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Funk A, Florin TA, Kuppermann N, Finkelstein Y, Kazakoff A, Baldovsky M, Tancredi DJ, Breslin K, Bergmann KR, Gardiner M, Pruitt CM, Liu DR, Neuman MI, Wilkinson M, Ambroggio L, Pang XL, Cauchemez S, Malley R, Klassen TP, Lee BE, Payne DC, Mahmud SM, Freedman SB. Household Transmission Dynamics of Asymptomatic SARS-CoV-2-Infected Children: A Multinational, Controlled Case-Ascertained Prospective Study. Clin Infect Dis 2024:ciae069. [PMID: 38530249 DOI: 10.1093/cid/ciae069] [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: 11/01/2023] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Asymptomatic SARS-CoV-2 infection in children is highly prevalent but its acute and chronic implications have been minimally described. METHODS In this controlled case-ascertained household transmission study, we recruited asymptomatic children <18 years with SARS-CoV-2 nucleic acid testing performed at 12 tertiary care pediatric institutions in Canada and the United States. We attempted to recruit all test-positive children and 1 to 3 test-negative, site-matched controls. After 14 days' follow-up we assessed the clinical (ie, symptomatic) and combined (ie, test-positive, or symptomatic) secondary attack rates (SARs) among household contacts. Additionally, post-COVID-19 condition (PCC) was assessed in SARS-CoV-2-positive participating children after 90 days' follow-up. RESULTS A total of 111 test-positive and 256 SARS-CoV-2 test-negative asymptomatic children were enrolled between January 2021 and April 2022. After 14 days, excluding households with co-primary cases, the clinical SAR among household contacts of SARS-CoV-2-positive and -negative index children was 10.6% (19/179; 95% CI: 6.5%-16.1%) and 2.0% (13/663; 95% CI: 1.0%-3.3%), respectively (relative risk = 5.4; 95% CI: 2.7-10.7). In households with a SARS-CoV-2-positive index child, age <5 years, being pre-symptomatic (ie, developed symptoms after test), and testing positive during Omicron and Delta circulation periods (vs earlier) were associated with increased clinical and combined SARs among household contacts. Among 77 asymptomatic SARS-CoV-2-infected children with 90-day follow-up, 6 (7.8%; 95% CI: 2.9%-16.2%) reported PCC. CONCLUSIONS Asymptomatic SARS-CoV-2-infected children, especially those <5 years, are important contributors to household transmission, with 1 in 10 exposed household contacts developing symptomatic illness within 14 days. Asymptomatic SARS-CoV-2-infected children may develop PCC.
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Affiliation(s)
- Anna Funk
- Department of Obstetrics and Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Division of Emergency Medicine, Ann and Robert H. Lurie Children's Hospital Chicago, Chicago, Illinois, USA
| | - Nathan Kuppermann
- Department of Emergency Medicine, University of California, Davis School of Medicine, Sacramento, California, USA
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alissa Kazakoff
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Michael Baldovsky
- Division of Pediatric Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Daniel J Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento, California, USA
| | - Kristen Breslin
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C., USA
| | - Kelly R Bergmann
- Department of Pediatric Emergency Medicine, Children's Minnesota, Minneapolis, Minnesota, USA
| | - Michael Gardiner
- Department of Pediatrics, University of California, San Diego School of Medicine, San Diego, California, USA
- Division of Emergency Medicine, Rady Children's Hospital, San Diego, California, USA
| | - Christopher M Pruitt
- Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Deborah R Liu
- Division of Emergency Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck USC School of Medicine, Los Angeles, California, USA
| | - Mark I Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts, USA
| | - Matthew Wilkinson
- Department of Pediatrics, University of Texas at Austin, Dell Medical School, Austin, Texas, USA
| | - Lilliam Ambroggio
- Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
- Section of Emergency Medicine, Children's Hospital Colorado, Aurora, Colorado, USA
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Simon Cauchemez
- Mathematical Modelling of Infectious Diseases Unit, Institut Pasteur, Université Paris Cité, CNRS UMR 2000, Paris, France
| | - Richard Malley
- Division of Infectious Diseases, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | - Terry P Klassen
- Children's Hospital Research Institute of Manitoba, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Daniel C Payne
- National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Salaheddin M Mahmud
- Dept of Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Section of Gastroenterology, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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2
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Dai X, Acosta N, Lu X, Hubert CRJ, Lee J, Frankowski K, Bautista MA, Waddell BJ, Du K, McCalder J, Meddings J, Ruecker N, Williamson T, Southern DA, Hollman J, Achari G, Ryan MC, Hrudey SE, Lee BE, Pang X, Clark RG, Parkins MD, Chekouo T. A Bayesian framework for modeling COVID-19 case numbers through longitudinal monitoring of SARS-CoV-2 RNA in wastewater. Stat Med 2024; 43:1153-1169. [PMID: 38221776 DOI: 10.1002/sim.10009] [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: 05/02/2023] [Revised: 11/11/2023] [Accepted: 12/21/2023] [Indexed: 01/16/2024]
Abstract
Wastewater-based surveillance has become an important tool for research groups and public health agencies investigating and monitoring the COVID-19 pandemic and other public health emergencies including other pathogens and drug abuse. While there is an emerging body of evidence exploring the possibility of predicting COVID-19 infections from wastewater signals, there remain significant challenges for statistical modeling. Longitudinal observations of viral copies in municipal wastewater can be influenced by noisy datasets and missing values with irregular and sparse samplings. We propose an integrative Bayesian framework to predict daily positive cases from weekly wastewater observations with missing values via functional data analysis techniques. In a unified procedure, the proposed analysis models severe acute respiratory syndrome coronavirus-2 RNA wastewater signals as a realization of a smooth process with error and combines the smooth process with COVID-19 cases to evaluate the prediction of positive cases. We demonstrate that the proposed framework can achieve these objectives with high predictive accuracies through simulated and observed real data.
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Affiliation(s)
- Xiaotian Dai
- Department of Mathematics, Illinois State University, Normal, Illinois, USA
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Xuewen Lu
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
| | - Casey R J Hubert
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Jangwoo Lee
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, Calgary, Alberta, Canada
| | - Maria A Bautista
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Barbara J Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Jon Meddings
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Norma Ruecker
- Water Services, City of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Centre for Health Informatics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jordan Hollman
- Department of Geosciences, University of Calgary, Calgary, Alberta, Canada
| | - Gopal Achari
- Department of Civil Engineering, University of Calgary, Calgary, Alberta, Canada
| | - M Cathryn Ryan
- Department of Geosciences, University of Calgary, Calgary, Alberta, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Rhonda G Clark
- Department of Biological Science, University of Calgary, Calgary, Alberta, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Alberta Health Services, Edmonton, Alberta, Canada
| | - Thierry Chekouo
- Department of Mathematics and Statistics, University of Calgary, Calgary, Alberta, Canada
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
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3
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Parkins MD, Lee BE, Acosta N, Bautista M, Hubert CRJ, Hrudey SE, Frankowski K, Pang XL. Wastewater-based surveillance as a tool for public health action: SARS-CoV-2 and beyond. Clin Microbiol Rev 2024; 37:e0010322. [PMID: 38095438 PMCID: PMC10938902 DOI: 10.1128/cmr.00103-22] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Indexed: 03/16/2024] Open
Abstract
Wastewater-based surveillance (WBS) has undergone dramatic advancement in the context of the coronavirus disease 2019 (COVID-19) pandemic. The power and potential of this platform technology were rapidly realized when it became evident that not only did WBS-measured SARS-CoV-2 RNA correlate strongly with COVID-19 clinical disease within monitored populations but also, in fact, it functioned as a leading indicator. Teams from across the globe rapidly innovated novel approaches by which wastewater could be collected from diverse sewersheds ranging from wastewater treatment plants (enabling community-level surveillance) to more granular locations including individual neighborhoods and high-risk buildings such as long-term care facilities (LTCF). Efficient processes enabled SARS-CoV-2 RNA extraction and concentration from the highly dilute wastewater matrix. Molecular and genomic tools to identify, quantify, and characterize SARS-CoV-2 and its various variants were adapted from clinical programs and applied to these mixed environmental systems. Novel data-sharing tools allowed this information to be mobilized and made immediately available to public health and government decision-makers and even the public, enabling evidence-informed decision-making based on local disease dynamics. WBS has since been recognized as a tool of transformative potential, providing near-real-time cost-effective, objective, comprehensive, and inclusive data on the changing prevalence of measured analytes across space and time in populations. However, as a consequence of rapid innovation from hundreds of teams simultaneously, tremendous heterogeneity currently exists in the SARS-CoV-2 WBS literature. This manuscript provides a state-of-the-art review of WBS as established with SARS-CoV-2 and details the current work underway expanding its scope to other infectious disease targets.
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Affiliation(s)
- Michael D. Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- O’Brien Institute of Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E. Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Nicole Acosta
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maria Bautista
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Casey R. J. Hubert
- Department of Biological Sciences, Faculty of Science, University of Calgary, Calgary, Alberta, Canada
| | - Steve E. Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, Calgary, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Provincial Health Laboratory, Alberta Health Services, Calgary, Alberta, Canada
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4
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Conradi N, Opoka RO, Mian Q, Conroy AL, Hermann LL, Charles O, Amone J, Nabwire J, Lee BE, Saleh A, Mandhane P, Namasopo S, Hawkes MT. Solar-powered O 2 delivery for the treatment of children with hypoxaemia in Uganda: a stepped-wedge, cluster randomised controlled trial. Lancet 2024; 403:756-765. [PMID: 38367643 DOI: 10.1016/s0140-6736(23)02502-3] [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] [Received: 05/22/2023] [Revised: 11/05/2023] [Accepted: 11/06/2023] [Indexed: 02/19/2024]
Abstract
BACKGROUND Supplemental O2 is not always available at health facilities in low-income and middle-income countries (LMICs). Solar-powered O2 delivery can overcome gaps in O2 access, generating O2 independent of grid electricity. We hypothesized that installation of solar-powered O2 systems on the paediatrics ward of rural Ugandan hospitals would lead to a reduction in mortality among hypoxaemic children. METHODS In this pragmatic, country-wide, stepped-wedge, cluster randomised controlled trial, solar-powered O2 systems (ie, photovoltaic cells, battery bank, and O2 concentrator) were sequentially installed at 20 rural health facilities in Uganda. Sites were selected for inclusion based on the following criteria: District Hospital or Health Centre IV with paediatric inpatient services; supplemental O2 on the paediatric ward was not available or was unreliable; and adequate space to install solar panels, a battery bank, and electrical wiring. Allocation concealment was achieved for sites up to 2 weeks before installation, but the study was not masked overall. Children younger than 5 years admitted to hospital with hypoxaemia and respiratory signs were included. The primary outcome was mortality within 48 h of detection of hypoxaemia. The statistical analysis used a linear mixed effects logistic regression model accounting for cluster as random effect and calendar time as fixed effect. The trial is registered at ClinicalTrials.gov, NCT03851783. FINDINGS Between June 28, 2019, and Nov 30, 2021, 2409 children were enrolled across 20 hospitals and, after exclusions, 2405 children were analysed. 964 children were enrolled before site randomisation and 1441 children were enrolled after site randomisation (intention to treat). There were 104 deaths, 91 of which occurred within 48 h of detection of hypoxaemia. The 48 h mortality was 49 (5·1%) of 964 children before randomisation and 42 (2·9%) of 1440 (one individual did not have vital status documented at 48 h) after randomisation (adjusted odds ratio 0·50, 95% CI 0·27-0·91, p=0·023). Results were sensitive to alternative parameterisations of the secular trend. There was a relative risk reduction of 48·7% (95% CI 8·5-71·5), and a number needed to treat with solar-powered O2 of 45 (95% CI 28-230) to save one life. Use of O2 increased from 484 (50·2%) of 964 children before randomisation to 1424 (98·8%) of 1441 children after randomisation (p<0·0001). Adverse events were similar before and after randomisation and were not considered to be related to the intervention. The estimated cost-effectiveness was US$25 (6-505) per disability-adjusted life-year saved. INTERPRETATION This stepped-wedge, cluster randomised controlled trial shows the mortality benefit of improving O2 access with solar-powered O2. This study could serve as a model for scale-up of solar-powered O2 as one solution to O2 insecurity in LMICs. FUNDING Grand Challenges Canada and The Women and Children's Health Research Institute.
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Affiliation(s)
- Nicholas Conradi
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Robert O Opoka
- Department of Paediatrics and Child Health, Mulago Hospital and Makerere University, Kampala, Uganda; Global Health Uganda, Kampala, Uganda
| | - Qaasim Mian
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Andrea L Conroy
- Indiana University School of Medicine, Indianapolis, IN, USA
| | | | - Olaro Charles
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Jackson Amone
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Piush Mandhane
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sophie Namasopo
- Ministry of Health, Kabale, Uganda; Kabale Regional Referral Hospital, Kabale, Uganda
| | - Michael T Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada; Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada; School of Public Health, University of Alberta, Edmonton, AB, Canada; Stollery Science Lab, Edmonton, AB, Canada; Women and Children's Health Research Institute, Edmonton, AB, Canada.
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5
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Hasing ME, Lee BE, Gao T, Li Q, Qiu Y, Ellehoj E, Graber TE, Fuzzen M, Servos M, Landgraff C, Delatolla R, Tipples G, Zelyas N, Hinshaw D, Maal-Bared R, Sikora C, Parkins M, Hubert CRJ, Frankowski K, Hrudey SE, Pang XL. Wastewater surveillance monitoring of SARS-CoV-2 variants of concern and dynamics of transmission and community burden of COVID-19. Emerg Microbes Infect 2023; 12:2233638. [PMID: 37409382 PMCID: PMC10408568 DOI: 10.1080/22221751.2023.2233638] [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: 11/21/2022] [Revised: 06/04/2023] [Accepted: 07/01/2023] [Indexed: 07/07/2023]
Abstract
Wastewater-based surveillance is a valuable approach for monitoring COVID-19 at community level. Monitoring SARS-CoV-2 variants of concern (VOC) in wastewater has become increasingly relevant when clinical testing capacity and case-based surveillance are limited. In this study, we ascertained the turnover of six VOC in Alberta wastewater from May 2020 to May 2022. Wastewater samples from nine wastewater treatment plants across Alberta were analysed using VOC-specific RT-qPCR assays. The performance of the RT-qPCR assays in identifying VOC in wastewater was evaluated against next generation sequencing. The relative abundance of each VOC in wastewater was compared to positivity rate in COVID-19 testing. VOC-specific RT-qPCR assays performed comparatively well against next generation sequencing; concordance rates ranged from 89% to 98% for detection of Alpha, Beta, Gamma, Omicron BA.1 and Omicron BA.2, with a slightly lower rate of 85% for Delta (p < 0.01). Elevated relative abundance of Alpha, Delta, Omicron BA.1 and BA.2 were each associated with increased COVID-19 positivity rate. Alpha, Delta and Omicron BA.2 reached 90% relative abundance in wastewater within 80, 111 and 62 days after their initial detection, respectively. Omicron BA.1 increased more rapidly, reaching a 90% relative abundance in wastewater after 35 days. Our results from VOC surveillance in wastewater correspond with clinical observations that Omicron is the VOC with highest disease burden over the shortest period in Alberta to date. The findings suggest that changes in relative abundance of a VOC in wastewater can be used as a supplementary indicator to track and perhaps predict COVID-19 burden in a population.
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Affiliation(s)
- Maria E. Hasing
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E. Lee
- Department of Paediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Qiaozhi Li
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Erik Ellehoj
- Ellehoj Redmond Consulting, Edmonton, Alberta, Canada
| | - Tyson E. Graber
- Children’s Hospital of Eastern Ontario Research Institute, Ottawa, Ontario, Canada
| | - Meghan Fuzzen
- Department of Biology, University of Waterloo, Waterloo, Ontario, Canada
| | - Mark Servos
- Department of Biology, University of Waterloo, Waterloo, Ontario, Canada
| | - Chrystal Landgraff
- Division of Enteric Diseases, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Robert Delatolla
- Department of Civil Engineering, University of Ottawa, Ottawa, Ontario, Canada
| | - Graham Tipples
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Deena Hinshaw
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Christopher Sikora
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Michael Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Casey R. J. Hubert
- Department of Biological Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, Calgary, Alberta, Canada
| | - Steve E. Hrudey
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoli L. Pang
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
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6
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Acosta N, Dai X, Bautista MA, Waddell BJ, Lee J, Du K, McCalder J, Pradhan P, Papparis C, Lu X, Chekouo T, Krusina A, Southern D, Williamson T, Clark RG, Patterson RA, Westlund P, Meddings J, Ruecker N, Lammiman C, Duerr C, Achari G, Hrudey SE, Lee BE, Pang X, Frankowski K, Hubert CRJ, Parkins MD. Wastewater-based surveillance can be used to model COVID-19-associated workforce absenteeism. Sci Total Environ 2023; 900:165172. [PMID: 37379934 PMCID: PMC10292917 DOI: 10.1016/j.scitotenv.2023.165172] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/21/2023] [Accepted: 06/25/2023] [Indexed: 06/30/2023]
Abstract
Wastewater-based surveillance (WBS) of infectious diseases is a powerful tool for understanding community COVID-19 disease burden and informing public health policy. The potential of WBS for understanding COVID-19's impact in non-healthcare settings has not been explored to the same degree. Here we examined how SARS-CoV-2 measured from municipal wastewater treatment plants (WWTPs) correlates with workforce absenteeism. SARS-CoV-2 RNA N1 and N2 were quantified three times per week by RT-qPCR in samples collected at three WWTPs servicing Calgary and surrounding areas, Canada (1.4 million residents) between June 2020 and March 2022. Wastewater trends were compared to workforce absenteeism using data from the largest employer in the city (>15,000 staff). Absences were classified as being COVID-19-related, COVID-19-confirmed, and unrelated to COVID-19. Poisson regression was performed to generate a prediction model for COVID-19 absenteeism based on wastewater data. SARS-CoV-2 RNA was detected in 95.5 % (85/89) of weeks assessed. During this period 6592 COVID-19-related absences (1896 confirmed) and 4524 unrelated absences COVID-19 cases were recorded. A generalized linear regression using a Poisson distribution was performed to predict COVID-19-confirmed absences out of the total number of absent employees using wastewater data as a leading indicator (P < 0.0001). The Poisson regression with wastewater as a one-week leading signal has an Akaike information criterion (AIC) of 858, compared to a null model (excluding wastewater predictor) with an AIC of 1895. The likelihood-ratio test comparing the model with wastewater signal with the null model shows statistical significance (P < 0.0001). We also assessed the variation of predictions when the regression model was applied to new data, with the predicted values and corresponding confidence intervals closely tracking actual absenteeism data. Wastewater-based surveillance has the potential to be used by employers to anticipate workforce requirements and optimize human resource allocation in response to trackable respiratory illnesses like COVID-19.
