Cambridge City Hall is lit up in red on Thursday, March 24 to mark World Tuberculosis Day.
Tuberculosis affects approximately 10 million people a year, according to the World Health Organization. More than 35 Canadian landmarks are lit up in red to spread awareness.
Prior to COVID-19, tuberculosis was the deadliest infectious disease, and the pandemic has only worsened the burden of this ancient epidemic.
The pandemic has also resulted in a diversion of resources which has interrupted tuberculosis care in Canada, and threatened progress toward the United Nations Sustainable Development goal of ending tuberculosis deaths by 2030.
Advocates are calling for government leaders to step up for those affected by tuberculosis in Canada and abroad.
Tina Campbell, co-chair of Stop TB Canada, says that long-term solutions are needed for tuberculosis care.
“My hope is that we catch the attention of leadership — locally, domestically and globally — and work toward making TB programming a priority,” says Campbell in a news release.
“TB continues to disproportionately affect Indigenous communities in our region. Recently we have declared three outbreaks of TB, and to identify and treat TB, we need long-term solutions.”
Malaria, the parasitic infection spread by mosquito bites, is especially deadly for young children. Long-lasting insecticidal nets (LLINs) have significantly reduced malaria infections in sub-Saharan Africa. However, a large proportion of mosquitoes have since developed resistance to the insecticides.
One study, published in The Lancet, tested LLINs with new active ingredients to evaluate their success against malaria vectors. The study found that LLINs treated with the insecticides chlorfenapyr and pyrethroid reduced malaria infections by nearly half.
“Malaria remains a huge problem across sub-Saharan Africa and is one of the leading causes of death in Tanzania,” said Jacklin F. Mosha, PhD, the first author of the study. “We urgently need new interventions to get control efforts back on track and protect young people from this deadly disease. These exciting results highlight that we have another effective tool to help control malaria.”
The investigators conducted a cluster-randomized trial in Misungwi, Tanzania, an area in sub-Saharan African with high malaria incidence among children. The clusters were villages of at least 119 households with children 6 months-14 years of age living in the central area.
Clusters received 1 of 4 types of LLIN treated with α-cypermethrin only (pyrethroid-only control group); pyriproxyfen and α-cypermethrin (pyriproxyfen group); chlorfenapyr and α-cypermethrin (chlorfenapyr group); or the synergist piperonyl butoxide and permethrin (piperonyl butoxide group). At least 1 LLIN was given to every 2 people.
The investigators collected malaria prevalence data by administering cross-sectional surveys to randomly chosen households within each cluster. Children 6 months-14 years were screened for Plasmodium falciparum malaria infection via rapid diagnostic testing.
Each of the duel-active-ingredient LLINs were compared to the standard pyrethroid-only LLINs. The primary study outcome was malaria prevalence at 24 months after LLIN distribution. Secondary outcomes included cost-effectiveness of dual-active-ingredient LLINs.
From May 11-July 2, 2018, the investigators recruited 39307 households, broken into 84 clusters. A total of 147230 LLINs were distributed amongst the households from January 26-January 28, 2019. LLIN use was reported in 72.1% of surveyed participants at 3 months after distribution, which decreased to a 40.9% response rate at 24 months after distribution.
Malaria infection at 24 months after LLIN dispersal was 45.8% in the pytheroid-only group, 37.5% in the pyriproxyfen group, 40.7% in the piperonyl butoxide group, and 25.6% in the chlorfenapyr group. The most cost-effective LLINs were chlorfenapyr, and the most commonly reported adverse events were skin irritation or paresthesia. The study authors noted that poor textile quality and active ingredient durability of the piperonyl butoxide and pyriproxyfen LLINs may have lowered their efficacy.
Overall, the LLINs treated with chlorfenapyr and pytheroid reduced malaria infections by 43% in the first year and 37% in the second year. Chlorfenapyr works differently from the standard pytheroid-only LLINs, causing wing muscles cramps that stop the mosquitos from flying, and thus from biting hosts.
