Health
Vaccine task force prepares for almost 100000 doses this week – Winnipeg Free Press
Manitoba’s vaccine task force has promised to do better after a week of glitches and setbacks.
The Manitoba government has said all eligible Manitobans who want the COVID-19 vaccine will get a single dose by the end of June — or as early as May 21 if there is a robust supply — as shipments from the federal government are set to increase substantially over the next 90 days.
Province taps WRHA employee to serve as new director of COVID-19 immunization clinics
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Two months after being hired as the provincial director of COVID-19 immunization clinics, Kurt Janzen is no longer overseeing clinic operations.
Janzen, a long time employee of Manitoba Liquor and Lotteries, was hired for the job in late January for a six to nine month term.
The role primarily involved overseeing the workforce hired for the immunization campaign, scheduling, payroll management and co-ordinating services, a government spokesman previously told the Free Press.
Premier Brian Pallister was asked about Janzen’s status with the COVID-19 immunization campaign at a press conference on Wednesday but declined to comment, saying it was a human resources issue.
“We can confirm that no one was removed from any role,” a government spokesman said in a statement to the Free Press.
Following Janzen’s departure, the director position was immediately backfilled temporarily, and an employee with the Winnipeg Regional Health Authority has since been seconded to the role full-time, the spokesman said.
The provincial director of COVID-19 immunization clinics reports to the operations lead for the COVID-19 vaccine implementation task force.
This week, Manitoba will receive 95,600 doses of COVID-19 vaccines, including the largest single shipment to date: 54,600 doses of the AstraZeneca vaccine from the United States.
Despite persistent delays at the mass vaccination clinic at the convention centre over the past week, Johanu Botha, co-lead for the task force, said everyone who went to the site and put up with lengthy lineups, received a shot on the day of their appointment.
“It’s a complex machine and we will make it hum, but I’d like to note that the RBC site is a part of a much larger system,” Botha said. “We had supersites across this province administering doses, pop-ups reaching more remote Manitobans and focused immunization teams deploying to vulnerable Manitobans in congregate living facilities.”
“While issues may arise in one part of our system, and we’ll keep monitoring for them and address them, more and more Manitobans are being immunized every day,” he said.
As of Wednesday, 199,322 doses had been given to people in Manitoba (including on First Nations), which accounts for about 80 per cent of the supply received from Ottawa. Over the next month, the province’s immunization network will have days where as many as 10,000 doses are administered, Botha said.
However, due to data entry backlogs at the Winnipeg vaccination clinic, the number of administered doses reported each day will be delayed 48 to 72 hours. Botha said his team is working to eliminate the backlog by adding data entry clerks.
The next shipment of AstraZeneca vaccine will again be administered at pharmacies and physicians’ offices. This time around, 400 to 500 locations will receive doses.
Provincial officials did not specify Wednesday whether any doses would be allocated to homecare providers or prioritized for people who cannot easily leave their home.
“We are ramping up and planning to preposition all of the necessary supplies with our partners like we did last time, so we can hit the ground running,” Botha said.
In the wake of safety concerns related to the AstraZeneca vaccine, following reports of a rare vaccine-induced blood clotting condition in Europe, the province’s medical lead for the COVID-19 task force again encouraged people who can receive the vaccine based on provincial eligibility criteria, to sign up for the shot.
“These vaccines are safe and effective and that particularly for people who are over 55, the risk of COVID, even the risk of blood clots due to COVID, is much greater than the risk of this very rare of blood clot with low platelets is from the AstraZeneca vaccine,” Dr. Joss Reimer said.
“We wouldn’t be offering this vaccine if we didn’t believe that we were actually providing them with more benefit than we were risk,” Reimer said.
Reimer said the current eligibility criteria for AstraZeneca which prioritized people under 65 years old with select medical conditions, but stops at anyone younger than 55 years old, in accordance with federal recommendations, ensures that those at highest risk of severe outcomes can access a vaccine.
“We don’t expect to see this rare side-effect in Manitoba. But we certainly have already seen severe long lasting outcomes, hospitalizations and deaths from COVID and we want to provide people with a way to protect themselves as quickly as possible,” Reimer said.
She said the province is taking a second look at its AstraZeneca eligibility criteria before releasing more doses to doctors and pharmacists, but will not offer the shot to people younger than 55.
Meanwhile, Botha said the task force is preparing for delays in receiving Moderna vaccines from the federal government.
A confirmed shipment of 28,000 doses of Moderna set to arrive next week has been delayed to at least April 12. Botha said the shipment could arrive as late as April 16. The province may be forced to reschedule pop-up clinics in rural and remote areas.
The province also intends to open a new mass vaccination clinic in each of the five health regions between mid-April and end of May, Botha said. The next supersite will be located in Winnipeg.