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Affiliation(s)
- Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Xiaotian Dai
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Maria A Bautista
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Barbara J Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Jangwoo Lee
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Puja Pradhan
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Chloe Papparis
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Xuewen Lu
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Thierry Chekouo
- Department of Mathematics and Statistics, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada; Division of Biostatistics, School of Public Health, University of Minnesota, 420 Delaware St. S.E., Minneapolis, MN 55455, USA
| | - Alexander Krusina
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Danielle Southern
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; O'Brien Institute for Public Health, University of Calgary, 3280 Hospital Dr NW, Calgary, Alberta T2N 4Z6, Canada
| | - Rhonda G Clark
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Raymond A Patterson
- Haskayne School of Business, University of Calgary, SH 250, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | | | - Jon Meddings
- Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada
| | - Norma Ruecker
- Water Services, City of Calgary, 625 25 Ave SE, Calgary, Alberta T2G 4k8, Canada
| | - Christopher Lammiman
- Calgary Emergency Management Agency (CEMA), City of Calgary, 673 1 St NE, Calgary, Alberta T2E 6R2, Canada
| | - Coby Duerr
- Calgary Emergency Management Agency (CEMA), City of Calgary, 673 1 St NE, Calgary, Alberta T2E 6R2, Canada
| | - Gopal Achari
- Department of Civil Engineering, University of Calgary, 622 Collegiate Pl NW, T2N 4V8, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Analytical and Environmental Toxicology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Women & Children's Health Research Institute, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Li Ka Shing Institute of Virology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Li Ka Shing Institute of Virology, University of Alberta, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada; Alberta Precision Laboratories, Public Health Laboratory, Alberta Health Services, 116 St. and 85 Ave, Edmonton, Alberta T6G 2R3, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, 3131 210 Ave SE, Calgary, Alberta T0L 0X0, Canada
| | - Casey R J Hubert
- Department of Biological Sciences, University of Calgary, 2500 University Drive NW, Calgary, Alberta T2N 1N4, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Department of Medicine, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada; Snyder Institute for Chronic Diseases, University of Calgary and Alberta Health Services, 3330 Hospital Drive NW, Calgary, Alberta T2N 4N1, Canada.
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7
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Lee J, Acosta N, Waddell BJ, Du K, Xiang K, Van Doorn J, Low K, Bautista MA, McCalder J, Dai X, Lu X, Chekouo T, Pradhan P, Sedaghat N, Papparis C, Buchner Beaudet A, Chen J, Chan L, Vivas L, Westlund P, Bhatnagar S, Stefani S, Visser G, Cabaj J, Bertazzon S, Sarabi S, Achari G, Clark RG, Hrudey SE, Lee BE, Pang X, Webster B, Ghali WA, Buret AG, Williamson T, Southern DA, Meddings J, Frankowski K, Hubert CRJ, Parkins MD. Campus node-based wastewater surveillance enables COVID-19 case localization and confirms lower SARS-CoV-2 burden relative to the surrounding community. Water Res 2023; 244:120469. [PMID: 37634459 DOI: 10.1016/j.watres.2023.120469] [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] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 08/06/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
Wastewater-based surveillance (WBS) has been established as a powerful tool that can guide health policy at multiple levels of government. However, this approach has not been well assessed at more granular scales, including large work sites such as University campuses. Between August 2021 and April 2022, we explored the occurrence of SARS-CoV-2 RNA in wastewater using qPCR assays from multiple complimentary sewer catchments and residential buildings spanning the University of Calgary's campus and how this compared to levels from the municipal wastewater treatment plant servicing the campus. Real-time contact tracing data was used to evaluate an association between wastewater SARS-CoV-2 burden and clinically confirmed cases and to assess the potential of WBS as a tool for disease monitoring across worksites. Concentrations of wastewater SARS-CoV-2 N1 and N2 RNA varied significantly across six sampling sites - regardless of several normalization strategies - with certain catchments consistently demonstrating values 1-2 orders higher than the others. Relative to clinical cases identified in specific sewersheds, WBS provided one-week leading indicator. Additionally, our comprehensive monitoring strategy enabled an estimation of the total burden of SARS-CoV-2 for the campus per capita, which was significantly lower than the surrounding community (p≤0.001). Allele-specific qPCR assays confirmed that variants across campus were representative of the community at large, and at no time did emerging variants first debut on campus. This study demonstrates how WBS can be efficiently applied to locate hotspots of disease activity at a very granular scale, and predict disease burden across large, complex worksites.
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Affiliation(s)
- Jangwoo Lee
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Nicole Acosta
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Barbara J Waddell
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Kevin Xiang
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Jennifer Van Doorn
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Kashtin Low
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Maria A Bautista
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Xiaotian Dai
- Department of Mathematics and Statistics, University of Calgary, Calgary, Canada
| | - Xuewen Lu
- Department of Mathematics and Statistics, University of Calgary, Calgary, Canada
| | - Thierry Chekouo
- Department of Mathematics and Statistics, University of Calgary, Calgary, Canada; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, USA
| | - Puja Pradhan
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Navid Sedaghat
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Chloe Papparis
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Alexander Buchner Beaudet
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Jianwei Chen
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Leslie Chan
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Laura Vivas
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | | | - Srijak Bhatnagar
- Department of Biological Sciences, University of Calgary, Calgary, Canada; Faculty of Science and Technology, Athabasca University, Athabasca, Alberta, Canada
| | - September Stefani
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Gail Visser
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada
| | - Jason Cabaj
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; Provincial Population & Public Health, Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada
| | | | - Shahrzad Sarabi
- Department of Geography, University of Calgary, Calgary, Canada
| | - Gopal Achari
- Department of Civil Engineering, University of Calgary, Calgary, Canada
| | - Rhonda G Clark
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute, Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Alberta Precision Laboratories, Public Health Laboratory, Alberta Health Services, Edmonton, Alberta, Canada; Li Ka Shing Institute of Virology, University of Alberta, Edmonton, Alberta, Canada
| | - Brendan Webster
- Occupational Health Staff Wellness, University of Calgary, Calgary, Canada
| | - William Amin Ghali
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada
| | - Andre Gerald Buret
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada
| | - Danielle A Southern
- Department of Community Health Sciences, University of Calgary, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada; Centre for Health Informatics, University of Calgary, Calgary, Canada
| | - Jon Meddings
- Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Kevin Frankowski
- Advancing Canadian Water Assets, University of Calgary, Calgary, Canada
| | - Casey R J Hubert
- Department of Biological Sciences, University of Calgary, Calgary, Canada
| | - Michael D Parkins
- Department of Microbiology, Immunology and Infectious Diseases, University of Calgary, 3330 Hospital Drive, NW, Calgary, Alberta T2N 2V5, Canada; Department of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada; O'Brien Institute for Public Health, University of Calgary, Calgary, Canada.
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8
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Qiu Y, Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Poonai N, Schuh S, Finkelstein Y, Xie J, Lee BE, Chui L, Pang X, On Behalf Of The Pediatric Emergency Research Canada Probiotic Regimen For Outpatient Gastroenteritis Utility Of Treatment Progut Trial Group. Significantly Longer Shedding of Norovirus Compared to Rotavirus and Adenovirus in Children with Acute Gastroenteritis. Viruses 2023; 15:1541. [PMID: 37515227 PMCID: PMC10386448 DOI: 10.3390/v15071541] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 06/07/2023] [Revised: 06/29/2023] [Accepted: 07/11/2023] [Indexed: 07/30/2023] Open
Abstract
Worldwide, acute gastroenteritis (AGE) is a major cause of morbidity and mortality in children under 5 years of age. Viruses, including norovirus, rotavirus, and enteric adenovirus, are the leading causes of pediatric AGE. In this prospective cohort study, we investigated the viral load and duration of shedding of norovirus, rotavirus, and adenovirus in stool samples collected from 173 children (median age: 15 months) with AGE who presented to emergency departments (EDs) across Canada on Day 0 (day of enrollment), and 5 and 28 days after enrollment. Quantitative RT-qPCR was performed to assess the viral load. On Day 0, norovirus viral load was significantly lower compared to that of rotavirus and adenovirus (p < 0.001). However, on Days 5 and 28, the viral load of norovirus was higher than that of adenovirus and rotavirus (p < 0.05). On Day 28, norovirus was detected in 70% (35/50) of children who submitted stool specimens, while rotavirus and adenovirus were detected in 52.4% (11/24) and 13.6% (3/22) of children (p < 0.001), respectively. Overall, in stool samples of children with AGE who presented to EDs, rotavirus and adenovirus had higher viral loads at presentation compared to norovirus; however, norovirus was shed in stool for the longest duration.
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Affiliation(s)
- Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Sarah Williamson-Urquhart
- Paediatric Emergency Research Team, Alberta Children's Hospital, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, ON K1H 8L1, Canada
| | - Serge Gouin
- Division of Paediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Ste-Justine, Université de Montréal, Montréal, QC H3T 1C5, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, London, ON N6A 5W9, Canada
| | - Suzanne Schuh
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Research Institute, Hospital for Sick Children, University of Toronto, Toronto, ON M5G 1X8, Canada
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, Stollery Children's Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada
- Alberta Precision Laboratory, Public Health Laboratory, Edmonton, AB T6G 2J2, Canada
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9
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Choi KB, Du T, Silva A, Golding GR, Pelude L, Mitchell R, Rudnick W, Hizon R, Al-Rawahi GN, Chow B, Davis I, Evans GA, Frenette C, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Comeau JL, Hota SS. Trends in Clostridioides difficile infection rates in Canadian hospitals during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:1180-1183. [PMID: 35978535 PMCID: PMC9433867 DOI: 10.1017/ice.2022.210] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 07/28/2022] [Accepted: 08/03/2022] [Indexed: 11/06/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has placed significant burden on healthcare systems. We compared Clostridioides difficile infection (CDI) epidemiology before and during the pandemic across 71 hospitals participating in the Canadian Nosocomial Infection Surveillance Program. Using an interrupted time series analysis, we showed that CDI rates significantly increased during the COVID-19 pandemic.
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Affiliation(s)
- Kelly B. Choi
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Anada Silva
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | - Linda Pelude
- Public Health Agency of Canada, Ottawa, Ontario, Canada
| | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Ghada N Al-Rawahi
- British Columbia Children’s Hospital, Vancouver, British Columbia, Canada
| | - Blanda Chow
- Alberta Health Services, Calgary, Alberta, Canada
| | - Ian Davis
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | | | | | | | - Pamela Kibsey
- Royal Jubilee Hospital, Victoria, British Columbia, Canada
| | - Kevin C. Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M. Langley
- Dalhousie University, Halifax, Nova Scotia, Canada
- IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Bonita E. Lee
- Stollery Children’s Hospital, Edmonton, Alberta, Canada
| | - Yves Longtin
- Jewish General Hospital, Montréal, Quebec, Canada
| | | | | | | | | | - Paula Stagg
- Western Memorial Regional Hospital, Corner Brook, Newfoundland, Canada
| | | | - Nisha Thampi
- Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Alice Wong
- Royal University Hospital, Saskatoon, Saskatchewan, Canada
| | | | - Susy S. Hota
- University Health Network, Toronto, Ontario, Canada
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10
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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.
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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
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11
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Li Q, Lee BE, Gao T, Qiu Y, Ellehoj E, Yu J, Diggle M, Tipples G, Maal-Bared R, Hinshaw D, Sikora C, Ashbolt NJ, Talbot J, Hrudey SE, Pang X. Number of COVID-19 cases required in a population to detect SARS-CoV-2 RNA in wastewater in the province of Alberta, Canada: Sensitivity assessment. J Environ Sci (China) 2023; 125:843-850. [PMID: 36375966 PMCID: PMC9068596 DOI: 10.1016/j.jes.2022.04.047] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [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: 04/01/2022] [Revised: 04/24/2022] [Accepted: 04/27/2022] [Indexed: 05/03/2023]
Abstract
With a unique and large size of testing results of 1,842 samples collected from 12 wastewater treatment plants (WWTP) for 14 months through from low to high prevalence of COVID-19, the sensitivity of RT-qPCR detection of SARS-CoV-2 RNA in wastewater that correspond to the communities was computed by using Probit analysis. This study determined the number of new COVID-19 cases per 100,000 population required to detect SARS-CoV-2 RNA in wastewater at defined probabilities and provided an evidence-based framework of wastewater-based epidemiology surveillance (WBE). Input data were positive and negative test results of SARS-CoV-2 RNA in wastewater samples and the corresponding new COVID-19 case rates per 100,000 population served by each WWTP. The analyses determined that RT-qPCR-based SARS-CoV-2 RNA detection threshold at 50%, 80% and 99% probability required a median of 8 (range: 4-19), 18 (9-43), and 38 (17-97) of new COVID-19 cases /100,000, respectively. Namely, the positive detection rate at 50%, 80% and 99% probability were 0.01%, 0.02%, and 0.04% averagely for new cases in the population. This study improves understanding of the performance of WBE SARS-CoV-2 RNA detection using the large datasets and prolonged study period. Estimated COVID-19 burden at a community level that would result in a positive detection of SARS-CoV-2 in wastewater is critical to support WBE application as a supplementary warning/monitoring system for COVID-19 prevention and control.
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Affiliation(s)
- Qiaozhi Li
- School of Public Health, University of Alberta, Edmonton, AB T6G 2R3, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Erik Ellehoj
- University of Alberta Central Receiving, Edmonton, Alberta, T6G 2R3, Canada
| | - Jiaao Yu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Mathew Diggle
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - Graham Tipples
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | | | - Deena Hinshaw
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Christopher Sikora
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Nicholas J Ashbolt
- Faculty of Science and Engineering, Southern Cross University, East Lismore NSW 2480, Australia
| | - James Talbot
- Department of Medicine, University of Alberta, Edmonton, AB T6G 2G3, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; Provincial Laboratory for Public Health, Edmonton, Alberta, Canada.
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12
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Acosta N, Bautista MA, Waddell BJ, Du K, McCalder J, Pradhan P, Sedaghat N, Papparis C, Beaudet AB, Chen J, Van Doorn J, Xiang K, Chan L, Vivas L, Low K, Lu X, Lee J, Westlund P, Chekouo T, Dai X, Cabaj J, Bhatnagar S, Ruecker N, Achari G, Clark RG, Pearce C, Harrison JJ, Meddings J, Leal J, Ellison J, Missaghi B, Kanji JN, Larios O, Rennert‐May E, Kim J, Hrudey SE, Lee BE, Pang X, Frankowski K, Conly J, Hubert CRJ, Parkins MD. Surveillance for SARS-CoV-2 and its variants in wastewater of tertiary care hospitals correlates with increasing case burden and outbreaks. J Med Virol 2023; 95:e28442. [PMID: 36579780 PMCID: PMC9880705 DOI: 10.1002/jmv.28442] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/20/2022] [Accepted: 12/26/2022] [Indexed: 12/30/2022]
Abstract
Wastewater-based SARS-CoV-2 surveillance enables unbiased and comprehensive monitoring of defined sewersheds. We performed real-time monitoring of hospital wastewater that differentiated Delta and Omicron variants within total SARS-CoV-2-RNA, enabling correlation to COVID-19 cases from three tertiary-care facilities with >2100 inpatient beds in Calgary, Canada. RNA was extracted from hospital wastewater between August/2021 and January/2022, and SARS-CoV-2 quantified using RT-qPCR. Assays targeting R203M and R203K/G204R established the proportional abundance of Delta and Omicron, respectively. Total and variant-specific SARS-CoV-2 in wastewater was compared to data for variant specific COVID-19 hospitalizations, hospital-acquired infections, and outbreaks. Ninety-six percent (188/196) of wastewater samples were SARS-CoV-2 positive. Total SARS-CoV-2 RNA levels in wastewater increased in tandem with total prevalent cases (Delta plus Omicron). Variant-specific assessments showed this increase to be mainly driven by Omicron. Hospital-acquired cases of COVID-19 were associated with large spikes in wastewater SARS-CoV-2 and levels were significantly increased during outbreaks relative to nonoutbreak periods for total SARS-CoV2, Delta and Omicron. SARS-CoV-2 in hospital wastewater was significantly higher during the Omicron-wave irrespective of outbreaks. Wastewater-based monitoring of SARS-CoV-2 and its variants represents a novel tool for passive COVID-19 infection surveillance, case identification, containment, and potentially to mitigate viral spread in hospitals.
