Public Health Agency Of Canada Research Articles

Rising syphilis rates in Canada, 2011-2020.

Syphilis rates are of public health concern in Canada, with multiple jurisdictions reporting outbreaks over the past five years. The objective of this article is to describe trends in infectious and congenital syphilis in Canada 2011-2020. Routine surveillance of syphilis is conducted through the Canadian Notifiable Disease Surveillance System (CNDSS). In response to rising rates of syphilis, all provinces and territories (P/Ts) have also submitted enhanced surveillance data on infectious syphilis to the Public Health Agency of Canada through the Syphilis Outbreak Investigation Coordinating Committee (SOICC) starting in 2018. Descriptive analyses of CNDSS and SOICC surveillance data 2011-2020 by age, sex, pregnancy status, male sexual orientation and P/Ts were performed. The national rate of infectious syphilis increased from 5.1 per 100,000 population in 2011 to 24.7 per 100,000 population in 2020.The rates increased in almost all P/Ts, with the Prairie provinces reporting the greatest relative increases from 2016 to 2020 (more than 400%). Rates in males were consistently higher than rates in females over the past 10 years; however, from 2016 to 2020, rates among females increased by 773%, compared with 73% among males. Although the proportion of cases who self-identify as gay, bisexual and other men who have sex with men decreased from 54% to 38% between 2018 and 2020, they still represent a high proportion of cases (according to data from eight P/Ts). From 2016 to 2020, rates of infectious syphilis increased in every age group, especially in females aged 15-39 years. Confirmed early congenital syphilis cases for 2020 increased considerably from prior years, with 50 cases reported in 2020, compared with 4 cases in 2016. Infectious and congenital syphilis rates are a growing concern in Canada and the nature of the syphilis epidemics across Canada appears to be evolving, as evidenced by recent trends. More data and research are needed to better understand the drivers associated with the recent changes in the epidemiology of syphilis in Canada.

A172 PSYCHOSOCIAL VARIABLES RELATED TO J-POUCH SURGERY FOR INFLAMMATORY BOWEL DISEASE: A SCOPING REVIEW

BackgroundUlcerative Colitis (UC) and Crohn’s Disease (CD) are subtypes of Inflammatory Bowel Disease (IBD) which is a condition with an unclear etiology causing inflammation of the small and large intestine (Public Health Agency of Canada, 2021). IBD is treated by diet, medications, and/or surgeries, with the most common surgery recommended to UC patients being j-pouch surgery (Crohn’s and Colitis Canada, n.d.). J-pouch surgery is often accompanied by numerous side effects (e.g., leakage, pouchitis), but it has been shown to help manage symptoms and restore function (Crohn’s and Colitis Canada, n.d.). While noteworthy research has examined the functional and biological outcomes of j-pouch surgery (e.g., Kayal et al., 2020), far less has considered the perioperative psychosocial implications.AimsThe aim of this scoping review is to assess the current literature concerning psychosocial factors related to j-pouch surgery for patients with IBD.MethodsWe used the PRISMA-ScR (Tricco et al., 2018) and JBI recommendations (Peters et al., 2020) as methodological guidelines for conducting this review. We conducted our search during the summer and fall of 2021 and searched the following sources: Medline, PsychInfo, CINAHL, EBM Reviews, ProQuest Dissertations and Theses Global, ResearchGate, Prospero, and PrePubMed. We included articles from 1980-September 13, 2021.ResultsOur initial search produced 718 articles. Of those that met our inclusion criteria, the majority discussed quality of life as their sole psychosocial variable. Among these studies, however, many used quality of life measures (e.g., IBDQ, SF-36) that prioritize health-related factors, with only a subset of questions directly addressing quality of life. The second most investigated psychosocial variables were those related to sexual health and functioning. When considering the levels of evidence, very few of our results were randomized control trials (RCT), while many were reviews (but not exclusively of RCT) and non-randomized controlled studies.ConclusionsWe have identified a substantial need for studies examining psychosocial implications of and for j-pouch surgery among patients with IBD. In our discussion, we identify common variables and outline the strongest articles in the current literature, investigate the disadvantages of currently used measures, and propose specific directions for future research.Funding AgenciesNone

Implementation of the BC Congenital Anomalies Surveillance System (BCCASS).

