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Ebrahimi M, Acha V, Hoang L, Martínez-Abad A, López-Rubio A, Rhazi L, Aussenac T. Extraction of homogeneous lignin oligomers by ozonation of Miscanthus giganteus and vine shoots in a pilot scale reactor. Bioresour Technol 2024; 402:130804. [PMID: 38718904 DOI: 10.1016/j.biortech.2024.130804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 04/30/2024] [Accepted: 05/05/2024] [Indexed: 05/13/2024]
Abstract
Lignin, a complex phenolic polymer crucial for plant structure, is mostly used as fuel but it can be harnessed for environmentally friendly applications. This article explores ozonation as a green method for lignin extraction from lignocellulosic biomass, aiming to uncover the benefits of the extracted lignin. A pilot-scale ozonation reactor was employed to extract lignin from Miscanthus giganteus (a grass variety) and vine shoots (a woody biomass). The study examined the lignin extraction and modification of the fractions and identified the generation of phenolic and organic acids. About 48 % of lignin was successfully extracted from both biomass types. Phenolic monomers were produced, vine shoots yielding fewer monomers than Miscanthus giganteus. Ozonation generated homogeneous lignin oligomers, although their molecular weight decreased during ozonation, with vine shoot oligomers exhibiting greater resistance to ozone. Extracted fractions were stable at 200 °C, despite the low molecular weight, outlining the potential of these phenolic fractions.
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Affiliation(s)
- M Ebrahimi
- Institut Polytechnique UniLaSalle, Université d'Artois, ULR 7519, 19 rue Pierre Waguet, BP 30313, 60026 Beauvais Cédex, France; Food Safety and Preservation Department, IATA-CSIC, Avda. Agustín Escardino 7, 46980 Paterna, Valencia, Spain
| | - V Acha
- Institut Polytechnique UniLaSalle, Université d'Artois, ULR 7519, 19 rue Pierre Waguet, BP 30313, 60026 Beauvais Cédex, France
| | - L Hoang
- Institut Polytechnique UniLaSalle, Université d'Artois, ULR 7519, 19 rue Pierre Waguet, BP 30313, 60026 Beauvais Cédex, France
| | - A Martínez-Abad
- Food Safety and Preservation Department, IATA-CSIC, Avda. Agustín Escardino 7, 46980 Paterna, Valencia, Spain
| | - A López-Rubio
- Food Safety and Preservation Department, IATA-CSIC, Avda. Agustín Escardino 7, 46980 Paterna, Valencia, Spain
| | - L Rhazi
- Institut Polytechnique UniLaSalle, Université d'Artois, ULR 7519, 19 rue Pierre Waguet, BP 30313, 60026 Beauvais Cédex, France
| | - T Aussenac
- Institut Polytechnique UniLaSalle, Université d'Artois, ULR 7519, 19 rue Pierre Waguet, BP 30313, 60026 Beauvais Cédex, France.
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Gupta AK, Lyons B, Hunter I, Arnold B, Gilbert M, Hoang L, Malleson S, Ryan V, Romney MG, Severini A, Wong J, Grennan T. The Resurgence of Lymphogranuloma Venereum: Changing Presentation of Lymphogranuloma Venereum in the Era of HIV Preexposure Prophylaxis, 2004 to 2022. Sex Transm Dis 2024; 51:233-238. [PMID: 38299874 DOI: 10.1097/olq.0000000000001944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
BACKGROUND Before the early 2000s, the sexually transmitted infection lymphogranuloma venereum (LGV) was rare in high-income countries. Initially, most cases in these countries were among symptomatic men who have sex with men (MSM) living with HIV. In the context of widespread HIV preexposure prophylaxis (PrEP), LGV's epidemiology may be changing. We aimed to characterize the epidemiology and clinical presentation of LGV in the PrEP era. METHODS A retrospective chart review was performed on all LGV cases occurring between November 2004 to October 2022 in British Columbia (BC), Canada. Cases were stratified by having occurred before (2004-2017) or after widespread PrEP availability in BC (2018-2022). Annual rates and test positivity percentages were calculated. Bivariate logistic regression was performed to identify drivers of asymptomatic infection in the PrEP era. RESULTS Among 545 cases identified, 205 (37.6%) occurred pre-PrEP and 340 (62.4%) occurred during the PrEP era. Most cases were among MSM (97.2%). The estimated rate of LGV has doubled from 2018 to 2022, reaching 1535.2 cases per 100,000 PrEP users. Most PrEP-era cases were among HIV-negative individuals (65.3%), particularly those on PrEP (72.6%). Cases in the PrEP era were often asymptomatic compared with pre-PrEP (38.6% vs. 19.3%; P < 0.001). Users of PrEP were more likely to experience asymptomatic infection compared with HIV-negative PrEP nonusers (odds ratio, 2.07; 95% confidence interval, 1.07-3.99). CONCLUSIONS In the context of increased asymptomatic testing, LGV may be increasing in BC. Most infections now occur among HIV-negative MSM. A high proportion of infections are asymptomatic.
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Affiliation(s)
| | | | - Ian Hunter
- British Columbia Centre for Disease Control
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3
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Hickman R, Nguyen J, Lee TD, Tyson JR, Azana R, Tsang F, Hoang L, Prystajecky NA. Rapid, high-throughput, cost-effective whole-genome sequencing of SARS-CoV-2 using a condensed library preparation of the Illumina DNA Prep kit. J Clin Microbiol 2024; 62:e0010322. [PMID: 38315007 DOI: 10.1128/jcm.00103-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 12/20/2023] [Indexed: 02/07/2024] Open
Abstract
The ongoing COVID-19 pandemic necessitates cost-effective, high-throughput, and timely whole-genome sequencing (WGS) of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) viruses for outbreak investigations, identifying variants of concern (VoC), characterizing vaccine breakthrough infections, and public health surveillance. In addition, the enormous demand for WGS on supply chains and the resulting shortages of laboratory supplies necessitated the use of low-reagent and low-consumable methods. Here, we report an optimized library preparation method (the BCCDC cutdown method) that can be used in a high-throughput scenario, where one technologist can perform 576 library preparations (6 plates of 96 samples) over the course of one 8-hour shift. The same protocol can also be used in a rapid turnaround time scenario, from primary samples (up to 96 samples) to loading on a sequencer in an 8-hour shift. This new method uses Freed et al.'s 1,200 bp primer sets (Biol Methods Protoc 5:bpaa014, 2020, https://doi.org/10.1093/biomethods/bpaa014) and a modified and condensed Illumina DNA Prep workflow (Illumina, CA, USA). Compared to the original protocol, the application of this new method using hundreds of clinical specimens demonstrated equivalent results to the full-length DNA Prep workflow at 45% of the cost, 15% of consumables required (such as pipet tips), 25% of manual hands-on time, and 15% of on-instrument time if performing on a liquid handler, with no compromise in sequence quality. Results demonstrate that this new method is a rapid, simple, cost-effective, and high-quality SARS-CoV-2 WGS protocol. IMPORTANCE Sequencing has played an invaluable role in the response to the COVID-19 pandemic. Ongoing work in this area, however, demands optimization of laboratory workflow to increase sequencing capacity, improve turnaround time, and reduce cost without compromising sequence quality. This report describes an optimized DNA library preparation method for improved whole-genome sequencing of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pathogen. The workflow advantages summarized here include significant time, cost, and consumable savings, which suggest that this new method is an efficient, scalable, and pragmatic alternative for SARS-CoV-2 whole-genome sequencing.
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Affiliation(s)
- Rebecca Hickman
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Jason Nguyen
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Tracy D Lee
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - John R Tyson
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Robert Azana
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Frankie Tsang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Natalie A Prystajecky
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
- The University of British Columbia, Vancouver, British Columbia, Canada
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4
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Lee LKF, Himsworth CG, Byers KA, Atwal HK, Gabaldon G, Ritchie G, Lowe CF, Matic N, Chorlton S, Hoang L, Wobeser BK, Leung V. Detection of multiple human enteropathogens in Norway rats (Rattus norvegicus) from an under-resourced neighborhood of Vancouver, British Columbia. PLoS Negl Trop Dis 2023; 17:e0011669. [PMID: 37844114 PMCID: PMC10602374 DOI: 10.1371/journal.pntd.0011669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 10/26/2023] [Accepted: 09/18/2023] [Indexed: 10/18/2023] Open
Abstract
Urban Norway rats (Rattus norvegicus) can carry various human pathogens, and may be involved in pathogen propagation and transmission to humans. From January 31-August 14, 2021, a community outbreak of Shigella flexneri serotype 2a occurred among unhoused or poorly housed people in the Downtown Eastside neighborhood of Vancouver, British Columbia, Canada. The source could not be identified; however, patients reported contact with rats, and previous studies indicated transmission of rat-associated zoonotic pathogens among the unhoused or poorly housed residents of this neighborhood. The study objective was to determine if rats trapped in the outbreak area were carriers of Shigella spp. and other zoonotic enteric pathogens. From March 23-April 9, 2021, 22 rats were lethally trapped within the outbreak area. Colonic content was analyzed using the BioFire FilmArray Gastrointestinal (multiplex PCR) panel for human enteropathogens, which detected: Campylobacter spp. (9/22), Clostridioides difficile (3/22), Yersinia enterocolitica (5/22), Cryptosporidium spp. (8/22), Giardia duodenalis (5/22), Rotavirus A (1/22), enteroaggressive Escherichia coli (2/22), enteropathogenic E. coli (10/22), and Shigella spp. or enteroinvasive E. coli (EIEC) (3/22). An ipaH PCR assay was used for targeted detection of Shigella spp./EIEC, with five rats positive. Two samples contained insertion sites unique to S. flexneri isolated from the human outbreak. This study highlights the potential for rats to carry a broad range of human pathogens, and their possible role in pathogen maintenance and/or transmission.
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Affiliation(s)
- Lisa K. F. Lee
- British Columbia Regional Centre, Canadian Wildlife Health Cooperative, Abbotsford, British Columbia, Canada
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, Saskatchewan, Canada
| | - Chelsea G. Himsworth
- British Columbia Regional Centre, Canadian Wildlife Health Cooperative, Abbotsford, British Columbia, Canada
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kaylee A. Byers
- British Columbia Regional Centre, Canadian Wildlife Health Cooperative, Abbotsford, British Columbia, Canada
| | - Harveen K. Atwal
- British Columbia Regional Centre, Canadian Wildlife Health Cooperative, Abbotsford, British Columbia, Canada
| | - Gus Gabaldon
- Abell Pest Control, Vancouver, British Columbia, Canada
| | - Gordon Ritchie
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Christopher F. Lowe
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Nancy Matic
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, British Columbia, Canada
| | - Samuel Chorlton
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Bruce K. Wobeser
- Department of Veterinary Pathology, Western College of Veterinary Medicine, Saskatoon, Saskatchewan, Canada
| | - Victor Leung
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Division of Medical Microbiology, Department of Pathology and Laboratory Medicine, Providence Health Care, Vancouver, British Columbia, Canada
- Division of Infectious Diseases, Department of Medicine, Providence Health Care, Vancouver, British Columbia, Canada
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Sawatzky P, Lefebvre B, Diggle M, Hoang L, Wong J, Patel S, Van Caessele P, Minion J, Garceau R, Jeffrey S, Haldane D, Lourenco L, Gravel G, Mulvey M, Martin I. Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2021. Can Commun Dis Rep 2023; 49:388-397. [PMID: 38463902 PMCID: PMC10919915 DOI: 10.14745/ccdr.v49i09a05] [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] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background In Canada, gonorrhea is the second most prevalent bacterial sexually transmitted infection. The Gonococcal Antimicrobial Surveillance Programme (GASP - Canada), a passive surveillance system monitoring antimicrobial resistance in Neisseria gonorrhoeae in Canada since 1985, is the source for this summary of demographics, antimicrobial resistance and N. gonorrhoeae multi-antigen sequence typing (NG-MAST) of gonococcal isolates collected in Canada in 2021. Methods Provincial and territorial public health laboratories submitted N. gonorrhoeae cultures and data to the National Microbiology Laboratory in Winnipeg as part of the surveillance system. The antimicrobial resistance and molecular type of each isolate received were determined. Results In total, 3,439 N. gonorrhoeae cultures were received from laboratories across Canada in 2021, a 9.9% increase since 2020 (n=3,130). Decreased susceptibility to cefixime increased significantly (p<0.001) in 2021 (1.5%) compared to 2017 (0.6%). No significant change in decreased susceptibility to ceftriaxone was detected between 2017 and 2021 (0.6%) (p>0.001); however, one ceftriaxone-resistant isolate was identified. Azithromycin resistance decreased significantly (p<0.001) in 2021 (7.6%) compared to 2017 (11.7%); however, there was a significant increase (p<0.001) in the proportion of cultures with an azithromycin minimum inhibitory concentration of at least 1 mg/L (2017=22.2% to 2021=28.1%). In 2021, NG-MAST-19875 (15.3%) was the most prevalent sequence type in Canada; 20.3% of isolates with this sequence type were resistant to azithromycin. Conclusion The spread of antimicrobial-resistant gonorrhea is a significant public health concern. The continued regional and national surveillance of antimicrobial resistance in N. gonorrhoeae is essential in ensuring effective treatment therapies are recommended.
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Affiliation(s)
- Pamela Sawatzky
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
| | | | - Mathew Diggle
- Provincial Laboratory for Public Health, Edmonton, AB
| | - Linda Hoang
- BC Centre for Disease Control Public Health Laboratory, Vancouver, BC
| | - Jason Wong
- BC Centre for Disease Control Public Health Laboratory, Vancouver, BC
| | - Samir Patel
- Public Health Ontario Laboratory, Toronto, ON
| | | | | | - Richard Garceau
- Dr. Georges-L.-Dumont University Hospital Centre, Moncton, NB
| | - Sarah Jeffrey
- Government of Northwest Territories, Yellowknife, NT
| | - David Haldane
- Queen Elizabeth II Health Sciences Centre, Halifax, NS
| | - Lillian Lourenco
- Centre for Communicable Diseases and Infection Control Branch, Public Health Agency of Canada, Ottawa, ON
| | - Genevieve Gravel
- Centre for Communicable Diseases and Infection Control Branch, Public Health Agency of Canada, Ottawa, ON
| | - Michael Mulvey
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
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6
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Caza M, Charles M, Locher K, Hoang L, Tucker M, Mandy J, Jewsbury H, Wilmer A. Evaluation of the Aptima BV and CV/TV assays compared to conventional laboratory based testing methods for the diagnosis of vaginitis. Diagn Microbiol Infect Dis 2023; 106:115953. [PMID: 37295185 DOI: 10.1016/j.diagmicrobio.2023.115953] [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: 01/31/2023] [Revised: 03/24/2023] [Accepted: 04/11/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Vaginitis is caused by bacterial vaginosis (BV), Candida vaginitis (CV) and Trichomonas vaginalis (TV). This retrospective study evaluates the performance of the Aptima CV/TV, and BV assays on the automated Panther system. METHODS Two hundred forty-two multitest swabs were tested on the CV/TV assay and 422 on the BV assay. Positive and negative percent agreement (PPA, NPA) of the Candida glabrata (CG), Candida species group (CSG), TV and BV targets were calculated using a modified gold standard, with review of Gram smear and the usage of the Allplex Vaginitis Screening Assay to resolve discrepancies. RESULTS The PPA and NPA were respectively 98.4% and 95.9% for BV, 100% and 95.4% for CSG, 100% and 99% for CG, and 100% and 100% for TV, and when compared to consensus results. CONCLUSION The CV/TV and BV assays surpassed the acceptance criteria threshold of 95%, and proved to be an excellent alternative to conventional testing.
