Examination of a prenatal syphilis screening program, Alberta, Canada: 2010-2011.

OBJECTIVES: In 2009, due to increasing congenital syphilis rates, prenatal syphilis tests (PST) at both mid-gestation and delivery were added to first trimester prenatal screening in the province of Alberta. We sought to determine the proportion of mothers who had all three recommended PSTs during this period and to identify factors associated with incomplete PST. METHODS: A cohort of all pregnancies resulting in a live or stillborn infant in Alberta for 2010 and 2011 was developed from Vital Statistics and linked with prenatal screening data to determine the number and timing of PSTs for pregnant women. The proportion of women who had PSTs at the three recommended time points in pregnancy and associated correlates were identified using basic statistics and logistic regressions. RESULTS: Of 99,609 pregnancies, 20.7% had all three PSTs at the recommended time points. Overall, 98.5% (98,162) had at least one PST, 1.5% only had PST at delivery and 1.5% had no PST performed. Independent risk factors for not having the three recommended PSTs included First Nations status (adjusted odds ratio [AOR]: 1.78 [95% CI: 1.62-1.96]), rural remote residence (AOR 3.61 [95% CI: 3.10-4.20]) and sole use of a midwife for prenatal care (AOR 13.70 [95% CI: 9.20-20.39]). CONCLUSIONS: Nearly all pregnant women in Alberta received a PST at least once during their pregnancy, however far fewer received PSTs at the recommended time points. Interventions that target those who are less likely to be prenatally screened may help to ensure that pregnant women get early and appropriate care for syphilis during pregnancy.

Public health surveillance response following the southern Alberta floods, 2013.

OBJECTIVE: In June of 2013, southern Alberta underwent flooding that affected approximately 100,000 people. We describe the process put in place for public health surveillance and assessment of the impacts on health. METHODS: Public health surveillance was implemented for the six-week period after the flood to detect anticipated health events, including injuries, mental health problems and infectious diseases. Data sources were emergency departments (EDs) for presenting complaints, public health data on the post-exposure administration of tetanus vaccine/immunoglobulin, administrative data on prescription drugs, and reportable diseases. RESULTS: An increase in injuries was detected through ED visits among Calgary residents (rate ratio [RR] 1.28, 95% confidence interval [CI]: 1.14-1.43) and was supported by a 75% increase in the average weekly administration of post-exposure prophylaxis against tetanus. Mental health impacts in High River residents were observed among females through a 1.64-fold (95% CI: 1.11-2.43) and 2.32-fold (95% CI: 1.45-3.70) increase in new prescriptions for anti-anxiety medication and sleep aids respectively. An increase in sexual assaults presenting to EDs (RR 3.18, 95% CI: 1.29-7.84) was observed among Calgary residents. No increases in infectious gastrointestinal disease or respiratory illness were identified. Timely identification and communication of surveillance alerts allowed for messaging around the use of personal protective equipment and precautions for personal safety. CONCLUSION: Existing data sources were used for surveillance following an emergency situation. The information produced, though limited, was sufficiently timely to inform public health decision-making.

Whole-Genome Sequencing of Measles Virus Genotypes H1 and D8 During Outbreaks of Infection Following the 2010 Olympic Winter Games Reveals Viral Transmission Routes.

We used whole-genome sequencing to investigate a dual-genotype outbreak of measles occurring after the XXI Olympic Winter Games in Vancouver, Canada. By sequencing 27 complete genomes from H1 and D8 genotype measles viruses isolated from outbreak cases, we estimated the virus mutation rate, determined that person-to-person transmission is typically associated with 0 mutations between isolates, and established that a single introduction of H1 virus led to the expansion of the outbreak beyond Vancouver. This is the largest measles genomics project to date, revealing novel aspects of measles virus genetics and providing new insights into transmission of this reemerging viral pathogen.

Neonatal vitamin K refusal and nonimmunization.

