Antimicrobial resistance and antimicrobial use associated with laboratory-confirmed cases of Campylobacter infection in two health units in Ontario.

AIM: A population-based study was conducted over a two-year period in the Perth District (PD) and Wellington-Dufferin-Guelph (WDG) health units in Ontario to document antimicrobial resistance and antimicrobial use associated with clinical cases of laboratory-confirmed campylobacteriosis. METHODS: Etest (bioMérieux SA, France) was used to determine the minimum inhibitory concentration of amoxicillin/clavulanic acid, ampicillin, chloramphenicol, ciprofloxacin (CIP), clindamycin, erythromycin (ERY), gentamicin, nalidixic acid and tetracycline. Data regarding antimicrobial use were collected from 250 cases. RESULTS: Of the 250 cases, 165 (65.7%) reported staying home or being hospitalized due to campylobacteriosis. Fifty-four per cent of cases (135 of 249) reported taking antimicrobials to treat campylobacteriosis. In 115 cases (51.1%), fecal culture results were not used for treatment decisions because they were not available before the initiation of antimicrobial treatment and/or they were not available before the cessation of symptoms. Of the 250 cases, 124 (49.6%) had available Campylobacter isolates, of which 66 (53.2%) were resistant to at least one of the antimicrobials tested. No resistance to ampicillin, chloramphenicol or gentamicin was found in these isolates. Six isolates (4.8%) were resistant to CIP. Two isolates (1.6%) were resistant to ERY; however, no isolates were resistant to both CIP and ERY. CONCLUSION: Prudent use practices should be promoted among physicians to reduce the use of antimicrobials for the treatment of gastroenteritis in general and campylobacteriosis in particular, as well as to minimize the future development of resistance to these antimicrobials in Campylobacter species.

OBJECTIF: Les chercheurs ont mené une étude en population pendant une période de deux ans dans les unités sanitaires du district de Perth et de Wellington-Dufferin-Guelph en Ontario, afin d'étayer la résistance antimicrobienne et l'utilisation d'antimicrobiens associées à des cas cliniques de campylobactériose confirmés en laboratoire. MÉTHODOLOGIE: Les chercheurs ont utilisé l'Etest (bioMérieux SA, France) pour déterminer la concentration inhibitrice minimale d'amoxicilline-acide clavulanique, d'ampicilline, de chloramphénicol, de ciprofloxacine (CIP), de clindamycine, d'érythromycine (ERY), de gentamicine, d'acide nalidixique et de tétracycline. Ils ont colligé les données sur l'utilisation d'antimicrobiens auprès de 250 cas. RÉSULTATS: Sur les 250 cas, 165 (65,74 %) ont déclaré être restés à la maison ou avoir été hospitalisés en raison de leur campylobactériose. Cinquante-quatre pour cent des cas (135 sur 249) ont déclaré avoir pris des antimicrobiens pour traiter leur campylobactériose. Dans 115 cas (51,1 %), les résultats de la coproculture n'ont pas été utilisés pour prendre les décisions thérapeutiques parce qu'ils n'étaient pas disponibles avant l'amorce du traitement antimicrobien ou avant l'arrêt des symptômes. Sur les 250 cas, 124 (49,6 %) disposaient d'isolats du Campylobacter, dont 66 (53,2 %) étaient résistants à au moins un des antimicrobiens testés. Les chercheurs n'ont relevé aucun cas de résistance à l'ampicilline, au chloramphénicol ou à la gentamicine dans ces isolats. Six (4,8 %) étaient résistants à la CIP et deux (1,6 %), à l'ERY, mais aucun n'était résistant à la fois à la CIP et à l'ERY. CONCLUSION: Il faudrait promouvoir des pratiques d'utilisation prudentes chez les médecins pour réduire l'utilisation d'antimicrobiens dans le traitement de la gastroentérite en général et de la campylobactériose en particulier, ainsi que pour limiter le plus possible l'apparition future de résistance à ces antimicrobiens dans les espèces de Campylobacter.

Canada in the face of the 2009 H1N1 pandemic.

