Advancing knowledge and increasing capacity to address climate-driven infectious diseases in Canada.

The sixth edition of the Canadian Tuberculosis Standards will soon be available in hard copy through the offices of the Canadian Lung Association (CLA), and the individual provincial and territorial lung associations, and in PDF format at . Historically, the Standards became important when effective treatment of tuberculosis became available and sanatoria closed. In contrast to the first (1972), second (1981), third (1988) and fourth (1996) editions, which were products of the Canadian Thoracic Society (CTS)/CLA alone, the fifth (2000) and sixth editions of the Standards were jointly produced by the CTS/CLA and Health Canada (fifth), and the Public Health Agency of Canada (PHAC) (sixth). The evolution of the Standards as a document dependent on the CTS for medical and scientific input, and on the PHAC for public health and policy input, was part of a broader shift from nongovernmental to governmental organization of tuberculosis prevention and control activity in Canada. The Tuberculosis Prevention and Control Program of the PHAC is the sponsor of the Canadian Tuberculosis Committee, a national committee with representation from each province and territory, Citizenship and Immigration Canada, First Nations and Inuit Health Branch of Health Canada, Correctional Service Canada, Canadian Public Health Laboratory Network, Association of Medical Microbiology and Infectious Disease, CLA, CTS and PHAC (both the National Microbiology Laboratory and the Tuberculosis Prevention and Control Program). It also houses the Canadian Tuberculosis Surveillance System and the Canadian Tuberculosis Laboratory Surveillance System, as well as represents Canada internationally. The major role of the Tuberculosis Committee of the CTS is now the preparation of the Standards. In fact, the membership of the CTS Tuberculosis Committee and the editorial committee of the Standards are one and the same; the editors of the Standards are the Chair of the CTS Tuberculosis Committee and the Manager of the Tuberculosis Prevention and Control Program of the PHAC. The sixth edition of the Standards is a substantial revision to its predecessor the fifth edition (see below). Chapters or appendixes already in the fifth edition were redacted, and new chapters and appendixes were added (Chapters 14, 15 and 18; Appendixes D, E, F, G, H and J) after a systematic survey of end-user satisfaction with the fifth edition undertaken by the CTS. In addition to the chapter-specific table of contents and expanded bibliographies, the text is populated with a series of Web resources that will be regularly updated by PHAC and other agencies. As in the fifth edition, treatment recommendations are rated using a roman numeral (I, II or III), which indicates the quality of evidence supporting the recommendation (1). The Standards are meant to be a definitive resource on issues pertaining to tuberculosis prevention and control in Canada. In contrast to provincial and territorial guidelines, which describe how an action is to be accomplished and how the structure of care is framed, the Canadian Tuberculosis Standards, like the International Standards for Tuberculosis Care (available at ), provide the foundation on which care can be based, presenting what should be done.

Social-behavioral/ecological risk assessment for Lyme disease in southern Québec, Canada.

The sixth edition of the Canadian Tuberculosis Standards will soon be available in hard copy through the offices of the Canadian Lung Association (CLA), and the individual provincial and territorial lung associations, and in PDF format at . Historically, the Standards became important when effective treatment of tuberculosis became available and sanatoria closed. In contrast to the first (1972), second (1981), third (1988) and fourth (1996) editions, which were products of the Canadian Thoracic Society (CTS)/CLA alone, the fifth (2000) and sixth editions of the Standards were jointly produced by the CTS/CLA and Health Canada (fifth), and the Public Health Agency of Canada (PHAC) (sixth). The evolution of the Standards as a document dependent on the CTS for medical and scientific input, and on the PHAC for public health and policy input, was part of a broader shift from nongovernmental to governmental organization of tuberculosis prevention and control activity in Canada. The Tuberculosis Prevention and Control Program of the PHAC is the sponsor of the Canadian Tuberculosis Committee, a national committee with representation from each province and territory, Citizenship and Immigration Canada, First Nations and Inuit Health Branch of Health Canada, Correctional Service Canada, Canadian Public Health Laboratory Network, Association of Medical Microbiology and Infectious Disease, CLA, CTS and PHAC (both the National Microbiology Laboratory and the Tuberculosis Prevention and Control Program). It also houses the Canadian Tuberculosis Surveillance System and the Canadian Tuberculosis Laboratory Surveillance System, as well as represents Canada internationally. The major role of the Tuberculosis Committee of the CTS is now the preparation of the Standards. In fact, the membership of the CTS Tuberculosis Committee and the editorial committee of the Standards are one and the same; the editors of the Standards are the Chair of the CTS Tuberculosis Committee and the Manager of the Tuberculosis Prevention and Control Program of the PHAC. The sixth edition of the Standards is a substantial revision to its predecessor the fifth edition (see below). Chapters or appendixes already in the fifth edition were redacted, and new chapters and appendixes were added (Chapters 14, 15 and 18; Appendixes D, E, F, G, H and J) after a systematic survey of end-user satisfaction with the fifth edition undertaken by the CTS. In addition to the chapter-specific table of contents and expanded bibliographies, the text is populated with a series of Web resources that will be regularly updated by PHAC and other agencies. As in the fifth edition, treatment recommendations are rated using a roman numeral (I, II or III), which indicates the quality of evidence supporting the recommendation (1). The Standards are meant to be a definitive resource on issues pertaining to tuberculosis prevention and control in Canada. In contrast to provincial and territorial guidelines, which describe how an action is to be accomplished and how the structure of care is framed, the Canadian Tuberculosis Standards, like the International Standards for Tuberculosis Care (available at ), provide the foundation on which care can be based, presenting what should be done.