“What really threw us for a long time was that in daytime tests the chlorfenapyr was not very toxic to the mosquito,” said Mark Rowland, PhD, an author of the study. “But at night when the malaria mosquitoes naturally fly up against the treated bednet it gets a severe case of muscle cramps so it buckles and falls to where it is likely to be carried off by scavenging ants. No other mosquito insecticide works like this, and because of the unique mode of action it kills all kind of mosquito that have evolved resistance to other insecticides. It should have a long future.”
The investigators concluded that after 2 years, the chlorfenapyr LLINs provided better malaria protection than the pyrethroid-only LLINs, in an area with pyrethroid-resistant mosquitoes.
However, they noted that switching over to the chlorfenapyr nets should be done with caution, to avoid the mosquitoes once again developing resistance. “The massive scale-up of standard pyrethroid LLINs 10-20 years ago led to the rapid spread of pyrethroid resistance. The challenge now is to preserve chlorfenapyr’s effectiveness by developing rational resistance management strategies,” said Natacha Protopopoff, PhD, a principal investigator.
As Hamilton began COVID-19 vaccination programs, we're tracking every dose administered.
Hamiltonnews.com is publishing data from Hamilton public health as it becomes available. Here’s what we know:
Hamilton's COVID vaccination sites
Hamilton public health has been administering doses of the vaccine through a mobile clinic since Jan. 10, 2021 and fixed-site clinic at Hamilton Health Sciences since Dec. 23, 2020. Doses of the vaccine also are being administered via a Ministry of Health mobile clinic and fixed-site clinics at St. Joseph’s Healthcare Hamilton, First Ontario Centre, ArcelorMittal Dofasco, Lime Ridge Mall and The Centre on Barton, as well as primary care and pharmacy clinics.
Doses of vaccine administered through Hamilton public health mobile clinic
There have been 122,614 doses of the vaccine administered.
Doses of vaccine administered through Ministry of Health mobile clinic
There have been 12,146 doses administered.
Doses of vaccine administered via fixed-site clinic at Hamilton Health Sciences
There have been 176,941 doses administered.
Doses of vaccine administered via fixed-site clinic at St. Joseph’s Healthcare
There have been 184,723 doses administered.
Doses of vaccine administered via fixed-site clinic at First Ontario Centre
There have been 179,683 doses administered.
Doses of vaccine administered via fixed-site clinic at ArcelorMittal Dofasco
There have been 17,580 doses administered.
Doses of vaccine administered via fixed-site clinic at Lime Ridge Mall
There have been 58,429 doses administered.
Doses of vaccine administered via fixed-site clinic at The Centre on Barton
There have been 65,595 doses administered.
Doses of vaccine administered via primary care clinics
There have been 99,288 doses administered.
Doses of vaccine administered via pharmacy clinics
The graph lists the most up-to-date information of doses administered in Hamilton so far, with numbers from the Hamilton public health mobile clinic, Ministry of Health mobile clinic, fixed-site clinic at Hamilton Health Sciences and fixed-site clinics at St. Joseph’s Healthcare Hamilton, First Ontario Centre, ArcelorMittal Dofasco, Lime Ridge Mall and The Centre on Barton, as well as primary care and pharmacy clinics for a total of 1,223,507. Doses administered may include health care workers who work in Hamilton but do not live here.
The bar chart above illustrates the most up-to-date number of vaccine doses that have been administered in Hamilton and compares them with the regional population.
The vaccination data used in the bar chart is manually compiled from each public health unit in Ontario and is being updated regularly.
As the vaccine generally requires two separate doses, the number of doses administered does not reflect the number of people who have completed vaccinations.
NEWS RELEASE
SIMCOE MUSKOKA DISTRICT HEALTH UNIT
*************************
Each year, the Simcoe Muskoka District Health Unit (SMDHU) commemorates World Tuberculosis (TB) Day on March 24 to raise awareness about the devastating health, social and economic consequences of TB.
For most living in Simcoe-Muskoka, the risk of being exposed to TB is low; however, recognition of World TB Day at a local level is essential to increase the community's awareness of this serious infectious disease to reduce the incidence of tuberculosis globally.