Congenital anomalies (CAs) can cause lifelong morbidity and accounted for 23.2% of infant deaths from 2003 to 2007. In British Columbia (BC), surveillance of CAs has been irregular since the early 2000s. To enhance CAs surveillance in BC, the Public Health Agency of Canada has provided funding for the implementation of the BC Congenital Anomalies Surveillance System (BCCASS). BCCASS is a population-based surveillance system. The system leverages existing administrative data sources that capture information regarding vital events, disease status, drug prescription, and healthcare utilization. The system uses a series of algorithms to capture specific CAs diagnoses, some of which are further validated with the support of the Provincial Advisory Committee. This Advisory Committee is a multi-stakeholder coalition that includes the BC Office of the Provincial Health Officer, subject matter experts, data partners, users, and academia, and acts to provide support, expertise, and strategic guidance to BCCASS. Through BCCASS, prevalence and historical trends for 35 CAs in BC are available. Information pertaining to maternal place of residence, risk, and protective factors can be used for association studies such as links to environmental hazards and cluster analysis. BCCASS is a cost-effective and sustainable system that leverages existing data sources necessary to understand the overall burden of CAs across the BC population. This is fundamental to support data-driven decisions around policy development, program planning, and evaluation of preventive measures. Strong coalitions with stakeholders are instrumental to ensure successful implementation and expansion in the future.

A semi-parametric mixed model for short-term projection of daily COVID-19 incidence in Canada

During a pandemic, data are very “noisy” with enormous amounts of local variation in daily counts, compared with any rapid changes in trend. Accurately characterizing the trends and reliable predictions on future trajectories are important for planning and public situation awareness. We describe a semi-parametric statistical model that is used for short-term predictions of daily counts of cases and deaths due to COVID-19 in Canada, which are routinely disseminated to the public by Public Health Agency of Canada. The main focus of the paper is the presentation of the model. Performance indicators of our model are defined and then evaluated through extensive sensitivity analyses. We also compare our model with other commonly used models such as generalizations of logistic models for similar purposes. The proposed model is shown to describe the historical trend very well with excellent ability to predict the short-term trajectory.

Assessment of Functional Mobility After COVID-19 in Adults Aged 50 Years or Older in the Canadian Longitudinal Study on Aging

The association of COVID-19 not requiring hospitalization with functional mobility in community-dwelling adults above and beyond the impact of the pandemic control measures implemented in 2020 remains to be elucidated. To evaluate the association between a COVID-19 diagnosis and change in mobility and physical function of adults in Canada aged 50 years or older during the initial pandemic lockdown. This population-based cohort study used data from the Canadian Longitudinal Study on Aging (CLSA) COVID-19 study. This study was launched on April 15, 2020, and the exit questionnaires were completed between September and December 2020. Prepandemic data from the first CLSA follow-up (2015-2018) were also used. Respondents included middle-aged and older community-dwelling participants residing in Canadian provinces. Data were analyzed from February to May 2021. The assessment for self-reported COVID-19 status was adapted from the Public Health Agency of Canada and the Centers for Disease Control and Prevention case definition available at the time of data collection; cases were classified as confirmed or probable, suspected, or non-COVID-19. Changes in mobility since the start of the COVID-19 pandemic were assessed using global rating of change in mobility scales at the COVID-19 exit questionnaire. Participant-reported new onset of difficulty in 3 physical function tasks was also examined. Among 51 338 participants at baseline, 21 491 participants (41.9%) were 65 years or older and 26 155 participants (51.0%) were women and 25 183 (49.1%) were men. Of 2748 individuals with confirmed or probable or suspected COVID-19, 113 (94.2%) were not hospitalized. Individuals with confirmed or probable COVID-19 had higher odds of worsening mobility in terms of ability to engage in household activity (odds ratio [OR], 1.89; 95% CI, 1.11-3.22), physical activity (OR, 1.91; 95% CI, 1.32-2.76), and standing up after sitting in a chair (OR, 2.33; 95% CI, 1.06-5.11) compared with adults without COVID-19 during the same pandemic time period. Similar results were found for suspected COVID-19 status (eg, household activity: OR, 2.09; 95% CI, 1.82-2.41). This cohort study among older adults in Canada found that receiving a COVID-19 diagnosis was significantly associated with worse mobility and functioning outcomes even in the absence of hospitalization. These findings suggest that interventions may be needed for individuals with mild to moderate COVID-19 who do not require hospitalization.

