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As peak flu season arrives, Canadian hospitals seeing higher than usual pediatric cases – The Globe and Mail

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An influenza strain that hits children hard is circulating widely in Canada, leading to increased pediatric hospitalizations, which experts say could worsen as we approach the peak of flu season.

Infectious disease experts say a type of influenza B is circulating at about the same rate as influenza A, which is not typical. In most years, influenza B doesn’t circulate until late in the season. This has experts on alert because this type of influenza is linked to a higher risk of hospitalizations and deaths among children.

The Public Health Agency of Canada’s most recent FluWatch report, released Friday, says the increased presence of influenza B likely explains why pediatric illnesses and hospitalizations are higher this year. According to PHAC, the number of pediatric hospitalizations linked to influenza A this season is similar to previous years.

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From Dec. 15 to Jan. 4, there were 258 pediatric hospitalizations linked to the flu reported by a national surveillance network that consists of 12 pediatric hospitals. PHAC said the number of cases is above the average seen in the previous five years.

Over all, there have been 370 pediatric hospitalizations linked to the flu in Canada so far this season. Of those, 54 per cent were tied to influenza B. About two-thirds of hospitalizations were in children under five years old. No flu-related deaths have been reported in children this season.

The particular type of influenza B that is circulating belongs to a family called the Victoria lineage, which is known to cause a higher rate of hospitalizations and deaths among children.

U.S. health officials say they are seeing a surge in flu cases and a much higher than usual number of pediatric flu hospitalizations and deaths. So far this flu season, 27 children have died in the U.S. as a result of the infection, with 18 of those cases being linked to the influenza B strain, according to the U.S. Centers for Disease Control and Prevention. Nine deaths were linked to H1N1, which is an influenza A virus.

“Any time we see more influenza B, especially [the Victoria lineage], we will see more children be affected,” said Michelle Murti, a physician at Public Health Ontario. “Some proportion of those will either be hospitalized or die.”

Alyson Kelvin, a virologist at Dalhousie University and a member of the Canadian Centre for Vaccinology, said it’s quite possible the number of pediatric cases will continue to climb here, as they have in the United States. She said people who haven’t had their flu shot should still get one.

“I think it’s a good idea to be vaccinated, due to this evidence,” she said.

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This year’s flu shot is not an exact match to the influenza B strain in circulation and experts don’t yet know how well the vaccine protects against the B strain, according to Dr. Murti. The good news, she said, is that the vaccine should still offer fairly good protection from influenza B, even if the shot isn’t matched to the virus.

Data showing how well this year’s flu shot match up to the circulating viruses won’t be available until next month, Dr. Murti said.

So far this year, 12,500 laboratory-confirmed cases of the flu have been detected in Canada. But these cases only represent a portion of the total, as most are typically not verified by a lab.

Just more than half of the flu cases detected in Canada this year are linked to the influenza A virus. Of those, H1N1 and H3N2 are both circulating, with the amount of H1N1 increasing in recent weeks. The flu shot is well matched to the H1N1 virus, Dr. Murti said.

According to PHAC, there have been 230 adult hospitalizations, seven intensive care unit admissions and fewer than five deaths linked to the flu. Of those, 90 per cent have been linked to influenza A. The FluWatch report says that 87 per cent of influenza A hospital admissions were linked to H1N1.

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Get COVID-19 and flu shot at the same time – Windsor Star

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You can get a COVID-19 vaccination and annual flu shot at the same time, Windsor Essex County Health Unit director of health protection Kristy McBeth said Thursday.

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The National Advisory Committee on Immunization, which makes recommendations on the use of vaccines in Canada, recommended recently that the COVID-19 vaccine can be administered at the same time or any time before or after other vaccines, including the flu shot.

Previously, the committee had recommended that COVID-19 vaccines be administered at least 28 days before or 14 days after other shots as a precautionary measure.

After reviewing the evolving evidence on COVID-19 vaccines and considering the extensive data on administering other routine vaccines at the same time or within days of each other, the committee has determined that the earlier, precautionary approach is no longer necessary.

