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Quebec to allow 90-day delay before second vaccine doses, more than double what national panel advises – CTV News Montreal

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QUEBEC CITY —
Quebec public health officials said Thursday that provincial advisors have recommended a prolonged COVID-19 vaccination schedule of up to 90 days between the first and second dose — more than double what a national advisory committee recommended a day earlier.

“In our context, that is the best strategy,” said Health Minister Christian Dubé at a Thursday press conference on Quebec’s vaccination progress.

Quebec announced in late December it would be delaying second doses or “booster shots” of the vaccine, but the province hasn’t said until Thursday what kind of delay it had in mind.

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Provincial officials now say the second dose should come between 42 and 90 days after the first.

Such a schedule would allow the province to give the vaccine to more people who would otherwise have to wait for their first dose, said the health officials.

A delay of 90 days is much longer than what’s been recommended by Pfizer (21 days, for its vaccine), Moderna (28 days, for its vaccine), and federal public health advisors in their recommendation on Wednesday (up to 42 days for both vaccines).

However, that national advisory panel, called NACI, said Thursday that provinces have some leeway to make their own decisions and they aren’t opposing Quebec’s 90-day timeline.

Canada’s Deputy Chief Public Health Officer, Dr. Howard Njoo, said that certain provinces’ “exceptional circumstances” may mean they need to depart from federal recommendations.

“It is sort of the interplay between the actual epidemiology, on the ground, the fact that there is a obviously increased rate of cases, hospitalizations,” said Njoo, and the vaccine guidelines.

EXTENSION BASED ON ‘EXPERIENCE,’ NOT DATA, SAYS QUEBEC

So why is the province talking about 90 days?

Health Ministry advisor Dr. Richard Massé said Quebec experts believe it’s likely that immunity will last longer than 42 days, as recommended by the NACI panel, but clinical trials have not extended past that.

What they’re relying on instead is past experience with other vaccines.

“What we have is the experience working with many vaccines,” said Massé. “Immunity is not something that is ‘on’ or ‘off.’”

While Quebec’s Ministry of Health has said that a single dose can provide up to about 90 per cent efficacy against the virus, Pfizer says that one dose alone is just 52.4 per cent effective.

Massé told reporters the discrepancy comes from different and more specific analysis of Pfizer’s trial data.

He said that Pfizer, when studying the issue, had been including people who had gotten their first dose but hadn’t had time to build up immunity.

“It takes 12 to 14 days to have immunity,” said Massé. “If you count people who get the disease two, three, five days after getting the vaccine, it’s not really a failure of vaccination because immunity [hasn’t been built up].”

One expert told CTV News this week that there are big variations in the efficacy estimates because of the small sample size of people who got only the first shot in the Pfizer trial. That expert, Dr. Donald Vinh, said that in his opinion the efficacy is likely somewhere in the range of 60 to 69 per cent.

In a statement to CTV News, Pfizer Canada spokeperson Christina Antoniou reiterated earlier statements that Pfizer has not evaluated the efficacy of its vaccine on alternative dosing schedules.

“There are no data to demonstrate that protection after the first dose is sustained after 21 days,” she said.

“We recognize that recommendations on alternative dosing intervals reside with health authorities and may include adapting public health recommendations in reaction to evolving circumstances during a pandemic,” she wrote.

But for Pfizer, “as a biopharmaceutical company working in a highly regulated industry, our position is supported by the label and indication agreed upon with Health Canada and informed by data from our Phase 3 study.”

Minister Dubé said the province has been talking to Pfizer. On Jan. 5, Pfizer told CTV News that Quebec had not informed the company before deciding to delay the second dose.

“We’ve had conversations with Pfizer,” said Dube, “to inform them as to why we were making those decisions.”

Earlier this week, Premier François Legault said that in discussions with the federal government, the province learned there may be a risk of losing Quebec’s vaccine supply if Pfizer isn’t happy with its dosing regime.

On Thursday, Pfizer’s statement said the company “remain[s] committed to our ongoing dialogue with regulators, health authorities and governments, and to our continued data-sharing efforts to help inform any public health decisions aimed at defeating this devastating pandemic.”

Both Massé and Dubé said they are hoping for an increased supply, since they would favour a shorter delay before the second dose if the province’s deliveries of vaccine increase.

“Saving lives is a moral imperative,” said Dubé.

“The more doses we have, the more we’re going to be able to decrease the time between the first and second dose.”

NEXT STEPS FOR QUEBEC’S VACCINATION

With about 65 per cent of CHSLD residents already given a first dose, Dubé said Quebec will begin vaccinating residents of private seniors’ homes (RPAs) on Jan. 25.