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Affiliation(s)
- Mélissa Caza
- Kelowna General Hospital, Kelowna, BC, Canada; University of British Columbia, Vancouver, BC, Canada.
| | - Marthe Charles
- University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada
| | - Kerstin Locher
- University of British Columbia, Vancouver, BC, Canada; Vancouver General Hospital, Vancouver, BC, Canada
| | - Linda Hoang
- University of British Columbia, Vancouver, BC, Canada; BCCDC Public Health Microbiology & Reference Laboratory, Vancouver, BC, Canada
| | - Morgan Tucker
- University of British Columbia Okanagan, Kelowna, BC, Canada
| | - Jeremy Mandy
- University of British Columbia Okanagan, Kelowna, BC, Canada
| | | | - Amanda Wilmer
- Kelowna General Hospital, Kelowna, BC, Canada; University of British Columbia, Vancouver, BC, Canada
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7
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Gadkar VJ, Goldfarb DM, Al-Rawahi GN, Srigley JA, Smailus DE, Coope RJN, Pleasance S, Watson N, Chen T, Lam S, Hoang L, Tilley PAG. Extraction-free clinical detection of SARS-CoV-2 virus from saline gargle samples using Hamilton STARlet liquid handler. Sci Rep 2023; 13:4241. [PMID: 36918604 PMCID: PMC10013237 DOI: 10.1038/s41598-023-30993-2] [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: 05/12/2022] [Accepted: 03/06/2023] [Indexed: 03/16/2023] Open
Abstract
As part of the COVID-19 pandemic, clinical laboratories have been faced with massive increases in testing, resulting in sample collection systems, reagent, and staff shortages. We utilized self-collected saline gargle samples to optimize high throughput SARS-CoV-2 multiplex polymerase chain reaction (PCR) testing in order to minimize cost and technologist time. This was achieved through elimination of nucleic acid extraction and automation of sample handling on a widely available robotic liquid handler, Hamilton STARlet. A customized barcode scanning script for reading the sample ID by the Hamilton STARlet's software system was developed to allow primary tube sampling. Use of pre-frozen SARS-CoV-2 assay reaction mixtures reduced assay setup time. In both validation and live testing, the assay produced no false positive or false negative results. Of the 1060 samples tested during validation, 3.6% (39/1060) of samples required retesting as they were either single gene positive, had internal control failure or liquid aspiration error. Although the overall turnaround time was only slightly faster in the automated workflow (185 min vs 200 min), there was a 76% reduction in hands-on time, potentially reducing staff fatigue and burnout. This described process from sample self-collection to automated direct PCR testing significantly reduces the total burden on healthcare systems in terms of human resources and reagent requirements.
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Affiliation(s)
- Vijay J Gadkar
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital, Room No 2K9, 4500 Oak St, Vancouver, V6H 3N1, Canada.
| | - David M Goldfarb
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jocelyn A Srigley
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Duane E Smailus
- Canada's Michael Smith Genome Science Centre at BC Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Robin J N Coope
- Canada's Michael Smith Genome Science Centre at BC Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Stephen Pleasance
- Canada's Michael Smith Genome Science Centre at BC Cancer, BC Cancer Research Institute, Vancouver, BC, Canada
| | - Nicole Watson
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
| | - Tammy Chen
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
| | - Sunny Lam
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
| | - Linda Hoang
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Public Health Laboratory, British Columbia Centre for Disease Control, Vancouver, Canada
| | - Peter A G Tilley
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Virology and Infection Control, BC Children's and Women's Hospital + Sunny Health Center, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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8
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Russell SL, Klaver BRA, Harrigan SP, Kamelian K, Tyson J, Hoang L, Taylor M, Sander B, Mishra S, Prystajecky N, Janjua NZ, Zlosnik JEA, Sbihi H. Clinical severity of Omicron subvariants BA.1, BA.2, and BA.5 in a population-based cohort study in British Columbia, Canada. J Med Virol 2023; 95:e28423. [PMID: 36546412 DOI: 10.1002/jmv.28423] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [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: 07/08/2022] [Revised: 11/11/2022] [Accepted: 12/05/2022] [Indexed: 12/24/2022]
Abstract
The SARS-CoV-2 variant Omicron emerged in late 2021. In British Columbia (BC), Canada, and globally, three genetically distinct subvariants of Omicron, BA.1, BA.2, and BA.5, emerged and became dominant successively within an 8-month period. SARS-CoV-2 subvariants continue to circulate in the population, acquiring new mutations that have the potential to alter infectivity, immunity, and disease severity. Here, we report a propensity-matched severity analysis from residents of BC over the course of the Omicron wave, including 39,237 individuals infected with BA.1, BA.2, or BA.5 based on paired high-quality sequence data and linked to comprehensive clinical outcomes data between December 23, 2021 and August 31, 2022. Relative to BA.1, BA.2 cases were associated with a 15% and 28% lower risk of hospitalization and intensive care unit (ICU) admission (aHRhospital = 1.17; 95% confidence interval [CI] = 1.096-1.252; aHRICU = 1.368; 95% CI = 1.152-1.624), whereas BA.5 infections were associated with an 18% higher risk of hospitalization (aHRhospital = 1.18; 95% CI = 1.133-1.224) after accounting for age, sex, comorbidities, vaccination status, geography, and social determinants of health. Phylogenetic analysis revealed no specific subclades associated with more severe clinical outcomes for any Omicron subvariant. In summary, BA.1, BA.2, and BA.5 subvariants were associated with differences in clinical severity, emphasizing how variant-specific monitoring programs remain critical components of patient and population-level public health responses as the pandemic continues.
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Affiliation(s)
- Shannon L Russell
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Braeden R A Klaver
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Sean P Harrigan
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Kimia Kamelian
- Public Health Agency of Canada, National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - John Tyson
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Beate Sander
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Public Health Ontario, Toronto, Ontario, Canada
| | - Sharmistha Mishra
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,MAP-Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - James E A Zlosnik
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hind Sbihi
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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9
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Thorington R, Sawatzky P, Lefebvre B, Diggle M, Hoang L, Patel S, Van Caessele P, Minion J, Garceau R, Matheson M, Haldane D, Gravel G, Mulvey MR, Martin I. Antimicrobial susceptibilities of Neisseria gonorrhoeae in Canada, 2020. Can Commun Dis Rep 2022; 48:571-579. [PMID: 38298531 PMCID: PMC10829890 DOI: 10.14745/ccdr.v48i1112a10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Background The Gonococcal Antimicrobial Surveillance Programme is a passive surveillance system that has monitored antimicrobial resistance in Neisseria gonorrhoeae in Canada since the 1980s. This article summarizes the demographics, antimicrobial resistances and NG-MAST (N. gonorrhoeae multiantigen sequence typing) for cultures collected in 2020. Methods The National Microbiology Laboratory (NML) in Winnipeg received resistant N. gonorrhoeae cultures from provincial and territorial public health laboratories. Agar dilution was used to determine the minimum inhibitory concentrations to ten antimicrobials for all cultures received at NML, according to Clinical and Laboratory Standards Institute guidelines. The NG-MAST typing was also determined for each culture. Results A total of 3,130 N. gonorrhoeae cases were cultured across Canada in 2020; a 36% decrease from 2019 (n=4,859). The level of decreased susceptibility to cefixime increased significantly between 2016 and 2020 to 2.8% (p=0.0054). Decreased susceptibility to ceftriaxone declined significantly between 2016 (1.8%) and 2020 to 0.9% (p=0.001), and there was no significant change with azithromycin between 2016 (7.2%) and 2020 (6.1%). The proportion of cultures with an azithromycin minimum inhibitory concentrations of ≥1 mg/L increased significantly from 11.6% in 2016 to 15.3% in 2020 (p=0.0017). The most common NG-MAST type in Canada for 2020 was sequence type (ST)-11461, while ST-12302 was most commonly associated with azithromycin resistance and ST-16639 with cephalosporin decreased susceptibility. Conclusion Antimicrobial resistance in N. gonorrhoeae remains an important public health concern and continued surveillance is imperative to monitor trends to ensure the recommended therapies will be the most effective.
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Affiliation(s)
- Robyn Thorington
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
| | - Pamela Sawatzky
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
| | | | - Mathew Diggle
- Provincial Laboratory of Public Health Alberta, Edmonton, Alberta, Canada
| | - Linda Hoang
- British Columbia Centres for Disease Control Public Health Microbiology & Reference Laboratory, Vancouver, BC
| | - Samir Patel
- Public Health Ontario Laboratory, Toronto, ON
| | | | | | - Richard Garceau
- Dr. Georges L. Dumont University Hospital Centre, Moncton, NB
| | - Myrna Matheson
- Government of the Northwest Territories, Yellowknife, NT
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, NS
| | - Genevieve Gravel
- Surveillance and Epidemiology Division, Centre for Communicable Diseases and Infection Control Branch, Public Health Agency of Canada, Ottawa, ON
| | - Michael R Mulvey
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory Branch, Public Health Agency of Canada, Winnipeg, MB
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10
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Vadlamudi NK, Sadatsafavi M, Patrick DM, Rose C, Hoang L, Marra F. Healthcare Costs for Pneumococcal Disease in the Era of Infant Immunization With 13-Valent Pneumococcal Conjugate Vaccine: A Population-Based Study. Value Health 2022; 25:1510-1519. [PMID: 35466049 DOI: 10.1016/j.jval.2022.03.017] [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: 10/18/2021] [Revised: 02/11/2022] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Invasive pneumococcal disease (IPD) and a variety of clinical syndromes caused by pneumococci, such as acute otitis media (AOM), acute sinusitis (AS), and community-acquired pneumonia (CAP), cause a substantial burden on healthcare systems. Few studies have explored the short-term financial burden of pneumococcal disease after the 13-valent pneumococcal conjugate vaccine (PCV13) introduction in the infant immunization programs. This population-based study evaluated changes in costs associated with healthcare utilization for pneumococcal disease after the PCV13 introduction in the infant immunization program in British Columbia, Canada. METHODS Individuals with pneumococcal disease were identified using provincial administrative data for the 2000 to 2018 period. Total direct healthcare costs were determined using case-mix methodology for hospitalization and fee-for-service codes for outpatient visits and medications dispensed. Costs were adjusted to 2018 Canadian dollars. Changes in the annual healthcare costs were evaluated across vaccine eras (pre-PCV13, 2000-2010; PCV13, 2011-2018) using generalized linear models, adjusting for the 7-valent pneumococcal conjugate vaccine program (2004-2010). RESULTS During the 19-year study period, pneumococcal disease resulted in 6.3 million cases among 85 million total patient-years, resulting in total healthcare costs of $7.9 billion. More than 6.2 million cases were treated in outpatient setting, costing $0.65 billion (8% of total costs associated with pneumococcal disease treatment), whereas 370 000 hospitalized cases were 3% of all cases, which accrued $7.25 billion (92% of total costs) in costs. Healthcare costs for all studied infections nearly doubled over the study period from $248 million in 2000 to $476 million in 2018 (P = .003). In contrast, there were large declines in total annual costs in the PCV13 era for IPD (adjusted relative rate (aRR) 0.73; 95% confidence interval [CI] 0.56-0.95; P = .032), AOM (aRR 0.70; 95% CI 0.59-0.83; P = .001), and AS (aRR 0.68; 95% CI 0.54-0.85; P = .004) compared with the pre-PCV13 era. Total costs increased marginally in the PCV13 era for all-cause CAP (aRR 1.04; 95% CI 0.94-1.15; P = .484). CONCLUSIONS This study confirms a temporal association in declining economic burden for IPD, AOM, and AS after the PCV13 introduction. Nevertheless, the total economic burden continues to be high in the PCV13 era, mainly driven by increasing CAP costs.
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Affiliation(s)
- Nirma Khatri Vadlamudi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, The University of British Columbia, Vancouver, BC, Canada
| | - David M Patrick
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Caren Rose
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, BC, Canada.
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11
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Golden A, Griffith A, Demczuk W, Lefebvre B, McGeer A, Tyrrell G, Zhanel G, Kus J, Hoang L, Minion J, Van Caeseele P, Smadi H, Haldane D, Zahariadis G, Mead K, Steven L, Strudwick L, Li A, Mulvey M, Martin I. Invasive pneumococcal disease surveillance in Canada, 2020. Can Commun Dis Rep 2022; 48:396-406. [PMID: 38124782 PMCID: PMC10732480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
Background Invasive pneumococcal disease (IPD), which is caused by Streptococcus pneumoniae, has been a nationally notifiable disease in Canada since 2000. The use of conjugate vaccines has markedly decreased the incidence of IPD in Canada; however, the distribution of serotypes has shifted in favour of non-vaccine types. This report summarizes the demographics, serotypes and antimicrobial resistance of IPD infections in Canada in 2020. Methods The Public Health Agency of Canada's National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of IPD. A total of 2,108 IPD isolates were reported in 2020. Serotyping was performed by Quellung reaction and antimicrobial susceptibilities were determined in collaboration with the University of Manitoba/Canadian Antimicrobial Resistance Alliance. Population-based IPD incidence rates were obtained through the Canadian Notifiable Disease Surveillance System. Results Overall incidence of IPD in Canada decreased significantly from 11.5 (95% confidence interval [CI]: 10.1-13.1) to 6.0 (95% CI: 5.0-7.2), and from 10.0 (95% CI: 9.7-10.3) to 5.9 (95% CI: 5.7-6.2) cases per 100,000 from 2019 to 2020; in those younger than five years and those five years and older, respectively. The most common serotypes overall were 4 (11.2%, n=237), 3 (10.9%, n=229) and 8 (7.2%, n=151). From 2016 to 2020, serotypes with increasing trends (p<0.05) included 4 (6.4%-11.2%), 3 (9.5%-10.9%), 8 (5.2%-7.2%) and 12F (3.6%-5.7%). The overall prevalence of PCV13 serotypes increased over the same period (30.3%-34.9%, p<0.05). Antimicrobial resistance rates in 2020 included 23.0% clarithromycin and 9.9% penicillin (IV meningitis breakpoints). Multidrug-resistant IPD has significantly increased since 2016 (4.2%-9.5%, p<0.05). Conclusion Though the incidence of IPD decreased in 2020 in comparison to previous years across all age groups, disease due to PCV13 serotypes 3 and 4, as well as non-PCV13 serotypes such as 8 and 12F, increased in prevalence. Continued surveillance of IPD is imperative to monitor shifts in serotype distribution and antimicrobial resistance.
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Affiliation(s)
- Alyssa Golden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, ON
| | - Gregory Tyrrell
- Provincial Laboratory for Public Health (Microbiology), Edmonton, AB
| | - George Zhanel
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Julianne Kus
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
| | | | | | - Hanan Smadi
- New Brunswick Department of Health, Fredericton, NB
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, NS
| | | | | | - Laura Steven
- Stanton Territorial Hospital Laboratory, Yellowknife, NT
| | | | - Anita Li
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Michael Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
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12
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Golden A, Griffith A, Demczuk W, Tyrrell G, Kus J, McGeer A, Domingo MC, Hoang L, Minion J, Van Caeseele P, Smadi H, Haldane D, Zahariadis G, Mead K, Steven L, Strudwick L, Li A, Mulvey M, Martin I. Invasive group A streptococcal disease surveillance in Canada, 2020. Can Commun Dis Rep 2022; 48:407-414. [PMID: 38106647 PMCID: PMC10723789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Background Invasive group A streptococcal (iGAS) disease (caused by Streptococcus pyogenes) has been a nationally notifiable disease in Canada since 2000. This report summarizes the demographics, emm types and antimicrobial resistance of iGAS infections in Canada in 2020. Methods The Public Health Agency of Canada's National Microbiology Laboratory (Winnipeg, Manitoba) collaborates with provincial and territorial public health laboratories to conduct national surveillance of invasive S. pyogenes. Emm typing was performed on all isolates using the Centers for Disease Control and Prevention emm sequencing protocol. Antimicrobial susceptibilities were determined using Kirby-Bauer disk diffusion according to Clinical and Laboratory Standards Institute guidelines. Population-based iGAS disease incidence rates up to 2019 were obtained through the Canadian Notifiable Disease Surveillance System. Results Overall, the incidence of iGAS disease in Canada has increased from 4.0 to 8.1 cases per 100,000 population from 2009 to 2019. The 2019 incidence represents a slight decrease from the 2018 rate of 8.6 cases per 100,000 population. A total of 2,867 invasive S. pyogenes isolates that were collected during 2020 are included in this report, representing a decrease from 2019 (n=3,194). The most common emm types in 2020 were emm49 (16.8%, n=483) and emm76 (15.0%, n=429), both increasing significantly in prevalence since 2016 (p<0.001). The former most prevalent type, emm1, decreased to 7.6% (n=217) in 2020 from 15.4% (n=325) in 2016. Antimicrobial resistance rates in 2020 included 11.5% resistance to erythromycin, 3.2% resistance to clindamycin and 1.6% nonsusceptibility to chloramphenicol. Conclusion Though the number of collected invasive S. pyogenes isolates decreased slightly in 2020 in comparison to previous years, iGAS disease remains an important public health concern. The emm distribution in Canada has been subtly shifting over the past five years, away from common and well-known emm1 and towards emm49 and emm76. It is important to continue surveillance of S. pyogenes in Canada to monitor expanding replacement emm types, as well as outbreak clones and antimicrobial resistance.
