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McCracken GR, Patriquin G, Hatchette TF, Davidson RJ, Goodall B, Barrett L, MacDonald J, Heinstein C, Pettipas J, Ross J, LeBlanc JJ. Taqman PACMAN: a simple molecular approach for positive rapid antigen test confirmation during periods of low prevalence. Microbiol Spectr 2024; 12:e0407323. [PMID: 38567975 PMCID: PMC11064490 DOI: 10.1128/spectrum.04073-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/13/2024] [Indexed: 05/03/2024] Open
Abstract
Antigen-based rapid diagnostic tests (Ag-RDTs) were widely deployed to enhance SARS-CoV-2 testing capacity during the COVID-19 pandemic. Consistent with national guidance for low prevalence settings, positive Ag-RDTs were confirmed using nucleic acid amplification tests (NAATs) to avoid false positive results. However, increasing demands for positive Ag-RDT confirmation competed with other testing priorities in clinical laboratories. This work hypothesized that real-time RT-PCR without nucleic acid extraction (NAE) would be sufficiently sensitive to support positive Ag-RDT confirmation. Ag-RDT and NAAT results from community-based asymptomatic testing sites prior to the omicron variant wave were compared to calculate the weekly false positive rate (FPR) and false detection rate (FDR). Real-time RT-PCR was compared with and without NAE using 752 specimens previously tested positive for SARS-CoV-2 using commercial NAATs and 344 specimens from Ag-RDT-positive individuals. The impact of SARS-CoV-2 prevalence on laboratory resources required to sustain Ag-RDT confirmation was modeled for the RT-PCR with and without NAE. Overall, FPR was low [0.07% (222/330,763)] in asymptomatic testing sites, but FDR was high [30.7% (222/724)]. When RT-PCR was compared with and without NAE, 100% concordance was obtained with NAAT-positive specimens, including those from Ag-RDT-positive individuals. NAE-free RT-PCR significantly reduced time to results, human resources, and overall costs. A 30.7% FDR reaffirms the need for NAAT-based confirmation of positive Ag-RDT results during low SARS-CoV-2 prevalence. NAE-free RT-PCR was shown to be a simple and cost-sparing NAAT-based solution for positive Ag-RDT confirmation, and its implementation supported data-driven broader Ag-RDT deployment into communities, workplaces, and households. IMPORTANCE Rapid antigen testing for SARS-CoV-2 was widely deployed during the COVID-19 pandemic. In settings of low prevalence, national guidance recommends that positive antigen test results be confirmed with molecular testing. Given the high testing burden on clinical laboratories during the COVID-19 pandemic, the high volume of positive antigen tests submitted for confirmatory testing posed challenges for laboratory workflow. This study demonstrated that a simple PCR method without prior nucleic acid purification is an accurate and cost-effective solution for positive rapid antigen test confirmation. Implementing this method allowed molecular confirmatory testing for positive antigen tests to be sustained as antigen testing was expanded into large populations such as workplaces, schools, and households.
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Affiliation(s)
- Gregory R. McCracken
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F. Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ross J. Davidson
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Barbara Goodall
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Barrett
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - James MacDonald
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Charles Heinstein
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, Nova Scotia, Canada
| | - John Ross
- Praxes Medical Group, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Pott H, J LeBlanc J, S ElSherif M, Hatchette TF, McNeil SA, Andrew MK. Clinical features and outcomes of influenza and RSV coinfections: a report from Canadian immunization research network serious outcomes surveillance network. BMC Infect Dis 2024; 24:147. [PMID: 38291361 PMCID: PMC10826021 DOI: 10.1186/s12879-024-09033-5] [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: 09/06/2023] [Accepted: 01/18/2024] [Indexed: 02/01/2024] Open
Abstract
BACKGROUND Influenza and RSV coinfections are not commonly seen but are concerning as they can lead to serious illness and adverse clinical outcomes among vulnerable populations. Here we describe the clinical features and outcomes of influenza and RSV coinfections in hospitalized adults. METHODS A cohort study was performed with pooled active surveillance in hospitalized adults ≥ 50 years from the Serious Outcomes Surveillance Network of the Canadian Immunization Research Network (CIRN SOS) during the 2012/13, 2013/14, and 2014/15 influenza seasons. Descriptive statistics summarized the characteristics of influenza/RSV coinfections. Kaplan-Meier estimated the probability of survival over the first 30 days of hospitalization. RESULTS Over three influenza seasons, we identified 33 cases of RSV and influenza coinfection, accounting for 2.39 cases per 1,000 hospitalizations of patients with acute respiratory illnesses. Adults aged 50 + years commonly reported cough (81.8%), shortness of breath (66.7%), sputum production (45.5%), weakness (33.3%), fever (27.3%), and nasal congestion (24.2%) as constitutional and lower respiratory tract infection symptoms. The mortality rate was substantial (12.1%), and age, comorbidity burden, and frailty were associated with a higher risk for adverse clinical outcomes. CONCLUSIONS Older adults are at higher risk for complications from influenza and RSV coinfections, especially those over 65 with a high comorbidity burden and frailty.
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Affiliation(s)
- Henrique Pott
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada.
- Department of Medicine, Universidade Federal de São Carlos, Rod. Washington Luis, km 235. São Carlos, São Carlos, 13656-905, Brazil.
| | - Jason J LeBlanc
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - May S ElSherif
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Pathology, Dalhousie University, Halifax, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, Dalhousie University, Halifax, Canada
- Department of Medicine (Geriatrics), Dalhousie University, Halifax, Canada
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3
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Murison K, Wilson CH, Clow KM, Gasmi S, Hatchette TF, Bourgeois AC, Evans GA, Koffi JK. Epidemiology and clinical manifestations of reported Lyme disease cases: Data from the Canadian Lyme disease enhanced surveillance system. PLoS One 2023; 18:e0295909. [PMID: 38100405 PMCID: PMC10723709 DOI: 10.1371/journal.pone.0295909] [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: 04/05/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
Lyme disease cases reported in seven Canadian provinces from 2009 to 2019 through the Lyme Disease Enhanced Surveillance System are described herein by demographic, geography, time and season. The proportion of males was greater than females. Bimodal peaks in incidence were observed in children and older adults (≥60 years of age) for all clinical signs except cardiac manifestations, which were more evenly distributed across age groups. Proportions of disease stages varied between provinces: Atlantic provinces reported mainly early Lyme disease, while Ontario reported equal proportions of early and late-stage Lyme disease. Early Lyme disease cases were mainly reported between May through November, whereas late Lyme disease were reported in December through April. Increased awareness over time may have contributed to a decrease in the proportion of cases reporting late disseminated Lyme disease. These analyses help better describe clinical features of reported Lyme disease cases in Canada.
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Affiliation(s)
- Kiera Murison
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Christy H. Wilson
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Katie M. Clow
- Department of Population Medicine, University of Guelph, Guelph, Ontario, Canada
| | - Salima Gasmi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Departments of Pathology, Immunology and Microbiology, Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Annie-Claude Bourgeois
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Ottawa, Ontario, Canada
| | - Gerald A. Evans
- Infection Prevention & Control, Kingston Health Sciences Centre, Biomedical & Molecular Sciences and Pathology & Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
| | - Jules K. Koffi
- Infectious Diseases and Vaccination Programs Branch, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
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Simms E, McCracken GR, Hatchette TF, McNeil SA, Davis I, Whelan N, Keenan A, LeBlanc JJ, Patriquin G. Real-world evaluation of the Lucira Check-It COVID-19 loop-mediated amplification (LAMP) test. Microbiol Spectr 2023; 11:e0277223. [PMID: 37962351 PMCID: PMC10714936 DOI: 10.1128/spectrum.02772-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 09/29/2023] [Indexed: 11/15/2023] Open
Abstract
IMPORTANCE In hospitals during the COVID-19 pandemic, laboratory testing was important to reduce SARS-CoV-2 transmissions, while facilitating patient flow in the emergency department and pre-operative settings, and allowing for the safe return to work of exposed healthcare workers. Delayed test results from laboratory nucleic acid amplification tests (NAATs) posed a barrier to maximizing efficient patient flow and minimizing staffing shortages. This quality improvement project sought to evaluate the analytical and clinical performance of the Lucira Check-It COVID-19 Test, a point-of-care test that used NAAT technology, in the perioperative setting, emergency department, and community testing sites. We found the Lucira Check-It to have comparable performance to laboratory NAATs. It can be employed with little training for specimen collection, processing, and interpretation, and at a cost justifiable from the resources saved from avoiding sample transport and laboratory testing.
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Affiliation(s)
- Elizabeth Simms
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Gregory R. McCracken
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Todd F. Hatchette
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Shelly A. McNeil
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ian Davis
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Noella Whelan
- COVID-19 Implementation and Planning, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Angela Keenan
- Occupational Health Safety & Wellness, People Services, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Department of Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
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Harrison R, Mubareka S, Papenburg J, Schober T, Allen UD, Hatchette TF, Evans GA. AMMI Canada 2023 update on influenza: Management and emerging issues. J Assoc Med Microbiol Infect Dis Can 2023; 8:176-185. [PMID: 38058499 PMCID: PMC10697102 DOI: 10.3138/jammi-2023-07-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Affiliation(s)
- Robyn Harrison
- University of Alberta, Alberta Health Services, Edmonton, Alberta, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | | | - Upton D Allen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd F Hatchette
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gerald A Evans
- Division of Infectious Diseases, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
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Renaud C, Osborn A, Parmley EJ, F Hatchette T, LeBlanc J, Weese JS, Misra V, Yamamura D, Forgie S, Renwick S, Webster D, Mubareka S. Highly pathogenic avian influenza: Unprecedented outbreaks in Canadian wildlife and domestic poultry. J Assoc Med Microbiol Infect Dis Can 2023; 8:187-191. [PMID: 38058495 PMCID: PMC10697099 DOI: 10.3138/jammi-2023-05-08] [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: 12/08/2023]
Abstract
Canada experienced a wave of HPAI H5N1 outbreaks in the spring of 2022 with millions of wild and farmed birds being infected. Seabird mortalities in Canada have been particularly severe on the Atlantic Coast over the summer of 2022. Over 7 million birds have been culled in Canada, and outbreaks continue to profoundly affect commercial bird farms across the world. This new H5N1 virus can and has infected multiple mammalian species, including skunks, foxes, bears, mink, seals, porpoises, sea lions, and dolphins. Viruses with mammalian adaptations such as the mutations PB2-E627K, E627V, and D701N were found in the brain of various carnivores in Europe and Canada. To date this specific clade of H5N1 virus has been identified in less than 10 humans. At the ground level, awareness should be raised among frontline practitioners most likely to encounter patients with HPAI.
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Affiliation(s)
- Christian Renaud
- Department of Microbiology, Infectiology and Immunology, & Department of Pediatrics, Université de Montréal, Montréal, Québec, Canada
| | | | | | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Central Zone Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Central Zone Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jeffrey Scott Weese
- Centre for Public Health and Zoonoses, University of Guelph, Guelph, Ontario, Canada
| | - Vikram Misra
- Department of Veterinary Microbiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Deborah Yamamura
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sarah Forgie
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | | | - Duncan Webster
- Division of Infectious Diseases, Faculty of Medicine, Dalhousie Medicine New Brunswick, Saint John, New Brunswick, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
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7
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Pott H, Andrew MK, Shaffelburg Z, Nichols MK, Ye L, ElSherif M, Hatchette TF, LeBlanc J, Ambrose A, Boivin G, Bowie W, Johnstone J, Katz K, Lagacé-Wiens P, Loeb M, McCarthy A, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Smith S, Smyth D, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Vaccine Effectiveness of non-adjuvanted and adjuvanted trivalent inactivated influenza vaccines in the prevention of influenza-related hospitalization in older adults: A pooled analysis from the Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN). Vaccine 2023; 41:6359-6365. [PMID: 37696717 DOI: 10.1016/j.vaccine.2023.08.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/17/2023] [Accepted: 08/25/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Influenza vaccines prevent influenza-related morbidity and mortality; however, suboptimal vaccine effectiveness (VE) of non-adjuvanted trivalent inactivated influenza vaccine (naTIV) or quadrivalent formulations in older adults prompted the use of enhanced products such as adjuvanted TIV (aTIV). Here, the VE of aTIV is compared to naTIV for preventing influenza-associated hospitalization among older adults. METHODS A test-negative design study was used with pooled data from the 2012 to 2015 influenza seasons. An inverse probability of treatment (IPT)-weighted logistic regression estimated the Odds Ratio (OR) for laboratory-confirmed influenza-associated hospitalization. VE was calculated as (1-OR)*100% with accompanying 95% confidence intervals (CI). RESULTS Of 7,101 adults aged ≥ 65, 3,364 received naTIV and 526 received aTIV. The overall VE against influenza hospitalization was 45.9% (95% CI: 40.2%-51.1%) for naTIV and 53.5% (42.8%-62.3%) for aTIV. No statistically significant differences in VE were found between aTIV and naTIV by age group or influenza season, though a trend favoring aTIV over naTIV was noted. Frailty may have impacted VE in aTIV recipients compared to those receiving naTIV, according to an exploratory analysis; VE adjusted by frailty was 59.1% (49.6%-66.8%) for aTIV and 44.8% (39.1%-50.0%) for naTIV. The overall relative VE of aTIV to naTIV against laboratory-confirmed influenza hospital admission was 25% (OR 0.75; 0.61-0.92), demonstrating statistically significant benefit favoring aTIV. CONCLUSIONS Adjusting for frailty, aTIV showed statistically significantly better protection than naTIV against influenza-associated hospitalizations in older adults. In future studies, it is important to consider frailty as a significant confounder of VE.
