The Current15:57Tackling rising syphilis cases across Canada
There has been a sharp increase in the number of babies born in Canada with syphilis, an infection that one doctor says “can be particularly devastating in pregnancy.”
“It can lead to outcomes such as fetal demise … or stillbirth,” said Dr. Darrell Tan, an infectious disease physician at St. Michael’s Hospital in Toronto, and the Canada Research Chair in HIV Prevention and STI Research.
“And then in a child [born with syphilis] there can be many, many manifestations … it can affect organ systems like the brain, the bones and joints, virtually any organ system in the body,” he told The Current’s guest host Mark Kelley.
Thirty newborns in Manitoba have been infected with congenital syphilis through the first eight months of 2020, according to information obtained by the Opposition NDP.
Historically, the disease has disproportionately affected men who have sex with men (MSM), but Dr. Troy Grennan said B.C. figures show a shift in 2022.
“For the first time the majority — so more than 50 per cent — of the new cases we’re seeing [in B.C. are] in non-MSM populations,” said Grennan, lead physician at B.C.’s Centre for Disease Control’s sexual health programs.
“One of the key challenges around that is that we’re seeing increasing cases in folks who are capable of getting pregnant,” he said.
Experts say there’s likely multiple factors behind the increase, including reduced condom use — a 2020 survey found that seven in 10 of Canadian respondents don’t use condoms. Some experts also point to the increasing availability of routine testing, and the idea that numbers are up in part because more infections are being detected.
Tan said the spread into new demographics “may simply be a numbers game.”
“When you have cases, case rates that are going up to this degree, you start to see it spread beyond just the core sexual networks that had traditionally been involved,” he said.
If caught early, an infection can be easily treated with antibiotics. But Tan said that structural inequalities, such as racism and the legacy of colonization, can also “impact people’s willingness or perhaps ability to access care at earlier stages — where we can maybe nip things in the bud.”
Syphilis can affect ‘virtually any organ system in the body,’ said Dr. Darrell Tan. (Lauren Pelley/CBC)
Diverse symptoms, or none at all
Syphilis can present a diverse range of symptoms, which can complicate catching the infection early, Tan said.
On initial infection, an ulcer can appear at the part of the body that was exposed, he said. But that ulcer might be painless, and perhaps on a body part where it’s hard to see, such as the vagina or rectum.
In other cases, the infection sparks a fever or rash. These symptoms may prompt someone to seek medical attention, but they can also be mistaken for many other illnesses.
“The most confusing and frustrating thing is that it can cause no symptoms at all, and people can contract it without even realizing it,” Tan said.
If left untreated, the infection can have serious implications, including neurological problems, organ damage, loss of vision and even death.
Rates of syphilis infection have been increasing steadily over the last 10 years. (Getty Images)
Vaccine work ‘not very far along’
Research into syphilis is complicated by the fact that the “bacterium is very difficult to work with,” said Caroline Cameron, one of the few researchers studying the infection in Canada.
“We really don’t understand how it works, how it infects a person or ways to appropriately combat it, or prevent that infection,” said Cameron, a professor in the department of biochemistry and microbiology at the University of Victoria.
While Cameron said she was drawn to those challenges, they’ve dissuaded many other researchers — but that is slowly changing.
“We are starting to get more philanthropic organizations who are providing funding for research and we’re starting to see more people join the field, which is what is really needed in order to get those innovative research programs going,” she said.
The aim is to produce better medical interventions, perhaps even a vaccine for syphilis, she said. But the difficulties in studying it mean that, globally, the research is “not very far along,” she said.
“Conservative estimates [for a vaccine] are five to 10 years away. But we really need more people to join the field to expand the research population,” she said.
New syphilis rapid test could slow disease’s spread, doctors say
Doctors and outreach workers are hopeful wider use of a new rapid test for syphilis could help slow the spread of the dangerous sexually transmitted infection.
Get tested, get treated
Syphilis can be detected by a simple blood test “that can be ordered by any clinician relatively easily,” but the challenge is often knowing when to request it, Tan said.
He suggested people who are sexually active with multiple partners should seek routine STI testing, as frequently as every three months.
PHAC guidelines stipulate universal screening for syphilis during the first trimester of pregnancy. For those at greater risk of exposure, the guidelines suggest a repeat screening at 28 to 32 weeks, and again at delivery.
However, problems can arise for “folks who unfortunately don’t access pre-natal care,” he said.
“We do have very effective treatments … simply two or more injections of plain old penicillin,” Tan said.
“But if folks are not accessing care earlier in the course of infection … then we can see cases continue to spiral as we’ve seen, and have a hard time getting control of the epidemic.”
The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
