Cost-effectiveness of influenza vaccination with a high dose quadrivalent vaccine of the elderly population in Belgium, Finland, and Portugal.

BACKGROUND: Seasonal influenza may result in severe outcomes, resulting in a significant increase of hospitalizations during the winter. To improve the protection provided by the standard dose influenza quadrivalent vaccine (SDQIV), a high-dose vaccine (HDQIV) has been developed specifically for adults aged 60 and older who are at higher risk of life-threatening complications. OBJECTIVES: The aim of this study was to determine the cost-effectiveness of HD QIV vs. SD-QIV in the recommended population of three European countries: Belgium, Finland and Portugal. METHODS: A cost-utility analysis comparing HDQIV vs. SDQIV was conducted using a decision tree estimating health outcomes conditional on influenza: cases, general practitioner and emergency department visits, hospitalizations and deaths. To account for the full benefit of the vaccine, an additional outcome-hospitalizations attributable to influenza-was also evaluated. Demographic, epidemiological and economic inputs were based on the respective local data. HDQIV relative vaccine efficacy vs. SDQIV was obtained from a phase IV efficacy randomized clinical trial. The incremental cost-effectiveness ratios (ICER) were computed for each country, and a probabilistic sensitivity analysis (1,000 simulations per country) was performed to assess the robustness of the results. RESULTS: In the base case analysis, HDQIV resulted in improved health outcomes (visits, hospitalizations, and deaths) compared to SDQIV. The ICERs computed were 1,397, 9,581, and 15,267 €/QALY, whereas the PSA yielded 100, 100, and 84% of simulations being cost-effective at their respective willingness-to-pay thresholds, for Belgium, Finland, and Portugal, respectively. CONCLUSION: In three European countries with different healthcare systems, HD-QIV would contribute to a significant improvement in the prevention of influenza health outcomes while being cost-effective.

Assessment of risk factors of treatment discontinuation among patients on paliperidone palmitate and risperidone microspheres in France, Germany and Belgium.

BACKGROUND: Long-acting antipsychotics (e.g. 1-monthly (PP1M) / 3-monthly (PP3M) injection forms of paliperidone palmitate) have been developed to improve treatment continuation in schizophrenia patients. We aim to assess risk factors of treatment discontinuation of patients on paliperidone palmitate and risperidone microsphere. Additionally, treatment discontinuation between patients with PP1M and PP3M was compared. METHODS: The IQVIA Longitudinal Prescription databases were used. Risk factors of treatment discontinuation were identified by a multilevel survival regression using Cox proportional hazards model. Kaplan Meier analyses were performed by identified significant risk factors. RESULTS: Twenty-five thousand three hundred sixty-one patients (France: 9,720; Germany: 14,461; Belgium: 1,180) were included. Over a one-year follow-up period, a significant lower treatment discontinuation was observed for patients newly initiated on paliperidone palmitate (53.8%) than those on risperidone microspheres (85.4%). Additionally, a significantly lower treatment discontinuation was found for 'stable' PP3M patients (19.2%) than 'stable' PP1M patients (37.1%). Patients were more likely to discontinue when drugs were prescribed by GP only (HR = 1.68, p < 0.001 vs. psychiatrist only) or if they were female (HR = 1.07, p < 0.001), whereas discontinuation decreased with age (31-50 years: HR = 0.95, p = 0.006 and > 50 years: HR = 0.91, p < 0.001 vs. 18-30 years). CONCLUSIONS: This study demonstrates that patients stay significantly longer on treatment when initiated on paliperidone palmitate as compared to risperidone microspheres. It also indicated a higher treatment continuation of PP3M over PP1M. Treatment continuation is likely to be improved by empowering GPs with mental health knowledge and managing patients by a collaborative primary care-mental health model. Further research is needed to understand why females and younger patients have more treatment discontinuation.

Hospital-acquired infections after acute ischaemic stroke and its association with healthcare-related costs and functional outcome.