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Affiliation(s)
- Henrique Pott
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Universidade Federal de São Carlos, São Carlos, Brazil
| | - Melissa K Andrew
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Zachary Shaffelburg
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Michaela K Nichols
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Public Health Agency of Canada, Halifax, Canada
| | - Lingyun Ye
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - May ElSherif
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Todd F Hatchette
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada
| | - Jason LeBlanc
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Pathology, Dalhousie University, Halifax, Canada
| | - Ardith Ambrose
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada
| | - Guy Boivin
- CHU de Québec-Université Laval, Québec, Québec
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | | | | | - Andre Poirier
- Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Grant Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | | | | | - Shelly A McNeil
- Canadian Centre for Vaccinology, Dalhousie University, Halifax, Canada; Department of Medicine, Dalhousie University, Halifax, Canada.
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8
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ElSherif M, Andrew MK, Ye L, Ambrose A, Boivin G, Bowie W, David MP, Gruselle O, Halperin SA, Hatchette TF, Johnstone J, Katz K, Langley JM, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Pirçon JY, Powis J, Richardson D, Semret M, Smith S, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA, LeBlanc JJ. Leveraging Influenza Virus Surveillance From 2012 to 2015 to Characterize the Burden of Respiratory Syncytial Virus Disease in Canadian Adults ≥50 Years of Age Hospitalized With Acute Respiratory Illness. Open Forum Infect Dis 2023; 10:ofad315. [PMID: 37441353 PMCID: PMC10334379 DOI: 10.1093/ofid/ofad315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023] Open
Abstract
Background Respiratory syncytial virus (RSV) disease in older adults is undercharacterized. To help inform future immunization policies, this study aimed to describe the disease burden in Canadian adults aged ≥50 years hospitalized with RSV. Methods Using administrative data and nasopharyngeal swabs collected from active surveillance among adults aged ≥50 years hospitalized with an acute respiratory illness (ARI) during the 2012-2013, 2013-2014, and 2014-2015 influenza seasons, RSV was identified using a respiratory virus multiplex polymerase chain reaction test to describe the associated disease burden, incidence, and healthcare costs. Results Of 7797 patients tested, 371 (4.8%) were RSV positive (2.2% RSV-A and 2.6% RSV-B). RSV prevalence varied by season from 4.2% to 6.2%. Respiratory virus coinfection was observed in 11.6% (43/371) of RSV cases, with influenza A being the most common. RSV hospitalization rates varied between seasons and increased with age, from 8-12 per 100 000 population in adults aged 50-59 years to 174-487 per 100 000 in adults aged ≥80 years. The median age of RSV cases was 74.9 years, 63.7% were female, and 98.1% of cases had ≥1 comorbidity. Among RSV cases, the mean length of hospital stay was 10.6 days, 13.7% were admitted to the intensive care unit, 6.4% required mechanical ventilation, and 6.1% died. The mean cost per RSV case was $13 602 (Canadian dollars) but varied by age and Canadian province. Conclusions This study adds to the growing literature on adult RSV burden by showing considerable morbidity, mortality, and healthcare costs in hospitalized adults aged ≥50 years with ARIs such as influenza.
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Affiliation(s)
- May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Andre Poirier
- Centre intégré universitaire de santé et services sociaux de la Mauricie et du Centre du Québec, Québec City, Québec, Canada
| | | | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Sylvie Trottier
- Centre de Recherche du Centre hospitalier universitaire de Québec-Université Laval, Québec City, Québec, Canada
| | | | - Duncan Webster
- Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
| | - Jason J LeBlanc
- Correspondence: Jason J. LeBlanc, PhD, FCCM, D(ABMM), Division of Microbiology, Nova Scotia Health, Queen Elizabeth II Health Sciences Centre, Room 404B, Mackenzie Bldg, 5788 University Ave, Halifax, NS B3H 1V8, Canada (); Shelly McNeil, MD, FRCPC, FIDSA, Canadian Center for Vaccinology, IWK Health Centre, 4th Floor Goldbloom Pavilion, 5850/5980 University Ave, Halifax, NS B3K 6R8, Canada ()
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Joy BK, Donovan AL, McCracken GR, Pettipas J, Grudeski E, Majer A, Mandes R, Booth TF, Hatchette TF, Patriquin G, LeBlanc JJ. Hunting for mpox (monkeypox) mimickers: Use of the Biofire meningitis/encephalitis panel on lesion swabs to support alternative viral diagnoses. J Clin Virol 2023; 159:105356. [PMID: 36608619 PMCID: PMC9789924 DOI: 10.1016/j.jcv.2022.105356] [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: 09/07/2022] [Revised: 12/08/2022] [Accepted: 12/18/2022] [Indexed: 12/26/2022]
Abstract
BACKGROUND Mpox (formerly monkeypox) is an emerging zoonotic disease of public health concern that presents as a rash mimicking other common viral exanthems. Unlike traditional testing algorithms relying on several assays, the BioFire FilmArray meningitis/encephalitis (ME) panel simultaneously detects common viruses causing rashes; however, Biofire ME is only licensed for testing on cerebral spinal fluid. OBJECTIVES This study evaluated use of the Biofire ME panel for detection and discrimination of herpes simplex virus types 1 and 2 (HSV-1 and HSV-2), varicella zoster virus (VZV), human herpesviruses type 6 (HHV-6), enteroviruses (EVs), and human paraechoviruses (HPeVs) from a dermal or mucocutaneous swabs collected in universal transport media (UTM). STUDY DESIGN Results of the BioFire ME panel were compared against methods used during clinical testing. Ten-fold serial dilutions in UTM of cultured viruses were used to compare analytical sensitivity, and analytical specificity was assessed using panels of microorganisms in UTM. Clinical sensitivity and specificity were assessed using 20 positive specimens each for HHV-1, HHV-2, HHV-6, VZV, EVs, and HPeV, as well as 35 known negative specimens that included 15 mpox-positive specimens. RESULTS Biofire ME was as sensitive as comparator methods, and correctly discriminated all HSV-1, HSV-2, VZV, HHV-6, EVs, and HPeVs from mpox and mpox-mimickers. Cross-reaction between EV and rhinoviruses A, B, and C were noted in the specificity panel. CONCLUSIONS Swabs in UTM collected for mpox testing are suitable for use on the Biofire ME panel, allowing more streamlined diagnostic testing for viral exanthems in patients under investigation for mpox infection.
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Affiliation(s)
- Bryn K. Joy
- Medical Sciences Program, Faculty of Sciences, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexis L. Donovan
- School of Medicine, Royal College of Surgeons in Ireland (RSCI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Gregory R. McCracken
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, Nova Scotia, Canada
| | - Elsie Grudeski
- Enteroviruses and Enteric Viruses Laboratory, National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada
| | - Anna Majer
- Enteroviruses and Enteric Viruses Laboratory, National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada
| | - Russell Mandes
- Enteroviruses and Enteric Viruses Laboratory, National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada
| | - Tim F. Booth
- Enteroviruses and Enteric Viruses Laboratory, National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada
| | - Todd F. Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.,Corresponding author at: Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health (NSH), Room 404B, MacKenzie Building, 5788 University Avenue, Halifax, Nova Scotia, B3H 1V8, Canada
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10
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Goodall BL, LeBlanc JJ, Hatchette TF, Barrett L, Patriquin G. Investigating the Sensitivity of Nasal or Throat Swabs: Combination of Both Swabs Increases the Sensitivity of SARS-CoV-2 Rapid Antigen Tests. Microbiol Spectr 2022; 10:e0021722. [PMID: 35762772 PMCID: PMC9430836 DOI: 10.1128/spectrum.00217-22] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 06/04/2022] [Indexed: 01/05/2023] Open
Abstract
The COVID-19 pandemic has been hallmarked by several waves of variants of concern (VoCs), each with novel challenges. Currently, the highly transmissible Omicron VoC is predominant worldwide, and sore throat is common, among other cold-like symptoms. Anecdotes on social media have suggested that sampling one's throat can increase the sensitivity for Omicron detection by antigen-based rapid testing devices (Ag-RDTs). This work aimed to improve the local testing strategy and determine whether the sensitivity of Ag-RDTs designed for nasal sampling is altered with the use of self-administered throat swabs in self-perceived asymptomatic individuals. This investigation used a common Ag-RDT (i.e., Abbott Panbio COVID-19 Ag rapid test device) to compare three sampling sites: nasal swab, throat swab, and combined nasal/throat. All Ag-RDT results were confirmed with molecular testing from residual test buffer. Compared to reverse transcriptase PCR (RT-PCR), samples from nasal or throat swabs each detected 64.5% of SARS-CoV-2 cases; however, combining the contributions of each swab increased the positive percent agreement (PPA) with RT-PCR to 88.7%. This trend was also evident with the Rapid Response Ag-RDT (BTNX), which uses more flexible swabs than does the Panbio. When nasal swab collection was compared to paired sampling of the nose/throat using a single swab with the Panbio Ag-RDT, the PPAs were 68.4% and 81.6%, respectively. No false-positive results were observed with nasal, throat, or combined nasal/throat sampling. Self-administered throat and nasal/throat swabs both had >90% acceptability. These findings support the use of self-collected combined nasal/throat sampling for Ag-RDT-based SARS-CoV-2 detection in self-perceived asymptomatic individuals. IMPORTANCE This quality project demonstrates that combining the results of nasal and throat swabs or using a combined single swab of the throat and nares resulted in increased detection of SARS-CoV-2 using a rapid antigen test, in an asymptomatic population. Importantly, no false positives were detected, and over 90% of people were willing to perform the combination swab. These types of projects are instrumental in informing local practices to improve testing strategies. These data support the option of using a combined nasal/throat swab in our local setting to enhance the detection of Omicron.
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Affiliation(s)
- Barbara L. Goodall
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F. Hatchette
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Barrett
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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11
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LeBlanc JJ, McCracken GR, Goodall B, Hatchette TF, Barrett L, Ross J, Davidson RJ, Patriquin G. Avoiding False-Positive SARS-CoV-2 Rapid Antigen Test Results with Point-of-Care Molecular Testing on Residual Test Buffer. Microbiol Spectr 2022; 10:e0063922. [PMID: 35863036 PMCID: PMC9430663 DOI: 10.1128/spectrum.00639-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 06/22/2022] [Indexed: 12/01/2022] Open
Abstract
Antigen-based rapid diagnostic tests (Ag-RDTs) have been widely used for the detection of SARS-CoV-2 during the coronavirus disease 2019 (COVID-19) pandemic. In settings of low disease prevalence, such as asymptomatic community testing, national guidelines recommend confirmation of positive Ag-RDT results with a nucleic acid amplification test (NAAT). This often requires patients to be recalled for repeat specimen recollection and subsequent testing in reference laboratories. This project assessed the use of a point-of-care molecular NAAT for SARS-CoV-2 detection (i.e., ID NOW), which was performed on-site at a volunteer-led asymptomatic community testing site on the residual test buffer (RTB) from positive Ag-RDTs. The ID NOW NAAT assay was performed on RTB from two Ag-RDTs: the Abbott Panbio and BTNX Rapid Response assays. Results of ID NOW were compared to real-time RT-PCR at a reference laboratory. Along with investigations into the clinical performance of ID NOW on RTB, analytical specificity was assessed with a panel of various respiratory organisms. Of the Ag-RDTs results evaluated, all 354 Ag-RDTs results characterized as true positives by RT-PCR were accurately identified with ID NOW testing of RTB. No SARS-CoV-2 detections by ID NOW were observed from 10 specimens characterized as false-positive Ag-RDTs, or from contrived specimens with various respiratory organisms. The use of on-site molecular testing on RTB provides a suitable option for rapid confirmatory testing of positive Ag-RDTs, thereby obviating the need for specimen recollection for molecular testing at local reference laboratories. IMPORTANCE During the COVID-19 pandemic, rapid antigen tests have been widely used for the detection of SARS-CoV-2. These simple devices allow rapid test results. However, false-positive results may occur. As such, individuals with positive rapid tests often must return to testing centers to have a second swab collected, which is then transported to a specialized laboratory for confirmation using molecular tests. As an alternative to requiring a repeat visit and a prolonged turn-around time for result confirmation, this project evaluated whether the leftover material from rapid antigen tests could be confirmed directly on a portable point-of-care molecular instrument. Using this approach, molecular confirmation of positive antigen tests could be performed in less than 15 min, and the results were equivalent to laboratory-based confirmation. This procedure eliminates the need for individuals to return to testing centers following a positive rapid antigen test and ensures accurate antigen test results through on-site confirmation.
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Affiliation(s)
- Jason J. LeBlanc
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gregory R. McCracken
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Barbara Goodall
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lisa Barrett
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - John Ross
- Praxes Medical Group, Halifax, Nova Scotia, Canada
| | - Ross J. Davidson
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Department of Pathology and Laboratory Medicine, Division of Microbiology, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
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12
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Patriquin G, LeBlanc JJ, Gillis HA, McCracken GR, Pettipas JJ, Hatchette TF. Combined oropharyngeal/nares and nasopharyngeal swab sampling remain effective for molecular detection of SARS-CoV-2 Omicron variant. J Med Microbiol 2022; 71. [PMID: 35671206 DOI: 10.1099/jmm.0.001545] [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] [Indexed: 11/18/2022] Open
Abstract
The world has experienced several waves of SARS-CoV-2 variants of concern (VoCs) throughout the COVID-19 pandemic since the first cases in December 2019. The Omicron VoC has increased transmission, compared to its predecessors, and can present with sore throat and other cold-like symptoms. Given the predominance of throat symptoms, and previous work demonstrating better sensitivity using antigen-based rapid detection tests when a throat swab is included in the standard nasal sampling, this quality improvement project sought to ensure ongoing suitability of both combined oropharyngeal/nares (OPN) and nasopharyngeal (NP) swab sampling used throughout the pandemic. Consenting participants meeting Public Health testing criteria (mostly symptomatic or a close contact of a known case) were enrolled, and paired NP and OPN swabs were subjected to nucleic acid amplification testing (NAAT). Comparing paired specimens from 392 participants sensitivity of NP swabs was 89.1 % (95 % CI, 78.8-94.9), and that of OPN was 98.4 % (95 % CI: 90.9->99.9) (P-value 0.052). This project demonstrated that both NP and combined OPN swabs detected the Omicron variant with similar sensitivity by NAAT, supporting the continued use of either swab collection for SARS-CoV-2 molecular detection.