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Affiliation(s)
- Alyssa Golden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - Gregory Tyrrell
- Provincial Laboratory for Public Health (Microbiology), Edmonton, AB
| | - Julianne Kus
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, ON
| | - Marc-Christian Domingo
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
| | | | | | - Hanan Smadi
- New Brunswick Department of Health, Fredericton, NB
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, NS
| | | | | | - Laura Steven
- Stanton Territorial Hospital Laboratory, Yellowknife, NT
| | | | - Anita Li
- Centre for Immunization & Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, ON
| | - Michael Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
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13
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Harrigan SP, Wilton J, Chong M, Abdia Y, Garcia HV, Rose C, Taylor M, Mishra S, Sander B, Hoang L, Tyson J, Krajden M, Prystajecky N, Janjua NZ, Sbihi H. Clinical Severity of Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Variant Relative to Delta in British Columbia, Canada: A Retrospective Analysis of Whole-Genome Sequenced Cases. Clin Infect Dis 2022; 76:e18-e25. [PMID: 36041009 PMCID: PMC9452171 DOI: 10.1093/cid/ciac705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In late 2021, the Omicron severe acute respiratory syndrome coronavirus 2 variant emerged and rapidly replaced Delta as the dominant variant. The increased transmissibility of Omicron led to surges in case rates and hospitalizations; however, the true severity of the variant remained unclear. We aimed to provide robust estimates of Omicron severity relative to Delta. METHODS This retrospective cohort study was conducted with data from the British Columbia COVID-19 Cohort, a large provincial surveillance platform with linkage to administrative datasets. To capture the time of cocirculation with Omicron and Delta, December 2021 was chosen as the study period. Whole-genome sequencing was used to determine Omicron and Delta variants. To assess the severity (hospitalization, intensive care unit [ICU] admission, length of stay), we conducted adjusted Cox proportional hazard models, weighted by inverse probability of treatment weights (IPTW). RESULTS The cohort was composed of 13 128 individuals (7729 Omicron and 5399 Delta). There were 419 coronavirus disease 2019 hospitalizations, with 118 (22%) among people diagnosed with Omicron (crude rate = 1.5% Omicron, 5.6% Delta). In multivariable IPTW analysis, Omicron was associated with a 50% lower risk of hospitalization compared with Delta (adjusted hazard ratio [aHR] = 0.50, 95% confidence interval [CI] = 0.43 to 0.59), a 73% lower risk of ICU admission (aHR = 0.27, 95% CI = 0.19 to 0.38), and a 5-day shorter hospital stay (aß = -5.03, 95% CI = -8.01 to -2.05). CONCLUSIONS Our analysis supports findings from other studies that have demonstrated lower risk of severe outcomes in Omicron-infected individuals relative to Delta.
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Affiliation(s)
| | | | - Mei Chong
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Younathan Abdia
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | | | - Caren Rose
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, School of Population and Public Health, BC, Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Sharmistha Mishra
- Department of Medicine, University of Toronto, Toronto, Canada,MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, Unity Health Toronto, Toronto, Canada,Division of Epidemiology and Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Institute of Medical Science, University of Toronto, Toronto, Canada
| | - Beate Sander
- Toronto Health Economics and Technology Assessment (THETA) collaborative, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada,Institute of Health Policy, Management and Evaluation (IHPME), Dalla Lana School of Public Health, University of Toronto, Toronto, Canada,Public Health Ontario Toronto, Canada,ICES, Toronto, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - John Tyson
- British Columbia Centre for Disease Control, British Columbia (BC), Canada
| | - Mel Krajden
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - Natalie Prystajecky
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, Pathology and Laboratory Medicine, BC, Canada
| | - Naveed Z Janjua
- British Columbia Centre for Disease Control, British Columbia (BC), Canada,University of British Columbia, School of Population and Public Health, BC, Canada,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - Hind Sbihi
- Corresponding author: Hind Sbihi (, 1-604-707-2662), Vancouver, BC. Canada
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14
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Bharat A, Mataseje L, Parmley EJ, Avery BP, Cox G, Carson CA, Irwin RJ, Deckert AE, Daignault D, Alexander DC, Allen V, El Bailey S, Bekal S, German GJ, Haldane D, Hoang L, Chui L, Minion J, Zahariadis G, Reid-Smith RJ, Mulvey MR. One Health Genomic Analysis of Extended-Spectrum β-Lactamase‒Producing Salmonella enterica, Canada, 2012‒2016. Emerg Infect Dis 2022; 28:1410-1420. [PMID: 35731173 PMCID: PMC9239887 DOI: 10.3201/eid2807.211528] [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
Extended-spectrum β-lactamases (ESBLs) confer resistance to extended-spectrum cephalosporins, a major class of clinical antimicrobial drugs. We used genomic analysis to investigate whether domestic food animals, retail meat, and pets were reservoirs of ESBL-producing Salmonella for human infection in Canada. Of 30,303 Salmonella isolates tested during 2012–2016, we detected 95 ESBL producers. ESBL serotypes and alleles were mostly different between humans (n = 54) and animals/meat (n = 41). Two exceptions were blaSHV-2 and blaCTX-M-1 IncI1 plasmids, which were found in both sources. A subclade of S. enterica serovar Heidelberg isolates carrying the same IncI1-blaSHV-2 plasmid differed by only 1–7 single nucleotide variants. The most common ESBL producer in humans was Salmonella Infantis carrying blaCTX-M-65, which has since emerged in poultry in other countries. There were few instances of similar isolates and plasmids, suggesting that domestic animals and retail meat might have been minor reservoirs of ESBL-producing Salmonella for human infection.
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15
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Nasreen S, Wang J, Sadarangani M, Kwong JC, Quach C, Crowcroft NS, Wilson SE, McGeer A, Morris SK, Kellner JD, Sander B, Kus JV, Hoang L, Marra F, Fadel SA. Estimating population-based incidence of community-acquired pneumonia and acute otitis media in children and adults in Ontario and British Columbia using health administrative data, 2005-2018: a Canadian Immunisation Research Network (CIRN) study. BMJ Open Respir Res 2022; 9:9/1/e001218. [PMID: 35764362 PMCID: PMC9240885 DOI: 10.1136/bmjresp-2022-001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/12/2022] [Indexed: 11/06/2022] Open
Abstract
Background There is a paucity of data on the burden of the full spectrum of community-acquired pneumonia (CAP) and acute otitis media (AOM) from outpatient and inpatient settings across the age spectrum. Methods We conducted a population-based retrospective study in Ontario and British Columbia (BC), Canada, to estimate the incidence rate of CAP and AOM in children and adults over a 14-year period using health administrative databases. CAP and AOM cases were identified from outpatient physician consultation and hospitalisation data in both provinces, and from emergency department visit data in Ontario. Results During 2005–2018, Ontario had 3 607 124 CAP, 172 290 bacterial CAP, 7814 pneumococcal pneumonia, and 8 026 971 AOM cases. The incidence rate of CAP declined from 3077/100 000 in 2005 to 2604/100 000 in 2010 before increasing to 2843/100 000 in 2018; bacterial CAP incidence rate also declined from 178/100 000 in 2005 to 112/100 000 in 2010 before increasing to 149/100 000 in 2018. The incidence rate of AOM decreased from 4192/100 000 in 2005 to 3178/100 000 in 2018. BC had 970 455 CAP, 317 913 bacterial CAP, 35 287 pneumococcal pneumonia and 2 022 871 AOM cases. The incidence rate of CAP in BC decreased from 2214/100 000 in 2005 to 1964/100 000 in 2010 before increasing to 2176/100 000 in 2018; bacterial CAP incidence rate increased from 442/100 000 in 2005 to 981/100 000 in 2018. The incidence rate of AOM decreased from 3684/100 000 in 2005 to 2398/100 000 in 2018. The incidence rate of bacterial CAP increased with age in older adults (≥65 years) with the highest burden in the oldest cohort aged ≥85 years both before and after 13-valent pneumococcal conjugate vaccine (PCV13) programme in both provinces. Hospitalised pneumococcal pneumonia decreased slightly but non-hospitalised pneumococcal pneumonia increased in BC during PCV13 period. No consistent direct benefit of PCV13 on CAP was observed in the paediatric population. Conclusions There is a substantial burden of CAP and AOM in Ontario and BC. Indirect benefits from childhood PCV vaccination and polysaccharide vaccination of older adults have not substantially decreased the burden of pneumococcal pneumonia in older adults.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada,Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada,University Health Network, Toronto, Ontario, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Montreal, Quebec, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sinai Health System, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, Ontario, Canada,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - James D Kellner
- Department of Paediatrics, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada,ICES, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada,Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shaza A Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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16
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Plotogea A, Taylor M, Parayno A, Sillje M, Stone J, Byrnes R, Bitzikos O, Redford T, Waters S, Fraser E, Hoang L, Zabek E, Tschetter L, Ziebell K, Chan YLE, Galanis E, Ghosh K, Hutton H, McKinley M, Tchao C, Rydings P, Prystajecky N. Human
Salmonella
enteritidis illness outbreak associated with exposure to live mice in British Columbia, Canada, 2018–2019. Zoonoses Public Health 2022. [DOI: 10.1111/zph.12978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Amalia Plotogea
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
- Public Health Agency of Canada Ottawa Ontario Canada
| | - Marsha Taylor
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
| | - Alicia Parayno
- Vancouver Island Health Authority Vancouver British Columbia Canada
| | - Mona Sillje
- Interior Health Authority Kelowna British Columbia Canada
| | - Jason Stone
- Fraser Health Authority Surrey British Columbia Canada
| | - Rakel Byrnes
- Northern Health Authority Prince George British Columbia Canada
| | - Olga Bitzikos
- Vancouver Coastal Health Authority Vancouver British Columbia Canada
| | - Tony Redford
- British Columbia Ministry of Agriculture, Food and Fisheries Creston British Columbia Canada
| | - Shannon Waters
- Vancouver Island Health Authority Vancouver British Columbia Canada
| | - Erin Fraser
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
- Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
| | - Linda Hoang
- Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
- British Columbia Public Health Laboratory Vancouver British Columbia Canada
| | - Erin Zabek
- British Columbia Ministry of Agriculture, Food and Fisheries Creston British Columbia Canada
| | | | - Kim Ziebell
- National Microbiology Laboratory Winnipeg Manitoba Canada
| | - YL Elaine Chan
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
- Public Health Agency of Canada Ottawa Ontario Canada
| | - Eleni Galanis
- British Columbia Centre for Disease Control Vancouver British Columbia Canada
- Faculty of Medicine University of British Columbia Vancouver British Columbia Canada
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17
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Ghafari C, Benusic M, Prystajecky N, Sbihi H, Kamelian K, Hoang L. Epidemiological analysis of the emergence and disappearance of the SARS-CoV-2 Kappa variant within a region of British Columbia, Canada. Can Commun Dis Rep 2022; 48:22-26. [PMID: 35273466 PMCID: PMC8856721 DOI: 10.14745/ccdr.v48i01a04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND The Kappa variant is designated as a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variant of interest (VOI). We identified 195 Kappa variant cases in a region of British Columbia, Canada-the largest published cluster in North America. OBJECTIVES To describe the epidemiology of the Kappa variant in relation to other circulating SARS-CoV-2 variants of concern (VOC) in the region to determine if the epidemiology of the Kappa variant supports a VOI or VOC status. METHODS Clinical specimens testing positive for SARS-CoV-2 collected between March 10 and May 2, 2021, were screened for the detection of known circulating VOCs; approximately 50% of specimens were subsequently selected for whole genome sequencing (WGS). Epidemiological analysis was performed comparing the characteristics of Kappa cases to the main circulating variants in the region (Alpha and Gamma) and to non-VOC/VOI cases. RESULTS A total of 2,079 coronavirus disease 2019 (COVID-19) cases were reported in the region during the study period, of which 54% were selected for WGS. The 1,131 sequenced cases were categorized into Kappa, Alpha, Gamma and non-VOC/VOI. While Alpha and Gamma cases were found to have a significantly higher attack rate among household contacts compared to non-VOI/VOC cases, Kappa was not. CONCLUSION Epidemiological analysis supports the designation of Kappa as a VOI and not a VOC. The Alpha and Gamma variants were found to be more transmissible, explaining their subsequent dominance in the region and the rapid disappearance of the Kappa variant. Variant surveillance strategies should focus on both detection of established VOCs and detection of potential new VOCs.
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Affiliation(s)
| | | | | | - Hind Sbihi
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Kimia Kamelian
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
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18
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Smith C, Griffiths A, Allison S, Hoyano D, Hoang L. Escherichia coli O103 outbreak associated with minced celery among hospitalized individuals in Victoria, British Columbia, 2021. Can Commun Dis Rep 2022; 48:46-50. [PMID: 35273469 PMCID: PMC8856827 DOI: 10.14745/ccdr.v48i01a07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND In April 2021, a Shiga toxin-producing Escherichia coli (E. coli) (STEC) O103 outbreak was identified among patients at two hospitals in Victoria, British Columbia (BC). The objective of this study is to describe this outbreak investigation and identify issues of food safety for high-risk products prepared for vulnerable populations. METHODS Confirmed cases of E. coli O103 were reported to the Island Health communicable disease unit. The provincial public health laboratory conducted whole genome sequencing on confirmed case isolates, as per routine practice for STEC in BC. Exposure information was obtained through case interviews and review of hospital menus. Federal and local public health authorities conducted an inspection of the processing plant for the suspect source. RESULTS Six confirmed cases of E. coli O103 were identified, all related by whole genome sequencing. The majority of cases were female (67%) and the median age was 61 years (range 24-87 years). All confirmed cases were inpatients or outpatients at two hospitals and were exposed to raw minced celery within prepared sandwiches provided by hospital food services. A local processor supplied the minced celery exclusively to the two hospitals. Testing of product at the processor was infrequent, and chlorine rinse occurred before mincing. The spread of residual E. coli contamination through the mincing process, in addition to temperature abuse at the hospitals, are thought to have contributed to this outbreak. CONCLUSION Raw vegetables, such as celery, are a potential source of STEC and present a risk to vulnerable populations. Recommendations from this outbreak include more frequent testing at the processor, a review of the chlorination and mincing process and a review of hospital food services practices to mitigate temperature abuse.