INTRODUCTION: Acute ischaemic stroke is associated with important mortality, morbidity, and healthcare-related costs. Age, pre-stroke functionality and stroke severity are important contributors to functional outcome. Stroke patients also risk developing infections during hospitalization. We sought to explore possible predictors of post-stroke infections and the relationship of post-stroke infection with healthcare-related costs and functional outcome. METHODS: This single-centre retrospective study included 530 patients treated for ischaemic stroke between January 2017 and February 2019. Antibiotics' administration was used as a proxy for post-stroke infection. Functional outcome at 90 days was assessed by the modified Rankin Scale (mRS). Total healthcare-related costs were recorded for the index hospital stay. Multivariable analysis for post-stroke infection was done with the independent factors sex, age, pre-stroke mRS, National Institutes of Health Stroke Scale (NIHSS) and diabetes mellitus. RESULTS: Twenty percent of patients had a post-stroke infection. NIHSS (OR 1.10, 95%CI 1.06-1.13, p < 0.0001) and diabetes mellitus (OR 2.18, 95%CI 1.28-3.71, p = 0.0042) were independent predictors for post-stroke infection. Mean total healthcare-related costs were 15,374 euro (SD 19,968; IQR 3,380-18,165), with a mean of 31,061 euro (SD 29,995; IQR 12,584-42,843) in patients with infection, compared to 11,406 euro (SD 13,987; IQR 3,083-12,726) in patients without (p < 0.0001). Median 90-days mRS was 5 (IQR 3-6) in patients with infection versus 1 (IQR 0-3.5) in patients without (p < 0.0001). CONCLUSIONS: In patients, admitted for acute ischaemic stroke, stroke severity and diabetes mellitus were identified as the main predictors for post-stroke infection. Hospital-acquired infections were associated with increased costs and worse functional outcome.

Assessing the use of antibiotics and the burden of varicella in Belgium using a retrospective GP database analysis.

BACKGROUND: Varicella is a highly contagious infection that typically occurs in childhood. While most cases have a generally benign outcome, infection results in a considerable healthcare burden and serious complications may occur. OBJECTIVES: The objective of this study was to characterize the burden of varicella in a real-world primary care setting in Belgium, including the rate of varicella-related complications, medication management and general practitioner (GP) visits. METHODS: The study was a retrospective observational study using data from a longitudinal patient database in a primary care setting in Belgium. Patients with a GP visit and a varicella diagnosis between January 2016 and June 2019 were eligible and data one month prior and three months after the diagnosis were included. Outcomes included varicella-related complications, antibiotic use, antiviral use, and GP follow-up visits. Antibiotic use could be specified by class of antibiotic and linked to a diagnosis. Complications were identified based on concomitant diagnosis with varicella during the study period. RESULTS: 3,847 patients with diagnosis of varicella were included, with a mean age of 8.4 years and a comparable distribution of gender. 12.6% of patients with varicella had a concomitant diagnosis of a varicella-related complication. During the follow-up period, 27.3% of patients with varicella were prescribed antibiotics, either systemic (19.8%) and/or topical (10.3%). The highest rate of antibiotic prescriptions was observed in patients with complications (63.5%) and in patients younger than 1 year (41.8%). Nevertheless, 5.3% of the patients were prescribed antibiotics without a concomitant diagnosis of another infection. The most commonly prescribed systemic antibiotics were amoxicillin alone or combined with beta-lactamase inhibitor, and thiamphenicol. Fusidic acid and tobramycin were the most prescribed topical antibiotics. Antivirals were prescribed for 2.7% of the study population. 4.7% of the patients needed a follow-up visit with their GP. CONCLUSIONS: This study reports a substantial burden of varicella in a primary care setting in Belgium, with high rates of complications and antibiotic use.

Real-world data confirming the efficacy and safety of decitabine in acute myeloid leukaemia - results from a retrospective Belgian registry study.