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Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Holly A Gillis
- Public Health, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Gregory R McCracken
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Janice J Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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13
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Andrew MK, Godin J, LeBlanc J, Boivin G, Valiquette L, McGeer A, McElhaney JE, Hatchette TF, ElSherif M, MacKinnon-Cameron D, Wilson K, Ambrose A, Trottier S, Loeb M, Smith SW, Katz K, McCarthy A, McNeil SA. Older Age and Frailty are Associated with Higher Mortality but Lower ICU Admission with COVID-19. Can Geriatr J 2022; 25:183-196. [PMID: 35747412 PMCID: PMC9156416 DOI: 10.5770/cgj.25.546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background We report characteristics and outcomes of adults admitted to Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network hospitals with COVID-19 in 2020. Methods Patients with laboratory-confirmed COVID-19 admitted to 11 sites in Ontario, Quebec, Alberta, and Nova Scotia up to December 31, 2020 were enrolled in this prospective observational cohort study. Measures included age, sex, demographics, housing, exposures, Clinical Frailty Scale, comorbidities; in addition, length of stay, intensive care unit (ICU) admission, mechanical ventilation, and survival were assessed. Descriptive analyses and multivariable logistic regressions were conducted. Results Among 2,011 patients, mean age was 71.0 (range 19–105) years. 29.7% were admitted from assisted living or long-term care facilities. The full spectrum of frailty was represented in both younger and older age groups. 81.8% had at least one underlying comorbidity and 27.2% had obesity. Mortality was 14.3% without ICU admission, and 24.6% for those admitted to ICU. Older age and frailty were independent predictors of lower ICU use and higher mortality; accounting for frailty, obesity was not an independent predictor of mortality, and associations of comorbidities with mortality were weakened. Conclusions Frailty is a critical clinical factor in predicting outcomes of COVID-19, which should be considered in research and clinical settings.
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Aoki FY, Papenburg J, Mubareka S, Allen UD, Hatchette TF, Evans GA. 2021-2022 AMMI Canada guidance on the use of antiviral drugs for influenza in the COVID-19 pandemic setting in Canada. J Assoc Med Microbiol Infect Dis Can 2022; 7:1-7. [PMID: 36340849 PMCID: PMC9603021 DOI: 10.3138/jammi-2022-01-31] [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: 01/31/2022] [Accepted: 01/31/2022] [Indexed: 06/16/2023]
Abstract
We provide an update to the Association of Medical Microbiology and Infectious Disease Canada seasonal influenza foundation guideline on the use of antiviral drugs for influenza for the upcoming 2021-2022 influenza season in Canada. Peramivir and baloxavir marboxil were licensed in Canada in 2017 and 2020, respectively, but neither is currently marketed. Thus, this guidance continues to focus on further optimizing the use of oseltamivir and zanamivir. Important issues for this year include the implications of co-circulation of severe acute respiratory syndrome coronavirus 2 and influenza viruses; the role of diagnostic testing in relation to impact on patient management; and dosing and administration recommendations for neuraminidase inhibitors for various at-risk age groups.
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Affiliation(s)
- Fred Y Aoki
- Medical Microbiology and Pharmacology and Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Jesse Papenburg
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
- Division of Microbiology, Department of Clinical Laboratory Medicine, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Upton D Allen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd F Hatchette
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Gerald A Evans
- Division of Infectious Diseases, Department of Medicine, Kingston Health Sciences Centre, Queen’s University, Kingston, Ontario, Canada
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LeBlanc JJ, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang ALS, Gillis HD, Martin I, Demczuk W, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil S. 1325. Recalibrating Estimates of Pneumococcal Disease in Hospitalized Canadian adults from 2010 to 2017 with Use of an Extended Spectrum Serotype-specific Urine Antigen Detection. Open Forum Infect Dis 2021. [PMCID: PMC8644227 DOI: 10.1093/ofid/ofab466.1517] [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: 12/02/2022] Open
Abstract
Background Pneumococcal vaccine recommendations in Canada include both age- and risk-based guidance. This study aimed to describe the burden of vaccine-preventable pneumococcal community acquired pneumonia (pCAP) and invasive pneumococcal disease (IPD) by age in hospitalized adults. Methods Active surveillance for all-cause CAP and IPD in hospitalized adults was performed from 2010 to 2017, including laboratory results, patient demographics, and outcomes. Streptococcus pneumoniae was detected using blood and sputum culture, or urine antigen detection (UAD). Serotype was assigned using Quellung reaction, PCR, or serotype-specific UADs spanning the 24 serotypes in PCV13 and PPV23 vaccines. Data were categorized by age (16-49, 50-64, 65+, and 50+ years) and over time. Results 11129 ACP cases and 216 cases of IPD (non-CAP) were identified. A laboratory test for S. pneumoniae was performed in 8912 of ACP cases, identifying 1264 (14.2%) as pCAP. Compared to non-pCAP, pCAP cases were more likely to be admitted to intensive care units and require mechanical ventilation. These serious outcomes, as well as mortality, were more prominent in bacteremic pCAP and IPD. Risk factors for death in pCAP included aged 75+ years, immune compromising conditions, and BMI < 18.5. When categorized by age, the proportion of individuals aged 65+ years for pCAP and IPD was 49.8% and 48.6%, and the 50-64 year age cohort represented 31.3% and 29.9%, respectively. The contributions of PCV13 and PPV23 serotypes remained relatively stable over time, and overall represented 57.6% and 90.9% for pCAP, and 35.0% and 72.0% for IPD, respectively. Conclusion Seven years following infant PCV13 immunization programs in Canada, PCV13 and PPV23 serotypes in pCAP and IPD remained predominant causes of pneumococcal disease. Serious outcomes were particularly evident in adults 50+, suggesting pneumococcal vaccines should be encouraged in this age group. Disclosures Jason J. LeBlanc, PhD, FCCM, D[ABMM], GSK (Research Grant or Support)Merck (Grant/Research Support)Pfizer (Grant/Research Support) Todd F Hatchette, MD, GSK (Grant/Research Support)Pfizer (Grant/Research Support) Melissa K. Andrew, MD, PhD, GSK (Grant/Research Support)Pfizer (Grant/Research Support, Advisor or Review Panel member)Sanofi (Consultant, Grant/Research Support, Advisor or Review Panel member)Seqirus (Advisor or Review Panel member) 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) Louis Valiquette, MD, M.Sc., Cubist (Consultant)GSK (Grant/Research Support)Merck (Consultant)Optimer (Consultant)Pfizer (Grant/Research Support) Shelly McNeil, FRCPC, MD, GSK (Grant/Research Support)Pfizer (Grant/Research Support)Sinofi Pasteur (Grant/Research Support)
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Affiliation(s)
- Jason J LeBlanc
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | | | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Irene Martin
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory (NML), Regina, MB, Canada
| | | | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Quebec, QC, Canada
| | - William Bowie
- Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Vancouver, BC, Canada
| | - Karen Green
- Mount Sinai Hospital, Toronto, ON, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Public Health Ontario and University of Toronto, Toronto, ON, Toronto, Ontario, Canada
| | - Mark Loeb
- McMaster University, Hamilton, ON, Hamilton, Ontario, Canada
| | - Anne McCarthy
- Ottawa Hospital General Campus, Ottawa, ON, Ottawa, ON, Canada
| | | | - Makeda Semret
- McGill University Health Centre, Montreal, QC, Montreal, QC, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec (QC), Quebec, QC, Canada
| | - Louis Valiquette
- Université de Sherbrooke, Sherbrooke, Quebec, Canada, Sherbrooke, QC, Canada
| | - Duncan Webster
- Saint John Regional Hospital, St. John, NB., Saint John, NB, Canada
| | - Shelly McNeil
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
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Patriquin G, Davidson RJ, Hatchette TF, Head BM, Mejia E, Becker MG, Meyers A, Sandstrom P, Hatchette J, Block A, Smith N, Ross J, LeBlanc JJ. Generation of False-Positive SARS-CoV-2 Antigen Results with Testing Conditions outside Manufacturer Recommendations: A Scientific Approach to Pandemic Misinformation. Microbiol Spectr 2021; 9:e0068321. [PMID: 34668722 PMCID: PMC8528119 DOI: 10.1128/spectrum.00683-21] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/29/2021] [Indexed: 11/20/2022] Open
Abstract
Antigen-based rapid diagnostics tests (Ag-RDTs) are useful tools for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) detection. However, misleading demonstrations of the Abbott Panbio coronavirus disease 2019 (COVID-19) Ag-RDT on social media claimed that SARS-CoV-2 antigen could be detected in municipal water and food products. To offer a scientific rebuttal to pandemic misinformation and disinformation, this study explored the impact of using the Panbio SARS-CoV-2 assay with conditions falling outside manufacturer recommendations. Using Panbio, various water and food products, laboratory buffers, and SARS-CoV-2-negative clinical specimens were tested with and without manufacturer buffer. Additional experiments were conducted to assess the role of each Panbio buffer component (tricine, NaCl, pH, and Tween 20) as well as the impact of temperature (4°C, 20°C, and 45°C) and humidity (90%) on assay performance. Direct sample testing (without the kit buffer) resulted in false-positive signals resembling those obtained with SARS-CoV-2 positive controls tested under proper conditions. The likely explanation of these artifacts is nonspecific interactions between the SARS-CoV-2-specific conjugated and capture antibodies, as proteinase K treatment abrogated this phenomenon, and thermal shift assays showed pH-induced conformational changes under conditions promoting artifact formation. Omitting, altering, and reverse engineering the kit buffer all supported the importance of maintaining buffering capacity, ionic strength, and pH for accurate kit function. Interestingly, the Panbio assay could tolerate some extremes of temperature and humidity outside manufacturer claims. Our data support strict adherence to manufacturer instructions to avoid false-positive SARS-CoV-2 Ag-RDT reactions, otherwise resulting in anxiety, overuse of public health resources, and dissemination of misinformation. IMPORTANCE With the Panbio severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test being deployed in over 120 countries worldwide, understanding conditions required for its ideal performance is critical. Recently on social media, this kit was shown to generate false positives when manufacturer recommendations were not followed. While erroneous results from improper use of a test may not be surprising to some health care professionals, understanding why false positives occur can help reduce the propagation of misinformation and provide a scientific rebuttal for these aberrant findings. This study demonstrated that the kit buffer's pH, ionic strength, and buffering capacity were critical components to ensure proper kit function and avoid generation of false-positive results. Typically, false positives arise from cross-reacting or interfering substances; however, this study demonstrated a mechanism where false positives were generated under conditions favoring nonspecific interactions between the two antibodies designed for SARS-CoV-2 antigen detection. Following the manufacturer instructions is critical for accurate test results.
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Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health (NSH), Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ross J. Davidson
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health (NSH), Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F. Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health (NSH), Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Breanne M. Head
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Edgard Mejia
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Michael G. Becker
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Adrienne Meyers
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Paul Sandstrom
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | | | - Ava Block
- Praxes Medical Group, Halifax, Nova Scotia, Canada
| | - Nicole Smith
- Praxes Medical Group, Halifax, Nova Scotia, Canada
| | - John Ross
- Praxes Medical Group, Halifax, Nova Scotia, Canada
| | - Jason J. LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health (NSH), Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
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17
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Smith GN, Moore KM, Hatchette TF, Nicholson J, Bowie W, Langley JM. Committee Opinion No. 399: Management of Tick Bites and Lyme Disease During Pregnancy. J Obstet Gynaecol Can 2021; 42:644-653. [PMID: 32414479 DOI: 10.1016/j.jogc.2020.01.001] [Citation(s) in RCA: 3] [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] [Received: 11/25/2019] [Accepted: 01/06/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Lyme disease is an emerging infection in Canada caused by the bacterium belonging to the Borrelia burgdorferi sensu lato species complex, which is transmitted via the bite of an infected blacklegged tick. Populations of blacklegged ticks continue to expand and are now established in different regions in Canada. It usually takes more than 24 hours of tick attachment to transfer B. burgdorferi to a human. The diagnosis of early localized Lyme disease is made by clinical assessment, as laboratory tests are not reliable at this stage. Most patients with early localized Lyme disease will present with a skin lesion (i.e., erythema migrans) expanding from the tick bite site and/or non-specific "influenza-like" symptoms (e.g., arthralgia, myalgia, and fever). Signs and symptoms may occur from between 3 and 30 days following the tick bite. The care of pregnant patients with a tick bite or suspected Lyme disease should be managed similarly to non-pregnant adults, including the consideration of antibiotics for prophylaxis and treatment. The primary objective of this committee opinion is to inform practitioners about Lyme disease and provide an approach to managing the care of pregnant women who may have been infected via a blacklegged tick bite. INTENDED USERS Health care providers who care for pregnant women or women of reproductive age. TARGET POPULATION Women of reproductive age. EVIDENCE In November 2018, Medline, EMBASE, PubMed, and CENTRAL databases were searched for 2 main categories: (1) Lyme disease and (2) other tick-borne diseases. Because the main focus was Lyme disease, and considering the limited number of the articles, no further filters were applied for publication time or type of study. For other tick-borne diseases, the results were restricted to a publication date within the last 10 years (2008-2018). The search terms were developed using MeSH terms and keywords including Lyme Disease, Pregnancy, Pregnant Women, Pregnancy Complications, Ehrlichiosis, Anaplasmosis, Rocky Mountain Spotted Fever, Babesiosis, Tularemia, Powassan Virus, Encephalitis Viruses, Tick-Borne, Tick-Borne Diseases, Colorado Tick Fever, Q Fever, Relapsing Fever, and Southern Tick-Associated Rash Illness. All articles on Lyme disease and other tick-borne diseases with a target population of pregnant women were included; other groups and populations were excluded. VALIDATION METHODS The content and recommendations of this committee opinion were drafted and agreed upon by the authors. The Board of Directors of the Society of Obstetricians and Gynaecologists of Canada approved the final draft for publication.
