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Canada
- Michael Garron Hospital, Toronto East Health Network, Toronto, Canada
| | | | | | - Sharmistha Mishra
- ICES, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada
- Institute of Medical Science, University of Toronto, Toronto, Canada
| | | | - Caroline Nott
- Division of Infectious Diseases, The Ottawa Hospital, Ottawa, Canada
| | - Sumit Raybardhan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Pharmacy Department, North York General Hospital, Toronto, Canada
| | - Mia Sapin
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
| | - Kevin L Schwartz
- ICES, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Public Health Ontario, Toronto, Canada
- Unity Health Toronto, Toronto, Canada
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- Toronto General Hospital Research Institute, Toronto, Canada
| | - Jean-Paul R Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Nick Daneman
- ICES, Toronto, Canada
- Division of Infectious Diseases, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| |
Collapse
|
13
|
Mitchell R, Lee D, Pelude L, Comeau J, Conly J, Ellis C, Ellison J, Embil J, Evans G, Johnston L, Johnstone J, Katz K, Kibsey P, Lee B, Lefebvre MA, Longtin Y, McGeer A, Mertz D, Minion J, Smith S, Srigley J, Suh K, Tomlinson J, Wong A, Thampi N, Frenette C. Nirmatrelvir-ritonavir use among adults hospitalized with COVID-19 during the Omicron phase of the COVID-19 pandemic, Canadian Nosocomial Infection Surveillance Program. Can Commun Dis Rep 2023; 49:351-357. [PMID: 38455882 PMCID: PMC10917417 DOI: 10.14745/ccdr.v49i78a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Abstract
Background Recent studies have demonstrated the effectiveness of nirmatrelvir-ritonavir in reducing the risk of progression to severe disease among outpatients with mild to moderate coronavirus disease 2019 (COVID-19); however, data are limited regarding the use and role of nirmatrelvir-ritonavir among hospitalized patients. This study describes the use and outcomes of nirmatrelvir-ritonavir among adults hospitalized with COVID-19 in a sentinel network of Canadian acute care hospitals during the Omicron variant phase of the pandemic. Methods The Canadian Nosocomial Infection Surveillance Program conducts surveillance of hospitalized patients with COVID-19 in acute care hospitals across Canada. Demographic, clinical, treatment and 30-day outcome data were collected by chart review by trained infection control professionals using standardized questionnaires. Results From January 1 to December 31, 2022, 13% (n=490/3,731) of adult patients (18 years of age and older) hospitalized with COVID-19 in 40 acute care hospitals received nirmatrelvir-ritonavir either at admission or during hospitalization. Most inpatients who received nirmatrelvir-ritonavir, 79% of whom were fully vaccinated, had at least one pre-existing comorbidity (97%) and were of advanced age (median=79 years). Few were admitted to an intensive care unit (2.3%) and among the 490 nirmatrelvir-ritonavir treated inpatients, there were 13 (2.7%) deaths attributable to COVID-19. Conclusion These findings from a large sentinel network of Canadian acute-care hospitals suggest that nirmatrelvir-ritonavir is being used to treat adult COVID-19 patients at admission who are at risk of progression to severe disease or those who acquired COVID-19 in hospital. Additional research on the efficacy and indications for nirmatrelvir-ritonavir use in hospitalized patients is warranted to inform future policies and guidelines.
Collapse
Affiliation(s)
| | - Diane Lee
- Public Health Agency of Canada, Ottawa, ON
| | | | | | | | | | | | | | | | | | | | - Kevin Katz
- North York General Hospital, Toronto, ON
| | | | - Bonita Lee
- Stollery Children’s Hospital, Edmonton, AB
| | | | | | | | - Dominik Mertz
- McMaster University and Hamilton Health Sciences, Hamilton, ON
| | | | | | | | | | | | - Alice Wong
- Royal University Hospital, Saskatoon, SK
| | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, ON
| | | |
Collapse
|
14
|
Kahlert CR, Strahm C, Güsewell S, Cusini A, Brucher A, Goppel S, Möller E, Möller JC, Ortner M, Ruetti M, Stocker R, Vuichard-Gysin D, Besold U, McGeer A, Risch L, Friedl A, Schlegel M, Vernazza P, Kuster SP, Kohler P. Post-Acute Sequelae After Severe Acute Respiratory Syndrome Coronavirus 2 Infection by Viral Variant and Vaccination Status: A Multicenter Cross-Sectional Study. Clin Infect Dis 2023; 77:194-202. [PMID: 36905145 PMCID: PMC10371307 DOI: 10.1093/cid/ciad143] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Disentangling the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants and vaccination on the occurrence of post-acute sequelae of SARS-CoV-2 (PASC) is crucial to estimate and reduce the burden of PASC. METHODS We performed a cross-sectional analysis (May/June 2022) within a prospective multicenter healthcare worker (HCW) cohort in north-eastern Switzerland. HCWs were stratified by viral variant and vaccination status at time of their first positive SARS-CoV-2 nasopharyngeal swab. HCWs without positive swab and with negative serology served as controls. The sum of 18 self-reported PASC symptoms was modeled with univariable and multivariable negative-binomial regression to analyze the association of mean symptom number with viral variant and vaccination status. RESULTS Among 2912 participants (median age: 44 years; 81.3% female), PASC symptoms were significantly more frequent after wild-type infection (estimated mean symptom number: 1.12; P < .001; median time since infection: 18.3 months), after Alpha/Delta infection (0.67 symptoms; P < .001; 6.5 months), and after Omicron BA.1 infections (0.52 symptoms; P = .005; 3.1 months) versus uninfected controls (0.39 symptoms). After Omicron BA.1 infection, the estimated mean symptom number was 0.36 for unvaccinated individuals versus 0.71 with 1-2 vaccinations (P = .028) and 0.49 with ≥3 prior vaccinations (P = .30). Adjusting for confounders, only wild-type (adjusted rate ratio [aRR]: 2.81; 95% confidence interval [CI]: 2.08-3.83) and Alpha/Delta infections (aRR: 1.93; 95% CI: 1.10-3.46) were significantly associated with the outcome. CONCLUSIONS Previous infection with pre-Omicron variants was the strongest risk factor for PASC symptoms among our HCWs. Vaccination before Omicron BA.1 infection was not associated with a clear protective effect against PASC symptoms in this population.
Collapse
Affiliation(s)
- Christian R Kahlert
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
- Department of Infectious Diseases and Hospital Epidemiology, Children’s Hospital of Eastern Switzerland, St. Gallen, Switzerland
| | - Carol Strahm
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Sabine Güsewell
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Alexia Cusini
- Division of Infectious Diseases, Cantonal Hospital of Grisons, Chur, Switzerland
| | - Angela Brucher
- Ambulatory Services, Psychiatry Services of the Canton of St. Gallen (South), St. Gallen, Switzerland
| | - Stephan Goppel
- Ambulatory Services, Psychiatry Services of the Canton of St. Gallen (North), St. Gallen, Switzerland
| | - Elisabeth Möller
- Department of Psychiatry, Clienia Littenheid, Littenheid, Switzerland
| | - J Carsten Möller
- Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | - Manuela Ortner
- Rheintal Werdenberg Sarganserland Hospital Group, Grabs, Switzerland
| | - Markus Ruetti
- Fuerstenland Toggenburg Hospital Group, Wil, Switzerland
| | | | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen, Switzerland
- Department of Research and Development, Swiss National Centre for Infection Prevention (Swissnoso), Berne, Switzerland
| | - Ulrike Besold
- Geriatric Clinic St. Gallen, St. Gallen, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Baden, Baden, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St. Gallen, Switzerland
| |
Collapse
|
15
|
Morgan G, Briollais L, Clausen M, Casalino S, Mighton C, Chowdhary S, Frangione E, Yiu Jordan Fung C, Arnoldo S, Bearss E, Binnie A, Borgundvaag B, Dagher M, Devine L, Friedman SM, Khan Z, McGeer A, McLeod SL, Richardson D, Stern S, Taher A, Wong I, Zarei N, Bombard Y, Lerner-Ellis J, Taher J. Public knowledge of SARS-CoV-2 serological and viral lineage laboratory testing and result interpretation: A GENCOV study cross-sectional survey. Clin Biochem 2023:110607. [PMID: 37406717 DOI: 10.1016/j.clinbiochem.2023.110607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 06/27/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
OBJECTIVES Concepts related to SARS-CoV-2 laboratory testing and result interpretation can be challenging to understand. A cross-sectional survey of COVID-19 positive adults residing in Ontario, Canada was conducted to explore how well people understand SARS-CoV-2 laboratory tests and their associated results. DESIGN AND METHODS Participants were recruited through fliers or by prospective recruitment of outpatients and hospitalized inpatients with COVID-19. Enrolled participants included consenting adults with a positive SARS-CoV-2 polymerase chain reaction test result. An 11-item questionnaire was developed by researchers, nurses, and physicians in the study team and was administered online between April 2021 to May 2022 upon enrolment into the study. RESULTS Responses were obtained from 940 of 1106 eligible participants (85% participation rate). Most respondents understood 1) that antibody results should not influence adherence to social distancing measures (n=602/888, 68%), 2) asymptomatic SARS-CoV-2 infection following test positivity (n=698/888, 79%), 3) serological test sensitivity in relation to post-infection timeline (n=540/891, 61%), and 4) limitations of experts' knowledge related to SARS-CoV-2 serology (n=693/887, 78%). Conversely, respondents demonstrated challenges understanding 1) conflicting molecular and serological test results and their relationship with immune protection (n=162/893, 18%) and 2) the impact of SARS-CoV-2 variants on vaccine effectiveness (n=235/891, 26%). Analysis of responses stratified by sociodemographic variables identified that respondents who were either: 1) female, 2) more educated, 3) aged 18-44, 4) from a high-income household, or 5) healthcare workers responded expectedly more often. CONCLUSIONS We have highlighted concepts related to SARS-CoV-2 laboratory tests and associated results which may be challenging to understand. The findings of this study enable us to identify 1) misconceptions related to various SARS-CoV-2 test results, 2) groups of individuals at risk, and 3) strategies to improve people's understanding of their test results.
Collapse
Affiliation(s)
- Gregory Morgan
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Marc Clausen
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Selina Casalino
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Chloe Mighton
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Sunakshi Chowdhary
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Erika Frangione
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Chun Yiu Jordan Fung
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Saranya Arnoldo
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; William Osler Health System, Brampton, ON, Canada
| | - Erin Bearss
- Mount Sinai Academic Family Health Team, Mount Sinai Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | | | - Bjug Borgundvaag
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Department of Emergency Medicine, Mount Sinai Hospital, Toronto, ON, Canada
| | - Marc Dagher
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Women's College Hospital, Toronto, ON, Canada
| | - Luke Devine
- Division of General Internal Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven M Friedman
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Emergency Medicine, University Health Network, Toronto, ON, Canada
| | | | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, ON, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Shelley L McLeod
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada; Schwartz/Reisman Emergency Medicine Institute, Sinai Health System, Toronto, ON, Canada
| | | | - Seth Stern
- Mackenzie Health, Richmond Hill, ON, Canada
| | - Ahmed Taher
- Mackenzie Health, Richmond Hill, ON, Canada; Division of Emergency Medicine, University of Toronto, Toronto, ON, Canada
| | - Iris Wong
- Mackenzie Health, Richmond Hill, ON, Canada
| | | | - Yvonne Bombard
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Jordan Lerner-Ellis
- Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada; Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Jennifer Taher
- Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, ON, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
| |
Collapse
|
16
|
Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove DM, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Russell JA. Outcomes and characteristics of patients hospitalized for COVID-19 in British Columbia, Ontario and Quebec during the Omicron wave. CMAJ Open 2023; 11:E672-E683. [PMID: 37527902 PMCID: PMC10400083 DOI: 10.9778/cmajo.20220194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/03/2023] Open
Abstract
BACKGROUND Omicron is the current predominant variant of concern of SARS-CoV-2. We hypothesized that vaccination alters outcomes of patients hospitalized with COVID-19 during the Omicron wave and that these patients have different characteristics and outcomes than in previous waves. METHODS This is a substudy of the Host Response Mediators in Coronavirus (COVID-19) Infection (ARBs CORONA I) trial, which included adults admitted to hospital with acute COVID-19 up to July 2022 from 9 hospitals in British Columbia, Ontario and Quebec. We excluded emergency department visits without hospital admission, readmissions and admissions for another reason. Using adjusted regression analysis, we compared mortality and organ dysfunction between vaccinated (≥ 2 doses) and unvaccinated patients during the Omicron wave, as well as between all patients in the Omicron and first 3 waves of the COVID-19 pandemic. RESULTS During the Omicron wave, 28-day mortality was significantly lower in vaccinated (n = 19/237) than unvaccinated hospitalized patients (n = 12/127) (adjusted odds ratio [OR] 0.36, 95% confidence interval [CI] 0.15-0.89); vaccinated patients had lower risk of admission to the intensive care unit, invasive ventilation and acute respiratory distress syndrome and shorter hospital length of stay. Patients hospitalized during the Omicron wave had more comorbidities than in previous waves, and lower 28-day mortality than in waves 1 and 2 (adjusted OR 0.38, 95% CI 0.24-0.59; and 0.42, 95% CI 0.26-0.65) but not wave 3 (adjusted OR 0.81, 95% CI 0.43-1.51) and had less organ dysfunction than in the first 2 waves. INTERPRETATION Patients who were at least double vaccinated had lower mortality than unvaccinated patients hospitalized during the Omicron wave. Patients hospitalized during the Omicron wave had more chronic disease and lower mortality than in the first 2 waves, but not wave 3. Changes in vaccination, treatments and predominant SARS-CoV-2 variant may have decreased mortality in patients hospitalized during the Omicron wave.
Collapse
Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Francois Lamontagne
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David M Maslove
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Science, St. Paul's Hospital, University of British Columbia (Lee, Singer), Vancouver, BC; Division of Infectious Diseases, Department of Medicine (Cheng, Vinh, Lee), McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine, Vancouver General Hospital; University of British Columbia (Tran), Vancouver, BC; Departments of Critical Care Medicine, Medicine and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary, Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; University of British Columbia; Centre for Heart Lung Innovation (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia (Boyd, Walley, Russell), Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mt. Sinai Hospital and University of Toronto (McGeer), Toronto, Ont.; University of Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care, Kingston General Hospital and Queen's University (Maslove), Kingston, Ont.; British Columbia Centre for Disease Control and University of British Columbia (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology, Department of Medicine (Burns), Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital and University of British Columbia (Murthy), Vancouver, BC; Black Tusk Research Group (Mann, Hernandez, Donohoe), Vancouver, BC
| |
Collapse
|
17
|
ElSherif M, Andrew MK, Ye L, Ambrose A, Boivin G, Bowie W, David MP, Gruselle O, Halperin SA, Hatchette TF, Johnstone J, Katz K, Langley JM, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Pirçon JY, Powis J, Richardson D, Semret M, Smith S, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA, LeBlanc JJ. Leveraging Influenza Virus Surveillance From 2012 to 2015 to Characterize the Burden of Respiratory Syncytial Virus Disease in Canadian Adults ≥50 Years of Age Hospitalized With Acute Respiratory Illness. Open Forum Infect Dis 2023; 10:ofad315. [PMID: 37441353 PMCID: PMC10334379 DOI: 10.1093/ofid/ofad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8-12 per 100 000 population in adults aged 50-59 years to 174-487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.
