A drug used to treat heart attacks has proven to be an effective treatment for the most common type of stroke, and an even better treatment than the current clinical standard, says a team of Canadian researchers.
Over 80 per cent of all strokes are ischemic strokes, caused by a blood clot blocking, or narrowing, an artery leading to the brain. For over 20 years, the standard of care has been the immediate delivery of a clot-busting medication called Alteplase (tPA).
In the largest study of its kind ever run in Canada, researchers at the University of Calgary and University of Toronto found that the drug Tenecteplase (TNK), currently used in heart attack treatment, is at least equally effective as tPA and possibly more effective in treating ischemic strokes.
“Tenecteplase is known to be an effective clot dissolving drug,” explained U of C researcher Dr. Bijoy Menon. “It is very easy to administer which makes it a game changer when seconds count to save brain cells.”
The Alteplase Compared to Tenecteplase study found Tenecteplase (TNK), a heart attack treatment drug, to be a much more favourable treatment for ischemic strokes than tPA as it’s easier to administer.
Menon says the findings of the AcT (Alteplase Compared to Tenecteplase) trial were so conclusive he expects TNK to become the standard of care worldwide in very short order.
“Guideline Committees get the results, they debate the results, and then the transition happens. So I see this move happening within the next few months,” said Menon.
“The results are very convincing. It’s quite clear at the end of the study that you now have a better choice, and because of the debilitating nature of stroke, there’s urgency to actually change care.”
The current standard of care, tPAm, is complex to administer. It takes up to an hour and requires an infusion pump that needs to be monitored. The pump makes it more difficult to transport patients within a hospital or by ambulance to a larger facility with a dedicated stroke center for treatment.
By comparison, TNK is administered with a single dose through a syringe. The method eases the burden on nurses and doctors, and shaves time off the delivery of the medicine. U of T researcher Dr. Rick Swartz says it also means it will be available as a treatment in more places.
“TNK could potentially be administered wherever the patient is seen first, at a medical centre or small hospital,” explained Swartz. “One of the reasons Tenecteplase is so effective is that in can be administered as a single immediate dose. That’s a big advantage, saving critical time and complication.”
TNK attaches itself to the clot for a longer period of time than tPA, meaning blood flow is restored faster and for a longer period of time. Project nurse lead Carol Kenney says it will save lives.
“In our field we say ‘time his brain’ and any minute or any second that we can save in treating a patient is critical,” said Kenney. “Giving them medication quicker, and trying to get rid of the clot in their brain and get them back to normal again quickly, is so important. It really matters for every patient.”
Stroke survivor André Lavoie, who suffered a stroke in 2015, was part of a focus group that helped guide researchers. While he has recovered from the stroke, Lavoie remains acutely aware of the need for effective, immediate treatment.
“It is really an advancement to get the people to survive, and the whole thing with a stroke is; you may survive a stroke, but it’s your quality of life that you will looking for,” said Lavoie
“So if you have a stroke, and you can have that drug within half an hour an hour, it’s much better than two hours, or three hours to get it. Brain cells usually do not regenerate. So when they die, they die.”
The cross-country AcT Trial included 1600 patients in 22 primary and comprehensive stroke centers across Canada. The results were presented at a conference in Montreal on Wednesday, and published in the medical journal The Lancet.
Polio largely vanished thanks to vaccines. So why is it now back in more countries? – CBC News
Polio, a potentially disabling virus that’s long been forgotten in many parts of the world, is now circulating in parts of the U.S. and U.K., on the heels of an outbreak in Israel — prompting health officials to launch vaccination campaigns to ensure the public is protected.
Even in Canada, a country free of polio for the last two decades, medical experts say it’s a wake-up call that the virus still poses a threat to anyone who remains unvaccinated, given polio’s ability to spread through global travel networks and wastewater systems.
On Wednesday, British health authorities announced they will offer a polio booster dose to children aged one to nine in London, after finding evidence the virus has been spreading in multiple regions of the capital. Britain’s Health Security Agency said polio virus samples were found in sewage water from eight boroughs of London, but there were no confirmed infections.
Still, the agency’s analysis showed transmission has likely “gone beyond a close network of a few individuals.”
“We know the areas in London where the poliovirus is being transmitted have some of the lowest vaccination rates,” said Dr. Vanessa Saliba, a consultant epidemiologist at the U.K. Health Security Agency.
WATCH | Hundreds could be infected with polio in New York state, officials say:
The agency said it was working closely with health authorities in the U.S. and Israel, as well as the World Health Organization, to investigate the links between polio viruses detected in those two countries.