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LeBlanc JJ, Pettipas J, Di Quinzio M, Hatchette TF, Patriquin G. Reliable detection of SARS-CoV-2 with patient-collected swabs and saline gargles: A three-headed comparison on multiple molecular platforms. J Virol Methods 2021; 295:114184. [PMID: 34029634 PMCID: PMC8141269 DOI: 10.1016/j.jviromet.2021.114184] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 05/11/2021] [Accepted: 05/11/2021] [Indexed: 02/06/2023]
Abstract
With increasing demands for SARS-CoV-2 testing, as well as the shortages for testing supplies, collection devices, and trained healthcare workers (HCWs) to collect specimens, self-collection is an attractive prospect to reduce the need for HCWs and expenditure of personal protective equipment. Apart from the traditional nasopharyngeal swab used for SARS-CoV-2 detection, alternative specimens have been validated such as a combined swabs of the oropharynx and anterior nares (OP/N), or throat samples using saline gargles. Both the alternative specimen types are amenable to self-collection. Objectives. This study aimed to compare the sensitivity of HCW-collected (OP/N) swabs, self-collected OP/N swabs, and self-collected saline gargles. Among 38 individuals previously testing positive for SARS-CoV-2 (or their close contacts), two self-collected specimen types (OP/N and saline gargles) were compared to HCW-collected OP/N swabs. SARS-CoV-2 testing was performed on three molecular assays: a laboratory-developed test (LDT), and two commercial assays on automated platforms: Cobas 6800 (Roche Diagnostics) and Panther (Hologic). The sensitivity of self-collected OP/N swabs was equivalent to healthcare worker (HCW)-collected OP/N swabs at 100.0 % [92.6%–100.0%] for all three molecular tests. The sensitivity of saline gargles was not significantly different than HCW-collected OP/N swabs, but varied slightly between instruments at 93.8 % [85.9%–93.8%] for the LDT, 96.8 % [88.6%–96.8%] for the Cobas assay, and 96.7 % [89.2%–96.9%] for the Panther assay. Overall, self-collection using OP/N swabs or saline gargles are reasonable alternatives to HCW-based collections for SARS-CoV-2 detection, and could facilitate broader surveillance strategies.
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Affiliation(s)
- Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada; Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Departments of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Janice Pettipas
- Provincial Public Health Laboratory Network of Nova Scotia (PPHLN), Halifax, Nova Scotia, Canada
| | - Melanie Di Quinzio
- Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada; Departments of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Departments of Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada; Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.
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19
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Andrew MK, MacDonald S, Godin J, McElhaney JE, LeBlanc J, Hatchette TF, Bowie W, Katz K, McGeer A, Semret M, McNeil SA. Persistent Functional Decline Following Hospitalization with Influenza or Acute Respiratory Illness. J Am Geriatr Soc 2020; 69:696-703. [PMID: 33294986 PMCID: PMC7984066 DOI: 10.1111/jgs.16950] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 10/15/2020] [Accepted: 10/23/2020] [Indexed: 01/23/2023]
Abstract
Background/objectives Influenza is associated with significant morbidity and mortality, particularly for older adults. Persistent functional decline following hospitalization has important impacts on older adults' wellbeing and independence, but has been under‐studied in relation to influenza. We aimed to investigate persistent functional change in older adults admitted to hospital with influenza and other acute respiratory illness (ARI). Design Protective observational cohort study. Setting Canadian Immunization Research Network Serious Outcomes Surveillance Network 2011 to 2012 influenza season. Participants A total of 925 patients aged 65 and older admitted to hospital with influenza and other ARI. Measurements Influenza was laboratory‐confirmed. Frailty was measured using a Frailty index (FI). Functional status was measured using the Barthel index (BI); moderate persistent functional decline was defined as a clinically meaningful loss of ≥10 to <20 points on the 100‐point BI. Catastrophic disability (CD) was defined as a loss of ≥20 points, equivalent to full loss of independence in two basic activities of daily living. Results Five hundred and nineteen (56.1%) were women; mean age was 79.4 (standard deviation=8.4) years. Three hundred and forty‐six (37.4%) had laboratory‐confirmed influenza. Influenza cases had lower baseline function (BI = 77.0 vs 86.9, P < .001) and higher frailty (FI = 0.23 vs 0.20, P < .001) than those with other ARI. A total of 8.4% died, 8.2% experienced persistent moderate functional decline, and 9.9% experienced CD. Higher baseline frailty was associated with increased odds of experiencing functional decline, CD, and death. The experience of functional decline and CD, and its association with frailty, was the same for influenza and other ARI. Conclusion Functional loss in hospital is common among older adults; for some this functional loss is persistent and catastrophic. This highlights the importance of prevention and optimal management of acute declines in health, including influenza, to avoid hospitalization. In the case of influenza, for which vaccines exist, this raises the potential of vaccine preventable disability.
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Affiliation(s)
- Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada
| | - Sarah MacDonald
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Jason LeBlanc
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- Department of Medicine (Infectious Diseases), University of British Columbia, Vancouver, British Columbia, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Makeda Semret
- McGill University Health Centre Research Institute, Montreal, Quebec, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, Halifax, Nova Scotia, Canada.,Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
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20
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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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21
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Mubareka S, Aoki FY, Allen UD, Hatchette TF, Papenburg J, Evans GA. 2020-2021 AMMI Canada guidance on the use of antiviral drugs for influenza in the setting of co-circulation of seasonal influenza and SARS-CoV-2 viruses in Canada. J Assoc Med Microbiol Infect Dis Can 2020; 5:214-222. [PMID: 36340057 PMCID: PMC9602880 DOI: 10.3138/jammi-2020-11-02] [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: 11/02/2020] [Accepted: 11/02/2020] [Indexed: 06/16/2023]
Abstract
We provide an update to the Association of Medical Microbiology and Infectious Disease Canada foundation guidance for the upcoming 2020-2021 influenza season in Canada. Important issues for this year include the implications of co-circulation of SARS-CoV-2, the role of diagnostic testing, and a restatement of dosing and administration recommendations for neuraminidase inhibitors in various age groups and underlying health conditions. Although peramivir and baloxivir are now licensed in Canada, neither is currently marketed, so this guidance focuses on further optimizing the use of oseltamivir and zanamivir.
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Affiliation(s)
- Samira Mubareka
- Department of Laboratory Medicine and Molecular Diagnostics, Sunnybrook Health Sciences Centre, and Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada
| | - Fred Y Aoki
- Medical Microbiology and Pharmacology and Therapeutics, Faculty of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Upton D Allen
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Division of Infectious Diseases, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Todd F Hatchette
- Department of Pathology, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
| | - Jesse Papenburg
- Department of Pathology and Laboratory Medicine, Nova Scotia Health, Halifax, Nova Scotia, Canada
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, Montreal, Quebec, Canada
| | - Gerald A Evans
- Division of Microbiology, Department of Clinical Laboratory Medicine, Optilab Montreal, McGill University Health Centre, Montreal, Quebec, Canada
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22
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Patriquin G, Hatchette JE, Hatchette TF. Canadian physicians' knowledge, attitudes, and beliefs about the risk of HTLV infection in solid organ transplantation. J Assoc Med Microbiol Infect Dis Can 2020; 5:124-126. [PMID: 36341315 PMCID: PMC9608730 DOI: 10.3138/jammi-2019-0017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 03/15/2020] [Indexed: 06/16/2023]
Affiliation(s)
- Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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23
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Nichols MK, Andrew MK, Ye L, Hatchette TF, Ambrose A, Boivin G, Bowie W, Dos Santos G, Elsherif M, Green K, Haguinet F, Katz K, Leblanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Powis J, Richardson D, Semret M, Sharma R, Shinde V, Smyth D, Trottier S, Valiquette L, Webster D, McNeil SA. The Impact of Prior Season Vaccination on Subsequent Influenza Vaccine Effectiveness to Prevent Influenza-related Hospitalizations Over 4 Influenza Seasons in Canada. Clin Infect Dis 2020; 69:970-979. [PMID: 30508064 DOI: 10.1093/cid/ciy1009] [Citation(s) in RCA: 13] [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: 04/27/2018] [Accepted: 11/30/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Recent studies have demonstrated the possibility of negative associations between prior influenza vaccines and subsequent influenza vaccine effectiveness (VE), depending on season and strain. We investigated this association over 4 consecutive influenza seasons (2011-2012 through 2014-2015) in Canada. METHODS Using a matched test-negative design, laboratory-confirmed influenza cases and matched test-negative controls admitted to hospitals were enrolled. Patients were stratified into 4 groups according to influenza vaccine history (not vaccinated current and prior season [referent], vaccinated prior season only, vaccinated current season only, and vaccinated both current and prior season). Conditional logistic regression was used to estimate VE; prior vaccine impact was assessed each season for overall effect and effect stratified by age (<65 years, ≥65 years) and type/subtype (A/H1N1, A/H3N2, influenza B). RESULTS Overall, mainly nonsignificant associations were observed. Trends of nonsignificant decreased VE among patients repeatedly vaccinated in both prior and current season relative to the current season only were observed in the A/H3N2-dominant seasons of 2012-2013 and 2014-2015. Conversely, in 2011-2012, during which B viruses circulated, and in 2013-2014, when A/H1N1 circulated, being vaccinated in both seasons tended to result in a high VE in the current season against the dominant circulating subtype. CONCLUSIONS Prior vaccine impact on subsequent VE among Canadian inpatients was mainly nonsignificant. Even in circumstances where we observed a trend of negative impact, being repeatedly vaccinated was still more effective than not receiving the current season's vaccine. These findings favor continuation of annual influenza vaccination recommendations, particularly in older adults. CLINICAL TRIALS REGISTRATION NCT01517191.
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Affiliation(s)
- M K Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - L Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - T F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - A Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - G Boivin
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | - W Bowie
- University of British Columbia, Vancouver, Canada
| | - G Dos Santos
- Business and Decision Life Sciences, Bruxelles, Belgium.,Present affiliation: GSK, Wavre, Belgium
| | - M Elsherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - K Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - K Katz
- North York General Hospital, Toronto
| | - J Leblanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | - M Loeb
- McMaster University, Hamilton
| | - D MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
| | | | | | - A McGeer
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J Powis
- Michael Garron Hospital, Toronto
| | | | - M Semret
- McGill University, Montreal, Québec
| | - R Sharma
- GSK, Mississauga, Ontario, Canada
| | - V Shinde
- GSK, King of Prussia, Pennsylvania.,Present affiliation: Novavax Vaccines, Washington, D.C
| | - D Smyth
- The Moncton Hospital, New Brunswick
| | - S Trottier
- Centre Hospitalier Universitaire de Québec, Québec City, Canada
| | | | - D Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - S A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia
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24
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Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, LeBlanc J, Bowie W, Boivin G, McGeer A, Poirier A, Powis J, Semret M, Webster D, Andrew MK. Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults. J Infect Dis 2020. [PMID: 32147711 DOI: 10.1093/infdis/jiaa092[publishedonlinefirst:2020/03/10]] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023] Open
Abstract
BACKGROUND We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. METHODS A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. RESULTS Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age. CONCLUSIONS Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.
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Affiliation(s)
- Caitlin Lees
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd F Hatchette
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | | | - André Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec City, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Duncan Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
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Lees C, Godin J, McElhaney JE, McNeil SA, Loeb M, Hatchette TF, LeBlanc J, Bowie W, Boivin G, McGeer A, Poirier A, Powis J, Semret M, Webster D, Andrew MK. Frailty Hinders Recovery From Influenza and Acute Respiratory Illness in Older Adults. J Infect Dis 2020; 222:428-437. [PMID: 32147711 PMCID: PMC7336554 DOI: 10.1093/infdis/jiaa092] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [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: 11/29/2019] [Accepted: 03/03/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined frailty as a predictor of recovery in older adults hospitalized with influenza and acute respiratory illness. METHODS A total of 5011 patients aged ≥65 years were admitted to Canadian Serious Outcomes Surveillance Network hospitals during the 2011/2012, 2012/2013, and 2013/2014 influenza seasons. Frailty was measured using a previously validated frailty index (FI). Poor recovery was defined as death by 30 days postdischarge or an increase of more than 0.06 (≥2 persistent new health deficits) on the FI. Multivariable logistic regression controlled for age, sex, season, influenza diagnosis, and influenza vaccination status. RESULTS Mean age was 79.4 (standard deviation = 8.4) years; 53.1% were women. At baseline, 15.0% (n = 750) were nonfrail, 39.3% (n = 1971) were prefrail, 39.8% (n = 1995) were frail, and 5.9% (n = 295) were most frail. Poor recovery was experienced by 21.4%, 52.0% of whom had died. Frailty was associated with lower odds of recovery in all 3 seasons: 2011/2012 (odds ratio [OR] = 0.70; 95% confidence interval [CI], 0.59-0.84), 2012/2013 (OR = 0.72; 95% CI, 0.66-0.79), and 2013/2014 (OR = 0.75; 95% CI, 0.69-0.82); results varied by season, influenza status, vaccination status, and age. CONCLUSIONS Increasing frailty is associated with lower odds of recovery, and persistent worsening frailty is an important adverse outcome of acute illness.