Collapse
Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Andre Poirier
- Centre intégré universitaire de santé et services sociaux de la Mauricie et du Centre du Québec, Québec City, Québec, Canada
| | | | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Sylvie Trottier
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | | | - Duncan Webster
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
| | - Jason J LeBlanc
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
| | | |
Collapse
|
18
|
Kohler P, Babouee Flury B, Güsewell S, Egger T, Leal O, Brucher A, Lemmenmeier E, Meier Kleeb D, Möller JC, Ortner M, Rieder P, Ruetti M, Schmid H, Stocker R, Vuichard‐Gysin D, Speer O, Wiggli B, Besold U, McGeer A, Risch L, Friedl A, Schlegel M, Vernazza P, Kahlert CR, Kuster SP. Clinical symptoms of SARS-CoV-2 breakthrough infection during the Omicron period in relation to baseline immune status and booster vaccination-A prospective multicentre cohort of health professionals (SURPRISE study). Influenza Other Respir Viruses 2023; 17:e13167. [PMID: 37346094 PMCID: PMC10279996 DOI: 10.1111/irv.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 05/22/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
The effects of different types of pre-existing immunity on the frequency of clinical symptoms caused by the SARS-CoV-2 breakthrough infection were prospectively assessed in healthcare workers during the Omicron period. Among 518 participants, hybrid immunity was associated with symptom reduction for dizziness, muscle or limb pain and headache as compared to vaccination only. Moreover, the frequencies of dizziness, cough and muscle or limb pain were lower in participants who had received a booster vaccine dose. Thus, hybrid immunity appeared to be superior in preventing specific symptoms during breakthrough infection compared to vaccination alone. A booster vaccine dose conferred additional symptom reduction.
Collapse
Affiliation(s)
- Philipp Kohler
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Baharak Babouee Flury
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Sabine Güsewell
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Onicio Leal
- EpitrackRecifeBrazil
- Department of EconomicsUniversity of ZurichZurichSwitzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St. Gallen (South)PfäfersSwitzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and PsychotherapyLittenheidSwitzerland
| | | | | | - Manuela Ortner
- Rheintal Werdenberg Sarganserland Hospital GroupGrabsSwitzerland
| | | | - Markus Ruetti
- Fuerstenland Toggenburg Hospital GroupWilSwitzerland
| | | | | | - Danielle Vuichard‐Gysin
- Division of Infectious Diseases and Hospital EpidemiologyThurgau Hospital GroupMuensterlingenSwitzerland
| | - Oliver Speer
- Thurgau Hospital GroupInstitute for Laboratory MedicineMuensterlingenSwitzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital EpidemiologyKantonsspital BadenBadenSwitzerland
| | | | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AGBuchsSwitzerland
- Private Universität im Fürstentum LiechtensteinTriesenLiechtenstein
- Center of Laboratory MedicineUniversity Institute of Clinical Chemistry, University of Bern, InselspitalBernSwitzerland
| | - Andrée Friedl
- Thurgau Hospital GroupInstitute for Laboratory MedicineMuensterlingenSwitzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | - Christian R. Kahlert
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
- Department of Infectious Diseases and Hospital EpidemiologyChildren's Hospital of Eastern SwitzerlandSt. GallenSwitzerland
| | - Stefan P. Kuster
- Division of Infectious Diseases and Hospital EpidemiologyCantonal Hospital St GallenSt GallenSwitzerland
| | | |
Collapse
|
19
|
Golden AR, Adam HJ, Karlowsky JA, Baxter M, Schellenberg J, Martin I, Demczuk W, Minion J, Van Caeseele P, Kus JV, McGeer A, Lefebvre B, Smadi H, Haldane D, Yu Y, Mead K, Mulvey MR, Zhanel GG. Genomic investigation of the most common Streptococcus pneumoniae serotypes causing invasive infections in Canada: the SAVE study, 2011-2020. J Antimicrob Chemother 2023; 78:i26-i36. [PMID: 37130587 DOI: 10.1093/jac/dkad067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
OBJECTIVES To investigate the lineages and genomic antimicrobial resistance (AMR) determinants of the 10 most common pneumococcal serotypes identified in Canada during the five most recent years of the SAVE study, in the context of the 10-year post-PCV13 period in Canada. METHODS The 10 most common invasive Streptococcus pneumoniae serotypes collected by the SAVE study from 2016 to 2020 were 3, 22F, 9N, 8, 4, 12F, 19A, 33F, 23A and 15A. A random sample comprising ∼5% of each of these serotypes collected during each year of the full SAVE study (2011-2020) were selected for whole-genome sequencing (WGS) using the Illumina NextSeq platform. Phylogenomic analysis was performed using the SNVPhyl pipeline. WGS data were used to identify virulence genes of interest, sequence types, global pneumococcal sequence clusters (GPSC) and AMR determinants. RESULTS Of the 10 serotypes analysed in this study, six increased significantly in prevalence from 2011 to 2020: 3, 4, 8, 9N, 23A and 33F (P ≤ 0.0201). Serotypes 12F and 15A remained stable in prevalence over time, while serotype 19A decreased in prevalence (P < 0.0001). The investigated serotypes represented four of the most prevalent international lineages causing non-vaccine serotype pneumococcal disease in the PCV13 era: GPSC3 (serotypes 8/33F), GPSC19 (22F), GPSC5 (23A) and GPSC26 (12F). Of these lineages, GPSC5 isolates were found to consistently possess the most AMR determinants. Commonly collected vaccine serotypes 3 and 4 were associated with GPSC12 and GPSC27, respectively. However, a more recently collected lineage of serotype 4 (GPSC192) was highly clonal and possessed AMR determinants. CONCLUSIONS Continued genomic surveillance of S. pneumoniae in Canada is essential to monitor for the appearance of new and evolving lineages, including antimicrobial-resistant GPSC5 and GPSC162.
Collapse
Affiliation(s)
- Alyssa R Golden
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Heather J Adam
- Clinical Microbiology, Shared Health, MS673-820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| | - James A Karlowsky
- Clinical Microbiology, Shared Health, MS673-820 Sherbrook Street, Winnipeg, Manitoba, R3A 1R9, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Melanie Baxter
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| | - John Schellenberg
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
| | - Jessica Minion
- Roy Romanow Provincial Laboratory, Saskatchewan Health Authority, 5 Research Drive, Regina, Saskatchewan, S4S 0A4, Canada
| | - Paul Van Caeseele
- Cadham Provincial Laboratory, Shared Health, 750 William Avenue, Winnipeg, Manitoba, R3E 3J7, Canada
| | - Julianne V Kus
- Public Health Ontario Laboratory, 661 University Avenue, Toronto, Ontario, M5G 1M1, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle-6th Floor, Toronto, Ontario, M5S 1A8, Canada
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital. 600 University Avenue-Suite 171, Toronto, Ontario, M5G 1X5, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, 20045 Ch Ste-Marie, Ste-Anne-de-Bellevue, Québec, H9X 3R5, Canada
| | - Hanan Smadi
- Epidemiology and Surveillance Branch, New Brunswick Department of Health, 520 King Street, Fredericton, New Brunswick, E3B 5G8, Canada
| | - David Haldane
- Department of Pathology and Laboratory Medicine, Queen Elizabeth II Health Science Centre, 1276 South Park Street, Halifax, Nova Scotia, B3H 2Y9, Canada
| | - Yang Yu
- Newfoundland and Labrador Public Health Laboratory, Dr. Leonard A. Miller Centre-Suite 1, 100 Forest Road, St. John's, Newfoundland and Labrador, A1A 1E3, Canada
| | - Kristen Mead
- Provincial Laboratory Services, Queen Elizabeth Hospital, 60 Riverside Drive, Charlottetown, Prince Edward Island, C1A 8T5, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, R3E 3R2, Canada
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, University of Manitoba, Room 543-745 Bannatyne Avenue, Winnipeg, Manitoba, R3E 0J9, Canada
| |
Collapse
|
20
|
Rudnick W, Conly J, Thirion DJG, Choi K, Pelude L, Cayen J, Bautista J, Beique L, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, Happe J, Katz K, Kibsey P, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, McKenna S, Neville HL, Slayter K, Suh KN, Tse-Chang A, Weiss K, Science M. Antimicrobial use among paediatric inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program, 2017/2018. Antimicrob Resist Infect Control 2023; 12:35. [PMID: 37072874 PMCID: PMC10111695 DOI: 10.1186/s13756-023-01219-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 02/16/2023] [Indexed: 04/20/2023] Open
Abstract
BACKGROUND Antimicrobial resistance threatens the ability to successfully prevent and treat infections. While hospital benchmarks regarding antimicrobial use (AMU) have been well documented among adult populations, there is less information from among paediatric inpatients. This study presents benchmark rates of antimicrobial use (AMU) for paediatric inpatients in nine Canadian acute-care hospitals. METHODS Acute-care hospitals participating in the Canadian Nosocomial Infection Surveillance Program submitted annual AMU data from paediatric inpatients from 2017 and 2018. All systemic antimicrobials were included. Data were available for neonatal intensive care units (NICUs), pediatric ICUs (PICUs), and non-ICU wards. Data were analyzed using days of therapy (DOT) per 1000 patient days (DOT/1000pd). RESULTS Nine hospitals provided paediatric AMU data. Data from seven NICU and PICU wards were included. Overall AMU was 481 (95% CI 409-554) DOT/1000pd. There was high variability in AMU between hospitals. AMU was higher on PICU wards (784 DOT/1000pd) than on non-ICU (494 DOT/1000pd) or NICU wards (333 DOT/1000pd). On non-ICU wards, the antimicrobials with the highest use were cefazolin (66 DOT/1000pd), ceftriaxone (59 DOT/1000pd) and piperacillin-tazobactam (48 DOT/1000pd). On PICU wards, the antimicrobials with the highest use were ceftriaxone (115 DOT/1000pd), piperacillin-tazobactam (115 DOT/1000pd), and cefazolin (111 DOT/1000pd). On NICU wards, the antimicrobials with the highest use were ampicillin (102 DOT/1000pd), gentamicin/tobramycin (78 DOT/1000pd), and cefotaxime (38 DOT/1000pd). CONCLUSIONS This study represents the largest collection of antimicrobial use data among hospitalized paediatric inpatients in Canada to date. In 2017/2018, overall AMU was 481 DOT/1000pd. National surveillance of AMU among paediatric inpatients is necessary for establishing benchmarks and informing antimicrobial stewardship efforts.
Collapse
Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Conly
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
- Foothills Medical Centre, Alberta Health Services, 3330 Hospital Dr. NW, Calgary, AB, T2N 2T9, Canada
| | - Daniel J G Thirion
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC, H3T 1J4, Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Kelly Choi
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Linda Pelude
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - Joelle Cayen
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | - John Bautista
- Central Newfoundland Regional Health Centre, 50 Union, Grand Falls-Windsor, NL, A2A 2E1, Canada
| | - Lizanne Beique
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON, K2E 7L9, Canada
| | | | - Bruce Dalton
- Alberta Health Services, 1620 29 St NW, Calgary, AB, T2N 4L7, Canada
| | - Johan Delport
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
| | - Rita Dhami
- London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada
- University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
- University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada
| | - Joanne Embree
- University of Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Shared Health Manitoba, Winnipeg, MB, R3T 2N2, Canada
- Children's Hospital Winnipeg, 840 Sherbrook St, Winnipeg, MB, R3E 0Z3, Canada
| | - Yannick Émond
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l'Assomption, Montréal, QC, H1T 2M4, Canada
| | - Gerald Evans
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Charles Frenette
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Susan Fryters
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB, T5H 3V9, Canada
| | - Jennifer Happe
- Infection Prevention and Control Canada, Red Deer, AB, T4N 6R2, Canada
| | - Kevin Katz
- North York General Hospital, 4001 Leslie St, North York, ON, M2K 1E1, Canada
| | - Pamela Kibsey
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC, V8R 1J8, Canada
| | - Joanne M Langley
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
- Dalhousie University, 6299 South St, Halifax, NS, B3H 4R2, Canada
| | - Bonita E Lee
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Marie-Astrid Lefebvre
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC, H4A 3J1, Canada
| | - Jerome A Leis
- Department of Medicine, University of Toronto, 1 King's College Cir, Toronto, ON, M5S 1A8, Canada
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON, M4N 3M5, Canada
| | - Allison McGeer
- Sinai Health System, 600 University Ave, Toronto, ON, M5G 1X5, Canada
- University of Toronto, 27 King's College Cir, Toronto, ON, M5S 1A1, Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, M5T 3M7, Canada
| | - Susan McKenna
- Kingston Health Sciences Centre, 76 Stuart St, Kingston, ON, K7L 2V7, Canada
| | - Heather L Neville
- Nova Scotia Health, 1276 South Park St, Halifax, NS, B3H 2Y9, Canada
| | - Kathryn Slayter
- IWK Health Centre, 5980 University Ave, Halifax, NS, B3K 6R8, Canada
| | - Kathryn N Suh
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON, K1H 8L6, Canada
| | - Alena Tse-Chang
- Stollery Children's Hospital, Edmonton, AB, T6G 2B7, Canada
- University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Karl Weiss
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1E2, Canada
| | | |
Collapse
|
21
|
Mitchell R, Cayen J, Thampi N, Frenette C, Bartoskzo J, Choi KB, Comeau JL, Conly J, Ellis C, Ellison J, Embil J, Evans G, Johnston L, Johnstone J, Katz KC, Kibsey P, Lee B, Lefebvre MA, Longtin Y, McGeer A, Mertz D, Minion J, Rudnick W, Silva A, Smith SW, Srigley JA, Suh KN, Tomlinson J, Wong A, Pelude L. Trends in Severe Outcomes Among Adult and Pediatric Patients Hospitalized With COVID-19 in the Canadian Nosocomial Infection Surveillance Program, March 2020 to May 2022. JAMA Netw Open 2023; 6:e239050. [PMID: 37079304 PMCID: PMC10119741 DOI: 10.1001/jamanetworkopen.2023.9050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
Importance Trends in COVID-19 severe outcomes have significant implications for the health care system and are key to informing public health measures. However, data summarizing trends in severe outcomes among patients hospitalized with COVID-19 in Canada are not well described. Objective To describe trends in severe outcomes among patients hospitalized with COVID-19 during the first 2 years of the COVID-19 pandemic. Design, Setting, and Participants Active prospective surveillance in this cohort study was conducted from March 15, 2020, to May 28, 2022, at a sentinel network of 155 acute care hospitals across Canada. Participants included adult (aged ≥18 years) and pediatric (aged 0-17 years) patients hospitalized with laboratory-confirmed COVID-19 at a Canadian Nosocomial Infection Surveillance Program (CNISP)-participating hospital. Exposures COVID-19 waves, COVID-19 vaccination status, and age group. Main Outcomes and Measures The CNISP collected weekly aggregate data on the following severe outcomes: hospitalization, admission to an intensive care unit (ICU), receipt of mechanical ventilation, receipt of extracorporeal membrane oxygenation, and all-cause in-hospital death. Results Among 1 513 065 admissions, the proportion of adult (n = 51 679) and pediatric (n = 4035) patients hospitalized with laboratory-confirmed COVID-19 was highest in waves 5 and 6 of the pandemic compared with waves 1 to 4 (77.3 vs 24.7 per 1000 patient admissions). Despite this, the proportion of patients with positive test results for COVID-19 who were admitted to an ICU, received mechanical ventilation, received extracorporeal membrane oxygenation, and died were each significantly lower in waves 5 and 6 when compared with waves 1 through 4. Admission to the ICU and in-hospital all-cause death rates were significantly higher among those who were unvaccinated against COVID-19 when compared with those who were fully vaccinated (incidence rate ratio, 4.3 and 3.9, respectively) or fully vaccinated with an additional dose (incidence rate ratio, 12.2 and 15.1, respectively). Conclusions and Relevance The findings of this cohort study of patients hospitalized with laboratory-confirmed COVID-19 suggest that COVID-19 vaccination is important to reduce the burden on the Canadian health care system as well as severe outcomes associated with COVID-19.
