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4.  The role of pediatricians as key stakeholders in influencing immunization policy decisions for the introduction of meningitis B vaccine in Canada: The Ontario perspective 
Invasive meningococcal disease is a rapidly progressing infection that can lead to death within 24 h of onset or cause serious life-threatening disabilities. Serogroup B is now the most common form in Canada. In Ontario, the Pediatrics Section of the Ontario Medical Asso ciation and the Pediatricians Alliance of Ontario have developed five recommendations regarding immunization policy with a primary focus on providing the vaccine for children. The recommendations presented by the authors are intended to assist practicing clinicians in advocating for the benefits of the new serogroup B vaccine and to spark discussion and build consensus regarding vaccination policies.
As key stakeholders in immunization policy decisions, the Pediatricians of Ontario held an accredited conference on January 18, 2014, to discuss prevention of invasive meningococcal disease. Five key recommendations were put forth regarding immunization strategies to protect children from meningococcal serogroup B disease. The recently approved four-component meningococcal B (4CMenB) vaccine should be recommended and funded as part of Ontario’s routine immunization schedule and should also be mandated for school attendance. Public funding for 4CMenB immunization is justified based on current MenB epidemiology, vaccine coverage, cost effectiveness and acceptability, as well as legal, political and ethical considerations related to 4CMenB immunization, particularly because routine recommendations and funding are currently in place for vaccination against meningococcal serogroups that cause significantly less disease in Canada than MenB. Broadly, the goals are to assist individual practitioners in advocating the benefits of 4CMenB vaccination to parents, and to counterbalance recommendations from the National Advisory Committee on Immunization and the Canadian Paediatric Society.
PMCID: PMC4556178  PMID: 26361485
4CMenB vaccine; Immunization policy; Invasive meningococcal disease (IMD); Pediatricians; Preventive care; Serogroup B
5.  Improving public health policy through infection transmission modelling: Guidelines for creating a Community of Practice 
Infection transmission models have been applied in the Canadian public health system to create modelling frameworks and knowledge translation methods that inform public health by linking theory, practice and policy. The Use of Mathematical Modelling in Public Health Decision Making for Infectious Diseases workshop was held by the Pandemic Influenza Outbreak Research Modelling team and the National Collaborating Centre for Infectious Diseases to establish the infrastructure, expertise and resources necessary for building a Community of Practice. The authors discuss the key presentations, as well as summarize the outcomes and action plans that emerged.
Despite significant research efforts in Canada, real application of modelling in public health decision making and practice has not yet met its full potential. There is still room to better address the diversity of the Canadian population and ensure that research outcomes are translated for use within their relevant contexts.
To strengthen connections to public health practice and to broaden its scope, the Pandemic Influenza Outbreak Research Modelling team partnered with the National Collaborating Centre for Infectious Diseases to hold a national workshop. Its objectives were to: understand areas where modelling terms, methods and results are unclear; share information on how modelling can best be used in informing policy and improving practice, particularly regarding the ways to integrate a focus on health equity considerations; and sustain and advance collaborative work in the development and application of modelling in public health.
The Use of Mathematical Modelling in Public Health Decision Making for Infectious Diseases workshop brought together research modellers, public health professionals, policymakers and other experts from across the country. Invited presentations set the context for topical discussions in three sessions. A final session generated reflections and recommendations for new opportunities and tasks.
Gaps in content and research include the lack of standard frameworks and a glossary for infectious disease modelling. Consistency in terminology, clear articulation of model parameters and assumptions, and sustained collaboration will help to bridge the divide between research and practice.
PMCID: PMC4556179  PMID: 26361486
Communities of Practice; Infectious disease terminology; Knowledge translation; Mathematical modelling; Policy decision-making; Public health
6.  Seroprevalences of hepatitis B virus and hepatitis C virus among participants of an Asian health fair in the Lower Mainland, British Columbia 
In Canada, the seroprevalences of the hepatitis B virus (HBV) and the hepatitis C virus (HCV) are believed to vary significantly among different ethnic groups and at-risk populations. Data regarding the prevalence of HBV and HCV in Southeast Asian Canadians may vary significantly from the general population. Because this population may be less likely to participate in epidemiological studies, it is possible that HBV and HCV seroprevalences are under-reported. The authors of this study correlated questionnaire answers regarding vaccination status to serological profiles collected from an Asian health fair in British Columbia to assess the seroprevalences of HBV and HBC in this population.
