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Soaring RSV rates in parts of Quebec lead national cases, strain hospital staff

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MONTREAL — Soaring cases of respiratory syncytial virus in Quebec have pushed the positivity rate to 15 per cent in Montreal and Quebec City.

Weekly provincial surveillance data ending Oct. 22 show positivity rates of the childhood illness hover just over 13 per cent provincewide, with slightly higher rates in the two cities and wide variation among smaller communities.

It’s several times the most recent federal positivity rate of 3.5 per cent, although that data is a week behind and covers the week ending Oct. 15.

The head of the pediatric emergency department at Montreal’s CHU Sainte-Justine said Tuesday his emergency rooms “are completely jammed with patients” with respiratory viruses, largely driven by RSV.

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“There’s just so much more — a larger wave with sicker patients therefore more hospitalizations, and our hospitals are just full to the brim,” Dr. Antonio D’Angelo said Tuesday.

“In the emergency rooms, well, they’re just all over the place — they’re in our respiratory unit in the emergency room but they’re also in sort of a makeshift corridor for a temporary unit there. And then we had to open up another corridor with patients with respiratory cases that needed treatments.

“And that’s very, very unusual. In fact, we’ve never had it this bad.”

A pediatric infectious disease specialist at the Montreal Children’s Hospital reported similar spikes there, noting that admissions suggest Quebec is already in the middle of a very bad RSV season when normally it shouldn’t have even started yet.

Dr. Jesse Papenburg explained the early onset as the legacy of a similarly early and intense RSV season last year. He said it began in September 2021 and “was over” by January, when other provinces hadn’t even yet reached their peak.

As for why Montreal saw the early spike, he said France and New York City each saw springtime RSV outbreaks in 2021. Since both regions attract a lot of travel from Montreal, it’s possible that importation combined with a susceptible population and easing pandemic measures created the right circumstances for a summer surge.

Further adding to the burden this year is the fact RSV seems to be hitting more than just babies and toddlers to include three- and four-year-olds, who are getting the virus for the first time because they had been shielded by now-lifted pandemic precautions, said D’Angelo.

D’Angelo said he expected similar rates to emerge in other Canadian centres, acknowledging that other hospitals are already seeing increasing numbers of respiratory patients, as well as strained resources and staff.

The national figures show a positivity rate of two per cent in Ontario and 3.4 in Atlantic Canada. The lowest rates were 1.4 per cent in British Columbia, one per cent on the Prairies and two per cent in the Territories.

Ottawa pediatric hospital CHEO said for the week ending Oct. 15, out of 298 RSV tests 30 were positive — about 10 per cent.

A CHEO spokesperson said 12 patients were hospitalized for RSV last month — the same record-high number as last year, and much higher than the pre-pandemic average of about one to two hospitalizations for September.

D’Angelo said RSV typically spreads by community, and does not generally emerge at the same time across the country.

“It often happens where there’ll be one sort of epicentre where everything sort of starts to occur, and then it sort of spreads out,” he said.

D’Angelo said strain at his hospital was compounded by the fact that about 30 per cent of patients there don’t have a family physician and end up going to emergency with minor ailments that otherwise could be treated elsewhere.

“Now everything’s sort of by appointment instead of just walk-in,” he said, believing more walk-in clinics could address hospital demand.

“With the amount of viruses that we’re seeing, a lot of these docs don’t have any more time available for their own patients, which is kind of sad.”

While only a small percentage of RSV cases result in hospitalization, the illness is common among children. By age two, 90 per cent of kids will have had an RSV infection, said Papenburg.

However, some infants are at greater risk of severe illness and that’s when it’s important to be have a predictable viral season, he said.

The RSV season typically runs from November to March but Quebec experts noticed a five per cent positivity rate in August, said Papenburg.

He said that prompted the province to move a preventive campaign for high-risk babies to mid-September, instead of the usual November.

A monoclonal antibody injected monthly to very high risk infants can cut their risk of hospitalizations by half, he said. These may include children younger than one year of age who were born very prematurely, or who have congenital cardiac disease or chronic lung conditions.

— With files from Cassandra Szklarski in Toronto.

This report by The Canadian Press was first published Oct. 25, 2022.

The Canadian Press

Note to readers: This is a corrected story. A previous version stated Quebec’s provincial RSV rates were nearly 14 per cent. In fact, they were slightly over 13 per cent.

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Flu shots are now free for everyone in Quebec due to overwhelmed hospital ERs

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While the campaign for flu shots has already been underway in Quebec for several weeks, the provincial government announced on Friday that immunization will now be free of charge for any Quebecer over the age of six months.

Previously, only people who met certain criteria (babies, seniors, the chronically ill, etc) were able to get the influenza immunization free of charge, and the vaccination sites set up for COVID-19 were only handling free flu shots. Meanwhile, the general population in Quebec was previously only able to get vaccinated at pharmacies, for a fee.

The decision was made due to the critical state of hospital ERs in the province, particularly at children’s hospitals in Montreal, where kids are being brought in by parents in larger numbers than usual due to rising rates of flu, COVID-19 and RSV infections.

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“With the trio of viruses currently circulating, the influenza vaccine is now available free of charge to all Quebecers who wish to take advantage of it. It’s one more tool to limit the pressure on our network.”

—Quebec Health Minister Christian Dubé

To schedule an appointment for a flu shot and/or a COVID-19 shot, please visit the Clic Santé website.

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Deadly Bird Flu Outbreak Is The Worst In U.S. History

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An ongoing outbreak of a deadly strain of bird flu has now killed more birds than any past flare-up in U.S. history.