Collapse
Affiliation(s)
- Robyn Mitchell
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Joelle Cayen
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Nisha Thampi
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Frenette
- Division of Infectious Diseases, Department of Medicine, McGill University Health Centre, Montréal, Québec, Canada
| | - Jessica Bartoskzo
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Kelly Baekyung Choi
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Jeannette L Comeau
- Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Conly
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Chelsey Ellis
- Department of Laboratory Medicine, The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Jennifer Ellison
- Infection, Prevention and Control, Alberta Health Services, Calgary, Alberta, Canada
| | - John Embil
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Gerald Evans
- Division of Infectious Diseases, Queen's University, Kingston, Ontario, Canada
| | - Lynn Johnston
- Division of Infectious Diseases, Department of Medicine, Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - Jennie Johnstone
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Kevin C Katz
- Infection Prevention and Control, North York General Hospital, Toronto, Ontario, Canada
| | - Pamela Kibsey
- Department of Pathology and Laboratory Medicine, Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Bonita Lee
- Department of Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
| | - Marie-Astrid Lefebvre
- Montreal Children's Hospital, McGill University Health Centre, Montréal, Québec, Canada
| | - Yves Longtin
- Infection Prevention and Control, SMBD Jewish General Hospital, Montréal, Québec, Canada
| | - Allison McGeer
- Infection Prevention and Control, Sinai Health, Toronto, Ontario, Canada
| | - Dominik Mertz
- Division of Infectious Diseases, Department of Medicine, McMaster University and Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Jessica Minion
- Department of Laboratory Medicine, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Wallis Rudnick
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Anada Silva
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Stephanie W Smith
- Faculty of Medicine, University of Alberta Hospital, Edmonton, Alberta, Canada
| | - Jocelyn A Srigley
- Infection Prevention and Control, BC Women's and BC Children's Hospital, Vancouver, British Columbia, Canada
| | - Kathryn N Suh
- Infection Prevention and Control, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Jen Tomlinson
- Infection Prevention and Control, Health Sciences Centre, Winnipeg, Manitoba, Canada
| | - Alice Wong
- Division of Infectious Diseases, Department of Medicine, Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | - Linda Pelude
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada
| |
Collapse
|
22
|
Walmsley SL, Szadkowski L, Wouters B, Clarke R, Colwill K, Rochon P, Brudno M, Ravindran R, Raboud J, McGeer A, Oza A, Graham C, Silva A, Manase D, Maksymowsky P, Parente L, Dayam RM, Simpson J, Pasculescu A, Gingras AC. COVID-19 Vaccine Antibody Responses in Community Dwelling Adults to 48 weeks Post Primary Vaccine Series. iScience 2023; 26:106506. [PMID: 37073374 PMCID: PMC10043971 DOI: 10.1016/j.isci.2023.106506] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/16/2023] [Accepted: 03/22/2023] [Indexed: 03/30/2023] Open
Abstract
We report a decentralized prospective cohort study of self-reported adverse events and antibody responses to COVID vaccines derived from dried blood spots. Data is presented for 911 older (aged >70 years) and 375 younger (30-50 years) recruits to 48 weeks after the primary vaccine series. After a single vaccine, 83% younger and 45% older participants had overall seropositivity (p<0.0001) increasing to 100/98% with the second dose respectively (p=0.084). A cancer diagnosis (p=.009), no mRNA1273 vaccine doses (p<.0001) and older age (p <.0001) predicted lower responses. Antibody levels declined in both cohorts at 12 and 24 weeks increasing with booster doses. At 48 weeks, for participants with 3 vaccine doses, the median antibody levels were higher in the older cohort (p=.04) with any dose of mRNA-1273 (p<.0001) and with COVID infection (p<.001). The vaccines were well tolerated. Breakthrough COVID infections were uncommon (16% older cohort, 29% younger cohort; p<0.0001) and mild.
Collapse
Affiliation(s)
- Sharon L. Walmsley
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
- Toronto General Hospital Research Institute, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
- Corresponding author
| | - Leah Szadkowski
- Biostatistics Research Unit, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Bradly Wouters
- Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Rosemarie Clarke
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Paula Rochon
- Women’s College Hospital Research Institute, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Michael Brudno
- Department of Computer Science, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Rizanni Ravindran
- Department of Medicine, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Janet Raboud
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Allison McGeer
- Department of Medicine, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Amit Oza
- Princess Margaret Cancer Center, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Christopher Graham
- Trillium Health Partners, Department of Medicine, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Amanda Silva
- Department of BioInformatics, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Dorin Manase
- Department of BioInformatics, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Peter Maksymowsky
- Department of BioInformatics, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Laura Parente
- Health Care Human Factors, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Roaya Monica Dayam
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Jacqueline Simpson
- Health Care Human Factors, University Health Network, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Adrian Pasculescu
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| |
Collapse
|
23
|
Bettinger JA, Irvine MA, Shulha HP, Valiquette L, Muller MP, Vanderkooi OG, Kellner JD, Top KA, Sadarangani M, McGeer A, Isenor JE, Marty K, Soe P, De Serres G. Adverse Events Following Immunization With mRNA and Viral Vector Vaccines in Individuals With Previous Severe Acute Respiratory Syndrome Coronavirus 2 Infection From the Canadian National Vaccine Safety Network. Clin Infect Dis 2023; 76:1088-1102. [PMID: 36310514 PMCID: PMC9620384 DOI: 10.1093/cid/ciac852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/17/2022] [Accepted: 10/26/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Adults previously infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) develop short-term immunity and may have increased reactogenicity to coronavirus disease 2019 (COVID-19) vaccines. This prospective, multicenter, active-surveillance cohort study examined the short-term safety of COVID-19 vaccines in adults with a prior history of SARS-CoV-2. METHODS Canadian adults vaccinated between 22 December 2020 and 27 November 2021 were sent an electronic questionnaire 7 days post-dose 1, dose 2, and dose 3 vaccination. The main outcome was health events occurring in the first 7 days after each vaccination that prevented daily activities, resulted in work absenteeism, or required a medical consultation, including hospitalization. RESULTS Among 684 998 vaccinated individuals, 2.6% (18 127/684 998) reported a prior history of SARS-CoV-2 infection a median of 4 (interquartile range: 2-6) months previously. After dose 1, individuals with moderate (bedridden) to severe (hospitalized) COVID-19 who received BNT162b2, mRNA-1273, or ChAdox1-S vaccines had higher odds of a health event preventing daily activities, resulting in work absenteeism or requiring medical consultation (adjusted odds ratio [95% confidence interval]: 3.96 [3.67-4.28] for BNT162b2, 5.01 [4.57-5.50] for mRNA-1273, and 1.84 [1.54-2.20] for ChAdox1-S compared with no infection). Following dose 2 and 3, the greater risk associated with previous infection was also present but was attenuated compared with dose 1. For all doses, the association was lower or absent after mild or asymptomatic infection. CONCLUSIONS Adults with moderate or severe previous SARS-CoV-2 infection were more likely to have a health event sufficient to impact routine activities or require medical assessment in the week following each vaccine dose.
Collapse
Affiliation(s)
- Julie A Bettinger
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | | | - Hennady P Shulha
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectious Diseases, Université de Sherbrooke, Sherbrooke, Canada
| | | | - Otto G Vanderkooi
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - James D Kellner
- Department of Pediatrics and Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Canada
| | - Karina A Top
- Canadian Center for Vaccinology, IWK Health and Department of Pediatrics, Dalhousie University, Halifax, Canada
| | - Manish Sadarangani
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, Canada
| | - Allison McGeer
- Sinai Health System and University of Toronto, Toronto, Canada
| | - Jennifer E Isenor
- College of Pharmacy and Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
| | - Kimberly Marty
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Phyumar Soe
- Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, Canada
| | - Gaston De Serres
- CHU de Québec-Université Laval, Quebec City, Canada
- Institut National de Santé Publique du Québec, Quebec City, Canada
| | | |
Collapse
|
24
|
Leece P, Whelan M, Costa AP, Daneman N, Johnstone J, McGeer A, Rochon P, Schwartz KL, Brown KA. Nursing home crowding and its association with outbreak-associated respiratory infection in Ontario, Canada before the COVID-19 pandemic (2014-19): a retrospective cohort study. Lancet Healthy Longev 2023; 4:e107-e114. [PMID: 36870336 PMCID: PMC9989831 DOI: 10.1016/s2666-7568(23)00018-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 03/05/2023] Open
Abstract
BACKGROUND Studies conducted during the COVID-19 pandemic have shown that crowding in nursing homes is associated with high incidence of SARS-CoV-2 infections, but this effect has not been shown for other respiratory pathogens. We aimed to measure the association between crowding in nursing homes and outbreak-associated respiratory infection incidence and related mortality before the COVID-19 pandemic. METHODS We conducted a retrospective cohort study of nursing homes in Ontario, Canada. We identified, characterised, and selected nursing homes through the Ontario Ministry of Long-Term Care datasets. Nursing homes that were not funded by the Ontario Ministry of Long-Term Care and homes that closed before January, 2020 were excluded. Outcomes consisting of respiratory infection outbreaks were obtained from the Integrated Public Health Information System of Ontario. The crowding index equalled the mean number of residents per bedroom and bathroom. The primary outcomes were the incidence of outbreak-associated infections and mortality per 100 nursing home residents per year. We examined the incidence of infections and deaths as a function of the crowding index by use of negative binomial regression with adjustment for three home characteristics (ie, ownership, number of beds, and region) and nine mean resident characteristics (ie, age, female sex, dementia, diabetes, chronic heart failure, renal failure, cancer, chronic obstructive pulmonary disease, and activities of daily living score). FINDINGS Between Sept 1, 2014, and Aug 31, 2019, 5107 respiratory infection outbreaks in 588 nursing homes were recorded, of which 4921 (96·4%), involving 64 829 cases of respiratory infection and 1969 deaths, were included in this analysis. Nursing homes with a high crowding index had higher incidences of respiratory infection (26·4% vs 13·8%; adjusted rate ratio per one resident per room increase in crowding 1·89 [95% CI 1·64-2·17]) and mortality (0·8% vs 0·4%; 2·34 [1·88-2·92]) than did homes with a low crowding index. INTERPRETATION Respiratory infection and mortality rates were higher in nursing homes with high crowding index than in homes with low crowding index, and the association was consistent across various respiratory pathogens. Decreasing crowding is an important safety target beyond the COVID-19 pandemic to help to promote resident wellbeing and decrease the transmission of prevalent respiratory pathogens. FUNDING None.
Collapse
Affiliation(s)
| | | | | | - Nick Daneman
- Public Health Ontario, Toronto, ON, Canada; Division of Infectious Diseases, Sunnybrook Research Institute, Toronto, ON, Canada
| | | | | | | | | | | |
Collapse
|
25
|
Fralick M, Nott C, Moggridge J, Castellani L, Raudanskis A, Guttman DS, Hinz A, Thampi N, Wong A, Manuel D, McGeer A, Doukhanine E, Mejbel H, Zanichelli V, Burella M, Donaldson SL, Wang PW, Kassen R, MacFadden DR. Detection of Covid-19 Outbreaks Using Built Environment Testing for SARS-CoV-2. NEJM Evid 2023; 2:EVIDoa2200203. [PMID: 38320044 DOI: 10.1056/evidoa2200203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
Built Environment Testing for SARS-CoV-2Wastewater testing has proven to be a valuable tool for forecasting Covid-19 outbreaks. Fralick et al. now report that swabbing of surfaces (i.e., floors) for SARS-CoV-2 may provide a similar benefit for predicting outbreaks in long-term care homes.
Collapse
Affiliation(s)
- Michael Fralick
- Division of General Internal Medicine, Sinai Health System, Toronto
| | - Caroline Nott
- The Ottawa Hospital Research Institute, Ottawa
- Department of Medicine, University of Ottawa, Ottawa
| | - Jason Moggridge
- Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto
| | - Lucas Castellani
- Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
- Clinical Sciences Division, NOSM University, Sudbury, Ontario, Canada
| | | | - David S Guttman
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto
- Department of Cell & Systems Biology, University of Toronto, Toronto
| | - Aaron Hinz
- Department of Biology, University of Ottawa, Ottawa
- Department of Biology, Carleton University, Ottawa
| | - Nisha Thampi
- Department of Pediatrics, University of Ottawa, Ottawa
- Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa
| | - Alex Wong
- Department of Biology, Carleton University, Ottawa
- Institute for Advancing Health Through Agriculture, Texas A&M AgriLife Research, College Station, TX
| | - Doug Manuel
- The Ottawa Hospital Research Institute, Ottawa
- Department of Family Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto
| | | | - Hebah Mejbel
- Department of Biology, University of Ottawa, Ottawa
| | | | - Madison Burella
- Division of General Internal Medicine, Sinai Health System, Toronto
- Sault Area Hospital, Sault Ste. Marie, Ontario, Canada
| | - Sylva L Donaldson
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto
- Department of Cell & Systems Biology, University of Toronto, Toronto
| | - Pauline W Wang
- Centre for the Analysis of Genome Evolution and Function, University of Toronto, Toronto
- Department of Cell & Systems Biology, University of Toronto, Toronto
| | - Rees Kassen
- Department of Biology, University of Ottawa, Ottawa
| | - Derek R MacFadden
- The Ottawa Hospital Research Institute, Ottawa
- Department of Medicine, University of Ottawa, Ottawa
| |
Collapse
|
26
|
Richard L, Nisenbaum R, Brown M, Liu M, Pedersen C, Jenkinson JIR, Mishra S, Baral S, Colwill K, Gingras AC, McGeer A, Hwang SW. Incidence of SARS-CoV-2 Infection Among People Experiencing Homelessness in Toronto, Canada. JAMA Netw Open 2023; 6:e232774. [PMID: 36912833 PMCID: PMC10011938 DOI: 10.1001/jamanetworkopen.2023.2774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Abstract
IMPORTANCE People experiencing homelessness are at high risk of SARS-CoV-2 infection. Incident infection rates have yet to be established in these communities and are needed to inform infection prevention guidance and related interventions. OBJECTIVE To quantify the SARS-CoV-2 incident infection rate among people experiencing homelessness in Toronto, Canada, in 2021 and 2022 and to assess factors associated with incident infection. DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study was conducted among individuals aged 16 years and older who were randomly selected between June and September 2021 from 61 homeless shelters, temporary distancing hotels, and encampments in Toronto, Canada. EXPOSURES Self-reported housing characteristics, such as number sharing living space. MAIN OUTCOMES AND MEASURES Prevalence of prior SARS-CoV-2 infection in summer 2021, defined as self-reported or polymerase chain reaction (PCR)- or serology-confirmed evidence of infection at or before the baseline interview, and SARS-CoV-2 incident infection, defined as self-reported or PCR- or serology-confirmed infection among participants without history of infection at baseline. Factors associated with infection were assessed using modified Poisson regression with generalized estimating equations. RESULTS The 736 participants (415 of whom did not have SARS-CoV-2 infection at baseline and were included in the primary analysis) had a mean (SD) age of 46.1 (14.6) years; 486 (66.0%) self-identified as male. Of these, 224 (30.4% [95% CI, 27.4%-34.0%]) had a history of SARS-CoV-2 infection by summer 2021. Of the remaining 415 participants with follow-up, 124 experienced infection within 6 months, representing an incident infection rate of 29.9% (95% CI, 25.7%-34.4%), or 5.8% (95% CI, 4.8%-6.8%) per person-month. Report after onset of the SARS-CoV-2 Omicron variant was associated with incident infection, with an adjusted rate ratio (aRR) of 6.28 (95% CI, 3.94-9.99). Other factors associated with incident infection included recent immigration to Canada (aRR, 2.74 [95% CI, 1.64-4.58]) and alcohol consumption over the past interval (aRR, 1.67 [95% CI, 1.12-2.48]). Self-reported housing characteristics were not significantly associated with incident infection. CONCLUSIONS AND RELEVANCE In this longitudinal study of people experiencing homelessness in Toronto, SARS-CoV-2 incident infection rates were high in 2021 and 2022, particularly once the Omicron variant became dominant in the region. Increased focus on homelessness prevention is needed to more effectively and equitably protect these communities.