The seroprevalences of hepatitis B virus (HBV) and hepatitis C virus (HCV) are 0.4% and 0.8%, respectively, in Canada, but varying rates have been reported in different populations.
To determine the seroprevalences of HBV and HCV among attendees of an Asian health fair in the Lower Mainland, British Columbia, as well as to correlate questionnaire answers regarding vaccination status to serological profiles.
Attendees at an Asian health fair were invited to participate in the present study on a voluntary basis. They provided answers to a questionnaire including ethnicity and vaccination status. Blood was then drawn for HBV and HCV serology. Active HBV was defined as HBV surface antigen (HBsAg) positive while HCV seroprevalence was defined as HCV antibody reactive. Previous exposure to HBV was defined as HBV core antibody (anti-HBc) positive and HBsAg negative. Nonimmunity was defined as anti-HBc negative and HBV surface antibody negative. Only those with correct demographic information matched to serological results were included in the study.
There were 192 consenting attendees of the fair, of whom 112 were included in the study. Of the participants, 91% were Chinese. Active HBV infection was found in three participants (2.7% [95% CI 0.6% to 7.6%]) and HCV infection was found in two participants (1.8% [95% CI 0.2% to 6.3%]). More than 40% of participants had been previously exposed to HBV (42% [95% CI 33% to 51%]). Almost 20% demonstrated nonimmunity to HBV (19% [95% CI 12% to 27%]). There was significant discordance when questionnaire answers regarding vaccination status were compared with serological profiles.
The seroprevalences of HBV and HCV in this cohort were 2.7% and 1.8%, respectively – higher than nationally reported rates. Our results highlight that the lack of knowledge of HBV infection and vaccination status remains a significant clinical issue in the Asian community of British Columbia.
PMCID: PMC4556180  PMID: 26361487
Hepatitis B; Hepatitis C; Seroprevalence
7.  Usefulness of previous methicillin-resistant Staphylococcus aureus screening results in guiding empirical therapy for S aureus bacteremia 
Staphylococcus aureus bacteremia (SAB), which may be caused by methicillin-resistant S aureus (MRSA), is a leading cause of bloodstream infections. SAB and MRSA can cause an increase in mortality, result in longer hospital stays and increase medical costs. However, it is possible that MRSA colonization may predict infection. Using a retrospective cohort investigation, this study evaluated the clinical utility of past MRSA screening swabs for predicting methicillin resistance and its use in guiding empirical antibiotic therapy for SAB.
Staphylococcus aureus bacteremia (SAB) is an important infection. Methicillin-resistant S aureus (MRSA) screening is performed on hospitalized patients for infection control purposes.
To assess the usefulness of past MRSA screening for guiding empirical antibiotic therapy for SAB.
A retrospective cohort study examined consecutive patients with confirmed SAB and previous MRSA screening swab from six academic and community hospitals between 2007 and 2010. Diagnostic test properties were calculated for MRSA screening swab for predicting methicillin resistance of SAB.
A total of 799 patients underwent MRSA screening swabs before SAB. Of the 799 patients, 95 (12%) had a positive and 704 (88%) had a negative previous MRSA screening swab. There were 150 (19%) patients with MRSA bacteremia. Overall, previous MRSA screening swabs had a positive likelihood ratio of 33 (95% CI 18 to 60) and a negative likelihood ratio of 0.45 (95% CI 0.37 to 0.54). Diagnostic accuracy differed depending on mode of acquisition (ie, community-acquired, nosocomial or health care-associated infection) (P<0.0001) and hospital (P=0.0002). At best, for health care-associated infection, prior MRSA screening swab had a positive likelihood ratio of 16 (95% CI 9 to 28) and a negative likelihood ratio of 0.27 (95% CI 0.17 to 0.41).