He said that with a prolonged schedule between the first and second doses, the province can also consider vaccinating the general senior population sooner.

With new vaccine shipments arriving in the province this week, Dubé said 115,000 people have now been vaccinated.

In total, the province has received 162,000 doses so far. Dubé says Quebec is on track to increase that total to 250,000 in February.

–With files from CTV’s Kelly Greig

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Toronto reports 2 more measles cases. Use our tool to check the spread in Canada – Toronto Star

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Canada has seen a concerning rise in measles cases in the first months of 2024.

By the third week of March, the country had already recorded more than three times the number of cases as all of last year. Canada had just 12 cases of measles in 2023, up from three in 2022.

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Cancer Awareness Month – Métis Nation of Alberta

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Cancer Awareness Month

Posted on: Apr 18, 2024

April is Cancer Awareness Month

As we recognize Cancer Awareness Month, we stand together to raise awareness, support those affected, advocate for prevention, early detection, and continued research towards a cure. Cancer is the leading cause of death for Métis women and the second leading cause of death for Métis men. The Otipemisiwak Métis Government of the Métis Nation Within Alberta is working hard to ensure that available supports for Métis Citizens battling cancer are culturally appropriate, comprehensive, and accessible by Métis Albertans at all stages of their cancer journey.

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Receiving a cancer diagnosis, whether for yourself or a loved one, can feel overwhelming, leaving you unsure of where to turn for support. In June, our government will be launching the Cancer Supports and Navigation Program which will further support Métis Albertans and their families experiencing cancer by connecting them to OMG-specific cancer resources, external resources, and providing navigation support through the health care system. This program will also include Métis-specific peer support groups for those affected by cancer.

With funding from the Canadian Partnership Against Cancer (CPAC) we have also developed the Métis Cancer Care Course to ensure that Métis Albertans have access to culturally safe and appropriate cancer services. This course is available to cancer care professionals across the country and provides an overview of who Métis people are, our culture, our approaches to health and wellbeing, our experiences with cancer care, and our cancer journey.

Together, we can make a difference in the fight against cancer and ensure equitable access to culturally safe and appropriate care for all Métis Albertans. Please click on the links below to learn more about the supports available for Métis Albertans, including our Compassionate Care: Cancer Transportation program.

I wish you all good health and happiness!

Bobbi Paul-Alook
Secretary of Health & Seniors

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Type 2 diabetes is not one-size-fits-all: Subtypes affect complications and treatment options – The Conversation

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You may have heard of Ozempic, the “miracle drug” for weight loss, but did you know that it was actually designed as a new treatment to manage diabetes? In Canada, diabetes affects approximately 10 per cent of the general population. Of those cases, 90 per cent have Type 2 diabetes.

This metabolic disorder is characterized by persistent high blood sugar levels, which can be accompanied by secondary health challenges, including a higher risk of stroke and kidney disease.

Locks and keys

In Type 2 diabetes, the body struggles to maintain blood sugar levels in an acceptable range. Every cell in the body needs sugar as an energy source, but too much sugar can be toxic to cells. This equilibrium needs to be tightly controlled and is regulated by a lock and key system.

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In the body’s attempt to manage blood sugar levels and ensure that cells receive the right amount of energy, the pancreatic hormone, insulin, functions like a key. Cells cover themselves with locks that respond perfectly to insulin keys to facilitate the entry of sugar into cells.

Unfortunately, this lock and key system doesn’t always perform as expected. The body can encounter difficulties producing an adequate number of insulin keys, and/or the locks can become stubborn and unresponsive to insulin.

All forms of diabetes share the challenge of high blood sugar levels; however, diabetes is not a singular condition; it exists as a spectrum. Although diabetes is broadly categorized into two main types, Type 1 and Type 2, each presents a diversity of subtypes, especially Type 2 diabetes.

These subtypes carry their own characteristics and risks, and do not respond uniformly to the same treatments.

To better serve people living with Type 2 diabetes, and to move away from a “one size fits all” approach, it is beneficial to understand which subtype of Type 2 diabetes a person lives with. When someone needs a blood transfusion, the medical team needs to know the patient’s blood type. It should be the same for diabetes so a tailored and effective game plan can be implemented.

This article explores four unique subtypes of Type 2 diabetes, shedding light on their causes, complications and some of their specific treatment avenues.

Severe insulin-deficient diabetes: We’re missing keys!