Collapse
Affiliation(s)
- Lucie Richard
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Michael Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Michael Liu
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Harvard Medical School, Boston, Massachusetts
| | - Cheryl Pedersen
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Jesse I. R. Jenkinson
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stefan Baral
- Department of Epidemiology, John Hopkins University, Baltimore, Maryland
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
27
|
Muller MP, Mishra S, McGeer A, Patel S, Gubbay J, Hasso M, Chan AK, Kozak R, Leis JA, Tan DS. Environmental Testing of Surfaces in the Room of a Patient With Mpox. Clin Infect Dis 2023; 76:179-181. [PMID: 35982540 DOI: 10.1093/cid/ciac654] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/28/2022] [Accepted: 08/09/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
| | | | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Canada
| | - Samir Patel
- Department of Microbiology, Public Health Ontario Laboratory, Toronto, Canada
| | - Jonathan Gubbay
- Department of Microbiology, Public Health Ontario Laboratory, Toronto, Canada
| | - Maan Hasso
- Department of Microbiology, Public Health Ontario Laboratory, Toronto, Canada
| | - Adrienne K Chan
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Robert Kozak
- Department of Laboratory Medicine and Pathobiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Jerome A Leis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Darrell S Tan
- Department of Medicine, St. Michael's Hospital, Toronto, Canada
| |
Collapse
|
28
|
O'Reilly R, Lu H, Kwong JC, McGeer A, To T, Sander B. The epidemiology and healthcare costs of community-acquired pneumonia in Ontario, Canada: a population-based cohort study. J Med Econ 2023; 26:293-302. [PMID: 36756847 DOI: 10.1080/13696998.2023.2176679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
OBJECTIVES The aim of the present study was to determine incidence-based short- and long-term healthcare costs attributable to community-acquired pneumonia (CAP) from the healthcare payer perspective in Ontario, Canada. METHODS We conducted a retrospective population-based matched cohort study of residents in Ontario, Canada using health administrative data. We identified subjects with an incident episode of CAP (exposed subjects) between 1 January 2012 and 31 December 2014. The index date of each episode was based on the first inpatient or outpatient claim for pneumonia. Exposed subjects were matched without replacement to unexposed subjects from the general population using hard and propensity score matching on age, sex, income quintile, rural residence, comorbidities, and healthcare costs prior to index date. Attributable costs represented the mean difference in costs between the exposed subjects and their matched pairs. RESULTS We identified 692,090 subjects with at least one episode of CAP between 1 January 2012 and 31 December 2014. Adults aged 65 years and older had the highest annual incidence rate of 50.1 episodes per 1,000 person-years, while adults aged 18-64 years and children (aged 0-17) had incidence rates of 12.9 and 24.7 episodes per 1,000 person-years, respectively. The majority of episodes involved care exclusively in the outpatient setting (92.6%), with most of these episodes involving a single physician visit. The mean attributable costs were $1,595 (95% CI: $1,572-$1,616) per outpatient CAP episode and $12,576 (95% CI: $12.392-$12,761) per inpatient CAP episode. Attributable costs were significantly higher for adult subjects and those with time spent in the intensive care unit. Alternative case definitions yielded different results, although demonstrated the same overall trends across groups. CONCLUSION CAP is associated with substantially increased acute and long-term healthcare costs compared to unexposed subjects. This study highlights the burden of CAP in both the inpatient and outpatient setting, and will serve to inform strategic healthcare planning for future interventions and healthcare programs.
Collapse
Affiliation(s)
- Ryan O'Reilly
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Hong Lu
- ICES, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Vaccine-Preventable Diseases, University of Toronto, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Teresa To
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
- Public Health Ontario, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
29
|
Kim P, Coleman B, Kwong JC, Plevneshi A, Hassan K, Green K, McNeil SA, Armstrong I, Gold WL, Gubbay J, Katz K, Kuster SP, Lovinsky R, Matukas L, Ostrowska K, Richardson D, McGeer A. Burden of Severe Illness Associated With Laboratory-Confirmed Influenza in Adults Aged 50-64 Years, 2010-2011 to 2016-2017. Open Forum Infect Dis 2022; 10:ofac664. [PMID: 36632417 PMCID: PMC9830541 DOI: 10.1093/ofid/ofac664] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Indexed: 12/28/2022] Open
Abstract
Background Understanding the burden of influenza is necessary to optimize recommendations for influenza vaccination. We describe the epidemiology of severe influenza in 50- to 64-year-old residents of metropolitan Toronto and Peel region, Canada, over 7 influenza seasons. Methods Prospective population-based surveillance for hospitalization associated with laboratory-confirmed influenza was conducted from September 2010 to August 2017. Conditions increasing risk of influenza complications were as defined by Canada's National Advisory Committee on Immunization. Age-specific prevalence of medical conditions was estimated using Ontario health administrative data. Population rates were estimated using Statistics Canada data. Results Over 7 seasons, 1228 hospitalizations occurred in patients aged 50-64 years: 40% due to A(H3N2), 30% A(H1N1), and 22% influenza B. The average annual hospitalization rate was 15.6, 20.9, and 33.2 per 100 000 in patients aged 50-54, 55-59, and 60-64 years, respectively; average annual mortality was 0.9/100 000. Overall, 33% of patients had received current season influenza vaccine; 963 (86%) had ≥1 underlying condition increasing influenza complication risk. The most common underlying medical conditions were chronic lung disease (38%) and diabetes mellitus (31%); 25% of patients were immunocompromised. The average annual hospitalization rate was 6.1/100 000 in those without and 41/100 000 in those with any underlying condition, and highest in those with renal disease or immunocompromise (138 and 281 per 100 000, respectively). The case fatality rate in hospitalized patients was 4.4%; median length of stay was 4 days (interquartile range, 2-8 days). Conclusions The burden of severe influenza in 50- to 64-year-olds remains significant despite our universal publicly funded vaccination program. These data may assist in improving estimates of the cost-effectiveness of new strategies to reduce this burden.
Collapse
Affiliation(s)
- Philip Kim
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Brenda Coleman
- Department of Microbiology, Sinai Health System, Toronto, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Jeffrey C Kwong
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Department of Family and Community Medicine, University of Toronto, Toronto, Canada,ICES, Toronto, Canada,Public Health Ontario, Toronto, Canada
| | - Agron Plevneshi
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Kazi Hassan
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Karen Green
- Department of Microbiology, Sinai Health System, Toronto, Canada
| | - Shelly A McNeil
- Department of Medicine, Dalhousie University, Halifax, Canada
| | | | - Wayne L Gold
- Department of Medicine, University Health Network, University of Toronto, Toronto, Canada
| | - Jonathan Gubbay
- Public Health Ontario, Toronto, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Department of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | - Larissa Matukas
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada,Division of Microbiology, Unity Health, Toronto, Canada
| | | | - David Richardson
- Department of Medical Microbiology and Infectious Diseases, William Osler Health System, Brampton, Canada
| | - Allison McGeer
- Correspondence: Allison McGeer, Mount Sinai Hospital, 600 University Ave, Room 171, Toronto, ON, Canada M5G 1X5 ()
| |
Collapse
|
30
|
Sukhdeo S, Muller M, McGeer A, Leis JA, Chan A, Gubbay JB, Patel S, Khan S, Perusini S, Li XA, Kozak R, Mishra S, Tan DHS, Kandel C. Environmental Surface Contamination With Monkeypox Virus in the Ambulatory Setting in Toronto, Canada. Open Forum Infect Dis 2022; 10:ofac648. [PMID: 36756631 PMCID: PMC9901272 DOI: 10.1093/ofid/ofac648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/06/2022] [Indexed: 12/28/2022] Open
Affiliation(s)
- Sharon Sukhdeo
- Correspondence: Sharon Sukhdeo, MD, FRCPC, Department of Medicine, University of Toronto, 200 Elizabeth St, Toronto, ON, Canada M5G 2C4 (); Christopher Kandel, MD, PhD, Michael Garron Hospital, 825 Coxwell Ave, Toronto, ON, Canada M4C 3E7 ()
| | - Matthew Muller
- Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Jerome A Leis
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Adrienne Chan
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Samir Patel
- Public Health Ontario Laboratory, Toronto, Ontario, Canada
| | - Saman Khan
- Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Xinliu Angel Li
- Department of Microbiology, Sinai Health System, Toronto, Ontario, Canada
| | - Robert Kozak
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada,MAP Center for Urban Health Solutions, Li Ka Shing Knowledge Institute, Toronto, Ontario, Canada,Department of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Darrell H S Tan
- Department of Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | |
Collapse
|
31
|
Mozafarihashjin M, Jamal AJ, Kandel C, Kohler P, Mataseje L, Mulvey M, Allen V, Barker KR, Baqi M, Borgia S, Coleman B, Faheem A, Farooqi L, Johnstone J, Katz K, Melano R, Muller M, Mubareka S, Patel S, Poutanen S, Richardson D, Li A, Zhong Z, McGeer A. 89. On-going impact of the SARS-CoV-2 pandemic on the evolution of carbapenemase-producing Enterobacterales in Ontario, Canada. Open Forum Infect Dis 2022. [PMCID: PMC9752332 DOI: 10.1093/ofid/ofac492.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background The spread of carbapenemase-producing Enterobacterales (CPE) is global threat. Numerous outbreaks of CPE have been reported during the COVID-19 pandemic. We describe the impact of of the SARS-CoV-2 pandemic on the emergence of CPE in south-central Ontario, Canada. Incidence of clinical isolates of CPE and isolates with different CPE genes in Toronto/Peel region, 2017–2021. The upper panel shows the incidence of patients with clinical isolates of CPE by year and quarter from q4 2007 to q1 2022. The lower panel shows the incidence of patients with clinical isolates with different carbapenemase genes by fiscal year during the same period. Methods TIBDN has performed population-based surveillance for CPE in Toronto/Peel region (pop 4.5M) from first identified isolate in 2007. All laboratories test/refer all carbapenem non-susceptible Enterobacterial isolates for identification of CPE. Hospital charts are reviewed and patients/physicians interviewed. Population data are obtained from Statistics Canada. Results From 10/2007 to 3/31/2022, 1367 persons colonized or infected with CPE were identified. Their median age was 68.7yrs (IQR 54–78yrs); 761 (56%) were male. 772 (56%) were colonized when first identified; 115 (8.4%) were bacteremic at identification or subsequently developed bacteremia. The most common organisms were E. coli (651, 48%), K. pneumoniae (436, 32%), Enterobacter spp. (146, 11%), Citrobacter spp (62, 5%); the most common genes were NDM±OXA-48 (722, 53%), OXA-48-like (341, 25%), KPC (225, 16%), VIM (44, 3%). The incidence of CPE infections increased steadily until 3/2020 then declined by 61% and remained stable until 3/2022 (Figure, upper panel). The decline was greater for E. coli (56% decrease), K. pneumoniae (62%) than for Enterobacter spp. (30%) and other species (19%). It occurred in all genes in 2020; however, KPC containing organisms increased again in 2021 (Figure, lower panel). Conclusion The advent of the COVID-19 pandemic was associated with an immediate, substantial decline in the incidence of patients with CPE in our population area. This decline occurred in both isolates with genes usually occurring in cases imported from other countries, and in those usually occurring in cases associated with transmission within Canadian hospitals. Decreased travel and enhanced infection prevention and control in hospitals may both have contributed to reductions in CPE during the pandemic. Disclosures All Authors: No reported disclosures.
Collapse
Affiliation(s)
| | - Alainna J Jamal
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Christopher Kandel
- Toronto East Health Network, University of Toronto, Toronto, Ontario, Canada
| | | | - Laura Mataseje
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Michael Mulvey
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Vanessa Allen
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | | | - Mahin Baqi
- William Osler Health System, Toront, Ontario, Canada
| | - Sergio Borgia
- William Osler Health System, Toront, Ontario, Canada
| | - Brenda Coleman
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Amna Faheem
- North York General Hospital, Toronto, Ontario, Canada
| | - Lubna Farooqi
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Matthew Muller
- Unity Health, University of Toronto, Toronto, Ontario, Canada
| | - Samira Mubareka
- Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Samir Patel
- Public Health Ontario, Toronto, Ontario, Canada
| | - Susan Poutanen
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | | | - Angel Li
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | - Zoe Zhong
- Sinai Health System, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
32
|
Fralick M, Moggridge J, Castellani L, Donaldson S, Guttman DS, Hinz A, Hug L, Manuel D, McGeer A, Mejbel H, Nott C, Raudanskis A, Thampi N, Wong A, Zanichelli V, Kassen R, Macfadden D. 1879. Detection of COVID-19 Outbreaks in Long-Term Care Homes Using Built Environment Testing for SARS-CoV-2: A Multicentre Prospective Study. Open Forum Infect Dis 2022. [PMCID: PMC9752473 DOI: 10.1093/ofid/ofac492.1506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Background Environmental surveillance of SARS-CoV-2 via wastewater has become an invaluable tool for population-level surveillance of COVID-19. More highly resolved environmental sampling approaches may also be useful for surveillance. Built environment sampling may provide a spatially refined approach for surveillance of COVID-19 in congregate living settings. Methods We conducted a prospective study of 10 long-term care homes (LTCHs) in both urban and rural settings in Ontario Canada between September 2021 and April 2022. Floor surfaces were sampled weekly at multiple locations within each building and were analyzed for the presence of SARS-CoV-2 using qPCR. The exposure variable was detection of SARS-CoV-2 on floors. The primary outcome was the presence of a COVID-19 outbreak. We calculated the test characteristics of the presence of SARS-CoV-2 on floors for detection of COVID-19 outbreaks. Results We followed 10 LTCHs for 214 cumulative weeks, and collected 3,219 swabs from 183 unique locations. Overall, 15 COVID-19 outbreaks occurred with 74.9 cumulative weeks of outbreaks. During time periods when there were outbreaks of COVID-19 the proportion of floor swabs positive for SaRS-CoV-2 was 50.8% (95% CI: 47.7-53.9). During time periods where there were no outbreaks of COVID-19 the proportion of floor swabs positive was 15.8% (95% CI:14.3-17.3). Using the proportion of positive floor swabs for SARS-CoV-2 to predict COVID-19 outbreak status for a given week, the area under the receiver operating curve was 0.84 (95% CI: 0.76-0.92). Using thresholds of ≥10%, ≥30%, and ≥50%, the prevalence of floor swabs positive for SARS-CoV-2 yielded positive predictive values for outbreak of 0.52 (0.43-0.61), 0.65 (0.53-0.75), and 0.72 (0.58-0.83) respectively, and negative predictive values of 0.93 (0.86-0.97), 0.85 (0.78-0.91), and 0.80 (0.73-0.86) respectively (Figure 1). 13 outbreaks had floor sampling performed in the week prior to them being identified, and of these 7 (54%) had positive swab proportions exceeding 30% in the week prior to the outbreak.
Test characteristics of built environment floor swabs for predicting COVID-19 outbreaks in LTCH. ![]() Figure 1. Test characteristics of different thresholds for percentage of floor swabs positive for SARS-CoV-2 at a given LTCH for predicting active COVID-19 outbreak in the same building in the same week. NPV = negative predictive value, PPV = positive predictive value, Sens = sensitivity, Spec = specificity. Conclusion Detection of SARS-CoV-2 on floors is strongly associated with COVID-19 outbreaks in LTCHs. These data suggest a potential role for floor sampling in improving early outbreak detection and management. Disclosures Michael Fralick, MD, ProofDx: Advisor/Consultant Doug Manuel, MD, PhD, World Bank: Advisor/Consultant.