A negative prior MRSA screening swab cannot reliably rule out MRSA bacteremia and should not be used to guide empirical antibiotic therapy for SAB. A positive prior MRSA screening swab greatly increases likelihood of MRSA, necessitating MRSA coverage in empirical antibiotic therapy for SAB.
PMCID: PMC4556181  PMID: 26361488
Antimicrobial stewardship; Empirical antimicrobial therapy; MRSA screening; Sensitivity; Specificity; Staphylococcus aureus bacteremia
8.  Identifying factors associated with changes in CD4+ count in HIV-infected adults in Saskatoon, Saskatchewan 
More than doubling the national mean, Saskatchewan has the highest incidence of HIV in Canada. The progression of HIV is characterized by the decline in CD4+ T cells over time and can lead to immunological AIDS. Clinicians in Saskatoon, Saskatchewan, have observed a more rapid progression to AIDS in the recent years. The goal of this retrospective longitudinal cohort study was to investigate the rate of CD4+ cell depletion, as well as to determine the effects of multiple clinical and social factors that may contribute to an accelerated progression of HIV to AIDS in this population.
To assess the impact of clinical and social factors unique to HIV-infected adults in Saskatoon, Saskatchewan, regarding the rate of CD4+ count change, and to identify factors associated with a risk of CD4+ count decline.
A retrospective longitudinal cohort study from medical chart reviews at two clinics was conducted in Saskatoon. Univariate and multivariate linear mixed effects models were used to assess the impact of selected factors on CD4+ count change.
Four hundred eleven HIV-infected patients were identified from January 1, 2003 to November 30, 2011. Two hundred eighteen (53%) were male, mean (± SD) age was 35.6 ±10.1 years, 257 (70.8%) were First Nations or Métis, 312 (80.2%) were hepatitis C virus (HCV) coinfected and 300 (73.3%) had a history of injection drug use (IDU). In univariate models, age, ethnicity, HCV, IDU, antiretroviral therapy and social assistance were significant. Using ethnicity, HCV and IDU, three multivariate models (models 1, 2, 3) were built due to high correlation. First Nations or Métis ethnicity, HCV coinfection and a history of IDU were associated with significantly lower CD4+ counts in multivariate models. Older age and social assistance were associated with significantly lower CD4+ counts in models 1 and 3. Age was marginally significant in model 2 (P=0.055). Not prescribed antiretroviral therapy was associated with a significantly negative CD4+ count slope in all multivariate models.
The unique epidemiology of this HIV-infected population may be contributing to CD4+ count change. Increased attention and resources focused on this high-risk population are needed to prevent disease progression and to improve overall health and quality of life.
PMCID: PMC4556182  PMID: 26361489
CD4+ count; First Nations; HCV; HIV; IDU; Métis; Rapid progression
9.  Pasteurella multocida non-native joint infection after a dog lick: A case report describing a complicated two-stage revision and a comprehensive review of the literature 
Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora of animals, including domestic cats and dogs. Prosthetic joint infections due to P multocida typically occur following an animal lick or bite. The present review describes a two-stage revision arthroplasty associated with a P multocida joint infection caused by a dog lick. The authors also provide a comprehensive review of the literature surrounding P multocida prosthetic joint infections.
Prosthetic joint infections (PJIs) are commonly caused by pathogens such as Staphylococcus aureus and coagulase-negative staphylococci; however, other microbial etiologies and specific risk factors are increasingly recognized. Pasteurella multocida is a Gram-negative coccobacillus that is part of the normal oral flora in many animals, and is particularly common in dogs and cats. PJIs caused by P multocida have been reported only rarely in the literature and typically occur in the context of an animal bite or scratch. The present article describes a P multocida joint infection that occurred after a dog lick and complicated a two-stage revision arthroplasty. A comprehensive review of the literature regarding P multocida PJIs follows.
