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Extraintestinal manifestations of Crohn's Disease | JIR – Dove Medical Press

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Introduction

Crohn’s disease (CD) is a chronic inflammatory disease of the intestine, of unknown etiology, which is characterized by a discontinuous, segmental manifestation and implication of all intestinal layers. Extra-intestinal manifestations of CD, characterized by inflammatory conditions outside the digestive tract, occur in about 25% of patients.1 Peripheral arthritis, erythema nodosum, pyoderma gangrene, episcleritis, anterior uveitis, oral recurrent ulcer, and ankylosing spondylitis are the most common extra-intestinal manifestations.2 However, inflammatory bowel disease (IBD)-related lung diseases are increasingly recognized. IBD-related respiratory diseases have a variety of clinical manifestations, which can involve the airway and lung interstitial pulmonary vessels, and usually appear several years preceding the diagnosis of IBD.3,4 Ulcerative colitis (UC) is more likely to involve the respiratory system than CD, and lung involvement can aggravate the condition of IBD and is a risk factor for poor prognosis.5

The clinical symptoms of IBD-associated lung disease are hidden, which increases the difficulty of diagnosis. Zhao et al6 found that only 2.7% of IBD patients had respiratory symptoms. Karadag et al7 reported that 15 UC patients were complicated with ground-glass changes in the lungs, but none of them felt uncomfortable. During the time of Corona virus disease (COVID-19), the imaging signs of novel coronavirus pneumonia can also present as interstitial lung disease (ILD), which is difficult to distinguish from the extraintestinal manifestations of CD.

We present a case of a patient with multiple intestinal ulcers associated with ILD in the time of COVID-19. This case had no pulmonary symptoms, which was consistent with previous studies. The purpose of this article is to elaborate on these rare extraintestinal manifestations of CD and to reveal that IBD-related ILD responds excellently to systemic steroid therapy. Moreover, the importance of short-term follow-up chest computed tomography (CT) for differential diagnosis is emphasized.

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Case Presentation

On December 9, 2020, a 27-year-old male patient, who is a student, presented with chief complaints of “loose stools for 4 months, intermittent low-grade fever for 1 month”, and he was admitted to the Departments of Gastroenterology, The First Affiliated Hospital of Wannan Medical College. His complaints did not include abdominal pain, abdominal distension, bloody purulent stool, cough, expectoration, chest tightness and shortness of breath. And a physical examination revealed no abnormalities. This patient has just returned from Japan (November 2, 2020) and has been quarantined for 14 days twice. In Japan, colonoscopy (October 7, 2020) showed multiple ulcers between the sigmoid colon to the terminal ileum (Figure 1A–D), and pathology found that inflammatory cell infiltration in intestinal mucosa and epithelioid granuloma in submucosa (Figure 1E). Regular use of mesalazine did not significantly improve the symptoms of loose stools. Meanwhile, taking levofloxacin orally was not effective for his fever.

Figure 1 (A–D) Colonoscopy showed segmental intestinal disease; (E) pathology found inflammatory cell infiltration in intestinal mucosa, epithelioid granuloma in submucosa; (F) chest CT scan showed multiple patchy ground-glass shadows; (G) a total gastrointestinal CT angiography showed segmental leaping thickening in part of colon; (H) a repeat chest CT scan after systemic steroid therapy; (I–L) a repeat colonoscopy after three infliximab treatments.

Laboratory investigations revealed a normocytic anaemia (hemoglobin 92g/L), hypoproteinemia (albumin 28.8g/L), raised inflammatory markers (C-reactive protein (CRP) 72.9mg/L, erythrocyte sedimentation rate (ESR) 74mm/h) and thrombocytosis (PLT 675*10^9/L). Examination of pathogenic microorganisms suggested that rubella virus immunoglobulin G (IgG) was 208.5IU/mL and cytomegalovirus IgG was 184.4U/mL, which were exceeds the normal limit. Fecal bacteria proportion showed that gram-positive coccus 10%, gram-positive bacillus 10%, gram-negative bacillus 80%, and no fungal spores were found. Fecal occult blood (OB) is negative, and no obvious abnormality was observed in tuberculosis antibody (TB-AB), tuberculous infection with T cells (T-sport), purified protein-derived tuberculin (PPD), blood coagulation, routine before blood transfusion and tumor markers.