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Affiliation(s)
- Nicole Acosta
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada
| | | | - Barbara J. Waddell
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada
| | - Kristine Du
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada
| | - Janine McCalder
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Puja Pradhan
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Navid Sedaghat
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Chloe Papparis
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | | | - Jianwei Chen
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | | | - Kevin Xiang
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Leslie Chan
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Laura Vivas
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Kashtin Low
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada
| | - Xuewen Lu
- Department of Mathematics and StatisticsUniversity of CalgaryCalgaryCanada
| | - Jangwoo Lee
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada
| | | | - Thierry Chekouo
- Department of Mathematics and StatisticsUniversity of CalgaryCalgaryCanada,Division of Biostatistics, School of Public HealthUniversity of MinnesotaMinneapolisMinnesotaUSA
| | - Xiaotian Dai
- Department of Mathematics and StatisticsUniversity of CalgaryCalgaryCanada
| | - Jason Cabaj
- Department of Community Health SciencesUniversity of CalgaryCalgaryCanada,Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Provincial Population & Public HealthAlberta Health ServicesCalgaryCanada,O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada
| | - Srijak Bhatnagar
- Faculty of Science and TechnologyAthabasca UniversityAthabascaAlbertaCanada
| | | | - Gopal Achari
- Department of Civil EngineeringUniversity of CalgaryCalgaryCanada
| | - Rhonda G. Clark
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada
| | - Craig Pearce
- Infection Prevention and ControlAlberta Health ServicesCalgaryCanada
| | - Joe J. Harrison
- Department of Biological SciencesUniversity of CalgaryCalgaryCanada,Snyder Institute for Chronic DiseasesUniversity of Calgary and Alberta Health ServicesCalgaryCanada
| | - Jon Meddings
- Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada
| | - Jenine Leal
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Community Health SciencesUniversity of CalgaryCalgaryCanada,O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada,Infection Prevention and ControlAlberta Health ServicesCalgaryCanada
| | - Jennifer Ellison
- Infection Prevention and ControlAlberta Health ServicesCalgaryCanada
| | - Bayan Missaghi
- Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Infection Prevention and ControlAlberta Health ServicesCalgaryCanada
| | - Jamil N. Kanji
- Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonAlbertaCanada,Alberta Precision Laboratories, Public Health LaboratoryAlberta Health ServicesEdmontonAlbertaCanada,Department of Pathology and Laboratory MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada
| | - Oscar Larios
- Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Infection Prevention and ControlAlberta Health ServicesCalgaryCanada,Alberta Precision Laboratories, Public Health LaboratoryAlberta Health ServicesEdmontonAlbertaCanada
| | - Elissa Rennert‐May
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of Community Health SciencesUniversity of CalgaryCalgaryCanada,Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada,Snyder Institute for Chronic DiseasesUniversity of Calgary and Alberta Health ServicesCalgaryCanada
| | - Joseph Kim
- Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Infection Prevention and ControlAlberta Health ServicesCalgaryCanada
| | - Steve E. Hrudey
- Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonAlbertaCanada,Department of Analytical and Environmental ToxicologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Bonita E. Lee
- Department of PediatricsUniversity of AlbertaEdmontonAlbertaCanada,Women & Children's Health Research InstituteEdmontonAlbertaCanada,Li Ka Shing Institute of VirologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Xiaoli Pang
- Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonAlbertaCanada,Alberta Precision Laboratories, Public Health LaboratoryAlberta Health ServicesEdmontonAlbertaCanada,Li Ka Shing Institute of VirologyUniversity of AlbertaEdmontonAlbertaCanada
| | - Kevin Frankowski
- Advancing Canadian Water AssetsUniversity of CalgaryCalgaryCanada
| | - John Conly
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,O'Brien Institute for Public HealthUniversity of CalgaryCalgaryCanada,Infection Prevention and ControlAlberta Health ServicesCalgaryCanada,Snyder Institute for Chronic DiseasesUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Department of Pathology and Laboratory MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada
| | | | - Michael D. Parkins
- Department of Microbiology, Immunology and Infectious DiseasesUniversity of CalgaryCalgaryCanada,Department of MedicineUniversity of Calgary and Alberta Health ServicesCalgaryCanada,Snyder Institute for Chronic DiseasesUniversity of Calgary and Alberta Health ServicesCalgaryCanada
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13
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Silva A, Du T, Choi KB, Pelude L, Golding GR, Hizon R, Lee BE, Chow B, Srigley JA, Hota SS, Comeau JL, Thampi N. Epidemiology of primary and recurrent healthcare-associated and community-associated pediatric Clostridioides difficile infection in Canada, 2015-2020. J Pediatric Infect Dis Soc 2023; 12:222-225. [PMID: 36718660 PMCID: PMC10146919 DOI: 10.1093/jpids/piad003] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 01/30/2023] [Indexed: 02/01/2023]
Abstract
Clostridioides difficile infection (CDI) among children remains a concerning cause of morbidity in hospital settings. We present epidemiological and molecular trends in healthcare- and community-associated CDI among children in Canadian inpatient and outpatient settings, including those who experienced recurrent infections.
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Affiliation(s)
| | - Tim Du
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | - Romeo Hizon
- National Microbiology Laboratory, Winnipeg, CA
| | | | | | | | | | | | - Nisha Thampi
- Children's Hospital of Eastern Ontario, Ottawa, CA
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14
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Maal-Bared R, Qiu Y, Li Q, Gao T, Hrudey SE, Bhavanam S, Ruecker NJ, Ellehoj E, Lee BE, Pang X. Does normalization of SARS-CoV-2 concentrations by Pepper Mild Mottle Virus improve correlations and lead time between wastewater surveillance and clinical data in Alberta (Canada): comparing twelve SARS-CoV-2 normalization approaches. Sci Total Environ 2023; 856:158964. [PMID: 36167131 PMCID: PMC9508694 DOI: 10.1016/j.scitotenv.2022.158964] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 09/13/2022] [Accepted: 09/19/2022] [Indexed: 05/02/2023]
Abstract
Wastewater-based surveillance (WBS) data normalization is an analyte measurement correction that addresses variations resulting from dilution of fecal discharge by non-sanitary sewage, stormwater or groundwater infiltration. No consensus exists on what WBS normalization parameters result in the strongest correlations and lead time between SARS-CoV-2 WBS data and COVID-19 cases. This study compared flow, population size and biomarker normalization impacts on the correlations and lead times for ten communities in twelve sewersheds in Alberta (Canada) between September 2020 and October 2021 (n = 1024) to determine if normalization by Pepper Mild Mottle Virus (PMMoV) provides any advantages compared to other normalization parameters (e.g., flow, reported and dynamic population sizes, BOD, TSS, NH3, TP). PMMoV concentrations (GC/mL) corresponded with plant influent flows and were highest in the urban centres. SARS-CoV-2 target genes E, N1 and N2 were all negatively associated with wastewater influent pH, while PMMoV was positively associated with temperature. Pooled data analysis showed that normalization increased ρ-values by almost 0.1 and was highest for ammonia, TKN and TP followed by PMMoV. Normalization by other parameters weakened associations. None of the differences were statistically significant. Site-specific correlations showed that normalization of SARS-CoV-2 data by PMMoV only improved correlations significantly in two of the twelve systems; neither were large sewersheds or combined sewer systems. In five systems, normalization by traditional wastewater strength parameters and dynamic population estimates improved correlations. Lead time ranged between 1 and 4 days in both pooled and site-specific comparisons. We recommend that WBS researchers and health departments: a) Investigate WWTP influent properties (e.g., pH) in the WBS planning phase and use at least two parallel approaches for normalization only if shown to provide value; b) Explore normalization by wastewater strength parameters and dynamic population size estimates further; and c) Evaluate purchasing an influent flow meter in small communities to support long-term WBS efforts and WWTP management.
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Affiliation(s)
- Rasha Maal-Bared
- Quality Assurance and Environment, EPCOR Water, Edmonton, Alberta, Canada.
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Qiaozhi Li
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Sudha Bhavanam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Norma J Ruecker
- Water Quality Services, City of Calgary, Calgary, Alberta, Canada
| | - Erik Ellehoj
- Ellehoj Redmond Consulting, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Paediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
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15
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Pang X, Gao T, Ellehoj E, Li Q, Qiu Y, Maal-Bared R, Sikora C, Tipples G, Diggle M, Hinshaw D, Ashbolt NJ, Talbot J, Hrudey SE, Lee BE. Wastewater-Based Surveillance Is an Effective Tool for Trending COVID-19 Prevalence in Communities: A Study of 10 Major Communities for 17 Months in Alberta. ACS ES T Water 2022; 2:2243-2254. [PMID: 36380772 PMCID: PMC9514327 DOI: 10.1021/acsestwater.2c00143] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 09/09/2022] [Accepted: 09/12/2022] [Indexed: 06/16/2023]
Abstract
The correlations between SARS-CoV-2 RNA levels in wastewater from 12 wastewater treatment plants and new COVID-19 cases in the corresponding sewersheds of 10 communities were studied over 17 months. The analysis from the longest continuous surveillance reported to date revealed that SARS-CoV-2 RNA levels correlated well with temporal changes of COVID-19 cases in each community. The strongest correlation was found during the third wave (r = 0.97) based on the population-weighted SARS-CoV-2 RNA levels in wastewater. Different correlations were observed (r from 0.51 to 0.86) in various sizes of communities. The population in the sewershed had no observed effects on the strength of the correlation. Fluctuation of SARS-CoV-2 RNA levels in wastewater mirrored increases and decreases of COVID-19 cases in the corresponding community. Since the viral shedding to sewers from all infected individuals is included, wastewater-based surveillance provides an unbiased and no-discriminate estimation of the prevalence of COVID-19 compared with clinical testing that was subject to testing-seeking behaviors and policy changes. Wastewater-based surveillance on SARS-CoV-2 represents a temporal trend of COVID-19 disease burden and is an effective and supplementary monitoring when the number of COVID-19 cases reaches detectable thresholds of SARS-CoV-2 RNA in wastewater of treatment facilities serving various sizes of populations.
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Affiliation(s)
- Xiaoli Pang
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
- Alberta
Precision Laboratories, Edmonton, Alberta T6G 2J2, Canada
| | - Tiejun Gao
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | - Erik Ellehoj
- Ellehoj
Redmond Consulting, Edmonton, Alberta T6G 0Y4, Canada
| | - Qiaozhi Li
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | - Yuanyuan Qiu
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | | | - Christopher Sikora
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | - Graham Tipples
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
- Alberta
Precision Laboratories, Edmonton, Alberta T6G 2J2, Canada
| | - Mathew Diggle
- Alberta
Precision Laboratories, Edmonton, Alberta T6G 2J2, Canada
| | - Deena Hinshaw
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | | | - James Talbot
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | - Steve E. Hrudey
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
| | - Bonita E. Lee
- Department
of Laboratory Medicine and Pathology, School of Public Health, Department of Medicine, and Department of
Pediatrics, University of Alberta, Edmonton, Alberta T6G 2E2, Canada
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16
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Hubert CRJ, Acosta N, Waddell BJM, Hasing ME, Qiu Y, Fuzzen M, Harper NBJ, Bautista MA, Gao T, Papparis C, Van Doorn J, Du K, Xiang K, Chan L, Vivas L, Pradhan P, McCalder J, Low K, England WE, Kuzma D, Conly J, Ryan MC, Achari G, Hu J, Cabaj JL, Sikora C, Svenson L, Zelyas N, Servos M, Meddings J, Hrudey SE, Frankowski K, Parkins MD, Pang XL, Lee BE. Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta, Canada. Emerg Infect Dis 2022. [PMID: 35867051 DOI: 10.1101/2022.03.07.22272055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023] Open
Abstract
Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021-January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.
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17
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Freedman SB, Finkelstein Y, Pang XL, Chui L, Tarr PI, VanBuren JM, Olsen C, Lee BE, Hall-Moore CA, Sapien R, O’Connell K, Levine AC, Poonai N, Roskind C, Schuh S, Rogers A, Bhatt S, Gouin S, Mahajan P, Vance C, Hurley K, Powell EC, Farion KJ, Schnadower D. Pathogen-Specific Effects of Probiotics in Children With Acute Gastroenteritis Seeking Emergency Care: A Randomized Trial. Clin Infect Dis 2022; 75:55-64. [PMID: 34596225 PMCID: PMC9402642 DOI: 10.1093/cid/ciab876] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND It is unknown if probiotics exert pathogen-specific effects in children with diarrhea secondary to acute gastroenteritis. METHODS Analysis of patient-level data from 2 multicenter randomized, placebo controlled trials conducted in pediatric emergency departments in Canada and the United States. Participants were 3-48 months with >3 diarrheal episodes in the preceding 24 hours and were symptomatic for <72 hours and <7 days in the Canadian and US studies, respectively. Participants received either placebo or a probiotic preparation (Canada-Lactobacillus rhamnosus R0011/Lactobacillus helveticus R0052; US-L. rhamnosus GG). The primary outcome was post-intervention moderate-to-severe disease (ie, ≥9 on the Modified Vesikari Scale [MVS] score). RESULTS Pathogens were identified in specimens from 59.3% of children (928/1565). No pathogen groups were less likely to experience an MVS score ≥9 based on treatment allocation (test for interaction = 0.35). No differences between groups were identified for adenovirus (adjusted relative risk [aRR]: 1.42; 95% confidence interval [CI]: .62, 3.23), norovirus (aRR: 0.98; 95% CI: .56, 1.74), rotavirus (aRR: 0.86; 95% CI: .43, 1.71) or bacteria (aRR: 1.19; 95% CI: .41, 3.43). At pathogen-group and among individual pathogens there were no differences in diarrhea duration or the total number of diarrheal stools between treatment groups, regardless of intervention allocation or among probiotic sub-groups. Among adenovirus-infected children, those administered the L. rhamnosus R0011/L. helveticus R0052 product experienced fewer diarrheal episodes (aRR: 0.65; 95% CI: .47, .90). CONCLUSIONS Neither probiotic product resulted in less severe disease compared to placebo across a range of the most common etiologic pathogens. The preponderance of evidence does not support the notion that there are pathogen specific benefits associated with probiotic use in children with acute gastroenteritis. CLINICAL TRIALS REGISTRATION NCT01773967 and NCT01853124.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Yaron Finkelstein
- Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Li Pang
- Alberta Precision Laboratories-Public Health Laboratory, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Alberta Precision Laboratories-Public Health Laboratory, Alberta, Canada
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - John M VanBuren
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Cody Olsen
- Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Women and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Carla A Hall-Moore
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Robert Sapien
- Department of Emergency Medicine, University of New Mexico Health Sciences Center, Albuquerque, New Mexico, USA
| | - Karen O’Connell
- Departments of Pediatrics and Emergency Medicine, The George Washington University School of Medicine and Health Sciences, Division of Emergency Medicine, Children’s National Hospital, Washington D.C., USA
| | - Adam C Levine
- Department of Emergency Medicine, Rhode Island Hospital/Hasbro Children’s Hospital and Brown University, Providence, Rhode Island, USA
| | - Naveen Poonai
- Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Cindy Roskind
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Suzanne Schuh
- Division of Pediatric Emergency Medicine, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Alexander Rogers
- Departments of Emergency Medicine and Pediatrics. Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Seema Bhatt
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | - Serge Gouin
- Departments of Pediatric Emergency Medicine & Pediatrics, Université de Montréal, Montréal, Quebec, Canada
| | - Prashant Mahajan
- Department of Emergency Medicine and Pediatrics, University of Michigan, Ann Arbor, Michigan, USA
| | - Cheryl Vance
- Departments of Emergency Medicine and Pediatrics, UC Davis, School of Medicine, Sacramento, California, USA
| | - Katrina Hurley
- Department of Emergency Medicine, IWK Health, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Elizabeth C Powell
- Department of Pediatrics, Division of Emergency Medicine, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USAand
| | - Ken J Farion
- Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Canada
| | - David Schnadower
- Division of Emergency Medicine, Cincinnati Children’s Hospital Medical Center and Department of Pediatrics University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
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18
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Hubert CRJ, Acosta N, Waddell BJM, Hasing ME, Qiu Y, Fuzzen M, Harper NBJ, Bautista MA, Gao T, Papparis C, Van Doorn J, Du K, Xiang K, Chan L, Vivas L, Pradhan P, McCalder J, Low K, England WE, Kuzma D, Conly J, Ryan MC, Achari G, Hu J, Cabaj JL, Sikora C, Svenson L, Zelyas N, Servos M, Meddings J, Hrudey SE, Frankowski K, Parkins MD, Pang XL, Lee BE. Tracking Emergence and Spread of SARS-CoV-2 Omicron Variant in Large and Small Communities by Wastewater Monitoring in Alberta, Canada. Emerg Infect Dis 2022; 28:1770-1776. [PMID: 35867051 PMCID: PMC9423933 DOI: 10.3201/eid2809.220476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Wastewater monitoring of SARS-CoV-2 enables early detection and monitoring of the COVID-19 disease burden in communities and can track specific variants of concern. We determined proportions of the Omicron and Delta variants across 30 municipalities covering >75% of the province of Alberta (population 4.5 million), Canada, during November 2021-January 2022. Larger cities Calgary and Edmonton exhibited more rapid emergence of Omicron than did smaller and more remote municipalities. Notable exceptions were Banff, a small international resort town, and Fort McMurray, a medium-sized northern community that has many workers who fly in and out regularly. The integrated wastewater signal revealed that the Omicron variant represented close to 100% of SARS-CoV-2 burden by late December, before the peak in newly diagnosed clinical cases throughout Alberta in mid-January. These findings demonstrate that wastewater monitoring offers early and reliable population-level results for establishing the extent and spread of SARS-CoV-2 variants.
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19
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Horne RG, Freedman SB, Johnson-Henry KC, Pang XL, Lee BE, Farion KJ, Gouin S, Schuh S, Poonai N, Hurley KF, Finkelstein Y, Xie J, Williamson-Urquhart S, Chui L, Rossi L, Surette MG, Sherman PM. Intestinal Microbial Composition of Children in a Randomized Controlled Trial of Probiotics to Treat Acute Gastroenteritis. Front Cell Infect Microbiol 2022; 12:883163. [PMID: 35774405 PMCID: PMC9238408 DOI: 10.3389/fcimb.2022.883163] [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] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
Compositional analysis of the intestinal microbiome in pre-schoolers is understudied. Effects of probiotics on the gut microbiota were evaluated in children under 4-years-old presenting to an emergency department with acute gastroenteritis. Included were 70 study participants (n=32 placebo, n=38 probiotics) with stool specimens at baseline (day 0), day 5, and after a washout period (day 28). Microbiota composition and deduced functions were profiled using 16S ribosomal RNA sequencing and predictive metagenomics, respectively. Probiotics were detected at day 5 of administration but otherwise had no discernable effects, whereas detection of bacterial infection (P<0.001) and participant age (P<0.001) had the largest effects on microbiota composition, microbial diversity, and deduced bacterial functions. Participants under 1 year had lower bacterial diversity than older aged pre-schoolers; compositional changes of individual bacterial taxa were associated with maturation of the gut microbiota. Advances in age were associated with differences in gut microbiota composition and deduced microbial functions, which have the potential to impact health later in life.