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Affiliation(s)
| | | | | | | | - Linda Hoang
- British Columbia Centres for Disease Control, Vancouver, BC
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19
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Vadlamudi NK, Patrick DM, Rose C, Sadatsafavi M, Hoang L, Marra F. A population-based analysis to determine the impact of the 13-valent pneumococcal conjugate vaccine on community-acquired pneumonia in British Columbia, Canada. Vaccine 2022; 40:1047-1053. [PMID: 35012778 DOI: 10.1016/j.vaccine.2021.12.065] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 12/20/2021] [Accepted: 12/28/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pneumonia is a leading cause of morbidity and mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on community-acquired pneumonia (CAP) rates eight years after the vaccine was introduced in the infant immunization program. METHODS Using diagnostic codes from administrative databases, we calculated the overall and age-specific CAP incidence per month (2000-2018). Changes in the CAP incidence before and after the PCV13 vaccine program introduction were evaluated using negative binomial regression model adjusting for 7-valent pneumococcal conjugate vaccine program. RESULTS The PCV13 vaccine infant immunization program was associated with declining CAP incidence among children aged 0-2 years (adjusted Incidence Rate Ratio (aIRR): 0.91; 95% CI: 0.87-0.96). Overall CAP incidence did not decrease in those aged 3-5 years (0.98; 95% CI: 0.93-1.04), 6-17 years (1.02; 95% CI: 0.97-1.08), 18-49 years (1.02; 95% CI:0.98-1.05), 50-64 years (1.07; 95% CI: 1.04-1.11), ≥65 years (1.05; 95% CI:1.02-1.08). CONCLUSIONS The PCV13 infant immunization program is temporally associated with a reduction in CAP incidence in vaccine target age group. However, no significant decrease in CAP incidence in other age groups warrants further study of the etiology of CAP to develop and implement effective prevention programs.
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Affiliation(s)
- Nirma K Vadlamudi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver V6T 1Z3, Canada
| | - David M Patrick
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Caren Rose
- School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada; British Columbia Centre for Disease Control, Vancouver, Canada
| | - Mohsen Sadatsafavi
- Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, Canada; Department of Medicine, Institute for Heart and Lung Health, The University of British Columbia, Vancouver, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver V6T 1Z3, Canada; School of Population and Public Health, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
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20
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Nasreen S, Wang J, Kwong JC, Crowcroft NS, Sadarangani M, Wilson SE, McGeer A, Kellner JD, Quach C, Morris SK, Sander B, Kus JV, Naus M, Hoang L, Rudzicz F, Fadel S, Marra F. Population-based incidence of invasive pneumococcal disease in children and adults in Ontario and British Columbia, 2002-2018: A Canadian Immunization Research Network (CIRN) study. Vaccine 2021; 39:7545-7553. [PMID: 34810001 DOI: 10.1016/j.vaccine.2021.11.032] [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] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 10/01/2021] [Accepted: 11/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Invasive pneumococcal disease (IPD) burden, evaluated in Canada using reported confirmed cases in surveillance systems, is likely underestimated due to underreporting. We estimated the burden of IPD in Ontario and British Columbia (BC) by combining surveillance data with health administrative databases. METHODS We established a cohort of 27,525 individuals in Ontario and BC. Laboratory-confirmed IPD cases were identified from Ontario's integrated Public Health Information System and the BC Centre for Disease Control Public Health Laboratory. Possible IPD cases were identified from hospitalization data in both provinces, and from emergency department visit data in Ontario. We estimated the age and sex adjusted annual incidence of IPD and pneumococcal conjugate/polysaccharide vaccine (PCV/PPV) serotype-specific IPD using Poisson regression models. RESULTS In Ontario, 20,205 overall IPD cases, including 15,299 laboratory-confirmed cases, were identified with relatively stable age- and sex-adjusted annual incidence rates ranging from 13.7/100,000 (2005) to 13.6/100,000 (2018). In BC, 7,320 overall IPD cases, including 5,932 laboratory-confirmed cases were identified; annual incidence rates increased from 10.9/100,000 (2002) to 13.2/100,000 (2018). Older adults aged ≥ 85 years had the highest incidence rates. During 2007-2018 the incidence of PCV7 serotypes and additional PCV13 serotypes decreased while the incidence of unique PPV23 and non-vaccine serotypes increased in both provinces. CONCLUSIONS IPD continues to cause a substantial public health burden in Canada despite publicly funded pneumococcal vaccination programs, resulting in part from an increase in unique PPV23 and non-vaccine serotypes.
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Affiliation(s)
- Sharifa Nasreen
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Jun Wang
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Jeffrey C Kwong
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada; University Health Network, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Vaccine Evaluation Center, BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sarah E Wilson
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada
| | - Allison McGeer
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada; Sinai Health System, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - James D Kellner
- Department of Pediatrics, University of Calgary, and Alberta Health Services, Calgary, Alberta, Canada
| | - Caroline Quach
- Departments of Microbiology, Infectious Diseases & Immunology and Pediatrics, University of Montreal, Quebec, Canada
| | - Shaun K Morris
- Division of Infectious Diseases, The Hospital for Sick Children, and Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- Public Health Ontario, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Monika Naus
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; BC Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Linda Hoang
- BC Centre for Disease Control, Vancouver, British Columbia, Canada; Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Frank Rudzicz
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, Ontario, Canada; Department of Computer Science, Faculty of Arts & Science, University of Toronto, Toronto, Ontario, Canada; Vector Institute for Artificial Intelligence, Toronto, Ontario, Canada
| | - Shaza Fadel
- Centre for Vaccine Preventable Diseases, University of Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada.
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21
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Nasreen S, Wang J, Kwong J, Crowcroft NS, Sadarangani M, Wilson S, McGeer A, Kellner JD, Quach C, Morris S, Bolotin S, Sander B, Naus MC, Hoang L, Rudzicz F, Fadel SA, Marra F. 1211. Incidence of All-Cause Community-Acquired Pneumonia in Ontario and British Columbia, Canada, 2002-2018; a Canadian Immunization Research Network (CIRN) study. Open Forum Infect Dis 2021. [PMCID: PMC8644744 DOI: 10.1093/ofid/ofab466.1403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Community-acquired pneumonia (CAP) causes substantial morbidity and mortality. There is a lack of data on the comprehensive burden of CAP across the life span in Canada. We estimated the incidence of all-cause CAP in all age groups in Ontario and British Columbia (BC), Canada. Methods We identified hospitalized and outpatient CAP episodes from the Discharge Abstract Database (DAD) and physician billing claims databases (Ontario Health Insurance Plan in Ontario and Medical Services Plan in BC) in both provinces. The National Ambulatory Care Reporting System was used to identify CAP episodes from emergency department visits in Ontario. CAP recorded with a primary or secondary diagnosis was identified using International Classification of Diseases 9 (480–486, 510, 513) and 10 (J10.0, J11.0, J12–J18, J86.9, J85.1) codes. We estimated the age and sex adjusted annual incidence of CAP overall, and by age groups (0–4, 5–17, 18–39, 40–64, 65–74, 75–84 and ≥85 years) according to routine childhood pneumococcal conjugate vaccine (PCV) immunization periods from 2005–2018 in Ontario and from 2002–2018 in BC. Poisson regression models were fitted with population denominators from Statistics Canada to estimate the incidence rates. Results Ontario had 3,607,186 CAP episodes from 2005–2015 with a mean annual incidence of 2,801 (95% confidence interval [CI]: 2,748, 2,854) per 100,000 population; incidence declined from 3,077/100,000 in 2005 to 2,604/100,000 in 2010 before increasing to 2,843/100,000 in 2018. BC had 1,146,172 CAP episodes from 2002–2008, with a mean annual incidence of 2,146 (95% CI: 2105, 2189); the incidence increased from 2,005 /100,000 in 2002 to 2,199/100,000 in 2018. A high incidence of CAP was observed in children aged 0–4 years and older adults, particularly in adults aged ≥85 years in both provinces across all PCV program periods (Figure 1). ![]()
Figure 1: Age group-specific incidence of all-cause community-acquired pneumonia according to childhood pneumococcal conjugate vaccine (PCV) program periods in Ontario (PCV7 [1 Jan 2005–30 Sep 2009]), PCV10 [1 Oct 2009–31 Oct 2010] and PCV13 [1 Nov 2010–31 Dec 2018]) and British Columbia (PCV7 [1 Sep 2003–31 May 2010] and PCV13 [1 Jun 2010–31 Dec 2018]), Canada Conclusion CAP continues to be a public health burden in Canada despite publicly funded pneumococcal vaccination programs. Ontario seems to have higher CAP burden than British Columbia that warrants further investigation. The youngest cohort of children and older adults contribute significantly to the CAP burden. Disclosures Manish Sadarangani, BM BCh, DPhil, GlaxoSmithKline (Grant/Research Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support)Sanofi Pasteur (Grant/Research Support)Seqirus (Grant/Research Support)Symvivo (Grant/Research Support)VBI Vaccines (Research Grant or Support) Allison McGeer, MSc,MD,FRCPC,FSHEA, GlaxoSmithKline (Advisor or Review Panel member)Merck (Advisor or Review Panel member, Research Grant or Support)Pfizer (Grant/Research Support, Scientific Research Study Investigator, Advisor or Review Panel member) James D. Kellner, MD, FRCPC, FIDSA, Pfizer, Merck, GSK, Moderna (Grant/Research Support) Shaun Morris, MD, MPH, DTM&H, FRCPC, FAAP, GSK (Speaker’s Bureau)Pfizer (Advisor or Review Panel member)Pfizer (Grant/Research Support) Shaza A. Fadel, PhD MPH, Merck (Other Financial or Material Support, Salary is paid by the University of Toronto via a donation by Merck to the Centre for Vaccine Preventable Diseases to support educational and operational activities.) Fawziah Marra, BSc(Pharm), PharmD, Pfizer Canada (Research Grant or Support)
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Affiliation(s)
| | - John Wang
- Public Health Ontario, Toronto, ON, Canada
| | | | | | | | | | | | | | | | - Shaun Morris
- Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Shelly Bolotin
- Public Health Ontario; University of Toronto, Toronto, Ontario, Canada
| | - Beate Sander
- University Health Network, Toronto, Ontario, Canada
| | - Monika C Naus
- BC CENTRE FOR DISEASE CONTROL, Vancouver , BC, Canada
| | - Linda Hoang
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | | | | | - Fawziah Marra
- University of British Columbia, Vancouver, British Columbia, Canada
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22
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Liu AC, Harvey M, Lee A, Hildebrand K, Hoang L, Gantt S, Al-Rawahi GN. Septic arthritis due to Mycoplasma orale in a young patient with hypogammaglobulinemia. J Assoc Med Microbiol Infect Dis Can 2021; 6:333-336. [PMID: 36338458 PMCID: PMC9629261 DOI: 10.3138/jammi-2021-0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 07/19/2021] [Indexed: 06/16/2023]
Abstract
Mycoplasma orale is an obligate intracellular bacterium usually found as a commensal in the human oral cavity. Symptomatic infections with this organism are rare, but severe disease has been described in the setting of impaired humoral immunity. Here, we describe a case in which M. orale was identified from the joint fluid of a patient with septic arthritis, splenic lesions, and agammaglobulinemia. A 15-year-old boy was admitted to the hospital with fever, progressive left knee swelling, and pain. His medical history was significant for Burkitt's lymphoma, the treatment of which had included rituximab 6 years earlier. M. orale was identified in the synovial fluid using 16S ribosomal RNA gene sequencing. He was also found to be hypogammaglobulinemic, and imaging revealed multiple splenic lesions. He was treated with doxycycline and intravenous immunoglobulin, which resulted in complete resolution of his arthritis and other symptoms. Mycoplasma species should be suspected in patients with humoral immunodeficiency and compatible findings.
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Affiliation(s)
- Aaron C Liu
- Department of Paediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Melissa Harvey
- Department of Paediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Alison Lee
- Department of Paediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Kyla Hildebrand
- Department of Paediatrics, University of British Columbia and BC Children’s Hospital, Vancouver, British Columbia, Canada
| | - Linda Hoang
- Department of Pathology and Laboratory Medicine, University of British Columbia and BC Centre for Disease Control Public Health Laboratory, Vancouver, British Columbia, Canada
| | - Soren Gantt
- Department of Microbiology, Infectiology and Immunology, Université de Montréal and CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Ghada N Al-Rawahi
- Department of Pathology and Laboratory Medicine, University of British Columbia, and BC Children’s Hospital, Vancouver, British Columbia, Canada
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23
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Teman SJ, Gaydos JK, Norman SA, Huggins JL, Lambourn DM, Calambokidis J, Ford JKB, Hanson MB, Haulena M, Zabek E, Cottrell P, Hoang L, Morshed M, Garner MM, Raverty S. Epizootiology of a Cryptococcus gattii outbreak in porpoises and dolphins from the Salish Sea. Dis Aquat Organ 2021; 146:129-143. [PMID: 34672263 DOI: 10.3354/dao03630] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Cryptococcus gattii is a fungal pathogen that primarily affects the respiratory and nervous systems of humans and other animals. C. gattii emerged in temperate North America in 1999 as a multispecies outbreak of cryptococcosis in British Columbia (Canada) and Washington State and Oregon (USA), affecting humans, domestic animals, and wildlife. Here we describe the C. gattii epizootic in odontocetes. Cases of C. gattii were identified in 42 odontocetes in Washington and British Columbia between 1997 and 2016. Species affected included harbor porpoises Phocoena phocoena (n = 26), Dall's porpoises Phocoenoides dalli (n = 14), and Pacific white-sided dolphins Lagenorhynchus obliquidens (n = 2). The probable index case was identified in an adult male Dall's porpoise in 1997, 2 yr prior to the initial terrestrial outbreak. The spatiotemporal extent of the C. gattii epizootic was defined, and cases in odontocetes were found to be clustered around terrestrial C. gattii hotspots. Case-control analyses with stranded, uninfected odontocetes revealed that risk factors for infection were species (Dall's porpoises), age class (adult animals), and season (winter). This study suggests that mycoses are an emerging source of mortality for odontocetes, and that outbreaks may be associated with anthropogenic environmental disturbance.
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Affiliation(s)
- Sarah J Teman
- The SeaDoc Society, Karen C. Drayer Wildlife Health Center - Orcas Island Office, UC Davis School of Veterinary Medicine, Eastsound, WA 98245, USA
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24
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Ahmed-Bentley J, Roman S, Mirzanejad Y, Fraser E, Hoang L, Young EJ, Morshed M, Deans G. Laboratory Exposures from an Unsuspected Case of Human Infection with Brucella canis. Emerg Infect Dis 2021; 27:2489-2491. [PMID: 34424169 PMCID: PMC8386805 DOI: 10.3201/eid2709.204701] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
We report a case of human infection with a Brucella canis isolate in an adult in Canada who was receiving a biologic immunomodulating medication. We detail subsequent investigations, which showed that 17 clinical microbiology staff had high-risk exposures to the isolate, 1 of whom had a positive result for B. canis.
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25
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Eckbo EJ, Wong T, Bharat A, Cameron-Lane M, Hoang L, Dawar M, Charles M. First reported outbreak of the emerging pathogen Candida auris in Canada. Am J Infect Control 2021; 49:804-807. [PMID: 33485922 DOI: 10.1016/j.ajic.2021.01.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 01/15/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Candida auris was first described in Japan in 2009 and has since been detected in over 40 countries. The yeast is concerning for multiple reasons, primarily: (1) challenges with accurate identification; (2) reported multidrug resistance; (3) published mortality rates of 30%-60%; and (4) persistence in the environment associated with human transmission. We report the emergence of a healthcare-associated cluster in the Greater Vancouver area in 2018 and describe the measures implemented to contain its transmission. METHODS Cases were identified through passive and ring surveillance of affected wards. Positive isolates were sent to provincial and national reference laboratories for confirmation and genomic characterization. Extensive infection control measures were implemented immediately after the initial case was identified. RESULTS Four cases were identified during the outbreak. In a 4-month period, over 700 swabs were collected in order to screen 180 contacts. Whole genome sequencing concluded that all isolates clustered together and belonged to the South Asian clade. No isolates harbored FKS gene mutations associated with resistance to echinocandins. Infection control measures, including surveillance, education, cleaning and/or disinfection, patient cohorting, isolation, and hand hygiene, effectively contained the outbreak; it was declared over within 2 months. CONCLUSIONS The spread of C auris in healthcare facilities has not spared Canadian institutions. Our experience demonstrates that strict infection control measures combined with microbiological screening can effectively halt transmission in healthcare centers. The necessity of active prospective screening remains unclear.