The next day (December 10, 2020), the patient developed a high fever with a body temperature of 39.8°C. A chest high resolution computed tomography (HRCT) was urgently performed and result showed infectious lesions in the upper lobe of the right lung and the lower lobe of both lungs, with multiple patchy ground-glass shadows and nodular ground-glass shadows, which suggested interstitial pneumonia (Figure 1F). Then, multiple novel coronavirus (2019-nCoV) pneumonia nucleic acid test was performed, and the results were all negative. Despite the empirical antibiotic and antiviral therapy that was started, his fever remained.

On the third day after admission (December 12, 2020), laboratory investigations revealed that fecal OB was positive and hemoglobin dropped from 92g/L to 84g/L. On the other hand, fecal general flora, Salmonella and Shigella culture were all negative. Acid-fast bacilli and general bacterial cultures in sputum were also negative. Gastroscopy showed chronic superficial gastritis. A total gastrointestinal CT angiography showed that segmental leaping thickening in part of jejunum, distal ileum, ileocecal, ascending colon and transverse colon, proliferation of peripheral small vessels, multiple enlarged lymph nodes around the diseased intestine and at the root of mesenteric vessels (Figure 1G). Pelvic magnetic resonance revealed no abnormalities, which suggested that the patient was without an internal fistula.

Based on the above evidences, this patient was finally diagnosed with CD, according to the World Gastroenterology Organization.8 According to the Montreal classification of IBD9 and Harvey and Bradshaw’s simplified Crohn’s disease activity index (CDAI) method,10 this patient was classified as A2L3B1, and his CDAI was 433.

Then, we used steroids 50mg/d, and the temperature was returned to normal quickly. A follow-up chest CT after 5 days (December 15, 2020) showed that multiple patellar ground glass shadows were almost completely absorbed under the pleura of the lower lobe of both lungs (Figure 1H). Then, infliximab was used. We can see the inflammatory markers were decreased gradually; however, nutritional status indicators were increased gradually. Meanwhile, fecal OB was negative and stool property returned to normal. A repeat colonoscopy after 4 months (April 19, 2021) revealed multiple hyperplastic small polyps in the terminal ileum, ascending colon, transverse colon and descending colon, with some scars (Figure 1I–L). And repeat laboratory investigations after 4 months showed that hemoglobin was 132g/L, platelet was 253*10^9/L, albumin 44.3g/L, CRP 0.88mg/L, ESR 4.7mm/h. He gained 10kg in weight.

Discussion

ILD was a rare extraintestinal manifestation associated with IBD.11 In 1976, Kraft first proposed that IBD can involve the respiratory tract, manifested as bronchitis, bronchiectasis, and chronic obstructive pulmonary disease.12 Pulmonary manifestations, despite being considered rare with an unknown prevalence, are increasingly recognized.13 Recently, Eliadou et al5 found that UC was more likely to involve ILD than CD. More than 50% of cases were drug-related, these drugs included mesalazine, golimumab, methotrexate, vedolizumab and infliximab. A large-scale study of the safety of infliximab in rheumatic patients showed that the probability of developing ILD was 0.5%.14 The symptoms of drug-related ILD included cough, shortness of breath, fever and lethargy with a mean duration of symptoms of 6.3 weeks, however symptoms were relieved after systemic steroid therapy. Patients can present with almost all histopathological patterns of ILD. Schwaiblmair et al15 reported that extremes of age, sex, ethnicity, oxygen, dose of medication, drug interaction and underlying lung disease were risk factors for developing drug-related lung disease.