Although TB is preventable, treatable and curable with antibiotics, it remains one of the most common and deadly infectious diseases in the world today. It is responsible for the deaths of almost one and a half million people each year, mostly in developing countries where diagnosis and treatment are not readily available.
Every year in Canada there are approximately 1,600 new cases of active TB reported. Those who have lived or travelled extensively in countries where TB is widespread are at higher risk of having contact with the bacteria. First Nations, Inuit and Métis people in Canada continue to be disproportionately affected by TB.
From 2000-2021, Simcoe Muskoka reported 79 cases of TB. Each case requires public health resources in prevention, control, and treatment. Tuberculosis is a reportable disease; therefore, when an active case of TB is identified in the community the health unit investigates close contacts of the individual to determine if any other persons have become infected.
If these contacts develop a latent infection, they are offered preventive medication to keep them from becoming sick. Those taking medications are monitored by public health throughout their treatment.
TB is an airborne bacterial infection caused by the organism Mycobacterium tuberculosis that primarily affects the lungs, although other organs and tissues may be involved. People with active TB can transmit the bacteria to others through the air by coughing and sneezing droplets that can be inhaled by people who are close by.
World Tuberculosis Day is an important occasion to mobilize society towards eliminating TB as a global public health burden. This year’s theme as designated by the World Health Organization is “Invest to End TB. Save Lives”. For more information, please visit StopTBCanada.ca.
For more information about TB symptoms, how it spreads, who is at risk, testing and treatment, and how TB can be prevented, visit smdhu.org.
A wildlife facility in Nova Scotia is raising funds to build a quarantine space for birds ranging from crows to bald eagles as the province deals with a growing number of cases of H5N1 avian flu.
Brenda Boates, wildlife operations manager of the Cobequid Wildlife Rehabilitation Centre in Brookfield, N.S., said Thursday that the organization estimates it needs $7,000 to build a structure to house birds it suspects are infected with the disease.
The organization is now using a modified garage to quarantine the birds. "We're looking at a separate building that's going to be built to our specifications and going to be able to be completely contained," Boates said in an interview.
The concern follows the province's first confirmed case of the highly pathogenic H5N1 avian flu strain in January and additional cases in wild birds and commercial flocks since, including the infection of a non-commercial flock in southern Nova Scotia discovered last week.
According to recent data from the Canadian Wildlife Health Cooperative, as of March 22, 33 dead birds and 31 live birds have tested positive for the H5N1 strain across the Atlantic region.
The rehabilitation centre's makeshift quarantine space houses three boxes for raptors, including bald eagles, owls and hawks, and smaller compartments for other birds, such as songbirds and crows. Boates said it is now empty after its most recent occupants were released either into the facility's flyways or back into the wild, making it a perfect time to build a permanent structure.
Birds are quarantined for up to 30 days if they have injuries or symptoms that suggest they're infected with the disease, she said, but none of the birds quarantined so far has tested positive.
Apart from the quarantine area, the organization has had as many as 56 animals in care at one time and the length of stay depends on the animal and the illness or injury the animal is dealing with, Boates said, ranging from a week to months.
This report by The Canadian Press was first published March 24, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
The new Omicron subvariant, BA.2, is spreading across the United States and will soon take over as the major COVID variant, White House chief medical adviser Dr. Anthony Fauci said Tuesday.
"Ultimately it will be the predominant variant in this country," Fauci told HealthDay. "It's occupying about 85% of the variants in the world, and somewhere around 30%-plus of the variants in the United States. It has what's called the transmission advantage, which means it transmits a bit more efficiently than the BA.1, which is the original Omicron variant."
However, Fauci and other infectious disease experts do not believe BA.2 will wreak the sort of havoc caused by earlier variants.
COVID cases might rise, perhaps even surge in some locales, but the experts are cautiously optimistic that BA.2 will not cause a sharp increase in hospitalizations and deaths—or an immediate need to return to masking and social distancing.
