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Ontario builds first-of-its-kind screening program to help children with hearing loss – The Globe and Mail

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18-month-old Francesca Jones plays at home with her father Will and mother Julia Tirabasso in early December.

Melissa Tait

When the wail of a fire alarm broke the night-time quiet of the hospital and her new baby did not stir, Julia Tirabasso knew something was wrong.

“I felt like it was the loudest sound I’d ever heard,” Ms. Tirabasso said, “And she slept through it.”

If her daughter, Francesca, had been born at another time or in a province other than Ontario, Ms. Tirabasso and her husband, William Jones, might never have found out exactly why their daughter could not hear the piercing alarm.

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Instead, within weeks of Francesca’s birth on May 25, 2018, Ms. Tirabasso and Mr. Jones learned that a common viral infection, passed from mother to baby in utero, had made their daughter deaf in both ears.

Francesca’s case was the first to be caught by the pilot phase of a new screening program in Ontario that, as of last July, expanded to become the first in the world to offer all parents the opportunity to have their newborns tested for congenital cytomegalovirus, or cCMV, the most common non-genetic cause of permanent hearing loss in children. The province has already caught 70 cases of congenital CMV infection, 53 of them since the program became universal.

The earlier that children with hearing loss are given hearing aids or cochlear implants, the likelier they are to learn to speak. For a cost of $600,000 a year, Ontario has built a program that should catch most children with cCMV-related hearing loss in time to dramatically improve their lives, raising questions about why other parts of Canada have yet to follow Ontario’s lead.

“People are looking very closely at what’s happening in Ontario,” said Sharon Cushing, an otolaryngologist at Toronto’s Hospital for Sick Children who helped craft Ontario’s cCMV screening program. “I travel all over the world, and they’re amazed at what we’re doing.”

For Francesca, early detection of her cCMV infection helped make it possible for her to become one of the youngest babies in the province to receive cochlear implants, electronic devices that partly restore hearing. She was nearly six months old when the implants were turned on for the first time, on Dec. 10, 2018.

Francesca Jones received cochlear implants when she was just five-months-old, one of the youngest in Ontario. At six months they were “turned on” and the video of baby Francesca reacting to her mother’s voice for the first time went viral. We visit the family one year on to see how Francesca is doing.

In a CBC news clip that has been viewed online nearly four million times, Francesca is quietly chewing on a rubber giraffe when a loud beep played by audiologist Susan Druker catches her attention. Francesca looks up and smiles.

Ms. Tirabasso leans in: “Ciao, Francesca.” Mr. Jones chimes in with, “Hi, Francesca.” The little girl rewards her parents with a wide grin. They both laugh with joy and relief.

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Getting to that moment was a journey that began not long after an outwardly healthy Francesca was born at Toronto’s Mount Sinai hospital.

Her case was caught during a pilot program that drew on two existing, but separate, screening programs for newborns: The Infant Hearing Program, which screens for hearing loss, and Newborn Screening Ontario, which co-ordinates the testing of heel-prick blood samples for more than 25 different diseases.

Until last year, Newborn Screening Ontario did not regularly test for congenital CMV.

Francesca is seen at an appointment with audiologist Susan Druker at Hospital for Sick Children in Toronto.

Melissa Tait

Most of the time, cytomegalovirus is no more dangerous than the common cold. But if a pregnant woman catches the virus through saliva or other bodily fluids and passes it on to her baby in utero, CMV infection can sometimes cause serious health problems. Symptoms range from the obvious – a small head, jaundice or a telltale rash – to the invisible, such as mild hearing loss that worsens over time.

If cCMV infection is identified quickly – ideally within the first four weeks of life – babies can be offered antivirals that work better the earlier they are started. Doctors can also monitor babies for hearing loss, which is especially important in cases where newborns with cCMV appear perfectly healthy.

“These children may, for a variety of reasons, pass their hearing screen at birth, but still be at risk,” said Jessica Dunn, medical lead for the CMV component of the new screening program and an infectious disease doctor at CHEO, a children’s health centre in Ottawa.

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Dr. Dunn said that, with the exception of Ontario’s new universal program, the Canadian health-care system has generally done a poor job of catching cCMV.