The virus, known as highly pathogenic avian influenza, has led to the deaths of 50.54 million domestic birds in the country this year, according to Agriculture Department data reported by Reuters on Thursday. That figure represents birds like chickens, ducks and turkeys from commercial poultry farms, backyard flocks and facilities such as petting zoos.

The count surpasses the previous record of 50.5 million dead birds from a 2015 outbreak, according to Reuters.

Separately, USDA data shows at least 3,700 confirmed cases among wild birds.

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Turkeys in a barn on a poultry farm.
Turkeys in a barn on a poultry farm.

Turkeys in a barn on a poultry farm.

On farms, some birds die from the flu directly, while in other cases, farmers kill their entire flocks to prevent the virus from spreading after one bird tests positive. Such farmers have occasionally drawn condemnation from animal welfare advocates for using a culling method known as “ventilation shutdown plus,” which involves sealing off the airways to a barn and pumping in heat to kill the animals.

The virus has raged through Europe and North America since 2021. A variety of wild birds have been affected worldwide, including bald eagles, vultures and seabirds. This month, Peru reported its first apparent outbreak of highly pathogenic avian influenza after 200 dead pelicans were found on a beach.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.
Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

Pelicans suspected to have died from highly pathogenic avian influenza are seen on a beach in Lima, Peru, on Nov. 24.

The migration of infected wild birds has been a major cause of the spread. Health and wildlife officials urge anyone who keeps domestic birds to prevent contact with their wild counterparts.

While health experts do not generally consider highly pathogenic avian influenza to be a major risk to mammals, a black bear cub in Alaska was euthanized earlier this month after contracting the virus. Wildlife veterinarian Dr. Kimberlee Beckmen told the Juneau Empire newspaper that the young cub had a weak immune system.

Over the summer, avian flu also spread among seals in Maine, which the National Oceanic and Atmospheric Administration believed contributed to an unusually high number of seal deaths.

The Centers for Disease Control and Prevention states that the risk “to the general public” from the bird flu outbreak is low. However, the agency recommends precautions like wearing personal protective equipment and thoroughly washing hands for people who have prolonged contact with birds that may be infected.

In April, a Colorado prisoner working at a commercial farm became the first person in the U.S. to test positive for the new strain, though he was largely asymptomatic.

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Successful tests in animal models pave way for strategy for universal flu vaccine

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An experimental mRNA-based vaccine against all 20 known subtypes of influenza virus provided broad protection from otherwise lethal flu strains in initial tests, according to a study.

This could serve one day as a general preventative measure against future flu pandemics, the researchers from University of Pennsylvania, US, said.

According to the study, tests in animal models showed that the vaccine dramatically reduced signs of illness and protected from death, even when the animals were exposed to flu strains different from those used in making the vaccine.

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The “multivalent” vaccine, which the researchers described in a paper published in the journal Science, used the same messenger ribonucleic acid (mRNA) technology employed in the Pfizer and Moderna SARS-CoV-2 vaccines, the study said.

This mRNA technology that enabled those Covid-19 vaccines was pioneered at Penn, the study said.

“The idea here is to have a vaccine that will give people a baseline level of immune memory to diverse flu strains, so that there will be far less disease and death when the next flu pandemic occurs,” said study senior author Scott Hensley.

Influenza viruses periodically cause pandemics with enormous death tolls. The best known of these was the 1918-19 “Spanish flu” pandemic, which killed at least tens of millions of people worldwide.

Flu viruses can circulate in birds, pigs, and other animals, and pandemics can start when one of these strains jumps to humans and acquires mutations that adapt it better for spreading among humans.

Current flu vaccines are merely “seasonal” vaccines that protect against recently circulating strains, but would not be expected to protect against new, pandemic strains. The strategy employed by the Penn researchers is to vaccinate using immunogens – a type of antigen that stimulates immune responses – from all known influenza subtypes in order to elicit broad protection, the study said.

The vaccine is not expected to provide “sterilizing” immunity that completely prevents viral infections. Instead, the new study showed that the vaccine elicited a memory immune response that can be quickly recalled and adapted to new pandemic viral strains, significantly reducing severe illness and death from infections.

“It would be comparable to first-generation SARS-CoV-2 mRNA vaccines, which were targeted to the original Wuhan strain of the coronavirus.

“Against later variants such as Omicron, these original vaccines did not fully block viral infections, but they continue to provide durable protection against severe disease and death,” said Hensley.

The experimental vaccine, when injected and taken up by the cells of recipients, started producing copies of a key flu virus protein, the hemagglutinin protein, for all twenty influenza hemagglutinin subtypes—H1 through H18 for influenza A viruses, and two more for influenza B viruses.

“For a conventional vaccine, immunizing against all these subtypes would be a major challenge, but with mRNA technology it’s relatively easy,” Hensley said.

In mice, the mRNA vaccine elicited high levels of antibodies, which stayed elevated for at least four months, and reacted strongly to all 20 flu subtypes. Moreover, the vaccine seemed relatively unaffected by prior influenza virus exposures, which can skew immune responses to conventional influenza vaccines.

The researchers observed that the antibody response in the mice was strong and broad, whether or not the animals had been exposed to flu virus before.

Hensley and his colleagues currently are designing human clinical trials, he said. The researchers envision that, if those trials are successful, the vaccine may be useful for eliciting long-term immune memory against all influenza subtypes in people of all age groups, including young children.

“We think this vaccine could significantly reduce the chances of ever getting a severe flu infection,” Hensley said.

In principle, he added, the same multivalent mRNA strategy can be used for other viruses with pandemic potential, including coronaviruses.

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