In July, Israel announced a recent outbreak of polio infections appeared to be under control, after multiple people became infected, including a Jerusalem girl who was paralyzed and now requires rehabilitation, according to the Jerusalem Post.
More recently, in the state of New York, one unvaccinated young adult suffered paralysis after a polio infection in Rockland County — an area known for low vaccination rates — which marked the first case reported in the U.S. in nearly a decade.
Vaccination campaigns are now underway as samples of the virus were also detected in the wastewater of both Rockland and another county, just north of New York City. Officials also say hundreds more people may already be infected.
“The scope may be even much larger than we can even fathom or imagine,” said New York-based immunologist Dr. Purvi Parikh.
“Because vaccines have become the victim of their own success, we don’t see it — so we may not even realize what the spread of polio is, because for the majority of us who are vaccinated, it doesn’t really [affect] us.”
Outbreaks do still happen in certain countries
Before mass vaccination campaigns largely wiped out polio from circulation in higher-income countries like Canada between the 1950s and early 1990s, the virus was known for sparking outbreaks and striking children, causing paralysis or death in some cases.
Parikh said polio cases aren’t entirely a surprise in any community where vaccination rates are lower, either due to anti-vaccine sentiments or disruptions to routine immunizations during the COVID-19 pandemic.
“Now the concern is, some of these infectious diseases that we haven’t seen in nearly decades may actually come back and pose to be a problem,” she said.
Part of the challenge in wiping polio out around the world actually comes from the vaccination approach used in certain regions. While higher-income countries now use an inactivated poliovirus vaccine given as a traditional shot, others rely on a weakened poliovirus that’s easy to administer by mouth.
Both types of vaccines helped curb global transmission and, crucially, neither one is capable of giving someone a case of symptomatic polio.
However, since the oral version winds up in the stomach, it’s eventually flushed out of the body into wastewater systems — where, over time, the virus can evolve back into a form that’s able to cause disease.
“So if you have a shedding of that particular virus and transmission of that in a community, it can cause a polio outbreak,” said Dr. Isaac Bogoch, an infectious diseases specialist with the University Health Network in Toronto.
“And in fact, if you look at many parts of the world, there have been small outbreaks of vaccine-derived polio.”
‘Polio is only a plane trip away’
Lab testing conducted on the case in New York, for instance, linked the virus samples to transmission from someone who’d received the oral vaccine, which hasn’t been used in the U.S. since 2000. “This suggests that the virus may have originated in a location outside of the U.S. where [the oral vaccine] is administered,” officials said.
In London, out of more than 100 polio samples identified in sewage, most were vaccine-like virus, according to the UK Health Security Agency, while others had enough mutations to be more like “wild” polio that can cause serious health impacts.
Global travel between countries with high rates of polio transmission and regions with lagging vaccination rates could pose a problem going forward, said Wes Hazlitt, a Winnipeg polio survivor, advocate, and president of the Post-Polio Network in Manitoba.
“Polio,” he added, “is only a plane trip away.”
Another challenge in tackling outbreaks stems from this virus’s ability to spread undetected, experts say, with most people unaware they’re even infected — leaving countries vulnerable to slow-growing outbreaks before any patients show up with major disease and paralysis.
“Most people will have no symptoms or mild symptoms, but about one in 200 or so will have significant symptoms,” Bogoch said.
WATCH | 1953, the year polio last stalked Canada:
Under-vaccinated communities remain at risk
So when it comes to experiencing a future polio outbreak, how at risk is Canada? That all depends on vaccination rates both now and in the future, multiple medical experts said.
“If you start not vaccinating the kids from the primary series — like the measles, mumps, rubella, diphtheria, tetanus, pertussis, polio — then you risk those diseases coming back,” warned Dr. Anna Banerji, a pediatrician and infectious disease specialist in Toronto.
A vast majority of the Canadian public has been vaccinated against polio, and while immunization rates among children ebb and flow, the latest available federal data from 2017 shows roughly 90 per cent of toddlers had all three required polio shots.
But that coverage isn’t uniform across the country. Polio vaccination rates were below 90 per cent in British Columbia and Manitoba, and close to just 80 per cent in Nunavut, while uptake in specific communities can vary and may have been disrupted by COVID-19 school closures.
“We do have our issues in Canada, with under-vaccinated communities for a variety of reasons, and a lot of this predates COVID-19,” said Bogoch, adding many public health teams across the country did offer immunization programs throughout the pandemic to get children caught up.