In severe insulin-deficient diabetes, beta cells limit production of the keys that unlock cells to allow entry of sugar from the blood.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Insulin is produced by beta cells, which are found in the pancreas. In the severe insulin-deficient diabetes (SIDD) subtype, the key factories — the beta cells — are on strike. Ultimately, there are fewer keys in the body to unlock the cells and allow entry of sugar from the blood.

SIDD primarily affects younger, leaner individuals, and unfortunately, increases the risk of eye disease and blindness, among other complications. Why the beta cells go on strike remains largely unknown, but since there is an insulin deficiency, treatment often involves insulin injections.

Severe insulin-resistant diabetes: But it’s always locked!

A diagram of three closed locks and lots of keys

In severe insulin-resistant diabetes, the locks start ignoring the keys, triggering the beta cells to produce even more keys to compensate.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

In the severe insulin-resistant diabetes (SIRD) subtype, the locks are overstimulated and start ignoring the keys. As a result, the beta cells produce even more keys to compensate. This can be measured as high levels of insulin in the blood, also known as hyperinsulinemia.

This resistance to insulin is particularly prominent in individuals with higher body weight. Patients with SIRD have an increased risk of complications such as fatty liver disease. There are many treatment avenues for these patients but no consensus about the optimal approach; patients often require high doses of insulin.

Mild obesity-related diabetes: The locks are sticky!

Illustration of a lock and key

In mild obesity-related diabetes, the locks are ‘sticky,’ making it difficult for the keys to open the locks.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Mild obesity-related (MOD) diabetes represents a nuanced aspect of Type 2 diabetes, often observed in individuals with higher body weight. Unlike more severe subtypes, MOD is characterized by a more measured response to insulin. The locks are “sticky,” so it is challenging for the key to click in place and open the lock. While MOD is connected to body weight, the comparatively less severe nature of MOD distinguishes it from other diabetes subtypes.

To minimize complications, treatment should include maintaining a healthy diet, managing body weight, and incorporating as much aerobic exercise as possible. This is where drugs like Ozempic can be prescribed to control the evolution of the disease, in part by managing body weight.

Mild age-related diabetes: I’m tired of controlling blood sugar!

Illustration of a lock and a beta cell

In people with mild age-related diabetes, both the locks and the beta cells that produce keys are tired, resulting in fewer keys and stubborn locks.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Mild age-related diabetes (MARD) happens more often in older people and typically starts later in life. With time, the key factory is not as productive, and the locks become stubborn. People with MARD find it tricky to manage their blood sugar, but it usually doesn’t lead to severe complications.

Among the different subtypes of diabetes, MARD is the most common.

Unique locks, varied keys

While efforts have been made to classify diabetes subtypes, new subtypes are still being identified, making proper clinical assessment and treatment plans challenging.

In Canada, unique cases of Type 2 diabetes were identified in Indigenous children from Northern Manitoba and Northwestern Ontario by Dr. Heather Dean and colleagues in the 1980s and 90s. Despite initial skepticism from the scientific community, which typically associated Type 2 diabetes with adults rather than children, clinical teams persisted in identifying this as a distinct subtype of Type 2 diabetes, called childhood-onset Type 2 diabetes.




Read more:
Indigenous community research partnerships can help address health inequities


Childhood-onset Type 2 diabetes is on the rise across Canada, but disproportionately affects Indigenous youth. It is undoubtedly linked to the intergenerational trauma associated with colonization in these communities. While many factors are likely involved, recent studies have discovered that exposure of a fetus to Type 2 diabetes during pregnancy increases the risk that the baby will develop diabetes later in life.

Acknowledging this distinct subtype of Type 2 diabetes in First Nations communities has led to the implementation of a community-based health action plan aimed at addressing the unique challenges faced by Indigenous Peoples. It is hoped that partnered research between communities and researchers will continue to help us understand childhood-onset Type 2 diabetes and how to effectively prevent and treat it.

A mosaic of conditions

Illustration of different subtypes of Type 2 diabetes

Type 2 diabetes is a mosaic of conditions, each with its own characteristics.
(Lili Grieco-St-Pierre, Jennifer Bruin/Created with BioRender.com)

Type 2 diabetes is not uniform; it’s a mosaic of conditions, each with its own characteristics. Since diabetes presents so uniquely in every patient, even categorizing into subtypes does not guarantee how the disease will evolve. However, understanding these subtypes is a good starting point to help doctors create personalized plans for people living with the condition.

While Indigenous communities, lower-income households and individuals living with obesity already face a higher risk of developing Type 2 diabetes than the general population, tailored solutions may offer hope for better management. This emphasizes the urgent need for more precise assessments of diabetes subtypes to help customize therapeutic strategies and management strategies. This will improve care for all patients, including those from vulnerable and understudied populations.

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