Comparison of different biomass methodologies to adjust sales data on veterinary antimicrobials in the USA.

ObjectivesThe United States (US) FDA, European Surveillance of Veterinary Antimicrobial Consumption (ESVAC), Public Health Agency of Canada (PHAC) and World Organisation for Animal Health (OIE) established methodologies that characterize antimicrobial sales for use in food animals by adjusting the sales by animal biomass. Our aim was to review and compare these methodologies on US-specific data.MethodsAnnual antimicrobial sales for cattle, swine, chickens and turkeys in the USA between 2016 and 2018 were adjusted by the FDA, ESVAC, PHAC and OIE methodologies. To better understand the advantages and disadvantages of the four methodologies, their biomass denominators were compared regarding the level of detail accounted for in the estimated US livestock biomass, their ability to observe temporal trends in animal biomass within a country and practicality in biomass estimation for comparing antimicrobial sales across countries.ResultsThe four methodologies resulted in substantially different estimates of biomass-adjusted antimicrobial sales for use in US food animals. The 2018 estimates were the highest with the ESVAC methodology (314.7 mg of active antimicrobial ingredient/kg of animal biomass), followed by PHAC (191.5 mg/kg), FDA (127.6 mg/kg) and OIE (111.5 mg/kg). The animal weight parameters used in each methodology had the most impact on the biomass-adjusted sales estimates.ConclusionsIn regard to the estimation of the animal biomass, no methodology was found to be perfect; however, the FDA methodology had the best resolution in characterizing the US livestock biomass while the OIE methodology was best for biomass estimation for global monitoring of antimicrobial sales for use in food animals.

Virtual Testing of Seniors: The Feasibility of Research with Online Neuropsychological Tests (FRONT)

Synergic@Home is a feasibility study evaluating the effects of exercise and cognitive interventions for the prevention of dementia in at-risk individuals over age 60. The COVID-19 pandemic changed the study’s methods, with standardized neuropsychological tests needing to be administered virtually. Experience and research into the viability of neuropsychological assessments administered virtually is limited. After receiving permission to adapt the tests for virtual administration, a neuropsychologist, project managers, and research coordinators developed their approach. A PowerPoint presentation using text and visual stimuli from the tests was developed with on-screen instructions for the raters. An iterative development process involved feedback from the team in order to maximize the fidelity of these methods compared to in-person administration. Mock assessments supervised by a neuropsychologist further refined the methods and confirmed rater adherence to standardized procedures. A secure videoconferencing platform meeting privacy requirements was used. Dual monitors for the raters provided instructions on one monitor while stimuli for the participant was on the second monitor. The participant could only see the stimuli. This method of administering neuropsychological assessment, the Feasibility of Research with Online Neuropsychological Testing (FRONT), is being used to evaluate older adult participants in Synergic@Home. Results from this feasibility study may set the stage for new research methodologies and/or clinical evaluations in the future. This project is funded by the New Brunswick Healthy Seniors Pilot Project and the Canadian Consortium on Neurodegeneration in Aging (with grants from Public Health Agency of Canada and the Canadian Institutes of Health Research, with additional funding partners).

The occurrence of potentially pathogenic fungi and protists in Canadian lakes predicted using geomatics, in situ and satellite-derived variables: Towards a tele-epidemiological approach