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26
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Nelson A, Kassimatis J, Estoque J, Yang C, McKee G, Bryce E, Hoang L, Daly P, Lysyshyn M, Hayden AS, Harding J, Boraston S, Dawar M, Schwandt M. Environmental detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from medical equipment in long-term care facilities undergoing COVID-19 outbreaks. Am J Infect Control 2021; 49:265-268. [PMID: 32645474 PMCID: PMC7336923 DOI: 10.1016/j.ajic.2020.07.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 12/22/2022]
Abstract
Environmental sampling was conducted at long-term care facilities to determine the extent of surface contamination with severe acute respiratory syndrome coronavirus 2 virus. Medical equipment used throughout the facility was determined to be contaminated.
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Affiliation(s)
- Atiba Nelson
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada
| | - Jennifer Kassimatis
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Jay Estoque
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Cicely Yang
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Geoff McKee
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Elizabeth Bryce
- Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Bacteriology and Mycology Laboratory, Vancouver, BC, Canada
| | - Patricia Daly
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Mark Lysyshyn
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Althea S Hayden
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - John Harding
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Suni Boraston
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Meena Dawar
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada
| | - Michael Schwandt
- University of British Columbia, School of Population and Public Health, Vancouver, BC, Canada; Vancouver Coastal Health, Office of the Chief Medical Health Officer, Vancouver, BC, Canada.
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Boyd E, Trmcic A, Taylor M, Shyng S, Hasselback P, Man S, Tchao C, Stone J, Janz L, Hoang L, Galanis E. Escherichia coli O121 outbreak associated with raw milk Gouda-like cheese in British Columbia, Canada, 2018. Can Commun Dis Rep 2021; 47:11-16. [PMID: 33746616 PMCID: PMC7972179 DOI: 10.14745/ccdr.v47i01a03] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND In 2018, a Shiga toxin-producing Escherichia coli O121 outbreak that affected seven individuals was associated with raw milk Gouda-like cheese produced in British Columbia, Canada. OBJECTIVES To describe the E. coli O121 outbreak investigation and recommend greater control measures for raw milk Gouda-like cheese. METHODS Cases of E. coli O121 were identified through laboratory testing results and epidemiologic surveillance data. The cases were interviewed on exposures of interest, which were analyzed against Foodbook Report values for British Columbia. Environmental inspection of the dairy plant and the cheese products was conducted to ascertain a source of contamination. Whole genome multi-locus sequence typing (wgMLST) was performed on all positive E. coli O121 clinical and food isolates at the provincial laboratory. RESULTS Four out of the seven cases consumed the same raw milk Gouda-like cheese between August and October 2018. The implicated cheese was aged longer than the required minimum of 60 days, and no production deficiencies were noted. One sample of the implicated cheese tested positive for E. coli O121. The seven clinical isolates and one cheese isolate matched by wgMLST within 6.5 alleles. CONCLUSION Raw milk Gouda and Gouda-like cheese has been implicated in three previous Shiga toxin-producing E. coli outbreaks in North America. It was recommended product labelling to increase consumer awareness and thermization of milk to decrease the risk of illness associated with raw milk Gouda and Gouda-like cheese.
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Affiliation(s)
- Eva Boyd
- British Columbia Centre for Disease Control, Vancouver, BC
- Correspondence:
| | - Aljosa Trmcic
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Marsha Taylor
- British Columbia Centre for Disease Control, Vancouver, BC
| | - Sion Shyng
- British Columbia Centre for Disease Control, Vancouver, BC
| | | | - Stephanie Man
- British Columbia Centre for Disease Control Public Health Laboratories, Vancouver, BC
| | - Christine Tchao
- British Columbia Centre for Disease Control Public Health Laboratories, Vancouver, BC
| | | | - Loretta Janz
- British Columbia Centre for Disease Control Public Health Laboratories, Vancouver, BC
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, BC
- British Columbia Centre for Disease Control Public Health Laboratories, Vancouver, BC
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC
| | - Eleni Galanis
- British Columbia Centre for Disease Control, Vancouver, BC
- School of Population and Public Health, University of British Columbia, Vancouver, BC
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Vadlamudi NK, Patrick DM, Hoang L, Rose C, Sadatsafavi M, Marra F. 1397. Long term impact of the 13-valent pneumococcal conjugate vaccine use in infant immunization program on all-cause pneumonia hospitalizations in British Columbia, Canada: a time series analysis. Open Forum Infect Dis 2020. [PMCID: PMC7776874 DOI: 10.1093/ofid/ofaa439.1579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Pneumonia is a leading cause of hospitalization and in-patient mortality globally. We determined the impact of 13-valent pneumococcal conjugate vaccine (PCV13) use on all-cause pneumonia hospitalization rates eight years after the vaccine was introduced in British Columbia, Canada.
Methods
Routine administrative databases, such as, hospital discharge abstract databases, registry and demographics were used to build the cohort. Overall and age-specific all-cause pneumonia hospital admissions per month (Jan 2000 to Dec 2018) for those aged < 2 years, 2-5 years, 6-17 years, 18-64 years and ≥ 65 years were obtained using International Classification of Diseases 9 and 10 codes (480-486, J12-J18). Changes in the all-cause pneumonia hospitalization incidence rates before and after the PCV13 vaccine program introduction were evaluated using a negative binomial regression and time-series modelling while adjusting for seasonality, influenza-likeness illnesses, 7-valent pneumococcal conjugate vaccine (PCV7) program and pre-PCV13 vaccine secular trends.
Results
Long term use of the PCV13 vaccine in the infant immunization program was associated with significant declines in all-cause pneumonia hospitalization rates among all children, < 2 years (IRR: 0.63; 95% Confidence Interval (CI): 0.59-0.67), 2-5 years (IRR: 0.82; 95%CI: 0.77-0.87) and 6-17 years (IRR: 0.73; 95%CI: 0.69-0.78). All-cause pneumonia rates did not change significantly in those aged 18-64 years (IRR: 0.98; 95%CI: 0.96-1), whereas a modest increase was observed in those 65 years and over (IRR: 1.05; 95%CI: 1.02-1.07). Consequently, we did not observe significant change in the overall rate (IRR: 1.02; 95%CI: 1-1.02).
Conclusion
Significant reduction in all-cause pneumonia hospitalization rates in children demonstrates long term beneficial effect of PCV13 use. A modest increase in all-cause pneumonia hospitalization rates in adults aged 65 years and over indicates a need for further microbial investigation.
Disclosures
Nirma Khatri Vadlamudi, BA, BS, MPH, Pfizer Inc (Research Grant or Support) Fawziah Marra, BSc (Pharm), PharmD, Pfizer Inc (Research Grant or Support)
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Affiliation(s)
- Nirma Khatri Vadlamudi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Linda Hoang
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Caren Rose
- University of British Columbia, Vancouver, BC, Canada; British Columbia Centre for Disease Control, Vancouver, BC, Canada;, VANCOUVER, BC, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Fawziah Marra
- University of British Columbia, Vancouver, British Columbia, Canada, Vancouver, BC, Canada
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Peterson SW, Martin I, Demczuk W, Barairo N, Naidu P, Lefebvre B, Allen V, Hoang L, Hatchette TF, Alexander D, Tomas K, Trubnikov M, Wong T, Mulvey MR. Multiplex real-time PCR assays for the prediction of cephalosporin, ciprofloxacin and azithromycin antimicrobial susceptibility of positive Neisseria gonorrhoeae nucleic acid amplification test samples. J Antimicrob Chemother 2020; 75:3485-3490. [PMID: 32830242 DOI: 10.1093/jac/dkaa360] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/23/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The incidence of antimicrobial-resistant Neisseria gonorrhoeae (GC) is rising in Canada; however, antimicrobial resistance (AMR) surveillance data are unavailable for infections diagnosed directly from clinical specimens by nucleic acid amplification tests (NAATs), representing over 80% of diagnoses. We developed a set of 10 improved molecular assays for surveillance of GC-AMR and prediction of susceptibilities in NAAT specimens. METHODS Multiplex real-time PCR (RT-PCR) assays were developed to detect SNPs associated with cephalosporin (ponA, porB, mtrR -35delA, penA A311V, penA A501, N513Y, G545S), ciprofloxacin (gyrA S91, parC D86/S87/S88) and azithromycin [23S (A2059G, C2611T), mtrR meningitidis-like promoter] resistance. The assays were validated on 127 gonococcal isolates, 51 non-gonococcal isolates and 50 NAATs with matched culture isolates. SNPs determined from the assay were compared with SNPs determined from in silico analysis of WGS data. MICs were determined for culture isolates using the agar dilution method. RESULTS SNP analysis of the 50 NAAT specimens had 96% agreement with the matched culture RT-PCR analysis. When compared with MICs, presence of penA A311V or penA A501 and two or more other SNPs correlated with decreased susceptibility and presence of three or more other SNPs correlated with intermediate susceptibility to cephalosporins; presence of any associated SNP correlated with ciprofloxacin or azithromycin resistance. NAAT-AMR predictions correlated with matched-culture cephalosporin, ciprofloxacin and azithromycin MICs at 94%, 100% and 98%, respectively. CONCLUSIONS We expanded molecular tests for N. gonorrhoeae AMR prediction by adding new loci and multiplexing reactions to improve surveillance where culture isolates are unavailable.
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Affiliation(s)
- S W Peterson
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - I Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - W Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - N Barairo
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - P Naidu
- Provincial Laboratory for Public Health, Edmonton, Alberta, Canada
| | - B Lefebvre
- Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, Québec, Canada
| | - V Allen
- Public Health Ontario Laboratories, Toronto, Ontario, Canada
| | - L Hoang
- British Columbia Centres for Disease Control Public Health Microbiology & Reference Laboratory, Vancouver, British Columbia, Canada
| | - T F Hatchette
- Queen Elizabeth II Health Sciences Centre, Halifax, Nova Scotia, Canada
| | - D Alexander
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - K Tomas
- Surveillance and Epidemiology Division, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - M Trubnikov
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Ontario, Canada
| | - T Wong
- First Nations and Inuit Health Branch, Indigenous Services Canada, Ottawa, Ontario, Canada
| | - M R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Vadlamudi NK, Patrick DM, Hoang L, Sadarangani M, Marra F. Incidence of invasive pneumococcal disease after introduction of the 13-valent conjugate pneumococcal vaccine in British Columbia: A retrospective cohort study. PLoS One 2020; 15:e0239848. [PMID: 32997698 PMCID: PMC7526878 DOI: 10.1371/journal.pone.0239848] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 09/14/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND A significant reduction in invasive pneumococcal disease (IPD) has been reported, across all ages, following the implementation of 7-valent conjugate pneumococcal vaccine (PCV7) globally, as part of infant immunization programs. We explored the additional impact of PCV13 on IPD over a 14-year period. METHODS Using provincial laboratory surveillance and hospitalization data (N = 5791), we calculated the annual incidence of IPD following the implementation of PCV13 vaccine. Poisson regression was used to evaluate changes in the overall incidence of IPD, and serotype-specific IPD between PCV7 (2004-10) and PCV13 (2011-2015) eras. RESULTS Overall, IPD rates have seen a modest decline in the PCV13 compared to the PCV7 era (IRR 0.84; 95% CI: 0.79-0.89); this was seen in children ≤2 years of age, and the majority of the adult cohort. Rates of vaccine-type IPD (PCV7 and PCV13) also decreased in the PCV13 era. In contrast, IPD incidence related to non-PCV13 (IRR: 1.56; 95%CI:1.43-1.72) and non-vaccine serotypes (IRR: 2.12; 95%CI:1.84-2.45) increased in the PCV13 era compared to the PCV7 era. CONCLUSIONS A modest reduction in IPD from the PCV13 vaccine was observed, with gains limited to the immunized cohort and adults. However, a significant increase in non-vaccine serotypes emphasizes the need for continued surveillance.
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Affiliation(s)
| | - David M. Patrick
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, Canada
- Department of Pathology and Laboratory Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Manish Sadarangani
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, Canada
| | - Fawziah Marra
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, Canada
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31
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Whyte KE, Hoang L, Sekirov I, Shuel ML, Hoang W, Tsang RSW. Emergence of a clone of invasive fucK-negative serotype e Haemophilus influenzae in British Columbia. J Assoc Med Microbiol Infect Dis Can 2020; 5:29-34. [PMID: 36339016 PMCID: PMC9603308 DOI: 10.3138/jammi.2019-0015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 09/30/2019] [Indexed: 06/16/2023]
Abstract
BACKGROUND Introduction of the Haemophilus influenzae serotype b (Hib) conjugate vaccine has changed the epidemiology of invasive H. influenzae disease, with most infections now caused by non-typeable (non-encapsulated) and non-Hib encapsulated strains. METHODS We describe nine invasive serotype e H. influenzae (Hie) from British Columbia that were determined to have complete deletion of their fucose operon genes. These nine isolates were recovered from blood cultures of three female and six male patients during 2011-2018, with eight recovered in the past 4 years. RESULTS All nine isolates were biotype IV, with eight showing identical pulsed field gel electrophoresis (PFGE) profiles, whereas the ninth showed 95% similarity. PFGE analysis also showed these fucose operon-negative Hie to be most (94%) similar to the multi-locus sequence type (ST)-18, the most common ST among Hie in British Columbia. These nine fucose operon-negative Hie represented 27.3% of the 33 invasive Hie isolated in British Columbia from 2010 to 2018. CONCLUSION Deletion of the fucose operon did not appear to impact the transmission ability of these strains or their ability to cause invasive disease.
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Affiliation(s)
- Kathleen E Whyte
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Linda Hoang
- BC Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Inna Sekirov
- BC Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Michelle L Shuel
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - William Hoang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Raymond SW Tsang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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32
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Brousseau N, Skowronski DM, Bellemare D, Amini R, Joffres Y, Clarke Q, Quach C, Rallu F, Hoang L, De Serres G. Impact of the adolescent pertussis booster dose on the incidence of pertussis in British Columbia and Quebec, Canada. Vaccine 2019; 38:427-432. [PMID: 31685295 DOI: 10.1016/j.vaccine.2019.10.063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 01/18/2019] [Revised: 08/16/2019] [Accepted: 10/23/2019] [Indexed: 10/25/2022]
Abstract
Impact of an adolescent tetanus toxoid, reduced diphtheria toxoid, and acellular pertussis (Tdap) vaccine program was assessed in the provinces of British Columbia and Quebec, Canada. In both provinces, the Tdap booster has been in place since 2004, targeting Grade 9 students (14-15-years-of-age). Incidence rate ratios (IRRs) standardizing notification rates among teens 15-19-years-old to infants <1-year-old decreased following introduction of the Tdap program and were significantly halved during the 2009-2012 post-Tdap versus 2000-2003 pre-Tdap period. This program impact, however, is tempered by the observation that pertussis incidence among 15-19-year-olds was already lower than any other pediatric age group, following gradual decline from pre-teen rates even before the Tdap program. The risk of hospitalization among adolescents 15-19-years-old was also low throughout at <1/100,000. Furthermore, IRRs increased in 2013-2017 when an increasing proportion of 15-19-year-olds were primed with acellular pertussis vaccine only, suggesting short-lived Tdap booster-dose effectiveness that warrants further monitoring.
