The isolation requirements for people who test positive for COVID-19 on Prince Edward Island will remain in place throughout November, according to Chief Public Health Officer Dr. Heather Morrison.
“The intention is to extend that isolation part of the order, but it will be the last time that we do so because we’ll be adjusting the messaging about the importance of staying home when you’re feeling sick,” she said.
Morrison said the province will continue to monitor infection rates, but as they are currently declining on P.E.I., the approach going forward will be to emphasize staying home if you’re ill to reduce the transmission of all illnesses.
“Whether it’s influenza or COVID or other kinds of cold viruses, many symptoms are the same,” she said.
“Just because you may not test positive for COVID, it’s important not to go out and sit with vulnerable people and be coughing and sneezing all over them.”
Islanders with COVID-19 must isolate for five days from when symptoms began or from the date of their positive COVID-19 test. Those who are immunocompromised must do so for 10 days.
Morrison said the Chief Public Health Office will continue to encourage Islanders to stay up-to-date with their booster and flu vaccines.
Vaccination rates low in young children
COVID-19 vaccines have been available for children under the age of five since July. But according to the province’s vaccination data, as of Oct. 9, less than 10 per cent of children in that age group have had one dose of a COVID-19 vaccine.
Morrison said the low vaccination rate in young children isn’t cause for concern. Previous infections, vaccine availability and timing may all play a part.
“If it had been available perhaps much earlier on in the pandemic, maybe there would have been a different uptake,” she said.
“But we also know that there’s some in that age group who had COVID within the last few months, so there may be some delay in even their ability to be vaccinated until a few months after they’ve had COVID.”
SARS-CoV-2 Seroprevalence Grew Rapidly in Canada
Editor’s note: Find the latest COVID-19 news and guidance in Medscape’s Coronavirus Resource Center.
By August 2022, 2½ years into the COVID-19 pandemic, most children and adults younger than 60 years had been vaccinated against SARS-CoV-2 or showed evidence of having been infected by the virus, new data suggest.
A Canadian seroprevalence study of almost 14,000 people found that fewer than 50% of people older than 60 years (the age group that is most vulnerable to severe outcomes) showed evidence of immunity from infection or had been vaccinated by August 2022. Older adults, who have the lowest infection rates but are at highest risk of severe outcomes, should continued to be prioritized for vaccination, according to the authors.
The data were published online December 5 in the Canadian Medical Association Journal.
Children Most Affected
Previous evidence suggests that a combination of infection and vaccination exposure may induce more robust and durable hybrid immunity than either infection or vaccination alone, study author Danuta Skowronski, MD, MHSc, an epidemiologist at the British Columbia Centre for Disease Control in Vancouver, told Medscape Medical News.
“Our main objective was to chronicle the changing proportion of the population considered immunologically naive and therefore susceptible to SARS-CoV-2,” she added. “It’s relevant for risk assessment to know what proportion has acquired some priming for more efficient immune memory response to the virus, because that reduces the likelihood of severe outcomes.” Standardized seroprevalence studies are essential for informing COVID-19 response, particularly in resource-limited regions.
The investigators analyzed anonymized residual sera from children and adults in an outpatient laboratory network in British Columbia’s Greater Vancouver and Fraser Valley region. They used at least three immunoassays per serosurvey to detect antibodies to SARS-CoV-2 spike (from vaccine) and to nucleocapsid antibodies (from infection).
The researchers determined any seroprevalence (vaccine-induced, infection-induced, or both) on the basis of a positive finding on any two assays. Infection-induced seroprevalence was also defined by dual-assay positivity but required both antinucleocapsid and antispike detection. Their estimates of infection-induced seroprevalence indicated considerable underascertainment of infections by standard case-based surveillance reports.
During the first year of the pandemic, when public health measures to curtail viral transmission were in place, the study population’s seroprevalence rate was less than 1% for the first three measurements. It was less than 5% by January 2021. With age-based vaccine rollouts, however, seroprevalence increased dramatically during the first half of 2021 to 56.2% by May–June 2021 and to 83% by September–October 2021. More than 85% of the population remained uninfected.