Eukaryotic pathogens including fungi and enteroparasites infect humans, animals and plants. As integrators of landscape catchment, lakes can reflect and record biological and geochemical events or anthropogenic changes and provide useful knowledge to formulate public health, food security and water policies to manage and prevent diseases. In this context, potentially pathogenic fungi and parasites were sampled using 18S rRNA gene amplicon sequencing in 382 lakes displaying a broad range of sizes and human impact on the watershed in 10 ecozones across Canada. Based on pathogen classifications from the ePATHogen database published by the Public Health Agency of Canada, we identified 23 health-relevant genera for human and animal hosts, including Cryptococcus and Cryptosporidium. Our study investigated the potential of remote sensing and geomatics to predict microbial contamination in a tele-epidemiological approach. We used boosted regression tree modeling to evaluate the probability of occurrence of the most common genera found in our dataset based on 10 satellite-derivable, geomatics and field survey variables which could be potential sources or transport mechanisms through the watershed or survival factors in the water. We found that southern ecozones that possess the highest agricultural and pasture activities tend to contain lakes with the largest number of potential pathogens including several fungi associated with plant diseases. Bio-optical factors, such as colored dissolved organic matter, were highly related to the occurrence of the genera, potentially by protecting against damage from ultraviolet light. Our results demonstrate the capability of tele-epidemiology to provide useful information to develop government policies for recreational and drinking water regulations as well as for food security.

The effect of the COVID-19 pandemic on influenza-related hospitalization, intensive care admission and mortality in children in Canada: A population-based study

BackgroundThe COVID-19 pandemic resulted in unprecedented implementation of wide-ranging public health measures globally. During the pandemic, dramatic decreases in seasonal influenza virus detection have been reported worldwide. Information on the impact on paediatric influenza-related hospitalisations is limited. We describe influenza-related hospitalisation in children in Canada following the onset of the COVID-19 pandemic.MethodsData on influenza-related hospitalisations, intensive care unit (ICU) admissions and in-hospital deaths in children across Canada were obtained from the Canadian Immunisation Monitoring Program, ACTive (IMPACT). This national active surveillance initiative comprises 90% of all tertiary care paediatric beds in Canada. The study period included eleven influenza seasons, from the 2010/2011 season until the 2020/2021 season inclusive. Time series modelling was used to compare the observed to predicted influenza-related hospitalisations following the COVID-19 pandemic.ResultsFollowing the COVID-19 pandemic there was a significant decrease in paediatric influenza-related hospitalisations compared to predicted influenza-related hospitalisations for this time period (p < 0•0001). No paediatric influenza-related hospitalisations, ICU admission or deaths were reported for the 2020/2021 influenza season.ConclusionsWe show complete absence of paediatric influenza infection-related hospitalisation in a Canadian National Surveillance Network during the 2020/2021 influenza season. This significant decrease is likely related in large part to non-pharmacological public health interventions implemented during the COVID-19 pandemic, although the potential role of viral interference is unknown.FundingThe Canadian Immunisation Monitoring Program, Active (IMPACT) influenza surveillance is a national surveillance initiative managed by the Canadian Paediatric Society and conducted by the IMPACT network of paediatric investigators on behalf of the Public Health Agency of Canada's Centre for Immunisation and Respiratory Infectious Diseases.

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

: 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. : 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. : 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. : 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.

Multisystem inflammatory syndrome in children in Canada.

This article provides a summary of the epidemiology of multisystem inflammatory syndrome in children (MIS-C) cases reported nationally in Canada by provincial and territorial health authorities. Multisystem inflammatory syndrome in children is a post-viral inflammatory syndrome that temporally follows coronavirus disease 2019 (COVID-19). Symptoms may include fever, abdominal pain, vomiting, diarrhea, skin rash and other signs of inflammation. In Canada, MIS-C is rare, with 269 cases reported to the Public Health Agency of Canada between March 11, 2020 and October 2, 2021. One hundred forty-two (53%) of these cases were lab-confirmed COVID-19 cases or epidemiologically-linked with COVID-19 cases. Cases have been reported in infants as young as one week to youth as old as 18 years, with a median age of six years. Cases were more likely to occur in males than females (58% vs 42%, respectively; p=0.006). Almost all MIS-C cases (99%) required hospitalization and 36% required intensive care unit admission. No deaths have been reported to date. The time trend of MIS-C aligns with the incidence rate time trend of COVID-19 reported in children, with a two to six-week lag.