“The supply that we have confirmed coming in across Pfizer and Moderna… is 40,000 a week,” Botha said. “But it’s not enough to fill the capacity of our existing supersites so we have a bit of time to get the other ones up.”
Planning is also underway to stage vaccination clinics in Winnipeg on a smaller, community level, over the next three months, he said.
danielle.dasilva@freepress.mb.ca
Health
Outdated cancer screening guidelines jeopardizing early detection, doctors say – Powell River Peak
A group of doctors say Canadian cancer screening guidelines set by a national task force are out-of-date and putting people at risk because their cancers aren’t detected early enough.
“I’m faced with treating too many patients dying of prostate cancer on a daily basis due to delayed diagnosis,” Dr. Fred Saad, a urological oncologist and director of prostate cancer research at the Montreal Cancer Institute, said at a news conference in Ottawa on Monday.
The Canadian Task Force on Preventive Health Care, established by the Public Health Agency of Canada, sets clinical guidelines to help family doctors and nurse practitioners decide whether and when to recommend screening and other prevention and early detection health-care measures to their patients.
Its members include primary-care physicians and nurse practitioners, as well as specialists, a spokesperson for the task force said in an email Monday.
But Saad and other doctors associated with the Coalition for Responsible Healthcare Guidelines, which organized the news conference, said the task force’s screening guidelines for breast, prostate, lung and cervical cancer are largely based on older research and conflict with the opinions of specialists in those areas.
For example, the task force recommends against wide use of the prostate specific antigen test, commonly known as a PSA test, for men who haven’t already had prostate cancer. Saad called that advice, which dates back to 2014, “outdated” and “overly simplistic.”
The task force’s recommendation is based on the harms of getting false positive results that lead to unnecessary biopsies and treatment, he said.
But that reasoning falsely assumes that everyone who gets a positive PSA test will automatically get a biopsy, Saad said.
“We are way beyond the era of every abnormal screening test leading to a biopsy and every biopsy leading to treatment,” he said, noting that MRIs can be used to avoid some biopsies.
“Canadian men deserve (to) have the right to decide what is important to them, and family physicians need to stop being confused by recommendations that go against logic and evidence.”
Dr. Martin Yaffe, co-director of the Imaging Research Program at the Ontario Institute for Cancer Research, raised similar concerns about the task force’s breast cancer screening guideline, which doesn’t endorse mammograms for women younger than 50.
That’s despite the fact that the U.S. task force says women 40 and older may decide to get one after discussing the risks and benefits with their primary-care provider.
The Canadian task force is due to update its guidance on breast cancer screening in the coming months, but Yaffe said he’s still concerned.
“The task force leadership demonstrates a strong bias against earlier detection of disease,” he said.
Like Saad, Yaffe believes it puts too much emphasis on the potential harm of false positive results.
“It’s very hard for us and for patients to balance this idea of being called back and being anxious transiently for a few days while things are sorted out, compared to the chance of having cancer go undetected and you end up either dying from it or being treated for very advanced disease.”
But Dr. Eddy Lang, a member of the task force, said the harms of false positives should not be underestimated.
“We’ve certainly recommended in favour of screening when the benefits clearly outweigh the harms,” said Lang, who is an emergency physician and a professor at the University of Calgary’s medical school.
“But we’re cautious and balanced and want to make sure that we consider all perspectives.”
For example, some men get prostate cancer that doesn’t progress, Lang said, but if they undergo treatments they face risks including possible urinary incontinence and erectile dysfunction.
Lang also said the task force monitors research “all the time for important studies that will change our recommendations.”
“And if one of them comes along, we prioritize the updating of that particular guideline,” he said.
The Canadian Cancer Society pulled its endorsement from the task force’s website in December 2022, saying it hadn’t acted quickly enough to review and update its breast cancer screening guidelines to consider including women between 40 and 50.
“(The Canadian Cancer Society) believes there is an obligation to ensure guidelines are keeping pace with the changing environment and new research findings to ensure people in Canada are supported with preventative health care,” it said in an emailed statement Monday evening.
Some provinces have implemented more proactive early detection programs, including screening for breast cancer at younger ages, using human papillomavirus (HPV) testing to screen for cervical cancer and implementing CT scanning to screen for lung cancer, doctors with the Coalition for Responsible Healthcare Guidelines said.
But that leads to “piecemeal” screening systems and unequal access across the country, said Dr. Shushiela Appavoo, a radiologist with the University of Alberta.
Plus, many primary-care providers rely on the national task force guidelines in their discussions with patients, she said.
“The strongest association … with a woman actually going for her breast cancer screen is whether or not her doctor recommends it to her. So if her doctor is not recommending it to her, it doesn’t matter what the provincial guideline allows,” Appavoo said.