While pockets of the population could remain vulnerable to polio infection, Fatima Tokhmafshan, a researcher and geneticist at the Research Institute of the McGill University Health Centre, said most Canadians shouldn’t be overly concerned.
“If you see something circulating, it’s good to be on your guard, but not panicking,” she said.
“So it’s important to keep an eye out. And reach out to your network, to your friends, your family — make sure everybody’s vaccinated.”
Quebec rejects plea to send army to northern region facing health worker shortage
MONTREAL — Quebec’s Health Department has rejected a request from officials in the northern region of Nunavik to have Armed Forces members brought in to help ease a shortage of health-care workers.
Kathleen Poulin, a spokeswoman for Nunavik Regional Board of Health, said Wednesday that labour shortages in the health sector are hitting Nunavik particularly hard due to the region’s “remoteness and its specific characteristics.”
“In some of the smaller villages that have only two to four nurses, the briefest absence can require a complete reorganization of activities in order to maintain services,” Poulin said in a statement.
“Considering the sizes of the communities, a handful of (additional) health-care workers can make a big difference in the level of services offered to the population.”
The health board, Poulin said, has been asking Quebec in recent weeks to supply medical workers. That included a request that Ottawa send Armed Forces members who can provide health care after some of Nunavik’s 14 Indigenous communities were forced over the summer to limit their services to emergencies only.
Health Minister Christian Dubé told reporters on Wednesday he would “soon” travel to the region to assess the situation, adding that Quebec has a “contingency plan” to handle the crisis.
“We have five or six paramedics already on their way, and doctors from other provinces that offered to help,” Dubé said.
The department, however, opted to seek the Canadian Red Cross’s help in Nunavik rather than the army, Dubé said, as the organization “helped a lot during the pandemic.” The department said the request for Armed Forces support was received Aug. 2.
“It’s a question of who’s the best and most appropriate group to complete our staff,” Dubé said. “The situation is already better than what it was.”
But Charlie Lapointe-Robert, a nurse who works in Inukjuak at the Inuulitsivik Health Centre, said Dubé’s statement is misleading. She said rather than being able to offer proper care to the community, health-care workers are forced to tell residents to “be careful.”
“We’re the ones who are supposed to take care of them,” Lapointe-Robert said in an interview on Wednesday, adding that her health centre still doesn’t know when to expect help from the government.
“We are accumulating delays, blood tests that need to be done, children’s vaccinations, followups, cancer prevention that isn’t done .… The situation is not better than it was. We are heading toward a greater crisis.”
The labour shortage in Nunavik’s health sector is not new — and neither are the requests for government action, Lapointe-Robert said.
The nurse, who’s currently on vacation in Montreal, said she doesn’t understand why it took so long to create a contingency plan as it is now a matter of days before the community could be left with no nurses on duty.
“We are on a tightrope, there is a risk of error and incredible tragedy,” she said, adding that normally up to six nurses are working in Inukjuak.
Poulin said a labour shortage affecting the entire province has left nursing agencies unable to meet the demand.
“Summer means vacation for many. It is necessary for the workers to take some time off, mostly after two years of COVID-19. Again, just a few people more or less make a big difference.”
The union representing nurses in the northern region, the Syndicat nordique des infirmières et infirmiers de la Baie d’Hudson, said it has been warning the government about the situation since last year.
“We are in a G7 country and I believe that the Inuit communities of Hudson Bay have a right to quality health care,” union president Cyril Gabreau said on social media. “Actions could have been taken yesterday to avoid tomorrow’s catastrophe.”
This report by The Canadian Press was first published on Aug. 10, 2022.
This story was produced with the financial assistance of the Meta and Canadian Press News Fellowship.
Virginie Ann, The Canadian Press
Montreal public health investigating after man dies from legionnaires’ disease
Montreal public health officials say they are investigating a deadly case of legionnaires’ disease in the city’s east end to see if it is linked to two other cases detected in the area.
The city’s public health department said today that the investigation will target water cooling towers in the area.
The victim was only identified as a man.
Last year, two people died after an outbreak of legionnaires’ disease in an adjacent area.
The public health department says 27 cases of legionnaires’ disease, which is caused by bacteria, have been detected in the city so far this year, and that 52 cases were detected last year.
The disease can cause fever, cough, shortness of breath and aches and pains, and it can be fatal in roughly 10 to 15 per cent of cases.
This report by The Canadian Press was first published Aug. 10, 2022.
The Canadian Press
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