In this study, our case had no pulmonary symptoms, which was consistent with previous studies6,7 but was not consistent with drug-related ILD mentioned above. This patient had negative virology and bacterial screen, and his fever improved rapidly after the administration of steroids. Therefore, we excluded the possibility of drug-induced ILD in this patient.

Clinical presentation of pulmonary disease associated with IBD is polymorphic and pathogenesis remains unclear. On the CT, pulmonary manifestations related to IBD are scattered, nonsegmental, unilateral or bilateral foci of consolidation, ill-defined centrilobular nodules, large irregular nodules, lung parenchymal mass-like lesions.16 However, the CT findings of our case were multiple patchy ground-glass shadows and nodular ground-glass shadows, which were similar to a reported case with novel coronavirus pneumonia.17 However, the main manifestations of novel coronavirus-associated pneumonia are thickening and blurring of lung texture and interweaving into a network, accompanied by ground glass shadow, patchy nodular or mass consolidation. In this case, both the empirical antibiotic and antiviral therapies were not effective, after diagnosing with CD, steroid therapy was used. A follow-up chest CT 5 days later showed that the pulmonary lesions had almost been cured. Thus, it is important to recognize these manifestations because they may mimic other diseases, leading to incorrect treatment. In addition, a short-term follow-up CT would be crucial.

This case had a high fever, did this fever relate to bowel disease activity or extraintestinal manifestations of CD? The fever was not relieved despite both antibiotic and antiviral therapies were used. On the other hand, during the period of fever, his intestinal manifestations were not aggravated. However, after using steroid therapy, his fever quickly relieved. Therefore, we concluded that his fever was related to the ILD associated with CD.

Colonic ulcers or interstitial lung disease, which comes first? Previous reported studies3,4 revealed that respiratory involvement may precede presentation of bowel disease by months or years. However, ILD appeared nearly 4 months after intestinal symptoms of CD in this case, which was consistent with another research.18

Overall, the prognosis of this patient is good as it responds well to treatment with systemic steroids and infliximab followed. The use of steroids is effective in treating the clinical symptoms of pulmonary involvement, and the symptoms of intestinal ulcers of CD are responding well to biological agent therapy.

Conclusions

In conclusion, as shown in Table 1, ILD is a rare extraintestinal manifestation, and only systemic steroid therapy is effective. Manifestations of pulmonary disease associated with IBD are polymorphic; therefore, clinicians should be more vigilant regarding IBD-related ILD and to avoid incorrect treatment, when infectious causes have been excluded especially in the time of COVID-19. Early recognition and treatment are important. For those with ILD related to IBD, a short-term follow-up CT would be crucial.

Table 1 All Points Summarized in This Article

Data Transparency

All information about the patient comes from the Department of Gastroenterology and Infection, Yijishan Hospital of Wannan Medical College. The data underlying this article are available in the article and will be shared on reasonable request to the corresponding author.

Ethics Approval and Consent to Participate

This study was approved by the Institutional Ethical Review Committee of the First Affiliated Hospital of Wannan Medical College. Written informed consent to publish the case details was obtained from the patient.

Acknowledgments

We sincerely thank the department of radiology and infection in our hospital for providing information.

Funding

No funding was received for this study.

Disclosure

The authors have no competing interests to declare that are relevant to the content of this article.

