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Avian flu: B.C. government provides update

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Thinking about a turkey with your Christmas dinner? It may be more difficult to find this year as the avian flu infects birds in B.C. and across the country.

Seven farms in Abbotsford and Chilliwack have been quarantined in the past week due to the disease, according to Ray Nickel of B.C. Poultry Industry Emergency Operations. He said it’s suspected at another farm, though the test results are not back yet.

The Canadian Food Inspection Agency says a total of 20 farms in B.C. are currently infected. They are mostly in the Lower Mainland, but also on Vancouver Island and in the Interior.

Nickel said birds are being destroyed at the farms under quarantine, and surveillance has been set up around the sites.

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Among those farms where the disease has hit are B.C. hatching egg production and turkey farms.

“Right now, every province has been dealing with the (avian influenza) impact,” said Nickel.

“Turkeys are seemingly more susceptible to avian influenza than some of the other bird species, so they’ve been hit the hardest, so there are some supply issues,” he explained.

B.C.’s agriculture minister said it’s a tough situation, and that the outbreaks on commercial farms are concerning.

“This year’s been a lot more difficult. We haven’t seen the disease pressure get alleviated as we normally would,” said Lana Popham.

The minister said the province has taken a proactive stance, with rules such as requiring commercial growers to keep their flocks indoors.

“I feel confident that we’re going to get on top of this, but currently there is a lot of pressure,” Popham said.

Farmers are feeling that pressure.

“It’s always your fear that something’s going to happen to your flock, and so we’ve been on pins and needles for months already,” said Nickel, who runs his own poultry farm.

About 276,000 birds have been culled in B.C. since the beginning of the outbreak in April, but that number is expected to rise.

“While the recent cases of avian influenza are a challenging situation for the B.C. poultry industry, avian influenza is not a food safety concern,” said the CFIA, in a statement.

“There is no evidence to suggest that poultry meat or eggs could transmit the avian influenza virus to humans. Poultry products from locations under investigation are not permitted to enter the food chain,” the statement reads.

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Toronto-based infectious disease expert seeing more older patients with flu in hospital

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An infectious diseases physician in Toronto is reporting an increase in the number of older patients he is seeing with seasonal influenza.

Dr. Isaac Bogoch at Toronto General Hospital noted this year’s flu season started early and escalated quickly.

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According to the Public Health Agency of Canada, children under five are still making up the largest age bracket of flu patients in hospital. However, rates among seniors (aged 65 and up) are on the rise.

Bogoch expects the number of flu cases to keep increasing. The season usually peaks in January.

To track the number of flu cases in Durham Region this season, click here.

 

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Breakthrough Infections More Likely in Infliximab Treated IBD Patients Than Those Treated With Vedolizumab

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Patients with inflammatory bowel disease (IBD) treated with infliximab who were vaccinated against SARS-CoV-2 were more likely to have a breakthrough infection than patients treated with vedolizumab, but the benefits of the vaccine are still superior.

A team, led by Zhigang Liu, PhD, Department of Metabolism, Digestion and Reproduction, Imperial College London, determined how infliximab and vedolizumab affect vaccine-induced neutralizing antibodies against highly transmissible omicron (B.1.1.529) BA.1, and BA.4 and BA.5 (hereafter BA.4/5) SARS-CoV-2 variants.

The Treatments

Anti-TNF drugs, including infliximab, are linked to attenuated antibody responses following SARS-CoV-2 vaccination. The variants included in the analysis have the ability to evade host immunity and with emerging sublineages are currently the dominating variants causing the current waves of infection.

In the prospective, multicenter, observation, CLARITY IBD cohort study, the investigators looked at the effect of infliximab and vedolizumab on SARS-CoV-2 infections and vaccinations in patients with IBD.

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The study included patients aged 5 years or older with an IBD diagnosis that were treated with infliximab or vedolizumab for 6 weeks or longer in infusion units at 92 hospitals in the UK. Each participant had uninterrupted biological therapy since recruitment and were not previously diagnosed with a SARS-CoV-2 infection.

Outcomes

The investigators sought primary outcomes of neutralizing antibody responses against SARS-CoV-2 wild-type and omicron subvariants BA.1 and BA.4/5 following 3 doses of a SARS-CoV-2 vaccine.

The team also investigated the risk of breakthrough infections in relation to neutralizing antibody titers using Cox proportional hazard models.

There were 7224 patients with IBD recruited to the study between September 22 and December 23, 2020. Of this group, 1288 had no previous SARS-CoV-2 infections after 3 doses of the vaccine that were established on either infliximab (n = 871) or vedolizumab (n = 417). The median age of the patient population was 46.1 years.