Objectives: Currently, there is no standard treatment for patients with acute myeloid leukaemia (AML) ineligible for standard induction chemotherapy (IC). This study aimed to report real-world evidence data on the efficacy and safety of decitabine in this patient group.Methods: This study was a Belgian, retrospective, non-interventional, multicentre registry of patients ≥ 65 years, with newly-diagnosed de novo or secondary AML ineligible for IC. Patients were treated according to routine clinical practice. Overall survival (OS), progression-free survival (PFS) and transfusion independence for ≥8 consecutive weeks were evaluated.Results: Forty-five patients were enrolled, including 67% (n = 30) with secondary AML. Median OS and PFS were 7.3 months (95% CI: 2.2-11.1) and 4.1 months (95% CI: 2.1-7.6) respectively. A subpopulation analysis showed that patients treated with ≥4 cycles (n = 21) had significantly better outcomes compared to patients receiving <4 cycles (median OS 17.5 vs 1.6 months; median PFS 17.5 vs. 1.4 months). Twenty-five percent and 58% of patients that were respectively RBC or platelet transfusion-dependent at baseline became transfusion independent during treatment.Conclusion: This real-world data confirms that decitabine can lead to transfusion independence and longer OS in AML patients, particularly after administering ≥4 cycles, as indicated in the summary of product characteristics.

Disease Control, Health Resource Use, Healthcare Costs, and Predictors in Gout Patients in the United States, the United Kingdom, Germany, and France: A Retrospective Analysis.

INTRODUCTION: The present study aimed to assess disease control, health resource utilization (HRU), and healthcare costs, and their predictors in gout patients across the USA, UK, Germany, and France. METHODS: Data were extracted from the PharMetrics Plus (USA), Clinical Practice Research Datalink-Hospital Episode Statistics (UK), and Disease Analyzer databases (Germany and France) for adult gout patients over a 3-year period: 2009-2011 (all dates +1 year for France). Patients had "prevalent established gout" (i.e., were treated with urate-lowering therapy [ULT] or eligible for ULT based on American College of Rheumatology guidelines) in the preindex panel-year, with January 1 of the second study year as the study index date. Assessments of disease control (uncontrolled gout definition: ≥1 serum urate (sUA) elevation or ≥2 flares; analysis limited to the subpopulation with sUA) data, HRU, and costs were in the second post-index panel-year, while potential predictors (demographics and gout treatment characteristics) were identified in the first post-index panel-year. RESULTS: Treatment rates were high (>70% with chronic urate-lowering treatment in all countries but France), while between 31.3% (France) and 62.9% (USA) of patients remained uncontrolled. Predictors of control included female gender and high adherence. In Germany, the UK, and France, lack of disease control predicted increased gout-attributed costs and increased HRU, both gout-attributed (also in the USA) and non-gout-attributed. CONCLUSION: Gout management remains suboptimal, as many patients remain uncontrolled despite using urate-lowering treatment. Effective and convenient treatment options are needed to improve disease control and minimize additional HRU and costs. FUNDING: AstraZeneca.

Comorbidity Burden in Trial-Aligned Patients with Established Gout in Germany, UK, US, and France: a Retrospective Analysis.

INTRODUCTION: Patients with gout have numerous comorbidities. We aimed to estimate the prevalence and incidence rates of renal and cardiovascular morbidities in trial-aligned patients with established gout in Germany (DE), the United Kingdom (UK), the United States (US), and France (FR). METHODS: This longitudinal cohort study used retrospective data from IMS Disease Analyzer™ (DE, FR), Clinical Practice Research Datalink-Hospital Episode Statistics (UK), and IMS' PharMetrics Plus database linked with outpatient laboratory results (US). Included patients were ≥18 years at index date (January 1, 2010; all dates +1 year for FR), with continuous enrollment during the pre-index year, had "prevalent established gout" determined by data in the pre-index year, and ≥1 documented visit after index date; additional inclusion/exclusion criteria were aligned with recent gout clinical trials. Look-back for comorbidity prevalence extended to January 1, 2003 (US: January 1, 2009). Follow-up for incidence extended from index date to at most March 26, 2013 (FR: May 31, 2014). Events of interest were identified by diagnostic codes and/or laboratory data. RESULTS: The trial-aligned cohorts included 35,118 (DE), 24,607 (UK), 121,591 (US), and 17,338 (FR) patients. Among renal conditions, baseline diagnosis of chronic kidney disease/renal failure was most prevalent in the UK followed by DE; abnormal serum creatinine was most prevalent in the UK. Hypertension was the most prevalent cardiovascular diagnosis in all countries, followed by ischemic heart disease (IHD) and myocardial infarction. Incidence rates (per 100 patient-years) for new/worsening renal impairment ranged from 1.67 (DE) to 4.34 (US) and for nephrolithiasis diagnosis from 0.31 (FR) to 3.79 (US). The incidence rates for hypertension diagnosis were highest among cardiovascular-related events, ranging from 3.23 (UK) to 20.27 (US), followed by IHD. CONCLUSIONS: Patients with established gout such as those included in gout trials have a high burden of established morbidity and new diagnoses of morbid events. Consideration of comorbidities, which greatly exacerbate disease burden, is important in gout management. FUNDING: AstraZeneca.