Collapse
Affiliation(s)
- Michael Fralick
- University of Toronto Department of Medicine, Toronto, Ontario, Canada
| | | | | | | | | | - Aaron Hinz
- Carleton University, Ottawa, Ontario, Canada
| | - Laura Hug
- University of Waterloo, Waterloo, Ontario, Canada
| | - Doug Manuel
- The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | | | | | | | | | - Alex Wong
- Carleton University, Ottawa, Ontario, Canada
| | | | - Rees Kassen
- University of Ottawa, Ottawa, Ontario, Canada
| | | |
Collapse
|
33
|
Kandel C, Lee Y, Taylor M, Llanes A, McCready J, Crowl G, Powis J, Li AX, Shigayeva A, Yip L, Katz K, Kozak R, Mubareka S, McGeer A. Viral dynamics of the SARS-CoV-2 Omicron Variant among household contacts with 2 or 3 COVID-19 vaccine doses. J Infect 2022; 85:666-670. [PMID: 36283495 PMCID: PMC9595488 DOI: 10.1016/j.jinf.2022.10.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES SARS-CoV-2 shedding has changed as new variants have emerged. It is important to understand the trajectory of PCR positivity due to Omicron in vaccinated populations. METHODS Double- or triple-vaccinated adult household contacts of individuals with COVID-19 self-collected oral-nasal swabs for 14 days. A hierarchical linear model estimated viral load trajectories and an exploratory logistic regression model assessed for factors associated with viral detection before symptom onset. RESULTS Forty-one participants developed COVID-19 with 37 (90%) symptomatic. Viral load peaked 3 days after symptom onset at a median concentration of 8.83 log10 copies/milliliter (range 5.95-10.32) and the mean difference between participants with two or three COVID-19 vaccine doses was 0.02 log10 copies/milliliter (95% CI -0.13 to 0.16). PCR positivity began with a range of 4 days prior to 3 days after symptom onset and was positive on the day of symptom onset in 76% (28/37). SARS-CoV-2 detection on the day of symptom onset was less likely among those with 2 vaccine doses (OR 0.13, 95%CI 0.02-0.79). 68% (25/37) of infected participants had detectable SARS-CoV-2 with Ct<30 at 7 days after symptom onset. CONCLUSIONS Peak viral load and duration of PCR positivity were similar in participants with COVID-19 after two versus three COVID-19 vaccine doses. Onset of viral detection relative to symptom onset was variable.
Collapse
Affiliation(s)
- Christopher Kandel
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada.
| | - Yaejin Lee
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada,Department of Laboratory Medicine and Pathobiology, King's College Cir, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Maureen Taylor
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada
| | - Andrea Llanes
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada
| | - Janine McCready
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada
| | - Gloria Crowl
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada
| | - Jeff Powis
- Toronto East Health Network, Michael Garron Hospital, 825 Coxwell Avenue, Toronto, Ontario M4C 3E7, Canada
| | - Angel Xinliu Li
- Sinai Health System, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Altynay Shigayeva
- Sinai Health System, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada
| | - Lily Yip
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Kevin Katz
- Department of Laboratory Medicine and Pathobiology, King's College Cir, University of Toronto, Toronto, Ontario M5S 1A8, Canada,North York General Hospital, 4001 Leslie St, North York, Ontario M2K 1E1, Canada,Shared Hospital Laboratory, 555 Finch Ave W, Toronto, Ontario M2R 1N5, Canada
| | - Robert Kozak
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada,Department of Laboratory Medicine and Pathobiology, King's College Cir, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Samira Mubareka
- Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada,Department of Laboratory Medicine and Pathobiology, King's College Cir, University of Toronto, Toronto, Ontario M5S 1A8, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, King's College Cir, University of Toronto, Toronto, Ontario M5S 1A8, Canada; Sinai Health System, 600 University Avenue, Toronto, Ontario M5G 1X5, Canada.
| |
Collapse
|
34
|
Babouee Flury B, Güsewell S, Egger T, Leal O, Brucher A, Lemmenmeier E, Meier Kleeb D, Möller JC, Rieder P, Rütti M, Schmid HR, Stocker R, Vuichard-Gysin D, Wiggli B, Besold U, McGeer A, Risch L, Friedl A, Schlegel M, Kuster SP, Kahlert CR, Kohler P. Risk and symptoms of COVID-19 in health professionals according to baseline immune status and booster vaccination during the Delta and Omicron waves in Switzerland-A multicentre cohort study. PLoS Med 2022; 19:e1004125. [PMID: 36342956 PMCID: PMC9678290 DOI: 10.1371/journal.pmed.1004125] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/21/2022] [Accepted: 10/14/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Knowledge about protection conferred by previous Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection and/or vaccination against emerging viral variants allows clinicians, epidemiologists, and health authorities to predict and reduce the future Coronavirus Disease 2019 (COVID-19) burden. We investigated the risk and symptoms of SARS-CoV-2 (re)infection and vaccine breakthrough infection during the Delta and Omicron waves, depending on baseline immune status and subsequent vaccinations. METHODS AND FINDINGS In this prospective, multicentre cohort performed between August 2020 and March 2022, we recruited hospital employees from ten acute/nonacute healthcare networks in Eastern/Northern Switzerland. We determined immune status in September 2021 based on serology and previous SARS-CoV-2 infections/vaccinations: Group N (no immunity); Group V (twice vaccinated, uninfected); Group I (infected, unvaccinated); Group H (hybrid: infected and ≥1 vaccination). Date and symptoms of (re)infections and subsequent (booster) vaccinations were recorded until March 2022. We compared the time to positive SARS-CoV-2 swab and number of symptoms according to immune status, viral variant (i.e., Delta-dominant before December 27, 2021; Omicron-dominant on/after this date), and subsequent vaccinations, adjusting for exposure/behavior variables. Among 2,595 participants (median follow-up 171 days), we observed 764 (29%) (re)infections, thereof 591 during the Omicron period. Compared to group N, the hazard ratio (HR) for (re)infection was 0.33 (95% confidence interval [CI] 0.22 to 0.50, p < 0.001) for V, 0.25 (95% CI 0.11 to 0.57, p = 0.001) for I, and 0.04 (95% CI 0.02 to 0.10, p < 0.001) for H in the Delta period. HRs substantially increased during the Omicron period for all groups; in multivariable analyses, only belonging to group H was associated with protection (adjusted HR [aHR] 0.52, 95% CI 0.35 to 0.77, p = 0.001); booster vaccination was associated with reduction of breakthrough infection risk in groups V (aHR 0.68, 95% CI 0.54 to 0.85, p = 0.001) and H (aHR 0.67, 95% CI 0.45 to 1.00, p = 0.048), largely observed in the early Omicron period. Group H (versus N, risk ratio (RR) 0.80, 95% CI 0.66 to 0.97, p = 0.021) and participants with booster vaccination (versus nonboosted, RR 0.79, 95% CI 0.71 to 0.88, p < 0.001) reported less symptoms during infection. Important limitations are that SARS-CoV-2 swab results were self-reported and that results on viral variants were inferred from the predominating strain circulating in the community at that time, rather than sequencing. CONCLUSIONS Our data suggest that hybrid immunity and booster vaccination are associated with a reduced risk and reduced symptom number of SARS-CoV-2 infection during Delta- and Omicron-dominant periods. For previously noninfected individuals, booster vaccination might reduce the risk of symptomatic Omicron infection, although this benefit seems to wane over time.
Collapse
Affiliation(s)
- Baharak Babouee Flury
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Sabine Güsewell
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Thomas Egger
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Onicio Leal
- Epitrack, Recife, Brazil
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St. Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | | | | | - Markus Rütti
- Fuerstenland Toggenburg Hospital Group, Wil, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Thurgau Hospital Group, Division of Infectious Diseases and Hospital Epidemiology, Muensterlingen, Switzerland
| | - Benedikt Wiggli
- Kantonsspital Baden, Division of Infectious Diseases and Hospital Epidemiology, Baden, Switzerland
| | - Ulrike Besold
- Geriatric Clinic St. Gallen, St. Gallen, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
- Center of Laboratory Medicine, University Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Andrée Friedl
- Kantonsspital Baden, Division of Infectious Diseases and Hospital Epidemiology, Baden, Switzerland
| | - Matthias Schlegel
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Stefan P. Kuster
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
| | - Christian R. Kahlert
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- Children’s Hospital of Eastern Switzerland, Department of Infectious Diseases and Hospital Epidemiology, St. Gallen, Switzerland
- * E-mail: (CRK); (PK)
| | - Philipp Kohler
- Cantonal Hospital St Gallen, Division of Infectious Diseases and Hospital Epidemiology, St Gallen, Switzerland
- * E-mail: (CRK); (PK)
| | | |
Collapse
|
35
|
Styra R, Hawryluck L, McGeer A, Dimas M, Lam E, Giacobbe P, Lorello G, Dattani N, Sheen J, Rac VE, Francis T, Wu PE, Luk WS, Nadarajah J, Gold WL. Support for health care workers and psychological distress: thinking about now and beyond the COVID-19 pandemic. Health Promot Chronic Dis Prev Can 2022; 42:421-430. [PMID: 35766916 PMCID: PMC9584174 DOI: 10.24095/hpcdp.42.10.01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study explores the relationship between emotional support, perceived risk and mental health outcomes among health care workers, who face high rates of burnout and mental distress since the beginning of the COVID-19 pandemic. METHODS A cross-sectional, multicentred online survey of health care workers in the Greater Toronto Area, Ontario, Canada, during the first wave of the COVID-19 pandemic evaluated coping strategies, confidence in infection control, impact of previous work during the 2003 SARS outbreak and emotional support. Mental health outcomes were assessed using the Generalized Anxiety Disorder scale, the Impact of Event Scale - Revised and the Patient Health Questionnaire (PHQ-9). RESULTS Of 3852 participants, 8.2% sought professional mental health services while 77.3% received emotional support from family, 74.0% from friends and 70.3% from colleagues. Those who felt unsupported in their work had higher odds ratios of experiencing moderate and severe symptoms of anxiety (odds ratio [OR] = 2.23; 95% confidence interval [CI]: 1.84-2.69), PTSD (OR = 1.88; 95% CI: 1.58-2.25) and depression (OR = 1.88; 95% CI: 1.57-2.25). Nearly 40% were afraid of telling family about the risks they were exposed to at work. Those who were able to share this information demonstrated lower risk of anxiety (OR = 0.58; 95% CI: 0.48-0.69), PTSD (OR = 0.48; 95% CI: 0.41-0.56) and depression (OR = 0.55; 95% CI: 0.47-0.65). CONCLUSION Informal sources of support, including family, friends and colleagues, play an important role in mitigating distress and should be encouraged and utilized more by health care workers.
Collapse
Affiliation(s)
- Rima Styra
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Laura Hawryluck
- Critical Care Medicine, University Health Network, Toronto, Ontario, Canada
| | - Allison McGeer
- Division of Infectious Diseases, University Health Network and Sinai Health System, Toronto, Ontario, Canada
| | - Michelle Dimas
- Department of Research, William Osler Health System, Brampton, Ontario, Canada
| | - Eileen Lam
- Centre for Mental Health, University Health Network, Toronto, Ontario, Canada
| | - Peter Giacobbe
- Department of Psychiatry, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gianni Lorello
- Department of Anesthesia and Pain Management, University Health Network, Toronto, Ontario, Canada
| | - Neil Dattani
- Department of Emergency and Urgent Care, William Osler Health System, Brampton, Ontario, Canada
| | - Jack Sheen
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
| | - Valeria E Rac
- Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Troy Francis
- Toronto Health Economics and Technology Assessment (THETA) Collaborative, University of Toronto, Toronto, Ontario, Canada
| | - Peter E Wu
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| | - Wing-Si Luk
- Patient Safety and Quality Improvement, University Health Network, Toronto, Ontario, Canada
| | - Jeya Nadarajah
- Division of Infectious Diseases, Markham Stouffville Hospital, Markham, Ontario, Canada
| | - Wayne L Gold
- Division of Infectious Diseases, University Health Network and Sinai Health System, Toronto, Ontario, Canada
- Division of General Internal Medicine, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
36
|
Zargartalebi H, Yousefi H, Flynn CD, Gomis S, Das J, Young TL, Chien E, Mubareka S, McGeer A, Wang H, Sargent EH, Nezhad AS, Kelley SO. Capillary-Assisted Molecular Pendulum Bioanalysis. J Am Chem Soc 2022; 144:18338-18349. [PMID: 36173381 DOI: 10.1021/jacs.2c06192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
The development of robust biosensing strategies that can be easily implemented in everyday life remains a challenge for the future of modern biosensor research. While several reagentless approaches have attempted to address this challenge, they often achieve user-friendliness through sacrificing sensitivity or universality. While acceptable for certain applications, these trade-offs hinder the widespread adoption of reagentless biosensing technologies. Here, we report a novel approach to reagentless biosensing that achieves high sensitivity, rapid detection, and universality using the SARS-CoV-2 virus as a model target. Universality is achieved by using nanoscale molecular pendulums, which enables reagentless electrochemical biosensing through a variable antibody recognition element. Enhanced sensitivity and rapid detection are accomplished by incorporating the coffee-ring phenomenon into the sensing scheme, allowing for target preconcentration on a ring-shaped electrode. Using this approach, we obtained limits of detection of 1 fg/mL and 20 copies/mL for the SARS-CoV-2 nucleoproteins and viral particles, respectively. In addition, clinical sample analysis showed excellent agreement with Ct values from PCR-positive SARS-CoV-2 patients.
Collapse
Affiliation(s)
- Hossein Zargartalebi
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada.,Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Hanie Yousefi
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Connor D Flynn
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208 United States.,Department of Chemistry, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Surath Gomis
- The Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON M5S 3G4, Canada
| | - Jagotamoy Das
- Department of Chemistry, Northwestern University, Evanston, Illinois 60208 United States
| | - Tiana L Young
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Emily Chien
- Sunnybrook Research Institute, Toronto, ON M4N 3N5, Canada
| | | | - Allison McGeer
- Department of Microbiology, Sinai Health System, Toronto, ON M5G 1X5, Canada
| | - Hansen Wang
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada
| | - Edward H Sargent
- The Edward S. Rogers Sr. Department of Electrical and Computer Engineering, University of Toronto, Toronto, ON M5S 3G4, Canada
| | - Amir Sanati Nezhad
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, Alberta T2N 1N4, Canada
| | - Shana O Kelley
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON M5S 3M2, Canada.,Department of Chemistry, Northwestern University, Evanston, Illinois 60208 United States.,Department of Biomedical Engineering, Northwestern University, Evanston, Illinois 60208, United States.,Department of Biochemistry and Molecular Genetics, Northwestern University, Chicago, Illinois 60611, United States
| |
Collapse
|
37
|
Golden A, Griffith A, Demczuk W, Lefebvre B, McGeer A, Tyrrell G, Zhanel G, Kus J, Hoang L, Minion J, Van Caeseele P, Smadi H, Haldane D, Zahariadis G, Mead K, Steven L, Strudwick L, Li A, Mulvey M, Martin I. Invasive pneumococcal disease surveillance in Canada, 2020. Can Commun Dis Rep 2022; 48:396-406. [PMID: 38124782 PMCID: PMC10732480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Invasive pneumococcal disease (IPD), which is caused by Streptococcus pneumoniae, has been a nationally notifiable disease in Canada since 2000. The use of conjugate vaccines has markedly decreased the incidence of IPD in Canada; however, the distribution of serotypes has shifted in favour of non-vaccine types. This report summarizes the demographics, serotypes and antimicrobial resistance of IPD infections in Canada in 2020. Methods The Public Health Agency of Canada's National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of IPD. A total of 2,108 IPD isolates were reported in 2020. Serotyping was performed by Quellung reaction and antimicrobial susceptibilities were determined in collaboration with the University of Manitoba/Canadian Antimicrobial Resistance Alliance. Population-based IPD incidence rates were obtained through the Canadian Notifiable Disease Surveillance System. Results Overall incidence of IPD in Canada decreased significantly from 11.5 (95% confidence interval [CI]: 10.1-13.1) to 6.0 (95% CI: 5.0-7.2), and from 10.0 (95% CI: 9.7-10.3) to 5.9 (95% CI: 5.7-6.2) cases per 100,000 from 2019 to 2020; in those younger than five years and those five years and older, respectively. The most common serotypes overall were 4 (11.2%, n=237), 3 (10.9%, n=229) and 8 (7.2%, n=151). From 2016 to 2020, serotypes with increasing trends (p<0.05) included 4 (6.4%-11.2%), 3 (9.5%-10.9%), 8 (5.2%-7.2%) and 12F (3.6%-5.7%). The overall prevalence of PCV13 serotypes increased over the same period (30.3%-34.9%, p<0.05). Antimicrobial resistance rates in 2020 included 23.0% clarithromycin and 9.9% penicillin (IV meningitis breakpoints). Multidrug-resistant IPD has significantly increased since 2016 (4.2%-9.5%, p<0.05). Conclusion Though the incidence of IPD decreased in 2020 in comparison to previous years across all age groups, disease due to PCV13 serotypes 3 and 4, as well as non-PCV13 serotypes such as 8 and 12F, increased in prevalence. Continued surveillance of IPD is imperative to monitor shifts in serotype distribution and antimicrobial resistance.
