Effectiveness and safety of a high-dose weekly vitamin D (20,000 IU) protocol in older adults living in residential care.

OBJECTIVES: To report 25 hydroxyvitamin D (25OHD) concentrations, an indicator of vitamin D status, in older adults living in residential care 1 year after a protocol of weekly 20,000 IU of vitamin D was started. DESIGN: Cross-sectional. SETTING: Five residential care facilities in British Columbia, Canada. PARTICIPANTS: Residents aged 65 and older from five facilities (N=236). MEASUREMENTS: Participants provided a blood sample. Demographic and health information was obtained from the medical record. RESULTS: Mean 25OHD was 102 nmol/L (95% confidence interval (CI)=98-106 nmol/L). Three percent of residents had a 25OHD concentration of less than 40 nmol/L, 6% <50 nmol/L, and 19% <75 nmol/L. In those who received 20,000 IU/wk or more for 6 months or longer (n=147), mean 25OHD was 112 nmol/L (95% CI=108-117 nmol/L), and none had a 25OHD level of less than 50 nmol/L. Hypercalcemia (>2.6 mmol/L), a potential consequence of too much vitamin D, was present in 14%, although 25OHD levels did not differ in those with and without hypercalcemia (108 vs 101 nmol/L; P=.17). CONCLUSION: Twelve months after implementation of a 20,000-IU/wk vitamin D protocol for older adults in residential care, mean 25OHD concentrations were high, and there was no evidence of poor vitamin D status. Given the absence of demonstrated benefit of high 25OHD concentrations to the residential care population, dosages less than 20,000 IU/wk of vitamin D are recommended.

Pregnant women's knowledge, practices, and needs related to food safety and listeriosis: a study in British Columbia.

OBJECTIVE: To understand the knowledge, attitudes, practices, and needs of pregnant women regarding food safety, including the risk of listeriosis, in order to develop targeted messages and educational resources in British Columbia (BC). DESIGN: Qualitative study using focus groups and quantitative study using a standardized questionnaire. SETTING: Seven family practice clinics in BC. Focus groups were conducted in 3 program groups for new mothers. PARTICIPANTS: Pregnant women and women who had recently delivered babies. METHODS: Three focus groups were conducted with women who had recently delivered. Qualitative analysis to identify common themes was conducted. A questionnaire was completed by pregnant women at their health care providers' (HCPs') offices. Statistical analysis was done to assess associations between demographic features, knowledge, and practices. Results from both study methods were compared and common findings were presented. MAIN FINDINGS: Participants reported that food safety and the risk of listeriosis were important to them during pregnancy; however, their knowledge of high-risk foods and safe food practices was limited. Although they identified their HCPs as a valuable source of information, they explained there were barriers to getting information from them. Participants reported doing their own research using books, websites, and social networks. They made recommendations to improve food safety messages, as well as the availability and format of resources. CONCLUSION: Women in BC identified a gap between the information on food safety and listeriosis that they needed during pregnancy and the resources that were available. Using the information collected from this study, resources that are targeted at women of childbearing years, as well as their HCPs, are under development in BC.

Investigation of the concurrent emergence of Salmonella enteritidis in humans and poultry in British Columbia, Canada, 2008-2010.

An increase in the rate of human infections with Salmonella enteritidis (SE) occurred between 2007 and 2010 in British Columbia (BC). During the same time period, an increase in SE from poultry-sourced isolates and increased clinical severity in poultry were also observed in BC. This article describes a multi-sectoral collaboration during a 3-year investigation, and the actions taken by public health and animal health professionals. Human cases were interviewed, clusters were investigated, and a case-control study was conducted. Environmental investigations were conducted in food service establishments (FSE). Suspect foods were tested. Laboratory data from poultry-sourced isolates were analysed. Five hundred and eighty-four human cases of SE with the same pulsed-field gel electrophoresis pattern were identified between May 2008 and August 2010. Seventy-three percentage of cases reported consumption of eggs. The odds of egg consumption were 2.4 times higher for cases than controls. Implicated FSE were found to use ungraded eggs, which had been distributed illegally. Investigation suggested that there were multiple suppliers of these eggs. Collaboration between public health and animal health professionals led to data sharing, improved understanding of SE, engagement with the poultry industry and public communication. Multi-disciplinary, multi-sectoral and multi-pronged investigations are recommended to identify the likely source of illness in large, protracted foodborne outbreaks caused by commonly consumed foods.

Where's the pump? Associating sporadic enteric disease with drinking water using a geographic information system, in British Columbia, Canada, 1996-2005.