The new recommendation is expected to help the rollout of the flu shot this fall as well as make it easier for people to get  other vaccines they may have missed during the pandemic.

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The flu shot is free in Ontario and available at doctors’ offices and pharmacies. Hospitals, long-term care homes, doctors’ offices, walk-in clinics and pharmacies here have already received their supplies.

People over age 65 and those at risk of complications from flu have been given priority and are receiving the vaccine now. The shot will be available to the general public in November.

The health unit will begin promoting the shot more widely next month.

“We will be doing some extra promotion, urging people to get it,” McBeth told the health unit’s board of directors.

Between 150,000 and 200,000 doses are expected to be administered here this season, up from 97,000 last year.

Ontario has ordered 7.6 million doses this year, 1.4 million more than last year, Health Minister Christine Elliott said Tuesday.

There were few cases of flu last season because many people worked from home, their children learned remotely and the economy and society were locked down.

But more cases are expected this season because many people have returned to offices, schools have reopened and many restrictions have been lifted, allowing people to be out in the community more and to socialize and travel.

People are being urged to get the flu shot to avoid overwhelming hospitals that are still caring for COVID-19 patients.

ajarvis@postmedia.com

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Canada scraps COVID-19 travel advisory; Ontario to end mask, vaccine rules by March

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Canada has scrapped an official advisory urging its citizens to shun  non-essential foreign travel, given its successful campaign to inoculate people against COVID-19, the country’s top medical officer said on Friday.

Hours later, Canada’s most populous province, Ontario, issued a timeline to lift all remaining COVID-19 restrictions, with the aim of removing all proof of vaccination and mask requirements by March 2022.

Canada’s travel warning was issued in March 2020, when the COVID-19 pandemic erupted.

Ottawa removed the advice to avoid unnecessary travel late on Thursday, however it is still telling people to avoid cruise ship travel outside of the country.

“The beginnings of the transition away from the more blanket approach really recognizes vaccines are very effective at preventing severe outcome,” Chief Medical Officer Theresa Tam told a briefing.

According to official data, just under 82% of eligible Canadians had been fully vaccinated against COVID-19 by Oct 8.

Tam said the latest surveillance data showed “a continued decline in disease activity nationally and in most jurisdictions.”

“Now is not the time to just freely go wherever,” she added, citing high cases of coronavirus in some nations.

Ontario laid out a six-month timeline to lift all COVID-19 restrictions, starting with removing capacity limits in the “vast majority” of public venues on Oct. 25, and culminating in an end to all mask and proof of vaccination requirements by March.

The timeline will be dependent on “the absence of concerning (pandemic) trends,” it said in a statement.

“This plan is built for the long term,” Premier Doug Ford said. “It will guide us safely through the winter and out of this pandemic, while avoiding lockdowns and ensuring we don’t lose the hard-fought gains we have made.”

Ontario spent much of the past 18 months in some form of  lockdown due to high infection rates and hospital bed occupancy of COVID-19 patients.

(Reporting by David Ljunggren in Ottawa and Moira Warburton in Vancouver; Editing by Paul Simao and Bill Berkrot)

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COVID-19 vaccines not linked to pregnancy loss; mixing vaccines may confer greater protection

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The following is a summary of some recent studies on COVID-19. They include research that warrants further study to corroborate the findings and that have yet to be certified by peer review.

COVID-19 vaccines not linked with pregnancy loss

Two studies in major medical journals add to evidence that COVID-19 vaccines are safe before and during pregnancy. One study, published in The New England Journal of Medicine on Wednesday, tracked nearly 18,500 pregnant women in Norway, including about 4,500 who had miscarriages. Researchers found no link between COVID-19 vaccines and risk of first-trimester miscarriage, regardless of whether the vaccines were from Moderna, Pfizer and BioNTech, or AstraZeneca. Overall, the women with miscarriages were 9% less likely to have been vaccinated, according to the researchers’ calculations. In a separate study published on Thursday in The Lancet, researchers tracked 107 women who became pregnant while participating in trials of AstraZeneca’s vaccine in the UK, Brazil and South Africa. Seventy-two of the women had received the vaccine while the others got a placebo. AstraZeneca’s vaccine had no effect on the odds of safely carrying the pregnancy to term, the researchers reported. “It is important that pregnant women are vaccinated since they have a higher risk of hospitalizations and COVID-19-complications, and their infants are at higher risk of being born too early,” the authors of the Norwegian study wrote. “Also, vaccination during pregnancy is likely to provide protection to the newborn infant against COVID-19 infection in the first months after birth.”