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Affiliation(s)
- Rachael G. Horne
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | | | - Xiao-Li Pang
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Bonita E. Lee
- Women and Children’s Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB, Canada
| | - Ken J. Farion
- Children’s Hospital of Eastern Ontario, University of Ottawa, Ottawa, ON, Canada
| | - Serge Gouin
- Departments of Emergency Medicine and Pediatrics, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Université de Montréal, Montréal, QC, Canada
| | - Suzanne Schuh
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Naveen Poonai
- Division of Pediatric Emergency Medicine, London Children’s Hospital Health Science Centre, Department of Pediatrics, Western University, London, ON, Canada
| | - Katrina F. Hurley
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Yaron Finkelstein
- Division of Emergency Medicine, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
| | - Jianling Xie
- Pediatric Emergency Medicine, Izaak Walton Killam (IWK) Children’s Hospital, Dalhousie University, Halifax, NS, Canada
| | - Sarah Williamson-Urquhart
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Linda Chui
- Alberta Precision Laboratories – Public Health Laboratory (ProvLab), Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Laura Rossi
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Michael G. Surette
- Department of Biochemistry and Biomedical Sciences, McMaster University Medical Centre, Hamilton, ON, Canada
| | - Philip M. Sherman
- Cell Biology Program, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
- Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Hospital for Sick Children, University of Toronto, Toronto, ON, Canada
- *Correspondence: Philip M. Sherman,
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20
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Nourbakhsh S, Fazil A, Li M, Mangat CS, Peterson SW, Daigle J, Langner S, Shurgold J, D’Aoust P, Delatolla R, Mercier E, Pang X, Lee BE, Stuart R, Wijayasri S, Champredon D. A wastewater-based epidemic model for SARS-CoV-2 with application to three Canadian cities. Epidemics 2022; 39:100560. [PMID: 35462206 PMCID: PMC8993419 DOI: 10.1016/j.epidem.2022.100560] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [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: 08/16/2021] [Revised: 03/07/2022] [Accepted: 04/03/2022] [Indexed: 02/03/2023] Open
Abstract
The COVID-19 pandemic has stimulated wastewater-based surveillance, allowing public health to track the epidemic by monitoring the concentration of the genetic fingerprints of SARS-CoV-2 shed in wastewater by infected individuals. Wastewater-based surveillance for COVID-19 is still in its infancy. In particular, the quantitative link between clinical cases observed through traditional surveillance and the signals from viral concentrations in wastewater is still developing and hampers interpretation of the data and actionable public-health decisions. We present a modelling framework that includes both SARS-CoV-2 transmission at the population level and the fate of SARS-CoV-2 RNA particles in the sewage system after faecal shedding by infected persons in the population. Using our mechanistic representation of the combined clinical/wastewater system, we perform exploratory simulations to quantify the effect of surveillance effectiveness, public-health interventions and vaccination on the discordance between clinical and wastewater signals. We also apply our model to surveillance data from three Canadian cities to provide wastewater-informed estimates for the actual prevalence, the effective reproduction number and incidence forecasts. We find that wastewater-based surveillance, paired with this model, can complement clinical surveillance by supporting the estimation of key epidemiological metrics and hence better triangulate the state of an epidemic using this alternative data source.
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Affiliation(s)
- Shokoofeh Nourbakhsh
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Aamir Fazil
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Michael Li
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada
| | - Chand S. Mangat
- One Health Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Shelley W. Peterson
- One Health Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Jade Daigle
- One Health Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Stacie Langner
- One Health Division, National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Jayson Shurgold
- Antimicrobial Resistance Division, Infectious Diseases Prevention and Control Branch, Public Health Agency of Canada, Ottawa, ON, Canada
| | - Patrick D’Aoust
- University of Ottawa, Department of Civil Engineering, Ottawa, ON, Canada
| | - Robert Delatolla
- University of Ottawa, Department of Civil Engineering, Ottawa, ON, Canada
| | - Elizabeth Mercier
- University of Ottawa, Department of Civil Engineering, Ottawa, ON, Canada
| | - Xiaoli Pang
- Public Health Laboratory, Alberta Precision Laboratory, Edmonton, AB, Canada,Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Bonita E. Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | | | - Shinthuja Wijayasri
- Toronto Public Health, Toronto, ON, Canada,Canadian Field Epidemiology Program, Emergency Management, Public Health Agency of Canada, Canada
| | - David Champredon
- Public Health Risk Sciences Division, National Microbiology Laboratory, Public Health Agency of Canada, Guelph, ON, Canada,Corresponding author
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21
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Du T, Choi KB, Silva A, Golding GR, Pelude L, Hizon R, Al-Rawahi GN, Brooks J, Chow B, Collet JC, Comeau JL, Davis I, Evans GA, Frenette C, Han G, Johnstone J, Kibsey P, Katz KC, Langley JM, Lee BE, Longtin Y, Mertz D, Minion J, Science M, Srigley JA, Stagg P, Suh KN, Thampi N, Wong A, Hota SS. Characterization of Healthcare-Associated and Community-Associated Clostridioides difficile Infections among Adults, Canada, 2015-2019. Emerg Infect Dis 2022; 28:1128-1136. [PMID: 35470794 PMCID: PMC9155897 DOI: 10.3201/eid2806.212262] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
We investigated epidemiologic and molecular characteristics of healthcare-associated (HA) and community-associated (CA) Clostridioides difficile infection (CDI) among adult patients in Canadian Nosocomial Infection Surveillance Program hospitals during 2015–2019. The study encompassed 18,455 CDI cases, 13,735 (74.4%) HA and 4,720 (25.6%) CA. During 2015–2019, HA CDI rates decreased by 23.8%, whereas CA decreased by 18.8%. HA CDI was significantly associated with increased 30-day all-cause mortality as compared with CA CDI (p<0.01). Of 2,506 isolates analyzed, the most common ribotypes (RTs) were RT027, RT106, RT014, and RT020. RT027 was more often associated with CDI-attributable death than was non-RT027, regardless of acquisition type. Overall resistance C. difficile rates were similar for all drugs tested except moxifloxacin. Adult HA and CA CDI rates have declined, coinciding with changes in prevalence of RT027 and RT106. Infection prevention and control and continued national surveillance are integral to clarifying CDI epidemiology, investigation, and control.
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22
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Böhrer M, Fitzpatrick E, Hurley K, Xie J, Lee BE, Pang X, Zhuo R, Parsons BD, Berenger BM, Chui L, Tarr PI, Ali S, Vanderkooi OG, Freedman SB, Zemek R, Newton M, Meckler G, Poonai N, Bhatt M, Maki K, McGahern C, Emerton R. Hematochezia in children with acute diarrhea seeking emergency department care - a prospective cohort study. Acad Emerg Med 2022; 29:429-441. [PMID: 34962688 DOI: 10.1111/acem.14434] [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: 07/25/2021] [Revised: 12/07/2021] [Accepted: 12/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Although the passage of blood in stools in children represents a medical emergency, children seeking emergency department (ED) care remain poorly characterized. Our primary objective was to compare clinical characteristics and etiologic pathogens in children with acute diarrhea with and without caregiver-reported hematochezia. Secondary objectives were to characterize interventions and resource utilization. METHODS We conducted a secondary analysis of the Alberta Provincial Pediatric EnTeric Infection TEam (APPETITE) database. Children <18 years presenting to two pediatric EDs within a 24-hour period and <7 days of symptoms were consecutively recruited. RESULTS Of 1,061 participants, 115 (10.8%) reported hematochezia at the enrollment visit at which time those with hematochezia, compared to those without, had more diarrheal episodes/24-hour period (9 vs. 6; difference: 2; 95% confidence interval [CI]: 2.0, 4.0; p < 0.001), and were less likely to have experienced vomiting (54.8% vs. 80.2%; difference: -25.4; 95% CI: -34.9, -16.0; p < 0.001). They were more likely to receive intravenous fluids (33.0% vs. 17.9%; difference: 15.2; 95% CI: 6.2, 24.1; p < 0.001) and require repeat health care visits (45.5% vs. 34.7%; difference: 10.7; 95% CI: 0.9, 20.6; p = 0.03). A bacterial pathogen was identified in 33.0% of children with hematochezia versus 7.9% without (difference: 25.1; 95% CI: 16.3, 33.9; p < 0.001); viruses were detected in 31.3% of children with hematochezia compared to 72.3% in those without (difference: -41.0%, 95% CI: -49.9, -32.1; p < 0.001). CONCLUSION In children with acute diarrhea, caregiver report of hematochezia, compared to the absence of hematochezia, was associated with more diarrheal but fewer vomiting episodes, and greater resource consumption. The former group of children was also more likely to have bacteria detected in their stool.
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Affiliation(s)
| | | | | | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary Calgary Canada
| | - Bonita E. Lee
- Departments of Pediatrics & Emergency Medicine Faculty of Medicine & Dentistry Women and Children's Health Research Institute University of Alberta Edmonton Alberta Canada
| | - Xiao‐Li Pang
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | | | - Byron M. Berenger
- Department of Pathology and Laboratory Medicine University of Calgary Calgary Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | | | - Samina Ali
- Department of Laboratory Medicine and Pathology University of Alberta Edmonton Canada
| | - Otto G. Vanderkooi
- Section of Pediatric Infectious Diseases. Departments of Pediatrics; Microbiology, Immunology & Infectious Diseases; Pathology and Laboratory Medicine; and Community Health Sciences University of Calgary Alberta Children’s Hospital Research Institute Calgary Canada
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology Departments of Pediatrics and Emergency Medicine Alberta Children’s Hospital and the Alberta Children’s Hospital Research Institute Cumming School of Medicine University of Calgary Calgary Canada
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23
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Wilson M, Qiu Y, Yu J, Lee BE, McCarthy DT, Pang X. Comparison of Auto Sampling and Passive Sampling Methods for SARS-CoV-2 Detection in Wastewater. Pathogens 2022; 11:pathogens11030359. [PMID: 35335683 PMCID: PMC8955177 DOI: 10.3390/pathogens11030359] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 01/06/2023] Open
Abstract
Wastewater-based surveillance is emerging as an important tool for the COVID-19 pandemic trending. Current methods of wastewater collection, such as grab and auto-composite sampling, have drawbacks that impede effective surveillance, especially from small catchments with limited accessibility. Passive samplers, which are more cost-effective and require fewer resources to process, are promising candidates for monitoring wastewater for SARS-CoV-2. Here, we compared traditional auto sampling with passive sampling for SARS-CoV-2 detection in wastewater. A torpedo-style 3D-printed passive sampler device containing both cotton swabs and electronegative filter membranes was used. Between April and June 2021, fifteen passive samplers were placed at a local hospital’s wastewater outflow alongside an autosampler. Reverse transcription and quantitative polymerase chain reaction (RT-qPCR) was used to detect SARS-CoV-2 in the samples after processing and RNA extraction. The swab and membrane of the passive sampler showed similar detection rates and cycle threshold (Ct) values for SARS-CoV-2 RNA for the N1 and N2 gene targets. The passive method performed as well as the grab/auto sampling, with no significant differences between N1 and N2 Ct values. There were discrepant results on two days with negative grab/auto samples and positive passive samples, which might be related to the longer duration of passive sampling in the study. Overall, the passive sampler was rapid, reliable, and cost-effective, and could be used as an alternative sampling method for the detection of SARS-CoV-2 in wastewater.
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Affiliation(s)
- Melissa Wilson
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.W.); (J.Y.); (X.P.)
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.W.); (J.Y.); (X.P.)
- Correspondence:
| | - Jiaao Yu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.W.); (J.Y.); (X.P.)
| | - Bonita E. Lee
- Department of Pediatrics, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - David T. McCarthy
- Environmental and Public Health Microbiology Laboratory (EPHM Lab), Department of Civil Engineering, Monash University, Clayton, VIC 3800, Australia;
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (M.W.); (J.Y.); (X.P.)
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, AB T6G 2J2, Canada
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24
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Qiu Y, Yu J, Pabbaraju K, Lee BE, Gao T, Ashbolt NJ, Hrudey SE, Diggle M, Tipples G, Maal-Bared R, Pang X. Validating and optimizing the method for molecular detection and quantification of SARS-CoV-2 in wastewater. Sci Total Environ 2022; 812:151434. [PMID: 34742974 PMCID: PMC8568330 DOI: 10.1016/j.scitotenv.2021.151434] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 10/29/2021] [Accepted: 10/31/2021] [Indexed: 05/18/2023]
Abstract
Wastewater surveillance of SARS-CoV-2 has become a promising tool to estimate population-level changes in community infections and the prevalence of COVID-19 disease. Although many studies have reported the detection and quantification of SARS-CoV-2 in wastewater, remarkable variation remains in the methodology. In this study, we validated a molecular testing method by concentrating viruses from wastewater using ultrafiltration and detecting SARS-CoV-2 using one-step RT-qPCR assay. The following parameters were optimized including sample storage condition, wastewater pH, RNA extraction and RT-qPCR assay by quantification of SARS-CoV-2 or spiked human coronavirus strain 229E (hCoV-229E). Wastewater samples stored at 4 °C after collection showed significantly enhanced detection of SARS-CoV-2 with approximately 2-3 PCR-cycle threshold (Ct) values less when compared to samples stored at -20 °C. Pre-adjustment of the wastewater pH to 9.6 to aid virus desorption followed by pH readjustment to neutral after solid removal significantly increased the recovery of spiked hCoV-229E. Of the five commercially available RNA isolation kits evaluated, the MagMAX-96 viral RNA isolation kit showed the best recovery of hCoV-229E (50.1 ± 20.1%). Compared with two-step RT-qPCR, one-step RT-qPCR improved sensitivity for SARS-CoV-2 detection. Salmon DNA was included for monitoring PCR inhibition and pepper mild mottle virus (PMMoV), a fecal indicator indigenous to wastewater, was used to normalize SARS-CoV-2 levels in wastewater. Our method for molecular detection of SARS-CoV-2 in wastewater provides a useful tool for public health surveillance of COVID-19.
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Affiliation(s)
- Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jiaao Yu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Kanti Pabbaraju
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Nicholas J Ashbolt
- Faculty of Science and Engineering, Southern Cross University, Lismore, New South Wales, Australia
| | - Steve E Hrudey
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Mathew Diggle
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | - Graham Tipples
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada
| | | | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, Alberta, Canada.
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25
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Zhi S, Parsons BD, Szelewicki J, Yuen YTK, Fach P, Delannoy S, Li V, Ferrato C, Freedman SB, Lee BE, Pang XL, Chui L. Identification of Shiga-Toxin-Producing Shigella Infections in Travel and Non-Travel Related Cases in Alberta, Canada. Toxins (Basel) 2021; 13:toxins13110755. [PMID: 34822539 PMCID: PMC8618429 DOI: 10.3390/toxins13110755] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/19/2021] [Accepted: 10/22/2021] [Indexed: 01/21/2023] Open
Abstract
It has long been accepted that Shiga toxin (Stx) only exists in Shigella dysenteriae serotype 1. However, in recent decades, the presence of Shiga toxin genes (stx) in other Shigella spp. have been reported. We screened 366 Shigella flexneri strains from Alberta, Canada (2003 to 2016) for stx and 26 positive strains were identified. These isolates are highly related with the majority originating from the Dominican Republic and three isolates with Haiti origin. Both phylogenetic and spanning tree analysis of the 26 Alberta and 29 stx positive S. flexneri originating from the U.S., France, Canada (Quebec) and Haiti suggests that there are geographic specific distribution patterns (Haiti and Dominican Republic clades). This study provides the first comprehensive whole genome based phylogenetic analysis of stx positive S. flexneri strains as well as their global transmission, which signify the public health risks of global spreading of these strains.
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Affiliation(s)
- Shuai Zhi
- The Affiliated Hospital of Medical School, Ningbo University, Ningbo 315000, China;
- School of Medicine, Ningbo University, Ningbo 315000, China
| | - Brendon D. Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (B.D.P.); (J.S.); (Y.T.K.Y.); (X.-L.P.)
| | - Jonas Szelewicki
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (B.D.P.); (J.S.); (Y.T.K.Y.); (X.-L.P.)
| | - Yue T. K. Yuen
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (B.D.P.); (J.S.); (Y.T.K.Y.); (X.-L.P.)
| | - Patrick Fach
- Agency for Food, Environmental and Occupational Health and Safety (ANSES), Food Safety Laboratory, COLiPATH Research Unit & IDPA Genomics Platform, FR-94700 Maisons-Alfort, France; (P.F.); (S.D.)
| | - Sabine Delannoy
- Agency for Food, Environmental and Occupational Health and Safety (ANSES), Food Safety Laboratory, COLiPATH Research Unit & IDPA Genomics Platform, FR-94700 Maisons-Alfort, France; (P.F.); (S.D.)
| | - Vincent Li
- Alberta Precision Laboratories-ProvLab, Edmonton, AB T6G 2J2, Canada;
| | - Christina Ferrato
- Alberta Precision Laboratories-ProvLab, Calgary, AB T2N 4W4, Canada;
| | - Stephen B. Freedman
- Alberta Children’s Hospital, Division of Pediatric Emergency Medicine and Gastroenterology, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada;
- Alberta Children’s Hospital Research Institute, Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Bonita E. Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 1C9, Canada;
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (B.D.P.); (J.S.); (Y.T.K.Y.); (X.-L.P.)
- Alberta Precision Laboratories-ProvLab, Edmonton, AB T6G 2J2, Canada;
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2B7, Canada; (B.D.P.); (J.S.); (Y.T.K.Y.); (X.-L.P.)
- Alberta Precision Laboratories-ProvLab, Edmonton, AB T6G 2J2, Canada;
- Correspondence:
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26
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Pang X, Gao T, Qiu Y, Caffrey N, Popadynetz J, Younger J, Lee BE, Neumann N, Checkley S. The prevalence and levels of enteric viruses in groundwater of private wells in rural Alberta, Canada. Water Res 2021; 202:117425. [PMID: 34284123 DOI: 10.1016/j.watres.2021.117425] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 06/13/2023]
Abstract
The prevalence and levels of enteric viruses in untreated groundwater of private wells used for drinking and/or agricultural practices in rural Alberta were studied using the qPCR panel assay, integrated cell culture with qPCR and cell culture in the volume of 500 liters per sample through serial sampling. Seven viruses were assessed including adenovirus, rotavirus, norovirus, astrovirus, sapovirus, reovirus and JC virus. Five viruses were detected with an overall positive detection rate of 6.33 % (45 of 711 samples). The most frequently detected virus was adenovirus (48.9%, 22/45) followed by rotavirus (44.4%, 20/45), reovirus (20%, 9/45), JC virus (6.7%, 3/45) and norovirus (6.7%, 3/45). There was no significant difference in the positive detection rates, ranging from 1.1% to 3.4% by various well settings used for broiler farms, cow/calf farms, feedlots and rural acreages. Effects of well characteristics (aquifer type, well depth, static level of water, well seal) and well completion lithology on potential viral contamination of groundwater of private wells were also analyzed upon available data. The findings demonstrate that occurrence of enteric viruses is low and viral contamination is sporadic in groundwater of private wells in rural Alberta. Conventional fecal bacterial indicators (coliform and/or E. coli) were not a representative marker for viral contamination in groundwater wells in rural Alberta.
