An estimated 61,000 long-stay home-care clients in Ontario and thousands more across Canada did not get a flu shot in 2019, researchers at the University of Waterloo have found.
John Hirdes, professor at the School of Public Health and Health Systems, said the number for Ontario is 18,000 more than the 2007 figure, when around 43,000 long-stay home-care clients did not get a flu shot.
He said the issue is critical now as the country grapples with “wave two” of the COVID-19 pandemic.
“One reason for that is, if we can protect people against influenza, that may help them to be a bit stronger if they get infected with COVID,” Hirdes told CBC News.
“The other is, by giving people the flu shot, we can keep them out of the emergency department, so that reduces pressure on the emergency department so they are not dealing with two viral outbreaks.
“Also, because there are so many similarities between the two conditions, if we get people the flu shot and can prevent the flu, then at least it may help in reducing some confusion of whether we’re dealing with the flu or COVID in cases where people are infected,” Hirdes added.
Study covered Alberta, BC, Ontario and Newfoundland
The study, which covered Alberta, BC, Ontario and Newfoundland in Canada, also included Belgium, New Zealand and the United States. It included individuals living in their communities who need on-going supports from the government’s home-care system.
According to the study, the rate of not being vaccinated for influenza in long-stay home-care clients is as follows:
Ontario — 28.3 per cent.
BC — 27.6 per cent.
Alberta — 23.2 per cent.
Newfoundland — 34.9 per cent.
“These are all frail, elderly people. They are very vulnerable to the effects of influenza so they definitely should be getting the flu shot,” Hirdes said.
John Hirdes, professor at the University of Waterloo School of Public Health and Health Systems. (Submitted by Julie Koreck)
Noting that Ontario “used to do OK” where only about 20 per cent of long-stay home-care clients did not get a flu shot in 2007, Hirdes said it’s “worrisome” that things have gotten worse over time.
Dr. Samir Sinha, director of geriatrics for Mount Sinai Hospital and the University Health Network in Toronto, said he’s not surprised by the findings.
He noted that while the Public Health Agency of Canada has recommended at least 80 per cent of Canadians get the flu shot, that target is not being met.
“We’re not even reaching that target amongst older Canadians and Canadians in general,” Sinha told CBC News.
“And that’s concerning, because if we don’t actually reach 80 per cent vaccination levels, we don’t create a situation that we call herd immunity, meaning that if flu is circulating around, it’s less likely to spread from one person to the other if 80 per cent of our population for example is immune, either by having recovered from the flu that year, or having received the flu vaccination that protects people from that strain of the flu.”
Dr. Samir Sinha heads geriatric medicine at Toronto’s Mount Sinai Hospital. He says while the Public Health Agency of Canada has recommended that at least 80 per cent of Canadians get the flu shot, that target is not being met. (CBC)
Most governments have made the flu vaccine freely available and accessible, even in places like pharmacies across the country. The vaccine is available for anyone who is six months or older.
“The challenge is that for the type of person that John and his team is studying, these tend to be people who are functionally homebound,” Sinha explained.
“These are folks for example who can’t really get out to see their doctor, can’t easily get out to see their pharmacist.
“They are often people who are getting their medication delivered from the pharmacy to them at home. And because these folks have challenges getting out of the house, it just creates an additional challenge or barrier for them to actually get vaccinated,” Sinha added.
‘Quite a bit of bureaucracy involved,’ Hirdes says
Meanwhile, Hirdes said home-care based clinicians need to urgently have a conversation with their clients to make them aware why they should be getting a flu shot — especially now that we are in the midst of the COVID-19 pandemic.
“The role of the home-care nurse is to encourage them and make them aware of the options. One of the things that we need to think about is can we simplify things to make it easier for home-care service providers to also provide the flu shot,” Hirdes said.
“Right now there is quite a bit of bureaucracy involved in this where home-care providers would have to ask to get flu doses from public health.
“A home-care nurse doesn’t carry it around in a small black bag so we need to think about ways to make it more convenient and easy to get flu shots to frail, elderly people in their homes,” he added.
(John Hirdes)
In August Canada’s chief public health officer, Dr. Theresa Tam, stressed the months ahead will be a “period of challenge” given the combination of COVID-19 and influenza.
Last month, Tam said preparations for administering this year’s flu vaccine is a “good rehearsal” for any COVID-19 vaccine.
The National Institute on Ageing has published a White Paper related to the issues of influenza in Canada. The findings include:
Influenza (and pneumonia) is the seventh leading cause of death in Canada, and it is the leading cause of death among vaccine-preventable diseases.
Influenza has been reported to cause an average of 12,200 hospitalizations and 3,500 related deaths each year in Canada.
The influenza vaccination rate for older adults is only 62 per cent, well below the Health Canada target of 80 per cent needed for population immunity.
In provinces where pharmacists are allowed to administer the influenza vaccine, more Canadians get vaccinated.
Influenza leads to an estimated 1.5 million lost work days each year. Despite making some progress in promoting vaccination uptake, Canada still lags behind other countries like the United States and Britain.
(National Institute on Ageing)
It’s not too late
Hirdes said it is not too late to get the vaccine to the thousands of long-stay home-care patients who did not get one last year.
“We’re just starting to get vaccinations going with this and so this is the time for the system to work. If this was April or May in 2021 it would be too late, but now is the time,” Hirdes told CBC News.
“The advantage that we’ve got is that the home-care agencies in the province have a complete list of all their clients who did not get a flu shot, so it’s actually very easy for them with their electronic health records to identify which of their clients did not get a flu shot and to reach out to them to encourage them to get a flu shot.
“We serve about 200,000 home-care clients in the province a year so it’s a manageable problem. These are people that are on the roster for home-care agencies — they can easily with their electronic health records identify who those folks are … it’s not going to be that hard to reach them,” Hirdes added.
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.
