Laboratory-acquired infections in Canada from 2016 to 2021.

incidents that result in an exposure to human pathogens and toxins can lead to laboratory-acquired infections or intoxications (LAIs). These infections can pose a risk to the public as well, should person-to-person transmission occur outside the laboratory after an LAI. Understanding factors that contribute to exposure incidents involving LAIs may contribute to ways to mitigate future occurrences to ensure the safety of laboratory workers and the communities in which they work. This paper describes nine exposure incidents resulting in LAIs that occurred in Canada from 2016 to 2021. Of the nine cases, most affected people had both high level of education and years of experience working with pathogens. There were varying laboratory types and activities where Salmonella spp. and Escherichia coli accounted for six out of the nine cases. Procedural issues, personal protective equipment issues and sharp-related incidents were the most cited root causes. From this information, it is clear that regular training (even of experienced staff), clear and accurate standard operating procedures, proper hygiene (especially with Salmonella spp. and E. coli) and recognition of exposure incidents at the time of occurrence are important in preventing future LAIs. Only regulated laboratories working with risk group 2 or higher organisms are required to report exposures and LAIs to the Laboratory Incident Notification Canada surveillance system. Because of the small sample size, results and inferences are based on descriptive analyses only.

Multivariate analyses of risk factors associated with laboratory exposure incidents.

Background: Laboratories involved in the study of pathogenic biological agents pose an inherent risk of exposure to the laboratory workforce and the community. Laboratory biosafety and biosecurity activities are fundamental in minimizing the likelihood of unintentional exposure incidents. The objective of this study is to describe the factors that are associated with the occurrence of exposure incidents in a laboratory setting through a predictive model. Methods: The Laboratory Incident Notification Canada is a nationally mandated surveillance system that gathers real-time data from submitted reports of laboratory incidents involving human pathogens and toxins. Data on laboratory exposure incidents were extracted from the system between 2016 and 2020. The occurrence of exposure incidents per month was modelled using a Poisson regression with several potential risk factors, including seasonality, sector, occurrence type, root causes, role and education of people exposed and years of laboratory experience. A stepwise selection method was used to develop a parsimonious model with consideration of the significant risk factors identified in the literature. Results: After controlling for other variables in the model, it was found that 1) for each human interaction related root cause, the monthly number of exposure incidents was expected to be 1.11 times higher compared to the number of incidents without human interaction (p=0.0017) as a root cause and 2) for each standard operating procedure-related root cause, the monthly number of exposure incidents was expected to be 1.13 times higher compared to the number of incidents without a standard operating procedure related root cause (p=0.0010). Conclusion: Laboratory biosafety and biosecurity activities should target these risk factors to reduce the occurrence of exposure incidents. Qualitative studies are needed to provide better reasoning for the association of these risk factors with the occurrence of exposure incidents.

Surveillance of laboratory exposures to human pathogens and toxins, Canada, 2021.

Background: The Laboratory Incident Notification Canada surveillance system monitors laboratory incidents that are mandated to be reported under the Human Pathogens and Toxins Act and the Human Pathogens and Toxins Regulations. This article describes laboratory exposure incidents that occurred in Canada in 2021 and individuals affected in these incidents. Methods: We extracted all laboratory incidents occurring in licensed Canadian laboratories in 2021 from the Laboratory Incident Notification Canada system and analyzed them using the software R. We calculated the rate of exposure incidents and performed descriptive statistics by sector, root cause, activity, occurrence type and type of pathogen/toxin. Analysis of the education level, route of exposure, sector, role and laboratory experience of the affected persons was also conducted. We conducted seasonality analysis to compare the median monthly occurrence of exposure incidents between 2016 and 2020 to monthly incidents in 2021. Results: Forty-three exposure incidents involving 72 individuals were reported to Laboratory Incident Notification Canada in 2021. There were two confirmed laboratory-acquired infections and one suspected infection. The annual incident exposure rate was 4.2 incidents per 100 active licenses. Most exposure incidents involved non-Security Sensitive Biological Agents (n=38; 86.4%) and human risk group 2 (RG2) pathogens (n=27; 61.4%), with bacteria (n=20; 45.5%) and viruses (n=16; 36.4%) as the most implicated agent types. Microbiology was the most common activity associated with these incidents (n=18; 41.9%) and most incidents were reported by the academic sector (n=20; 46.5%). Sharps-related (n=12; 22.2%) incidents were the most common, while human interaction (e.g. workload constraints/pressures/demands, human error) (n=29, 28.2%) was the most common root cause. Most affected individuals were exposed through inhalation (n=38; 52.8%) and worked as technicians or technologists (n=51; 70.8%). Seasonality analyses revealed that the number of exposure incidents reported in 2021 were highest in September and May. Conclusion: The rate of laboratory incidents was slightly lower in 2021 than in 2020. The most common occurrence type was sharps-related while issues with human interaction was the most cited root cause.