Collapse
Affiliation(s)
- Alyssa Golden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, ON
| | - Gregory Tyrrell
- Provincial Laboratory for Public Health (Microbiology), Edmonton, AB
| | - George Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Julianne Kus
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
| | | | | | - Hanan Smadi
- New Brunswick Department of Health, Fredericton, NB
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, NS
| | | | | | - Laura Steven
- Stanton Territorial Hospital Laboratory, Yellowknife, NT
| | | | - Anita Li
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Michael Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| |
Collapse
|
38
|
Golden A, Griffith A, Demczuk W, Tyrrell G, Kus J, McGeer A, Domingo MC, Hoang L, Minion J, Van Caeseele P, Smadi H, Haldane D, Zahariadis G, Mead K, Steven L, Strudwick L, Li A, Mulvey M, Martin I. Invasive group A streptococcal disease surveillance in Canada, 2020. Can Commun Dis Rep 2022; 48:407-414. [PMID: 38106647 PMCID: PMC10723789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Invasive group A streptococcal (iGAS) disease (caused by Streptococcus pyogenes) has been a nationally notifiable disease in Canada since 2000. This report summarizes the demographics, emm types and antimicrobial resistance of iGAS infections in Canada in 2020. Methods The Public Health Agency of Canada's National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of invasive S. pyogenes. Emm typing was performed on all isolates using the Centers for Disease Control and Prevention emm sequencing protocol. Antimicrobial susceptibilities were determined using Kirby-Bauer disk diffusion according to Clinical and Laboratory Standards Institute guidelines. Population-based iGAS disease incidence rates up to 2019 were obtained through the Canadian Notifiable Disease Surveillance System. Results Overall, the incidence of iGAS disease in Canada has increased from 4.0 to 8.1 cases per 100,000 population from 2009 to 2019. The 2019 incidence represents a slight decrease from the 2018 rate of 8.6 cases per 100,000 population. A total of 2,867 invasive S. pyogenes isolates that were collected during 2020 are included in this report, representing a decrease from 2019 (n=3,194). The most common emm types in 2020 were emm49 (16.8%, n=483) and emm76 (15.0%, n=429), both increasing significantly in prevalence since 2016 (p<0.001). The former most prevalent type, emm1, decreased to 7.6% (n=217) in 2020 from 15.4% (n=325) in 2016. Antimicrobial resistance rates in 2020 included 11.5% resistance to erythromycin, 3.2% resistance to clindamycin and 1.6% nonsusceptibility to chloramphenicol. Conclusion Though the number of collected invasive S. pyogenes isolates decreased slightly in 2020 in comparison to previous years, iGAS disease remains an important public health concern. The emm distribution in Canada has been subtly shifting over the past five years, away from common and well-known emm1 and towards emm49 and emm76. It is important to continue surveillance of S. pyogenes in Canada to monitor expanding replacement emm types, as well as outbreak clones and antimicrobial resistance.
Collapse
Affiliation(s)
- Alyssa Golden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Gregory Tyrrell
- Provincial Laboratory for Public Health (Microbiology), Edmonton, AB
| | - Julianne Kus
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, ON
| | - Marc-Christian Domingo
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
| | | | | | - Hanan Smadi
- New Brunswick Department of Health, Fredericton, NB
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, NS
| | | | | | - Laura Steven
- Stanton Territorial Hospital Laboratory, Yellowknife, NT
| | | | - Anita Li
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Michael Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| |
Collapse
|
39
|
Cholette F, Fabia R, Harris A, Ellis H, Cachero K, Schroeder L, Mesa C, Lacap P, Arnold C, Galipeau Y, Langlois MA, Colwill K, Gingras AC, McGeer A, Giles E, Day J, Osiowy C, Durocher Y, Hankins C, Mazer B, Drebot M, Kim J. Comparative performance data for multiplex SARS-CoV-2 serological assays from a large panel of dried blood spot specimens. Heliyon 2022; 8:e10270. [PMID: 36060461 PMCID: PMC9420314 DOI: 10.1016/j.heliyon.2022.e10270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 08/06/2022] [Accepted: 08/09/2022] [Indexed: 11/02/2022] Open
Abstract
The extent of the COVID-19 pandemic will be better understood through serosurveys and SARS-CoV-2 antibody testing. Dried blood spot (DBS) samples will play a central role in large scale serosurveillance by simplifying biological specimen collection and transportation, especially in Canada. Direct comparative performance data on multiplex SARS-CoV-2 assays resulting from identical DBS samples are currently lacking. In our study, we aimed to provide performance data for the BioPlex 2200 SARS-CoV-2 IgG (Bio-Rad), V-PLEX SARS-CoV-2 Panel 2 IgG (MSD), and Elecsys Anti-SARS-CoV-2 (Roche) commercial assays, as well as for two highly scalable in-house assays (University of Ottawa and Mount Sinai Hospital protocols) to assess their suitability for DBS-based SARS-CoV-2 DBS serosurveillance. These assays were evaluated against identical panels of DBS samples collected from convalescent COVID-19 patients (n = 97) and individuals undergoing routine sexually transmitted and bloodborne infection (STBBI) testing prior to the COVID-19 pandemic (n = 90). Our findings suggest that several assays are suitable for serosurveillance (sensitivity >97% and specificity >98%). In contrast to other reports, we did not observe an improvement in performance using multiple antigen consensus-based rules to establish overall seropositivity. This may be due to our DBS panel which consisted of samples collected from convalescent COVID-19 patients with significant anti-spike, -receptor binding domain (RBD), and -nucleocapsid antibody titers. This study demonstrates that biological specimens collected as DBS coupled with one of several readily available assays are useful for large-scale COVID-19 serosurveillance.
Collapse
|
40
|
Strahm C, Seneghini M, Güsewell S, Egger T, Leal-Neto O, Brucher A, Lemmenmeier E, Meier Kleeb D, Möller JC, Rieder P, Ruetti M, Rutz R, Schmid HR, Stocker R, Vuichard-Gysin D, Wiggli B, Besold U, Kuster SP, McGeer A, Risch L, Friedl A, Schlegel M, Schmid D, Vernazza P, Kahlert CR, Kohler P. Symptoms Compatible With Long Coronavirus Disease (COVID) in Healthcare Workers With and Without Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection-Results of a Prospective Multicenter Cohort. Clin Infect Dis 2022; 75:e1011-e1019. [PMID: 35090015 PMCID: PMC9383387 DOI: 10.1093/cid/ciac054] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND The burden of long-term symptoms (ie, long COVID) in patients after mild COVID-19 is debated. Within a cohort of healthcare workers (HCWs), frequency and risk factors for symptoms compatible with long COVID are assessed. METHODS Participants answered baseline (August/September 2020) and weekly questionnaires on SARS-CoV-2 nasopharyngeal swab (NPS) results and acute disease symptoms. In January 2021, SARS-CoV-2 serology was performed; in March, symptoms compatible with long COVID (including psychometric scores) were asked and compared between HCWs with positive NPS, seropositive HCWs without positive NPS (presumable asymptomatic/pauci-symptomatic infections), and negative controls. The effect of time since diagnosis and quantitative anti-spike protein antibodies (anti-S) was evaluated. Poisson regression was used to identify risk factors for symptom occurrence. RESULTS Of 3334 HCWs (median, 41 years; 80% female), 556 (17%) had a positive NPS and 228 (7%) were only seropositive. HCWs with positive NPS more frequently reported ≥1 symptom compared with controls (73% vs 52%, P < .001); seropositive HCWs without positive NPS did not score higher than controls (58% vs 52%, P = .13), although impaired taste/olfaction (16% vs 6%, P < .001) and hair loss (17% vs 10%, P = .004) were more common. Exhaustion/burnout was reported by 24% of negative controls. Many symptoms remained elevated in those diagnosed >6 months ago; anti-S titers correlated with high symptom scores. Acute viral symptoms in weekly questionnaires best predicted long-COVID symptoms. Physical activity at baseline was negatively associated with neurocognitive impairment and fatigue scores. CONCLUSIONS Seropositive HCWs without positive NPS are only mildly affected by long COVID. Exhaustion/burnout is common, even in noninfected HCWs. Physical activity might be protective against neurocognitive impairment/fatigue symptoms after COVID-19.
Collapse
Affiliation(s)
- Carol Strahm
- Correspondence: C. Strahm, Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, Rorschacherstrasse 95, 9011 St Gallen, Switzerland ()
| | - Marco Seneghini
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Sabine Güsewell
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Thomas Egger
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Onicio Leal-Neto
- Epitrack, Recife, Brazil
- Department of Economics, University of Zurich, Zurich, Switzerland
| | - Angela Brucher
- Psychiatry Services of the Canton of St Gallen (South), St Gallen, Switzerland
| | - Eva Lemmenmeier
- Clienia Littenheid AG, Private Clinic for Psychiatry and Psychotherapy, Littenheid, Switzerland
| | | | - J Carsten Möller
- Center for Neurological Rehabilitation, Zihlschlacht, Switzerland
| | | | - Markus Ruetti
- Fuerstenland Toggenburg Hospital Group, Wil, Switzerland
| | - Remus Rutz
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | | | - Danielle Vuichard-Gysin
- Division of Infectious Diseases and Hospital Epidemiology, Thurgau Hospital Group, Muensterlingen, Switzerland
| | - Benedikt Wiggli
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | | | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
- Federal Office of Public Health, Bern, Switzerland
| | | | - Lorenz Risch
- Labormedizinisches Zentrum Dr Risch Ostschweiz AG, Buchs, Switzerland
- Private Universität im Fürstentum Liechtenstein, Triesen, Liechtenstein
- Center of Laboratory Medicine, Institute of Clinical Chemistry, University of Bern, Inselspital, Bern, Switzerland
| | - Andrée Friedl
- Division of Infectious Diseases and Hospital Epidemiology, Kantonsspital Baden, Baden, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Dagmar Schmid
- Clinic for Psychosomatic and Consultation Psychiatry, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - Pietro Vernazza
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St Gallen, St Gallen, Switzerland
| | | | | |
Collapse
|
41
|
Sheikh-Mohamed S, Isho B, Chao GY, Zuo M, Cohen C, Lustig Y, Nahass GR, Salomon-Shulman RE, Blacker G, Fazel-Zarandi M, Rathod B, Colwill K, Jamal A, Li Z, de Launay KQ, Takaoka A, Garnham-Takaoka J, Patel A, Fahim C, Paterson A, Li AX, Haq N, Barati S, Gilbert L, Green K, Mozafarihashjin M, Samaan P, Budylowski P, Siqueira WL, Mubareka S, Ostrowski M, Rini JM, Rojas OL, Weissman IL, Tal MC, McGeer A, Regev-Yochay G, Straus S, Gingras AC, Gommerman JL. Systemic and mucosal IgA responses are variably induced in response to SARS-CoV-2 mRNA vaccination and are associated with protection against subsequent infection. Mucosal Immunol 2022; 15:799-808. [PMID: 35468942 PMCID: PMC9037584 DOI: 10.1038/s41385-022-00511-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 59.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Revised: 03/02/2022] [Accepted: 03/23/2022] [Indexed: 02/04/2023]
Abstract
Although SARS-CoV-2 infects the upper respiratory tract, we know little about the amount, type, and kinetics of antibodies (Ab) generated in the oral cavity in response to COVID-19 vaccination. We collected serum and saliva samples from participants receiving two doses of mRNA COVID-19 vaccines and measured the level of anti-SARS-CoV-2 Ab. We detected anti-Spike and anti-Receptor Binding Domain (RBD) IgG and IgA, as well as anti-Spike/RBD associated secretory component in the saliva of most participants after dose 1. Administration of a second dose of mRNA boosted the IgG but not the IgA response, with only 30% of participants remaining positive for IgA at this timepoint. At 6 months post-dose 2, these participants exhibited diminished anti-Spike/RBD IgG levels, although secretory component-associated anti-Spike Ab were more stable. Examining two prospective cohorts we found that participants who experienced breakthrough infections with SARS-CoV-2 variants had lower levels of vaccine-induced serum anti-Spike/RBD IgA at 2-4 weeks post-dose 2 compared to participants who did not experience an infection, whereas IgG levels were comparable between groups. These data suggest that COVID-19 vaccines that elicit a durable IgA response may have utility in preventing infection. Our study finds that a local secretory component-associated IgA response is induced by COVID-19 mRNA vaccination that persists in some, but not all participants. The serum and saliva IgA response modestly correlate at 2-4 weeks post-dose 2. Of note, levels of anti-Spike serum IgA (but not IgG) at this timepoint are lower in participants who subsequently become infected with SARS-CoV-2. As new surges of SARS-CoV-2 variants arise, developing COVID-19 booster shots that provoke high levels of IgA has the potential to reduce person-to-person transmission.
