Adding COVID-19 to 'designated diseases' could boost vaccine uptake among children - The Conversation | Canada News Media
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Adding COVID-19 to 'designated diseases' could boost vaccine uptake among children – The Conversation

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My research includes the moral and legal aspects and policy implications of childhood vaccination. COVID-19’s effects on children has an impact on that research. And these effects appear to be changing, making the need for widespread COVID-19 vaccine uptake among children more urgent.

Early in the pandemic, evidence suggested children generally avoided severe COVID-19 infections. That rosier picture is now fading. Emerging research signals that children’s susceptibility to SARS-CoV-2, the virus that causes COVID-19, has increased in “frequency and severity” over the course of the pandemic.

One newly released study of British Columbia’s Lower Mainland chronicles the dramatic rise in infections among those under 19. This surge in childhood infection with the Omicron variant is consistent with estimates in other parts of Canada and beyond.

Increased frequency of infections among children will necessarily yield a greater number of cases with severe outcomes, including hospitalizations and deaths. Children with co-morbidities are especially vulnerable to severe COVID-19 outcomes.

Like adults, children can also suffer from long COVID that can damage their lungs, their brains and create a host of other health problems.




Read more:
Do kids get long COVID? And how often? A paediatrician looks at the data


Low vaccination uptake among minors

A multi-pronged approach to restrict transmission, including masking, is advised over any one single preventive measure. This is likely even more important with new variants on the horizon.

Yet vaccination remains one of the best means to protect against severe outcomes when breakthrough infection occurs. Additionally, vaccination may decrease the likelihood of long COVID. The Ontario government recommends vaccination for those under 18.

That’s why it’s alarming that vaccine uptake among minors of the primary series of two doses, particularly for those under 12, remains low.

Compared to the provincial average of 90 per cent for those 12 and above, only 41 per cent of Ontario children aged five to 11 have completed their primary series. Uptake among those under five is almost non-existent, with just six per cent receiving their first doses in the two months since Health Canada approved a COVID-19 vaccine for this cohort. Numbers across the country are roughly similar.

Notably, Ontario declined to add COVID-19 to the list of “designated diseases” in its Immunization of School Pupils Act last fall, despite support for this move by some school boards and both the opposition Liberals and NDP.

It’s time to revisit that decision.

Adding COVID-19 to the act will not make COVID-19 vaccination mandatory for school entry. Whether childhood vaccines should be mandatory is a separate debate. But it may, nonetheless, help address the COVID-19 vaccine uptake among the province’s school-aged children.

Children wait in a physical distancing circle at a Toronto elementary school in September 2020.
THE CANADIAN PRESS/Nathan Denette

Vaccine requirements for school entry

Ontario, New Brunswick and British Columbia are the only Canadian jurisdictions that have vaccination requirements for school entry. But minors aren’t required in any of those provinces to be vaccinated to attend day care, elementary or high school.

British Columbia’s regulation explicitly makes the duty a reporting one only. Ontario requirements are somewhat different, as the parental duty is to “cause the pupil to complete the prescribed program of immunization.” Yet the duty does not apply where the parent “has filed a statement of conscience or religious belief.”

This means a parent can refuse to have their child vaccinated against any or all of the designated diseases by signing and having notarized a government-issued form affirming a “sincere belief.”

In practical terms, this makes the duty a reporting one in Ontario as well. The situation in New Brunswick is virtually the same.

Where Ontario and New Brunswick differ, however, is that Ontario requires that parents seeking a sincere-belief exemption also attend an “education session.” For some, access to this education session is the real benefit of listing COVID-19 among the designated diseases.

A young boy is vaccinated during the first day of vaccination for children aged five to 11 in Montréal in November 2021.
THE CANADIAN PRESS/Paul Chiasson

Vaccine hesitancy and COVID-19

Vaccine hesitancy is attributed as the cause for low vaccine uptake when it comes to COVID-19. But it’s complicated.

While a small percentage of parents reject all vaccines, many more are selective about vaccines and are generally more cautious about newer ones than older ones. In fact, generally positive parental attitudes about routine childhood vaccines are a poor indicator of their attitudes toward COVID-19 vaccines, both in Canada and elsewhere.

When it came into effect in Ontario in 2017, the requirement to undergo an education session for those seeking a sincere-belief exemption made little difference in attitude because vaccine uptake against the designated diseases, while less than optimal, was still generally high.

And education sessions can be like sermons to that dogged minority whose minds are made up on the topic. Mandatory education can also be counterproductive and cause people to become more entrenched in their opinions.




Read more:
Five reasons why young people should get a COVID booster vaccine


However, there is a very large gap between low childhood vaccination rates for COVID-19 and the high rates for routine childhood vaccines.

Not anti-vaxxers

This suggests that most parents who have so far refused COVID-19 shots are not hard-core anti-vaxxers. This may provide an opening to sway more parents to have their children vaccinated.

Research about parental attitudes toward COVID-19 vaccination is fast-moving, and understandably there are large gaps. But the general conclusion is that vaccination campaigns targeted to specific demographics can increase uptake.

It’s unclear whether adding COVID-19 to the list of “designated diseases” in Ontario or elsewhere in Canada would have the desired effect. And certainly the design and content of education sessions matter.

But it defies logic to have a regulatory scheme already in place committed to increasing “the protection of the health of children” and decide that a pandemic is not a good time to use it.

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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