Reduced ability to engage in social and physical activity and mental health of older adults during the COVID-19 pandemic: longitudinal analysis from the Canadian Longitudinal Study on Aging

BackgroundRestrictions implemented to mitigate the transmission of COVID-19 have affected the ability of many older adults to engage in social and physical activities. We examined the mental health outcomes for older adults whose ability to be socially and physically active was reduced during the course of the COVID-19 pandemic. MethodsData from the Canadian Longitudinal Study on Aging (CLSA), a nationally representative longitudinal cohort of Canadian residents aged 45–85 years, at CLSA baseline (2012–15), follow-up 1 (2018), COVID-19 baseline (April–May, 2020), and COVID-19 exit surveys (September–December, 2020) were used. Participants were asked the degree to which their ability to participate in social and physical activity had been affected by the COVID-19 pandemic. Binary logistic regression was used to examine the relationship between the risk of a positive screen for depression (Center for Epidemiological Studies Depression Scale score >10) and anxiety (Generalised Anxiety Disorder Assessment-7 score >10) and reduced participants' ability to participate in social and physical activity. Models were adjusted for age group, dwelling type, geographic area, household composition, Center for Epidemiological Studies Depression Scale, and smoking status at COVID-19 baseline; alcohol consumption at COVID-19 exit; and multimorbidity, physical activity, income, social participation, and diagnosis of anxiety or mood disorders before the COVID-19 pandemic. FindingsOf the 24 108 participants who completed the COVID-19 exit survey, 5219 (22·0%) screened positive for depression and 1132 (5·0%) screened positive for anxiety. Depression and anxiety were associated with a decreased ability to participate in social activity (odds ratio [OR] 1·85 [95% CI 1·67–2·04] for depression; 1·66 [1·37–2·02] for anxiety) and physical activity (2·46 [2·25–2·69] for depression; 1·96 [1·68–2·30] for anxiety). InterpretationOlder adults whose ability to participate in social and physical activities was reduced during the COVID-19 pandemic had poorer mental health outcomes than those whose ability remained the same or improved. Individuals who had low pre-COVID-19 levels of social and physical activity had a higher frequency of positive depression and anxiety screens. These findings highlight the importance of fostering social and physical activity resources in advance of, and during, future lockdown measures. FundingThe CLSA COVID-19 Questionnaire study was funded by the Juravinski Research Institute, Faculty of Health Sciences, McMaster University, McMaster University Provost Fund, McMaster Institute for Research on Aging, Public Health Agency of Canada, and Government of Nova Scotia. The CLSA is funded by the Government of Canada through the Canadian Institutes of Health Research (grant number LSA94473) and the Canada Foundation for Innovation. PR holds the Raymond and Margaret Labarge Chair in Optimal Aging and Knowledge Application for Optimal Aging, and a Tier 1 Canada Research Chair in Geroscience. TDC is a Michael Smith Foundation for Health Research Scholar (grant number SCH-2020-0490).

Keeping Up With the Medical Literature: Why, How, and When?

Keeping Up With the Medical Literature: Why, How, and When?

Public health leadership: Competencies to guide practice.

In 2013, the Community Health Nurses of Canada in partnership with the Canadian Institute of Public Health Inspectors and the Manitoba Public Health Managers Network received funding from the Public Health Agency of Canada to develop a set of interdisciplinary leadership competencies for seven public health disciplines. The Leadership Competencies for Public Health Practice in Canada project comprised a multimethod research approach that included a scoping literature review, on-line survey, webinar-based focus groups, and a modified Delphi process. The 49 leadership competencies for public health practice were organized according to the LEADS Canada capabilities. The leadership competencies extend the core public health competencies and discipline-specific competencies and reflect foundational values of public health. The leadership competencies can be applied to professional development pathways, mentoring programs, and performance appraisals to advance public health practice. How these competencies have been enacted by public health leaders during the COVID-19 pandemic is discussed.

Predicting Methicillin-Resistant Staphylococcus aureus (MRSA) Bloodstream Infection Incidence Rates using Canadian Nosocomial Infection Surveillance Program (CNISP)