Collapse
Affiliation(s)
| | - Baweleta Isho
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Gary Y.C. Chao
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Michelle Zuo
- Department of Immunology, University of Toronto, Toronto, ON, Canada
| | - Carmit Cohen
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Yaniv Lustig
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel,Central Virology Laboratory, Public Health Services, Ministry of Health, Sheba Medical Center, Tel-Hashomer, Tel-Aviv University, Tel Aviv-Yafo, Israel,Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - George R. Nahass
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA,University of Illinois-Chicago, College of Medicine, Chicago, USA
| | - Rachel E. Salomon-Shulman
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Grace Blacker
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Bhavisha Rathod
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Karen Colwill
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Alainna Jamal
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Zhijie Li
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | - Keelia Quinn de Launay
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Alyson Takaoka
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Julia Garnham-Takaoka
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Anjali Patel
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Christine Fahim
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Aimee Paterson
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Angel Xinliu Li
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Nazrana Haq
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Shiva Barati
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Lois Gilbert
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Karen Green
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | | | - Philip Samaan
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Patrick Budylowski
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | | | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada,Sunnybrook Health Sciences Centre, Toronto, ON, Canada
| | - Mario Ostrowski
- Department of Immunology, University of Toronto, Toronto, ON, Canada,Department of Medicine, University of Toronto, Toronto, ON, Canada,Keenan Research Centre for Biomedical Science, Toronto, ON, Canada
| | - James M. Rini
- Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada,Department of Biochemistry, University of Toronto, Toronto, ON, Canada
| | - Olga L. Rojas
- Krembil Research Institute, University Health Network, Toronto, ON, Canada
| | - Irving L. Weissman
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Michal Caspi Tal
- Institute for Stem Cell Biology and Regenerative Medicine and the Ludwig Cancer Center, Stanford University School of Medicine, Stanford, CA, USA
| | - Allison McGeer
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Gili Regev-Yochay
- Sheba Medical Center Tel Hashomer, Ramat Gan, Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - Sharon Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada,Department of Molecular Genetics, University of Toronto, Toronto, ON, Canada
| | | |
Collapse
|
42
|
Pedersen J, Koumakpayi IH, Babuadze G, Baz M, Ndiaye O, Faye O, Diagne CT, Dia N, Naghibosadat M, McGeer A, Muberaka S, Moukandja IP, Ndidi S, Tauil CB, Lekana-Douki JB, Loucoubar C, Faye O, Sall A, Magalhães KG, Weis N, Kozak R, Kobinger GP, Fausther-Bovendo H. Cross-reactive immunity against SARS-CoV-2 N protein in Central and West Africa precedes the COVID-19 pandemic. Sci Rep 2022; 12:12962. [PMID: 35902675 PMCID: PMC9333058 DOI: 10.1038/s41598-022-17241-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 07/22/2022] [Indexed: 12/22/2022] Open
Abstract
Early predictions forecasted large numbers of severe acute respiratory syndrome coronavirus (SARS-CoV-2) cases and associated deaths in Africa. To date, Africa has been relatively spared. Various hypotheses were postulated to explain the lower than anticipated impact on public health in Africa. However, the contribution of pre-existing immunity is yet to be investigated. In this study, the presence of antibodies against SARS-CoV-2 spike (S) and nucleocapsid (N) proteins in pre-pandemic samples from Africa, Europe, South and North America was examined by ELISA. The protective efficacy of N specific antibodies isolated from Central African donors was tested by in vitro neutralization and in a mouse model of SARS-CoV-2 infection. Antibodies against SARS-CoV-2 S and N proteins were rare in all populations except in Gabon and Senegal where N specific antibodies were prevalent. However, these antibodies failed to neutralize the virus either in vitro or in vivo. Overall, this study indicates that cross-reactive immunity against SARS-CoV-2 N protein was present in Africa prior to the pandemic. However, this pre-existing humoral immunity does not impact viral fitness in rodents suggesting that other human immune defense mechanisms could be involved. In Africa, seroprevalence studies using the N protein are over-estimating SARS-CoV-2 circulation.
Collapse
Affiliation(s)
- Jannie Pedersen
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Quebec City, Canada
| | | | - Giorgi Babuadze
- Biological Sciences Platform, University of Toronto, Sunnybrook Research Institute at Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Mariana Baz
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Quebec City, Canada
| | | | - Oumar Faye
- Institut Pasteur de Dakar, Dakar, Senegal
| | | | - Ndongo Dia
- Institut Pasteur de Dakar, Dakar, Senegal
| | - Maedeh Naghibosadat
- Biological Sciences Platform, University of Toronto, Sunnybrook Research Institute at Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Microbiology, Sinai Health System/University Health Network, Toronto, Canada
| | - Samira Muberaka
- Biological Sciences Platform, University of Toronto, Sunnybrook Research Institute at Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Stella Ndidi
- Centre Hospitalier Universitaire de Libreville, Libreville, Gabon
| | - Carlos B Tauil
- Laboratory of Immunology and Inflammation, University of Brasilia, Brasilia, Brazil
| | - Jean-Bernard Lekana-Douki
- Unité d'Evolution Epidémiologie et Résistances Parasitaires, Centre Interdisciplinaire de Recherches Médicales de Franceville, Franceville, Gabon
| | | | | | | | - Kelly G Magalhães
- Laboratory of Immunology and Inflammation, University of Brasilia, Brasilia, Brazil
| | - Nina Weis
- Department of Infectious Diseases, Copenhagen University Hospital, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Kozak
- Biological Sciences Platform, University of Toronto, Sunnybrook Research Institute at Sunnybrook Health Sciences Centre, Toronto, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada.,Department of Laboratory Medicine and Molecular Diagnostics, Division of Microbiology, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Gary P Kobinger
- Galveston National Laboratory, University of Texas Medical Branch, Galveston, TX, USA
| | - Hugues Fausther-Bovendo
- Département de Microbiologie-Infectiologie et Immunologie, Université Laval, Quebec City, Canada. .,Global Urgent and Advanced Research and Development, 911 Rue Principale, Unit 100, Batiscan, QC, G0X 1A0, Canada.
| |
Collapse
|
43
|
George PBL, Rossi F, St-Germain MW, Amato P, Badard T, Bergeron MG, Boissinot M, Charette SJ, Coleman BL, Corbeil J, Culley AI, Gaucher ML, Girard M, Godbout S, Kirychuk SP, Marette A, McGeer A, O’Shaughnessy PT, Parmley EJ, Simard S, Reid-Smith RJ, Topp E, Trudel L, Yao M, Brassard P, Delort AM, Larios AD, Létourneau V, Paquet VE, Pedneau MH, Pic É, Thompson B, Veillette M, Thaler M, Scapino I, Lebeuf M, Baghdadi M, Castillo Toro A, Cayouette AB, Dubois MJ, Durocher AF, Girard SB, Diaz AKC, Khalloufi A, Leclerc S, Lemieux J, Maldonado MP, Pilon G, Murphy CP, Notling CA, Ofori-Darko D, Provencher J, Richer-Fortin A, Turgeon N, Duchaine C. Antimicrobial Resistance in the Environment: Towards Elucidating the Roles of Bioaerosols in Transmission and Detection of Antibacterial Resistance Genes. Antibiotics (Basel) 2022; 11:antibiotics11070974. [PMID: 35884228 PMCID: PMC9312183 DOI: 10.3390/antibiotics11070974] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/30/2022] [Accepted: 07/15/2022] [Indexed: 02/01/2023] Open
Abstract
Antimicrobial resistance (AMR) is continuing to grow across the world. Though often thought of as a mostly public health issue, AMR is also a major agricultural and environmental problem. As such, many researchers refer to it as the preeminent One Health issue. Aerial transport of antimicrobial-resistant bacteria via bioaerosols is still poorly understood. Recent work has highlighted the presence of antibiotic resistance genes in bioaerosols. Emissions of AMR bacteria and genes have been detected from various sources, including wastewater treatment plants, hospitals, and agricultural practices; however, their impacts on the broader environment are poorly understood. Contextualizing the roles of bioaerosols in the dissemination of AMR necessitates a multidisciplinary approach. Environmental factors, industrial and medical practices, as well as ecological principles influence the aerial dissemination of resistant bacteria. This article introduces an ongoing project assessing the presence and fate of AMR in bioaerosols across Canada. Its various sub-studies include the assessment of the emissions of antibiotic resistance genes from many agricultural practices, their long-distance transport, new integrative methods of assessment, and the creation of dissemination models over short and long distances. Results from sub-studies are beginning to be published. Consequently, this paper explains the background behind the development of the various sub-studies and highlight their shared aspects.
Collapse
Affiliation(s)
- Paul B. L. George
- Département de Médecine Moléculaire, Université Laval, Quebec City, QC G1V 0A6, Canada; (P.B.L.G.); (J.C.); (I.S.)
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
| | - Florent Rossi
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Chimie de Clermont-Ferrand, SIGMA Clermont, CNRS, Université Clermont-Auvergne, 63178 Clermont-Ferrand, France; (P.A.); (A.-M.D.)
| | - Magali-Wen St-Germain
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Pierre Amato
- Institut de Chimie de Clermont-Ferrand, SIGMA Clermont, CNRS, Université Clermont-Auvergne, 63178 Clermont-Ferrand, France; (P.A.); (A.-M.D.)
| | - Thierry Badard
- Centre de Recherche en Données et Intelligence Géospatiales (CRDIG), Quebec City, QC G1V 0A6, Canada;
| | - Michel G. Bergeron
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Axe Maladies Infectieuses et Immunitaires, Quebec City, QC G1V 4G2, Canada; (M.G.B.); (M.B.); (É.P.)
| | - Maurice Boissinot
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Axe Maladies Infectieuses et Immunitaires, Quebec City, QC G1V 4G2, Canada; (M.G.B.); (M.B.); (É.P.)
| | - Steve J. Charette
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Brenda L. Coleman
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (B.L.C.); (A.M.)
| | - Jacques Corbeil
- Département de Médecine Moléculaire, Université Laval, Quebec City, QC G1V 0A6, Canada; (P.B.L.G.); (J.C.); (I.S.)
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Axe Maladies Infectieuses et Immunitaires, Quebec City, QC G1V 4G2, Canada; (M.G.B.); (M.B.); (É.P.)
| | - Alexander I. Culley
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Marie-Lou Gaucher
- Research Chair in Meat Safety, Département de Pathologie et Microbiologie, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada;
| | | | - Stéphane Godbout
- Institut de Recherche et de Développement en Agroenvironnement (IRDA), Quebec City, QC G1P 3W8, Canada; (S.G.); (A.D.L.); (A.K.C.D.)
- Département des Sols et de Génie Agroalimentaire, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Shelley P. Kirychuk
- Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X8, Canada; (S.P.K.); (B.T.); (A.C.T.); (C.A.N.)
| | - André Marette
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Allison McGeer
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada; (B.L.C.); (A.M.)
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Patrick T. O’Shaughnessy
- Department of Occupational and Environmental Health, The University of Iowa, Iowa City, IA 52246, USA;
| | - E. Jane Parmley
- Canadian Wildlife Health Cooperative, University of Guelph, Guelph, ON N1G 2W1, Canada;
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.J.R.-S.); (M.P.M.)
| | - Serge Simard
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Richard J. Reid-Smith
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.J.R.-S.); (M.P.M.)
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1G 3W4, Canada; (C.P.M.); (D.O.-D.)
| | - Edward Topp
- Agriculture and Agri-Food Canada, London Research and Development Centre, London, ON N5V 4T3, Canada;
- Department of Biology, The University of Western Ontario, London, ON N6A 5B7, Canada
| | - Luc Trudel
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
| | - Maosheng Yao
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, Beijing 100871, China;
| | - Patrick Brassard
- Département des Sols et de Génie Agroalimentaire, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Anne-Marie Delort
- Institut de Chimie de Clermont-Ferrand, SIGMA Clermont, CNRS, Université Clermont-Auvergne, 63178 Clermont-Ferrand, France; (P.A.); (A.-M.D.)
| | - Araceli D. Larios
- Institut de Recherche et de Développement en Agroenvironnement (IRDA), Quebec City, QC G1P 3W8, Canada; (S.G.); (A.D.L.); (A.K.C.D.)
- Tecnológico Nacional de México/ITS de Perote, Perote 91270, Mexico
| | - Valérie Létourneau
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Valérie E. Paquet
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Marie-Hélène Pedneau
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Émilie Pic
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Axe Maladies Infectieuses et Immunitaires, Quebec City, QC G1V 4G2, Canada; (M.G.B.); (M.B.); (É.P.)
| | - Brooke Thompson
- Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X8, Canada; (S.P.K.); (B.T.); (A.C.T.); (C.A.N.)
| | - Marc Veillette
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Mary Thaler
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Ilaria Scapino
- Département de Médecine Moléculaire, Université Laval, Quebec City, QC G1V 0A6, Canada; (P.B.L.G.); (J.C.); (I.S.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Maria Lebeuf
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Mahsa Baghdadi
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Alejandra Castillo Toro
- Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X8, Canada; (S.P.K.); (B.T.); (A.C.T.); (C.A.N.)
| | - Amélia Bélanger Cayouette
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Marie-Julie Dubois
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Alicia F. Durocher
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Sarah B. Girard
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Andrea Katherín Carranza Diaz
- Institut de Recherche et de Développement en Agroenvironnement (IRDA), Quebec City, QC G1P 3W8, Canada; (S.G.); (A.D.L.); (A.K.C.D.)
- Département des Sols et de Génie Agroalimentaire, Université Laval, Quebec City, QC G1V 0A6, Canada;
| | - Asmaâ Khalloufi
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Research Chair in Meat Safety, Département de Pathologie et Microbiologie, Université de Montréal, Saint-Hyacinthe, QC J2S 2M2, Canada;
| | - Samantha Leclerc
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Joanie Lemieux
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Centre de Recherche en Infectiologie, Centre de Recherche du CHU de Québec-Université Laval, Axe Maladies Infectieuses et Immunitaires, Quebec City, QC G1V 4G2, Canada; (M.G.B.); (M.B.); (É.P.)
| | - Manuel Pérez Maldonado
- Department of Population Medicine, University of Guelph, Guelph, ON N1G 2W1, Canada; (R.J.R.-S.); (M.P.M.)
| | - Geneviève Pilon
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON M5S 1A8, Canada
| | - Colleen P. Murphy
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1G 3W4, Canada; (C.P.M.); (D.O.-D.)
| | - Charly A. Notling
- Department of Medicine, University of Saskatchewan, Saskatoon, SK S7N 0X8, Canada; (S.P.K.); (B.T.); (A.C.T.); (C.A.N.)
| | - Daniel Ofori-Darko
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, ON N1G 3W4, Canada; (C.P.M.); (D.O.-D.)
| | - Juliette Provencher
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Institut de Biologie Intégrative et des Systèmes, Université Laval, Quebec City, QC G1V 0A6, Canada
| | - Annabelle Richer-Fortin
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Nathalie Turgeon
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
| | - Caroline Duchaine
- Département de Biochimie, de Microbiologie et de Bio-Informatique, Université Laval, Quebec City, QC G1V 0A6, Canada; (F.R.); (M.-W.S.-G.); (S.J.C.); (A.I.C.); (L.T.); (V.E.P.); (M.T.); (M.B.); (A.B.C.); (A.F.D.); (S.B.G.); (A.K.); (S.L.); (J.L.); (J.P.); (A.R.-F.)
- Centre de Recherche de L’Institut Universitaire de Cardiologie et de Pneumologie de Québec, Quebec City, QC G1V 4G5, Canada; (A.M.); (S.S.); (V.L.); (M.-H.P.); (M.V.); (M.L.); (M.-J.D.); (G.P.); (N.T.)
- Correspondence:
| |
Collapse
|
44
|
Nasreen S, Wang J, Sadarangani M, Kwong JC, Quach C, Crowcroft NS, Wilson SE, McGeer A, Morris SK, Kellner JD, Sander B, Kus JV, Hoang L, Marra F, Fadel SA. Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005-2018: a Canadian Immunisation Research Network (CIRN) study. BMJ Open Respir Res 2022; 9:9/1/e001218. [PMID: 35764362 PMCID: PMC9240885 DOI: 10.1136/bmjresp-2022-001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a paucity of data on the burden of the full spectrum of community-acquired pneumonia (CAP) and acute otitis media (AOM) from outpatient and inpatient settings across the age spectrum. Methods We conducted a population-based retrospective study in Ontario and British Columbia (BC), Canada, to estimate the incidence rate of CAP and AOM in children and adults over a 14-year period using health administrative databases. CAP and AOM cases were identified from outpatient physician consultation and hospitalisation data in both provinces, and from emergency department visit data in Ontario. Results During 2005–2018, Ontario had 3 607 124 CAP, 172 290 bacterial CAP, 7814 pneumococcal pneumonia, and 8 026 971 AOM cases. The incidence rate of CAP declined from 3077/100 000 in 2005 to 2604/100 000 in 2010 before increasing to 2843/100 000 in 2018; bacterial CAP incidence rate also declined from 178/100 000 in 2005 to 112/100 000 in 2010 before increasing to 149/100 000 in 2018. The incidence rate of AOM decreased from 4192/100 000 in 2005 to 3178/100 000 in 2018. BC had 970 455 CAP, 317 913 bacterial CAP, 35 287 pneumococcal pneumonia and 2 022 871 AOM cases. The incidence rate of CAP in BC decreased from 2214/100 000 in 2005 to 1964/100 000 in 2010 before increasing to 2176/100 000 in 2018; bacterial CAP incidence rate increased from 442/100 000 in 2005 to 981/100 000 in 2018. The incidence rate of AOM decreased from 3684/100 000 in 2005 to 2398/100 000 in 2018. The incidence rate of bacterial CAP increased with age in older adults (≥65 years) with the highest burden in the oldest cohort aged ≥85 years both before and after 13-valent pneumococcal conjugate vaccine (PCV13) programme in both provinces. Hospitalised pneumococcal pneumonia decreased slightly but non-hospitalised pneumococcal pneumonia increased in BC during PCV13 period. No consistent direct benefit of PCV13 on CAP was observed in the paediatric population. Conclusions There is a substantial burden of CAP and AOM in Ontario and BC. Indirect benefits from childhood PCV vaccination and polysaccharide vaccination of older adults have not substantially decreased the burden of pneumococcal pneumonia in older adults.