Rapid review of multisystem inflammatory syndrome in paediatrics: What we know one year later.

BACKGROUND: : Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19) is an emerging condition that was first identified in paediatrics at the onset of the COVID-19 pandemic. The condition is also known as pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (PIMS-TS or PIMS), and multiple definitions have been established for this condition that share overlapping features with Kawasaki Disease and toxic shock syndrome. METHODS: : A review was conducted to identify literature describing the epidemiology of MIS-C, published up until March 9, 2021. A database established at the Public Health Agency of Canada with COVID-19 literature was searched for articles referencing MIS-C, PIMS or Kawasaki Disease in relation to COVID-19. RESULTS: : A total of 195 out of 988 articles were included in the review. The median age of MIS-C patients was between seven and 10 years of age, although children of all ages (and adults) can be affected. Multisystem inflammatory syndrome in children disproportionately affected males (58% patients), and Black and Hispanic children seem to be at an elevated risk for developing MIS-C. Roughly 62% of MIS-C patients required admission to an intensive care unit, with one in five patients requiring mechanical ventilation. Between 0% and 2% of MIS-C patients died, depending on the population and available interventions. CONCLUSION: : Multisystem inflammatory syndrome in children can affect children of all ages. A significant proportion of patients required intensive care unit and mechanical ventilation and 0%-2% of cases resulted in fatalities. More evidence is needed on the role of race, ethnicity and comorbidities in the development of MIS-C.

Surveillance of laboratory exposures to human pathogens and toxins, Canada 2020.

BACKGROUND: The Laboratory Incident Notification Canada surveillance system monitors laboratory incidents reported under the Human Pathogens and Toxins Act and the Human Pathogens and Toxins Regulations. The objective of this report is to describe laboratory exposures that were reported in Canada in 2020 and the individuals who were affected. METHODS: Laboratory incident exposures occurring in licensed Canadian laboratories in 2020 were analyzed. The exposure incident rate was calculated and the descriptive statistics were performed. Exposure incidents were analyzed by sector, activity type, occurrence type, root cause and pathogen/toxin. Affected persons were analyzed by education, route of exposure sector, role and laboratory experience. The time between the incident and the reporting date was also analyzed. RESULTS: Forty-two incidents involving 57 individuals were reported to Laboratory Incident Notification Canada in 2020. There were no suspected or confirmed laboratory acquired infections. The annual incident exposure rate was 4.2 incidents per 100 active licenses. Most exposure incidents occurred during microbiology activities (n=22, 52.4%) and/or were reported by the hospital sector (n=19, 45.2%). Procedural issues (n=16, 27.1%) and sharps-related incidents (n=13, 22.0%) were the most common occurrences. Most affected individuals were exposed via inhalation (n=28, 49.1%) and worked as technicians or technologists (n=36, 63.2%). Issues with standard operating procedures was the most common root cause (n=24, 27.0%), followed by human interactions (n=21, 23.6%). The median number of days between the incident and the reporting date was six days. CONCLUSION: The rate of laboratory incidents were lower in 2020 than 2019, although the ongoing pandemic may have contributed to this decrease because of the closure of non-essential workplaces, including laboratories, for a portion of the year. The most common occurrence type was procedural while issues with not complying to standard operating procedures and human interactions as the most cited root causes.

COVID-19: A case for the collection of race data in Canada and abroad.