Following 3 doses of SARS-CoV-2 vaccine, 50% neutralizing titers were significantly lower in the infliximab group compared to patients treated with vedolizumab against wild-type (geometric mean, 2062; 95% CI, 1720–2473 vs geometric mean, 3440; 95% CI, 2939–4026; P <0.0001), BA.1 (geographic mean, 107.3; 95% CI, 86.40–133.2 vs geographic mean, 648.9; 95% CI, 523.5–804.5; P <0.0001), and BA.4/5 (geographic mean, 40.63; 95% CI, 31.99–51.60] vs geographic mean, 223.0; 95% CI, 183.1–271.4; P <0.0001) variants.

Breakthrough infections more frequently occurred in patients treated with infliximab (n = 119; 13.7%; 95% CI, 11.5–16.2) than in those treated with vedolizumab (n = 29; 7.0%; 95% CI, 4.8–10.0; P = 0.00040).

The Cox proportional hazard models show time to breakthrough infection after the third vaccine dose in the infliximab group was associated with a higher hazard risk than treatment with vedolizumab (HR, 1.71; 95% CI, 1.08-2.71; P = 0.022).

There was also higher neutralizing antibody titers against BA.4/5 with a lower hazard risk in the group with a breakthrough infection and a longer time to breakthrough infection (HR, 0.87; 95% CI, 0.79-0.95; P = 0.0028).

“Our findings underline the importance of continued SARS-CoV-2 vaccination programs, including second-generation bivalent vaccines, especially in patient subgroups where vaccine immunogenicity and efficacy might be reduced, such as those on anti-TNF therapies,” the authors wrote.

The study, “Neutralizing antibody potency against SARS-CoV-2 wild-type and omicron BA.1 and BA.4/5 variants in patients with inflammatory bowel disease treated with infliximab and vedolizumab after three doses of COVID-19 vaccine (CLARITY IBD): an analysis of a prospective multicenter cohort study,” was published online in The Lancet Gastroenterology & Hepatology.

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Flu shot uptake in children ‘too low,’ P.E.I. CPHO says

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With flu cases on the rise in the province, P.E.I.’s Chief Public Health Officer is urging parents to get their young children a flu shot.

Currently, just 19 per cent of children under the age of 10 have gotten a vaccine.

“I do think that’s too low,” said Dr. Heather Morrison, the province’s chief public health officer. “On the other hand, we’ve had great uptake of our high dose influenza for those who are 65 years of age and up.”

Morrison said there are some clinics on the weekend in Charlottetown through public health nursing and appointments are available “to really help those who may not be able to come during the week.”

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By Dec. 3 there have been 155 lab-confirmed cases, according to a P.E.I. government website. The median age of cases to date is 14 years old. The site says there was “widespread flu activity” last week on P.E.I. with flu activity “above expected levels for this time of year.”

‘They are getting better now’

Without vaccines, children four and under are most at risk of being hospitalized, Morrison said. That’s exactly what happened to Island resident Shidhin Philip’s youngest son, Adam, who was less than a month old when he was hospitalized with influenza and RSV.

Shidhin Philip’s youngest child, Adam, at the QEH when he was sick with RSV and influenza at less than a month old. (Submitted by Shidhin Philip)

“We were really scared,” said Philip. “But we know we took him to the hospital at the right time, so that was a good decision.”

On Wednesday, Philip brought two of his older children to the children’s clinic in Sherwood to get their flu shot.

“They all had the flu, the sore throat, running nose, they had fever, they were throwing up. They were absent from school for two weeks,” Philip said. “They are getting better now, I don’t want to get it back again. So I took the appointment for the flu shot today.”

A man in a puffy green jacket wraps his arms around his two daughters, who stand on either side of him.
Shidhin Philip and two of his four children, Angel and Anna, outside a vaccination clinic in Charlottetown. (Steve Bruce/CBC)

But he says having vaccines available at public schools would make it easier for busy parents to get their children vaccinated.

“They can send the paper home, we can sign the consent,” he said. “Instead of making an appointment or waiting [a] long time, you know, it can finish in one day.”

Morrison says there are some logistical issues with making the vaccine available in schools, but it is something the province is potentially looking into for future years.

“It’s something that we certainly would be very open to having that conversation with education, public health, nursing, Health P.E.I,” she said. “It has been something that has been discussed over the years.”

In the meantime, she encourages parents to make an appointment and hopes strong messaging, combined with the recent spike in flu cases, will motivate parents to book their kids’ shots.

“Children are at school, and activities, we’re all busy,” she said. “But if we can get it now, get our children vaccinated, ourselves vaccinated, it will protect us in time for the holidays.”

Visit P.E.I.’s weekly influenza summary and flu vaccination clinics websites for more information.

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