Paper pubished on Canadian surveillance of EV-D68Oct292015

Today the BC Centre for Disease Control (BCCDC) in collaboration with each of the local health authorities in BC and partners in Alberta, Quebec and nationally at the Public Health Agency of  Canada published a paper in the peer-reviewed journal EuroSurveillance describing epidemic features of enterovirus D68 (EV-D68) in Canada during the fall of 2014.

For the full publication (open access), see: http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=21283. For a synopsis, see below.

Why and how the investigation was undertaken:

EVD68Current understanding of EV-D68 has mostly been driven by local hospital-based clusters of severe  respiratory illness involving children and this may have skewed overall impressions of the spectrum of illness and age groups affected. In response to US alerts during the fall 2014, the current study assessed EV-D68 among both community and hospital patients of all ages.

Two surveillance systems were used to learn about patient risk for EV-D68: community-based testing of patients with symptoms similar to influenza-like illness (ILI) in three provinces (BC, Alberta and Quebec) participating in the Sentinel Practitioner Surveillance Network (SPSN) and laboratory-based enhanced passive surveillance among respiratory specimens submitted to the BC Public Health Microbiology and Reference Laboratory from outpatients and inpatients in BC.

What was found:

Investigators were able to confirm and quantify a widespread community epidemic during the fall of 2014 and, because monitoring was population-based in BC, the incidence of EV-D68 hospitalizations could also be derived and compared by age and sex.

Among SPSN outpatients with ILI, the study showed an 8-fold increase in EV-D68 detections from October to December 2014 compared to the same period in 2013. Children and adults who sought care from a general practitioner for ILI were equally affected, suggesting susceptibility across a wide range of pediatric and adult age groups.

However, children were more likely to be hospitalized with severe respiratory disease compared to adults. Children under the age of 10 had a 4 to 5-fold higher rate of hospitalization related to EV-D68 compared to older children between the ages of 10-19 and a 15 to 20-fold higher rate compared to adults over age 20. Boys had higher rates of EV-D68-associated hospitalization than girls, but this same sex difference was not observed in adults.

Five cases of acute flaccid paralysis, a condition defined by neurological symptoms and extreme muscle weakness, were identified in association with laboratory-confirmed EV-D68 infection in BC during the 2014 outbreak, with symptoms persisting at follow-up more than 9-11 months later. Three deaths were also reported in BC in association with laboratory-confirmed EV-D68 infection. However, it remains unclear if EV-D68 infections caused these severe illnesses. The three patients who died all had underlying conditions or co-infections that likely contributed to their cause of death.

Genomic analyses showed that the EV-D68 strains that circulated in BC, Alberta and Quebec during the fall of 2014 were similar to other strains globally, including those that caused the 2014 outbreak in the US, with no evidence of phylogenetic clustering by disease severity or risk factors.

What now

The BC provincial laboratory has continued to test for EV-D68 in 2015, with no cases found in August or September of this year. Given preferred late summer/early autumn seasonality, it is unlikely that EV-D68 will be a prominent contributor to enterovirus circulation this year. The periodicity of cyclical peaks in EV-D68 activity is not known but may span several years. For this reason, continued monitoring is warranted in case of resurgence during subsequent seasons.

Active surveillance, including both outpatient and inpatient settings, is needed from more areas and additional seasons to further inform EV-D68 incidence, spectrum of illness, and potential at-risk groups for severe or unusual outcomes.

 

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IPAC Survey for PHSA employeesOct142015

WhatDoYouThinkPHSA’s Infection Prevention and Control (IPAC) team would like to hear what you think of the services they provide.  Their survey is open to all employees of the agencies they serve:

  • BC Women’s Hospital
  • BC Children’s Hospital and Sunny Hill
  • BC Cancer Agency (all centers)
  • BC Centre for Disease Control
  • BC Mental Health and Addictions
  • BC Emergency Health Services

The survey is completely anonymous, and takes about 5 minutes to complete. You could also win a Starbucks gift card! Please note: you must use Google Chrome, not Internet Explorer, to complete the survey. If you don’t have Chrome on your computer, you can contact the Service Desk.

Click here to take the survey

The survey is open from October 14-31, 2015. Prize winners will be contacted on November 4th.

More about the Infection Prevention and Control (IPAC) Perception Survey

What?  The IPAC team at PHSA needs your input in order to improve the quality of IPAC services delivered at the PHSA agencies they serve. The survey is completely anonymous.

Who?  Employees of the PHSA agencies listed above are invited to complete the survey:

When? The survey runs from October 14 -31, 2015.

Questions?  If you have questions about this survey, please contact Jun Collet, Infection Control Epidemiologist, PHSA IPAC services, at jccollet@cw.bc.ca or (604) 8752345 ext.7427.

The IPAC team is looking forward to hearing from you!