Racialized populations have consistently been shown to have poorer health outcomes worldwide. This pattern has become even more prominent in the wake of the coronavirus disease 2019 (COVID-19) pandemic. In countries where race disaggregated data are routinely collected, such as the United States and the United Kingdom, preliminary reports have identified that racialized populations are at a heightened risk of COVID-19 infection and mortality. Similar patterns are emerging in Canada but rely on proxy measures such as neighbourhood diversity to account for race, in the absence of person-level data. It follows that the collection of race disaggregated data in Canada is a crucial element in identifying individuals at risk of poorer COVID-19 outcomes and developing targeted public health interventions to mitigate risk among Canada's racialized populations. Given this continuing gap, advocating for timely access to this data is of great importance owing to the challenges that the COVID-19 pandemic has highlighted amongst racialized populations in Canada and worldwide.

Epidemiologic and clinical characteristics of multisystem inflammatory syndrome in adults: a rapid review.

Multisystem inflammatory disease in children (MIS-C) is one of the severe presentations of the coronavirus disease 2019 (COVID-19) that has been described in the literature since the beginning of the pandemic. Although MIS-C refers to children, cases with similar clinical characteristics have been recently described in adults. A description of the epidemiologic and clinical characteristics of multisystem inflammatory disease in adults (MIS-A) is a starting point for better knowledge and understanding of this emerging disease. We identified nine case reports of MIS-A in the literature, five from the United States, two from France and two from the United Kingdom. The case descriptions revealed similarities in clinical features, including occurrence during post-acute disease phase, fever, digestive symptoms, cardiac involvement and elevated inflammatory markers. All the patients were hospitalized, three required admission to the intensive care unit and one died. The most common treatments were intravenous immunoglobulin, prednisolone and aspirin. These findings suggest that MIS-A is a severe complication of COVID-19 disease that can lead to death. Further studies to improve our understanding of the pathogenesis of MIS-A, which will help improve treatment decisions and prevent sequelae or death.

Serum antibody response in COVID-19-recovered patients who retested positive.

BACKGROUND: Research studies comparing antibody response from coronavirus disease 2019 (COVID-19) cases that retested positive (RP) using reverse transcription polymerase chain reaction (RT-PCR) and those who did not retest positive (NRP) were used to investigate a possible relationship between antibody response and retesting status. METHODS: Seven data bases were searched. Research criteria included cohort and case-control studies, carried out worldwide and published before September 9, 2020, that compared the serum antibody levels of hospitalized COVID-19 cases that RP after discharge to those that did NRP. RESULTS: There is some evidence that immunoglobulin G (IgG) and immunoglobulin M (IgM) antibody levels in RP cases were lower compared with NRP cases. The hypothesis of incomplete clearance aligns with these findings. The possibility of false negative reverse transcription polymerase chain reaction (RT-PCR test results during viral clearance is also plausible, as concentration of the viral ribonucleic acid (RNA) in nasopharyngeal and fecal swabs fluctuate below the limits of RT-PCR detection during virus clearance. The probability of reinfection was less likely to be the cause of retesting positive because of the low risk of exposure where cases observed a 14 day-quarantine after discharge. CONCLUSION: More studies are needed to better explain the immune response of recovered COVID-19 cases retesting positive after discharge.

Impact of school closures and re-openings on COVID-19 transmission.

BACKGROUND: Globally, the education of students at primary and secondary schools has been severely disrupted by the implementation of school closures to reduce the spread of coronavirus disease 2019 (COVID-19). The effectiveness of school closures in reducing transmission of COVID-19 and the impact of re-opening schools are unclear. METHODS: Research criteria for this rapid review included empirical studies, published or pre-published worldwide before January 25, 2021, that assessed the effectiveness of school closures in reducing the spread of COVID-19 and the impact of school re-openings on COVID-19 transmission. RESULTS: Twenty-four studies on the impact of school closures and re-openings on COVID-19 transmission were identified through the seven databases that were searched. Overall the evidence from these studies was mixed and varied due to several factors such as the time of implementation of public health measures, research design of included studies and variability among the levels of schooling examined. CONCLUSION: Preliminary findings suggest that school closures have limited impact on reducing COVID-19 transmission, with other non-pharmaceutical interventions considered much more effective. However, due to the limitations of the studies, further research is needed to support the use of this public health measure in response to the COVID-19 pandemic.