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Affiliation(s)
- Nicholas Brousseau
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada.
| | - Danuta M Skowronski
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; School of Population and Public Health, Department of Medicine, University of British Columbia, Vancouver V6T 1Z3, Canada
| | - David Bellemare
- Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
| | - Rachid Amini
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada
| | - Yayuk Joffres
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Quinten Clarke
- Communicable Diseases and Immunization Service, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada
| | - Caroline Quach
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Fabien Rallu
- Department of Microbiology, Infectious Diseases, and Immunology, University of Montreal, Montreal H3T 1J4, Canada; Division of Paediatric Infectious Diseases and Department of Medical Microbiology, CHU Sainte-Justine, Montreal H3T 1C5, Canada
| | - Linda Hoang
- Public Health Laboratory, BC Centre for Disease Control, Vancouver V5Z 4R4, Canada; Department of Pathology and Laboratory Medicine, Department of Medicine, University of British Columbia, Vancouver V6T 2B5, Canada
| | - Gaston De Serres
- Risques biologiques et santé au travail, Institut national de santé publique du Québec, Québec G1V 5B3, Canada; Département de médecine sociale et préventive, Université Laval, Québec G1V 0A6, Canada
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Tsang RSW, Shuel M, Ahmad T, Hayden K, Knox N, Van Domselaar G, Hoang L, Tyrrell GJ, Minion J, Van Caeseele P, Kus JV, Ulanova M, Lefebvre B, Haldane D, Garceau R, German G, Zahariadis G, Hanley B, Kandola K, Patterson M. Whole genome sequencing to study the phylogenetic structure of serotype a Haemophilus influenzae recovered from patients in Canada. Can J Microbiol 2019; 66:99-110. [PMID: 31661630 DOI: 10.1139/cjm-2019-0406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
This study examined the phylogenetic structure of serotype a Haemophilus influenzae (Hia) isolates recovered from patients in Canada. Hia isolates from 490 separate patients and an American Type Culture Collection (ATCC) strain were analyzed by multilocus sequence typing (MLST), with 18 different sequence types (STs) identified. Most (85.7%) Hia patient isolates were typed as ST-23 and another 12.7% belonged to 14 different STs with 6, 5, or 4 MLST gene loci related to ST-23 (ST-23 complex). Core genome single-nucleotide variation phylogeny (SNVPhyl) on whole genome sequence (WGS) data of 121 Hia patient isolates representing all identified STs and the ATCC strain revealed 2 phylogenetic populations, with all the ST-23 complex isolates within 1 population. The other phylogenetic population contained only the ATCC strain and 3 patient isolates. Concatenated hitABC sequences retrieved from WGS data and analyzed by MEGA (Molecular Evolutionary Genetic Analysis) alignment confirmed the phylogeny obtained by SNVPhyl. The sodC gene was found only in isolates in the minor phylogenetic population. The 2 phylogenetic populations of the Canadian Hia isolates are similar to the 2 clonal divisions described for serotype b H. influenzae. Combining MLST, core SNVPhyl, and hitABC gene sequence alignment showed that most (99.4%) Canadian Hia patient isolates belonged to 1 major phylogenetic population.
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Affiliation(s)
- Raymond S W Tsang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Michelle Shuel
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Tauqeer Ahmad
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Kristy Hayden
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Natalie Knox
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Gary Van Domselaar
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.,Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Linda Hoang
- BC Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | | | - Jessica Minion
- Roy Romanow Provincial Laboratory, Regina, Saskatchewan, Canada
| | | | - Julianne V Kus
- Public Health Ontario, Toronto, Ontario, Canada.,Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Marina Ulanova
- Northern Ontario School of Medicine, Thunder Bay, Ontario, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - David Haldane
- Nova Scotia Health Authority, Halifax, Nova Scotia, Canada.,Dalhousie University, Halifax, Nova Scotia, Canada
| | - Richard Garceau
- Communicable Disease Control Unit, Department of Health, Government of New Brunswick, Fredericton, New Brunswick, Canada
| | - Greg German
- Department of Health, Government of Prince Edward Island, Charlottetown, Prince Edward Island, Canada
| | - George Zahariadis
- Provincial Public Health Laboratory, Eastern Health Microbiology Services, St. John's, Newfoundland and Labrador, Canada.,Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Brendan Hanley
- Department of Health and Social Services, Government of Yukon, Whitehorse, Yukon, Canada
| | - Kami Kandola
- Department of Health and Social Services, Government of Northwest Territories, Yellowknife, Northwest Territories, Canada
| | - Michael Patterson
- Department of Health, Government of Nunavut, Iqaluit, Nunavut, Canada
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Vadlamudi NK, Patrick D, Hoang L, Marra F. 2706. Indirect Effects of Infant 13-valent Conjugate Pneumococcal Vaccination Program on Invasive Pneumococcal Disease in Adults in British Columbia, Canada. Open Forum Infect Dis 2019. [PMCID: PMC6810888 DOI: 10.1093/ofid/ofz360.2383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Many jurisdictions report a significant reduction in invasive pneumococcal disease (IPD) in adults following implementation of the pneumococcal conjugate vaccines, 7-valent (PCV7) and 13-valent (PCV13) in childhood immunization programs. This study evaluates the indirect effect of conjugate vaccines on IPD in British Columbia, Canada over a 14 year period (2002–2015). Methods Using provincial IPD laboratory surveillance data, we calculated the annual incidence following implementation of PCV7 (September 2004), and PCV13 (September 2010) in adults 18 years of age and older. We also compared incidence rate ratios (IRR) against pre-PCV13 (2004–2010) and pre-PCV7 (2002–2003) baselines for overall and age-specific IPD rates using Poisson regression. Results A total of 3793 cases were reported over the 14 year period. The overall annual incidence increased from 4.32 cases per 100,000 population in 2002 to 8.61 cases per 100,000 population in 2015. Overall, IPD has increased by 80% (IRR: 1.80; 95% CI: 1.59–2.04) compared with baseline, especially in adults ≥ 85 years of age (PCV13 vs baseline: IRR: 1.90; 95% CI: 1.25–03.05). This increase was the highest after introduction of PCV7 (IRR: 1.87; 95% CI: 1.65–2.11); the incremental change after introduction of PCV13 was non-significant (IRR 0.96; 95% CI: 0.90–1.03). While PCV7 type IPD plummeted by 76% (IRR 0.24; 95% CI: 0.18–0.31) since introduction of PCV7 compared with baseline, a modest decline in PCV13 type IPD of 20% was seen (IRR 0.80; 95% CI: 0.71–0.89) since introduction of PCV13. Conclusion Although PCV7-type IPD has decreased substantially, only a modest reduction in IPD from the additional 6 serotypes in the PCV13 vaccine was observed. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - David Patrick
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Hoang
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Fawziah Marra
- University of British Columbia, Vancouver, BC, Canada
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35
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Vadlamudi NK, Patrick D, Hoang L, Marra F. 2705. Serotype Replacement Following Childhood Pneumococcal Conjugate Vaccination Programs in British Columbia, Canada. Open Forum Infect Dis 2019. [PMCID: PMC6810407 DOI: 10.1093/ofid/ofz360.2382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background Pneumococcal conjugate vaccines have substantially reduced the incidence of invasive pneumococcal disease (IPD); however, the impact of the vaccine on non-vaccine serotypes (NVT) remains unclear. We evaluated the effect of PCV13 use in British Columbia, Canada. Methods The annual incidence following implementation of PCV7 (September 2004), and PCV13 (September 2010) was calculated using provincial laboratory surveillance data. We also compared incidence rate ratios (IRR) against pre-PCV13 (2004–10) and pre-PCV7 (2002–03) baselines using Poisson regression for non-conjugate vaccine type IPD. Results A total of 4,490 cases were reported over the 14 year period. The overall annual incidence increased from 5.73 cases per 100,000 population in 2002 to 7.90 cases per 100,000 population in 2015. Compared with baseline, PCV7 reduced VT-IPD (IRR: 0.49; 95% CI: 0.42–0.56), but the additional 6 serotypes in the PCV13 vaccine caused 214% increase in IPD (IRR: 2.65; 95% CI: 2.12–3.39). The majority of this increase is related to an increase in NVT disease (IRR: 3.17; 95% CI: 2.62–3.87) such as 23B, 23A, 9N, 20, 33F, 15C, 17F and 6C. IPD from PCV13 vaccine serotypes 19A and 7F which emerged after PCV7 continue to be high. Conclusion The introduction of PCV13 has a modest impact on IPD rates, due to inadequate control of serotypes 19A and 7F, and, of concern, IPD rates continue to escalate due to serotype replacement by non-vaccine serotypes. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - David Patrick
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Hoang
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Fawziah Marra
- University of British Columbia, Vancouver, BC, Canada
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36
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Vadlamudi NK, Patrick D, Hoang L, Marra F. 2701. The Impact of Infant 13-valent Conjugate Pneumococcal Vaccination Program on Invasive Pneumococcal Disease in Children in British Columbia, Canada. Open Forum Infect Dis 2019. [PMCID: PMC6810777 DOI: 10.1093/ofid/ofz360.2378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background A significant reduction in invasive pneumococcal disease (IPD) has been reported following implementation of the 7-valent pneumococcal conjugate vaccine (PCV7) infant immunization program, but not much has been reported after introduction of the 13-valent vaccine (PCV13). This study represents the effect of PCV13 on IPD in British Columbia, Canada over a 14 year period (2002–2015). Methods Using provincial IPD laboratory surveillance data, we calculated the annual incidence following implementation of PCV7 (September 2004), and PCV13 (September 2010) in children less than 17 years of age. We also compared incidence rate ratios (IRR) against pre-PCV13 (2004–2010) and pre-PCV7 (2002–2003) baselines for overall and age-specific IPD rates using Poisson regression. Results A total of 697 cases were reported over the 14 year period. The overall annual incidence decreased from 10.9 cases per 100,000 population in 2002 to 4.64 cases per 100,000 population in 2015. While overall decline of IPD was 59% (IRR 0.41; 95% CI: 0.35–0.51) compared with baseline, this reduction was greatest after introduction of PCV7 (IRR 0.44; 95% CI: 0.37–0.53); the incremental change after introduction of PCV13 was non-significant (IRR 0.94; 95% CI: 0.78–1.13). The greatest reduction in IPD was in children <2 years of age (PCV13 vs baseline: IRR 0.19; 95% CI: 0.14–0.25), followed by children 3–5 years of age (PCV13 vs baseline: IRR 0.34; 95% CI: 0.21–0.56); no significant change was observed in 6–17 year olds. Conclusion While IPD rates have been significantly reduced since the introduction of the PCV vaccines, the impact of the additional 6 serotypes in the PCV13 vaccine is non-significant. Disclosures All authors: No reported disclosures.
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Affiliation(s)
| | - David Patrick
- Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda Hoang
- British Columbia Center for Disease Control, Vancouver, BC, Canada
| | - Fawziah Marra
- University of British Columbia, Vancouver, BC, Canada
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Guthrie JL, Kong C, Roth D, Jorgensen D, Rodrigues M, Hoang L, Tang P, Cook V, Johnston J, Gardy JL. Molecular Epidemiology of Tuberculosis in British Columbia, Canada: A 10-Year Retrospective Study. Clin Infect Dis 2019; 66:849-856. [PMID: 29069284 PMCID: PMC5850024 DOI: 10.1093/cid/cix906] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [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: 09/06/2017] [Accepted: 10/17/2017] [Indexed: 11/14/2022] Open
Abstract
Background Understanding regional molecular epidemiology allows for the development of more efficient tuberculosis prevention strategies in low-incidence settings. Methods We analyzed 24-locus mycobacterial interspersed repetitive-unit–variable-number tandem repeat (MIRU-VNTR) genotyping for 2290 Mycobacterium tuberculosis clinical isolates collected in the province of British Columbia (BC), Canada, in 2005–2014. Laboratory data for each isolate were linked to case-level clinical and demographic data. These data were used to describe the molecular epidemiology of tuberculosis across the province. Results We detected >1500 distinct genotypes across the 4 major M. tuberculosis lineages, reflecting BC’s diverse population. Disease site and clustering rates varied across lineages, and MIRU-VNTR was used to group the 2290 isolates into 189 clusters (2–70 isolates per cluster), with an overall clustering rate of 42.4% and an estimated local transmission rate of 34.1%. Risk factors for clustering varied between Canadian-born and foreign-born individuals; the former had increased odds (odds ratio, 7.8; 95% confidence interval [CI], 6.2–9.6) of belonging to a genotypic cluster, although nearly one-quarter of clusters included both Canadian- and foreign-born persons. Large clusters (≥10 cases) occurred more frequently within the M. tuberculosis Euro-American lineage, and individual-level risk factors associated with belonging to a large cluster included being Canadian born (adjusted odds ratio, 3.3; 95% CI, 2.3–4.8), residing in a rural area (2.3; 1.2–4.5), and illicit drug use (2.0; 1.2–3.4). Conclusions Although tuberculosis in BC largely arises through reactivation of latent tuberculosis in foreign-born persons, locally transmitted infections occur in discrete populations with distinct disease and risk factor profiles, representing groups for targeted interventions.
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Affiliation(s)
| | - Clare Kong
- British Columbia Centre for Disease Control Public Health Laboratory
| | - David Roth
- British Columbia Centre for Disease Control
| | | | - Mabel Rodrigues
- British Columbia Centre for Disease Control Public Health Laboratory
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory.,Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Patrick Tang
- Department of Pathology, Sidra Medical and Research Center, Doha, Qatar
| | - Victoria Cook
- British Columbia Centre for Disease Control.,Respiratory Medicine, University of British Columbia, Vancouver, Canada
| | - James Johnston
- British Columbia Centre for Disease Control.,Respiratory Medicine, University of British Columbia, Vancouver, Canada
| | - Jennifer L Gardy
- School of Population and Public Health, University of British Columbia.,British Columbia Centre for Disease Control
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Currie A, Honish L, Cutler J, Locas A, Lavoie MC, Gaulin C, Galanis E, Tschetter L, Chui L, Taylor M, Jamieson F, Gilmour M, Ng C, Mutti S, Mah V, Hamel M, Martinez A, Buenaventura E, Hoang L, Pacagnella A, Ramsay D, Bekal S, Coetzee K, Berry C, Farber J, Team OBOTNI. Outbreak of Escherichia coli O157:H7 Infections Linked to Mechanically Tenderized Beef and the Largest Beef Recall in Canada, 2012. J Food Prot 2019; 82:1532-1538. [PMID: 31414901 DOI: 10.4315/0362-028x.jfp-19-005] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Contaminated beef is a known vehicle of Escherichia coli O157:H7 infection, although more attention is given to the control of E. coli O157:H7 in ground, rather than whole-cut, beef products. In September 2012, an investigation was initiated at an Alberta, Canada, beef plant after the detection of E. coli O157:H7 in two samples of trim cut from beef originating from this plant. Later in September 2012, Alberta Health Services identified five laboratory-confirmed infections of E. coli O157:H7, and case patients reported eating needle-tenderized beef steaks purchased at a store in Edmonton, Alberta, produced with beef from the Alberta plant. In total, 18 laboratory-confirmed illnesses in Canada in September and October 2012 were linked to beef from the Alberta plant, including the five individuals who ate needle-tenderized steaks purchased at the Edmonton store. A unique strain of E. coli O157:H7, defined by molecular subtyping and whole genome sequencing, was detected in clinical isolates, four samples of leftover beef from case patient homes, and eight samples of Alberta plant beef tested by industry and food safety partners. Investigators identified several deficiencies in the control of E. coli O157:H7 at the plant; in particular, the evaluation of, and response to, the detection of E. coli O157 in beef samples during routine testing were inadequate. To control the outbreak, 4,000 tons of beef products were recalled, making it the largest beef recall in Canadian history. This outbreak, in combination with similar outbreaks in the United States and research demonstrating that mechanical tenderization can transfer foodborne pathogens present on the surface into the interior of beef cuts, prompted amendments to Canada's Food and Drug Regulations requiring mechanically tenderized beef to be labeled as such and to provide safe cooking instructions to consumers. A detailed review of this event also led to recommendations and action to improve the safety of Canada's beef supply.