A description of clinical characteristics and treatment patterns observed within prescribed opioid users in Germany and the UK.

AIMS: To describe a cohort of new opioid users (adult noncancer patients) in terms of clinical characteristics and treatment patterns in the UK and Germany. MATERIAL & METHODS: Data used were extracted from electronic medical records databases (UK: Clinical Practice Research Database-Hospital Episode Statistics; Germany: IMS Disease Analyzer) covering the 2008-2012 period. RESULTS: Most eligible patients were treated with opioids for less than 6 months (UK: 78.7% and Germany: 93.7%) and indexed on weak opioids (UK: 89.5% and Germany: 88.6%). Most prescribed opioids were codeine (UK) and tramadol (Germany). Most prevalent comorbidities were dorsalgia/depression. Constipation was observed in 16.8%/17.4% (UK/Germany) of chronic users (>6 months). CONCLUSION: While both populations were highly morbid populations largely initiated on weak opioids, chronic use was less common in Germany.

Description of cardiovascular event rates in patients initiating chronic opioid therapy for noncancer pain in observational cohort studies in the US, UK, and Germany.

INTRODUCTION: Previous observational studies in the US suggest that opioid analgesic use increases the risk of cardiovascular (CV) events. The current study provides additional background event rates for five prespecified CV outcomes of interest in patients from three countries. METHODS: Three observational cohort studies were conducted in patients from the US (N = 17,604), the UK (N = 9,823), and Germany (N = 9,412). Patients were new opioid users who had undergone ≥6 months of chronic, continuous therapy. De-identified data were collated from electronic healthcare databases in the respective countries. Demographics, clinical characteristics, and opioid use were examined. Overall rates, prevalence rates in patients with established CV disease, and incidence rates in patients without established CV disease were determined for myocardial infarction (MI), stroke, transient ischemic attack, unstable angina, and congestive heart failure (CHF). RESULTS: Cardiovascular disease at baseline was more prevalent in US and German patients. Back pain and depression were prevalent preexisting comorbidities. The majority of patients were using various weak opioids (based on receptor affinities), CV medications, and antidepressants. Overall rates by individual CV outcome per 1,000 patient-years by country were greatest for CHF (US 37.2, 95% CI 24.1-40.5), unstable angina (UK 8.2, 95% CI 7.0-9.6), and stroke (Germany 5.3, 95% CI 4.1-6.7). Overall rates for MI were: US, 10.7 (95% CI 9.1-12.5), UK, 6.7 (95% CI 5.6-8.0), and Germany, 2.7 (95% CI 1.9-3.7). Overall rates for each CV outcome, prevalence rates in patients with preexisting CV disease, and incidence rates in patients without established CV disease differed by country. Rates were higher in patients with preexisting CV disease. CONCLUSIONS: CV risk for new opioid users with ≥6 months of therapy was increased in patients with established CV disease compared with those without established CV disease, and the risk for specific outcomes differed by country. Assessment of CV safety events of new therapies introduced to chronic opioid users should consider sample size and population heterogeneity in the design of an observational study.

Prospective study of acute health effects in relation to exposure to cyanobacteria.