Vaccine combinations with different technologies may be best

Healthcare workers in France who got a first shot of AstraZeneca’s COVID-19 vaccine and then the Pfizer/BioNTech vaccine for their second shot showed stronger immune responses than those who had received two shots of the Pfizer vaccine, in a recent study. Combining different technologies is known to boost immune responses to other viruses, and the current study suggests it may be true for the coronavirus as well. Both vaccines in the study deliver instructions that teach cells in the body to make a piece of protein that resembles the spike on the coronavirus and that triggers an immune response. But they do it in very different ways. Both protocols provided “safe and efficient” protection, said Vincent Legros of Universite de Lyon in France, coauthor of a report published on Thursday in Nature. But combining the AstraZeneca shot with the Pfizer/BioNTech vaccine “conferred even better protection” than two doses of Pfizer’s shot, including against the Delta variant, Legros said. The two technologies combined induced an antibody response of better quality, with more neutralizing antibodies that could block the virus, and more cells that have been “trained” by the vaccine to have increased defense potential, he said. Combination vaccination “is safe and may provide interesting options… for clinicians to prevent SARS-CoV-2 infection,” Legros concluded.

Cognitive problems seen in middle-aged COVID-19 survivors

A “substantial proportion” of middle-aged COVID-19 survivors with no previous dementia had cognitive problems more than half a year after diagnosis, researchers have found. They looked at 740 people who ranged in age from 38 to 59. About half were white, and 63% were female. On tests of thinking skills, 20% had trouble converting short-term memories to long-term memories, 18% had trouble processing information rapidly, and 16% had trouble with skills needed for planning, focusing attention, remembering instructions, and juggling multiple tasks. The average time from diagnosis was 7.6 months. About one-in-four patients had been hospitalized, but most of them were not critically ill. “We can’t exactly say that the cognitive issues were lasting because we can’t determine when they began,” said Dr. Jacqueline Becker of the Icahn School of Medicine at Mount Sinai in New York City, who co-led the study published on Friday in JAMA Network Open. “But we can say that our cohort had higher than anticipated frequency of cognitive impairment” given that they were relatively young and healthy, Becker said.

Data support use of Pfizer vaccine in children and teens

The Pfizer/BioNTech COVID-19 vaccine showed 90.7% efficacy against the coronavirus in a trial of children ages 5 to 11, the U.S. drugmaker said on Friday in briefing documents submitted to the U.S. Food and Drug Administration but not formally published. The children were given two shots of a 10-microgram dose of the vaccine – a third of the strength given to people 12 and older. The study was not primarily designed to measure efficacy against the virus. Instead, it compared the amount of neutralizing antibodies induced by the vaccine in the children to the response of recipients in their adult trial. Pfizer and BioNTech said the vaccine induced a robust immune response in the children. Outside advisers to the FDA are scheduled to meet on Tuesday to vote on whether to recommend authorization of the vaccine for that age group. A separate study from Israel conducted while the Delta variant was prevalent and published on Wednesday in The New England Journal of Medicine, compared nearly 95,000 12- to -18-year-olds who had received Pfizer’s vaccine with an equal number of adolescents who had not been vaccinated. The results show the vaccine “was highly effective in the first few weeks after vaccination against both documented infection and symptomatic COVID-19 with the Delta variant” in this age group, the research team reported.

Click for a Reuters graphic https://tmsnrt.rs/3c7R3Bl on vaccines in development.

 

(Reporting by Nancy Lapid; Additional reporting by Michael Erman; Editing by Bill Berkrot)

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