One University of Alberta study published in 2014 found that, between 2005 and 2008, Canadian pediatricians reported only 49 cases of congenital CMV, or 4.5 cases for every 100,000 births – a much lower birth prevalence than would be expected based on previous studies.

“The most likely explanation for the low reporting rate is missed diagnosis,” the study, published in the journal Paediatric Child Health, found.

Hoping to remedy that, Newborn Screening Ontario modified an existing blood test to detect cCMV in the dried blood spot, obtained from the heel prick, that NSO already collected from 99 per cent of the approximately 143,000 babies born in the province every year.

Once developed, the test cost about $2 a sample.

During the pilot phase, beginning in May, 2018, parents were offered the chance to opt-in to cCMV testing only after their children failed a full hearing screening test. Once the program became universal, last July, all parents were able to opt-in to testing for cCMV and three genetic risk factors for hearing loss, even if their children passed the initial hearing screen.

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Once Francesca tested positive for cCMV infection, Toronto’s Hospital for Sick Children immediately set up a day’s worth of appointments for the stunned couple and their one-month-old baby, whisking them from an infectious diseases doctor to an ear, nose and throat specialist and on to the audiology department.

“I was crying all day,” Ms. Tirabasso said. But she also found reason for hope. Dr. Cushing told Ms. Tirabasso and Mr. Jones that the health system had a “toolbox,” full of ways to help Francesca.

With guidance from 11 different types of doctors and health-care workers, including an auditory verbal therapist, an occupational therapist, a family support worker and an in-home teacher, Francesca, now 18 months old, can sing her alphabet, count, make animal sounds and mimic her parents as they read to her.

Ms. Tirabasso reads to her daughter.

Melissa Tait

“Do you want to read?” Ms. Tirabasso asked her daughter on a recent afternoon, holding up a board book titled Little Blue Truck.

“Read!” Francesca replied. As Little Blue Truck drove around his farm, Francesca repeated his signature sound, “Beep beep!” and quacked, neighed and mooed along with the animals. “All done!” Francesca said as she shut the book.

Softly, she called out for “Papa!” then switched to Mr. Jones’s lap. He read the opening of a Dr. Seuss book. “One fish, two fish, red fish, blue fish, black fish, blue fish, old fish …” Francesca interjected, “new fish.”

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“You’ve never said that before,” Mr. Jones said, clearly tickled.

To get Francesca to this point, where she comprehends words and speaks as well as any hearing toddler, has taken an all-encompassing effort by Ms. Tirabasso, a lawyer, and Mr. Jones, a product manager for a medical-device company.

They talk to Francesca constantly, narrating as they serve her tomatoes and cheese for dinner in their apartment north of downtown Toronto. Taped to the walls of the apartment are notes with tips from a language therapist: “6 sounds everyday e, a, ouu, mmm, siii, shh; use word ‘sandwiches’; Don’t feed her with full plate. Empty plate + ask her what she wants.”

When Francesca was younger, they hid around corners and rang bells, banged wooden spoons against pots and softly shook rice inside Tupperware containers, watching to see if Francesca could follow the source of the sounds.

If not for the small gadgets above Francesca’s ears, you might never guess that, when the external portion of the cochlear devices are removed for bath or bedtime, Francesca can’t hear at all.

Marlene Bagatto, an audiology professor and researcher at University of Western Ontario who chairs the Canadian Infant Hearing Task Force, said all Canadian children with hearing loss deserve the kind of early intervention that has helped Francesca to develop language. “The best chance you have for developing spoken language really well is up to age two. Earlier is better,” she says.

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The task force’s 2019 report card on Canadian early hearing detection and intervention programs rated only Alberta, British Columbia, Northwest Territories, Nova Scotia, Ontario and Yukon as having programs “sufficient” to identify hearing loss in babies and intervene to improve their odds of developing language. And only Ontario offers universal screening for cCMV. “It’s not okay for babies in this country,” Dr. Bagatto said.

Francesca Jones at The Hospital for Sick Children in Toronto after an appointment with the audiologist in early December.

Melissa Tait

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A look at COVID-19 vaccinations in Canada on Jan. 24, 2021 – BarrieToday

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The latest numbers on COVID-19 vaccinations in Canada as of 10:30 p.m. ET on Sunday Jan. 24, 2021.

In Canada, the provinces are reporting 15,213 new vaccinations administered for a total of 816,451 doses given. The provinces have administered doses at a rate of 2,154.265 per 100,000.