We conducted a study to investigate the relationship between exposure to cyanobacteria and microcystins and the incidence of symptoms in humans living in close proximity to lakes affected by cyanobacteria. The design was a prospective study of residents living around three lakes (Canada), one of which has a water treatment plant supplying potable water to local residents. Participants had to keep a daily journal of symptoms and record contact (full or limited) with the water body. Samples were collected to document cyanobacteria and microcystin concentrations. Symptoms potentially associated with cyanobacteria (gastrointestinal: 2 indices (GI1: diarrhea or abdominal pain or nausea or vomiting; GI2: diarrhea or vomiting or [nausea and fever] or [abdominal cramps and fever]); upper and lower respiratory tract; eye; ear; skin; muscle pain; headaches; mouth ulcers) were examined in relation with exposure to cyanobacteria and microcystin by using Poisson regression. Only gastrointestinal symptoms were associated with recreational contact. Globally, there was a significant increase in adjusted relative risk (RR) with higher cyanobacterial cell counts for GI2 (<20,000 cells/mL: RR=1.52, 95% CI=0.65-3.51; 20,000-100,000 cells/mL: RR=2.71, 95% CI=1.02-7.16; >100,000 cells/mL: RR=3.28, 95% CI=1.69-6.37, p-trend=0.001). In participants who received their drinking water supply from a plant whose source was contaminated by cyanobacteria, an increase in muscle pain (RR=5.16; 95% CI=2.93-9.07) and gastrointestinal (GI1: RR=3.87; 95% CI=1.62-9.21; GI2: RR=2.84; 95% CI=0.82-9.79), skin (RR=2.65; 95% CI=1.09-6.44) and ear symptoms (RR=6.10; 95% CI=2.48-15.03) was observed. The population should be made aware of the risks of gastrointestinal symptoms associated with contact (full or limited) with cyanobacteria. A risk management plan is needed for water treatment plants that draw their water from a source contaminated with cyanobacteria.

Approaches for improving continuity of care in medication management: a systematic review.

PURPOSE: Medication-related problems frequently occur during transitions and lead to patient harm, increased use of healthcare resources and increased costs. The objective of this systematic review is to synthesize the impact of approaches to optimize the continuity of care in medication management upon hospital admission and/or discharge. DATA SOURCES: MEDLINE, EMBASE, CINAHL, IPA and the Cochrane Database of Systematic Reviews from 1995 through December 2010. STUDY SELECTION: Controlled, parallel-group trials. Data extraction Data were extracted by one researcher and checked by another. Both reviewers independently assessed the study quality. RESULTS: Thirty studies met the inclusion criteria, but only 14 reached the predefined minimum quality score. Most studies focused on discharge and targeted the patients, sometimes together with primary care providers. The majority of studies found improvements in process measures. Patient education and counseling provided upon discharge and reinforced after discharge, sometimes together with improved communication with healthcare professionals, was shown to reduce the risk of adverse drug events and hospital re-admissions in some studies, but not all. Heterogeneity in study population as well as in intervention and outcome reporting precluded meta-analysis and limited interpretation. Most studies had important methodological limitations and were underpowered to show significant benefits on clinical outcomes. CONCLUSIONS: The evidence for an impact of approaches on optimization of continuity of care in medication management remains limited. Further research should better target high-risk populations, use multicentered designs and have adequate sample size to evaluate the impact on process measures, clinical outcomes and cost-effectiveness.

The economic burden associated with skeletal-related events in patients with bone metastases secondary to solid tumors in Belgium.

OBJECTIVES: More than 1.5 million patients worldwide are affected by bone metastases. Patients with bone metastases frequently develop skeletal-related events (SREs, including radiation to bone, non-vertebral fracture, vertebral fracture, surgery to bone, and spinal cord compression) that are associated with high healthcare costs. This study aims to provide an estimate of the cost per SRE in both the inpatient and outpatient settings in Belgian patients with bone metastases secondary to solid tumors (breast, prostate, and lung cancers). METHODS: Patients were retrieved from the IMS Hospital Disease database from 2005-2007. Inclusion was based on the International Classification of Diseases and Related Health Problems Version 9 (ICD-9) diagnosis and/or procedure codes covering patients with breast, prostate, or lung cancer with bone metastases who were hospitalized for one or more SREs. All costs were extrapolated to 2010 using progression in hospitalization costs since 2001. Additional outpatient costs resulting from radiation to bone and diagnostic tests performed in ambulatory settings were estimated by combining published unit costs with resource use data obtained from a Delphi panel. RESULTS: The average cost per SRE across solid tumor types based on the weighted average of inpatient and outpatient costs was €2653 for radiation to bone, €5015 for a vertebral fracture, and €7087 for a non-vertebral fracture. Costs were €12,885 and €15,267 for surgery to bone and spinal cord compression, respectively. LIMITATIONS: No patient follow-up across calendar years could be done. Also, details regarding the exact anatomic sites of SREs were not always available. CONCLUSIONS: SREs add a substantial cost to the management of patients with bone metastases. Avoiding SREs can lead to important cost-savings for the healthcare payer.

