Canadian laboratory incidents with human pathogens and toxins: An overview of reports, 2016-2022.

Background: When the Public Health Agency of Canada's Human Pathogens and Toxins Act and Human Pathogens and Toxins Regulations came into force, the reporting of laboratory incidents to the Laboratory Incident Notification Canada (LINC) surveillance system became mandatory. This report summarizes the laboratory exposure and non-exposure data reported from 2016 to 2022, with a particular focus on factors that are not typically presented in LINC's annual report. Methods: Reported laboratory incidents from 2016 to 2022 were analyzed. Exposures were analyzed by severity, occurrence and root cause, and affected individuals were analyzed by disease outcome, role and applied interventions. Non-exposures were analyzed by incident type. Exposure and non-exposure incident rates were calculated. Results: Events reported to LINC totalled 928. Of those, 355 were confirmed non-exposures, 361 were confirmed exposures, and 111 were other events. Both exposure and non-exposure incident rates per 100 active licences peaked in 2018 (9.44 and 7.11, respectively). Most exposures were rated as minor or negligible severity. The most cited exposure occurrence types were sharps-related and procedure-related (23% each), and standard operating procedure-related root causes were most cited (24%). While 781 individuals were affected in the exposure incidents, most did not develop a laboratory-acquired infection (n=753; 96%) and received at least one form of treatment post-exposure (n=717; 92%). Inadvertent possession/production cases were the most common non-exposure incidents reported. Conclusion: Exposure and non-exposure incident rates have decreased since 2018. Among exposure incidents, sharps-related and procedure-related occurrences were the most common, and the root cause was usually a standard operating procedure. Non-exposure incidents were mostly inadvertent possession/production cases. Exposure and illness outcome severity was mostly minor.

Surveillance of laboratory exposures to human pathogens and toxins, Canada, 2022.

Background: The Laboratory Incident Notification Canada (LINC) surveillance system was launched in 2015 to monitor the mandated national reporting of laboratory incidents. This report describes the laboratory exposures reported in 2022. Methods: Exposure incidents were analyzed by activity, occurrence, sector, root cause and pathogens/toxins implicated, while affected individuals were analyzed by education, exposure route, role and years of laboratory experience. An analysis of the median number of exposures per month was conducted, and time between the exposure incident date and the date the incident was reported to LINC was examined. Results: Forty confirmed laboratory exposure incident reports were received, with two suspected laboratory-acquired infections. The exposure incident rate per 100 active licences was 3.8, and the number of exposure incidents was highest in September. The majority of exposure incidents involved risk group 2 pathogens (n=27; 63%) and non-security sensitive biological agents (n=36; 84%). Microbiology was the most cited activity occurring during the exposure event (n=20; 50%), and sharps and procedure-related issues were the most common occurrences (n=15; 24.2% each). Most incidents were reported by the academic sector (n=16; 40%). Human interaction was the most common root cause (n=20; 23.8%) and most affected individuals were technicians/technologists (n=68; 73.1%). The median time delay between the incident date and reporting date was 5.5 days. Conclusion: The exposure incident rate was lower in 2022 than in 2021. Incidents related to sharps and standard operating procedures remained the most common occurrence types. The most cited root cause of exposure incidents involved human interaction.

Discrepant HPV/cytology cotesting results: Are there differences between cytology-negative versus HPV-negative cervical intraepithelial neoplasia?

BACKGROUND: The objective of this study was to compare cervical high-grade squamous intraepithelial lesions subcategorized as cervical intraepithelial neoplasia-3 (CIN-3)-positive after a negative cytology result but positive for high-risk human papillomavirus (HR-HPV) testing to those with a negative HR-HPV test but positive cytology (atypical squamous cells of undetermined significance [ASCUS]-positive/HPV-negative) and to assess reasons for discrepancies. METHODS: The authors retrospectively analyzed women who underwent screening with cytology and HPV testing from 2010 through 2013. After a review of surgical specimens and cytology, discrepancies were classified as sampling or interpretation error. Clinical and pathologic findings were compared. RESULTS: In total, 15,173 women (age range, 25-95 years; 7.1% were aged < 30 years) underwent both HPV and cytologic testing, and 1184 (8.4%) underwent biopsy. Cytology was positive in 19.4% of specimens, and HPV was positive in 14.5%. Eighty-four CIN-3-positive specimens were detected, including 55 that tested ASCUS-positive/HPV-positive, 11 that tested negative for intraepithelial lesion or malignancy (NILM)/HPV-positive, 10 that tested ASCUS-positive/HPV-negative, 3 that tested NILM/HPV-negative, and 5 tests that were unsatisfactory. There was no significant difference between NILM/HPV-positive and ASCUS-positive/HPV-negative CIN-3 in terms of size, time to occurrence, the presence of a cytopathic effect, screening history, race, or age. Six of 11 NILM/HPV-positive cases were reclassified as ASCUS, indicating an interpreting error of 55% and a sampling error of 45%. No ASCUS-positive/HPV-negative cases were reclassified. Seven cases of CIN-3 with positive cytology were HPV-negative. CONCLUSIONS: There are no significant clinical or pathologic differences between NILM/HPV-positive and ASCUS-positive/HPV-negative CIN-3-positive specimens. Cytologic sampling or interpretation remains the main reason for discrepancies. However, HPV-negative CIN-3 with positive cytology exists and may be missed by primary HPV screening. Cancer Cytopathol 2017;125:795-805. © 2017 American Cancer Society.

"Everyone just keeps their eyes closed and their fingers crossed": sexual health communication among black parents and children in Nova Scotia, Canada.

BACKGROUND: Black Canadian youth remain disproportionally affected by an array of social and health issues, including sexually transmitted infections. While research exists in support of the involvement of parents as a key means to prevent or modify harmful behaviours among youth, less is known about how parent-child communication can serve as a prevention intervention strategy within Black families in Canada. This study explores sexual health communication between Black parents and youth in Nova Scotia and identifies facilitators, obstacles and issues that families face in dialoguing about sexual health. METHODS: Focus groups and in-depth interview sessions were held with a diverse sample of parents of Black youth, health and education professionals, and Black youth in Nova Scotia, as part of a larger study aimed at exploring parent-child communication on sexual health and HIV. The research team worked in partnership with and received feedback from key informants and a community advisory committee throughout the various stages of this study. All sessions were audio-taped with permission and thematic analysis was carried out on the verbatim transcripts. RESULTS: Six key themes emerged from the data analysis in relation to parent-child communication within Black families in Nova Scotia: 1. the gendered nature of [sexual] health communication; 2. fear and uncertainty as obstacles; 3. open and honest dialogue from an early age as a facilitator; 4. media as both a catalyst and a barrier; 5. peers as a catalyst; and 6. time constraints as an obstacle. CONCLUSIONS: The findings of this study reveal that parent-child communication regarding sexual health promotion within Black families in Nova Scotia remains varied and is heavily affected by a myriad of intersecting determinants of health faced by Black youth and their parents. Health promotion interventions aimed at fostering and supporting parent-child communication on sexual health must simultaneously target both parents and youth and further, such efforts must engage a high level of cultural competency in order to better meet the needs of this population.