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Affiliation(s)
- Caitlin Lees
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Judith Godin
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly A McNeil
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Todd F Hatchette
- Department of Medicine (Infectious Diseases), Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
- Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | | | - André Poirier
- Centre Intégré Universitaire de Santé et Services Sociaux, Quebec City, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | - Duncan Webster
- Saint John Hospital Regional Hospital, Dalhousie University, New Brunswick, Canada
| | - Melissa K Andrew
- Geriatric Medicine Research, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
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LeBlanc JJ, Gubbay JB, Li Y, Needle R, Arneson SR, Marcino D, Charest H, Desnoyers G, Dust K, Fattouh R, Garceau R, German G, Hatchette TF, Kozak RA, Krajden M, Kuschak T, Lang ALS, Levett P, Mazzulli T, McDonald R, Mubareka S, Prystajecky N, Rutherford C, Smieja M, Yu Y, Zahariadis G, Zelyas N, Bastien N. Real-time PCR-based SARS-CoV-2 detection in Canadian laboratories. J Clin Virol 2020; 128:104433. [PMID: 32405254 PMCID: PMC7219382 DOI: 10.1016/j.jcv.2020.104433] [Citation(s) in RCA: 81] [Impact Index Per Article: 20.3] [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: 05/02/2020] [Accepted: 05/09/2020] [Indexed: 12/21/2022]
Abstract
With emergence of pandemic COVID-19, rapid and accurate diagnostic testing is essential. This study compared laboratory-developed tests (LDTs) used for the detection of SARS-CoV-2 in Canadian hospital and public health laboratories, and some commercially available real-time RT-PCR assays. Overall, analytical sensitivities were equivalent between LDTs and most commercially available methods.
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Affiliation(s)
- Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Room 404B, MacKenzie Building, 5788 University Avenue, Halifax, Nova Scotia B3H 1V8, Canada; Departments of Pathology, Medicine, and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.
| | - Jonathan B Gubbay
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Public Health Ontario Laboratories, Toronto, Ontario, Canada; Hospital for Sick Children, Toronto, Ontario, Canada
| | - Yan Li
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Robert Needle
- Public Health and Microbiology Laboratory, St. John's, Newfoundland, Canada
| | - Sandra Radons Arneson
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Dionne Marcino
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Hugues Charest
- Laboratoire De Santé Publique Du Québec/INSPQ, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Guillaume Desnoyers
- Centre Hospitalier Universitaire Dr. Georges L. Dumont, Moncton, New-Brunswick, Canada
| | - Kerry Dust
- Cadham Provincial Laboratory, Winnipeg, Manitoba, Canada
| | - Ramzi Fattouh
- Department of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Richard Garceau
- Centre Hospitalier Universitaire Dr. Georges L. Dumont, Moncton, New-Brunswick, Canada
| | - Gregory German
- Queen Elizabeth Hospital, Charlottetown, Prince Edward Island, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Room 404B, MacKenzie Building, 5788 University Avenue, Halifax, Nova Scotia B3H 1V8, Canada; Departments of Pathology, Medicine, and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Robert A Kozak
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Mel Krajden
- Public Health Laboratory, British Columbia Centre for Disease Control (BCCDC), Vancouver, British Columbia, Canada
| | - Theodore Kuschak
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Amanda L S Lang
- Roy Romanow Provincial Laboratory (RRPL), Saskatchewan Health Authority (SHA), Regina, Saskatchewan, Canada
| | - Paul Levett
- Public Health Laboratory, British Columbia Centre for Disease Control (BCCDC), Vancouver, British Columbia, Canada
| | - Tony Mazzulli
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Ryan McDonald
- Roy Romanow Provincial Laboratory (RRPL), Saskatchewan Health Authority (SHA), Regina, Saskatchewan, Canada
| | - Samira Mubareka
- Department of Laboratory Medicine and Pathobiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Natalie Prystajecky
- Public Health Laboratory, British Columbia Centre for Disease Control (BCCDC), Vancouver, British Columbia, Canada
| | | | - Marek Smieja
- St Joseph's Healthcare, Hamilton, Ontario, Canada
| | - Yang Yu
- Public Health and Microbiology Laboratory, St. John's, Newfoundland, Canada
| | - George Zahariadis
- Public Health and Microbiology Laboratory, St. John's, Newfoundland, Canada
| | - Nathan Zelyas
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Room 404B, MacKenzie Building, 5788 University Avenue, Halifax, Nova Scotia B3H 1V8, Canada; Provincial Laboratory for Public Health (ProvLab), Calgary, Alberta, Canada
| | - Nathalie Bastien
- National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
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27
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LeBlanc JJ, Heinstein C, MacDonald J, Pettipas J, Hatchette TF, Patriquin G. A combined oropharyngeal/nares swab is a suitable alternative to nasopharyngeal swabs for the detection of SARS-CoV-2. J Clin Virol 2020; 128:104442. [PMID: 32540034 PMCID: PMC7228872 DOI: 10.1016/j.jcv.2020.104442] [Citation(s) in RCA: 61] [Impact Index Per Article: 15.3] [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: 05/05/2020] [Accepted: 05/13/2020] [Indexed: 01/12/2023]
Abstract
Given the global shortage of nasopharyngeal (NP) swabs typically used for respiratory virus detection, alternative collection methods were evaluated during the COVID-19 pandemic. This study showed that a combined oropharyngeal/nares swab is a suitable alternative to NP swabs for the detection of SARS-CoV-2, with sensitivities of 91.7% and 94.4%, respectively.
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Affiliation(s)
- Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada; Departments of Pathology, Medicine, and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles Heinstein
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Jimmy MacDonald
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Janice Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada; Departments of Pathology, Medicine, and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Glenn Patriquin
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada; Departments of Pathology, Medicine, and Microbiology and Immunology, Dalhousie University, Halifax, Nova Scotia, Canada.
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28
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Smith GN, Moore KM, Hatchette TF, Nicholson J, Bowie W, Langley JM. Opinion du comité No 399 : Prise en charge des morsures de tiques et de la maladie de Lyme pendant la grossesse. Journal of Obstetrics and Gynaecology Canada 2020; 42:654-664. [DOI: 10.1016/j.jogc.2020.02.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Liu Y, Lam TTY, Lai FYL, Krajden M, Drews SJ, Hatchette TF, Fraaij PLA, van Kampen JJA, Badarch D, Nymadawa P, Tee KK, Lee HK, Koay ESC, Jennings L, Koopmans M, Tang JW. Comparative seasonalities of influenza A, B and 'common cold' coronaviruses - setting the scene for SARS-CoV-2 infections and possible unexpected host immune interactions. J Infect 2020; 81:e62-e64. [PMID: 32360499 PMCID: PMC7189195 DOI: 10.1016/j.jinf.2020.04.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 04/22/2020] [Indexed: 01/25/2023]
Affiliation(s)
- Yang Liu
- MRC Biostatistics Unit, University of Cambridge, Cambridge, UK
| | - Tommy T Y Lam
- School of Public Health, University of Hong Kong, Hong Kong SAR, China
| | | | - Mel Krajden
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Steven J Drews
- Canadian Blood Services, Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Todd F Hatchette
- Todd Hachette, Department of Pathology and Laboratory Medicine, Dalhousie University, Halifax, Canada
| | | | | | - Darmaa Badarch
- National Center of Communicable Diseases, Ministry of Health, Mongolia
| | | | - Kok Keng Tee
- Department of Medical Microbiology, University of Malaya, Kuala Lumpur, Malaysia
| | - Hong Kai Lee
- Singapore Immunology Network, Agency for Science, Technology and Research
| | - Evelyn S C Koay
- Molecular Diagnosis Diagnosis Unit, National University Hospital, Singapore
| | | | | | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, UK.
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30
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LeBlanc J, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang AL, Gillis HD, Martin I, Demczuk WH, LaFerriere C, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil SA. Age-stratified burden of pneumococcal community acquired pneumonia in hospitalised Canadian adults from 2010 to 2015. BMJ Open Respir Res 2020; 7:e000550. [PMID: 32188585 PMCID: PMC7078693 DOI: 10.1136/bmjresp-2019-000550] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/25/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Canada, 13-valent pneumococcal conjugate vaccine (PCV13) is recommended in childhood, in individuals at high risk of invasive pneumococcal disease (IPD) and in healthy adults aged ≥65 years for protection against vaccine-type IPD and pneumococcal community-acquired pneumonia (pCAP). Since vaccine recommendations in Canada include both age-based and risk-based guidance, this study aimed to describe the burden of vaccine-preventable pCAP in hospitalised adults by age. METHODS Surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed prospectively from 2010 to 2015. CAP was radiologically confirmed, and pCAP was identified using blood and sputum culture and urine antigen testing. Patient demographics and outcomes were stratified by age (16-49, 50-64, ≥65 and ≥50 years). RESULTS Of 6666/8802 CAP cases tested, 830 (12.5%) had pCAP, and 418 (6.3%) were attributed to a PCV13 serotype. Of PCV13 pCAP, 41% and 74% were in adults aged ≥65 and ≥50 years, respectively. Compared with non-pCAP controls, pCAP cases aged ≥50 years were more likely to be admitted to intensive care units (ICUs) and to require mechanical ventilation. Older adults with pCAP were less likely to be admitted to ICU or required mechanical ventilation, given their higher mortality and goals of care. Of pCAP deaths, 67% and 90% were in the ≥65 and ≥50 age cohorts, respectively. CONCLUSIONS Adults hospitalised with pCAP in the age cohort of 50-64 years contribute significantly to the burden of illness, suggesting that an age-based recommendation for adults aged ≥50 years should be considered in order to optimise the impact of pneumococcal vaccination programmes in Canada.
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Affiliation(s)
- Jason LeBlanc
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda Ls Lang
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irene Martin
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | - Walter H Demczuk
- Streptocococcus & STI Unit, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, Manitoba, Canada
| | | | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - William Bowie
- Department of Medicine, Vancouver General Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Green
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Jennie Johnstone
- Department of Medicine, Public Health Ontario and University of Toronto, Toronto, Ontario, Canada
| | - Mark Loeb
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Anne McCarthy
- Division of Infectious Diseases, Ottawa Hospital General Campus and University of Ottawa, Hamilton, Ontario, Canada
| | - Allison McGeer
- Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Makeda Semret
- Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada
| | - Sylvie Trottier
- Department of Microbiology-Immunology and Infectious Diseases, Centre Hospitalier Universitaire de Québec, Quebec City, Quebec, Canada
| | - Louis Valiquette
- Department of Microbiology and Infectiology, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Duncan Webster
- Department of Medicine, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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LeBlanc JJ, ElSherif M, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Lang ALS, Gillis HD, Martin I, Demczuk W, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil S. 2715. Pneumococcal Community-Acquired Pneumonia Attributed to PCV13 Serotypes in Hospitalized Adults: Comparison of the 50–64 and 65+ Age Groups. Open Forum Infect Dis 2019. [PMCID: PMC6810608 DOI: 10.1093/ofid/ofz360.2392] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Methods Results Conclusion Disclosures
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Affiliation(s)
- Jason J LeBlanc
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Amanda L S Lang
- Saskatchewan Health Authority, Roy Romanow Provincial Lab, Regina, SK, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Irene Martin
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | - William Bowie
- Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mark Loeb
- McMaster University, Hamilton, ON, Canada
| | | | | | - Makeda Semret
- McGill University Health Centre, Montreal, QC, Canada
| | | | | | | | - Shelly McNeil
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA) Halifax, NS, Canada,Dalhousie University, Halifax, Nova Scotia (NS), Halifax, NS, Canada
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32
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LeBlanc JJ, ElSherif M, Lang ALS, Gillis HD, Ye L, MacKinnon-Cameron D, Ambrose A, Hatchette TF, Martin I, Demczuk W, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Semret M, Trottier S, Valiquette L, Webster D, McNeil S. 2714. Streptococcus pneumoniae Nasopharyngeal Carriage in Canadian Adults Hospitalized with Community-Acquired Pneumonia from 2010 to 2017. Open Forum Infect Dis 2019. [PMCID: PMC6809650 DOI: 10.1093/ofid/ofz360.2391] [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 Streptococcus pneumoniae can colonizes the human nasopharynx, and can cause life-threatening infections like community-acquired pneumonia (CAP) and invasive pneumococcal diseases (IPD). In Canada, the 13-valent conjugate vaccine (PCV13) was introduced in childhood immunization since 2010, with hopes that it would not only protect the vaccinated, but also confer indirect protection to adults through herd immunity. Given data on S. pneumoniae nasopharyngeal (NP) carriage in adults is scarce, this study reports on S. pneumoniae-positivity and serotype distribution in adult carriage from years 2010 to 2017. Methods Active surveillance was performed in adults hospitalized with for CAP or IPD from December 2010 to 2017. For assessment of S. pneumoniae carriage, NP swabs were tested using lytA and cpsA real-time PCR. S. pneumoniae-positive NPs were subjected to serotyping using conventional and real-time multiplex PCRs. Results Overall, 6472 NP swabs were tested, and Spn was identified in 366 (5.7%). Of the 366 S. pneumoniae-positive NP swabs, a serotype was assigned in 355 (97.0%). From years 2010 to 2017, the proportion of S. pneumoniae-positive NP swabs declined from 8.9% to 4.3%. This was also reflected in the proportion of serotypeable results attributed to PCV13 serotypes, which also declined from 76.9% to 42.2%. The decline was primarily attributed to PCV13 serotypes 7F and 19A. PCV13 serotype 3 remained predominant throughout the study, as did non-PCV13 serotypes like 22F, 33F, and 11A. On the other hand, a proportional rise over time was noted for non-vaccine serotypes (from 15.4% to 31.1%). This was primarily attributed to serotypes 23A, 15A, and 35B. Conclusion Monitoring serotype trends is important to assess the impact of pneumococcal vaccines. While herd immunity from PCV13 childhood immunization was anticipated, few studies have assessed its impact on adult carriage. This study described Spn serotype distribution in adults over years 2010 to 2017, demonstrating not only a reduction of PCV13 serotypes over time, but a proportional rise in non-vaccine serotypes. These emerging serotypes may represent the emergence of serotype replacement. Ongoing serotype surveillance will be needed to compare S. pneumoniae carriage to serotypes associated with pneumococcal CAP and IPD. Disclosures All authors: No reported disclosures.