Infection-induced seroprevalence was less than 15% in September–October 2021 until the arrival of the Omicron waves, after which it rose to 42.5% by March 2022 and 61.1% by July–August 2022. Combined seroprevalence from vaccination or infection was more than 95% by the summer, with most children, but fewer than half of adults older than 60 years, showing evidence of having been infected.
“We found the highest infection rates among children, closely followed by young adults, which may reflect their greater interconnectedness, including between siblings and parents in the household, as well as with peers in schools and the community,” the authors write. They note that the low cumulative infection rates among older adults may reflect their higher vaccination rates and greater social isolation.
US data show similar age-related infection rates, but data among children from other Canadian provinces are limited, the authors write.
Broadly Applicable Findings
Commenting on the study for Medscape, Marc Germain, MD, PhD, vice president of medical affairs and innovation at Héma-Québec in Quebec City, said that the pattern observed in British Columbia is representative of what happened across Canada and the United States, including the sweeping effect of the Omicron variant and the differences in impact according to age. “But regional differences might very well exist — for example, due to differential vaccine uptake — and are also probably related in part to the different testing platforms being used,” he said. Germain was not involved in the study.
Caroline Quach-Thanh, MD, PhD, a pediatrician and epidemiologist-infectologist at the University of Montreal, pointed out that in Quebec, seroprevalence surveys that were based on residual blood samples from children and adults who visited emergency departments for any reason showed higher rates of prior infection than the British Columbia surveys. “But Dr Skowronski’s findings are likely applicable to settings where some nonpharmacological interventions were put in place, but without strict confinement — and thus are likely applicable to most settings in the US and Canada.” Quach-Thanh was not involved in the study.
She added that the use of residual blood samples always entails a risk for bias, “but the fact that the study method was stable should have captured a similar population from time to time. It would be unlikely to result in a major overestimation in the proportion of individuals positive for SARS-CoV-2 antibodies.”
A recent global meta-analysis found that while global seroprevalence rates have risen considerably, albeit variably by region, more than a third of the world’s population is still seronegative to the SARS-CoV-2 virus.
The Public Health Agency of Canada and the Michael Smith Foundation for Health Research provided funding for the study. Skowronski has received institutional grants from the Canadian Institutes of Health Research and the British Columbia Centre for Disease Control Foundation for Public Health for other SARS – CoV-2 work. Germain and Quach-Thanh have disclosed no relevant financial relationships.
CMAJ. Published online December 4, 2022. Full text
Diana Swift is a freelance medical journalist based in Toronto.
Exposure to SARS-CoV-2 vaccination and infection may provide more durable immunity: Canadian study – LabPulse
A study published in the Canadian Medical Association Journal (CMAJ) on Monday points to a significant change in the proportion of the Canadian population with SARS-CoV-2 antibodies over the first two and a half years of the pandemic and the probability that exposure to both vaccination and infection provides the most durable immunity.
The study, conducted by the British Columbia Centre for Disease Control (BCCDC) and involving almost 14,000 people, provides a clear view of the changing antibody landscape during the pandemic, and its findings hold implications for pandemic risk assessment and response, according to the authors.
During the pandemic, there was a change from virtually all pediatric and adult participants being immunologically naïve and susceptible to SARS-CoV-2 to almost all having been immunologically primed through vaccination or infection, or both.
By August 2022, most children and adults younger than 60 living in the lower mainland region of British Columbia, the location of the study participants, had acquired evidence of both SARS-CoV-2 vaccination and infection.
In the first year of the pandemic, most participants were immunologically naïve, or susceptible to the virus. “Thereafter, age-based vaccine roll-out dramatically changed the immunoepidemiological landscape such that, by September 2021, more than 80% of the study population had antibody evidence of immunological priming, while more than 85% remained uninfected,” the authors wrote.
Exposure to vaccination and infection “likely provides stronger, broader, and more durable hybrid immunity than either exposure alone, especially against severe outcomes,” the researchers added.
The findings related to the change in proportions of immunologically-naïve and immunologically-primed populations holds significant implications for pandemic risk assessment and response, the team observed.