References

1. Ephgrave K. Extra-intestinal manifestations of Crohn’s disease. Surg Clin North Am. 2007;87(3):673–680. doi:10.1016/j.suc.2007.03.003

2. Desai D, Patil S, Udwadia Z, Maheshwari S, Abraham P, Joshi A. Pulmonary manifestations in inflammatory bowel disease: a prospective study. Indian J Gastroenterol. 2011;30(5):225–228. doi:10.1007/s12664-011-0129-1

3. Camus P, Colby TV. The lung in inflammatory bowel disease. Eur Respir J. 2000;15(1):5–10. doi:10.1183/09031936.00.15100500

4. Shulimzon T, Rozenman J, Perelman M, Bardan E, Ben-Dov I. Necrotizing granulomata in the lung preceding colonic involvement in 2 patients with Crohn’s disease. Respiration. 2007;74:698–702. doi:10.1159/000092854

5. Eliadou E, Moleiro J, Ribaldone DG, et al. Interstitial and granulomatous lung disease in inflammatory bowel disease patients. J Crohns Colitis. 2020;14(4):480–489. doi:10.1093/ecco-jcc/jjz165

6. Zhao YJ, Xia YJ, Liu ZJ. Clinical evaluation of lung function in 74 patients with inflammatory bowel disease. Chin J Dig. 2014;34(6):379–383. doi:10.3760/cma.j.issn.0254-1432.2014.06.004

7. Karadag F, Ozhan MH, Akçiçek E, Günel O, Alper H, Veral A. Is it possible to detect ulcerative colitis-related respiratory syndrome early? Respirology. 2001;6(4):341–346. doi:10.1046/j.1440-1843.2001.00347.x

8. Bernstein CN, Fried M, Krabshuis JH, et al. World gastroenterology organization practice guidelines for the diagnosis and management of IBD in 2010. Inflamm Bowel Dis. 2010;16(1):112–124. doi:10.1002/ibd.21048

9. Satsangi J, Silverberg MS, Vermeire S, Colombel JF. The Montreal classification of inflammatory bowel disease: controversies, consensus and implication. Gut. 2006;55(6):749–753. doi:10.1136/gut.2005.082909

10. Harvey RF, Bradshaw JM. A simple index of Crohn’s-disease activity. Lancet. 1980;1(8167):514. doi:10.1016/s0140-6736(80)92767-1

11. Black H, Mendoza M, Murin S. Thoracic manifestations of inflammatory bowel disease. Chest. 2007;131:524–532. doi:10.1378/chest.06-1074

12. Kraft SC, Earle RH, Roesler M, Esterly JR. Unexplained bronchopulmonary disease with inflammatory bowel disease. Arch Intern Med. 1976;136:454–459.

13. Casella G, Villanacci V, Di Bella C, Antonelli E, Baldini V, Bassotti G. Pulmonary diseases associated with inflammatory bowel diseases. J Crohns Colitis. 2010;4:384–389. doi:10.1016/j.crohns.2010.02.005

14. Ostör AJ, Chilvers ER, Somerville MF, et al. Pulmonary complications of infliximab therapy in patients with rheumatoid arthritis. J Rheumatol. 2006;33(3):622–628.

15. Schwaiblmair M, Behr W, Haeckel T, Märkl B, Foerg W, Berghaus T. Drug induced interstitial lung disease. Open Respir Med J. 2012;6:63–74. doi:10.2174/1874306401206010063

16. Betancourt SL, Palacio D, Jimenez CA, Martinez S, Marom EM. Thoracic manifestations of inflammatory bowel disease. AJR Am J Roentgenol. 2011;197(3):W452–6. doi:10.2214/AJR.10.5353

17. An P, Song P, Lian K, Wang Y. CT manifestations of novel coronavirus pneumonia: a case report. Balkan Med J. 2020;37(3):163–165. doi:10.4274/balkanmedj.galenos.2020.2020.2.15

18. Xie F, Fang QH, Bu XN. Clinical characteristics of 12 cases of respiratory diseases associated with inflammatory bowel disease. Zhonghua Jie He He Hu Xi Za Zhi. 2018;41(09):724–727.

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Flu surges on heels of RSV, COVID-19 to overwhelm children’s hospitals in Canada – Stettler Independent

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A flu season that started early, hospitalized far more children than usual and overwhelmed emergency departments has revealed that Canada’s health-care system is chronically underfunded when it comes to the most vulnerable citizens, a pediatric infectious diseases specialist says.