There were zero new vaccines delivered to the provinces and territories for a total of 1,122,450 doses delivered so far. The provinces and territories have used 72.74 per cent of their available vaccine supply.

Please note that Newfoundland, P.E.I., Nova Scotia, New Brunswick and the territories typically do not report on a daily basis.

Newfoundland is reporting 3,258 new vaccinations administered over the past seven days for a total of 8,549 doses given. The province has administered doses at a rate of 16.326 per 1,000. There were zero new vaccines delivered to Newfoundland for a total of 16,500 doses delivered so far. The province has received enough of the vaccine to give 3.2 per cent of its population a single dose. The province has used 51.81 per cent of its available vaccine supply.

P.E.I. is reporting 1,423 new vaccinations administered over the past seven days for a total of 6,525 doses given. The province has administered doses at a rate of 41.134 per 1,000. There were zero new vaccines delivered to P.E.I. for a total of 9,225 doses delivered so far. The province has received enough of the vaccine to give 5.8 per cent of its population a single dose. The province has used 70.73 per cent of its available vaccine supply.

Nova Scotia is reporting 2,975 new vaccinations administered over the past seven days for a total of 10,575 doses given. The province has administered doses at a rate of 10.836 per 1,000. There were zero new vaccines delivered to Nova Scotia for a total of 28,850 doses delivered so far. The province has received enough of the vaccine to give 3.0 per cent of its population a single dose. The province has used 36.66 per cent of its available vaccine supply.

New Brunswick is reporting 2,704 new vaccinations administered over the past seven days for a total of 10,436 doses given. The province has administered doses at a rate of 13.379 per 1,000. There were zero new vaccines delivered to New Brunswick for a total of 21,675 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 48.15 per cent of its available vaccine supply.

Quebec is reporting 8,503 new vaccinations administered for a total of 218,755 doses given. The province has administered doses at a rate of 25.565 per 1,000. There were zero new vaccines delivered to Quebec for a total of 238,100 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 91.88 per cent of its available vaccine supply.

Ontario is reporting 4,427 new vaccinations administered for a total of 280,573 doses given. The province has administered doses at a rate of 19.101 per 1,000. There were zero new vaccines delivered to Ontario for a total of 411,650 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 68.16 per cent of its available vaccine supply.

Manitoba is reporting 1,389 new vaccinations administered for a total of 28,941 doses given. The province has administered doses at a rate of 21.017 per 1,000. There were zero new vaccines delivered to Manitoba for a total of 55,650 doses delivered so far. The province has received enough of the vaccine to give 4.0 per cent of its population a single dose. The province has used 52.01 per cent of its available vaccine supply.

Saskatchewan is reporting 654 new vaccinations administered for a total of 33,039 doses given. The province has administered doses at a rate of 28.019 per 1,000. There were zero new vaccines delivered to Saskatchewan for a total of 32,725 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 101 per cent of its available vaccine supply.

Alberta is reporting 240 new vaccinations administered for a total of 99,047 doses given. The province has administered doses at a rate of 22.50 per 1,000. There were zero new vaccines delivered to Alberta for a total of 122,725 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 80.71 per cent of its available vaccine supply.

British Columbia is reporting zero new vaccinations administered for a total of 110,566 doses given. The province has administered doses at a rate of 21.546 per 1,000. There were zero new vaccines delivered to British Columbia for a total of 144,550 doses delivered so far. The province has received enough of the vaccine to give 2.8 per cent of its population a single dose. The province has used 76.49 per cent of its available vaccine supply.

Yukon is reporting zero new vaccinations administered for a total of 3,730 doses given. The territory has administered doses at a rate of 89.382 per 1,000. There were zero new vaccines delivered to Yukon for a total of 14,400 doses delivered so far. The territory has received enough of the vaccine to give 35 per cent of its population a single dose. The territory has used 25.9 per cent of its available vaccine supply.

The Northwest Territories are reporting zero new vaccinations administered for a total of 1,893 doses given. The territory has administered doses at a rate of 41.956 per 1,000. There were zero new vaccines delivered to the Northwest Territories for a total of 14,400 doses delivered so far. The territory has received enough of the vaccine to give 32 per cent of its population a single dose. The territory has used 13.15 per cent of its available vaccine supply.