Learning from serosurveillance for SARS-CoV-2 to inform pandemic preparedness and response

International community ramps up Ebola vaccine effort

The burden of illness due to food-borne pathogens each year in Canada is significant. Investigations of food-borne illness outbreaks, particularly those with cases in more than one jurisdiction, are complex. Accordingly, efficient outbreak response requires the coordination and collaboration of many investigative partners. To highlight the Public Health Agency of Canada's Food-borne Illness Outbreak Response Protocol (FIORP), the primary guidance document for investigations of multi-jurisdictional food-borne illness outbreaks in Canada. The current version of the FIORP was developed in 2010 by the Public Health Agency of Canada following consultation with Health Canada, the Canadian Food Inspection Agency, and provincial and territorial stakeholders. The FIORP outlines guiding principles and operating procedures to enhance collaboration and coordination among multiple investigative partners in response to multi-jurisdictional food-borne illness outbreaks. It has provided guidance for the conduct of 22 such investigations led by the Public Health Agency of Canada's Centre for Food-borne, Environmental and Zoonotic Infectious Diseases between 2011 and 2013. Furthermore, it has also served as a guide for the development of provincial protocols. The timely and effective investigation of and response to multi-jurisdictional food-borne illness outbreaks in Canada is facilitated and enhanced by the FIORP.

This paper describes the work of the National Advisory Committee on Infection Prevention and Control (NAC-IPC), previously Infection Prevention and Control Expert Working Group, a longstanding external advisory body that provides subject matter expertise and advice to the Public Health Agency of Canada (PHAC) on the prevention and control of infectious diseases in Canadian health care settings. Originally established by Health Canada as the Infection Control Guidelines Steering Committee in 1992, this advisory board has been providing expert advice on infection prevention and control (IPC) guideline development for over 25 years. The NAC-IPC provides advice to inform the development of comprehensive or concise guidelines, quick reference guides and interim guidelines (usually for emerging pathogens), working closely with PHAC's national Healthcare-Associated Infections (HAIs) surveillance programs for Canadian health care facilities. PHAC's HAI-IPC professionals conduct the necessary literature research, data extraction, evidence synthesis, evidence grading (where applicable) and scientific writing for the guidelines. Due to the paucity of clinical trials and high quality observational studies to inform recommendations for emerging pathogens, expert opinion is critical for interpreting available evidence. .

The Public Health Agency of Canada (PHAC) is the main governmental agency that oversees public health programs, services, and policies. Its mission is “to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health.” PHAC consists of two branches: Planning and Public Health Integration, and Infectious Disease and Emergency Preparedness. It is managed by the chief public health officer of Canada. The PHAC website is organized into three main categories: diseases and conditions, health and safety, and research and statistics. Agency reports and publications are also available free of charge.