Dr. Jesse Papenburg, who works at Montreal Children’s Hospital, said a system that was already struggling with a surge of respiratory syncytial virus, or RSV, on the heels of COVID-19 is now overwhelmed in much of the country.

“Certainly, Ontario and Alberta in particular have been hit very hard with an early and really quite explosive influenza season in pediatrics when it comes to more severe disease requiring complex hospitalization. And we’re also observing in Montreal as well that our influenza admissions are really starting to pick up,” he said.

The last week of November saw the highest number of pediatric hospitalizations for a single week in the past decade, said Papenburg, who is also an investigator for IMPACT, a program that monitors hospitalizations for vaccine-preventable diseases at 12 children’s hospitals across the country.

A typical flu season sees about 1,000 kids admitted to hospital. Due to pandemic public health measures, he said last season saw only 400 and there were none the season before that.

Up to the end of November, over 700 children had been hospitalized with the H3N2 strain of the flu, which typically takes a toll on older adults. But the season could continue until March or April, Papenburg said of the unexpected epidemic.

“When you’re already stretched to the limit under normal circumstances and there’s something exceptional that takes place, it really has a greater impact on the type of care that we can deliver to Canadian children,” he said. “It’s unacceptable, in my view, that this is happening, that we are having to delay important surgeries for children because we need those resources for dealing with acute respiratory infections.”

While the number of RSV hospitalizations is stabilizing, there’s still a “significant burden of disease requiring complex hospitalization,” he said of the Montreal hospital.

Alex Munter, president of Ottawa pediatric hospital CHEO, said the Red Cross will be helping take some of the pressure off critical-care staff starting this week.

He said two teams of nine people will work rotating overnight shifts and that some will be porters while others get supplies or sit with patients.

“Having these Red Cross teams on-site will allow us to send back redeployed staff to their home base,” he said.

“The test positivity rate last week for flu was 30 per cent compared to 10 per cent at the end of October. That’s a big increase and it’s still climbing so flu hospitalizations are increasing and RSV is plateauing,” Munter said.

CHEO, including its emergency department and urgent care clinic, is also getting help from pediatricians, family doctors and nurses in the community while some patients are being transferred to adult hospitals, Munter said.

“We can’t run our hospital this way in perpetuity. I think the moral of the story here is that we have undersized child and youth health system in Canada.”

SickKids in Toronto continues to see high patient volumes in the pediatric intensive care unit and since November has reduced the number of surgeries so staff can be redeployed to provide care in that unit.

“We have been co-ordinating closely with other hospital partners that have the ability to care for some pediatric patients,” the hospital said in a statement, adding it is not currently seeking staffing support from external organizations.

Dr. Shazma Mithani, an emergency room doctor at both the Stollery Children’s Hospital and Royal Alexandra Hospital in Edmonton, said a temporary closure of a pediatric hospice in Calgary is “tragic” as staff are being diverted to a children’s hospital.

“It means that kids who are dying are not getting the palliative and comfort care that they deserve and need, and that acute care is taking priority over that,” Mithani said.

Federal Health Minister Jean-Yves Duclos has said Ottawa recently gave provinces an additional $2 billion as calls grow for both levels of government to do more to help hospitals facing unprecedented challenges.

Mithani said funding has to be targeted for children’s hospitals and could also go to staffing after-hours clinics, for example.

She said people planning large indoor gatherings over Christmas and for New Year’s Eve should consider scaling back, while schools should transition to temporary online learning if they have a large number of viral illnesses

Health officials also need to make a concerted effort to educate the public on the importance of vaccination amid misinformation on social media, Mithani said.

“The most vulnerable people in our society are suffering as a result of the decisions that adults made. That’s what’s happening here, that kids are suffering from the poor decisions of adult decision-makers who can’t seem to do the right thing in order to protect our kids.”