Methicillin-Resistant Staphylococcus aureus (MRSA) is among the most prevalent nosocomial pathogens globally, causing significant morbidity, mortality, and healthcare costs. MRSA bloodstream infection (BSI) incidence rates in Canadian hospitals have significantly risen by almost 60% and have a mortality of over 20% upon Intensive Care Unit admission. MRSA is believed to be spread through healthcare workers; thus, high hand hygiene compliancy in addition to environmental cleaning are the cornerstone countermeasures to disrupting its transmission. The Public Health Agency of Canada (PHAC), in collaboration with the Canadian Nosocomial Infection Surveillance Program (CNISP), conducts national, sentinel surveillance on healthcare-associated infections like MRSA. As a Student Epidemiologist, I developed a research proposal detailing two study objectives: 1) develop a regression model to predict all incident MRSA BSI rates among acute-care hospitals in Canada using CNISP MRSA BSI incident cases from 2000 to 2019, and 2) create a compartmental (Susceptible-Infected-Recovered-Deceased) model to determine the impact of various Infection Prevention and Control (IPC) measures on the risk of healthcare-associated MRSA BSI transmission specifically. This study hopes to demonstrate that proper IPC compliance is associated with lower incident MRSA BSI rates with the goal being to produce a manuscript draft by 2021. MRSA poses a serious threat to patient safety globally and is becoming a growing national public health concern in Canada; determining which IPC strategy is most effective at disrupting MRSA transmission is essential to reducing incidence and mortality rates.

Real-World Serologic Responses to Extended-Interval and Heterologous COVID-19 mRNA Vaccination in Frail Elderly - Interim Report from a Prospective Observational Cohort Study

Background: The Coronavirus disease 2019 (Covid-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has prompted accelerated vaccines development. Their use was prioritized to protect the most vulnerable, notably, the elderly. Because of fluctuations in vaccine availability, strategies such as delayed second dose and heterologous prime-boost have been employed. The effectiveness of these strategies in the frail elderly are unknown. Methods: In this real-world vaccination study, under a government-decreed rationing strategy, elderly adults residing in long-term care facilities, with or without previously-documented SARS-CoV-2 infection, were administered homologous or heterologous mRNA vaccines, with an extended 16-week interval between doses. Clinical data and blood were serially collected during and after this interval period. Sera were tested for SARS-CoV-2-specific IgG antibodies (to trimeric S; RBD; nucleocapsid) by automated chemiluminescent ELISA. Findings: After a significant increase 4 weeks post-prime dose, there was a significant decline in anti-RBD and anti-S IgG levels until the boost dose, followed by an increase 4 weeks later. Previously uninfected individuals exhibited lower antibody responses up to 16 weeks post-prime dose, but achieved comparable levels to previously infected counterparts by 4 weeks post-second dose. Individuals primed with BNT162b2 exhibited larger decrease in anti-RBD and anti-S IgG levels with 16-week interval between doses, compared to those who received mRNA-1273. No differences in antibody levels 4 weeks after the second dose were noted between the two vaccines, in either homologous or heterologous combinations. Interpretations: These interim results of this ongoing longitudinal study show that, among frail elderly, neither age, sex, nor comorbidity affect antigenicity of mRNA-based COVID vaccines, but previous SARS-CoV-2 infection and type of mRNA vaccine influenced antibody responses when used with a 16-week interval between doses. Homologous/heterologous use of mRNA vaccines was not associated with significant differences in antibody responses 4 weeks following second dose, supporting their interchangeability.Funding: This project was supported by funding from the Public Health Agency of Canada, through the Vaccine Surveillance Reference group and the COVID-19 Immunity Task Force (CITF).Declaration of Interest: None to declare.Ethical Approval: This study was conducted in 12 LTC facilities of the Montréal Centre-Sud – Integrated University Health and Social Services Centre (CIUSSS du Centre-Sud-de-l'Île-de-Montréal) and was approved by its research ethics board (Comité d'éthique de la rechercheVieillissement-Neuroimagerie, protocol number 20-21-36 MP).

Summary of the National Advisory Committee on Immunization (NACI) Seasonal Influenza Vaccine Statement for 2021-2022.