PMCID: PMC4556183  PMID: 26361490
Dog bite; Dog lick; Pasteurella multocida; Prosthetic joint infection
10.  A confirmed case of toxic shock syndrome associated with the use of a menstrual cup 
Toxic shock syndrome (TSS) is caused by toxic bacteria and has been associated with prolonged, continual use of high-absorbency tampons. This article documents the first case of TSS associated with the use of a menstrual cup in a 37-year-old woman. The authors also discuss the history of TSS associated with tampon use and the mechanisms by which menstrual cups may also lead to the syndrome.
Menstrual cups have been reported to be an acceptable substitute for tampons. These flexible cups have also been reported to provide a sustainable solution to menstrual management, with modest cost savings and no significant health risk.
The present article documents the first case of toxic shock syndrome associated with the use of a menstrual cup in a woman 37 years of age, using a menstrual cup for the first time. Toxic shock syndrome and the literature on menstrual cups is reviewed and a possible mechanism for the development of toxic shock syndrome in the patient is described.
PMCID: PMC4556184  PMID: 26361491
Feminine hygiene products; Menstrual cups; Staphylococcus aureus; Toxic shock syndrome; Vaginal cups
11.  Avian influenza A (H5N1) infection with respiratory failure and meningoencephalitis in a Canadian traveller 
Since 1997, more than 600 individuals worldwide have been infected with the poultry-originating influenza, H5N1. This report describes the first case of avian influenza A (H5N1) in the Western hemisphere in a 28-year-old woman who had just returned from a trip to Beijing, China. The typical manifestations of H5N1 are described, and signs and symptoms are discussed.
In an urban centre in Alberta, an otherwise healthy 28-year-old woman presented to hospital with pleuritic chest and abdominal pain after returning from Beijing, China. After several days, this was followed by headache, confusion and, ultimately, respiratory failure, coma and death. Microbiology yielded influenza A subtype H5N1 from various body sites and neuroimaging was consistent with meningoencephalitis. While H5N1 infections in humans have been reported in Asia since 1997, this is the first documented case of H5N1 influenza in the Western Hemisphere. The present case demonstrated the typical manifestation of H5N1 influenza but, for the first time, also confirmed previous suggestions from human and animal studies that H5N1 is neurotropic and can manifest with neurological symptoms and meningoencephalitis.
PMCID: PMC4556185  PMID: 26361492
Encephalitis; H5N1; Influenza A; Meningoencephalitis
13.  Preventing ophthalmia neonatorum 
The use of silver nitrate as prophylaxis for neonatal ophthalmia was instituted in the late 1800s to prevent the devastating effects of neonatal ocular infection with Neisseria gonorrhoeae. At that time – during the preantibiotic era – many countries made such prophylaxis mandatory by law. Today, neonatal gonococcal ophthalmia is rare in Canada, but ocular prophylaxis for this condition remains mandatory in some provinces/ territories. Silver nitrate drops are no longer available and erythromycin, the only ophthalmic antibiotic eye ointment currently available for use in newborns, is of questionable efficacy. Ocular prophylaxis is not effective in preventing chlamydial conjunctivitis. Applying medication to the eyes of newborns may result in mild eye irritation and has been perceived by some parents as interfering with mother-infant bonding. Physicians caring for newborns should advocate for rescinding mandatory ocular prophylaxis laws. More effective means of preventing ophthalmia neonatorum include screening all pregnant women for gonorrhea and chlamydia infection, and treatment and follow-up of those found to be infected. Mothers who were not screened should be tested at delivery. Infants of mothers with untreated gonococcal infection at delivery should receive ceftriaxone. Infants exposed to chlamydia at delivery should be followed closely for signs of infection.
PMCID: PMC4507834
Chlamydia; Gonococcus; Neonatal ophthalmia; Prophylaxis; Screening in pregnancy; STIs
14.  Canada’s National Advisory Committee on Immunization: Celebrating 50 years 
Vaccines have saved more lives than any other innovation in modern medicine. National immunization committees play a vital role in the development of evidence-based recommendations for the use of vaccines. The present article describes the evolution and work of the National Advisory Committee on Immunization in Canada as the group marks its 50th anniversary. The article also provides insight into the future challenges that the committee is likely to face.