There is a paucity of information about the impact of mood and anxiety disorders on Canadians and the approaches used to manage them. To address this gap, the 2014 Survey on Living with Chronic Diseases in Canada-Mood and Anxiety Disorders Component (SLCDC-MA) was developed. The purpose of this paper is to describe the methodology of the 2014 SLCDC-MA and examine the sociodemographic characteristics of the final sample. The 2014 SLCDC-MA is a cross-sectional follow-up survey that includes Canadians from the 10 provinces aged 18 years and older with mood and/or anxiety disorders diagnosed by a health professional that are expected to last, or have already lasted, six months or more. The survey was developed by the Public Health Agency of Canada (PHAC) through an iterative, consultative process with Statistics Canada and external experts. Statistics Canada performed content testing, designed the sampling frame and strategies and collected and processed the data. PHAC used descriptive analyses to describe the respondents' sociodemographic characteristics, produced nationally representative estimates using survey weights provided by Statistics Canada, and generated variance estimates using bootstrap methodology. The final 2014 SLCDC-MA sample consists of a total of 3361 respondents (68.9% response rate). Among Canadian adults with mood and/or anxiety disorders, close to twothirds (64%) were female, over half (56%) were married/in a common-law relationship and 60% obtained a post-secondary education. Most were young or middle-aged (85%), Canadian born (88%), of non-Aboriginal status (95%), and resided in an urban setting (82%). Household income was fairly evenly distributed between the adequacy quintiles; however, individuals were more likely to report a household income adequacy within the lowest (23%) versus highest (17%) quintile. Forty-five percent reported having a mood disorder only, 24% an anxiety disorder only and 31% both kinds of disorder. The 2014 SLCDC-MA is the only national household survey to collect information on the experiences of Canadians living with a professionally diagnosed mood and/or anxiety disorder. The information collected offers insights into areas where additional support or interventions may be needed and provides baseline information for future public health research in the area of mental illness.

Immunization in Canada 2007

Public health is comprised of services, programs, and policies aimed at promoting health, preventing injury and chronic diseases, and responding to health emergencies. Public health professionals include front line providers, consultants, and specialists from various disciplines and professions, such as medicine, nursing, and epidemiology. Public health in Canada is provided through the collaboration between three levels of government, namely municipal, provincial or territorial, and federal. While public health is a shared responsibility of all levels of government, the volume and direction of allocated resources for related activities varies between the provinces and territories. Canada’s public health history predates its founding in 1867. A turning point in public health in the country occurred following the Severe Acute Respiratory Syndrome (SARS) outbreak in 2003. The following year, the federal Public Health Agency of Canada (PHAC) was created. Its role is to improve and maintain population health in Canada. The Chief Public Health Officer is the deputy head of the PHAC and is the government’s lead public health professional. The public health landscape in Canada will continue to evolve to meet the growing needs of its population and to address existing health challenges including adverse health events related to chronic diseases and unhealthy lifestyles. Moreover, it will further adapt to respond to new public health threats, such as the emergence of tropical illnesses, the northward spread of infectious agents due to climate change, and disease transmission related to international travel.

Objective: To rebuild the software that underpins the Global Public Health Intelligence Network using modern natural language processing techniques to support recent and future improvements in situational awareness capability.Introduction: The Global Public Health Intelligence Network is a non-traditional all-hazards multilingual surveillance system introduced in 1997 by the Government of Canada in collaboration with the World Health Organization.1 GPHIN software collects news articles, media releases, and incident reports and analyzes them for information about communicable diseases, natural disasters, product recalls, radiological events and other public health crises. Since 2016, the Public Health Agency of Canada (PHAC) and National Research Council Canada (NRC) have collaborated to replace GPHIN with a modular platform that incorporates modern natural language processing techniques to support more ambitious situational awareness goals.Methods: The updated GPHIN platform assembles several natural language processing tools to annotate incoming data in order to support situational awareness; broadly, GPHIN aims to extract knowledge from data.Data are collected in 10 languages and are machine translated to English. Several of the machine translation models use high performance neural networks. Language models are updated regularly and support external dictionaries for handling emerging domain-specific terms that might not yet exist in the parallel corpora used to train the models.All incoming documents are assigned a relevance score. Machine learning models estimate a score based on similarity to sets of known high-relevance and known low-relevance documents. PHAC analysts provide feedback on the scoring from time to time in the course of their work, and this feedback is used to periodically retrain scoring models.Documents are assigned keywords using two ontologies: an all-hazards multilingual taxonomy hand-compiled at PHAC, and the U.S. National Library of Medicine’s Unified Medical Language System (UMLS).Categories are assigned probabilistically to incoming articles (e.g., human infectious diseases, animal infectious diseases, substance abuse, environmental hazards), largely using affinity scores that correspond to keywords.Dates and times are resolved to canonical forms, so that mentions like last Tuesday get resolved to specific dates; this makes it possible to sequence data about a single event that are released at varying frequencies and with varying timeliness.Cities, states/provinces, and countries are identified in the documents, and gaps in the hierarchical geographic relationships are filled in. Locations are disambiguated based on collocations; the system distinguishes between and correctly resolves Ottawa, KS vs. Ottawa, ON, Canada, for example. Countries are displayed with their socio-economic population statistics (Gini coefficient, human development index, median age, and so on).The system attempts to detect and reconcile near-duplicate articles in order to handle instances where one article is released on a newswire and subsequently gets lightly edited and syndicated in dozens or hundreds of local papers; this improves the signal-to-noise ratio of the data in GPHIN for better productivity. Template-based reports (where the same document may get re-issued with a new number of cases but no other changes, for example) are still a challenge, but whitelisting tools reduce the false positive rate.The system provides tools for constructing arbitrarily detailed searches, tied to colour-coded maps and graphs that update on-the-fly, and offers short extractive summaries of each search result for easy filtering. GPHIN also generates topical knowledge graphs about sets of articles that seek to reveal surprising correlations in the data; for example, graphically reconciling and highlighting cases where several neighbouring countries all have reports of a mysterious disease and where a particular mosquito is mentioned.Next steps in the ongoing rejuvenation involve collating discrete articles and documents into narrative timelines that track an ongoing event: collecting all data about the spread of an infectious disease outbreak or perhaps the aftermath of an earthquake in the developing world. Our research is focussing on how to build line lists from such a stream of news articles about an event and how to detect important change points in the ongoing narrative.Results: The new GPHIN platform was launched in August 2016 in order to support syndromic surveillance activities for the Rio 2016 Olympics, and has been updated incrementally since then to offer further capabilities to professional users in 30 countries. Its modular construction supports current situational awareness activities as well as further research into advanced natural language processing techniques.Conclusions: We improved (and continue to improve) GPHIN with modern natural language processing techniques, including better translations, relevance scoring, categorization, near-duplicate detection, and improved data visualization tools, all towards the goal of more productive and more trustworthy situational awareness.