That's partly because BA.2 is not a completely new COVID variant, as were Delta and Omicron, noted Dr. William Schaffner, medical director of the National Foundation for Infectious Diseases.
"You can almost think of it as 'Son of Omicron.' It's slightly different, but not very different," Schaffner said.
"It appears to be even more contagious than Omicron is, if you can imagine," Schaffner continued. "But there are two characteristics about BA.2 that are fortunate. The first is that it appears not to produce more severe disease. And the second is that it would appear our current vaccines provide just about the same degree of protection against BA.2 that they do against Omicron."
Omicron BA.2 is rolling through the United Kingdom and the European Union, and those countries are providing a forecast for what Americans might expect, said Fauci, who is also director of the U.S. National Institute of Allergy and Infectious Diseases.
"They are having an uptick in cases that does not seem to be accompanied by an uptick in severity of disease as manifested by an unusual increase in hospitalizations," Fauci said. "So, even though there appears to be more cases, they're not seeing an increase in utilization of intensive care unit beds, which is a reflection that there does not appear to be more severity of disease associated with BA.2."
Protection from hospitalization, if not infection
Sadly, scientists have learned that vaccine protection appears to wane "pretty easily" in both the vaccinated and those who've suffered a natural infection, Fauci noted.
"If you look at the vaccine efficacy and you measure just symptomatic infection, after a few months following either infection and/or vaccination you have a rather significant diminution of vaccine efficacy," Fauci said.
"What appears to hold up, even after several months, is protection against hospitalization," Fauci said. "The bottom line is it's much easier to protect against hospitalization than it is to protect against infection."
So, although you might have a greater chance of catching a mild case of BA.2, if you're vaccinated and boosted your chances of landing in the emergency room are low, experts said.
"People that are vaccinated and boosted, they don't seem to be having a significantly increased hospitalization rate of serious illness between BA.1 and BA.2," said Dr. Aaron Glatt, chief of infectious diseases at Mount Sinai South Nassau in Oceanside, N.Y. "BA.2 is more contagious than BA.1, but it's also a fact that BA.2 is not more dangerous than BA.1. Those are two facts we can take to the bank."
Glatt also suspects that places hit hard by Omicron will not receive a one-two punch from BA.2, since the two are very nearly the same. Natural immunity acquired from the original BA.1 variant will likely carry over to some extent to BA.2.
Because of these factors, infectious disease experts don't expect masking and social distancing requirements to be reinstituted wholesale due to BA.2, even if case counts begin to rise.
The U.S. Centers for Disease Control and Prevention recently updated its community COVID tracking to focus on hospitalizations more than case counts. If BA.2 isn't causing more hospitalizations, then communities won't come under pressure to bring back masking.
Timing also plays a role—BA.2 is gaining steam as the spring and summer months begin in the United States, said Dr. Abinash Virk, an infectious disease specialist with the Mayo Clinic in Rochester, Minn.
"There's more ability to be outside and do more outdoor stuff, so indoor activity concentration goes down," Virk said. "Hopefully the infection rates will not be as high as they were with Omicron BA.1."
Vaccines remain best protection
Experts continue to recommend that people get vaccinated and boosted against COVID, to prevent hospitalizations and better protect against BA.2.
"We've still got to do better with vaccination," Fauci said. "We only have 65% of the total population fully vaccinated. Of those who've been vaccinated, only 50% of them have had their booster."
And people at increased risk of severe COVID—the unvaccinated, elderly or the immune-compromised—should consider still wearing a mask and maintaining social distance as BA.2 spreads, Virk added.
"On an individual level, I think people may still continue to make decisions for themselves," Virk said. "Some days I wear a mask to go to the grocery store, and sometimes I don't. It just depends on how crowded it is and those kind of things."
Finally, there's always the chance that another COVID variant will emerge that poses an even greater threat, the experts said. Such a thing could completely turn over the card table.
"A new variant could occur that might evade the protection of our current vaccines," Schaffner said. "If that happens, then Katie, bar the door, we'll have to start over."