BACKGROUND: Initial public health responses to the 2009 influenza H1N1 pandemic were based on difficult decisions in the face of substantial uncertainty. Policy effectiveness depends critically on such decisions, and future planning for maximum protection of community health requires understanding of the impact of public health responses in observed scenarios. OBJECTIVES: In alignment with the objectives of the Pandemic Influenza Outbreak Research Modelling Team (Pan-InfORM) and the Centre for Disease Modelling (CDM), a focused workshop was organized to: (i) evaluate Canada's response to the spring and autumn waves of the novel H1N1 pandemic; (ii) learn lessons from public health responses, and identify challenges that await public health planners and decision-makers; and (iii) understand how best to integrate resources to overcome these challenges. MAIN OUTCOME MEASURES: We report on key presentations and discussions that took place to achieve the objectives of the workshop. CONCLUSIONS: Future emerging infectious diseases are likely to bring far greater challenges than those imposed by the 2009 H1N1 pandemic. Canada must address these challenges and enhance its capacity for emergency responses by integrating modelling, surveillance, planning, and decision-making.

Annual universal influenza vaccination: ready or not?

Influenza causes annual worldwide epidemics of respiratory disease. Currently, the United States and many other countries recommend influenza vaccination for persons who are at high risk for influenza-related complications. This commentary explores the potential benefits of a policy advocating universal annual influenza vaccination and outlines obstacles that need to be overcome to make such a recommendation feasible. The 5-year experience of a free influenza vaccination program for everyone > or =6 months of age in the Canadian province of Ontario is reviewed.

The Canadian Pandemic Influenza Plan: an evolution to the approach for national communicable disease emergencies.

Advance planning for a large-scale and widespread health emergency is required to optimize health care delivery during an influenza pandemic. The Canadian Pandemic Influenza Plan (CPIP) is an example of a successful communicable disease emergency plan that ensures a national, coordinated approach to preparedness, response and recovery activities in the event of an influenza pandemic. The general concepts incorporated into the CPIP may be utilised in the contingency planning for a bioterrorism event or other communicable disease emergencies, including: a national, coordinated approach in planning; an emergency management structure to conduct the response; the use of common terminology to facilitate communication and response coordination, and the establishment of specific technical, communications and operational response groups and networks in advance. The multinational outbreak of Severe Acute Respiratory Syndrome (SARS) in 2003 offered the opportunity for the testing of these concepts. The experiences and lessons learnt during the SARS response may be utilised to strengthen communicable disease preparedness and response capacity.

Influenza pandemic planning.

Periodically, novel influenza viruses emerge and spread rapidly through susceptible populations, resulting in worldwide epidemics or pandemics. Three pandemics occurred in the 20th century. The first and most devastating of these, the "Spanish Flu" (A/H1N1) pandemic of 1918-1919, is estimated to have resulted in 20-50 million or more deaths worldwide, with unusually high mortality among young adults [C.W. Potter, Chronicle of influenza pandemics, in: K.G. Nicholson, R.G. Webster, A.J. Hay (Eds.), Textbook of Influenza, Blackwell Science, Oxford, 1998, p. 3]. Mortality associated with the 1957 "Asian Flu" (A/H2N2) and the 1968 "Hong Kong Flu" (A/H3N2) pandemics was less severe, with the highest excess mortality in the elderly and persons with chronic diseases [J. Infect. Dis. 178 (1998) 53]. However, considerable morbidity, social disruption and economic loss occurred during both of these pandemics [J. Infect. Dis. 176 (Suppl. 1) (1997) S4]. It is reasonable to assume that future influenza pandemics will occur, given historical evidence and current understanding of the biology, ecology, and epidemiology of influenza. Influenza viruses are impossible to eradicate, as there is a large reservoir of all subtypes of influenza A viruses in wild aquatic birds. In agricultural-based communities with high human population density such as are found in China, conditions exist for the emergence and spread of pandemic viruses. It is also impossible to predict when the next pandemic will occur. Moreover, the severity of illness is also unpredictable, so contingency plans must be put in place now during the inter-pandemic period. These plans must be flexible enough to respond to different levels of disease.

A Prevalence Survey of Salmonella in Raw Milk in Ontario, 1986-87.

In a survey to determine the incidence and prevalence of Salmonella in the bulk milk supply of dairy farms in southwestern Ontario 1986-87, milk filters from 813 farms were cultured over four sampling periods in six months. Prevalence rates during the four sampling periods were as follows: September 1986: 1.23%; October-November: 0.40%; December-January: 0.19%; and February 1987: 0%. Incidence rates increased from 0.15% per month in the first sampling period to 0.20% in the second and third period, then dropped to 0% in the fourth sampling period. Eight isolates of S. muenster and two of S. mbandaka were recovered from nine different farms. All of the isolates were sensitive to the commonly used antimicrobials tested. Owing to the steady decline in the prevalence over the study period, no seasonal patterns were apparent. The results of this survey indicate that the presence of Salmonella in bulk milk supplies is dynamic.