PMCID: PMC4507835
Advisory committee; Canada; Decision making; Immunization programs
16.  Improving health care efficiency through the integration of a physician assistant into an infectious diseases consult service at a large urban community hospital 
Physician assistants have recently been introduced into the Canadian health care system. The impact of the integration of physician assistants into various health care fields in the United States has been studied in detail; however, there is a lack of Canadian data regarding this topic. Accordingly, this study compared outcomes related to health care efficiency in the two-year period before the integration of a physician assistant at an infectious diseases consult service with the two-year period after integration.
Physician assistants (PAs) have recently been introduced into the Canadian health care system in some provinces; however, there are little data demonstrating their impact.
A retrospective case-control study was conducted between January 2010 and December 2013. Length of stay (LOS) and mortality were examined in the infectious diseases consult service (IDCS) compared with hospital-wide controls. The two-year period before the introduction of the PA to the IDCS of a large urban community hospital in Canada (2010 to 2011) was compared with the two-year period following the introduction of the PA (2012 to 2013).
Following the introduction of a PA to the IDCS, there was a decrease in time to consultation from 21.4 h to 14.3 h (P<0.0001). LOS was significantly decreased among IDCS patients by 3.6 days more than that seen in matched hospital-wide controls (P=0.0001). Mortality did not significantly change after PA introduction in either cases or controls.
PAs can improve health efficiencies in the Canadian health care setting, leading to reduction in LOS.
PMCID: PMC4507837
Length of stay; Mortality; Physician assistant
17.  Urinary tract infection diagnosis and response to therapy in long-term care: A prospective observational study 
Urinary tract infections are common in long-term care facilities. However, these infections may actually be overdiagnosed in this setting due to factors such as a high rate of asymptomatic culture positivity, altered mental status and dehydration among residents of long-term care facilities, which can lead to inappropriate prescription of antibiotics. The authors of this study aimed to assess the symptoms associated with positive urine cultures, prescription of antibiotics and response to antibiotic treatments.
The prevalence of asymptomatic bacteriuria among residents of long-term care (LTC) facilities is high, and is a source of inappropriate antibiotic prescription.
To establish symptoms and signs associated with a positive urine culture, and to determine whether antibiotic therapy is associated with functional improvement.
A total of 101 LTC patients were prospectively observed after submission of urine for culture.
The culture positivity rate was consistent with the expected asymptomatic bacteriuria rate. Change in mental status and male sex were associated with culture positivity. Treatment decisions were not consistent with culture results. Treatment did not lead to improvement in activities of daily living scores at two days or seven days.
Significant growth cannot be well predicted based on clinical variables; thus, the decision to submit urine is somewhat arbitrary. Because urine culture testing and treatment does not lead to functional improvement, restricting access to the test may be reasonable.
Urine culture testing in LTC facilities does not lead to functional improvement.
PMCID: PMC4507838
Antibiotic stewardship; Asymptomatic bacteriuria; Diagnosis; Long-term care; Urinary tract infection
18.  Antimicrobial susceptibility of Canadian isolates of Helicobacter pylori in Northeastern Ontario 
Colonization of the stomach with Helicobacter pylori can contribute to the development of gastric ulcers and stomach cancer. The typical treatment course for H pylori infection is a proton pump inhibitor in addition to at least two antibiotics. Increasing resistance to these antibiotics has led to a considerable decline in the eradication rate following treatment over the past several years. The purpose of this study was to assess the rates of resistance to several of the antibiotics commonly used to treat H pylori infection, by investigating a population of patients presenting to a single health care facility in Sudbury, Ontario. Multiple methods were used to assess antibiotic resistance.
Helicobacter pylori plays a significant role in gastritis and ulcers. It is a carcinogen as defined by the WHO, and infection can result in adenocarcinomas and mucosa-associated lymphoid tissue lymphomas. In Canada, rates of antimicrobial resistance are relatively unknown, with very few studies conducted in the past 15 years.