"That is something that is a possibility, and we've got to be prepared for it," Fauci said of another new COVID variant surfacing. "Remember, we've had variants that have come out of nowhere and surprised us. Delta did not originate in the United States. It originated in India. Omicron originated in southern Africa.
"As long as there's a lot of viral dynamics throughout the world, there's always a risk of a variant emerging that's very different from what we've experienced now," Fauci continued. "Although we're all pleased that we're heading in the right direction and that we continue to have a diminution in cases and in hospitalizations and deaths, we can't be overconfident. We must be prepared for the eventuality of having another variant."
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As several countries report an uptick in COVID-19 cases partly blamed on a more contagious version of the Omicron variant, the question becomes whether Canada's next wave will be a surge or a ripple.
The confluence of easing COVID-19 protocols and the rise of BA.2, a sublineage of the Omicron variant, is complicating the epidemiological forecast for spring, experts say.
While most agree that Canada's immunization rates should blunt the impacts of the so-called "stealth" subvariant, some worry that decreased public health vigilance could clear a path for BA.2 to drive up infections and hospitalizations.
Canada's chief public health officer suggested last week that the country should be shielded from the worst of the COVID-19 resurgence that's roiling regions abroad, instead predicting a spring "blip" as public health measures are lifted.
While evidence suggests that BA.2 is more transmissible than its Omicron predecessor, the subvariant is spreading at a relatively slow rate in Canada, said Dr. Theresa Tam.
It doesn't appear to to cause more severe illness than other variants, she said, but international data suggests BA.2 targets people who aren't protected by vaccination or previous exposure to the Omicron variant.
That means Canada's high immunization uptake — with 81 per cent of the population considered fully vaccinated — should keep hospitalizations at manageable levels even if cases rise, said Tam.
But Dr. Lynora Saxinger, an infectious disease specialist at the University of Alberta, warned that the risks of BA.2 could be unevenly distributed across Canada.
Omicron reinfection appears to be rare, Saxinger said, so regions that were hit hard by the BA.1 surge may fare better than those where the variant hasn't been circulating.
"I think it will be very variable between even cities, communities and provinces, and overall across the country," she said. "In places where they haven't had a lot of infection recently, I think there is a bit more risk that this highly transmissible variant could make a bigger wave."
Another factor to consider is uptake of third vaccine doses, which do a lot "heavy lifting" in protecting against severe outcomes from Omicron infection, said Saxinger. Federal numbers suggest that roughly 46 per cent of the population has received a booster shot.
What's less clear to Saxinger is whether reimposing COVID-19 rules would do much to curb BA.2's spread, noting that the subvariant has gained steam in places with strict public health measures.
"I think there's a wide playing field in between giving up, which I don't think is the right answer, and doing some sort of draconian lockdown on an early signal."
Caroline Colijn, a mathematician and epidemiologist at Simon Fraser University, isn't convinced that BA.2 will register as just a "blip" in Canada's COVID-19 trajectory.
The Canada 150 Research Chair in Mathematics for Evolution, Infection and Public Health said her modelling suggests that Canada is well positioned to weather an uptick in transmission driven by either BA.2 or relaxing COVID-19 restrictions independently, but the combination of the two could cause problems.
"We can be very resilient to a rise in transmission, and BA.2 will give us a rise in transmission. But reducing our measures and removing our protections will also give us another rise in transmission at the same time," Colijn said.
"I think we are resilient to some increase in transmission. But I think we will probably see a surge from these two increases in transmission arriving at the same time."
Of particular concern to Colijn is how BA.2 could affect those who are most vulnerable to severe COVID-19 outcomes, such as people who are older or immunocompromised.
These groups were prioritized for early boosters in many parts of the country, Colijn noted, and so the immunity provided by these doses are more likely to have waned in the months since.
As many provinces have restricted access to testing, Colijn said, we may not have the data we need to measure to increased COVID-19 transmission before hospitalizations tick up, at which point, it'll be too late to contain the situation.
"I think we should be going into this with our eyes open and watching carefully," she said.
This report by The Canadian Press was first published March 22, 2022.
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