We investigated whether risk of sporadic enteric disease differs by drinking water source and type using surveillance data and a geographic information system. We performed a cross-sectional analysis, at the individual level, that compared reported cases of enteric disease with drinking water source (surface or ground water) and type (municipal or private). We mapped 814 cases of campylobacteriosis, cryptosporidiosis, giardiasis, salmonellosis and verotoxigenic Escherichia coli infection, in a region of British Columbia, Canada, from 1996 to 2005, and determined the water source and type for each case's residence. Over the 10-year period, the risk of disease was 5.2 times higher for individuals living on land parcels serviced by private wells and 2.3 times higher for individuals living on land parcels serviced by the municipal surface/ground water mixed system, than the municipal ground water system. Rates of sporadic enteric disease potentially differ by drinking water source and type. Geographic information system technology and surveillance data are accessible to local public health authorities and used together are an efficient and affordable way to assess the role of drinking water in sporadic enteric disease.

Effectiveness of pneumococcal conjugate vaccine in Greater Vancouver, Canada: 2004-2005.

Active, population-based surveillance for invasive pneumococcal infections in Greater Vancouver (population 473,000 children) demonstrated a rapid, substantial decrease in incidence rates for children 6-23 months old with routine infant vaccination. In the subpopulation with best case ascertainment disease rates for 6-23 month olds decreased 84.6% (92.5% for vaccine serotypes).

An Outbreak of Human Coronavirus OC43 Infection and Serological Cross-reactivity with SARS Coronavirus.

BACKGROUND: In summer 2003, a respiratory outbreak was investigated in British Columbia, during which nucleic acid tests and serology unexpectedly indicated reactivity for severe acute respiratory syndrome coronavirus (SARS-CoV). METHODS: Cases at a care facility were epidemiologically characterized and sequentially investigated for conventional agents of respiratory infection, SARS-CoV and other human CoVs. Serological cross-reactivity between SARS-CoV and human CoV-OC43 (HCoV-OC43) was investigated by peptide spot assay. RESULTS: Ninety-five of 142 residents (67%) and 53 of 160 staff members (33%) experienced symptoms of respiratory infection. Symptomatic residents experienced cough (66%), fever (21%) and pneumonia (12%). Eight residents died, six with pneumonia. No staff members developed pneumonia. Findings on reverse transcriptase-polymerase chain reaction assays for SARS-CoV at a national reference laboratory were suspected to represent false positives, but this was confounded by concurrent identification of antibody to N protein on serology. Subsequent testing by reverse transcriptase-polymerase chain reaction confirmed HCoV-OC43 infection. Convalescent serology ruled out SARS. Notably, sera demonstrated cross-reactivity against nucleocapsid peptide sequences common to HCoV-OC43 and SARS-CoV. CONCLUSIONS: These findings underscore the virulence of human CoV-OC43 in elderly populations and confirm that cross-reactivity to antibody against nucleocapsid proteins from these viruses must be considered when interpreting serological tests for SARS-CoV.

Rapid and fatal meningococcal disease due to a strain of Neisseria meningitidis containing the capsule null locus.

BACKGROUND: Neisseria meningitidis continues to be an important cause of invasive bacterial disease among children and young adults worldwide. In Canada, N. meningitidis strains that bear serogroups B and C polysaccharide capsules predominate. We report the first documented case of invasive meningococcal disease in an immunocompetent host caused by an acapsular strain of N. meningitidis containing the capsule null locus (cnl). METHODS: Analysis of the isolate was performed with use of serological and molecular methods, including multilocus sequence typing and cnl gene identification. Analysis of 16S ribosomal RNA (rRNA) and porA genes was also performed to confirm the identity of the bacterium. RESULTS: The patient was a healthy, immunocompetent 13-year-old child, and N. meningitidis was recovered from a sample of her cerebrospinal fluid before death. The isolate was nontypeable by both conventional antisera and indirect whole-cell enzyme-linked immuosorbent assay methods using antibodies to serogroups B, C, Y, and W135. The isolate was further identified as a cnl strain, serotype 15 (ST-198). N. meningitidis-specific DNA was identified in the isolate and in the pre- and postmortem specimens by 16S rRNA and porA gene analysis. CONCLUSIONS: This is the first reported case of fatal meningococcal disease caused by an acapsular cnl strain of N. meningitidis that was isolated from an immunocompetent host. Routine molecular diagnostic methods targeted at the cnl locus failed to detect this organism, indicating a need to determine the incidence of infection with cnl strains among patients with culture-negative invasive disease.