To examine rates of resistance in Sudbury, Ontario, compare antimicrobial susceptibility methods and attempt to determine the molecular basis of antibiotic resistance.
Patients attending scheduled visits at Health Sciences North (Sudbury, Ontario) provided gastric biopsy samples on a volunteer basis. In total, 20 H pylori isolates were collected, and antimicrobial susceptibility testing (on amoxicillin, tetracycline, metronidazole, ciprofloxacin, levofloxacin and clarithromycin) was conducted using disk diffusion and E-test methods. Subsequently, genomic DNA from these isolates was sequenced to detect mutations associated with antimicrobial resistance.
Sixty-five percent of the isolates were found to be resistant to at least one of the listed antibiotics according to E-test. Three isolates were found to be resistant to ≥3 of the above-mentioned antibiotics. Notably, 25% of the isolates were found to be resistant to both metronidazole and clarithromycin, two antibiotics that are normally prescribed as part of first-line regimens in the treatment of H pylori infections in Canada and most of the world. Among the resistant strains, the sequences of 23S ribosomal RNA and gyrA, which are linked to clarithromycin and ciprofloxacin/levofloxacin resistance, respectively, revealed the presence of known point mutations associated with antimicrobial resistance.
In general, resistance to metronidazole, ciprofloxacin/levofloxacin and clarithromycin has increased since the studies in the early 2000s. These results suggest that surveillance programs of H pylori antibiotic resistance may need to be revisited or improved to prevent antimicrobial therapy failure.
PMCID: PMC4507839
Antimicrobial susceptibility; Helicobacter pylori; Northern Ontario; Resistance
19.  A case series of third-trimester raltegravir initiation: Impact on maternal HIV-1 viral load and obstetrical outcomes 
The use of antiretroviral therapy (ART) has led to a marked reduction in the incidence of perinatal transmission of HIV. With ART, it is possible for the viral load to be reduced to undetectable levels during pregnancy. However, some patients (eg, those with poor adherence or those who acquired HIV during pregnancy) may still exhibit high viral loads by the third trimester. The purpose of this study was to examine the effect of raltegravir in a combination ART regimen in a series of 11 cases in which women presented with high viral loads in the third trimester of pregnancy.
To describe the impact of initiating raltegravir (RAL)-containing combination antiretroviral therapy (cART) regimens on HIV viral load (VL) in pregnant women who have high or suboptimal VL suppression late in pregnancy.
HIV-infected pregnant women who started RAL-containing cART after 28 weeks’ gestation from 2007 to 2013 were identified in two university hospital centres.
Eleven HIV-infected women started RAL at a median gestational age of 35.7 weeks (range 31.1 to 38.0 weeks). Indications for RAL initiation were late presentation in pregnancy (n=4) and suboptimal VL suppression secondary to poor adherence or viral resistance (n=7). Mean VL at the time of RAL initiation was 73,959 copies/mL (range <40 to 523,975 copies/mL). Patients received RAL for a median of 20 days (range one to 71 days). The mean decline in VL from the time of RAL initiation to delivery was 1.93 log, excluding one patient who received only one RAL dose and one patient with undetectable VL at the time of RAL initiation. After eight days on RAL, 50% of the women achieved a VL <1000 copies/mL (the threshold for recommended Caesarean section to reduce the risk for perinatal transmission). There were no cases of perinatal HIV transmission.
The present study provides preliminary data to support the use of RAL-containing cART to expedite HIV-1 VL reduction in women who have a high VL or suboptimal VL suppression late in pregnancy, and to decrease the risk of HIV perinatal transmission while avoiding Caesarean section. Further assessment of RAL safety during pregnancy is warranted.
PMCID: PMC4507840
HIV-1; Integrase inhibitor; Pregnancy; Raltegravir; Viral load
20.  Lyme disease: Knowledge and practices of family practitioners in southern Quebec 
As the range of the blacklegged tick (Ixodes scapularis) expands into southern Quebec, cases of Lyme disease – caused by Borrelia burgdorferi and transmitted by blacklegged ticks – are also expected to rise. The authors of this article aimed to compare the experience, knowledge and practices regarding Lyme disease of physicians in Montérégie, a region affected by Lyme disease, with phyisicians in other regions not yet affected by the disease.