Nunavut is reporting zero new vaccinations administered for a total of 3,822 doses given. The territory has administered doses at a rate of 98.693 per 1,000. There were zero new vaccines delivered to Nunavut for a total of 12,000 doses delivered so far. The territory has received enough of the vaccine to give 31 per cent of its population a single dose. The territory has used 31.85 per cent of its available vaccine supply.

*Notes on data: The figures are compiled by the COVID-19 Open Data Working Group based on the latest publicly available data and are subject to change. Note that some provinces report weekly, while others report same-day or figures from the previous day. Vaccine doses administered is not equivalent to the number of people inoculated as the approved vaccines require two doses per person. The vaccines are currently not being administered to children under 18 and those with certain health conditions.

This report was automatically generated by The Canadian Press Digital Data Desk and was first published Jan. 24, 2021.

The Canadian Press

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Military to support vaccination efforts in northern Ontario Indigenous communities – pentictonherald.ca

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TORONTO – The Canadian military is set to help with COVID-19 vaccine distribution in northern Ontario, as officials investigate the death of a teenager who had the virus and worked at a long-term care home in the province’s southwest.

Federal Public Safety Minister Bill Blair tweeted Sunday that the Canadian Armed Forces will support vaccine efforts in 32 communities of the Nishnawbe Aski Nation. The move came after a request from the province for assistance in getting vaccine to First Nations communities, he wrote.

“ur government will always be there to support the fight against #COVID19,” he wrote on Twitter.

The Nishnawbe Aski Nation, whose territory comprises 49 remote communities in northwestern Ontario, did not immediately comment on the pending deployment.

Meanwhile, officials in Middlesex-London said Sunday that a male teen who worked in a long-term care facility in the region was among the three deaths reported on the area’s COVID-19 case site earlier in the weekend.

Dr. Alexander Summers, associate medical officer of health for the Middlesex-London Health Unit, said he couldn’t provide the exact age or any other details about the teen.

But he said the person was a staff member of the long-term care home who was recently diagnosed with COVID-19 and died earlier in the week.

“Through the course of our investigation, the potential exposures could be many, but certainly the long-term care home is a potential exposure for this individual,” Summers said in an interview.

Summers said to his knowledge, the teen was not hospitalized with COVID-19.

He is the youngest person to have died after contracting the virus in the county, Summers said, noting the majority of deaths they’ve seen among COVID-19 patients have been in an older demographic.

“It can have severe impacts on people of all ages and this story and this unfortunate and tragic situation as a reminder of that,” Summers said.

“Certainly, this is a very rare occurrence. It’s a rare event. And the investigation continues as to understanding what exactly might have happened. However, regardless, it’s a sad day.”

The Roberta Place Retirement Lodge long-term care home in Barrie, Ont., north of Toronto, also made headlines over the weekend after health officials said a U.K. variant of COVID-19 was behind a deadly outbreak there.

On Sunday, the Simcoe Muskoka District Health Unit said it had learned of an additional individual with the U.K. variant within the region.

The unit said that individual had close contact with a person who is also part of a COVID-19 outbreak at Bradford Valley Care Community, a long-term care home in Bradford West Gwillimbury, south of Barrie.

Officials are now investigating whether that outbreak is also due to the U.K. variant.

Ontario reported 2,417 new cases of COVID-19 and 50 more deaths related to the virus on Sunday.

The numbers were slightly up from Saturday’s 2,359 cases, though deaths declined by two from previous figures.

Health Minister Christine Elliott said there were 785 new cases in Toronto, 404 in Peel Region, 215 in York Region and 121 in Niagara.

Over 48,900 tests had been completed in Ontario over the past 24 hours.

The province reported that 4,427 doses of a COVID-19 vaccine were administered since the province’s last report, and 1,436 are hospitalized with the virus.

A total of 280,573 doses of the COVID-19 vaccine have been administered in Ontario so far.

Since the pandemic began, there have been 255,002 confirmed cases of COVID-19 in Ontario. Of those, 225,046 have recovered and 5,803 people have died.

On Monday, the province plans to issue the results of a weekend-long expansion of its “inspection blitz” of big-box stores to ensure they were following COVID-19 guidelines.

