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.
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.
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.
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.
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.
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.
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.
“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.”
“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.
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.
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BC Eyeing Record Influenza Vaccine Rollout – CFNR Network
British Columbia is looking to break records when it comes to this year’s influenza vaccine rollout, according to Minister Adrian Dix.
Dix says that the province has received 2.4 million doses of vaccines, 200 thousand more than last year.
Experts are expecting a flu season for the record books as well, after Covid lockdowns nearly killed off all spread last year.
In recent years, British Columbia has been accustomed to closer to 1.5 million doses, but the province is expecting more demand as Covid restrictions begin to loosen.
COVID-19 drives up demand for flu shots; N.S. to launch campaign later this week – CTV News Atlantic
With the colder winds of fall starting to blow, flu season will soon be on us again, but it seems scores of people are hoping to head off the sickness by getting a flu shot.
Unlike last year, when it was essentially pre-empted by COVID-19, experts say influenza will be back this year.
Just hours after getting a shipment and posting signage outside lineups started to form inside a north end Halifax pharmacy.
“We just got our flu shots, and people start showing up right away,” said pharmacist and store owner Ghada Gabr.
“I think this is going to be a lot of demand.”
It’s the same story a few blocks away, where pharmacist Greg Richard is expecting his first shipment of flu vaccine later this week.
With COVID-19 still around, customers like Kathy Lynch, who hasn’t had a flu shot in five years, is anxious to get one.
“I mean, I feel great. I’ve had no problem with either of the vaccinations, so, to put another layer on top is just the best thing, I think,” she said.
“People are eager to get their doses into them right off the bat,” said Richard. “They’re not looking to wait until November or December. So, I have a list of folks I’m going to reach out to as soon as they (the vaccines) arrive, and I anticipate to run through my stock pretty quickly.”
And it might very turn out to be the same thing across the country.
There’s word today Ontario has ordered an extra 1.4 million doses, with an aim to make the shots available to everyone by next month.
In Nova Scotia, the Health Minister says the official kickoff will come later this week, and supply should not be a problem,
“We do anticipate having enough vaccine for folks,” said Michelle Thompson.
“And I would really encourage people to ensure they have both their COVID-19 vaccine and the influenza vaccine this year.”
But, if early demand is any indication there might not be need for much encouragement.
A sign of the times as more and more of us take steps to avoid getting sick.
PG woman denied high dose flu shot, although her age and health condition makes her eligible – CKPGToday.ca
“I’m an advocate for my health and I want the best that there is–everybody should have what they need,” said Newman.
Today, the province announced it’s beginning its influenza immunization campaign.
“The influenza vaccine is for free for anybody over six months of age, for whom it’s recommended. But particularly for people who have underlying health conditions,” said Dr. Bonnie Henry, Provincial Health Officer
Newman’s condition requires a higher dose of the flu shot and she has been eager to get it. However, she says she’s been denied even though she’s eligible.
“I have Non-Hodgkin’s Lymphoma, which is a cancer of your lymphatic system–your germ fighting network. So as soon as the flu shots were available, I phone my pharmacy to get the high dose vaccine. I was told that the high doses were not available,” said Newman.
Because of her cancer, she’s also classified as a Clinically Extremely Vulnerable person (CEV). She has qualified for the high dose shot in the last three years. But after calling more than a dozen pharmacies and Northern Health, she was told she wasn’t eligible yet.
“It’s really hard to get answers. But when I’ve had it in the past and people in my situation have had the high dose in the past. I just don’t get why we cannot get it. Nobody can tell me. They don’t say it’s a supply issue or anything, so I just don’t understand,” said Newman.
According to ImmunizeBC’s website, First Nations communities, residents in long term care, residents in assisted living facilities, and who are 65 and older are able to receive the high dose for free.
This means Newman’s age alone qualifies her.
CKPG-TV reached out to the Ministry of Health for clarification as to why she wasn’t able to get a high dose shot. At the time that this article was written, this was the response that was given:
“As of today, the province is proud to announce the implementation of free publicly-funded influenza vaccines for those 6 months and older (those under 6 months aren’t eligible to receive this vaccine). FluZone HD, also referred to as the “high-dose influenza vaccine,” was never publicly-funded in BC until the federal government made it available in limited supply last year. With publicly funded FluZone HD, eligibility is restricted to residents of LTC/AL who are 65 or older. This year, eligibility was extended to people 65 or older residing in Indigenous communities. No pharmacy within Northern Health has a stock of publicly funded FluZone HD reserved for these eligible populations; they are administered through other means. Some pharmacies may pay for private-pay stock of FluZone HD. That is their prerogative and the Ministry is only responsible for publicly-funded stock. If those over 65 who do not live in an Indigenous community or are an LTC resident can receive a standard-dose influenza vaccine, they should accept it,” said Ministry of Health.
Newman says that she’s not undermining the importance of the other groups getting the high dose, she’s upset that the province didn’t plan for high-risk people like herself to get one.
“It just astounds me. To me, there’s no common sense. I know common sense is not so common, but what is right is right and you know I’ve already gotten my covid booster shot. I felt guilty getting that before some people in long care even got it. I just want what’s right for everybody.” said Newman.
She says she’s not going to give up on her fight and she thanks all healthcare workers for their fight against COVID-19.
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