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Affiliation(s)
- Andrea Currie
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Lance Honish
- Alberta Health Services, Edmonton, Alberta, Canada T5J 2Y2
| | - Jennifer Cutler
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Annie Locas
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | | | - Colette Gaulin
- Ministère de la Santé et des Services Sociaux du Québec, Québec, Québec, Canada G1S 2M1
| | - Eleni Galanis
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Lorelee Tschetter
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada R3E 3R2
| | - Linda Chui
- Provincial Laboratory for Public Health: Alberta Public Laboratories, Alberta, Canada T6G 2J2
| | - Marsha Taylor
- Communicable Disease Prevention and Control Services, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Fred Jamieson
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Matthew Gilmour
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada R3E 3R2
| | - Constance Ng
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Sarbjit Mutti
- Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Victor Mah
- Alberta Health, Edmonton, Alberta, Canada T5J 1S6
| | - Meghan Hamel
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Amalia Martinez
- Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada K1A 0K9
| | | | - Linda Hoang
- British Columbia Public Health Microbiology and Reference Laboratory, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Ana Pacagnella
- British Columbia Public Health Microbiology and Reference Laboratory, British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Danielle Ramsay
- Ministère de l'Agriculture, des Pêcheries et de l'Alimentation du Québec, 200 Chemin Ste-Foy, 11ème étage, Québec, Québec, Canada G1R 4X6
| | - Sadjia Bekal
- Laboratoire de Santé Publique du Québec, Sainte-Anne de Bellevue, Québec, Canada H9X 3Y3
| | - Kelly Coetzee
- Department of Health and Community Services, Government of Newfoundland and Labrador, St. John's, Newfoundland and Labrador, Canada A1B 4J6
| | - Chrystal Berry
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada R3E 3R2
| | - Jeff Farber
- University of Guelph, Guelph, Ontario, Canada N1G 2W1
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Ivaska L, Alyazidi R, Hoang L, Goldfarb DM. Dermacoccus sp. isolated from a brain abscess in a 4-year-old child. J Infect Chemother 2019; 25:1070-1073. [PMID: 31253474 DOI: 10.1016/j.jiac.2019.05.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 05/27/2019] [Accepted: 05/29/2019] [Indexed: 11/25/2022]
Abstract
Dermacoccus spp. have rarely been reported as human pathogens. We describe a case of a 4-year-old boy with congenital heart disease who was diagnosed with a brain abscess. The abscess was drained and the sample grew Streptococcus intermedius, Aggregatibacter aphrophilus and Dermacoccus sp.. Dermacoccus grew after 5 days of incubation and the patient was treated with meropenem.
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Affiliation(s)
- Lauri Ivaska
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, Kiinanmyllynkatu 4-8, 20521, Turku, Finland; University of British Columbia and BC Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada.
| | - Raidan Alyazidi
- University of British Columbia and BC Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada; Department of Pediatrics, Faculty of Medicine, King Abdulaziz University, Prince Majid Rd, Al Sulaymaniyah, Jeddah, 22252, Saudi Arabia.
| | - Linda Hoang
- BC Centre for Disease Control Public Health Microbiology, 655 W 12th Ave, Vancouver, BC, V5Z 4R4, Canada.
| | - David M Goldfarb
- University of British Columbia and BC Children's Hospital, 4480 Oak St, Vancouver, BC, V6H 3N1, Canada; Department of Pathology and Laboratory Medicine, University of British Columbia, 2329 West Mall, Vancouver, BC, V6T 1Z4, Canada.
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40
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Tsang RS, Hoang L, Tyrrell GJ, Minion J, Van Caeseele P, Kus JV, Lefebvre B, Haldane D, Garceau R, German G, Zahariadis G, Hanley B. Increase in ST-11 serogroup W Neisseria meningitidis invasive meningococcal disease in Canada, 2016-2018. Can Commun Dis Rep 2019; 45:164-169. [PMID: 31285709 PMCID: PMC6587698 DOI: 10.14745/ccdr.v45i06a04] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Many countries have experienced increases in invasive meningococcal disease (IMD) due to a serogroup W Neisseria meningitidis (MenW) strain of the multilocus sequence type (ST)-11 clonal complex (CC). MenW ST-11 was first reported in Ontario, Canada, in 2014. By 2016, this strain caused IMD in five provinces and was responsible for 18.8% of the IMD cases in Canada. OBJECTIVE To provide an update on invasive MenW disease in Canada including the strain characteristics, specimen source of isolates, age, sex and geographic distribution of cases. METHODS N. meningitidis from culture-positive IMD cases are routinely submitted to the National Microbiology Laboratory (NML) for serogroup, serotype, serosubtype and sequence type analysis. The data from January 1, 2016 to December 31, 2018 were analyzed by calculating the proportion of IMD cases caused by MenW compared with other serogroups. In addition, trends based on age, sex and geographic distribution of cases and specimen source of isolates were analyzed based on information on specimen requisition forms. RESULTS Over the 3-year period, 292 individual IMD case isolates were analyzed. The percentage of IMD case isolates typed as MenW more than doubled from 19% (n=15) to 44% (n=51) in 2018 when MenW became the most common serogroup, exceeded the number of MenB, MenC or MenY. In total, 93 MenW case isolates were identified, 91% (n=85) belonged to the ST-11 CC. The increase in MenW affected all age groups (but was most common in those older than 60) and both sexes, and occurred across the country but most prevalent in western Canada. The most common specimen source was blood. CONCLUSION In 2018, MenW was the most common serogroup for isolates received by the NML from culture-positive IMD cases in Canada. Over 90% of the MenW serogroup isolates belonged to the ST-11 CC. The quadrivalent ACWY meningococcal conjugate vaccine protects against IMD caused by strains in the A, C, W or Y serogroups and therefore may protect against IMD caused by the new MenW ST-11 strain; however, more research is needed. The emergence of variant strains highlight the importance of strain characterization in IMD surveillance and research.
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Affiliation(s)
- RS Tsang
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB
| | - L Hoang
- BC Public Health Microbiology and Reference Laboratory, Vancouver, BC
| | - GJ Tyrrell
- Provincial Laboratory for Public Health, Edmonton, AB
| | - J Minion
- Saskatchewan Disease Control Laboratory, Regina, SK
| | | | - JV Kus
- Public Health Ontario, Toronto, ON
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON
| | - B Lefebvre
- Laboratoire de santé publique du Québec, Institut national de santé publique du Québec, Sainte-Anne-de-Bellevue, QC
| | - D Haldane
- Nova Scotia Health Authority, Halifax, NS
- Dalhousie University, Halifax, NS
| | - R Garceau
- Communicable Disease Control Unit, Department of Health, Government of New Brunswick, Fredericton, NB
| | - G German
- Department of Health, Government of Prince Edward Island, Charlottetown, PE
| | - G Zahariadis
- Provincial Public Health Laboratory, Eastern Health Microbiology Services, St. John’s, NL
- Department of Laboratory Medicine, Faculty of Medicine, Memorial University of Newfoundland, St. John’s, NL
| | - B Hanley
- Yukon Communicable Disease Control, Yukon Health and Social Services, Whitehorse, YT
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41
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Mataseje LF, Boyd DA, Fuller J, Haldane D, Hoang L, Lefebvre B, Melano RG, Poutanen S, Van Caeseele P, Mulvey MR. Characterization of OXA-48-like carbapenemase producers in Canada, 2011-14. J Antimicrob Chemother 2019; 73:626-633. [PMID: 29272439 DOI: 10.1093/jac/dkx462] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/07/2017] [Indexed: 01/23/2023] Open
Abstract
Objectives Since the first identification of the OXA-48 carbapenemase in 2001, Enterobacteriaceae harbouring OXA-48-like enzymes have been reported globally. Here, we applied WGS to characterize the molecular epidemiology of these bacterial isolates. Methods Enterobacteriaceae non-susceptible to carbapenems isolated from patients between 2011 and 2014 were voluntarily submitted to the Canadian National Microbiology Laboratory where they were screened for carbapenemase genes. WGS was conducted on OXA-48-like producers using the Illumina MiSeq platform. WGS data were used for single nucleotide variant (SNV) analysis, MLST analysis, detection of resistance genes and partial plasmid characterization. Susceptibilities were determined using Vitek2 and Etest. Patient data provided from sites were reviewed. Results Sixty-seven non-duplicated cases were identified among Escherichia coli (n = 21) and Klebsiella pneumoniae (n = 46). Recent international travel was observed in 40.4% of cases. OXA-181 (52.2%) and OXA-48 (31.3%) were the most common variants, one E. coli OXA-48 producer was found to harbour the acquired colistin resistance gene mcr-1. The dominant STs were ST38 and ST410 in E. coli and ST14 in K. pneumoniae. Three common plasmid types were observed among isolates: IncL/M associated with OXA-48 producers, and ColKP3 and IncX3 associated with OXA-181/232 producers. Conclusions Enterobacteriaceae with OXA-48-like carbapenemases are emerging in Canada. This study highlights the complexity of OXA-48-types identified in Canada owing to travel and the successful clones and plasmids harbouring the OXA-48-like enzyme.
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Affiliation(s)
- Laura F Mataseje
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - David A Boyd
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Jeffrey Fuller
- Provincial Laboratory of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - David Haldane
- Nova Scotia Health Authority, Pathology and Microbiology, Halifax, Nova Scotia, Canada
| | - Linda Hoang
- British Columbia Public Health Microbiology and Reference Laboratory, Provincial Health Services Authority Laboratories, Vancouver, British Columbia, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Roberto G Melano
- Public Health Ontario Laboratories, Laboratory Medicine and Pathobiology, Toronto, Ontario, Canada
| | - Susan Poutanen
- Mount Sinai Hospital, Department of Microbiology, Toronto, Ontario, Canada
| | | | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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42
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Reimer A, Weedmark K, Petkau A, Peterson CL, Walker M, Knox N, Kent H, Mabon P, Berry C, Tyler S, Tschetter L, Jerome M, Allen V, Hoang L, Bekal S, Clark C, Nadon C, Van Domselaar G, Pagotto F, Graham M, Farber J, Gilmour M. Shared genome analyses of notable listeriosis outbreaks, highlighting the critical importance of epidemiological evidence, input datasets and interpretation criteria. Microb Genom 2019; 5. [PMID: 30648944 PMCID: PMC6412057 DOI: 10.1099/mgen.0.000237] [Citation(s) in RCA: 10] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The persuasiveness of genomic evidence has pressured scientific agencies to supplement or replace well-established methodologies to inform public health and food safety decision-making. This study of 52 epidemiologically defined Listeria monocytogenes isolates, collected between 1981 and 2011, including nine outbreaks, was undertaken (1) to characterize their phylogenetic relationship at finished genome-level resolution, (2) to elucidate the underlying genetic diversity within an endemic subtype, CC8, and (3) to re-evaluate the genetic relationship and epidemiology of a CC8-delimited outbreak in Canada in 2008. Genomes representing Canadian Listeria outbreaks between 1981 and 2010 were closed and manually annotated. Single nucleotide variants (SNVs) and horizontally acquired traits were used to generate phylogenomic models. Phylogenomic relationships were congruent with classical subtyping and epidemiology, except for CC8 outbreaks, wherein the distribution of SNV and prophages revealed multiple co-evolving lineages. Chronophyletic reconstruction of CC8 evolution indicates that prophage-related genetic changes among CC8 strains manifest as PFGE subtype reversions, obscuring the relationship between CC8 isolates, and complicating the public health interpretation of subtyping data, even at maximum genome resolution. The size of the shared genome interrogated did not change the genetic relationship measured between highly related isolates near the tips of the phylogenetic tree, illustrating the robustness of these approaches for routine public health applications where the focus is recent ancestry. The possibility exists for temporally and epidemiologically distinct events to appear related even at maximum genome resolution, highlighting the continued importance of epidemiological evidence.
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Affiliation(s)
- Aleisha Reimer
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Kelly Weedmark
- 2Health Canada, Bureau of Microbial Hazards, Ottawa, ON, K1A 0K9, Canada
| | - Aaron Petkau
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | | | - Matthew Walker
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Natalie Knox
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Heather Kent
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Philip Mabon
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Chrystal Berry
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Shaun Tyler
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | | | - Morganne Jerome
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Vanessa Allen
- 3Public Health Ontario, Toronto, ON, M5G 1M1, Canada
| | - Linda Hoang
- 4British Columbia Centre for Disease Control, Public Health Microbiology and Reference Laboratory, Vancouver, BC V5Z 4R4, Canada
| | - Sadjia Bekal
- 5Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, H9X 3R5, Canada
| | - Clifford Clark
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Celine Nadon
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | | | - Franco Pagotto
- 2Health Canada, Bureau of Microbial Hazards, Ottawa, ON, K1A 0K9, Canada
| | - Morag Graham
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
| | - Jeff Farber
- 6University of Guelph, Guelph, ON, N1G 2W, Canada
| | - Matthew Gilmour
- 1Public Health Agency of Canada, Winnipeg, MB, R3E 3R2, Canada
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Labbé G, Rankin MA, Robertson J, Moffat J, Giang E, Lee LK, Ziebell K, MacKinnon J, Laing CR, Parmley EJ, Agunos A, Daignault D, Bekal S, Chui L, MacDonald KA, Hoang L, Slavic D, Ramsay D, Pollari F, Nash JHE, Johnson RP. Targeting discriminatory SNPs in Salmonella enterica serovar Heidelberg genomes using RNase H2-dependent PCR. J Microbiol Methods 2018; 157:81-87. [PMID: 30592979 DOI: 10.1016/j.mimet.2018.12.021] [Citation(s) in RCA: 4] [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: 11/08/2018] [Revised: 12/21/2018] [Accepted: 12/24/2018] [Indexed: 11/16/2022]
Abstract
We report a novel RNase H2-dependent PCR (rhPCR) genotyping assay for a small number of discriminatory single-nucleotide polymorphisms (SNPs) that identify lineages and sub-lineages of the highly clonal pathogen Salmonella Heidelberg (SH). Standard PCR primers targeting numerous SNP locations were initially designed in silico, modified to be RNase H2-compatible, and then optimized by laboratory testing. Optimization often required repeated cycling through variations in primer design, assay conditions, reagent concentrations and selection of alternative SNP targets. The final rhPCR assay uses 28 independent rhPCR reactions to target 14 DNA bases that can distinguish 15 possible lineages and sub-lineages of SH. On evaluation, the assay correctly identified the 12 lineages and sub-lineages represented in a panel of 75 diverse SH strains. Non-specific amplicons were observed in 160 (15.2%) of the 1050 reactions, but due to their low intensity did not compromise assay performance. Furthermore, in silico analysis of 500 closed genomes from 103 Salmonella serovars and laboratory rhPCR testing of five prevalent Salmonella serovars including SH indicated the assay can identify Salmonella isolates as SH, since only SH isolates generated amplicons from all 14 target SNPs. The genotyping results can be fully correlated with whole genome sequencing (WGS) data in silico. This fast and economical assay, which can identify SH isolates and classify them into related or unrelated lineages and sub-lineages, has potential applications in outbreak identification, source attribution and microbial source tracking.
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Affiliation(s)
- Geneviève Labbé
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Marisa A Rankin
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - James Robertson
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Jonathan Moffat
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Elissa Giang
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Lok Kan Lee
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Kim Ziebell
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Joanne MacKinnon
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Chad R Laing
- National Centres for Animal Disease Lethbridge Laboratory, Canadian Food Inspection Agency, Lethbridge, AB, Canada
| | - E Jane Parmley
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Agnes Agunos
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - Danielle Daignault
- National Microbiology Laboratory, Public Health Agency of Canada, St-Hyacinthe, Québec, Canada
| | - Sadjia Bekal
- Laboratoire de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Québec, Canada
| | - Linda Chui
- Provincial Laboratory for Public Health-Alberta Public Laboratories, Edmonton, Alberta, Canada; Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | - Kimberley A MacDonald
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada; British Columbia Centre for Disease Control, Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control, Public Health Microbiology and Reference Laboratory, Vancouver, British Columbia, Canada
| | - Durda Slavic
- Animal Health Laboratory, Laboratory Services Division, University of Guelph, Guelph, Ontario, Canada
| | - Danielle Ramsay
- Ministère de l'Agriculture, des Pêcheries, et de l'Alimentation du Québec, Québec, Canada
| | - Frank Pollari
- Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada
| | - John H E Nash
- National Microbiology Laboratory, Public Health Agency of Canada, Toronto, Ontario, Canada
| | - Roger P Johnson
- National Microbiology Laboratory, Public Health Agency of Canada, Guelph, Ontario, Canada.