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Affiliation(s)
- Xiaoli Pang
- The Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.19 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada; Alberta Precision Laboratories, 2B4.58 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB, T6G 2J2, Canada.
| | - Tiejun Gao
- The Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.19 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Yuanyuan Qiu
- The Department of Laboratory Medicine and Pathology, University of Alberta, 4B1.19 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada
| | - Niamh Caffrey
- Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, TRW 2D01 Calgary, AB, T2N 4Z6, Canada
| | - Jessica Popadynetz
- Alberta Health Services, 10055 - 106 Street NW, Edmonton, AB, T5J 2Y2, Canada
| | - John Younger
- Alberta Health Services, 10055 - 106 Street NW, Edmonton, AB, T5J 2Y2, Canada
| | - Bonita E Lee
- The Department of Pediatrics, University of Alberta, Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Norman Neumann
- School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 AveEdmonton, AB, T6G 1C9, Canada
| | - Sylvia Checkley
- Alberta Precision Laboratories, 2B4.58 Walter Mackenzie Centre, 8440 - 112 Street, Edmonton, AB, T6G 2J2, Canada; Faculty of Veterinary Medicine, University of Calgary, 3280 Hospital Drive NW, TRW 2D01 Calgary, AB, T2N 4Z6, Canada
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27
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Abstract
IMPORTANCE Every year, respiratory viruses exact a heavy burden on Canadian hospitals during winter months. Generalizable seasonal patterns of respiratory virus transmission may estimate the evolution of SARS-CoV-2 or other emerging pathogens. OBJECTIVE To describe the annual and biennial variation in respiratory virus seasonality in a northern climate. DESIGN, SETTING, AND PARTICIPANTS This cohort study is an epidemiological assessment using population-based surveillance of patients with medically attended respiratory tract infection from 2005 through 2017 in Alberta, Canada. Incident cases of respiratory virus infection and infant respiratory syncytial virus (RSV) hospitalizations in Alberta were extracted from the Data Integration for Alberta Laboratories platform and Alberta Health Services Discharge Abstract Database, respectively. A deterministic susceptible-infected-recovered-susceptible mathematical model with seasonal forcing function was fitted to the data for each virus. The possible future seasonal course of SARS-CoV-2 in northern latitudes was modeled on the basis of these observations. The analysis was conducted between December 15, 2020, and February 10, 2021. EXPOSURES Seasonal respiratory pathogens. MAIN OUTCOMES AND MEASURES Incidence (temporal pattern) of respiratory virus infections and RSV hospitalizations. RESULTS A total of 37 719 incident infections with RSV, human metapneumovirus, or human coronaviruses 229E, NL63, OC43, or HKU1 among 35 375 patients (18 069 [51.1%] male; median [interquartile range], 1.29 [0.42-12.2] years) were documented. A susceptible-infected-recovered-susceptible model mirrored the epidemiological data, including a striking biennial variation with alternating severe and mild winter peaks. Qualitative description of the model and numerical simulations showed that strong seasonal contact rate and temporary immunity lasting 6 to 12 months were sufficient to explain biennial seasonality in these various respiratory viruses. The seasonality of 10 212 hospitalizations among children younger than 5 years with RSV was also explored. The median (interquartile range) rate of hospitalizations per 1000 live births was 18.6 (17.6-19.9) and 11.0 (10.4-11.7) in alternating even (severe) and odd (less-severe) seasons, respectively (P = .001). The hazard of admission was higher for children born in severe (even) seasons compared with those born in less-severe (odd) seasons (hazard ratio, 1.68; 95% CI, 1.61-1.75; P < .001). CONCLUSIONS AND RELEVANCE In this modeling study of respiratory viruses in Alberta, Canada, the seasonality followed a pattern estimated by simple mathematical models, which may be informative for anticipating future waves of pandemic SARS-CoV-2.
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Affiliation(s)
- Michael T. Hawkes
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, Alberta, Canada
- University of Alberta School of Public Health, Edmonton, Alberta, Canada
- Stollery Science Lab, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E. Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Jamil N. Kanji
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Nathan Zelyas
- Public Health Laboratory, Alberta Precision Laboratories, University of Alberta Hospital, Edmonton, Alberta, Canada
- Department of Laboratory Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Kerry Wong
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Michelle Barton
- London Health Sciences Centre, Western University, London, Ontario, Canada
| | - Shamir Mukhi
- Canadian Network for Public Health Intelligence, Edmonton, Alberta, Canada
| | - Joan L. Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women and Children’s Research Institute, University of Alberta, Edmonton, Alberta, Canada
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Tarr GAM, Downey E, Pang XL, Zhuo R, Strickland AJ, Ali S, Lee BE, Chui L, Tarr PI, Freedman SB. Clinical Profiles of Childhood Astrovirus-, Sapovirus-, and Norovirus-Associated Acute Gastroenteritis in Pediatric Emergency Departments in Alberta, 2014-2018. J Infect Dis 2021; 225:723-732. [PMID: 34432027 PMCID: PMC9890912 DOI: 10.1093/infdis/jiab429] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 05/27/2021] [Accepted: 08/23/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Infections by previously underdiagnosed viruses astrovirus and sapovirus are poorly characterized compared with norovirus, the most common cause of acute gastroenteritis. METHODS Children <18 years old with acute gastroenteritis were recruited from pediatric emergency departments in Alberta, Canada between 2014 and 2018. We described and compared the clinical course of acute gastroenteritis in children with astrovirus, sapovirus, and norovirus. RESULTS Astrovirus was detected in 56 of 2688 (2.1%) children, sapovirus was detected in 146 of 2688 (5.4%) children, and norovirus was detected in 486 of 2688 (18.1%) children. At illness onset, ~60% of astrovirus cases experienced both diarrhea and vomiting. Among sapovirus and norovirus cases, 35% experienced diarrhea at onset and 80% of 91% (sapovirus/norovirus) vomited; however, diarrhea became more prevalent than vomiting at approximately day 4 of illness. Over the full course of illness, diarrhea was 18% (95% confidence interval [CI], 8%- 29%) more prevalent among children with astrovirus than norovirus infections and had longer duration with greater maximal events; there were a median of 4.0 fewer maximal vomiting events (95% CI, 2.0-5.0). Vomiting continued for a median of 24.8 hours longer (95% CI, 9.6-31.7) among children with sapovirus versus norovirus. Differences between these viruses were otherwise minimal. CONCLUSIONS Sapovirus infections attended in the emergency department are more similar to norovirus than previously reported, whereas astrovirus infections have several distinguishable characteristics.
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Affiliation(s)
- Gillian A M Tarr
- Correspondence: G. A. M. Tarr, PhD, MHS, CPH, MMC 807, Room 1240, 420 Delaware St. SE, Minneapolis, MN, USA ()
| | | | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada,Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Ali J Strickland
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada,Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada,Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Stephen B Freedman
- Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children’s Hospital, Calgary, Alberta, Canada,Alberta Children’s Hospital Research Institute, Alberta Children’s Hospital, Calgary, Alberta, Canada
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29
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Lee BE, Sikora C, Faulder D, Risling E, Little LA, Qiu Y, Gao T, Bulat R, Craik S, Hrudey SE, Ohinmaa A, Estabrooks CA, Gingras AC, Charlton C, Kim J, Wood H, Robinson A, Kanji JN, Zelyas N, O'Brien SF, Drews S, Pang XL. Early warning and rapid public health response to prevent COVID-19 outbreaks in long-term care facilities (LTCF) by monitoring SARS-CoV-2 RNA in LTCF site-specific sewage samples and assessment of antibodies response in this population: prospective study protocol. BMJ Open 2021; 11:e052282. [PMID: 34417219 PMCID: PMC8382669 DOI: 10.1136/bmjopen-2021-052282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The COVID-19 pandemic has an excessive impact on residents in long-term care facilities (LTCF), causing high morbidity and mortality. Early detection of presymptomatic and asymptomatic COVID-19 cases supports the timely implementation of effective outbreak control measures but repetitive screening of residents and staff incurs costs and discomfort. Administration of vaccines is key to controlling the pandemic but the robustness and longevity of the antibody response, correlation of neutralising antibodies with commercial antibody assays, and the efficacy of current vaccines for emerging COVID-19 variants require further study. We propose to monitor SARS-CoV-2 in site-specific sewage as an early warning system for COVID-19 in LTCF and to study the immune response of the staff and residents in LTCF to COVID-19 vaccines. METHODS AND ANALYSIS The study includes two parts: (1) detection and quantification of SARS-CoV-2 in LTCF site-specific sewage samples using a molecular assay followed by notification of Public Health within 24 hours as an early warning system for appropriate outbreak investigation and control measures and cost-benefit analyses of the system and (2) testing for SARS-CoV-2 antibodies among staff and residents in LTCF at various time points before and after COVID-19 vaccination using commercial assays and neutralising antibody testing performed at a reference laboratory. ETHICS AND DISSEMINATION Ethics approval was obtained from the University of Alberta Health Research Ethics Board with considerations to minimise risk and discomforts for the participants. Early recognition of a COVID-19 case in an LTCF might prevent further transmission in residents and staff. There was no direct benefit identified to the participants of the immunity study. Anticipated dissemination of information includes a summary report to the immunity study participants, sharing of study data with the scientific community through the Canadian COVID-19 Immunity Task Force, and prompt dissemination of study results in meeting abstracts and manuscripts in peer-reviewed journals.
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Affiliation(s)
- Bonita E Lee
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
- Women & Children's Health Research Institute, Li Ka Shing Institute of Virology, Edmonton, Alberta, Canada
| | - Christopher Sikora
- Medical Officer of Health (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
- Department of Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Douglas Faulder
- Medical Director, Continuing Care (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
- Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Eleanor Risling
- Executive Director, Continuing Care (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
| | - Lorie A Little
- Director, Facility and Supportive Living (Edmonton Zone), Alberta Health Services, Edmonton, Alberta, Canada
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Ross Bulat
- EPCOR Water Services Inc, Edmonton, Alberta, Canada
| | | | - Steve E Hrudey
- Analytical and Environmental Toxicology, University of Alberta, Edmonton, Alberta, Canada
| | - Arto Ohinmaa
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | | | - Anne-Claude Gingras
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, Ontario, Canada
- Department of Molecular Genetics, University of Toronto, Toronto, Ontario, Canada
| | - Carmen Charlton
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory; Li Ka Shing Institute of Virology, Alberta Health Services, Edmonton, Alberta, Canada
| | - John Kim
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - Heidi Wood
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | | | - Jamil N Kanji
- Public Health Laboratory, Alberta Precision Laboratories, Calgary, Alberta, Canada
- Division of Infectious Diseases, Department of Medicine, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Nathan Zelyas
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory, Alberta Health Services, Edmonton, Alberta, Canada
| | - Sheila F O'Brien
- Epidemiology and Surveillance, Canadian Blood Services, Ottawa, Ontario, Canada
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Steven Drews
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Microbiology, Canadian Blood Services, Edmonton, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
- Alberta Precision Laboratories, Public Health Laboratory; Li Ka Shing Institute of Virology, Alberta Health Services, Edmonton, Alberta, Canada
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30
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Freedman SB, Xie J, Lee BE, Ali S, Pang XL, Chui L, Zhuo R, Vanderkooi OG, Tellier R, Funk AL, Tarr PI. Microbial Etiologies and Clinical Characteristics of Children Seeking Emergency Department Care Due to Vomiting in the Absence of Diarrhea. Clin Infect Dis 2021; 73:1414-1423. [PMID: 33993272 PMCID: PMC9794187 DOI: 10.1093/cid/ciab451] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [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: 03/05/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND As children with isolated vomiting are rarely able to provide a specimen suitable for routine pathogen testing, we have limited knowledge about their infecting pathogens. METHODS Between December 2014 and August 2018, children <18 years old with presumed acute gastroenteritis who presented to 2 emergency departments (EDs) in Alberta, Canada, were recruited. Eligible participants had ≥3 episodes of vomiting and/or diarrhea in a 24-hour period, <7 days of symptoms, and provided a rectal swab or stool specimen. We quantified the proportion of children with isolated vomiting in whom an enteropathogen was identified, and analyzed clinical characteristics, types of enteropathogens, resources used, and alternative diagnoses. RESULTS Of the 2695 participants, at the ED visit, 295 (10.9%), 1321 (49.0%), and 1079 (40.0%) reported having isolated diarrhea, vomiting and diarrhea, or isolated vomiting, respectively. An enteropathogen was detected most commonly in those with vomiting and diarrhea (1067/1321; 80.8%); detection did not differ between those with isolated diarrhea (170/295; 57.6%) and isolated vomiting (589/1079; 54.6%) (95% confidence interval of the difference: -3.4%, 9.3%). Children with isolated vomiting most often had a virus (557/1077; 51.7%), most commonly norovirus (321/1077; 29.8%); 5.7% (62/1079) had a bacterial pathogen. X-rays, ultrasounds, and urine tests were most commonly performed in children with isolated vomiting. Alternate etiologies were most common in those with isolated vomiting (5.7%; 61/1079). CONCLUSIONS The rate of enteropathogen identification in children with isolated vomiting using molecular diagnostic tests and rectal swabs is substantial. Molecular diagnostics offer an emerging diagnostic strategy in children with isolated vomiting.
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Affiliation(s)
- Stephen B Freedman
- Division of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada,Correspondence: S. B. Freedman, Professor of Pediatrics and Emergency Medicine, Alberta Children’s Hospital Foundation Professor in Child Health and Wellness, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB Canada T3B 6A8 ()
| | - Jianling Xie
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children’s Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada,Public Health Laboratory, Alberta Precision Laboratories, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory of Medicine and Pathology, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Section of Pediatric Infectious Diseases, Department of Pediatrics, Microbiology, Immunology, and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences. Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta,Canada
| | - Raymond Tellier
- Department of Medicine, McGill University and Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Division of Pediatric Gastroenterology, Hepatology & Nutrition, Department of Pediatrics, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
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31
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Ali S, Maki C, Xie J, Lee BE, Dickinson J, MacDonald SE, Poonai N, Thull-Freedman J, Vanderkooi O, Rajagopal M, Sivakumar M, Chui L, Graham TAD, Nettel-Aguirre A, Svenson LW, Freedman SB. Characterizing Pain in Children with Acute Gastroenteritis Who Present for Emergency Care. J Pediatr 2021; 231:102-109.e3. [PMID: 33333114 DOI: 10.1016/j.jpeds.2020.12.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To characterize the pain experienced by children with acute gastroenteritis (AGE) in the 24 hours before emergency department (ED) presentation. Secondary objectives included characterizing ED pain, discharge recommendations, overall analgesic use, and factors that influenced analgesic use and pain severity. STUDY DESIGN A prospective cohort was recruited from 2 pediatric EDs (December 2014 to September 2017). Eligibility criteria included <18 years of age, AGE (≥3 episodes of diarrhea or vomiting in the previous 24 hours), and symptom duration <7 days at presentation. RESULTS We recruited 2136 patients, median age 20.8 months (IQR 10.4, 47.4) and 45.8% (979/2136) female. In the 24 hours before enrollment, most caregivers reported moderate (28.6% [610/2136, 95% CI 26.7-30.5]) or severe (46.2% [986/2136, CI 44.0-48.3]) pain for their child. In the ED, they reported moderate (31.1% [664/2136, 95% CI 29.1-33.1]) or severe ([26.7% [571/2136, 95% CI 24.9-28.7]) pain; analgesia was provided to 21.2% (452/2131). The most common analgesics used in the ED were acetaminophen and ibuprofen. At discharge, these were also most commonly recommended. Factors associated with greater analgesia use in the ED were high pain scores during the index visit, having a primary care physician, earlier presentation to emergency care, fewer diarrheal episodes, presence of fever, and hospitalization at index visit. CONCLUSIONS Most caregivers of children presenting to the ED with AGE reported moderate or severe pain, both before and during their visit. Future research should focus on the development of effective, safe, and timely pain management plans.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada.
| | - Claudia Maki
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada
| | - James Dickinson
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Shannon E MacDonald
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), Edmonton, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada; School of Public Health, University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Naveen Poonai
- Department of Emergency Medicine, Section of Pediatric Emergency Medicine, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Jennifer Thull-Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Otto Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Manasi Rajagopal
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Mithra Sivakumar
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Alberta Public Health Laboratories-ProvLab, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Timothy A D Graham
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada; Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Departments of Family Medicine and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Bhavanam S, Freedman SB, Lee BE, Zhuo R, Qiu Y, Chui L, Xie J, Ali S, Vanderkooi OG, Pang XL. Differences in Illness Severity among Circulating Norovirus Genotypes in a Large Pediatric Cohort with Acute Gastroenteritis. Microorganisms 2020; 8:E1873. [PMID: 33256234 PMCID: PMC7760397 DOI: 10.3390/microorganisms8121873] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [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: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/23/2020] [Indexed: 12/12/2022] Open
Abstract
Norovirus is a major pathogen identified in children with acute gastroenteritis (AGE), little is known about the strain's diversity and their clinical severity. Stool and/or rectal swabs were collected from children ≤18 years of age recruited at emergency departments (ED), and a provincial nursing advice phone line due to AGE symptoms in the province of Alberta, Canada between December 2014 and August 2018. Specimens were tested using a reverse transcription real time PCR and genotyped by Sanger sequencing. The Modified Vesikari Scale score (MVS) was used to evaluate the disease severity. The objectives are to identify the Genogroup and Genotype distribution and to compare illness severity between the GI and GII genogroups and to complete further analyses comparing the GII genotypes identified. GII.4 was the genotype most commonly identified. Children with GII.4 had higher MVS scores (12.0 (10.0, 14.0; p = 0.002)) and more prolonged diarrheal (5 days (3.0, 7.8)) and vomiting (3.2 days (1.7, 5.3; p < 0.001)) durations compared to other non GII.4 strains. The predominant strain varied by year with GII.4 Sydney[P31] predominant in 2014/15, GII.4 Sydney[P16] in 2015/16 and 2017/18, and GII.3[P12] in 2016/17. Genogroup II norovirus strains predominated in children with AGE with variance between years; clinical severity associated with different strains varied with episodes being most severe among GII.4 infected children.