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Affiliation(s)
- Jason J LeBlanc
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Amanda L S Lang
- Saskatchewan Health Authority, Roy Romanow Provincial Lab, Regina, SK, Canada
| | - Hayley D Gillis
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Irene Martin
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Walter Demczuk
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Québec, QC, Canada
| | - William Bowie
- Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mark Loeb
- McMaster University, Hamilton, ON, Canada
| | | | | | - Makeda Semret
- McGill University Health Centre, Montreal, QC, Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Quebec, QC, Canada
| | | | | | - Shelly McNeil
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
- Dalhousie University, Halifax, NS, Canada
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McParland C, Nichols M, Andrew MK, Hatchette TF, Ambrose A, Ye L, Elsherif M, McNeil SA. 2496. A Comparative Evaluation of the Burden of Disease Caused by Influenza A and Influenza B During the 2011–2012, 2012–2013, and 2013–2014 Influenza Seasons in Canada. Open Forum Infect Dis 2018. [PMCID: PMC6255668 DOI: 10.1093/ofid/ofy210.2148] [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: 11/25/2022] Open
Abstract
Background When assessing burden of influenza disease, influenza B has typically been associated with infection in children and young adults, and is considered less prevalent and/or severe in older adults. We sought to assess the burden of influenza type A disease compared with influenza type B disease in Canadian adults admitted to hospital with laboratory-confirmed influenza. Methods The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for laboratory-confirmed influenza in adults (≥16 years) hospitalized across Canada during the 2011–2014 influenza seasons. Eligible patients who were admitted to hospital with any acute respiratory illness or symptom had a nasopharyngeal swab collected and tested for influenza virus using reverse transcriptase polymerase chain reaction (PCR). Demographic/clinical information, as well as in-hospital outcomes were collected. Frailty Index scores were also recorded at baseline and 30-days after discharge, when possible, in patients ≥65 years. Patients with influenza A and B were compared using descriptive statistics; discrete outcomes were compared using Chi-squared (χ2) tests; continuous outcomes were compared using student’s t-tests. Results Overall, there were 3484 influenza A cases and 1375 influenza B cases enrolled in the SOS Network from 2011 to 2014. Mean age was significantly different between influenza A and influenza B cases (mean age of influenza A: 65.8, mean age of influenza B: 71.2, P < 0.01). A significantly larger proportion of influenza B patients were admitted from long-term care (A: 5.5%, B: 12.1%, P < 0.01). There was no significant difference with respect to length of hospitalization (influenza A: 11.1 days, influenza B: 10.27 days, P = 0.07) or mortality (A: 9.01%, B: 9.45%, P = 0.63) between influenza A and B. Patients with influenza B were significantly more frail prior to the onset of illness (A: 0.21, B: 0.22, P < 0.01). Conclusion Current attitudes consider influenza A to be the more significant virus in terms of morbidity and mortality in adults. However, influenza B is responsible for similar duration of hospitalization and similar mortality rates. In addition, influenza B predominantly affected the frail elderly and thus optimizing influenza B protection is important in this population. Disclosures M. K. Andrew, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Sanofi Pasteur: Grant Investigator, Research grant. T. F. Hatchette, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Abbvie: Consultant, Speaker honorarium. S. A. McNeil, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Merck: Collaborator and Consultant, Contract clinical trials and Speaker honorarium. Novartis: Collaborator, Contract clinical trials. Sanofi Pasteur: Collaborator, Contract clinical trials.
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Affiliation(s)
- Caoimhe McParland
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Michaela Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - May Elsherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
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Nichols M, Andrew MK, Hatchette TF, Ambrose A, Boivin G, Elsherif M, Green K, Johnstone J, Katz K, Leblanc J, Loeb M, Mackinnon-Cameron D, Mccarthy A, McElhaney J, McGeer A, Poirier A, Powis J, Richardson D, Semret M, Smyth D, Trottier S, Valiquette L, Webster D, Ye L, McNeil SA. 992. 2016–2017 Influenza Burden of Disease and End-of-Season Influenza Vaccine Effectiveness (VE) Estimates for Preventing Influenza-Related Hospitalization Among Canadian Adults: An Analysis From the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network. Open Forum Infect Dis 2018. [PMCID: PMC6255298 DOI: 10.1093/ofid/ofy210.829] [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
Background To inform public health decision making around influenza prevention and treatment, ongoing surveillance of the influenza burden of disease and assessment of influenza vaccine effectiveness (VE) is critical. The Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) Network conducts active surveillance each influenza season to characterize the burden of influenza disease and to provide estimates of influenza VE to prevent influenza-related hospitalization in Canadian adults (≥16 years of age). Methods Active surveillance for influenza was conducted at 13 hospitals in four provinces beginning on November 15, 2016 and ending April 30, 2017. Patients admitted with any respiratory diagnosis or symptom were eligible for enrolment. Eligible patients had a nasopharyngeal swab collected and tested for influenza using polymerase chain reaction (PCR). Patients who tested positive for influenza were considered cases; patients who tested negative for influenza were eligible to become matched controls. Detailed demographic and medical information were obtained from the medical record. Influenza VE was estimated as 1 − odds ratio (OR) of influenza in vaccinated vs. unvaccinated patients × 100% using conditional logistic regression, with corresponding 95% confidence intervals (CIs). Results A total of 1,431 influenza cases were enrolled; the majority were influenza A (n = 1,299) and 100% of patients with known influenza A subtype were A/H3N2. Among all influenza cases, 144 (10.1%) patients were admitted to the intensive care unit (ICU) and 91 (6.4%) patients died within 30 days of discharge. Overall adjusted influenza VE for prevention of influenza-related hospitalization in all ages was 23.3% (95% CI: 2.9–39.4%), with slightly lower VE observed in patients ≥65 years (VE: 19.4%; 95% CI: −7.8–39.8%) and higher VE observed in patients <65 years (VE: 47.9%; 95% CI: 9.9–69.9%). Conclusion Overall, influenza VE was low but effective (VE: 23%) for preventing influenza-related hospitalization during the 2016–2017 season in Canada. Given the low influenza VE observed, continued assessment of influenza VE is crucial to inform immunization policy in Canada and to emphasize the importance of the development and utilization of improved influenza vaccines. Disclosures M. K. Andrew, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. T. F. Hatchette, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Abbvie: Consultant, Speaker honorarium. J. McElhaney, GSK: Scientific Advisor, Speaker honorarium. sanofi pasteur: Scientific Advisor, Speaker honorarium. A. McGeer, GSK: Grant Investigator, Research grant. Hoffman La Roche: Grant Investigator, Research grant. sanofi pasteur: Grant Investigator, Research grant. A. Poirier, sanofi pasteur: Investigator, Research grant. Actelion: Grant Investigator, Research grant. J. Powis, GSK: Grant Investigator, Research grant. Merck: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. Synthetic Biologics: Investigator, Grant recipient. M. Semret, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. S. Trottier, CIHR: Grant Investigator, Research grant. S. A. McNeil, GSK: Grant Investigator, Research grant. Pfizer: Grant Investigator, Research grant. Merck: Collaborator and Consultant, Contract clinical trials and Speaker honorarium. Novartis: Collaborator, Contract clinical trials. sanofi pasteur: Collaborator, Contract clinical trials.
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Affiliation(s)
- Michaela Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada
| | - May Elsherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | | | - Jennie Johnstone
- McMaster University, Hamilton, ON, Canada
- Public Health Ontario, Toronto, ON, Canada
| | - Kevin Katz
- North York General Hospital, Toronto, ON, Canada
| | - Jason Leblanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Mark Loeb
- McMaster University, Hamilton, ON, Canada
| | - Donna Mackinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | | | - Janet McElhaney
- Health Sciences North Research Institute, Sudbury, ON, Canada
| | | | - Andre Poirier
- Centre Intégré Universitaire de santé et services sociaux, Trois-Rivieres, QC, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, ON, Canada
| | | | | | | | - Sylvie Trottier
- Centre Hospitalier Universitaire de Quebec, Quebec City, QC, Canada
| | | | - Duncan Webster
- Saint John Regional Hospital, Dalhousie University, Saint John, NB, Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, NS, Canada
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Patriquin G, Drebot M, Cole T, Lindsay R, Schleihauf E, Johnston BL, Dimitrova K, Traykova-Andonova M, Mask A, Haldane D, Hatchette TF. High Seroprevalence of Jamestown Canyon Virus among Deer and Humans, Nova Scotia, Canada. Emerg Infect Dis 2018; 24:118-121. [PMID: 29260667 PMCID: PMC5749476 DOI: 10.3201/eid2401.170484] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Using residual serum samples from Nova Scotia, Canada, we found that 87.8% of tested deer and an estimated 20.6% of the human population were infected with Jamestown Canyon virus. Human seropositivity reached 48.2% in 1 region. This virus may be an underrecognized cause of disease in Nova Scotia.
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Patriquin G, Hatchette JE, Hatchette TF. Risk acceptance of human T-lymphotropic virus infection in solid organ transplantation-A survey of Atlantic Canadian ambulatory patients. Transpl Infect Dis 2018; 20:e12958. [PMID: 29959880 DOI: 10.1111/tid.12958] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 05/28/2018] [Accepted: 06/22/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Human T-lymphotropic virus (HTLV) has an estimated prevalence of 12 per 100 000 in the general Canadian population (with higher rates in distinct groups) and is most commonly transmitted by breast feeding, sexual intercourse, sharing injection tools, and blood transfusions. A minority of those infected will develop severe disease. Health Canada mandates that people who are positive for HTLV are not suitable to be solid organ donors. Given the apparent low-disease burden of HTLV in Canada, we explored HTLV risk tolerance among patients, in the context of organ transplantations. METHODS Using telephone, and in-person questionnaires, we assessed willingness of patients to accept the risk of HTLV infection in hypothetical scenarios in which they required an organ transplant for survival. RESULTS Seventy-four outpatients attending various medical clinics participated in the survey. In a standard gamble scenario, 37.5% of respondents would have accepted a solid organ transplant regardless of HTLV risk, as compared to 27.3% and 24.6% accepting organ transplantation if there was a risk of human immunodeficiency virus (HIV) or of human virus Y (HVY; a fictitious virus describing HTLV in terms of neurological outcomes), respectively. Similarly, the median longevity traded to ensure a virus-free organ was 4-5 years regarding all viruses, except for HVY, for which the median time exchanged to ensure a virus-free organ was 10 (out of a possible 20) years. CONCLUSIONS These data suggest that patients, though willing to accept some risk of viral infection, would not be willing to forgo HTLV screening of solid organs.
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Affiliation(s)
- Glenn Patriquin
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jill E Hatchette
- Research Services, IWK Health Centre, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Division of Medical Microbiology, Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada.,Division of Infectious Diseases, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
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Nichols MK, Andrew MK, Hatchette TF, Ambrose A, Boivin G, Bowie W, Chit A, Dos Santos G, ElSherif M, Green K, Haguinet F, Halperin SA, Ibarguchi B, Johnstone J, Katz K, Lagacé-Wiens P, Langley JM, LeBlanc J, Loeb M, MacKinnon-Cameron D, McCarthy A, McElhaney JE, McGeer A, Poirier A, Powis J, Richardson D, Schuind A, Semret M, Shinde V, Smith S, Smyth D, Stiver G, Taylor G, Trottier S, Valiquette L, Webster D, Ye L, McNeil SA. Influenza vaccine effectiveness to prevent influenza-related hospitalizations and serious outcomes in Canadian adults over the 2011/12 through 2013/14 influenza seasons: A pooled analysis from the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS Network). Vaccine 2018; 36:2166-2175. [PMID: 29548608 DOI: 10.1016/j.vaccine.2018.02.093] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [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: 11/14/2017] [Revised: 02/21/2018] [Accepted: 02/22/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Ongoing assessment of influenza vaccine effectiveness (VE) is critical to inform public health policy. This study aimed to determine the VE of trivalent influenza vaccine (TIV) for preventing influenza-related hospitalizations and other serious outcomes over three consecutive influenza seasons. METHODS The Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research Network (CIRN) conducted active surveillance for influenza in adults ≥16 years (y) of age during the 2011/2012, 2012/2013 and 2013/2014 seasons in hospitals across Canada. A test-negative design was employed: cases were polymerase chain reaction (PCR)-positive for influenza; controls were PCR-negative for influenza and were matched to cases by date, admission site, and age (≥65 y or <65 y). All cases and controls had demographic and clinical characteristics (including influenza immunization status) obtained from the medical record. VE was estimated as 1-OR (odds ratio) in vaccinated vs. unvaccinated patients × 100%. The primary outcome was VE of TIV for preventing laboratory-confirmed influenza-related hospitalization; secondary outcomes included VE of TIV for preventing influenza-related intensive care unit (ICU) admission/mechanical ventilation, and influenza-related death. RESULTS Overall, 3394 cases and 4560 controls were enrolled; 2078 (61.2%) cases and 2939 (64.5%) controls were ≥65 y. Overall matched, adjusted VE was 41.7% (95% Confidence Interval (CI): 34.4-48.3%); corresponding VE in adults ≥65 y was 39.3% (95% CI: 29.4-47.8%) and 48.0% (95% CI: 37.5-56.7%) in adults <65 y, respectively. VE for preventing influenza-related ICU admission/mechanical ventilation in all ages was 54.1% (95% CI: 39.8-65.0%); in adults ≥65 y, VE for preventing influenza-related death was 74.5% (95% CI: 44.0-88.4%). CONCLUSIONS While effectiveness of TIV to prevent serious outcomes varies year to year, we demonstrate a statistically significant and clinically important TIV VE for preventing hospitalization and other serious outcomes over three seasons. Public health messaging should highlight the overall benefit of influenza vaccines over time while acknowledging year to year variability. ClinicalTrials.gov Identifier: NCT01517191.