Collapse
Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada,University Health Network, Toronto, Ontario, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sinai Health System, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James D Kellner
- Department of Paediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaza A Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
45
|
Andrew MK, Godin J, LeBlanc J, Boivin G, Valiquette L, McGeer A, McElhaney JE, Hatchette TF, ElSherif M, MacKinnon-Cameron D, Wilson K, Ambrose A, Trottier S, Loeb M, Smith SW, Katz K, McCarthy A, McNeil SA. Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19. Can Geriatr J 2022; 25:183-196. [PMID: 35747412 PMCID: PMC9156416 DOI: 10.5770/cgj.25.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background We report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. Methods Patients with laboratory-confirmed COVID-19 admitted to 11 sites in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020 were enrolled in this prospective observational cohort study. Measures included age, sex, demographics, housing, exposures, Clinical Frailty Scale, comorbidities; in addition, length of stay, intensive care unit (ICU) admission, mechanical ventilation, and survival were assessed. Descriptive analyses and multivariable logistic regressions were conducted. Results Among 2,011 patients, mean age was 71.0 (range 19–105) years. 29.7% were admitted from assisted living or long-term care facilities. The full spectrum of frailty was represented in both younger and older age groups. 81.8% had at least one underlying comorbidity and 27.2% had obesity. Mortality was 14.3% without ICU admission, and 24.6% for those admitted to ICU. Older age and frailty were independent predictors of lower ICU use and higher mortality; accounting for frailty, obesity was not an independent predictor of mortality, and associations of comorbidities with mortality were weakened. Conclusions Frailty is a critical clinical factor in predicting outcomes of COVID-19, which should be considered in research and clinical settings.
Collapse
|
46
|
Jain A, Deshpande P, Yoon EW, Lee KS, McGeer A, Shah V. 2% aqueous vs alcohol-based chlorhexidine for skin antisepsis in VLBW neonates undergoing peripheral venipuncture: a non-inferiority trial. J Perinatol 2022; 42:636-641. [PMID: 35184146 DOI: 10.1038/s41372-022-01337-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 01/05/2022] [Accepted: 01/28/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare 2% aqueous chlorhexidine gluconate (AQC) vs. 2% chlorhexidine gluconate in 70% isopropyl alcohol (ALC) for pre-venipuncture skin antisepsis in very-low-birth-weight neonates (VLBW, birth-weight <1500 grams). STUDY DESIGN Double-blind, non-inferiority trial randomized 199 VLBW neonates, age 2-28 days, to receive pre-venipuncture skin preparation using single application of swabstick impregnated with AQC (n = 99) or ALC (n = 100). Skin clearance rate (percentage post-cleansing skin swabs with <15 bacterial colony forming units) with a 10% non-inferiority margin for AQC was primary outcome. Absolute and relative CFU reduction and adverse skin reactions were compared. RESULTS AQC's clearance was non-inferior to ALC (91% vs. 88%; 95% CI -6.6%, +12.4%). Median (interquartile range) absolute [61 (16, 110) vs. 63 (18, 100); p = 0.65] and relative [100% (97%, 100%) vs. 100% (99.7%, 100%); p = 0.20] CFU reductions were similar. Neither group experienced any adverse reactions. CONCLUSION AQC may provide non-inferior skin disinfection to ALC in VLBW neonates. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov NCT01270776.
Collapse
Affiliation(s)
- Amish Jain
- Department of Paediatrics, University of Toronto, Toronto, Canada.
| | - Poorva Deshpande
- Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Eugene W Yoon
- Maternal and Infant Care Research Center (MiCare), University of Toronto, Toronto, Canada
| | - Kyong-Soon Lee
- Division of Neonatology, the Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Allison McGeer
- Microbiology, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Vibhuti Shah
- Department of Paediatrics, University of Toronto, Toronto, Canada
| |
Collapse
|
47
|
Ren A, Sohaei D, Ulndreaj A, Pons-Belda OD, Fernandez-Uriarte A, Zacharioudakis I, Sigal GB, Stengelin M, Mathew A, Campbell C, Padmanabhan N, Romero D, Joe J, Soosaipillai A, Kulasingam V, Mazzulli T, Li XA, McGeer A, Diamandis EP, Prassas I. Ultrasensitive assay for saliva-based SARS-CoV-2 antigen detection. Clin Chem Lab Med 2022; 60:771-777. [PMID: 35170269 DOI: 10.1515/cclm-2021-1142] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/28/2022] [Indexed: 12/17/2022]
Abstract
OBJECTIVES Widespread SARS-CoV-2 testing is invaluable for identifying asymptomatic/pre-symptomatic individuals. There remains a technological gap for highly reliable, easy, and quick SARS-CoV-2 diagnostic tests suitable for frequent mass testing. Compared to nasopharyngeal (NP) swab-based tests, saliva-based methods are attractive due to easier and safer sampling. Current saliva-based SARS-CoV-2 rapid antigen tests (RATs) are hindered by limited analytical sensitivity. Here, we report one of the first ultrasensitive, saliva-based SARS-CoV-2 antigen assays with an analytical sensitivity of <0.32 pg/mL, corresponding to four viral RNA copies/µL, which is comparable to that of PCR-based tests. METHODS Using the novel electrochemiluminescence (ECL)-based immunoassay, we measured the SARS-CoV-2 nucleocapsid (N) antigen concentration in 105 salivas, obtained from non-COVID-19 and COVID-19 patients. We then verified the results with a second, independent cohort of 689 patients (3.8% SARS-CoV-2 positivity rate). We also compared our method with a widely used point-of-care rapid test. RESULTS In the first cohort, at 100% specificity, the sensitivity was 92%. Our assay correctly identified samples with viral loads up to 35 CT cycles by saliva-based PCR. Paired NP swab-based PCR results were obtained for 86 cases. Our assay showed high concordance with saliva-based and NP swab-based PCR in samples with negative (<0.32 pg/mL) and strongly positive (>2 pg/mL) N antigen concentrations. In the second cohort, at 100% specificity, sensitivity was also 92%. Our assay is about 700-fold more sensitive than the Abbott Panbio Rapid Test. CONCLUSIONS We demonstrated the ultrasensitivity and specificity assay and its concordance with PCR. This novel assay is especially valuable when compliance to frequent swabbing may be problematic.
Collapse
Affiliation(s)
- Annie Ren
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Dorsa Sohaei
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Antigona Ulndreaj
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | - Oscar D Pons-Belda
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
| | | | | | | | | | - Anu Mathew
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | | | | | - Daniel Romero
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | - Jessica Joe
- Meso Scale Diagnostics, LLC. (MSD), Rockville, MD, USA
| | | | - Vathany Kulasingam
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Microbiology, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | - Xinliu A Li
- Department of Microbiology, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | - Allison McGeer
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Department of Microbiology, University Health Network, Mount Sinai Hospital, Toronto, Canada
| | - Eleftherios P Diamandis
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
- Department of Clinical Biochemistry, University Health Network, Toronto, ON, Canada
| | - Ioannis Prassas
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Canada
- Department of Pathology and Laboratory Medicine, Mount Sinai Hospital, Toronto, Canada
| |
Collapse
|
48
|
Coleman BL, Fischer K, Maunder R, Kim J, Straus S, Bondy S, McGeer A. Study of the epidemiology of COVID-19 in Ontario elementary and secondary school education workers: an interim analysis following the first school year. Can J Public Health 2022; 113:185-195. [PMID: 35175584 PMCID: PMC8853268 DOI: 10.17269/s41997-022-00613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Accepted: 01/24/2022] [Indexed: 12/02/2022]
Abstract
Objective To estimate the incidence of SARS-CoV-2 in education workers and the factors associated with infection between March 2020 and July 2021. Methods A prospective cohort study of education workers working ≥8 h per week in Ontario, Canada. Participants self-reported results of tests for SARS-CoV-2 and completed online surveys about demographic information, exposures, and vaccinations against SARS-CoV-2. Participants submitted self-collected dried blood spots. Antibodies to SARS-CoV-2 spike, the receptor binding domain of spike, and nucleocapsid were assessed. Multivariable regression was used to assess risk factors for infection. Results Of 2834 participants, 85% were female, 81% were teaching staff, and 86% had received at least one dose of SARS-CoV-2 vaccine. Of the 1983 who had been tested via a respiratory specimen, 4.9% reported a positive test. Five additional participants had serologic testing suggestive of a previous infection (3.6% overall incidence). In multivariable regression analysis, risk factors for infection included exposure to a SARS-CoV-2 infected adult (adjusted incidence rate ratio (aIRR) 13.6; 95% confidence interval 8.6, 21.3) or child (aIRR 2.3; 1.3, 4.2) in the household, or school student (aIRR 1.9; 1.2, 3.2), or travel outside the province within 14 days of testing (aIRR 6.0; 1.5, 23.6). Conclusion In the first 18 months of the pandemic, education workers had a similar risk of infection with SARS-CoV-2 as other Ontario residents. Practicing protective measures whenever any household member has been exposed to a possible case and at all times when exposed to anyone from outside the home would help reduce the risk of infection.
Collapse
Affiliation(s)
- Brenda L Coleman
- Sinai Health System, Toronto, ON, Canada.
- University of Toronto, Toronto, ON, Canada.
| | | | - Robert Maunder
- Sinai Health System, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| | - John Kim
- National Microbiology Laboratory, Winnipeg, MB, Canada
| | - Sharon Straus
- University of Toronto, Toronto, ON, Canada
- Unity Health, Toronto, ON, Canada
| | | | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada
- University of Toronto, Toronto, ON, Canada
| |
Collapse
|
49
|
Lee T, Cheng MP, Vinh DC, Lee TC, Tran KC, Winston BW, Sweet D, Boyd JH, Walley KR, Haljan G, McGeer A, Lamontagne F, Fowler R, Maslove D, Singer J, Patrick DM, Marshall JC, Burns KD, Murthy S, Mann PK, Hernandez G, Donohoe K, Rocheleau G, Russell JA. Organ dysfunction and death in patients admitted to hospital with COVID-19 in pandemic waves 1 to 3 in British Columbia, Ontario and Quebec, Canada: a cohort study. CMAJ Open 2022; 10:E379-E389. [PMID: 35440485 PMCID: PMC9022939 DOI: 10.9778/cmajo.20210216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There have been multiple waves in the COVID-19 pandemic in many countries. We sought to compare mortality and respiratory, cardiovascular and renal dysfunction between waves in 3 Canadian provinces. METHODS We conducted a substudy of the ARBs CORONA I study, a multicentre Canadian pragmatic observational cohort study that examined the association of pre-existing use of angiotensin receptor blockers with outcomes in adults admitted to hospital with acute COVID-19 up to April 2021 from 9 community and teaching hospitals in 3 Canadian provinces (British Columbia, Ontario and Quebec). We excluded emergency department admissions without hospital admission, readmissions and admissions for another reason. We used logistic and 0-1-inflated β regression models to compare 28-day and in-hospital mortality, and the use of invasive mechanical ventilation, vasopressors and renal replacement therapy (RRT) between the first 3 waves of the COVID-19 pandemic in these provinces. RESULTS A total of 520, 572 and 245 patients in waves 1, 2 and 3, respectively, were included. Patients in wave 3 were on average younger and had fewer comorbidities than those in waves 1 and 2. The unadjusted 28-day mortality rate was significantly lower in wave 3 (7.8%) than in wave 1 (18.3%) (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.24-0.78) and wave 2 (16.3%) (OR 0.46, 95% CI 0.27-0.79). After adjustment for differences in baseline characteristics, the difference in 28-day mortality remained significant (adjusted OR wave 3 v. wave 1: 0.46, 95% CI 0.26-0.81; wave 3 v. wave 2: 0.52, 95% CI 0.29-0.91). In-hospital mortality findings were similar. Use of invasive mechanical ventilation or vasopressors was less common in waves 2 and 3 than in wave 1, and use of RRT was less common in wave 3 than in wave 1. INTERPRETATION Severity of illness decreased (lower mortality and less use of organ support) across waves among patients admitted to hospital with acute COVID-19, possibly owing to changes in patient demographic characteristics and management, such as increased use of dexamethasone. Continued application of proven therapies may further improve outcomes. STUDY REGISTRATION ClinicalTrials.gov, no. NCT04510623.
Collapse
Affiliation(s)
- Terry Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Matthew P Cheng
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Donald C Vinh
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Todd C Lee
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Karen C Tran
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Brent W Winston
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Sweet
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John H Boyd
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Keith R Walley
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Greg Haljan
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Allison McGeer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - François Lamontagne
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Robert Fowler
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David Maslove
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Joel Singer
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - David M Patrick
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - John C Marshall
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kevin D Burns
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Srinivas Murthy
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Puneet K Mann
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Geraldine Hernandez
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Kathryn Donohoe
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - Genevieve Rocheleau
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| | - James A Russell
- Centre for Health Evaluation and Outcome Sciences (T. Lee, Singer), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Division of Infectious Diseases (Cheng, Vinh, T.C. Lee), Department of Medicine, McGill University Health Centre, Montréal, Que.; Division of General Internal Medicine (Tran), Vancouver General Hospital; University of British Columbia (Tran, Sweet, Patrick, Murthy), Vancouver, BC; Departments of Critical Care Medicine (Winston), Medicine (Winston) and Biochemistry and Molecular Biology (Winston), Foothills Medical Centre; University of Calgary (Winston), Calgary, Alta.; Division of Critical Care Medicine (Sweet), Vancouver General Hospital; Centre for Heart Lung Innovation (Boyd, Walley, Russell) and Division of Critical Care Medicine (Boyd, Walley, Russell), St. Paul's Hospital, University of British Columbia, Vancouver, BC; Department of Medicine (Haljan), Surrey Memorial Hospital, Surrey, BC; Mount Sinai Hospital (McGeer); University of Toronto (McGeer), Toronto, Ont.; Université de Sherbrooke (Lamontagne), Sherbrooke, Que.; Sunnybrook Health Sciences Centre (Fowler), Toronto, Ont.; Department of Critical Care (Maslove), Kingston General Hospital and Queen's University, Kingston, Ont.; British Columbia Centre for Disease Control (Patrick), Vancouver, BC; Department of Surgery (Marshall), St. Michael's Hospital, Toronto, Ont.; Division of Nephrology (Burns), Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ont.; BC Children's Hospital (Murthy); Black Tusk Research Group (Mann, Hernandez, Donohoe, Rocheleau), Vancouver, BC
| |
Collapse
|
50
|
Casalino S, Mighton C, Clausen M, Frangione E, Chowdhary S, Chung M, Jordan Fung CY, Morgan G, MacDonald G, Lapadula E, Faghfoury H, Arnoldo S, Bearss E, Binnie A, Borgundvaag B, Chertkow H, Devine L, Friedmen SM, Gingras AC, Khan Z, Mazzulli T, McGeer A, McLeod S, Pugh T, Richardson D, Simpson J, Stern S, Strug L, Taher A, Wong I, Zarei N, Kaushik D, Goneau L, Dagher M, Noor A, Greenfeld E, Bombard Y, Taher J, Lerner-Ellis J. eP294: Return of genome sequencing results in ostensibly healthy COVID-19 positive individuals: GENCOV Study Canada. Genet Med 2022. [PMCID: PMC8935071 DOI: 10.1016/j.gim.2022.01.330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|