BACKGROUND: Neonatal Vitamin K prophylaxis is an effective intervention for reducing vitamin K deficiency bleeding. A recently published report of parental refusal of vitamin K prompted an investigation of the prevalence and characteristics of this group, and exploration of whether these same parents were likely to subsequently refuse immunization for their children. METHODS: We conducted a retrospective population-based cohort study of all infants born in Alberta between 2006 and 2012 by using linkage of administrative health data. Risk factors for vitamin K refusal were determined by using Poisson regression. The association between vitamin K refusal and nonimmunization was assessed using relative risk. RESULTS: Among the 282378 children in the cohort, 99.7% received vitamin K and 0.3% declined. Midwife-assisted deliveries were more likely to be associated with vitamin K refusal compared with physician-attended delivery (risk ratio 8.4, 95% confidence interval [CI] 6.5-11.0). Planned home delivery (risk ratio 4.9, CI 3.8-6.4) or delivery in a birth center (risk ratio 3.6, CI 2.3-5.6) were more likely to result in decline of vitamin K compared with hospital delivery. Vitamin K refusal was associated with a 14.6 (CI 13.9-15.3) higher relative risk of having no recommended childhood vaccines at 15 months. CONCLUSIONS: This is the first population-based study to characterize parents who are likely to decline vitamin K for their infants and whose children are likely to be unimmunized. These findings enable earlier identification of high-risk parents and provide an opportunity to enact strategies to increase uptake of vitamin K and childhood immunizations.

The epidemiology of invasive pneumococcal disease in British Columbia following implementation of an infant immunization program: increases in herd immunity and replacement disease.

OBJECTIVES: In 2003, British Columbia (BC) introduced a universal heptavalent pneumococcal conjugate vaccine (PCV-7) program for infants, and in 2007 revised the recommended schedule from four doses to three doses. We describe trends in the incidence of invasive pneumococcal disease (IPD) in association with these program changes. METHODS: All confirmed cases are reported to the BC Centre for Disease Control (BCCDC) using a standardized data collection process; isolates are forwarded to the BCCDC Public Health and Reference Microbiology Laboratory for serotyping and to the National Reference Laboratory for confirmation. Upon implementation of the reduced dose program in 2007, additional epidemiological data, including immunization history, were collected for children < or = 16 years. RESULTS: Seven years after implementation of the program, a 78% decline in incidence of IPD among children under five has been achieved; this is largely a direct effect of the PCV-7 program. Among those >16 years of age, herd immunity is evident and decreasing trends of PCV-7 serotypes continued even after the dose reduction program was introduced. However, gains in disease reduction were offset by increases in replacement serotypes, particularly among the over-65 age group. This has resulted in no net change in adult IPD rates. CONCLUSIONS: The implementation of the PCV-7 program has changed the epidemiology of IPD in BC through direct effects of the vaccine, herd immunity and serotype replacement. The introduction of a three-dose schedule was not associated with an excess of vaccine failures.

Occupational exposure to diesel and gasoline emissions and lung cancer in Canadian men.

The International Agency for Research on Cancer classifies diesel exhaust as a probable human carcinogen; this decision is based largely from lung cancer evidence. Gasoline exhaust is classified as a possible carcinogen. Epidemiological studies are needed that improve upon some of the limitations of previous research with respect to the characterization of exposure, and the control for the potential confounding influence of smoking and other occupational exposures. Our objective was to investigate associations between occupational exposure to diesel and gasoline engine emissions and lung cancer. We used a case-control study design that involved men 40 years of age and older at the time of interview. Analyses are based on 1681 incident cases of lung cancer and 2,053 population controls. A self-reported questionnaire elicited a lifetime occupational history, including general tasks, and information on other potential risk factors. Occupational exposures to diesel and gasoline emissions, crystalline silica, and asbestos were assigned to each job held by study subjects by industrial hygienists who were blind to case-control status. Exposure metrics for diesel and gasoline emissions that were modeled included: ever exposure, cumulative exposure, and concentration of exposure. We found a dose-response relationship between cumulative occupational exposure to diesel engine emissions and lung cancer. This association was more pronounced for the squamous and large cell subtypes with adjusted odds ratios across the three increasing tertiles of cumulative lifetime exposure relative to those with no exposure of 0.99, 1.25, and 1.32 (p=0.04) for squamous cell carcinoma, and 1.06, 1.19, 1.68 (p=0.02) for large cell carcinoma. While the association with cumulative exposure to gasoline was weakly positive, it was not statistically significant. Our findings suggest that exposure to diesel engine emissions increases the risk of lung cancer particularly for squamous and large cell carcinoma subtypes.