“That is because primed individuals are expected to have swifter immune memory responses to reduce the risk, especially of severe outcomes, from novel viruses like SARS-CoV-2,” Dr. Danuta Skowronski, principal investigator and lead author of the study, said in an email. “Our serosurvey shows we are now much better poised to achieve [a reduced risk of severe outcomes] compared to the start of the COVID-19 pandemic.”
Older adults remain the most susceptible to severe outcomes. This population “remains most consistent with immunization goals to prevent serious morbidity and preserve health care capacity as the 2022-23 respiratory virus season begins,” the authors wrote.
Consequently, they suggested, older adults should be prioritized for vaccination.
The BCCDC had launched a SARS-CoV-2 baseline serosurvey in March 2020. “Baseline assessment was followed by additional serosurveys that spanned the time from mRNA vaccine availability in mid-December 2020 through seven pandemic waves associated with multiple variants of concern to August 2022,” the study authors wrote.
Eight cross-sectional serosurveys were conducted between March 2020 and August 2022, chronicling the evolution of pediatric and adult seroprevalence.
Participants were split into several age groups: 0-4; 5-9; 10-19; 20-29; 30-39; 40-49; 50-59; 60-69; 70-79; and 80 years or older. The team excluded individuals seeking SARS-CoV-2 antibody testing and residents of long-term care, assisted-living, and correctional facilities because of different pretest likelihood of positivity.
The first two serosurveys sampled 100 sera per age group; subsequent surveys sampled 200 per age group. The researchers obtained residual sera from the outpatient laboratory network LifeLabs and used at least three commercially available chemiluminescent immunoassays that target either the spike or nucleocapsid proteins for SARS-CoV-2. From this, they analyzed the antibody landscape and estimated seroprevalence in the population due to vaccination, infection, or both.
“By January 2021, we estimated that any seroprevalence remained less than 5%, increasing with vaccine rollout to 56% by May-June 2021, 83% by September-October 2021, and 95% by March 2022,” the authors wrote.
Infection-induced seroprevalence was low throughout September and October 2021, but increased with the emergence of a series of Omicron waves by March 2022 to 42% and by July and August 2022 to 61%.
Additionally, by August 2022, “[70% to 80%] of children younger than 20 years and [60% to 70%] of adults aged [20 to 59] years had been infected, but fewer than half of adults aged 60 years and older had been infected,” they continued.
The research team has plans to conduct further studies. “We plan further serosurveys among children, young adults, and most notably seniors to inform evolution in vaccine and infection-induced seroprevalence as relevant to ongoing risk assessment,” Skowronski said.
Cold and Flu Med Shortage for Kids: What Parents Can Do
- The FDA and manufacturers are reporting shortages of key medications for children this holiday season.
- Flu and RSV has spiked in young children this winter.
- Experts say there are steps parents can take to help young children even if they have difficulty finding medication at drugstores.
As the holiday season has arrived, so have many winter illnesses like the common cold and seasonal flu.
And this rise in cases is hitting children especially hard.
The U.S. Food and Drug Administration (FDA) along with parents and pharmacists are reporting that medications to treat children’s ear infections, sore throats, influenza, and common upper respiratory illnesses are becoming hard to find.
Experts believe that this problem is due to increased demand for medications as children have become ill earlier in cold and flu season than expected.
According to the U.S. Centers for Disease Control, influenza and RSV are likely the culprits for this recent rise in illness.
“We have had a record number of RSV and influenza hospitalizations nationwide this fall,” says Dr. James Antoon, Assistant Professor of Pediatrics, Divisions of Pediatric Hospital Medicine at Monroe Carell Jr. Children’s Hospital at Vanderbilt.
Antoon attributes the increase due to a dramatic decline in RSV, influenza, and other respiratory viruses during the COVID-19 pandemic.
“As a result, there are a large number of children less than three years old who have never been exposed to RSV and influenza, and the pool of susceptible children with no underlying natural immunity to these viruses is much larger this year than years past.”