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PICNet Co-Directors Lead Pilot StudyOct062015

NEWS RELEASE from Genome BC

Are self-disinfecting surfaces the “Midas” touch for reducing hospital infections? Pilot study examines environmental and genomic solution for healthcare associated infections

Healthcare associated infections (HAIs) are a major burden on patients and healthcare systems worldwide.  Despite strict hygiene practices and other preventative measures in hospitals there are an estimated 220,000 cases with 8,000 deaths per year in Canada. Costs associated with HAIs are estimated to be over $15 million per year for Vancouver Coastal Health (VCHA) alone. One of the highest risk groups for HAIs are Bone Marrow Transplant (BMT) patients.  These patients’ immune systems are weakened during the course of their treatment making them highly vulnerable to pathogens until their immune system recovers. 

Dr Elizabeth Bryce, Regional Medical Director for Infection Prevention and Control, Vancouver Coastal Health, Dr. Raewyn Broady, Director of the BMT program, and Dr. Linda Hoang, Medical Microbiologist, at the BC Public Health Lab, part of the BC Centre for Disease Control, are leading a two-year pilot study that will tackle reducing the risk of infection in BMT patients using two complimentary and novel approaches. First, to reduce the bio-burden on all touch surfaces, three patient isolation rooms will be re-engineered with self-disinfecting surfaces containing copper-nickel and titanium dioxide and outfitted with contact-free motion activated devices, filtered water, and ultraviolet light in the bathroom. Second, surveillance for pathogens in patients, healthcare workers and rooms will be addressed by microbiome profiling and the current standard of care microbial culturing.

The study leaders anticipate valuable insights into the role that the hospital environment (and healthcare staff) may have on the evolution of a BMT patient’s microbiome during the transplant and recovery process.  This in turn should provide ideas into improved methods to reduce HAIs for this target patient cohort as well as informing general infection prevention strategies.  Their hope is to gather enough evidence to establish a future large scale study across the country to reduce HAIs and ultimately decrease the morbidity and associated economic burden on healthcare spending.

“Infections cost patients and hospitals. By taking advantage of novel engineering along with advances in genomics, we hope to better understand the transmission dynamics of microbes between the patient, the healthcare worker and the environment,”  Says Dr. Bryce. “Clearer understanding of this relationship will allow us to better evaluate newer healthcare technologies and improve the effectiveness of infection prevention measures.”

Previous health economic evaluations on infection prevention and control programs at Vancouver Coastal Health demonstrated that improved strategies can lead to significant HAI reductions and millions of dollars in cost avoidance- increasing optimization of bed occupation, reduction in isolation cleaning, medications, and an increased returned time to nursing care.

“Incorporating microbiome surveillance into the multifaceted hospital environment including, patients, workers, and the rooms themselves provides a unique level of detail,” says Dr. Alan Winter, President and CEO of Genome BC. “We are pleased to be supporting a project that could prevent infection in some of the most susceptible patients in BC and beyond.”

This project, Prevention of Healthcare Associated Infections in Bone Marrow Transplant Patients is valued at approximately $400,000 and was funded by Genome BC’s User Partnership Program (UPP), the VGH & UBC Hospital Foundation and is also supported by the Public Health Agency of Canada. Project management and products have been donated through the Coalition Healthcare Acquired Infection Reduction (CHAIR) Canada.

For more information on the UPP program please click here

About Genome British Columbia:
Genome British Columbia is a catalyst for the life sciences cluster on Canada’s West Coast, and manages a cumulative portfolio of over $710M in 254 research projects and science and technology platforms. Working with governments, academia and industry across sectors such as forestry, fisheries and aquaculture, agri-food, energy and mining, environment, and human health, the goal of the organization is to generate social and economic benefits for British Columbia and Canada. Genome BC is supported by the Province of British Columbia, the Government of Canada through Genome Canada and Western Economic Diversification Canada and more than 300 international public and private co-funding partners. www.genomebc.ca

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Nobel Prizes in MedicineOct052015

Three scientists from Ireland, Japan and China won the Nobel Prize in medicine on Monday for discovering drugs against malaria and other parasitic diseases that affect hundreds of millions of people every year. The Nobel judges in Stockholm awarded the prestigious prize to Irish-born William Campbell, Satoshi Omura of Japan and Tu Youyou — the first-ever Chinese medicine laureate.

Campbell and Omura were cited for discovering avermectin, derivatives of which have helped lower the incidence of river blindness and lymphatic filariasis, two diseases caused by parasitic worms that affect millions of people in Africa and Asia. Tu discovered artemisinin, a drug that has helped significantly reduce the mortality rates of malaria patients.

The Nobel committee said the winners, who are all in their 80s and made their breakthroughs in the 1970s and ‘80s, had given humankind powerful tools to combat debilitating diseases.

You can read the full article on the Globe and Mail website

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