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B.C. to start public push to get more kids vaccinated against flu as cases climb – Energeticcity.ca

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VANCOUVER — British Columbia health officials are urging parents to get their young children vaccinated against influenza ahead of the holiday season as the province deals with crowded emergency rooms.

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Provincial health officer Dr. Bonnie Henry said after two years of low rates of flu, mostly due to travel restrictions, the province is seeing a “dramatic increase” in illness and it arrived sooner than normal. 

“We know, much more than COVID, influenza can cause more severe illness in children, especially young children, and it can lead to secondary bacterial infections with things like streptococcus and pneumococcus that can cause very severe pneumonia,” she said Monday.

“And so that’s the concern that we have now.”

Henry said there is still time for people to get a flu vaccine to protect themselves and their children, especially as the holiday season approaches. 

“We’re starting to see the impact of a large number of children who haven’t been exposed to influenza for a few years and a small proportion of them are getting severely ill,” she said.

“So now’s the time to really make a difference and get that vaccine now.”

According to the most recent numbers from the B.C. Centre for Disease Control, for the week of Nov. 20, 169 patients were in BC Children’s Hospital with some form of a respiratory virus. Of those, 71 had influenza.

Henry said the province started seeing influenza numbers climb about two weeks ago and that the flu season typically lasts about two months.

While the province is on track for a record number of people getting their flu shot this year, Dr. Penny Ballem, with BC Vaccine Operations, said Monday that only 20 per cent of children under five have been vaccinated.

The government will be using its provincial health registry to contact parents in an attempt to increase that number.

Ballem said they’ll be sending texts and emails to the families of about 150,000 children under five who are not part of the province’s vaccine booking system and inviting them to make appointments.

She said there’s also a significant social media campaign from the government and health authorities encouraging people to get vaccinated.

Health Minister Adrian Dix said visits to provincial emergency rooms had been averaging 6,700 per day, but that is now peaking up to 6,900 patients daily, with extra pressure on BC Children’s and Fraser Health hospitals. 

B.C. Children’s briefly called a code orange on Saturday, a step sometimes used in mass casualty events. It was lifted 28 minutes later.

Dix said it was determined the code did not need to be enacted in order to make the mandatory overtime call-out, which was required at the time.

This report by The Canadian Press was first published Dec. 5, 2022.

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B.C. ramps up appeal to vaccinate as influenza surges in children – Times Colonist

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The province is ramping up its flu-shot campaign, especially for young children, as hospital emergency departments deal with a flu-driven spike in visits.

Provincial health officer Dr. Bonnie Henry said the province is seeing a “dramatic increase” in cases of Influenza A, particularly H3N2, which can cause severe illness, especially in children.

The surge began about two weeks ago and while it’s leveling off in older teens, it continues to spike in younger children who — along with seniors — are most susceptible to serious illness and complications.

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Henry, speaking at a news conference in Vancouver Monday with Health Minister Adrian Dix, said it’s not too late for vaccination to make a difference. “We can blunt that and we can prevent that ongoing transmission to older adults as we come together over the holiday season, which is often when we see our influenza peaking.”

Prior to the COVID-19 pandemic, the flu season usually lasted six weeks to two months, peaking after the winter holidays when people gather indoors. Typically in Canada every year, 15,000 to 20,000 people would be hospitalized with the flu and 2,500 to 3,000 would die.

Now, however, it’s surging earlier and the number of cases of Influenza A is way up, said Henry.

Children’s hospitals across the country have seen a surge in patients, including those affected by COVID-19, flu and respiratory syncytial virus, or RSV, for which there is no vaccine.

On Monday, children’s critical care beds in the province were at 63 per cent capacity, with high acuity/pediatric ICU beds at 85 per cent. (On the Island, the numbers were slightly lower: Children’s critical care bed capacity at Nanaimo Regional General Hospital was at 44 per cent capacity and Victoria General Hospital was at 50 per cent. High acuity/pediatric ICU beds at Victoria General Hospital were at 60 per cent capacity.)