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Affiliation(s)
- Sudha Bhavanam
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Stephen B. Freedman
- Divisions of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Bonita E. Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (B.E.L.); (S.A.)
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, AB T6G 2J2, Canada
| | - Jianling Xie
- Departments of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children’s Health Research Institute, Stollery Children’s Hospital, University of Alberta, Edmonton, AB T6G 2R3, Canada; (B.E.L.); (S.A.)
| | - Otto G. Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences, Alberta Children’s Hospital, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB T3B 6A8, Canada;
| | - Xiaoli L. Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB T6G 2R3, Canada; (S.B.); (R.Z.); (Y.Q.); (L.C.)
- Public Health Laboratories (ProvLab), Alberta Precision Laboratories (APL), Edmonton, AB T6G 2J2, Canada
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Xie J, Pang XL, Tarr GAM, Mu Y, Zhuo R, Chui L, Lee BE, Vanderkooi OG, Tarr PI, Ali S, MacDonald SE, Freedman SB. Influenza virus detection in the stool of children with acute gastroenteritis. J Clin Virol 2020; 131:104565. [PMID: 32810839 DOI: 10.1016/j.jcv.2020.104565] [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: 01/07/2020] [Revised: 07/18/2020] [Accepted: 07/28/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To determine if the clinical characteristics of children with gastroenteritis and influenza identified in their stool differ from those whose stool was influenza-negative. METHODS Children <18-years with gastroenteritis whose stool tested negative for enteropathogen were tested for influenza in stool. The clinical features between influenza-positive and influenza-negative gastroenteritis cases were compared. Stools from controls without infection were also tested for influenza. RESULTS Among the 440 gastroenteritis cases, those who were influenza test-positive were older [median age 4.0 (IQR: 2.3, 5.5) vs. 1.5 (IQR: 0.5, 4.0) years; P = 0.008], more likely to present in fall or winter (92.3 % vs. 48.0 %; P = 0.001), be febrile (84.6 % vs. 30.6 %; P < 0.001), have respiratory symptoms (91.7 % vs. 44.8 %; P = 0.002), have dehydration [median Clinical Dehydration Scale score: 4 (IQR: 1.5, 4.5) vs. 2 (IQR: 0, 3); P = 0.034], and have higher Modified Vesikari Scale scores [median: 13 (IQR: 10.5, 14.0) vs. 10 (IQR: 9.0, 13.0); P = 0.044], than those who tested negative. Thirteen gastroenteritis cases (13/440; 3.0 %) including one child without respiratory symptoms vs. one control (1/250; 0.4 %) were influenza stool positive. CONCLUSIONS Fever, respiratory symptoms, more severe illness, and older age were more common in children with gastroenteritis with influenza detected in stool, compared to those tested negative.
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Affiliation(s)
- Jianling Xie
- Section of Pediatric Emergency Medicine, Department of Pediatric, Alberta Children Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xiao-Li Pang
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Gillian A M Tarr
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Yuan Mu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada; Department of Clinical Laboratory, Children's Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Alberta Precision Laboratories-Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Department of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology & Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Division of Gastroenterology, Hepatology & Nutrition, Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada; Women & Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada
| | - Shannon E MacDonald
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Stephen B Freedman
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Section of Pediatric Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Tarr GAM, Pang XL, Zhuo R, Lee BE, Chui L, Ali S, Vanderkooi OG, Michaels-Igbokwe C, Tarr PI, MacDonald SE, Currie G, MacDonald J, Kim K, Freedman SB. Attribution of Pediatric Acute Gastroenteritis Episodes and Emergency Department Visits to Norovirus Genogroups I and II. J Infect Dis 2020; 223:452-461. [PMID: 32614406 DOI: 10.1093/infdis/jiaa391] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/23/2020] [Accepted: 06/25/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Norovirus is a leading cause of acute gastroenteritis. With vaccines in development, population-based estimates of norovirus burden are needed to identify target populations, quantify potential benefits, and understand disease dynamics. METHODS We estimated the attributable fraction (AF) for norovirus infections in children, defined as the proportion of children testing positive for norovirus whose gastroenteritis was attributable to norovirus. We calculated the standardized incidence and emergency department (ED) visit rates attributable to norovirus using provincial gastroenteritis visit administrative data. RESULTS From 3731 gastroenteritis case patients and 2135 controls we determined that the AFs were 67.0% (95% confidence interval [CI], 31.5%-100%) and 91.6% (88.8%-94.4%) for norovirus genogroups I (GI) and II (GII), respectively. Norovirus GII AF varied by season but not age. We attributed 116 episodes (95% CI, 103-129) and 59 (51-67) ED visits per 10 000 child-years to norovirus GII across all ages, accounting for 20% and 18% of all medically attended gastroenteritis episodes and ED visits, respectively. CONCLUSIONS In children, a large proportion of norovirus GII detections reflect causation, demonstrating significant potential for norovirus GII vaccines. Seasonal variation in the norovirus GII AF may have implications for understanding the role asymptomatic carriage plays in disease dynamics.
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Affiliation(s)
- Gillian A M Tarr
- Division of Environmental Health Sciences, University of Minnesota, Minneapolis, Minnesota, USA
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Ran Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Precision Laboratories-ProvLab, Edmonton, Alberta, Canada
| | - Samina Ali
- Departments of Pediatrics and Emergency Medicine, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - Otto G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Christine Michaels-Igbokwe
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Phillip I Tarr
- Division of Gastroenterology, Hepatology, & Nutrition, Washington University School of Medicine, St Louis, Missouri, USA
| | | | - Gillian Currie
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Judy MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Freedman SB, Xie J, Nettel-Aguirre A, Pang XL, Chui L, Williamson-Urquhart S, Schnadower D, Schuh S, Sherman PM, Lee BE, Gouin S, Farion KJ, Poonai N, Hurley KF, Qiu Y, Ghandi B, Lloyd C, Finkelstein Y. A randomized trial evaluating virus-specific effects of a combination probiotic in children with acute gastroenteritis. Nat Commun 2020; 11:2533. [PMID: 32439860 PMCID: PMC7242434 DOI: 10.1038/s41467-020-16308-3] [Citation(s) in RCA: 24] [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: 12/18/2019] [Accepted: 04/25/2020] [Indexed: 01/11/2023] Open
Abstract
Gastroenteritis accounts for nearly 500,000 deaths in children younger than 5 years annually. Although probiotics have been touted as having the potential to expedite diarrhea resolution, recent clinical trials question their effectiveness. A potential explanation is a shift in pathogens following the introduction of a rotavirus vaccine. Here, we report the results of a multi-center, double-blind trial of 816 children with acute gastroenteritis who completed follow-up and provided multiple stool specimens. Participants were randomized to receive a probiotic containing Lactobacillus rhamnosus and Lactobacillus helveticus or placebo. We report no virus-specific beneficial effects attributable to the probiotic, either in reducing clinical symptoms or viral nucleic acid clearance from stool specimens collected up to 28 days following enrollment. We provide pathophysiological and microbiologic evidence to support the clinical findings and conclude that our data do not support routine probiotic administration to children with acute gastroenteritis, regardless of the infecting virus.
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Affiliation(s)
- Stephen B Freedman
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada.
| | - Jianling Xie
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Alberto Nettel-Aguirre
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - Xiao-Li Pang
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Linda Chui
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Sarah Williamson-Urquhart
- Alberta Children's Hospital Foundation Professor in Child Health and Wellness, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, 28 Oki Drive NW, Calgary, AB, T3B 6A8, Canada
| | - David Schnadower
- University of Cincinnati, 3333 Burnet Ave, Cincinnati, OH, UCA 45229, USA
| | - Suzanne Schuh
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Philip M Sherman
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
| | - Bonita E Lee
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Serge Gouin
- Université de Montréal, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 1C5, Canada
| | - Ken J Farion
- University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Naveen Poonai
- University of Western Ontario, 800 Commissioners Road E, London, ON, N6A 5W9, Canada
| | - Katrina F Hurley
- Dalhousie University, 5980 University Avenue, PO Box 9700, Halifax, NS, B3K 6R8, Canada
| | - Yuanyuan Qiu
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Binal Ghandi
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Colin Lloyd
- University of Alberta, 116 St & 85 Ave., Edmonton, AB, T6G 2R3, Canada
| | - Yaron Finkelstein
- University of Toronto, 555 University Avenue, Toronto, ON, M5G 1X8, Canada
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36
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Rudnick W, Science M, Thirion DJG, Abdesselam K, Choi KB, Pelude L, Amaratunga K, Comeau JL, Dalton B, Delport J, Dhami R, Embree J, Émond Y, Evans G, Frenette C, Fryters S, German G, Grant JM, Happe J, Katz K, Kibsey P, Kosar J, Langley JM, Lee BE, Lefebvre MA, Leis JA, McGeer A, Neville HL, Simor A, Slayter K, Suh KN, Tse-Chang A, Weiss K, Conly J. Antimicrobial use among adult inpatients at hospital sites within the Canadian Nosocomial Infection Surveillance Program: 2009 to 2016. Antimicrob Resist Infect Control 2020; 9:32. [PMID: 32054539 PMCID: PMC7020554 DOI: 10.1186/s13756-020-0684-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 10/25/2019] [Accepted: 01/23/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Antimicrobial resistance is a growing threat to the world's ability to prevent and treat infections. Links between quantitative antibiotic use and the emergence of bacterial resistance are well documented. This study presents benchmark antimicrobial use (AMU) rates for inpatient adult populations in acute-care hospitals across Canada. METHODS In this retrospective surveillance study, acute-care adult hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP) submitted annual AMU data on all systemic antimicrobials from 2009 to 2016. Information specific to intensive care units (ICUs) and non-ICU wards were available for 2014-2016. Data were analyzed using defined daily doses (DDD) per 1000 patient days (DDD/1000pd). RESULTS Between 2009 and 2016, 16-18 CNISP adult hospitals participated each year and provided their AMU data (22 hospitals participated in ≥1 year of surveillance; 11 in all years). From 2009 to 2016, there was a significant reduction in use (12%) (from 654 to 573 DDD/1000pd, p = 0.03). Fluoroquinolones accounted for the majority of this decrease (47% reduction in combined oral and intravenous use, from 129 to 68 DDD/1000pd, p < 0.002). The top five antimicrobials used in 2016 were cefazolin (78 DDD/1000pd), piperacillin-tazobactam (53 DDD/1000pd), ceftriaxone (49 DDD/1000pd), vancomycin (combined oral and intravenous use was 44 DDD/1000pd; 7% of vancomycin use was oral), and ciprofloxacin (combined oral and intravenous use: 42 DDD/1000pd). Among the top 10 antimicrobials used in 2016, ciprofloxacin and metronidazole use decreased significantly between 2009 and 2016 by 46% (p = 0.002) and 26% (p = 0.002) respectively. Ceftriaxone (85% increase, p = 0.0008) and oral amoxicillin-clavulanate (140% increase, p < 0.0001) use increased significantly but contributed only a small component (8.6 and 5.0%, respectively) of overall use. CONCLUSIONS This study represents the largest collection of dispensed antimicrobial use data among inpatients in Canada to date. Between 2009 and 2016, there was a significant 12% decrease in AMU, driven primarily by a 47% decrease in fluoroquinolone use. Modest absolute increases in parenteral ceftriaxone and oral amoxicillin-clavulanate use were noted but contributed a small amount of total AMU. Ongoing national surveillance is crucial for establishing benchmarks and antimicrobial stewardship guidelines.
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Affiliation(s)
- Wallis Rudnick
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 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
| | - Kahina Abdesselam
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
| | - Kelly B. 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
| | - Kanchana Amaratunga
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
| | - Jeannette L. Comeau
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 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 General Hospital, 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
| | - Greg German
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
| | - Jennifer M. Grant
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 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
| | - Justin Kosar
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 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
- Sunnybrook Research Institute, 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 Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
| | - Heather L. Neville
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
| | - Andrew Simor
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 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
| | - John Conly
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
| | - the Canadian Nosocomial Infection Surveillance Program
- Public Health Agency of Canada, 130 Colonnade Rd, Ottawa, ON K2E 7L9 Canada
- SickKids, 555 University Ave, Toronto, ON M5G 1X8 Canada
- Université de Montréal, 2900 Boulevard Edouard-Montpetit, Montréal, QC H3T 1J4 Canada
- McGill University Health Centre, 1001 Boulevard Décarie, Montréal, QC H4A 3J1 Canada
- The Ottawa Hospital, 501 Smyth Rd, Ottawa, ON K1H 8L6 Canada
- IWK Health Centre, 5980 University Ave, Halifax, NS B3K 6R8 Canada
- Dalhousie University, 6299 South St, Halifax, NS B3H 4R2 Canada
- Alberta Health Services, 1620 29 St NW, Calgary, AB T2N 4L7 Canada
- 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
- 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
- Hôpital Maisonneuve-Rosemont, 5415 Boulevard de l’Assomption, Montréal, QC H1T 2M4 Canada
- Kingston General Hospital, 76 Stuart St, Kingston, ON K7L 2V7 Canada
- Alberta Health Services, 10240 Kingsway Avenue, Edmonton, AB T5H 3V9 Canada
- Health PEI, 16 Garfield St, Charlottetown, PEI C1A 6A5 Canada
- University of British Columbia, 2329 West Mall, Vancouver, BC V6T 1Z4 Canada
- Infection Prevention and Control Canada, Red Deer, AB T4N 6R2 Canada
- North York General Hospital, 4001 Leslie St, North York, ON M2K 1E1 Canada
- Royal Jubilee Hospital, 1952 Bay St, Victoria, BC V8R 1J8 Canada
- Saskatchewan Health Authority, Saskatoon, SK S7N 0W8 Canada
- Stollery Children’s Hospital, Edmonton, AB T6G 2B7 Canada
- University of Alberta, Edmonton, AB T6G 2R7 Canada
- Sunnybrook Research Institute, 2075 Bayview Ave, Toronto, ON M4N 3M5 Canada
- Sinai Health System, 600 University Ave, Toronto, ON M5G 1X5 Canada
- University of Toronto, 27 King’s College Cir, Toronto, ON M5S Canada
- Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7 Canada
- Nova Scotia Health Authority, 1276 South Park St, Halifax, NS B3H 2Y9 Canada
- Sunnybrook Health Sciences Centre, 2015 Bayview Ave, Toronto, ON M4N 3M5 Canada
- SMBD-Jewish General Hospital, 3755 Chemin de la Côte-Sainte-Catherine, Montréal, QC H3T 1E2 Canada
- University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1 Canada
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Katz KC, Golding GR, Choi KB, Pelude L, Amaratunga KR, Taljaard M, Alexandre S, Collet JC, Davis I, Du T, Evans GA, Frenette C, Gravel D, Hota S, Kibsey P, Langley JM, Lee BE, Lemieux C, Longtin Y, Mertz D, Mieusement LMD, Minion J, Moore DL, Mulvey MR, Richardson S, Science M, Simor AE, Stagg P, Suh KN, Taylor G, Wong A, Thampi N. The evolving epidemiology of Clostridium difficile infection in Canadian hospitals during a postepidemic period (2009-2015). CMAJ 2019; 190:E758-E765. [PMID: 29941432 DOI: 10.1503/cmaj.180013] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND The clinical and molecular epidemiology of health care-associated Clostridium difficile infection in nonepidemic settings across Canada has evolved since the first report of the virulent North American pulsed-field gel electrophoresis type 1 (NAP1) strain more than 15 years ago. The objective of this national, multicentre study was to describe the evolving epidemiology and molecular characteristics of health care-associated C. difficile infection in Canada during a post-NAP1-epidemic period, particularly patient outcomes associated with the NAP1 strain. METHODS Adult inpatients with C. difficile infection were prospectively identified, using a standard definition, between 2009 and 2015 through the Canadian Nosocomial Infection Surveillance Program (CNISP), a network of 64 acute care hospitals. Patient demographic characteristics, severity of infection and outcomes were reviewed. Molecular testing was performed on isolates, and strain types were analyzed against outcomes and epidemiologic trends. RESULTS Over a 7-year period, 20 623 adult patients admitted to hospital with health care-associated C. difficile infection were reported to CNISP, and microbiological data were available for 2690 patients. From 2009 to 2015, the national rate of health care-associated C. difficile infection decreased from 5.9 to 4.3 per 10 000 patient-days. NAP1 remained the dominant strain type, but infection with this strain has significantly decreased over time, followed by an increasing trend of infection with NAP4 and NAP11 strains. The NAP1 strain was significantly associated with a higher rate of death attributable to C. difficile infection compared with non-NAP1 strains (odds ratio 1.91, 95% confidence interval [CI] 1.29-2.82). Isolates were universally susceptible to metronidazole; one was nonsusceptible to vancomycin. The proportion of NAP1 strains within individual centres predicted their rates of health care-associated C. difficile infection; for every 10% increase in the proportion of NAP1 strains, the rate of health care-associated C. difficile infection increased by 3.3% (95% CI 1.7%-4.9%). INTERPRETATION Rates of health care-associated C. difficile infection have decreased across Canada. In nonepidemic settings, NAP4 has emerged as a common strain type, but NAP1, although decreasing, continues to be the predominant circulating strain and remains significantly associated with higher attributable mortality.