Cost-utility of pregabalin as add-on to usual care versus usual care alone in the management of peripheral neuropathic pain in Belgium.

BACKGROUND AND OBJECTIVES: The cost effectiveness of pregabalin as an add-on to the standard treatment of Belgian patients with post-herpetic neuralgia (PHN) had been demonstrated in a previously published Markov model. The purpose of this study was to update that model with more recent cost data and clinical evidence, and reevaluate the cost effectiveness from the payer's perspective of add-on pregabalin in a wider set of NeP conditions. METHODS: The model, featuring 4-week cycles and a 1-year time horizon, consisted in four possible health states: mild, moderate or severe pain and withdrawn from therapy. Three versions of the model were developed, using transition probabilities derived from pain scores reported in three placebo-controlled studies. The two treatment arms were 'usual care' or 'usual care + pregabalin'. Resource use and utility data were obtained from a chart review and unit costs from recent published data. The final outcome of the model was the incremental cost per quality-adjusted life-year (QALY) gained when adding pregabalin to standard care. RESULTS: Based on 1000 simulations, two versions of the model showed that pregabalin was dominant respectively in 94.8% and 67.2% of the simulations, while the incremental cost per QALY was below €32,000/QALY in respectively 99.1% and 94.6% of the simulations. The third version did not show cost effectiveness, despite an incremental cost of only €300 after 1 year. However, in the corresponding study, patients seemed less responsive to GABA analogs, since 55% of them had failed to respond to gabapentin before study inclusion. LIMITATIONS: The studies upon which the model is based have a short follow-up time as compared to the model horizon. The endpoints of two studies were only provided at the aggregated level and do not necessarily reflect the real practice. CONCLUSION: Based on this analysis, it can be concluded that from a Belgium payer perspective pregabalin offers a slight increase in quality of life in the studied populations as compared to standard care. Pregabalin is cost effective in the majority of cases except in one published clinical study, despite a low incremental cost per year (€300).

Antimicrobial-resistant Escherichia coli in public beach waters in Quebec.

INTRODUCTION: Human exposure to antimicrobial-resistant bacteria may result in the transfer of resistance to commensal or pathogenic microbes present in the gastrointestinal tract, which may lead to severe health consequences and difficulties in treatment of future bacterial infections. It was hypothesized that the recreational waters from beaches represent a source of antimicrobial-resistant Escherichia coli for people engaging in water activities. OBJECTIVE: To describe the occurrence of antimicrobial-resistant E coli in the recreational waters of beaches in southern Quebec. METHODS: Sampling occurred over two summers; in 2004, 674 water samples were taken from 201 beaches, and in 2005, 628 water samples were taken from 177 beaches. The minimum inhibitory concentrations of the antimicrobial-resistant E coli isolates against a panel of 16 antimicrobials were determined using microbroth dilution. RESULTS: For 2004 and 2005, respectively, 28% and 38% of beaches sampled had at least one water sample contaminated by E coli resistant to one or more antimicrobials, and more than 10% of the resistant isolates were resistant to at least one antimicrobial of clinical importance for human medicine. The three antimicrobials with the highest frequency of resistance were tetracycline, ampicillin and sulfamethoxazole. DISCUSSION: The recreational waters of these beaches represent a potential source of antimicrobial-resistant bacteria for people engaging in water activities. Investigations relating the significance of these findings to public health should be pursued.