Several influenza vaccines are authorized in Canada and the evidence on influenza immunization is continually evolving. The National Advisory Committee on Immunization (NACI) provides recommendations regarding the use of seasonal influenza vaccines annually to the Public Health Agency of Canada (PHAC). To summarize NACI recommendations regarding the use of seasonal influenza vaccines for 2021-2022 and to highlight new recommendations. Annual influenza vaccine recommendations are developed by NACI's Influenza Working Group for consideration and approval by NACI. The development of the recommendations is based on the NACI evidence-based process. The following new recommendations were made: 1) Influvac® Tetra may be considered as an option among the standard dose quadrivalent inactivated influenza vaccines (IIV4-SD) offered to adults and children three years of age and older; 2) Fluzone High Dose Quadrivalent (IIV4-HD) may be considered an option for individuals 65 years of age and older who are currently recommended to receive Fluzone® High Dose (trivalent); and 3) Flucelvax® Quad may be considered amongst the quadrivalent influenza vaccines offered to adults and children nine years of age and older for annual influenza immunization. Guidance for use of influenza immunizations during the coronavirus disease 2019 pandemic is also highlighted. NACI continues to recommend that an age-appropriate influenza vaccine should be offered annually to anyone six months of age and older who does not have contraindications to the vaccine. Vaccination should be offered as a priority to people at high risk of influenza-related complications or hospitalization, people capable of transmitting influenza to those at high risk of complications, and others as indicated.

Toward Health Equity Guide Interview Project:

For my practicum, I worked with the Health Equity Integration Team (HEIT) to improve the application of Sex- and Gender-Based Analysis + (SGBA+) at The Public Health Agency of Canada (PHAC). SGBA+ is an analytical tool used in the federal government to ensure the consideration of diversity and intersectionality in programs and policies. One of the training resources on SGBA+ at PHAC is called Toward Health Equity: The SGBA+ Guide. This guide provides an overview of SGBA+, associated concepts, and a case study. I was part of a team tasked with updating this document to make the guide more applicable to current agency priorities. However, in revising the guide it became clear that there was a significant gap in understanding what document users needed. To make this guide as user-friendly and relevant as possible, I suggested that we conduct interviews with key informants throughout the agency to gather feedback and identify barriers to SGBA+ application. This project was part of a Knowledge Translation (KT) process that involved employees from many different roles and divisions at PHAC. The interviews allowed readers to identify the guide’s strengths, weaknesses, and gaps in clarity and content. Improving SGBA+ application at the federal public health level is important, because it is the agency’s way of applying a health equity lens to the work that they do. This project was also significant because it interrupted the standard process of KT, which follows a linear path and only integrates user feedback at the end. Instead, this project promoted an iterative process, involving document users throughout the development and revision of the guide to create a final product that is more tailored to their needs. Clear and effective communication is crucial to public health practice; this project is an example of how to achieve that by incorporating constructive feedback.

Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic.

Rapid Onset Functional Tic-Like Behaviors in Young Females During the COVID-19 Pandemic.

The art and science of a strategic grantmaker: the experience of the Public Health Agency of Canada\u2019s Innovation Strategy

SettingThe Public Health Agency of Canada’s Innovation Strategy (PHAC-IS) was established amid calls for diverse structural funding mechanisms that could support research agendas to inform policy making across multiple levels and jurisdictions. Influenced by a shifting emphasis towards a population health approach and growing interest in social innovation and systems change, the PHAC-IS was created as a national grantmaking program that funded the testing and delivery of promising population health interventions between 2009 and 2020.InterventionDuring its decade-long tenure, the PHAC-IS supported the development of innovative, locally driven programs that emphasized health equity, encouraged iterative learning to respond reflexively to complex public health problems (the art), while at the same time promoting and integrating population health intervention research (the science) for improved health at the individual, community, and systems levels through four program components.OutcomesPHAC-IS projects reached priority audiences in over 1700 communities. Over 1400 partnerships were established by community-led organizations across multiple sectors with more than $30 million of leveraged funds. By the final phase of funding, 90% of the projects and partnership networks had a sustained impact on policy and public health practice. By the end of the program, 82% of the projects were able to continue their intervention beyond PHAC-IS funding. Through a phased approach, projects were able to adapt, reflect, and build partnership networks to impact policy and practice while increasing reach and scale towards sustainability.ImplicationsAnalysis and reflection throughout the course of this initiative showed that strong partnerships that contribute sufficient time to collaboration are critical to achieving meaningful outcomes. Building on evaluation cycles that strengthen project design can ensure both scale and sustainability of project achievements. Furthermore, a flexible, phased approach allows for iterative learning and adjustments across various phases to realize sustained population and systems change. The model and reflexive approach underlying the PHAC-IS has the potential to apply to a broad range of public programs.