Public health authorities in Quebec have responded to the progressive emergence of Lyme disease (LD) with surveillance activities and education for family physicians (FPs) who are key actors in both vigilance and case management.
To describe FPs’ clinical experience with LD, their degree of knowledge, and their practices in two areas, one with known infected tick populations (Montérégie) and one without (regions nearby Montérégie).
In the present descriptive cross-sectional study, FPs were recruited during educational sessions. They were asked to complete a questionnaire assessing their clinical experience with Lyme disease, their knowledge of signs and symptoms of LD, and their familiarity with accepted guidelines for diagnosing and treating LD in two clinical scenarios (tick bite and erythema migrans).
A total of 201 FPs participated, mostly from Montérégie (n=151). Overall, results revealed a moderate lack of knowledge and suboptimal practices rather than systematically insufficient knowledge or inadequate practices. A majority of participants agreed to more education on LD. As expected, FPs from Montérégie had a higher clinical experience with tick bites (57% versus 25%), better knowledge of LD endemic areas in Canada and erythema migrans characteristics, and better management of erythema migrans (72% versus 50%).
The present study documented the inappropriate intention to order serology tests for tick bites and the unjustified intention to use tick analysis for diagnostic purposes. Such practices should be discouraged because they are unnecessary and overuse collective laboratory and medical resources. In addition, public health authorities must pursue their education efforts regarding FPs to optimize case management.
PMCID: PMC4507841
Lyme disease; Health knowledge, attitudes, practice; Quebec
21.  A family cluster of Chagas disease detected through selective screening of blood donors: A case report and brief review 
Chagas disease is rare in Canada, and is most frequently observed among individuals who have resided in Latin America. The disease can enter a prolonged asymptomatic phase during which infected individuals do not experience symptoms, thus hindering its diagnosis – particularly in nonendemic regions such as Canada. This article describes a cluster of cases of Chagas disease among a single family, which was discovered on screening after two affected members of the family donated blood. The current state of screening programs for Trypanosoma cruzi are discussed, and suggestions for future directions are included.
Chagas disease (CD) is a protozoan infection caused by Trypanosoma cruzi, which is transmitted by triatomine insect vectors in parts of Latin America. In a nonendemic country, such as Canada, spread can still occur via vertical transmission, and infected blood or organ donations. The Canadian Blood Services and Héma-Québec have both implemented selective screening of blood donors for CD based on risk factors. In 2011, Héma-Québec identified two seropositive ‘at-risk’ Chilean siblings who had donated blood in Montreal, Quebec. They were referred to the JD MacLean Centre for Tropical Diseases (Montreal, Quebec) for confirmatory testing (T cruzi excreted-secreted antigen ELISA, polymerase chain reaction and/or radioimmunoprecipitation assay) and follow-up. Screening of the rest of the family revealed two other seropositive family members (the mother and sister). While their geographical history in Chile suggests vectorial transmission, this family cluster of CD raises the possibility of vertical transmission. Congenital infection should always be considered among CD-positive mothers and pregnant women. With blood donor screening, Canadian physicians will increasingly see patients with CD and should know how to manage them appropriately. In addition to the case presentation, the authors review the transmission, screening and clinical management of CD in a nonendemic context.
PMCID: PMC4507842
Blood donor screening; Chagas disease; ELISA; PCR; RIPA; Vertical transmission
22.  Parents’ and adolescents’ willingness to be vaccinated against serogroup B meningococcal disease during a mass vaccination in Saguenay–Lac-St-Jean (Quebec) 
Since the implementation of the meningococcal C conjugate vaccine as a component of the routine vaccination schedule of children in Quebec, the incidence of meningitis caused by serogroup C Neisseria meningitidis has declined significantly. Currently, serogroup B causes the majority of cases of invasive meningococcal disease in Quebec. A vaccine against serogroup B became available in 2013; accordingly, a mass vaccination campaign was launched in Saguenay–Lac-St-Jean, Quebec, in 2014. At the beginning of the campaign, a telephone survey was conducted to assess opinions on the vaccine, and willingness to be vaccinated among adolescents (16 to 18 years of age) and parents of children <16 years of age.