At B.C. Children’s Hospital, where ER wait times were reported as 10 hours on Friday and nine on Saturday, a “code orange” that’s generally used for disasters and mass-casualty incidents was called at 6:35 a.m. Saturday and cancelled 28 minutes later.

Dix said the alert was based on information “available at the time” and promptly cancelled with new information.

Henry said while other respiratory viruses, including RSV, are levelling off in B.C., pediatricians and children’s hospitals are reporting more severe influenza and in some cases complications from influenza. Many children haven’t been exposed to the flu virus during the restrictions of the pandemic and thus haven’t built immunity.

Prime Minster Justin Trudeau said Monday he is “extremely worried” about a rise in respiratory illnesses among children as hospitals across the country report they are struggling to keep up with high volumes of patients.

Trudeau said it’s everyone’s responsibility to get vaccinated against both COVID-19 and influenza. He said health officials will consider measures such as mandatory masks.

Influenza A H3N2, which causes more severe illness, particularly in children age five and younger, is the main strain in circulation. Influenza is more concerning in young children than COVID because it can lead to secondary bacterial infections such as streptococcus or pneumococcus that can cause serious bacterial pneumonia, said Henry.

The vaccine offered this year includes H1N1 and H3N2 and two B strains, and appears to be a “very good” match to the virus circulating, offering 50 to 70 per cent protection against infection and illness, said Henry.

In B.C., influenza vaccine is free to anyone six months and older through health clinics, doctors’ offices, and pharmacies — with enhanced vaccines for seniors and FluMist for children who can’t tolerate needles.

So far, about 1.5 million British Columbians — including more than 50 per cent of those age 65 and older — have been vaccinated, using about 70 per cent of the current vaccine stock, with more expected.

However, only 20 per cent of children ages six months to 11 are vaccinated against the flu, and just 15 per cent of those age 12 to 17, said Dix, who urged parents to vaccinate their children. “What we’re seeing amongst children is a more significant influenza season by a very significant margin than last year and that reflects on the presentation at emergency departments.”

Emergency room visits in September and October of about 6,700 have increased to 6,800 to 6,900, he said.

Dr. Penny Ballem, executive lead of Immunized B.C. vaccine operations, said the province will host a vaccination blitz Dec. 9, 10, and 11 to get more people vaccinated through pharmacists, family doctors or health authority clinics designed for children, with thousands of appointments available on the GetVaccinated system.

The province will also send out emails and texts to the families of about 150,000 children age 5 and younger inviting them to make appointments.

B.C. Green Leader Sonia Furstenau, MLA for Cowichan Valley, called on the province to take steps beyond vaccination, including focusing on ventilation, masks and physical distancing.

A high number of children and teachers are missing school because they are sick, children’s wards and ERs are overwhelmed, and operations for children and infants are being cancelled, said Furstenau at a news conference Monday at the Pan Pacific Hotel in Vancouver. “I am deeply concerned for children and families in this province right now,” she said.

Dr. Sanjiv Gandhi, a pediatric cardiovascular and thoracic surgeon at B.C. Children’s Hospital who joined Furstenau at the news conference, said mandating masks is a reasonable and effective tool that should be used in addition to vaccination.

As a heart surgeon, Gandhi said, he’s seeing kids with viral infections who are sicker than he’s seen in decades. “We have all the tools to change the trajectory of this horrible situation — and it’s horrible. The only missing ingredient is courage, the courage for our leaders to be transparent to the public about what’s happening in our hospitals.”

Henry said masking in schools now is “very unlikely” to have any effect on the trajectory of the several viruses that are circulating.

Masks continue to be required in health-care settings, she said, but a general mask mandate is a “heavy handed” measure used as a “last resort when it’s something that is absolutely needed, everywhere, all the time.”

ceharnett@timescolonist.com

>>> To comment on this article, write a letter to the editor: letters@timescolonist.com

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