INTRODUCTION: L'exposition humaine à des bactéries résistant aux antimicrobiens peut provoquer le transfert de la résistance à des microbes commensaux ou pathogènes présents dans le tube digestif, ce qui peut avoir de graves conséquences sur la santé et compliquer le traitement de futures infections bactériennes. On a soulevé l'hypothèse que les eaux de baignade des plages représentent une source d'infection à l'Escherichia coli résistant aux antimicrobiens pour les personnes qui s'adonnent à des activités aquatiques. La présente étude visait principalement à décrire l'occurrence d'E coli résistant aux antimicrobiens dans les eaux de baignade du sud du Québec. MÉTHODOLOGIE: Les chercheurs ont procédé à l'échantillonnage sur deux étés. En 2004, ils ont prélevé 674 échantillons d'eau sur 201 plages, et en 2005, 628 échantillons d'eau sur 177 plages. Ils ont établi les concentrations inhibitrices minimales des isolats d'E coli résistant aux antimicrobiens par rapport à un groupe de 16 antimicrobiens au moyen d'une dilution en bouillon. RÉSULTATS: En 2004 et en 2005, respectivement, 28 % et 38 % des plages échantillonnées comptaient au moins un échantillon d'eau contaminée par l'E coli résistant à au moins un antimicrobien, et plus de 10 % de ces isolats résistaient à un moins un antimicrobien d'importance clinique en médecine humaine. La tétracycline, l'ampicilline et le sulfaméthoxazole étaient les trois antimicrobiens les plus touchés par la résistance. EXPOSÉ: Les eaux de baignade de ces plages représentent une source potentielle de bactéries résistant aux antimicrobiens pour les personnes qui s'adonnent à des activités aquatiques. Il faudrait poursuivre les recherches sur la signification de ces observations en matière de santé publique.

Vulnerability of Quebec drinking-water treatment plants to cyanotoxins in a climate change context.

Cyanobacteria are a growing concern in the province of Quebec due to recent highly publicised bloom episodes. The health risk associated with the consumption of drinking water coming from contaminated sources was unknown. A study was undertaken to evaluate treatment plants' capacity to treat cyanotoxins below the maximum recommended concentrations of 1.5 microg/L microcystin-LR (MC-LR) and the provisional concentration of 3.7 microg/L anatoxin-a, respectively. The results showed that close to 80% of the water treatment plants are presently able to treat the maximum historical concentration measured in Quebec (5.35 microg/L MC-LR equ.). An increase, due to climate change or other factors, would not represent a serious threat because chlorine, the most popular disinfectant, is effective in treating MC-LR under standard disinfection conditions. The highest concentration of anatoxin-a (2.3 microg/L) measured in natural water thus far in source water is below the current guideline for treated waters. However, higher concentrations of anatoxin-a would represent a significant challenge for the water industry as chlorine is not an efficient treatment option. The use of ozone, potassium permanganate or powder activated carbon would have to be considered.

[A study to assess the microbial contamination of Mya arenaria clams from the north shore of the St Lawrence River estuary, (Québec, Canada)]. / Etude de la contamination microbienne des myes (Mya arenaria) de la rive nord de l'estuaire maritime du fleuve Saint-Laurent (Québec, Canada)

The aims of the present study were to assess the microbial quality of Mya arenaria clams from the north shore of the St. Lawrence River estuary and to validate various microbial indicator microorganisms of bivalve mollusks contamination. Clams were collected from nine sites, including four harvesting sites closed by virtue of the Canadian Shellfish Sanitation Program (CSSP). Six contamination indicators (fecal coliforms, somatic coliphages, F-specific coliphages, fecal streptococci, Clostridium perfringens, and Escherichia coli) and four pathogens (Campylobacter sp., Cryptosporidium parvum, Giardia sp., and Salmonella sp.) were identified in the clams. Indicators sensibility, specificity and predictive values with respect to the presence of pathogens were calculated. Pathogenic microorganisms detection frequency in clams was important (92%). Globally, pathogens tend to be less frequently detected in opened harvesting sites (p = 0.086). Although the assessed indicators were not perfect, when F-specific coliphages are associated with E. coli or fecal coliforms, a good sensibility (62%-64%) and good positive predictive value (88%) with respect to the investigated pathogens are obtained.