A mass vaccination campaign with the 4CMenB vaccine (Bexsero®; Novartis Pharmaceutical Canada Inc) was launched in a serogroup B endemic area in Quebec. A telephone survey was conducted to assess parental and adolescent opinions about the acceptability of the vaccine. Intent to receive the vaccine or vaccine receipt was reported by the majority of parents (93%) and adolescents (75%). Meningitis was perceived as being a dangerous disease by the majority of parents and adolescents. The majority of respondents also considered the 4CMenB vaccine to be safe and effective. The main reason for positive vaccination intention or behaviour was self-protection, while a negative attitude toward vaccination in general was the main reason mentioned by parents who did not intend to have their child vaccinated. Adolescents mainly reported lack of interest, time or information, and low perceived susceptibility and disease severity as the main reasons for not intending to be vaccinated or not being vaccinated.
PMCID: PMC4507843
4CMenB vaccine; Adolescents; Children; Meningococcal serogroup B vaccine; Vaccine acceptability
23.  An unusual case of meningitis 
Pasteurella multocida is a Gram-negative anaerobe that is known to colonize household pets; in fact, it has been reported to be present in a majority of cats and dogs. P multocida can cause a variety of infections in humans, of which skin infections are the most common. This article describes a case involving a 56-year-old man who developed meningitis caused by P multocida following tympanomastoidectomy. The authors discuss the treatment course and most likely route of infection in this case, and summarize the cases of P multocida-associated meningitis presented in the literature.
Pasteurella multocida is a rare cause of bacterial meningitis. A 56-year-old man with several pets developed a profoundly decreased level of consciousness following left tympanomastoidectomy. Lumbar puncture produced cerebrospinal fluid with the typical findings of meningitis (low glucose, high protein, high leukocytes). Cultures from the cerebrospinal fluid and a swab of the left ear revealed Gram-negative coccobacillus identified as P multocida. The organism was sensitive to ceftriaxone, ampicillin and penicillin, and a 14-day course of intravenous penicillin was used as definitive treatment, resulting in full recovery. Although rare, P multocida should be considered as a potential cause of meningitis in patients with animal exposure, particularly in the setting of recent cranial surgery.
PMCID: PMC4507844
Pasteurella multocida; Meningitis; Tympanomoastoidectomy; Zoonosis
25.  Mortality related to coagulase-negative staphylococcal bacteremia in febrile neutropenia: A cohort study 
Coagulase-negative staphylococci (CoNS) are currently the most common isolates recovered from the blood of patients with cancer and febrile neutropenia (FN).
To assess the mortality associated with bloodstream infections (BSIs) caused by CoNS in cancer patients with FN.
A prospective cohort study was conducted in a single tertiary hospital from October 2009 to August 2011. Follow-ups were performed on all of the adult patients who were admitted to the hematology ward with cancer and FN. Bacteremia caused by CoNS was defined as two positive results of two independent cultures. Twenty-eight days after the onset of FN, the mortality rates of the patients with BSIs caused by CoNS were compared with those of patients with BSIs caused by other pathogens.
A total of 169 subjects were evaluated. During the study period, 78 patients with BSIs were documented. Twenty-three BSIs (29.4%) were a result of CoNS. CoNS-induced bacteremia resulted in lower 28-day mortality compared with bacteremia caused by other pathogens (4.3% versus 32.7%; log-rank P=0.009). In a Cox proportional hazards regression analysis, BSIs caused by CoNS were independently associated with lower mortality (HR 0.09 [95% CI 0.01 to 0.74]).
In adult patients with cancer and FN, BSIs caused by CoNS were associated with lower mortality compared with BSIs caused by other pathogens.
PMCID: PMC3950980  PMID: 24634691
Bacteremia; Fever; Immunocompromised host; Mortality; Neutropenia; Staphylococcus

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