Zoonoses and Public HealthVolume 56, Issue 6-7 p. 257-257 Emerging Zoonoses: Recent Advances and Future Challenges J. A. Richt, J. A. Richt Kansas State University, College of Veterinary Medicine, Manhattan, KS, USASearch for more papers by this authorH. Feldmann, H. Feldmann National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada & Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada E-mail: [email protected] Present Address: Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA.Search for more papers by this author J. A. Richt, J. A. Richt Kansas State University, College of Veterinary Medicine, Manhattan, KS, USASearch for more papers by this authorH. Feldmann, H. Feldmann National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Canada & Department of Medical Microbiology, University of Manitoba, Winnipeg, MB, Canada E-mail: [email protected] Present Address: Laboratory of Virology, Division of Intramural Research, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Rocky Mountain Laboratories, Hamilton, MT, USA.Search for more papers by this author First published: 09 July 2009 https://doi.org/10.1111/j.1863-2378.2009.01288.xCitations: 3 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article.Citing Literature Volume56, Issue6-7August 2009Pages 257-257 RelatedInformation

1Department of Paediatrics, Western University, London; 2Centre for Food Environmental and Zoonotic Infectious Diseases, Public Health Agency of Canada, Ottawa, Ontario; 3National Microbiology Laboratory, National Public Health Laboratories, Public Health Agency of Canada, Winnipeg, Manitoba; 4Departments of Paediatrics and Community Health and Epidemiology, Dalhousie University and IWK Health Centre, Halifax, Nova Scotia; 5Centre for Food Environmental and Zoonotic Infectious Diseases; 6Laboratory for Foodborne Zoonoses, National Public Health Laboratories, Public Health Agency of Canada, Saint-Hyacinthe, Quebec Correspondence: Canadian Paediatric Surveillance Program, 2305 St Laurent Boulevard, Ottawa, Ontario K1G 4J8. Telephone 613-526-9397 ext 239, fax 613-526-3332, e-mail cpsp@cps.ca, website www.cpsp.cps.ca Accepted for publication April 8, 2015 A six-year-old boy presented to a walk-in clinic with a four-day history of an isolated, painless, nonpruritic, red rash with gradually expanding borders on his right arm. There was no history of fever, headache, myalgia, joint symptoms, palpitations, fainting or facial weakness. His family had returned two days previously from a three-week camping trip in the Point Pelee area of southern Ontario. During the trip, the patient had worn shorts and T-shirts most of the time, and rarely applied insect repellents. His examination was normal except the exanthem on his arm, which had a ‘bull’s eye’ appearance and measured 5 cm in diameter (Figure 1). He received a three-week course of amoxicillin and the rash was noted to gradually disappear over the period of therapy. Serological laboratory testing for Lyme disease was negative. He improved during follow-up, with resolution of the rash and no occurrence of neurological or musculoskeletal symptoms.

Health Canada and the Public Health Agency of Canada (PHAC) stalled media access to the National Advisory Committee on Immunization (NACI) at the same time Canada’s chief public health officer suspended regular pandemic briefings and interviews “in light of the election.” Just before the Aug