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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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First West Nile virus-positive mosquitoes of the year confirmed in Peel Region – CP24

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Mississauga, Brampton, and Caledon residents are being reminded to protect themselves from mosquito bites and remove any standing water from their property after the first West Nile virus-positive mosquitoes of the year were confirmed in Peel Region.

The infected insects were recently collected from three traps in Brampton, near the intersections of Chinguacousy Road and Williams Parkway, Hurontario Street and Steeles Avenue, and The Gore Road and Cottrelle Boulevard.

Peel’s public health unit monitors West Nile virus activity through 33 mosquito traps set across the region. Trapped mosquitoes are collected and tested weekly from late June to September.

The health unit also surveys public areas for stagnant water that could serve as breeding sites for mosquitoes. Identified locations are treated with larvicide, they said in an Aug. 9 news release.

So far this year, there are no confirmed human cases of the mosquito-borne illness, which is passed to humans through the bite of an infected mosquito, in the Region of Peel.

While the risk of acquiring the virus is low, the Region of Peel is urging people to protect themselves against mosquito bites by applying a Health Canada approved insect repellent containing an ingredient effective against mosquitoes, like as DEET or icaridin, to exposed skin and clothing.

They’re also advising people to wear light-colored, tightly woven, loose-fitting clothing like long pants, a long-sleeved shirt, shoes, and socks to protect exposed skin and avoid shaded or wooded areas with high mosquito populations, especially at dusk and dawn when mosquitoes are most active.

Residents should also ensure all windows and door screens fit securely and are free of tears and holes.

Further, people can help prevent mosquito bites by removing stagnant water or draining items on their property. Water stagnant for more than seven days is an ideal breeding site for mosquitoes, the region noted.

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Health Unit has limited number of monkeypox vaccine doses – BayToday.ca

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The North Bay Parry Sound District Health Unit says it has received a very limited number of monkeypox PrEP vaccine doses.

PrEP is a vaccine that is administered prior to contact with the virus.

“Due to low supply, appointments for the monkeypox vaccine for eligible individuals will be booked on a first come first served basis,” says a news release.

“We recognize the issues with such limited access to the monkeypox PrEP vaccines and regret that offering an equitable booking approach is difficult to do at this time,” explains Dr. Carol Zimbalatti, Public Health Physician at the Health Unit. “We continue to work with the province to advocate for additional supply, but understandably, with no evidence of transmission of monkeypox locally, we expect most of the vaccine to continue to go to public health districts with more monkeypox cases.”

Should more vaccine become available, the public will be notified.

To get on the list, call 1-800-563-2808 ext. 5252 and leave a message Wednesday between 9. to 10 a.m.   

Monkeypox is a rare disease not common in North America. It spreads through close contact with a person infected with the virus, or their clothing or linens. Monkeypox can enter the body through skin-to-skin contact with body fluids and through mucus membranes or respiratory droplets during prolonged face-to-face contact.

Anyone, regardless of sexual orientation, age, or gender can spread monkeypox through contact with body fluids, monkeypox sores, or by sharing contaminated items.

For more information on monkeypox and its symptoms visit myhealthunit.ca/monkeypox. If you believe you may have monkeypox, please call the Health Unit at 1-800-563-2808 ext. 5229.

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Ontario confident in monkeypox vaccine strategy, Moore says, but some seek expansion – Cornwall Seaway News

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TORONTO — Ontario’s top doctor says the province’s current monkeypox vaccination strategy is working and cases of the virus appear to be levelling off, but some who work with people in shelters say the immunization program should be expanded to better serve those communities.

Chief Medical Officer of Health Dr. Kieran Moore said the province has vaccinated more than 20,000 people against monkeypox so far, with the priority group being gay, bisexual and other men who have sex with men that meet certain criteria.

“We have been able to get the vaccines that we need from our federal partners, we’ve been able to staff our immunization clinics to meet the needs of our population, we have the funding necessary and the partnerships to ensure that our health system protects those at risk from this virus,” Moore said in a recent interview.

“Our response in Ontario has been quite robust. We’ve got a long ways to go still, but it appears that our total number of (monkeypox) cases is plateauing.”

But for some, the province’s vaccination strategy doesn’t do enough to protect those living in high-risk settings like homeless shelters, noting a recent confirmed monkeypox case in a person who attended a Toronto shelter.

Diana Chan McNally, a community worker at a Toronto centre for people in need, said she believes monkeypox vaccines should be broadly available to those living in shelters given the congregate nature of the settings and the fact those who live there might share belongings.

“This kind of laissez-faire attitude towards the vaccine is part and parcel of the fact that we don’t seem to prioritize creating special protocols or really taking into account the unique conditions that can lead to monkeypox infection in the shelter system,” said Chan McNally.

She also said the current monkeypox vaccine strategy doesn’t account for intersections between people who live in shelters and those who might be eligible for the shot, such as sex workers and people in the LGBTQ community experiencing homelessness, who may not have access to city-run immunization clinics.

“Why we can’t bring, even in small amounts, dedicated amounts of the vaccine to the priority groups within the shelter system, I don’t know,” she said. “I think that’s something that could potentially help mitigate any potential for spread.”

Chan McNally also said she wants to see the shot offered to shelter workers. “If we protect their health, we can protect other people in the shelter system,” she said.

Toronto Public Health held pop-up monkeypox vaccine clinics at the shelter where a case was recently reported, which Moore says is part of Ontario’s “ring immunization” strategy targeting those who may have been exposed to a known case.

Patricia Mueller, CEO of Homes First, the company that oversees the shelter where the case was confirmed, said there have been no further cases of monkeypox linked to that one. She said their staff, the city and Toronto Public Health acted quickly to move the infected individual to an isolation and recovery site and set up a vaccination clinic.

Mueller added that shelter workers are considered low risk for monkeypox infection.

Rita Shahin, associate medical officer of health at Toronto Public Health, said the city is not currently planning a larger monkeypox vaccine program for all shelter residents, though those who meet the criteria are eligible for the shot.

“We need to watch where the disease is, who’s most at risk, and if we see additional cases or spread in the shelter system, that’s certainly something we would look at,” Shahin said.

Shahin also said the city’s monkeypox vaccine supply is “fairly limited,” though Moore said the province has a “significant reserve” of doses ready for emergency situations.

Thomas Tenkate, a professor at the School of Occupational and Public Health at Toronto Metropolitan University, said he agrees men who have sex with men should remain the primary group targeted for monkeypox vaccination based on transmission trends, but added that pop-up clinics in shelters could be a way to proactively curb spread of the virus.

“If you’re going to vaccinate people who are in shelters, the strategies have to be different than the general community,” Tenkate said. “People who use shelters or are homeless, you really have to go to them.”

He said another challenge to vaccinating those in shelter settings is understanding their health history to flag any possible complications from getting the shot. “That might be a limiting factor to implementing it as well,” he said.

Public Health Ontario reported a total of 449 confirmed cases of monkeypox in the province as of Thursday, up from 423 on Tuesday. The agency’s latest report said the majority of cases — more than 77 per cent — were reported in Toronto.

It also said almost all the people infected are male, with only two reported in female patients. The virus generally doesn’t spread easily and is transmitted through prolonged close contact via respiratory droplets, direct contact with skin lesions or bodily fluids, or through contaminated clothes or bedding.

— With files from Allison Jones.

This report by The Canadian Press was first published Aug. 8, 2022.

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