CDC estimated that this season there have been 8.7 million illnesses due to influenza. The CDC also reports that in multiple US regions there has been an increase in RSV detection and emergency department visits. Historical data suggests that there are approximately 2.1 million outpatient visits due to RSV in children younger than 5 years old.
“Locally and nationally, pediatricians are experiencing a huge surge in upper respiratory infections – from a high amount of respiratory viruses including one of the worst influenza seasons we’ve seen in about a decade to the worst RSV surge in years,” says Dr. Alok Patel, Pediatrician at Stanford Children’s Health.
Patel says, “we’ve seen an overwhelming amount of upper respiratory infections in all levels, from outpatient cases to hospitalized children needing oxygen support to critically ill children in the ICU needing further intervention and neither I or my colleagues have ever seen such an early, rapid rise in RSV-associated hospitalizations in young infants and toddlers.”
According to prescribing data, Tamiflu, the prescription medication for treating influenza, is seeing an increase compared to previous years.
The current prescription fill rate for this medication through early December is already equivalent to the rate that is traditionally seen at the peak of the influenza season usually in later December and January. It is expected that the demand for this medication will continue to rise.
This increase in Tamiflu use is causing shortages in this medication, say experts.
This is a serious problem for young kids as Tamiflu is currently the only medication approved by the FDA for the treatment of influenza in children less than five years of age.
While antibiotics can’t treat a virus, they can help secondary bacterial infections that can develop after that initial illness.
This winter there are reports that common antibiotics, like amoxicillin, are in increased demand which has led to shortages of these vital medications, according to data from the FDA.
“Bacterial infections, such as ear infections and pneumonias, can occur during or after viral infections and given the large number of RSV and flu infections this season there is likely an increase in these secondary infections as well,” Antoon tells Healthline.
Experts stress that antibiotics should not be used to treat viruses since they will not help these conditions.
Patel reminds parents, “parents and caretakers should remember that the majority of upper respiratory infections are caused by viruses and resolve without the need for any antibiotics.”
Similarly, over-the-counter medications like Children’s Tylenol and Motrin are in short supply.
In a statement by Tylenol, company executives said they understand that consumer demand is high but they say they are doing everything they can to ensure that people have access to the products they need.
Understandably, parents worry about not being able to provide medication for their children, especially when they are sick. However, health experts say that parents should not be alarmed, and medications may be available with assistance from your healthcare provider.
One of the first things that parents can do to help their children is to get them tested if they have symptoms of the cold, flu or COVID-19.
Understanding if your child has influenza, RSV, COVID-19, or another virus can prevent you from needing prescription antibiotics to take care of an illness.
The unnecessary use of antibiotics not only leads to additional infections but can lead to antibiotic resistance as well.
Antoon encourages prevention as a way for avoiding the need for medications in the first place.
“The best way to protect your child from getting sick this winter season is prevention. Vaccination is the best way to prevent getting seriously ill from influenza and COVID. If your child hasn’t been vaccinated for flu or vaccinated and boosted for COVID, now is the time.”
There is no vaccine available for RSV.
Antoon says, “if the pharmacies in your area do not have the medicine, talk to your doctor about what alternative formulations, such as chewable or crushable tablets, or medications, such as second-line antibiotics, may be used.”
There are also remedies that parents can try that don’t include medications and may help relieve symptoms for sick kids.
While fevers should be controlled with anti-fever medications such as ibuprofen or acetaminophen, other symptoms can be treated with more natural remedies.
Using a humidifier or even steam from a shower can assist with nasal congestion. Some advocates recommend using warm therapy such as a bath to help with body aches, and thicker substance foods such as honey to help with sore throats.
Honey should not be given to any children under the age of 12 months.
Patel strongly advises against using smaller doses of adult medications on children.
“Parents should not try and give smaller adult doses or attempt to treat infections on their own with another antibiotic, a leftover supply, or a relative or friend’s antibiotic. Antibiotic misuse is, on its own, a widespread and dangerous problem that should be avoided,” he told Healthline.
Dr. Rajiv Bahl, is an emergency medicine physician, board member of the Florida College of Emergency Physicians, and health writer. You can find him at RajivBahlMD.com.
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