Assessing and managing risks arising from exposure to endocrine-active chemicals.

Managing risks to human health and the environment produced by endocrine-active chemicals (EAC) is dependent on sound principles of risk assessment and risk management, which need to be adapted to address the uncertainties in the state of the science of EAC. Quantifying EAC hazard identification, mechanisms of action, and dose-response curves is complicated by a range of chemical structure/toxicology classes, receptors and receptor subtypes, and nonlinear dose-response curves with low-dose effects. Advances in risk science including toxicogenomics and quantitative structure-activity relationships (QSAR) along with a return to the biological process of hormesis are proposed to complement existing risk assessment strategies, including that of the Endocrine Disruptor Screening and Testing Advisory Committee (EDSTAC 1998). EAC represents a policy issue that has captured the public's fears and concerns about environmental health. This overview describes the process of EAC risk assessment and risk management in the context of traditional risk management frameworks, with emphasis on the National Research Council Framework (1983), taking into consideration the strategies for EAC management in Canada, the United States, and the European Union.

Case report: a metabolic disorder presenting as pediatric manganism.

CONTEXT: Manganese is a trace element, essential for physiologic functioning but neurotoxic at high doses. Common exposure sources include dietary intake as well as drinking water in some regions; toxicity is most often associated with inhalation exposures in occupational settings. In this article we describe the investigation of a pediatric case of manganism using both clinical and environmental assessment methods. CASE PRESENTATION: A previously healthy 6-year-old child presented with severe Mn neurotoxicity, iron deficiency, and elevated cobalt levels. Immediate and selected extended family members had elevated plasma Mn but remained asymptomatic. An exposure assessment identified seasonal ingestion exposures to Mn at the family's summer cottage; these were common to the four immediate family members. Well water used for drinking and cooking exceeded recommended guidelines, and foods high in Mn predominated in their diet. No inhalation exposures were identified. Only pica was unique to the patient. DISCUSSION: The combined evidence of the environmental assessment and biomonitoring of blood Mn levels supported a seasonal ingestion exposure source; this alone was insufficient to explain the toxicity because the patient's 7-year-old sibling was asymptomatic with almost identical exposures (except pica). A metabolic disorder involving divalent metals (Mn, Fe, and Co) interacting with environmental exposures is the most likely explanation. RELEVANCE TO CLINICAL OR PROFESSIONAL PRACTICE: This case report adds to the emerging body of evidence linking neurologic effects to ingestion Mn exposure.

Association of the frequency of respiratory illness in early childhood with a change in the distribution of blood lymphocyte subpopulations.

Little is known about the distribution of lymphocyte phenotypes in young children and the association specific phenotypes may have with respiratory illnesses. The objective of this study was to describe lymphocyte distributions in children at approximately 2 years of age and to test for associations with the frequency of respiratory illness during the first 2 years of life. We hypothesized that an increased frequency of illness would be associated with those phenotypes that reflect previous antigen exposure and/or immune activation. Seventy-three children were followed during their first 2 years of life with daily symptom diaries and twice-monthly telephone calls to ascertain the incidence of respiratory illness. After the children reached 2 years of age, the phenotypes of circulating blood lymphocytes were measured by flow cytometry. Associations between illness and phenotypes were adjusted for education level of parents; hours per week in day care; hours per week exposed to environmental tobacco smoke, mould, or water damage in bedroom; and parental history of allergy and asthma. The resulting median lymphocyte count was 4.0 x 109 per litre (standard deviation, 1.3) with a CD4/CD8 count of 2.28, consistent with published values. Illness rates were positively associated with the percentage of CD8+ CD38+ T cells (unadjusted p = .03, adjusted p = .014), CD8+ CD45RO+ T cells (unadjusted p = .06, adjusted p = .036), and CD4+ CD45RO+ T cells (unadjusted p = .01, adjusted p = .005). Our conclusions is that there is an association between the distribution of lymphocyte phenotypes and the incidence of respiratory illness early in life. Future research is recommended to determine the directionality of this association.