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Affiliation(s)
- Kevin C Katz
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont.
| | - George R Golding
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Kelly Baekyung Choi
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Linda Pelude
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Kanchana R Amaratunga
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Monica Taljaard
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Stephanie Alexandre
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Jun Chen Collet
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Ian Davis
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Tim Du
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Gerald A Evans
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Charles Frenette
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Denise Gravel
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Susy Hota
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Pamela Kibsey
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Joanne M Langley
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Bonita E Lee
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Camille Lemieux
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Yves Longtin
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Dominik Mertz
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Lorraine Maze Dit Mieusement
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Jessica Minion
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Dorothy L Moore
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Michael R Mulvey
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Susan Richardson
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Michelle Science
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Andrew E Simor
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Paula Stagg
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Kathryn N Suh
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Geoffrey Taylor
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Alice Wong
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
| | - Nisha Thampi
- North York General Hospital (Katz), Toronto, Ont.; National Microbiology Laboratory (Golding, Du, Mulvey), Winnipeg, Man.; Public Health Agency Canada (Choi, Pelude, Amaratunga, Alexandre, Gravel), Ottawa, Ont.; Ottawa Hospital Research Institute (Taljaard), Ottawa, Ont.; BC Children's Hospital, BC Women's Hospital (Collet), Vancouver, BC; Queen Elizabeth II Health Sciences Centre (Davis), Halifax, NS; Kingston General Hospital (Evans), Kingston, Ont.; McGill University Health Centre (Frenette), Montréal, Que.; University Health Network (Hota, Lemieux), Toronto, Ont.; Royal Jubilee Hospital (Kibsey), Victoria, BC; IWK Health Centre (Langley), Halifax, NS; Stollery Children's Hospital (Lee), Edmonton, Alta.; Jewish General Hospital (Longtin), Montréal, Que.; Hamilton Health Sciences (Mertz), Hamilton, Ont.; Mount Sinai Hospital (Maze Dit Mieusement), Toronto, Ont.; Regina General Hospital (Minion), Regina, Sask.; Montreal Children's Hospital (Moore), Montréal, Que.; The Hospital for Sick Children (Richardson, Science), Toronto, Ont.; Sunnybrook Health Sciences Centre (Simor), Toronto, Ont.; Western Memorial Regional Hospital (Stagg), Corner Brook, NL; The Ottawa Hospital (Suh, Amaratunga), Ottawa, Ont.; University of Alberta Hospital (Taylor), Edmonton, Alta., Royal University Hospital (Wong), Saskatoon, Sask.; Children's Hospital of Eastern Ontario (Thampi), Ottawa, Ont
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Tarr GAM, Chui L, Lee BE, Pang XL, Ali S, Nettel-Aguirre A, Vanderkooi OG, Berenger BM, Dickinson J, Tarr PI, Drews S, MacDonald J, Kim K, Freedman SB. Performance of Stool-testing Recommendations for Acute Gastroenteritis When Used to Identify Children With 9 Potential Bacterial Enteropathogens. Clin Infect Dis 2019; 69:1173-1182. [PMID: 30517612 PMCID: PMC7348586 DOI: 10.1093/cid/ciy1021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [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: 10/17/2018] [Accepted: 11/29/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The ability to identify bacterial pathogens that necessitate specific clinical management or public health action in children with acute gastroenteritis is crucial to patient care and public health. However, existing stool-testing guidelines offer inconsistent recommendations, and their performance characteristics are unknown. We evaluated 6 leading gastroenteritis guidelines (eg, those of the Centers for Disease Control and Prevention and Infectious Disease Society of America) that recommend when to test children's stool for bacterial enteropathogens. METHODS Via 2 emergency departments in Alberta, Canada, we enrolled 2447 children <18 years old who presented with ≥3 episodes of diarrhea and/or vomiting in a 24-hour period. All participants were tested for 9 bacterial enteropathogens: Aeromonas, Campylobacter, Escherichia coli O157, other Shiga toxin-producing E. coli, enterotoxigenic E. coli, Salmonella, Shigella, Vibrio, and Yersinia. Patient data gathered at the index visit were used to determine whether guidelines would recommend testing. Sensitivity and specificity to recommend testing for children with bacterial enteropathogens were calculated for each guideline. RESULTS Outcome data were available for 2391 (97.7%) participants, and 6% (144/2391) of participants tested positive for a bacterial enteropathogen. Guideline sensitivity ranged from 25.8% (95% confidence interval [CI] 18.7-33.0%) to 66.9% (95% CI 59.3-74.6%), and varied for individual pathogens. Guideline specificity for all bacterial enteropathogens ranged from 63.6% (95% CI 61.6-65.6%) to 96.5% (95% CI 95.7-97.2%). CONCLUSIONS No guideline provided optimally balanced performance. The most sensitive guidelines missed one-third of cases and would drastically increase testing volumes. The most specific guidelines missed almost 75% of cases.
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Affiliation(s)
- Gillian A M Tarr
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Linda Chui
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Xiao-Li Pang
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Samina Ali
- Department of Pediatrics, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
- Department of Emergency Medicine, Women and Children’s Health Research Institute, University of Alberta, Alberta, Canada
| | - Alberto Nettel-Aguirre
- Departments of Pediatrics and Community Health Sciences, University of Calgary, Alberta, Canada
| | - Otto G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine, and Community Health Sciences, Alberta Children’s Hospital Research Institute, Alberta, Canada
| | - Byron M Berenger
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Canada
- Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - James Dickinson
- Department of Family Medicine, University of Calgary, Alberta, Canada
| | - Phillip I Tarr
- Department of Pediatrics, Washington University in St. Louis School of Medicine, Missouri
| | - Steven Drews
- Department of Laboratory Medicine and Pathology, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Judy MacDonald
- Alberta Health Services and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, University of Calgary, University of Alberta and Alberta Provincial Laboratory for Public Health, Alberta, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Alberta, Canada
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Pang X, Qiu Y, Gao T, Zurawell R, Neumann NF, Craik S, Lee BE. Prevalence, levels and seasonal variations of human enteric viruses in six major rivers in Alberta, Canada. Water Res 2019; 153:349-356. [PMID: 30743085 DOI: 10.1016/j.watres.2019.01.034] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 12/21/2018] [Accepted: 01/12/2019] [Indexed: 06/09/2023]
Abstract
The prevalence and seasonal variation of 7 viruses in 6 major rivers in Alberta were assessed using a combination of qPCR, cell culture and integrated cell culture with qPCR (ICC-qPCR). Water samples were collected monthly from rivers at different sites upstream and downstream of major urban centers. Seven viruses including rotavirus, adenovirus, astrovirus, norovirus, sapovirus, JC virus and enterovirus, were detected in at least one of the water samples at each site using qPCR. Rotavirus was most common with concentration ranging from 2.3 to 4.5 log10 genomic equivalent (GE) copies/L. Norovirus, sapovirus, astrovirus, adenoviruses and JC virus peaked during the winter (November to March). Viruses were most prevalent at the Bow River sampling site downstream of the City of Calgary, followed by the North Saskatchewan River site downstream of the City of Edmonton and the Red Deer River site downstream of the City of Red Deer. The detection rates and quantity of viruses had significant difference in the sampling sites between upstream and downstream of major urban centers (p < 0.001). 14% of the samples tested positive using viral culture indicating the presence of infectious viruses in river. Sequencing analysis identified human rotavirus in 75% of the samples collected from downstream versus 37% of the samples collected from upstream sites (p < 0.02). Multivariate binary regression showed that human activity in watersheds is a significant determinant of viruses in Alberta's Rivers. The discharge from wastewater treatment plants may be the possible sources of viral contamination. Seasonal coincidence of acute viral gastroenteritis outbreaks and monthly peak occurrence of enteric viruses in river water implies potential impact of waterborne viruses on human health.
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Affiliation(s)
- Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada; Provincial Laboratory for Public Health, 8440-112st, Edmonton, AB, T6G 2J2, Canada.
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Tiejun Gao
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G 2R3, Canada
| | - Ron Zurawell
- Environmental Monitoring and Science Division, Alberta Environment and Parks, Edmonton, AB, T5J 5C6, Canada
| | - Norman F Neumann
- School of Public Health, University of Alberta, 1405-87 Ave, Edmonton, AB, T6G 1C9, Canada
| | - Stephen Craik
- EPCOR Water, 9469 Rossdale Rd NW, Edmonton, AB, T5K 2E9, Canada
| | - Bonita E Lee
- Department of Paediatrics, University of Alberta, 1405-87 Ave, Edmonton, AB, T6G 1C9, Canada
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Hasing ME, Lee BE, Qiu Y, Xia M, Pabbaraju K, Wong A, Tipples G, Jiang X, Pang XL. Changes in norovirus genotype diversity in gastroenteritis outbreaks in Alberta, Canada: 2012-2018. BMC Infect Dis 2019; 19:177. [PMID: 30782126 PMCID: PMC6381812 DOI: 10.1186/s12879-019-3792-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [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: 09/24/2018] [Accepted: 02/07/2019] [Indexed: 11/10/2022] Open
Abstract
Background The emergence of norovirus genotype GII.4 variants has been associated with gastroenteritis pandemics worldwide, prompting molecular surveillance for early detection of novel strains. In this study, we aimed to analyze the outbreak activity of norovirus and characterize the norovirus strains circulating in Alberta between July 2012 and February 2018. Methods Stool samples from gastroenteritis outbreaks in Alberta were tested for norovirus at the Provincial Laboratory for Public Health using a multiplex real time-RT PCR assay. The ORF1 and ORF2-genotypes of norovirus positive samples were assigned based on phylogenetic analyses of partial polymerase and capsid sequences, respectively. Results A total of 530 norovirus outbreaks were identified. During July 2012 and June 2017 there was a gradual decrease in the annual number of GII.4 outbreaks, however, outbreak numbers increased from June 2017–February 2018. Four novel strains emerged: GII.17 Kawasaki in July 2014–June 2015, GII.P16/GII.4 Sydney in July 2015–June 2016, GII.P16/GII.2 and GII.P4 New Orleans/GII.4 Sydney in July 2016–June 2017. GII.Pe/GII.4 Sydney was the single predominant strain responsible for the majority (over 50%) of all norovirus outbreaks up to June 2015. Between June 2017 and February 2018, GII.P16/GII.4 Sydney was the leading strain causing 63% of all norovirus outbreaks. Conclusions GII.4 stands as the predominant capsid genotype causing a large majority of the norovirus outbreaks in early 2018. An increase in genotype diversity was observed in the last years, characterized by a high circulation of non-GII.4 strains and GII.4 recombinants. Electronic supplementary material The online version of this article (10.1186/s12879-019-3792-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maria E Hasing
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Bonita E Lee
- Department of Paediatrics, University of Alberta, Edmonton, AB, Canada
| | - Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Ming Xia
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - Kanti Pabbaraju
- Provincial Laboratory for Public Health (Microbiology), University of Alberta Hospital, WMC 2B4.58, 8440-112 Street, Edmonton, Alberta, T6G 2J2, Canada
| | - Anita Wong
- Provincial Laboratory for Public Health (Microbiology), University of Alberta Hospital, WMC 2B4.58, 8440-112 Street, Edmonton, Alberta, T6G 2J2, Canada
| | - Graham Tipples
- Department of Medical Microbiology and Immunology, University of Alberta, Edmonton, AB, Canada.,Provincial Laboratory for Public Health (Microbiology), University of Alberta Hospital, WMC 2B4.58, 8440-112 Street, Edmonton, Alberta, T6G 2J2, Canada
| | - Xi Jiang
- Division of Infectious Diseases, Cincinnati Children's Hospital Medical Centre, Cincinnati, OH, USA
| | - Xiaoli L Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada. .,Provincial Laboratory for Public Health (Microbiology), University of Alberta Hospital, WMC 2B4.58, 8440-112 Street, Edmonton, Alberta, T6G 2J2, Canada.
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Qiu Y, Li Q, Lee BE, Ruecker NJ, Neumann NF, Ashbolt NJ, Pang X. UV inactivation of human infectious viruses at two full-scale wastewater treatment plants in Canada. Water Res 2018; 147:73-81. [PMID: 30300783 DOI: 10.1016/j.watres.2018.09.057] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 09/27/2018] [Accepted: 09/30/2018] [Indexed: 05/19/2023]
Abstract
Ultraviolet (UV) disinfection is widely used to inactivate microorganisms prior to release of treated municipal wastewater. However, limited data are available for in situ inactivation of infectious enteric viruses by UV treatment at full-scale. In this study, a total of 51 pre-UV and 50 post-UV samples were collected over a two-year period from two wastewater treatment plants (WWTPs) and analyzed for noroviruses, rotavirus, reovirus, sapovirus, astrovirus, enteroviruses, adenoviruses and JC virus. Both pre-UV and post-UV samples had relatively high concentrations of these viruses determined by qPCR. Infectious viruses were also observed in 98% of pre-UV samples and 76% of post-UV samples by cell culture, using either cytopathic effect (CPE) or integrated cell culture with qPCR (ICC-qPCR). Reovirus was the most common virus detected by ICC-qPCR, present in 92% of pre-UV and 48% of post-UV samples. Infectious enterovirus and adenovirus were detected by ICC-qPCR in 33% and 31% of pre-UV samples, 14% and 20% of post-UV samples, respectively. Mean log10 reduction estimates for infectious reovirus was 1.2 and 1.8 log for the two WWTPs as assessed by ICC-qPCR, which was similar to the reduction of total infectious viruses (1.5 and 1.7 log) as assessed by CPE in cells culture. Overall, quantification of infectious reovirus appears to provide a useful index of enteric virus inactivation during wastewater treatment at full-scale. To our knowledge, this is the first comprehensive study to assess UV inactivation of human enteric viruses at full-scale in WWTPs using both molecular and cell culture techniques, providing important information for quantitative microbial risk assessment of UV inactivation of human viruses in municipal wastewater.
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Affiliation(s)
- Yuanyuan Qiu
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G. 2R3, Canada
| | - Qiaozhi Li
- School of Public Health, University of Alberta, 11405-87Ave, Edmonton, AB, T6G 1C9, Canada
| | - Bonita E Lee
- Department of Pediatrics, University of Alberta, 11405-87Ave, Edmonton, AB, T6G 1C9, Canada
| | - Norma J Ruecker
- City of Calgary, Water Resources, 625, 25 Avenue SE, Calgary, AB, T2G 4K8, Canada
| | - Norman F Neumann
- School of Public Health, University of Alberta, 11405-87Ave, Edmonton, AB, T6G 1C9, Canada
| | - Nicholas J Ashbolt
- School of Public Health, University of Alberta, 11405-87Ave, Edmonton, AB, T6G 1C9, Canada; Provincial Laboratory for Public Health, 8440-112st, Edmonton, AB, T6G 2J2, Canada
| | - Xiaoli Pang
- Department of Laboratory Medicine and Pathology, University of Alberta, 116st & 85 Ave, Edmonton, AB, T6G. 2R3, Canada; Provincial Laboratory for Public Health, 8440-112st, Edmonton, AB, T6G 2J2, Canada.
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Freedman SB, Williamson-Urquhart S, Farion KJ, Gouin S, Willan AR, Poonai N, Hurley K, Sherman PM, Finkelstein Y, Lee BE, Pang XL, Chui L, Schnadower D, Xie J, Gorelick M, Schuh S. Multicenter Trial of a Combination Probiotic for Children with Gastroenteritis. N Engl J Med 2018; 379:2015-2026. [PMID: 30462939 DOI: 10.1056/nejmoa1802597] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [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: 11/19/2022]
Abstract
BACKGROUND Gastroenteritis accounts for approximately 1.7 million visits to the emergency department (ED) by children in the United States every year. Data to determine whether the use of probiotics improves outcomes in these children are lacking. METHODS We conducted a randomized, double-blind trial involving 886 children 3 to 48 months of age with gastroenteritis who presented to six pediatric EDs in Canada. Participants received a 5-day course of a combination probiotic product containing Lactobacillus rhamnosus R0011 and L. helveticus R0052, at a dose of 4.0×109 colony-forming units twice daily or placebo. The primary outcome was moderate-to-severe gastroenteritis, which was defined according to a post-enrollment modified Vesikari scale symptom score of 9 or higher (scores range from 0 to 20, with higher scores indicating more severe disease). Secondary outcomes included the duration of diarrhea and vomiting, the percentage of children who had unscheduled physician visits, and the presence or absence of adverse events. RESULTS Moderate-to-severe gastroenteritis within 14 days after enrollment occurred in 108 of 414 participants (26.1%) who were assigned to probiotics and 102 of 413 participants (24.7%) who were assigned to placebo (odds ratio, 1.06; 95% confidence interval [CI], 0.77 to 1.46; P=0.72). After adjustment for trial site, age, detection of rotavirus in stool, and frequency of diarrhea and vomiting before enrollment, trial-group assignment did not predict moderate-to-severe gastroenteritis (odds ratio, 1.06; 95% CI, 0.76 to 1.49; P=0.74). There were no significant differences between the probiotic group and the placebo group in the median duration of diarrhea (52.5 hours [interquartile range, 18.3 to 95.8] and 55.5 hours [interquartile range, 20.2 to 102.3], respectively; P=0.31) or vomiting (17.7 hours [interquartile range, 0 to 58.6] and 18.7 hours [interquartile range, 0 to 51.6], P=0.18), the percentages of participants with unscheduled visits to a health care provider (30.2% and 26.6%; odds ratio, 1.19; 95% CI, 0.87 to 1.62; P=0.27), and the percentage of participants who reported an adverse event (34.8% and 38.7%; odds ratio, 0.83; 95% CI, 0.62 to 1.11; P=0.21). CONCLUSIONS In children who presented to the emergency department with gastroenteritis, twice-daily administration of a combined L. rhamnosus-L. helveticus probiotic did not prevent the development of moderate-to-severe gastroenteritis within 14 days after enrollment. (Funded by the Canadian Institutes of Health Research and others; PROGUT ClinicalTrials.gov number, NCT01853124 .).
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Affiliation(s)
- Stephen B Freedman
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Sarah Williamson-Urquhart
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Ken J Farion
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Serge Gouin
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Andrew R Willan
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Naveen Poonai
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Katrina Hurley
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Philip M Sherman
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Yaron Finkelstein
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Bonita E Lee
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Xiao-Li Pang
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Linda Chui
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - David Schnadower
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Jianling Xie
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Marc Gorelick
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
| | - Suzanne Schuh
- From the Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute (S.B.F.), and the Section of Pediatric Emergency Medicine, Alberta Children's Hospital (S.W.-U., J.X.), Cumming School of Medicine, University of Calgary, Calgary, the Departments of Pediatrics and Emergency Medicine, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa (K.J.F.), the Division of Pediatric Emergency Medicine, Department of Pediatrics, Centre Hospitalier Universitaire Sainte-Justine, Université de Montréal, Montreal (S.G.), Ontario Child Health Support Unit, SickKids Research Institute, the Division of Biostatistics, Dalla Lana School of Public Health (A.R.W.), the Division of Gastroenterology, Hepatology, and Nutrition (P.M.S.), the Divisions of Pediatric Emergency Medicine and Clinical Pharmacology and Toxicology (Y.F.), and the Division of Pediatric Emergency Medicine and Research Institute (S.S.), Hospital for Sick Children, University of Toronto, Toronto, the Division of Emergency Medicine, London Health Sciences Centre, Department of Pediatrics, Schulich School of Medicine and Dentistry, Western University, London, ON (N.P.), the Division of Pediatric Emergency Medicine, IWK Health Centre, Halifax, NS (K.H.), the Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute (B.E.L.) and the Provincial Laboratory for Public Health-Alberta Public Laboratories and Department of Laboratory Medicine and Pathology (X.-L.P., L.C.), University of Alberta, Edmonton - all in Canada; the Division of Pediatric Emergency Medicine, Washington University School of Medicine, St. Louis (D.S.); and Children's Minnesota and Department of Pediatrics, University of Minnesota Medical School, Minneapolis (M.G.)