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Affiliation(s)
- Michaela K Nichols
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | - William Bowie
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Ayman Chit
- Sanofi Pasteur, Swiftwater, PA, USA; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | | | - May ElSherif
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Green
- Mount Sinai Hospital, Toronto, Ontario, Canada
| | | | - Scott A Halperin
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | - Kevin Katz
- North York General Hospital, Toronto, Ontario, Canada
| | | | - Joanne M Langley
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason LeBlanc
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Mark Loeb
- McMaster University, Hamilton, Ontario, Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | | | | | - Andre Poirier
- Centre Intégré Universitaire de santé et services sociaux, Quebec, Quebec, Canada
| | - Jeff Powis
- Michael Garron Hospital, Toronto, Ontario, Canada
| | | | | | | | | | | | - Daniel Smyth
- The Moncton Hospital, Moncton, New Brunswick, Canada
| | - Grant Stiver
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | | | | | - Lingyun Ye
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Canadian Center for Vaccinology, IWK Health Centre and Nova Scotia Health Authority, Dalhousie University, Halifax, Nova Scotia, Canada.
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Al Sidairi H, Binkhamis K, Jackson C, Roberts C, Heinstein C, MacDonald J, Needle R, Hatchette TF, LeBlanc JJ. Comparison of two automated instruments for Epstein-Barr virus serology in a large adult hospital and implementation of an Epstein-Barr virus nuclear antigen-based testing algorithm. J Med Microbiol 2017; 66:1628-1634. [PMID: 29034860 DOI: 10.1099/jmm.0.000616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 11/18/2022] Open
Abstract
Serology remains the mainstay for diagnosis of Epstein-Barr virus (EBV) infection. This study compared two automated platforms (BioPlex 2200 and Architect i2000SR) to test three EBV serological markers: viral capsid antigen (VCA) immunoglobulins of class M (IgM), VCA immunoglobulins of class G (IgG) and EBV nuclear antigen-1 (EBNA-1) IgG. Using sera from 65 patients at various stages of EBV disease, BioPlex demonstrated near-perfect agreement for all EBV markers compared to a consensus reference. The agreement for Architect was near-perfect for VCA IgG and EBNA-1 IgG, and substantial for VCA IgM despite five equivocal results. Since the majority of testing in our hospital was from adults with EBNA-1 IgG positive results, post-implementation analysis of an EBNA-based algorithm showed advantages over parallel testing of the three serologic markers. This small verification demonstrated that both automated systems for EBV serology had good performance for all EBV markers, and an EBNA-based testing algorithm is ideal for an adult hospital.
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Affiliation(s)
- Hilal Al Sidairi
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Khalifa Binkhamis
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada.,King Saud University, Riyadh, Saudi Arabia
| | - Colleen Jackson
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
| | - Catherine Roberts
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
| | - Charles Heinstein
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
| | - Jimmy MacDonald
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada
| | - Robert Needle
- Public Health & Microbiology Laboratory, Eastern Health, St. John's, NL, Canada
| | - Todd F Hatchette
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
| | - Jason J LeBlanc
- Division of Microbiology, Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority (NSHA), Halifax, NS, Canada.,Dalhousie University, Halifax, NS, Canada
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Tang JW, Lam TT, Zaraket H, Lipkin WI, Drews SJ, Hatchette TF, Heraud JM, Koopmans MP. Global epidemiology of non-influenza RNA respiratory viruses: data gaps and a growing need for surveillance. Lancet Infect Dis 2017; 17:e320-e326. [PMID: 28457597 PMCID: PMC7164797 DOI: 10.1016/s1473-3099(17)30238-4] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Revised: 01/06/2017] [Accepted: 02/07/2017] [Indexed: 01/13/2023]
Abstract
Together with influenza, the non-influenza RNA respiratory viruses (NIRVs), which include respiratory syncytial virus, parainfluenza viruses, coronavirus, rhinovirus, and human metapneumovirus, represent a considerable global health burden, as recognised by WHO's Battle against Respiratory Viruses initiative. By contrast with influenza viruses, little is known about the contemporaneous global diversity of these viruses, and the relevance of such for development of pharmaceutical interventions. Although far less advanced than for influenza, antiviral drugs and vaccines are in different stages of development for several of these viruses, but no interventions have been licensed. This scarcity of global genetic data represents a substantial knowledge gap and impediment to the eventual licensing of new antiviral drugs and vaccines for NIRVs. Enhanced genetic surveillance will assist and boost research and development into new antiviral drugs and vaccines for these viruses. Additionally, understanding the global diversity of respiratory viruses is also part of emerging disease preparedness, because non-human coronaviruses and paramyxoviruses have been listed as priority concerns in a recent WHO research and development blueprint initiative for emerging infectious diseases. In this Personal View, we explain further the rationale for expanding the genetic database of NIRVs and emphasise the need for greater investment in this area of research.
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Affiliation(s)
- Julian W Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, UK; Department of Infection, Inflammation and Immunity, University of Leicester, Leicester, UK.
| | - Tommy T Lam
- School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Hassan Zaraket
- Department of Experimental Pathology, Immunology, and Microbiology, American University of Beirut, Beirut, Lebanon
| | - W Ian Lipkin
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Steven J Drews
- Alberta Provincial Laboratory for Public Health, University of Alberta, Edmonton, AB, Canada
| | - Todd F Hatchette
- Department of Microbiology and Immunology, Dalhousie University, Halifax, NS, Canada
| | | | - Marion P Koopmans
- Department of Viroscience, Erasmus Medical Centre, Rotterdam, Netherlands
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Gillis HD, Lang ALS, ElSherif M, Martin I, Hatchette TF, McNeil SA, LeBlanc JJ. Assessing the diagnostic accuracy of PCR-based detection of Streptococcus pneumoniae from nasopharyngeal swabs collected for viral studies in Canadian adults hospitalised with community-acquired pneumonia: a Serious Outcomes Surveillance (SOS) Network of the Canadian Immunization Research (CIRN) study. BMJ Open 2017; 7:e015008. [PMID: 28600368 PMCID: PMC5623389 DOI: 10.1136/bmjopen-2016-015008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 03/28/2017] [Accepted: 04/12/2017] [Indexed: 12/02/2022] Open
Abstract
STUDY DESIGN Detection and serotyping of Streptococcus pneumoniae are important to assess the impact of pneumococcal vaccines. This study describes the diagnostic accuracy of PCR-based detection of S. pneumoniae directly from nasopharyngeal (NP) swabs collected for respiratory virus studies. METHODS Active surveillance for community-acquired pneumonia (CAP) in hospitalised adults was performed from December 2010 to 2013. Detection of pneumococcal CAP (CAPSpn) was performed by urine antigen detection (UAD), identification of S. pneumoniae in sputum or blood cultures. S. pneumoniae was detected in NP swabs using lytA and cpsA real-time PCR, and serotyping was performed using conventional and real-time multiplex PCRs. For serotyping, the Quellung reaction, PCR-based serotyping or a serotype-specific UAD was used. RESULTS NP swab results were compared against CAP cases where all pneumococcal tests were performed (n=434), or where at least one test was performed (n=1616). CAPSpn was identified in 22.1% (96/434) and 14.9% (240/1616), respectively. The sensitivity of NP swab PCR for the detection of S. pneumoniae was poor for CAPSpn (35.4% (34/96) and 34.17% (82/240)), but high specificity was observed (99.4% (336/338) and 97.89% (1347/1376)). Of the positive NP swabs, a serotype could be deduced by PCR in 88.2% (30/34) and 93.9% (77/82), respectively. CONCLUSIONS While further optimisation may be needed to increase the sensitivity of PCR-based detection, its high specificity suggests there is a value for pneumococcal surveillance. With many laboratories archiving specimens for influenza virus surveillance, this specimen type could provide a non-culture-based method for pneumococcal surveillance.
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Affiliation(s)
- Hayley D Gillis
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Amanda L S Lang
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
| | - May ElSherif
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Irene Martin
- National Microbiology Laboratory (NML), Winnipeg, Manitoba, Canada
| | - Todd F Hatchette
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Shelly A McNeil
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Jason J LeBlanc
- Canadian Centre for Vaccinology (CCfV), IWK Health Center, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia, Canada
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LeBlanc JJ, ElSherif M, Ye L, MacKinnon-Cameron D, Li L, Ambrose A, Hatchette TF, Lang AL, Gillis H, Martin I, Andrew MK, Boivin G, Bowie W, Green K, Johnstone J, Loeb M, McCarthy A, McGeer A, Moraca S, Semret M, Stiver G, Trottier S, Valiquette L, Webster D, McNeil SA. Burden of vaccine-preventable pneumococcal disease in hospitalized adults: A Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network study. Vaccine 2017; 35:3647-3654. [PMID: 28554501 DOI: 10.1016/j.vaccine.2017.05.049] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [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: 10/14/2016] [Revised: 05/11/2017] [Accepted: 05/16/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Pneumococcal community acquired pneumonia (CAPSpn) and invasive pneumococcal disease (IPD) cause significant morbidity and mortality worldwide. Although childhood immunization programs have reduced the overall burden of pneumococcal disease, there is insufficient data in Canada to inform immunization policy in immunocompetent adults. This study aimed to describe clinical outcomes of pneumococcal disease in hospitalized Canadian adults, and determine the proportion of cases caused by vaccine-preventable serotypes. METHODS Active surveillance for CAPSpn and IPD in hospitalized adults was performed in hospitals across five Canadian provinces from December 2010 to 2013. CAPSpn were identified using sputum culture, blood culture, a commercial pan-pneumococcal urine antigen detection (UAD), or a serotype-specific UAD. The serotype distribution was characterized using Quellung reaction, and PCR-based serotyping on cultured isolates, or using a 13-valent pneumococcal conjugate vaccine (PCV13) serotype-specific UAD assay. RESULTS AND CONCLUSIONS In total, 4769 all-cause CAP cases and 81 cases of IPD (non-CAP) were identified. Of the 4769 all-cause CAP cases, a laboratory test for S. pneumoniae was performed in 3851, identifying 14.3% as CAPSpn. Of CAP cases among whom all four diagnostic test were performed, S. pneumoniae was identified in 23.2% (144/621). CAPSpn cases increased with age and the disease burden of illness was evident in terms of requirement for mechanical ventilation, intensive care unit admission, and 30-day mortality. Of serotypeable CAPSpn or IPD results, predominance for serotypes 3, 7F, 19A, and 22F was observed. The proportion of hospitalized CAP cases caused by a PCV13-type S. pneumoniae ranged between 7.0% and 14.8% among cases with at least one test for S. pneumoniae performed or in whom all four diagnostic tests were performed, respectively. Overall, vaccine-preventable pneumococcal CAP and IPD were shown to be significant causes of morbidity and mortality in hospitalized Canadian adults in the three years following infant PCV13 immunization programs in Canada.
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Affiliation(s)
- Jason J LeBlanc
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada.
| | - May ElSherif
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Lingyun Ye
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Donna MacKinnon-Cameron
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Li Li
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Ardith Ambrose
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Todd F Hatchette
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Amanda L Lang
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Hayley Gillis
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Irene Martin
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Melissa K Andrew
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Guy Boivin
- Centre Hospitalier Universitaire de Québec, Québec, Québec (QC), Canada
| | - William Bowie
- Vancouver General Hospital, and University of British Columbia, Vancouver, BC, Canada
| | | | | | - Mark Loeb
- McMaster University, Hamilton, ON, Canada
| | | | | | - Sanela Moraca
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada
| | - Makeda Semret
- McGill University Health Centre, Montreal, QC, Canada
| | - Grant Stiver
- Centre Hospitalier Universitaire de Québec, Québec, Québec (QC), Canada
| | - Sylvie Trottier
- Centre Hospitalier Universitaire de Québec, Québec, Québec (QC), Canada
| | - Louis Valiquette
- Centre Intégré Universitaire de Santé et de Services Sociaux de l'Estrie - Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Shelly A McNeil
- Canadian Center for Vaccinology (CCfV), IWK Health Centre, Nova Scotia Health Authority (NSHA), and Dalhousie University, Halifax, Nova Scotia (NS), Canada.