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44
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Luna S, Taylor M, Galanis E, Asplin R, Huffman J, Wagner D, Hoang L, Paccagnella A, Shelton S, Ladd-Wilson S, Seelman S, Whitney B, Elliot E, Atkinson R, Marshall K, Basler C. Outbreak of Salmonella Chailey Infections Linked To Precut Coconut Pieces - United States and Canada, 2017. MMWR Morb Mortal Wkly Rep 2018; 67:1098-1100. [PMID: 30286052 PMCID: PMC6171899 DOI: 10.15585/mmwr.mm6739a5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Foodborne salmonellosis causes an estimated 1 million illnesses and 400 deaths annually in the United States (1). In recent years, salmonellosis outbreaks have been caused by foods not typically associated with Salmonella. On May 2, 2017, PulseNet, CDC's national molecular subtyping network for foodborne disease surveillance, identified a cluster of 14 Salmonella Chailey isolates with a rare pulsed-field gel electrophoresis (PFGE) pattern. On May 29, Canadian health officials informed CDC that they were also investigating a cluster of five Salmonella Chailey infections in British Columbia with the same PFGE pattern. Nineteen cases were identified and investigated by CDC, U.S. state health departments, the Public Health Agency of Canada, and the British Columbia Centre for Disease Control. Isolates from all cases were highly related by whole genome sequencing (WGS). Illness onset dates ranged from March 10 to May 7, 2017. Initial interviews revealed that infected persons consumed various fresh foods and shopped at grocery chain A; focused questionnaires identified precut coconut pieces from grocery chain A as a common vehicle. The Canadian Food Inspection Agency (CFIA) and the U.S. Food and Drug Administration (FDA) conducted a traceback investigation that implicated a single lot of frozen, precut coconut as the outbreak source. Grocery chain A voluntarily removed precut coconut pieces from their stores. This action likely limited the size and scope of this outbreak.
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45
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Hoang L, Islam S, Hindenburg A. Utilization rates of enoxaparin and heparin in deep venous thrombosis prophylaxis after education and electronic order change at a single institution: a quality improvement study. J Thromb Thrombolysis 2018; 46:502-506. [DOI: 10.1007/s11239-018-1727-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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46
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Demczuk WHB, Martin I, Desai S, Griffith A, Caron-Poulin L, Lefebvre B, McGeer A, Tyrrell GJ, Zhanel GG, Gubbay J, Hoang L, Levett PN, Van Caeseele P, Raafat Gad R, Haldane D, Zahariadis G, German G, Daley Bernier J, Strudwick L, Mulvey MR. Serotype distribution of invasive Streptococcus pneumoniae in adults 65 years of age and over after the introduction of childhood 13-valent pneumococcal conjugate vaccination programs in Canada, 2010-2016. Vaccine 2018; 36:4701-4707. [PMID: 29937245 DOI: 10.1016/j.vaccine.2018.06.018] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 01/15/2018] [Revised: 05/24/2018] [Accepted: 06/06/2018] [Indexed: 01/22/2023]
Abstract
The 13-valent conjugate vaccine (PCV13) was recommended for childhood immunization programs in 2010 in Canada and has decreased the incidence of invasive pneumococcal disease (IPD) in children and changed the epidemiology of IPD in adults. This study investigated the epidemiology of IPD in adults 65 years of age and older in Canada. A total of 7282 invasive S. pneumoniae isolated from adults ≥65 years old were serotyped from 2010 to 2016 and antimicrobial susceptibility was performed on 2527 isolates. Serotyping was performed by Quellung reaction using commercial antisera and antimicrobial susceptibilities were determined by broth microdilution. PCV7 serotypes decreased non-significantly from 2010 to 2016 from 9.1% (n = 96) to 6.7% (n = 72) while the additional six PCV13 serotypes declined significantly from 39.5% (n = 418) to 18.6% (n = 201) (p < 0.05). The 23-valent pneumococcal polysaccharide vaccine (PPV23) and non-vaccine (NVT) serotypes increased from 26.3% (n = 278) to 36.2% (n = 393) (p < 0.05), and from 25.1% (n = 266) to 38.4% (n = 416) (p < 0.05), respectively. There were no significant changes in antimicrobial resistance rates from 2011 to 2016: 24.1% of the IPD from adults ≥65 years were resistant to clarithromycin (n = 609), 10.0% to doxycycline (n = 254), 11.8% to penicillin (n = 299), 5.2% to cefuroxime (n = 131), 6.6% to clindamycin (n = 168), 6.0% to trimethoprim-sulfamethoxazole (n = 152), and 0.5% (n = 12) to ceftriaxone. Although overall incidence of IPD in adults ≥65 years has remained relatively constant from 2010 to 2016, childhood PCV13 vaccination programs have been successful in indirectly reducing IPD caused by PCV13 serotypes in adults through herd immunity effects.
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Affiliation(s)
- Walter H B Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Shalini Desai
- Vaccine Preventable Diseases Section, Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Averil Griffith
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Laurence Caron-Poulin
- Vaccine Preventable Diseases Section, Surveillance and Epidemiology Division, Centre for Immunization and Respiratory Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Brigitte Lefebvre
- Laboratoire de santé publique du Québec, Ste-Anne-de-Bellevue, Québec, Canada
| | - Allison McGeer
- Toronto Invasive Bacterial Diseases Network (TIBDN), Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Gregory J Tyrrell
- The Provincial Laboratory for Public Health (Microbiology), Edmonton, Alberta, Canada
| | - George G Zhanel
- Department of Medical Microbiology and Infectious Diseases, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Linda Hoang
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, Saskatchewan, Canada
| | | | - Rita Raafat Gad
- New Brunswick, Office of the Chief Medical Officer of Health, New Brunswick Department of Health, Fredericton, New Brunswick, Canada
| | - David Haldane
- Queen Elizabeth II Health Science Centre, Halifax, Nova Scotia, Canada
| | - George Zahariadis
- Newfoundland Public Health Laboratory, St. John's, Newfoundland and Labrador, Canada
| | - Gregory German
- Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | | | - Lori Strudwick
- Yukon Communicable Disease Control, Government of Yukon, Whitehorse, Yukon, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada.
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47
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Stolnicu S, Barsan I, Hoang L, Patel P, Terinte C, Pesci A, Aviel-Ronen S, Kiyokawa T, Alvarado-Cabrero I, Oliva E, Park KJ, Abu-Rustum NR, Pike MC, Soslow RA. Stromal invasion pattern identifies patients at lowest risk of lymph node metastasis in HPV-associated endocervical adenocarcinomas, but is irrelevant in adenocarcinomas unassociated with HPV. Gynecol Oncol 2018; 150:56-60. [PMID: 29859673 DOI: 10.1016/j.ygyno.2018.04.570] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [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: 03/29/2018] [Revised: 04/24/2018] [Accepted: 04/28/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The Silva invasion pattern-based classification system stratifies endocervical adenocarcinomas (ECAs) into 3 categories corresponding to risk of metastasis and recurrence, but has only been evaluated for HPV-associated ECAs of usual type. We examined whether the Silva system is applicable to all endocervical adenocarcinomas, especially those not associated with HPV. METHODS Complete slide sets from 341 surgical specimens of ECA were collected from 7 institutions worldwide. All specimens were associated with clinical records covering at least 5 years of follow-up. Tumors were classified as HPV-associated (HPVA) or not (NHPVA) by both morphology and detection of HPV using in situ hybridization. Recurrence and survival were analyzed by multivariate Mantel-Haenszel methods. RESULTS Most specimens (292; 85.6%) were HPVA, while 49 (14.3%) were NHPVA. All NHPVAs were Silva pattern C, while 76.0% of HPVAs were pattern C, 14.7% pattern A, and 9.3% pattern B. Including both HPVAs and NHPVAs, lymphovascular invasion (LVI) was detected in 0% of pattern A, 18.5% of pattern B and 62.6% of pattern C cases (p < 0.001). None of the pattern A or B cases were associated with lymph node metastases (LNM), in contrast to pattern C cases (21.8%). Among patients with Silva pattern C ECA, those with HPVA tumors had a lower recurrence rate and better survival than those with NHPVA; however, when adjusted for stage at diagnosis, the difference in recurrence and mortality was small and not statistically significant. CONCLUSIONS Application of the Silva system is only relevant in HPVA cervical adenocarcinoma.
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Affiliation(s)
- S Stolnicu
- University of Medicine, Targu Mures, Romania
| | - I Barsan
- University of Medicine, Targu Mures, Romania
| | - L Hoang
- Vancouver General Hospital, Vancouver, BC, Canada
| | - P Patel
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - C Terinte
- Regional Institute of Oncology, Iasi, Romania
| | - A Pesci
- Ospedale Sacro Cuore Don Calabria, Negrar, Italy
| | - S Aviel-Ronen
- Sheba Medical Center, Tel-Hashomer, Ramat Gan, Israel
| | - T Kiyokawa
- Jikei University School of Medicine, Tokyo, Japan
| | | | - E Oliva
- Massachusetts General Hospital, Boston, MA, USA
| | - K J Park
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - N R Abu-Rustum
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - M C Pike
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - R A Soslow
- Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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48
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Teatero S, McGeer A, Tyrrell GJ, Hoang L, Smadi H, Domingo MC, Levett PN, Finkelstein M, Dewar K, Plevneshi A, Athey TBT, Gubbay JB, Mulvey MR, Martin I, Demczuk W, Fittipaldi N. Canada-Wide Epidemic of emm74 Group A Streptococcus Invasive Disease. Open Forum Infect Dis 2018; 5:ofy085. [PMID: 29780850 DOI: 10.1093/ofid/ofy085] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [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: 03/08/2018] [Accepted: 04/17/2018] [Indexed: 11/14/2022] Open
Abstract
Background The number of invasive group A Streptococcus (iGAS) infections due to hitherto extremely rare type emm74 strains has increased in several Canadian provinces since late 2015. We hypothesized that the cases recorded in the different provinces are linked and caused by strains of an emm74 clone that recently emerged and expanded explosively. Methods We analyzed both active and passive surveillance data for iGAS infections and used whole-genome sequencing to investigate the phylogenetic relationships of the emm74 strains responsible for these invasive infections country-wide. Results Genome analysis showed that highly clonal emm74 strains, genetically different from emm74 organisms previously circulating in Canada, were responsible for a country-wide epidemic of >160 invasive disease cases. The emerging clone belonged to multilocus sequence typing ST120. The analysis also revealed dissemination patterns of emm74 subclonal lineages across Canadian provinces. Clinical data analysis indicated that the emm74 epidemic disproportionally affected middle-aged or older male individuals. Homelessness, alcohol abuse, and intravenous drug usage were significantly associated with invasive emm74 infections. Conclusions In a period of 20 months, an emm74 GAS clone emerged and rapidly spread across several Canadian provinces located more than 4500 km apart, causing invasive infections primarily among disadvantaged persons.
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Affiliation(s)
- Sarah Teatero
- Public Health Ontario Laboratory, Toronto, ON, Canada
| | - Allison McGeer
- Sinai Health System, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Gregory J Tyrrell
- Alberta Provincial Laboratory for Public Health, and Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, AB, Canada
| | - Linda Hoang
- British Columbia Centre for Disease Control Public Health Laboratory, Vancouver, BC, Canada
| | - Hanan Smadi
- New Brunswick Department of Health, Communicable Disease and Control, Fredericton, NB, Canada
| | - Marc-Christian Domingo
- Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Ste-Anne de Bellevue, QC, Canada
| | - Paul N Levett
- Saskatchewan Disease Control Laboratory, Regina, SK, Canada
| | | | - Ken Dewar
- Genome Québec Innovation Centre, and McGill University, Montreal, QC, Canada
| | | | | | - Jonathan B Gubbay
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Michael R Mulvey
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Nahuel Fittipaldi
- Public Health Ontario Laboratory, Toronto, ON, Canada.,Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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49
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Payne M, Croxen MA, Lee TD, Mayson B, Champagne S, Leung V, Bariso S, Hoang L, Lowe C. mcr-1-Positive Colistin-Resistant Escherichia coli in Traveler Returning to Canada from China. Emerg Infect Dis 2018; 22:1673-5. [PMID: 27533019 PMCID: PMC4994352 DOI: 10.3201/eid2209.160177] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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50
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Currie A, Galanis E, Chacon PA, Murray R, Wilcott L, Kirkby P, Honish L, Franklin K, Farber J, Parker R, Shyng S, Sharma D, Tschetter L, Hoang L, Chui L, Pacagnella A, Wong J, Pritchard J, Kerr A, Taylor M, Mah V, Flint J. Outbreak of Escherichia coli O157:H7 Infections Linked to Aged Raw Milk Gouda Cheese, Canada, 2013. J Food Prot 2018; 81:325-331. [PMID: 29369688 DOI: 10.4315/0362-028x.jfp-17-283] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Between 12 July and 29 September 2013, 29 individuals in five Canadian provinces became ill following infection with the same strain of Escherichia coli O157:H7 as defined by molecular typing results. Five case patients were hospitalized, and one died. Twenty-six case patients (90%) reported eating Gouda cheese originating from a dairy plant in British Columbia. All of the 22 case patients with sufficient product details available reported consuming Gouda cheese made with raw milk; this cheese had been produced between March and July 2013 and was aged for a minimum of 60 days. The outbreak strain was isolated from the implicated Gouda cheese, including one core sample obtained from an intact cheese wheel 83 days after production. The findings indicate that raw milk was the primary source of the E. coli O157:H7, which persisted through production and the minimum 60-day aging period. This outbreak is the third caused by E. coli O157:H7 traced to Gouda cheese made with raw milk in North America. These findings provide further evidence that a 60-day ripening period cannot ensure die-off of pathogens that might be present in raw milk Gouda cheese after production and have triggered an evaluation of processing conditions, physicochemical parameters, and options to mitigate the risk of E. coli O157:H7 infection associated with raw milk Gouda cheese produced in Canada.
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Affiliation(s)
- Andrea Currie
- 1 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Eleni Galanis
- 2 Communicable Disease Prevention and Control Services
| | - Pedro A Chacon
- 3 Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Regan Murray
- 1 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | | | - Paul Kirkby
- 3 Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Lance Honish
- 5 Alberta Health Services, Edmonton, Alberta, Canada T5J 2Y2
| | - Kristyn Franklin
- 1 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Jeff Farber
- 6 Bureau of Microbial Hazards, Health Canada, Ottawa, Ontario, Canada K1A 0K9.,7 University of Guelph, Guelph, Ontario, Canada N1G 2W1
| | - Rob Parker
- 8 Interior Health Authority, Kelowna, British Columbia, Canada V1Y 0C5
| | | | - Davendra Sharma
- 3 Canadian Food Inspection Agency, Ottawa, Ontario, Canada K1A 0Y9
| | - Lorelee Tschetter
- 9 National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada R3E 3R2
| | - Linda Hoang
- 10 British Columbia Public Health Microbiology and Reference Laboratory, Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Linda Chui
- 11 Provincial Laboratory for Public Health, Edmonton, Alberta, Canada T2N 4W4.,12 Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada T6G 2R7
| | - Ana Pacagnella
- 10 British Columbia Public Health Microbiology and Reference Laboratory, Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Julie Wong
- 10 British Columbia Public Health Microbiology and Reference Laboratory, Centre for Disease Control, Vancouver, British Columbia, Canada V5Z 4R4
| | - Jane Pritchard
- 13 Ministry of Agriculture, Abbotsford, British Columbia, Canada V3G 2M3; and
| | - Ashley Kerr
- 1 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
| | - Marsha Taylor
- 2 Communicable Disease Prevention and Control Services
| | - Victor Mah
- 14 Alberta Health, Edmonton, Alberta, Canada T5J 1S6
| | - James Flint
- 1 Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Guelph, Ontario, Canada N1H 8J1
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