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No need to change Canada's plans after WHO declares global emergency: Hajdu – Toronto Sun

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Canada is already taking the right steps to control the spread of the novel coronavirus, so there is no need to change things now that the World Health Organization has declared a global emergency over the outbreak, federal Health Minister Patty Hajdu said Thursday.

“The World Health Organization’s global emergency status is really … about helping countries that do not have the same level of sophistication as Canada, or perhaps the United States, to protect their citizens if in fact they have a citizen who returns from China who is ill, or has been close to someone who has returned from China who is ill,” Hajdu told reporters in Ottawa.

“You know this has been working very well in Canada, because we have actually been able to detect cases very quickly, support those people to get better and prevent the spread of disease,” she said. “And what the World Health Organization is saying is that we’ve got to make sure that other countries can do that as well, because it is in the interest of world health that we support everyone in this process.”

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The World Health Organization declared the outbreak, which was sparked by a new virus in China that has been exported to more than a dozen countries, as a global emergency Thursday. The UN health agency defines an international emergency as an “extraordinary event” that constitutes a risk to other countries and requires a co-ordinated response.

Though many people experience only mild symptoms from the virus, China has reported more than 7,800 cases, including 170 deaths.

Hajdu stressed the need — and the responsibility — to remain calm.

“I think that anything that we are doing as politicians or leaders or members of the media that will create a sense of anxiety or panic is actually a dangerous road to travel down,” she said.

Earlier Thursday, Ontario’s chief medical officer of health said the relatively low number of cases here is “reassuring,” even though it is still early days in dealing with the virus.

There are three confirmed cases of the virus in Canada — two in Ontario and one in British Columbia — and all are linked to recent travel in China.

Dr. David Williams and Ontario’s associate chief medical officer of health, Dr. Barbara Yaffe, held a briefing on the new virus Thursday and said there are no new presumptive or confirmed cases in Ontario. Williams said he would be much more concerned at this point if the province had already seen around seven to 10 cases.

“This is reassuring in a way, but not that we’re going to sit back and coast,” he said. “The system is working. We’re investigating. Individuals of concern have self-reported, are coming forward and we haven’t seen ones that out of the blue show up already quite ill and infected. We’re not seeing that yet, but it’s still early days.”

There are 27 cases currently under investigation in the province, and 38 people have already been tested and cleared.

Williams said the coronavirus does not seem to be much different from regular influenza in terms of transmissibility, and evidence suggests it is not transmissible when a person is not feeling symptoms.

The two Ontario cases are a husband and wife, and since they had both travelled to the affected area in China, it’s unclear whether the woman — as the second case — got it in Wuhan or from her husband.

Asked about the novel virus Thursday afternoon, Prime Minister Justin Trudeau warned against stigmatizing the Chinese-Canadian community.

“We’ve seen too many instances of unreasonable fears being spread either on the internet or in other ways. We need to know this is a time for Canadians — all Canadians, including Canadians of Chinese origin — to pull together and to lean on each other,” Trudeau told reporters in Brampton, Ont.

Meanwhile, Quebec has no confirmed cases of the new virus, and the chances of its being transmitted to the community are considered low, the province’s director of public health said Thursday.

Dr. Horacio Arruda warned the public against wearing masks, which he said “do not constitute, by science, a useful tool for the general population in Quebec, even in the context of a coronavirus outbreak.” Instead, he suggested people practice “respiratory hygiene” by washing their hands and covering their mouths when sneezing or coughing.

If people have respiratory symptoms and have to go out in public, wearing a mask can help prevent transmission, Yaffe said, but it is not useful for the general population.

“Anybody who’s feeling well, wearing a mask is not going to do anything,” she said. “In fact, it might give them a false sense of security.”

— With files from The Associated Press.

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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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