In addition to updating its guideline for breast cancer screening this spring, the task force is due to review its guidelines for cervical cancer screening in 2025 and for lung cancer and prostate cancer screening in 2026, according to its website.
This report by The Canadian Press was first published April 16, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
Nicole Ireland, The Canadian Press
Health
Opioid Deaths Doubled Across Canada After Pandemic Onset – Medscape
Premature opioid-related deaths doubled in Canada after the onset of COVID-19 pandemic, and more than one in four deaths occurred in young adults, a new study suggested.
“The intersection of the COVID-19 pandemic with the drug toxicity crisis in Canada has created an urgent need to better understand the patterns of opioid-related deaths across the country to inform targeted public health responses,” the study authors wrote.
Some Canadian provinces were disproportionately affected by the crisis, they noted. For example, in Alberta, close to half of all deaths among people aged 20-39 years were opioid-related.
“Although the finding that the early loss of life was increasing over time was expected, the magnitude of this burden across Canada surprised me,” lead author Shaleesa Ledlie, MPH, a PhD candidate at the Leslie Dan Faculty of Pharmacy of the University of Toronto, Toronto, Ontario, Canada, told Medscape Medical News.
In addition to the increase in Alberta, she said, “in Manitoba, opioid-related death rates and the associated years of life lost increased almost fivefold between 2019 and 2021. This really reinforces the urgency of this issue across Canada and identifies regions where focused attention might be warranted.”
The study was published online on April 15 in Canadian Medical Association Journal.
Significant Increases
Researchers conducted a repeated cross-sectional analysis of accidental opioid-related deaths from 2019 through 2021 in nine Canadian provinces and territories. All provinces and territories for which age- and sex-stratified data were available at the time of the study were included: British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, New Brunswick, Nova Scotia, and the Northwest Territories. These areas represent 98% of Canada’s population.
Deaths were determined to be accidental or intentional by the coroner or medical examiner in each province or territory who investigated the death, according to Ledlie.
The primary outcome was the burden of premature opioid-related death, measured by potential years of life lost (YLL). The secondary outcome was the proportion of deaths attributable to opioids.
Overall, the annual YLL from opioid-related deaths doubled during the study period, from 3.5 YLL per 1000 population in 2019 to 7.0 YLL per 1000 in 2021.
In 2021, the highest burdens of death were observed among men (9.9 YLL per 1000) and young adults aged 20-29 years (12.8 YLL per 1000) and 30-39 years (16.5 YLL per 1000).
More than 70% of all opioid-related deaths occurred among men each year (73.9% in 2021), and about 25% of deaths occurred among people between the ages of 30 and 39 years (29.5% in 2021).
Geographic Variation
The annual increases by age and sex in each province and territory were generally consistent with the overall analysis. The observed changes in YLL over time varied geographically, however. They ranged from a 0.8-fold decrease in Nova Scotia (1581 YLL in 2019 to 1324 YLL in 2021) to a 4.7-fold increase in Manitoba (2434 YLL in 2019 to 11,543 YLL in 2021).
In 2021, the rate of YLL ranged from a low of 1.4 per 1000 in Nova Scotia to a high of 15.6 per 1000 in Alberta, whereas the absolute number of YLL ranged from 93 in the Northwest Territories to 111,633 in Ontario.
Between 2019 and 2021, the average percentage of all deaths attributed to opioids increased in all age groups. In 2019, 1.7% of deaths among people younger than 85 years were related to opioids. This proportion increased to 3.2% of deaths in 2021.
The largest relative increase between 2019 and 2021 (50.3%) was among young people. Opioid-attributable deaths increased from 19.3% to 29.0% among those aged 30-39 years. This change was followed by a 48.0% increase among those aged 20-29 years from 19.8% to 29.3%.
The authors noted that the study was limited by their inability to examine four provinces and territories for which the numbers of opioid-related deaths were suppressed because of small counts (ie, < 5). However, sensitivity analyses suggested that the demographic distribution of these deaths followed a pattern like that of the overall results.
More Information Needed
Commenting on the study for Medscape Medical News, S. Monty Ghosh, MD, MPH, an assistant professor at the University of Alberta, clinical assistant professor at the University of Calgary, and co-medical lead of Alberta Health Services’ Rapid Access Addiction Medicine program in Calgary, said, “The study was fairly robust in its evaluation. Their approach statistically is sound and makes sense, given the quality of data they received.” Ghosh did not participate in the analysis.
It would be important to know whether the premature deaths were polysubstance related, he noted. “More nuanced data in Alberta demonstrated that most of the deaths are related to polysubstance use on top of fentanyl. This includes alcohol, meth, as well as substance contaminants such as benzodiazepines, and more lately (outside of the research period), xylazine.”