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Ogden NH, Arsenault J, Hatchette TF, Mechai S, Lindsay LR. Antibody responses to Borrelia burgdorferi detected by western blot vary geographically in Canada. PLoS One 2017; 12:e0171731. [PMID: 28182723 PMCID: PMC5300191 DOI: 10.1371/journal.pone.0171731] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 01/23/2017] [Indexed: 02/03/2023] Open
Abstract
Lyme disease is emerging in eastern and central Canada, and most cases are diagnosed using the two-tier serological test (Enzyme Immuno Assay [EIA] followed by Western blot [WB]). Simplification of this algorithm would be advantageous unless it impacts test performance. In this study, accuracy of individual proteins of the IgG WB algorithm in predicting the overall test result in samples from Canadians was assessed. Because Borrelia burgdorferi strains vary geographically in Canada, geographic variations in serological responses were also explored. Metrics of relative sensitivity, specificity and the kappa statistic measure of concordance were used to assess the capacity of responses to individual proteins to predict the overall IgG WB result of 2524 EIA (C6)-positive samples from across Canada. Geographic and interannual variations in proportions of samples testing positive were explored by logistic regression. No one protein was highly concordant with the IgG WB result. Significant variations were found amongst years and geographic regions in the prevalence of samples testing positive using the overall IgG WB algorithm, and for individual proteins of the algorithm. In most cases the prevalence of samples testing positive were highest in Nova Scotia, and lower in samples from Manitoba westwards. These findings suggest that the current two tier test may not be simplified and continued use of the current two-tier test method and interpretation is recommended. Geographic and interannual variations in the prevalence of samples testing positive may be consistent with B. burgdorferi strain variation in Canada, and further studies are needed to explore this.
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Affiliation(s)
- Nicholas H. Ogden
- National Microbiology Laboratory, Public Health Agency of Canada, Saint-Hyacinthe, Québec, Canada
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- * E-mail:
| | - Julie Arsenault
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - Todd F. Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Department of Pathology, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Samir Mechai
- Groupe de recherche en épidémiologie des zoonoses et santé publique (GREZOSP), Saint-Hyacinthe, Québec, Canada
- Département de pathologie et microbiologie, Faculté de médecine vétérinaire, Université de Montréal, Saint-Hyacinthe, Québec, Canada
| | - L. Robbin Lindsay
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
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Hatchette TF, Scholz H, Bolotin S, Crowcroft NS, Jackson C, McLachlan E, Severini A. Calibration and Evaluation of Quantitative Antibody Titers for Measles Virus by Using the BioPlex 2200. Clin Vaccine Immunol 2017; 24:e00269-16. [PMID: 27852634 PMCID: PMC5216424 DOI: 10.1128/cvi.00269-16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 10/18/2016] [Indexed: 11/20/2022]
Abstract
The BioPlex 2200 (Bio-Rad Laboratories, Hercules, CA) is a rapid, automated platform, which can screen large numbers of specimens for antibodies to measles, mumps, rubella, and varicella. Although approved for producing qualitative results, in this study we validated the test (off-label) to allow reporting of quantitative results. To do this, we used the third anti-measles World Health Organization standard to generate a calibration curve that allowed relative fluorescence intensity to be translated into quantitative antibody titer (antibody units [AU]/ml). The results from the BioPlex 2200 and the reference plaque reduction neutralization test (PRNT) exhibited a reasonable correlation following an exponential function, but correlation was poor in low-titer samples. Using a receiver operating characteristics analysis, an equivocal zone for the BioPlex 2200 was established between ≥0.13 and <1.10 AU/ml to achieve 100% specificity (95% confidence interval [CI] = 83.2 to 100%) and 100% sensitivity (95% CI = 93.5 to 100%) versus PRNT. By determining an equivocal range requiring confirmation by PRNT, we can avoid underestimating the levels of immunity through false-negative results and optimize methods for seroepidemiological studies.
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Affiliation(s)
- Todd F Hatchette
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
- Canadian Center for Vaccinology, IWK Health Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Shelly Bolotin
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Natasha S Crowcroft
- Public Health Ontario, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Colleen Jackson
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, Nova Scotia, Canada
| | - Elizabeth McLachlan
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
| | - Alberto Severini
- National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada
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Binkhamis K, Gillis H, Lafreniere JD, Hiebert J, Mendoza L, Pettipas J, Severini A, Hatchette TF, LeBlanc JJ. Comparison of monoplex and duplex RT-PCR assays for the detection of measles virus. J Virol Methods 2016; 239:58-60. [PMID: 27838260 DOI: 10.1016/j.jviromet.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/04/2016] [Accepted: 11/05/2016] [Indexed: 11/25/2022]
Abstract
Rapid and accurate detection of measles virus is important for case diagnosis and public health management. This study compared the performance of two monoplex RT-PCR reactions targeting the H and N genes to a duplex RT-PCR targeting both genes simultaneously. The duplex simplified processing without compromising assay performance characteristic.
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Affiliation(s)
- Khalifa Binkhamis
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | - Hayley Gillis
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | | | - Joanne Hiebert
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Lillian Mendoza
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Janice Pettipas
- Nova Scotia Provincial Public Health Laboratory Network (PPHLN), Halifax, NS, Canada
| | - Alberto Severini
- Viral Exanthemata and STDs, National Microbiology Laboratory (NML), Public Health Agency of Canada (PHAC), Winnipeg, MB, Canada
| | - Todd F Hatchette
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada
| | - Jason J LeBlanc
- Nova Scotia Health Authority (NSHA) and Dalhousie University, Halifax, NS, Canada.
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Lang AL, Gillis HD, Elsherif M, Martin I, Hatchette TF, McNeil SA, LeBlanc JJ. Refining PCR-based serotyping for detection of vaccine-preventable Streptococcus pneumoniae. ACTA ACUST UNITED AC 2016. [DOI: 10.5430/jer.v3n1p28] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Hatchette TF, Johnston BL, Schleihauf E, Mask A, Haldane D, Drebot M, Baikie M, Cole TJ, Fleming S, Gould R, Lindsay R. Epidemiology of Lyme Disease, Nova Scotia, Canada, 2002-2013. Emerg Infect Dis 2016; 21:1751-8. [PMID: 26401788 PMCID: PMC4593424 DOI: 10.3201/eid2110.141640] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Nova Scotia has the highest reported incidence in Canada, but risk is localized to identified disease-endemic regions. Ixodes scapularis ticks, which transmit Borreliaburgdorferi, the causative agent of Lyme disease (LD), are endemic to at least 6 regions of Nova Scotia, Canada. To assess the epidemiology and prevalence of LD in Nova Scotia, we analyzed data from 329 persons with LD reported in Nova Scotia during 2002–2013. Most patients reported symptoms of early localized infection with rash (89.7%), influenza-like illness (69.6%), or both; clinician-diagnosed erythema migrans was documented for 53.2%. In a separate serosurvey, of 1,855 serum samples screened for antibodies to B.burgdorferi, 2 were borderline positive (both with an indeterminate IgG on Western blot), resulting in an estimated seroprevalence of 0.14% (95% CI 0.02%–0.51%). Although LD incidence in Nova Scotia has risen sharply since 2002 and is the highest in Canada (16/100,000 population in 2013), the estimated number of residents with evidence of infection is low, and risk is localized to currently identified LD-endemic regions.
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LeBlanc JJ, Pettipas J, Gaston D, Taylor R, Hatchette TF, Booth TF, Mandes R, McDermid A, Grudeski E. Outbreak of Norovirus GII.P17-GII.17 in the Canadian Province of Nova Scotia. Can J Infect Dis Med Microbiol 2016; 2016:1280247. [PMID: 27366155 PMCID: PMC4904589 DOI: 10.1155/2016/1280247] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/13/2015] [Indexed: 11/25/2022]
Abstract
Background. Norovirus is the leading cause of viral gastroenteritis, with GII.4 being the most common circulating genotype. Recently, outbreaks in China revealed that norovirus GII.17 GII.P17 had become predominant. Objective. This study aimed to characterize the distribution of norovirus genotypes circulating in Nova Scotia. Methods. Stool specimens were collected from gastrointestinal outbreaks in Nova Scotia between Jan 2014 and June 2015 and subjected to real-time RT-PCR. Norovirus-positive specimens were referred to the National Microbiology Laboratory for sequence-based genotyping. Results. The first norovirus GII.P17-GII.17 outbreak in Canada was identified, but no widespread activity was observed in Nova Scotia. Discussion. It is unknown whether GII.P17-GII.17 is more widespread in Canada since contributions to Canadian surveillance are too sparse to effectively monitor the epidemiology of emerging norovirus genotypes. Conclusions. Presence of norovirus GII.17:P17 in Canada highlights the need for more systematic surveillance to ensure that molecular targets used for laboratory detection are effective and help understand norovirus evolution, epidemiology, and pathogenesis.
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Affiliation(s)
- Jason J. LeBlanc
- Nova Scotia Health Authority (NSHA), Halifax, NS, Canada B3H 1V8
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | - Janice Pettipas
- Nova Scotia Health Authority (NSHA), Halifax, NS, Canada B3H 1V8
- Provincial Public Health Laboratory Network of Nova Scotia (PPHLN), Halifax, NS, Canada B3H 1V8
| | - Daniel Gaston
- Nova Scotia Health Authority (NSHA), Halifax, NS, Canada B3H 1V8
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | - Robin Taylor
- Nova Scotia Health Authority (NSHA), Halifax, NS, Canada B3H 1V8
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | - Todd F. Hatchette
- Nova Scotia Health Authority (NSHA), Halifax, NS, Canada B3H 1V8
- Dalhousie University, Halifax, NS, Canada B3H 4R2
| | - Tim F. Booth
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada R3E 3R2
- University of Manitoba, Winnipeg, MB, Canada R3T 2N2
| | - Russell Mandes
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada R3E 3R2
| | | | - Elsie Grudeski
- National Microbiology Laboratory (NML), Winnipeg, MB, Canada R3E 3R2
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Abstract
Increasing the transparency of the evidence base behind health interventions such as pharmaceuticals, biologics, and medical devices, has become a major point of critique, conflict, and policy focus in recent years. Yet the lack of publicly available information regarding the immunogenicity assays upon which many important, widely used vaccines are based has received no attention to date. In this paper we draw attention to this critical public health problem by reporting on our efforts to secure vaccine assay information in respect of 10 vaccines through Canada's access to information law. We argue, under Canadian law, that the public health interest in having access to the methods for these laboratory procedures should override claims by vaccine manufacturers and regulators that this information is proprietary; and, we call upon several actors to take steps to ensure greater transparency with respect to vaccine assays, including regulators, private firms, researchers, research institutions, research funders, and journal editors.
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Affiliation(s)
- Matthew Herder
- a Faculties of Medicine and Law; Health Law Institute ; Dalhousie University ; Halifax , Nova Scotia , Canada
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Patriquin G, LeBlanc J, Heinstein C, Roberts C, Lindsay R, Hatchette TF. Cross-reactivity between Lyme and syphilis screening assays: Lyme disease does not cause false-positive syphilis screens. Diagn Microbiol Infect Dis 2015; 84:184-6. [PMID: 26707064 DOI: 10.1016/j.diagmicrobio.2015.11.019] [Citation(s) in RCA: 3] [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: 07/09/2015] [Revised: 11/16/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022]
Abstract
Increased rates of Lyme disease and syphilis in the same geographic area prompted an assessment of screening test cross-reactivity. This study supports the previously described cross-reactivity of Lyme screening among syphilis-positive sera and reports evidence against the possibility of false-positive syphilis screening tests resulting from previous Borrelia burgdorferi infection.
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Affiliation(s)
- Glenn Patriquin
- Department of Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada.
| | - Jason LeBlanc
- Department of Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada
| | - Charles Heinstein
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Catherine Roberts
- Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada
| | - Robbin Lindsay
- Public Health Agency of Canada (PHAC), National Microbiology Laboratory (NML), Winnipeg, MB, Canada
| | - Todd F Hatchette
- Department of Medicine, Nova Scotia Health Authority and Dalhousie University, Halifax, NS, Canada; Department of Pathology and Laboratory Medicine, Nova Scotia Health Authority, Halifax, NS, Canada; Department of Pathology, Dalhousie University, Halifax, NS, Canada
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LeBlanc JJ, Heinstein C, MacDonald J, Gallant R, Roberts C, Jackson C, Lou A, Nassar BA, Hatchette TF. Pushing the limits of chemistry point-of-care testing for the management of patients under investigation for Ebola virus disease. Ann Clin Biochem 2015; 53:288-91. [DOI: 10.1177/0004563215581651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/20/2015] [Indexed: 11/15/2022]
Abstract
Background With the recent outbreak in West Africa, hospitals worldwide have been developing protocols for suspect of cases of Ebola virus disease. Patients with Ebola virus disease present with a severe gastroenteritis leading to dehydration and electrolyte abnormalities and as such, routine chemistry analysis is essential for patient management. While point-of-care testing can be used with additional precautions for rapid chemistry analyses in a laboratory setting, significant delays could ensue before specimens arrive to the laboratory. This study evaluated the stability of eight chemistry analytes up to 4 h post-collection. Methods Blood was collected by venipuncture from 20 healthy volunteers and tested at times 0, 30, 60, 90, 120 and 240 h. Approximately 100 µl of blood was dispensed into a CHEM 8+Cartridge and processed on a model 300 i-STAT 1 Analyzer (Abbott Point of Care Inc.) and ANOVA was used to assess statistical significant difference from the initial time point. Results While the manufacturer recommends testing within 30 min of collection, no significant variation was observed for most analytes with time points extending up to 4 h. In contrast, glucose concentrations decreased significantly ( P < 0.0001) over time at an average rate of 0.0032 mmol/L per min. Conclusions This study provides supporting data suggesting that delays up to 4 h can be tolerated, giving ample time for collection and transport of specimens to the clinical laboratory. For glucose, POC testing could still be used, taking into account the collection time and the average rate of decrease.
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Affiliation(s)
- Jason J LeBlanc
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
- Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada
| | - Charles Heinstein
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - James MacDonald
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Roy Gallant
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Catherine Roberts
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Colleen Jackson
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
| | - Amy Lou
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
- Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada
| | - Bassam A Nassar
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
- Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada
| | - Todd F Hatchette
- Department of Pathology and Laboratory Medicine, Novo Scotia Health Authority (NSHA), Halifax, Nova Scotia, Canada
- Department of Pathology Dalhousie University, Halifax, Nova Scotia, Canada
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