The workplace inspections, which started in the Greater Toronto and Hamilton areas last weekend, stretched out to Ottawa, Windsor, Niagara and Durham regions.

Preliminary figures from Saturday showed inspectors went into 310 big-box stores and issued 34 tickets and 53 orders, Labour Minister Monte McNaughton said Sunday.

Overall, inspectors found the stores were only at “64 per cent compliance, which the minister said wasn’t good enough.

“The three big issues that we’re finding this weekend: masking protocols aren’t being followed, in some cases; the physical distancing is still an issue in some stores; and this weekend we found that some of these big-box stores don’t have a safety plan that’s required of them to prevent COVID-19 from coming into the workplace,” McNaughton said in an interview.

“Every business should know at this point in the pandemic what’s expected of them.”

This report by The Canadian Press was first published Jan. 24, 2021.

Note to readers: This is a corrected story. A previous version said there had been 102 deaths in Ontario over the past 24 hours. There were, in fact, 50 deaths.

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Health unit probes whether COVID-19 variant behind 2nd Ontario long-term care home outbreak – CBC.ca

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The Simcoe Muskoka District Health Unit is investigating whether an outbreak at a long-term care home in the town of Bradford West Gwillimbury is due to the variant first detected in the United Kingdom.

At a news conference on Sunday, the health unit said a person linked to the Bradford Valley Care Community has tested positive for the variant. This person has had close contact with another person who is a part of the outbreak at that home, it said.

Dr. Charles Gardner, medical officer of health for the Simcoe Muskoka District Health Unit, said the Public Health Ontario Laboratory told the health unit about the positive case late Saturday.

“Given this situation, we are working together in partnership with the residence to implement additional measures to contain the spread while pursuing the necessary tests to determine if it is the U.K. variant of COVID-19 that is the cause of this outbreak,” Gardner said in a new release.

The health unit said it is investigating “all other connections” to the person who tested positive. Gardner said the person worked in a retail setting in Simcoe County that offered curbside pickup, and two COVID-19 cases are linked to this setting.

The news comes after the health unit said the variant is behind a deadly outbreak at Roberta Place Long Term Care in Barrie, Ont., on Saturday. Genome sequencing on six COVID-19 samples from the home have been identified as the highly contagious variant.

An outbreak at Roberta Place, first declared on Jan. 8, has resulted in the deaths of 40 residents and one essential caregiver as of Sunday.

There are 127 resident and 86 staff cases of COVID-19 at Roberta Place. Six residents are also in hospital with COVID-19. 

The body of a deceased resident of Roberta Place Long Term Care in Barrie, Ont., is removed on Jan. 18. (Evan Mitsui/CBC)

The outbreak at Bradford Valley Care Community, meanwhile, was declared on Jan. 14. As of Sunday, six residents out of 230 and three staff out of 260 have tested positive for COVID-19.

The health unit said more testing will be done to determine whether the outbreak is due to the variant. It added that the outbreak is “well under control at this time with a relatively low case count,” but the possibility that it may be due to the variant must be assessed and managed. 

Dr. Andrea Moser, chief medical officer for Sienna Senior Living, which owns and operates the facility, said in a news release on Sunday that staff members at the home are working to contain the outbreak.

“We are being extremely vigilant in our monitoring for signs and symptoms of COVID-19 and are taking all of the necessary steps to protect the safety of our residents and team members,” Moser said.

“We are working proactively with public health and community partners, as fighting the virus will require everyone’s expertise and teamwork.”  

Staff at home implementing measures to control outbreak

Moser said case and contact measures are being undertaken, including:

  • Extending the length of isolation for cases and close contacts.
  • More readily identifying close contacts.
  • Quarantining all household contacts of confirmed or probable cases as quickly as possible.

The health unit said its staff vaccinated most of the residents in Bradford Valley Care Community on Jan. 15 as a protective measure against COVID-19. 

As of Jan. 16, all residents of long-term care homes in Simcoe Muskoka have been offered their first dose of immunization against COVID-19, the health unit added.

Moser said about 60 per cent of staff members and 96 per cent of residents at Bradford Valley Care Community have received the first dose of the Pfizer-BioNTech vaccine.

“We appreciate all the efforts from our partners in the community with the rollout of the vaccine and will continue working closely with them as additional doses are available for deployment,” she said.

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