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Xie J, Nettel-Aguirre A, Lee BE, Chui L, Pang XL, Zhuo R, Parsons B, Vanderkooi OG, Tarr PI, Ali S, Dickinson JA, Hagen E, Svenson LW, MacDonald SE, Drews SJ, Tellier R, Graham T, Lavoie M, MacDonald J, Freedman SB. Relationship between enteric pathogens and acute gastroenteritis disease severity: a prospective cohort study. Clin Microbiol Infect 2018; 25:454-461. [PMID: 29964235 DOI: 10.1016/j.cmi.2018.06.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 03/07/2018] [Revised: 05/28/2018] [Accepted: 06/09/2018] [Indexed: 12/18/2022]
Abstract
OBJECTIVES To evaluate the relationship between individual bacterial and viral pathogens and disease severity. METHODS Children <18 years with three or more episodes of vomiting and/or diarrhoea were enrolled in two Canadian paediatric emergency departments between December 2014 and August 2016. Specimens were analysed employing molecular panels, and outcome data were collected 14 days after enrolment. The primary outcome was severe disease over the entire illness (symptom onset until 14-day follow-up), quantified employing the Modified Vesikari Scale (MVS) score. The score was additionally analysed in two other time periods: index (symptom onset until enrolment) and follow-up (enrolment until 14-day follow-up). RESULTS Median participant age was 20.7 (IQR: 11.3, 44.2) months; 47.4% (518/1093) and 73.4% (802/1093) of participants had index and total MVS scores ≥11, respectively. The most commonly identified pathogens were rotavirus (289/1093; 26.4%) and norovirus (258/1093; 23.6%). In multivariable analysis, severe disease over the entire illness was associated with rotavirus (OR = 9.60; 95%CI: 5.69, 16.19), Salmonella (OR = 6.61; 95%CI: 1.50, 29.17), adenovirus (OR = 2.53; 95%CI: 1.62, 3.97), and norovirus (OR = 1.43; 95%CI: 1.01, 2.01). Pathogens associated with severe disease at the index visit were: rotavirus only (OR = 6.13; 95%CI: 4.29, 8.75), Salmonella (OR = 4.59; 95%CI: 1.71, 12.29), adenovirus only (OR = 2.06; 95%CI: 1.41, 3.00), rotavirus plus adenovirus (OR = 3.15; 95%CI: 1.35, 7.37), and norovirus (OR = 0.68; 95%CI: 0.49, 0.94). During the follow-up period, rotavirus (OR = 2.21; 95%CI: 1.50, 3.25) and adenovirus (OR = 2.10; 95%CI: 1.39, 3.18) were associated with severe disease. CONCLUSIONS In children presenting for emergency department care with acute gastroenteritis, pathogens identified were predominantly viruses, and several of which were associated with severe disease. Salmonella was the sole bacterium independently associated with severe disease.
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Affiliation(s)
- J Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - A Nettel-Aguirre
- Departments of Pediatrics and of Community Health Sciences, Cumming School of Medicine, Faculty of Kinesiology, Alberta Children's Hospital Research Institute, O'Brien Population Health Institute, University of Calgary, Calgary, Alberta, Canada
| | - B E Lee
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - L Chui
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - X L Pang
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Zhuo
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - B Parsons
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - O G Vanderkooi
- Departments of Pediatrics, Microbiology, Immunology and Infectious Diseases, Pathology and Laboratory Medicine and Community Health Sciences and the Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - P I Tarr
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Washington University School of Medicine, St Louis, MO, USA
| | - S Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta, Canada
| | - J A Dickinson
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - E Hagen
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, University of Calgary, Calgary, Alberta, Canada
| | - L W Svenson
- Analytics and Performance Reporting, Alberta Health Division of Preventive Medicine, School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - S E MacDonald
- Faculty of Nursing, University of Alberta, Edmonton, Canada; School of Public Health, University of Alberta, Edmonton, Canada; Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - S J Drews
- Provincial Laboratory for Public Health, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - R Tellier
- Provincial Laboratory for Public Health, Alberta, Canada; Departments of Pathology and Laboratory Medicine and Microbiology, Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - T Graham
- Alberta Health Services, Edmonton Zone, Alberta, Canada; Department of Emergency Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M Lavoie
- Population and Public Health, Fraser Health, Surrey, British Columbia, Canada
| | - J MacDonald
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - S B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Chan MCW, Hu Y, Chen H, Podkolzin AT, Zaytseva EV, Komano J, Sakon N, Poovorawan Y, Vongpunsawad S, Thanusuwannasak T, Hewitt J, Croucher D, Collins N, Vinjé J, Pang XL, Lee BE, de Graaf M, van Beek J, Vennema H, Koopmans MPG, Niendorf S, Poljsak-Prijatelj M, Steyer A, White PA, Lun JH, Mans J, Hung TN, Kwok K, Cheung K, Lee N, Chan PKS. Global Spread of Norovirus GII.17 Kawasaki 308, 2014-2016. Emerg Infect Dis 2018; 23:1359-1354. [PMID: 28726618 PMCID: PMC5547775 DOI: 10.3201/eid2308.161138] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Analysis of complete capsid sequences of the emerging norovirus GII.17 Kawasaki 308 from 13 countries demonstrated that they originated from a single haplotype since the initial emergence in China in late 2014. Global spread of a sublineage SL2 was identified. A new sublineage SL3 emerged in China in 2016.
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Kawaguchi A, Bates A, Lee BE, Drews S, Garros D. Virus detection in critically ill children with acute respiratory disease: a new profile in view of new technology. Acta Paediatr 2018; 107:504-510. [PMID: 29131392 PMCID: PMC7159542 DOI: 10.1111/apa.14148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Revised: 11/06/2017] [Accepted: 11/07/2017] [Indexed: 12/15/2022]
Abstract
AIM To describe the epidemiology of critically ill children admitted to a paediatric intensive care unit (PICU) with acute respiratory disease. The association with intubation was analysed for the three most prevalent viruses and in those with and without viral co-infection. METHODS Patients admitted to the PICU (2004-2014) with acute respiratory disease were included. Analyses were performed utilising each respiratory viral infection or multiple viral infections as an exposure. RESULTS There were 1766 admissions with acute respiratory disease of which 1372 had respiratory virus testing and 748 had one or more viruses detected. The risk of intubation before or during the PICU stay was higher if parainfluenza virus was detected compared to respiratory syncytial virus (RSV) (OR: 2.20; 95% CI: 1.06-4.56). Sixty-three admissions had two or more viruses detected, and the combination of RSV and Rhinovirus/enterovirus was the most common. No significant difference was observed in the risk of intubation between patients with multiple and single viral infections. CONCLUSION Higher risk of intubation was found in patients with parainfluenza as compared to RSV. The risk of intubation comparing parainfluenza virus to other viruses and for patients with multiple versus single virus needs to be further studied.
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Affiliation(s)
- Atsushi Kawaguchi
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
- School of Public Health; University of Alberta; Edmonton AB Canada
| | - Angela Bates
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
| | - Bonita E. Lee
- Department of Pediatrics; Pediatric Infectious Disease; University of Alberta; Edmonton AB Canada
| | - Steven Drews
- Provincial Laboratory for Public Health; Alberta Health Services; Edmonton AB Canada
- Department of Laboratory Medicine and Pathology; University of Alberta; Edmonton AB Canada
| | - Daniel Garros
- Department of Pediatrics; Pediatric Critical Care Medicine; University of Alberta; Edmonton AB Canada
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Zhuo R, Parsons BD, Lee BE, Drews SJ, Chui L, Louie M, Crago B, Freedman SB, Ali S, Pang X. Identification of Enteric Viruses in Oral Swabs from Children with Acute Gastroenteritis. J Mol Diagn 2018; 20:56-62. [DOI: 10.1016/j.jmoldx.2017.09.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 08/23/2017] [Accepted: 09/22/2017] [Indexed: 01/01/2023] Open
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Freedman SB, Eltorki M, Chui L, Xie J, Feng S, MacDonald J, Dixon A, Ali S, Louie M, Lee BE, Osterreicher L, Thull-Freedman J. Province-Wide Review of Pediatric Shiga Toxin-Producing Escherichia coli Case Management. J Pediatr 2017; 180:184-190.e1. [PMID: 27745751 DOI: 10.1016/j.jpeds.2016.09.013] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [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] [Received: 06/01/2016] [Revised: 07/27/2016] [Accepted: 09/08/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To identify the gaps in the care of children infected with Shiga toxin-producing Escherichia coli (STEC), we sought to quantitate care received and management timelines. Such knowledge is crucial to the design of interventions to prevent the development of hemolytic uremic syndrome (HUS). STUDY DESIGN We conducted a retrospective case-series study of 78 children infected with STEC in Alberta, Canada, through the linkage of microbiology and laboratory results, telephone health advice records, hospital charts, physician billing submissions, and outpatient antimicrobial dispensing databases. Outcomes were the time intervals between initial presentation and reporting of positive culture result and symptom onset to HUS and to describe the proportions that had baseline blood work performed and received antibiotics. RESULTS Seventy-eight children infected with STEC were identified; 13% (10/78) developed HUS. Median time from initial presentation to laboratory stool sample receipt was 33 hours (IQR 18, 42); time to positive culture was 120 hours (IQR 86, 205). Time from symptom onset to HUS diagnosis was 188 ± 37 hours. Baseline blood tests were obtained in 74% (58/78) of infected children. Antibiotics were administered to 50% (5/10) of those who developed HUS and 22% (15/78) of those who did not; P = .11. The provincial telephone advice system received 31 calls regarding 24 children infected with STEC; 23% (7/31) of callers were recommended to seek emergency department care. CONCLUSIONS A significant proportion of children developed HUS following multiple interactions with the health care system. Delays in the confirmation of STEC infection occurred. There are numerous opportunities to improve the timing, monitoring, and interventions in children infected with STEC.
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Affiliation(s)
- Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children's Hospital, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada.
| | - Mohamed Eltorki
- Division of Pediatric Emergency Medicine, McMaster Children's Hospital, McMaster University, Hamilton, Ontario, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Jianling Xie
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sharon Feng
- Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Judy MacDonald
- Population, Public and Indigenous Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Andrew Dixon
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Marie Louie
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada; Department of Microbiology Immunology and Infectious Diseases, University of Calgary, Calgary, Alberta, Canada
| | - Bonita E Lee
- Department of Pediatrics, Faculty of Medicine & Dentistry, Women and Children's Health Research Institute, University of Alberta, Edmonton, Alberta
| | - Lara Osterreicher
- Provincial Clinical Programs, Health Link, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jennifer Thull-Freedman
- Section of Pediatric Emergency Medicine, Alberta Children's Hospital, Department of Pediatrics, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
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Martin LJ, Im C, Dong H, Lee BE, Talbot J, Meurer DP, Mukhi SN, Drews SJ, Yasui Y. Influenza-like illness-related emergency department visits: Christmas and New Year holiday peaks and relationships with laboratory-confirmed respiratory virus detections, Edmonton, Alberta, 2004-2014. Influenza Other Respir Viruses 2017; 11:33-40. [PMID: 27442911 PMCID: PMC5155650 DOI: 10.1111/irv.12416] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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] [Accepted: 07/08/2016] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Emergency department (ED) visit volumes can be especially high during the Christmas-New Year holidays, a period occurring during the influenza season in Canada. METHODS Using daily data, we examined the relationship between ED visits for the chief complaint "cough" (for Edmonton, Alberta residents) and laboratory detections for influenza A and respiratory syncytial virus (RSV) (for Edmonton and surrounding areas), lagged 0-5 days ahead, for non-pandemic years (2004-2008 and 2010-2014) using multivariable linear regression adjusting for temporal variables. We defined these cough-related visits as influenza-like illness (ILI)-related ED visits and, for 2004-2014, compared Christmas-New Year holiday (December 24-January 3) and non-holiday volumes during the influenza season (October-April). RESULTS Adjusting for temporal variables, ILI-related ED visits were significantly associated with laboratory detections for influenza A and RSV. During non-pandemic years, the highest peak in ILI-related visit volumes always occurred during the holidays. The median number of holiday ILI-related visits/day (42.5) was almost twice the non-holiday median (24) and was even higher in 2012-2013 (80) and 2013-2014 (86). Holiday ILI-related ED visit volumes/100 000 population ranged from 56.0 (2010-2011) to 117.4 (2012-2013). In contrast, lower visit volumes occurred during the holidays of pandemic-affected years (2008-2010). CONCLUSIONS During non-pandemic years, ILI-related ED visit volumes were associated with variations in detections for influenza A and RSV and always peaked during the Christmas-New Year holidays. This predictability should be used to prepare for, and possibly prevent, this increase in healthcare use; however, interventions beyond disease prevention strategies are likely needed.
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Affiliation(s)
- Leah J. Martin
- School of Public HealthUniversity of AlbertaEdmontonABCanada
| | - Cindy Im
- School of Public HealthUniversity of AlbertaEdmontonABCanada
| | - Huiru Dong
- School of Public HealthUniversity of AlbertaEdmontonABCanada
| | - Bonita E. Lee
- Department of PediatricsUniversity of AlbertaEdmontonABCanada
| | - James Talbot
- Office of the Chief Medical Officer of HealthAlberta HealthEdmontonABCanada
| | | | - Shamir N. Mukhi
- School of Public HealthUniversity of AlbertaEdmontonABCanada
- Canadian Network for Public Health IntelligenceNational Microbiology LaboratoryWinnipegMBCanada
| | - Steven J. Drews
- Provincial Laboratory for Public Health (ProvLab) AlbertaAlberta Health ServicesEdmontonABCanada
- Department of Laboratory Medicine and PathologyUniversity of AlbertaEdmontonABCanada
| | - Yutaka Yasui
- School of Public HealthUniversity of AlbertaEdmontonABCanada
- Department of Epidemiology and Cancer ControlSt. Jude Children's Research HospitalMemphisTNUSA
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Suresh S, Lee BE, Robinson JL, Akinwumi MS, Preiksaitis JK. A risk-stratified approach to cytomegalovirus prevention in pediatric solid organ transplant recipients. Pediatr Transplant 2016; 20:970-980. [PMID: 27565955 DOI: 10.1111/petr.12786] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/27/2016] [Indexed: 12/19/2022]
Abstract
Optimal strategies to prevent cytomegalovirus (CMV) disease following pediatric solid organ transplantation remain controversial. The purpose of this study was to review the outcomes of a risk-stratified strategy that uses a hybrid or prophylactic strategy for donor (D)+ recipient (R)- patients, a preemptive strategy for D+R+/D-R+, and clinical follow-up alone for D-R+ patients. A retrospective chart review was undertaken at the Stollery Children's Hospital in Edmonton, Alberta for pediatric solid organ transplants 2004 through 2010. Transplants were risk-stratified according to D/R CMV serostatus, organ group, and type of induction or rejection immunosuppression. The incidence of DNAemia and CMV disease and adverse effects from prophylaxis were analyzed. The study included 197 recipients. CMV DNAemia was detected in 49 of 197 recipients (24.8%), and CMV disease occurred in eight of 197 (4%) of which all but one were D+R-. All recovered. Seventeen of 142 recipients who received prophylaxis (12%) had hematologic toxicity. No other toxicities were identified. In conclusion, A risk-stratified approach resulted in very low rates of CMV disease with minimal adverse effects. Lowering the dosage rather than stopping antivirals in the face of neutropenia has the potential to further lower the rate of CMV disease.
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Affiliation(s)
- Sneha Suresh
- Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Bonita E Lee
- Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Joan L Robinson
- Department of Pediatrics, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada.
| | - Michael S Akinwumi
- Department of Mathematical and Statistical Sciences, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
| | - Jutta K Preiksaitis
- Department of Medicine, Stollery Children's Hospital and University of Alberta, Edmonton, AB, Canada
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Plitt SS, Osman M, Sahni V, Lee BE, Charlton C, Simmonds K. Examination of a prenatal syphilis screening program, Alberta, Canada: 2010-2011. Can J Public Health 2016; 107:e285-e290. [PMID: 27763844 DOI: 10.17269/cjph.107.5320] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Revised: 05/12/2016] [Accepted: 05/15/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVES In 2009, due to increasing congenital syphilis rates, prenatal syphilis tests (PST) at both mid-gestation and delivery were added to first trimester prenatal screening in the province of Alberta. We sought to determine the proportion of mothers who had all three recommended PSTs during this period and to identify factors associated with incomplete PST. METHODS A cohort of all pregnancies resulting in a live or stillborn infant in Alberta for 2010 and 2011 was developed from Vital Statistics and linked with prenatal screening data to determine the number and timing of PSTs for pregnant women. The proportion of women who had PSTs at the three recommended time points in pregnancy and associated correlates were identified using basic statistics and logistic regressions. RESULTS Of 99,609 pregnancies, 20.7% had all three PSTs at the recommended time points. Overall, 98.5% (98,162) had at least one PST, 1.5% only had PST at delivery and 1.5% had no PST performed. Independent risk factors for not having the three recommended PSTs included First Nations status (adjusted odds ratio [AOR]: 1.78 [95% CI: 1.62-1.96]), rural remote residence (AOR 3.61 [95% CI: 3.10-4.20]) and sole use of a midwife for prenatal care (AOR 13.70 [95% CI: 9.20-20.39]). CONCLUSIONS Nearly all pregnant women in Alberta received a PST at least once during their pregnancy, however far fewer received PSTs at the recommended time points. Interventions that target those who are less likely to be prenatally screened may help to ensure that pregnant women get early and appropriate care for syphilis during pregnancy.
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Affiliation(s)
- Sabrina S Plitt
- Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, ON.
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