Furthermore, Ghosh added, “It would be good to see more demographic information around the youth in Alberta. For instance, were they housed or unhoused? Are they Indigenous? Anecdotally, we know that blue-collar workers, especially those in Alberta who work in construction and oil rigs, have a disproportionate rate of substance use and at times substance death. This was seen in British Columbia and Ontario.”
What’s Being Done
The government of Alberta is responding to these data, said Ghosh. For example, in 2022, specialized funding was provided to enable young adults to access gold-standard opioid agonist treatment. The treatment was rolled out through Alberta’s Virtual Opioid Dependency Program (VODP) and other community-based addiction programs. “This [program] still needs to be more focused on homeless youth, however, who may not have access to technology or other resources.”
Furthermore, the government recently announced a $1.55-billion plan to continue building the Alberta Recovery model, he said. “This is the largest investment seen in our province. Safer supply or prescribed alternatives is very controversial in Alberta and thus is not an option available to this population.”
In addition, he said, the Ministry of Seniors and Community Social Services recently began “coordinated work with other ministries to support vulnerable and equity-deserving populations around this issue, including creating navigation centers for housing, income support, and access to treatment through the VODP.”
Ledlie noted that various policies and programs have been developed in response to the ongoing drug toxicity crisis. Some were included in a recent review that her team conducted to summarize the evidence from Canadian safer opioid supply programs. “We found that in general, these programs had positive impacts on clients, including reduced rates of opioid toxicities and improvements in quality of life.”
“Because most healthcare is coordinated at the provincial or territorial level, the investments into, and accessibility of, treatment and harm-reduction services tend to vary across Canada,” she said. “Even in regions where these programs exist, we know that they are not always accessible for various reasons, such as a lack of resources preventing widespread expansion and geographic barriers in more remote and rural regions.”
“One example of a simple yet life-saving harm reduction measure that has been effectively implemented by most provincial and territorial governments is the availability of publicly funded naloxone kits,” she added. “Given the widespread societal impacts of opioid toxicities described in our study, we believe it is pivotal for all levels of government to coordinate to ensure equitable access to evidence-based services across the country, while still providing the opportunity to tailor and adapt those responses to the unique needs of local communities.”
The study was supported by grants from the Ontario Ministry of Health and the Canadian Institutes of Health Research. Ledlie is supported by an Ontario Graduate Scholarship and the Network for Improving Health Systems Trainee Award. Ledlie and Ghosh declared no relevant financial relationships.
Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.
Health
Nunavut sets up mobile tuberculosis clinic in Naujaat as outbreak grows
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3 have died since outbreak began, 21 diagnosed with active TB
Nunavut’s Health department has opened a community-wide mobile testing clinic in Naujaat, in the hopes of testing as many people as possible for tuberculosis.
It’s been almost a year since a TB outbreak was first declared in the community of 1,200 people on May 16, 2023.
Kevin Tegumiar, Naujaat’s mayor, said the hamlet has been asking for such a clinic for several months.
“Without accurate numbers, we’re not really sure where we are. This clinic will help clear things up,” Tegumiar said.
Tegumiar said three Naujaat residents have died since the outbreak began in the community. Nunavut’s Health department confirmed those numbers in a recent interview with CBC.
Since January 2023, 21 people in Naujaat have been diagnosed with active TB.
Another 118 others have been diagnosed with latent TB, according to the department, which is almost double the number reported in November last year.
Hundreds of tests
Health officials have set a goal to test 1,000 people in Naujaat for TB by the end of the clinic, on May 30.
“We hope that every one of them are coming and get screened during the time that we are here,” said Ekua Agyemang, Nunavut’s deputy chief public health officer. “When TB is identified early, the disease is very easy to treat in the community.”
The Health department said they will deploy a team of health-care workers, including a doctor, four nurses, an epidemiologist, a radiology technician and laboratory technician.
Canada’s chief public health officer, Dr. Theresa Tam, will also visit Naujaat this week as part of a tour alongside Nunavut Tunngavik Inc. officials and the territory’s health minister. Tam will also visit Pond Inlet and Iqaluit.
“Though TB will be a focus of the entire visit, Dr. Tam will also meet with community groups and organizations to discuss homelessness, health education, mental health, and health research initiatives in Nunavut, among other topics,” a news release from NTI said.
Agyemang said in February, the department visited schools and organized a community event to raise awareness about tuberculosis in Naujaat.
Two other outbreaks
Two other TB outbreaks are still ongoing in Pangnirtung and Pond Inlet.
A screening clinic was held in Pangnirtung last fall, which allowed about 70 per cent of the population to be tested.
“There’s definitely ongoing work that still needs to be done, but at this point in time, they’re at a good place in Pangnirtung,” Agyeman said.
Agyeman said at this point, the department does not intend to hold a clinic in Pond Inlet. She also could not provide specific information about the number of cases in the community.
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