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Why guidelines for what Canadians can and can't do after getting COVID-19 vaccines are still unclear – CBC.ca

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Canada has delayed second doses of COVID-19 vaccines by up to four months — the longest interval recommended by a country so far — but has yet to provide any new guidance to Canadians on what they can or can’t do while waiting for the second shot.

The National Advisory Committee on Immunization (NACI) changed its guidelines earlier this month on the recommended time between doses of COVID-19 vaccines from three weeks to four months.

NACI said it based its revised guidelines on emerging real world evidence and the reality of Canada’s limited supply of COVID-19 vaccines, although there is no research yet on the long-term effect the delay could have on immunity to the coronavirus disease.

The decision was also informed by findings from the British Columbia Centre for Disease Control that determined that one dose of the vaccine was actually more effective than clinical trials had initially shown. 

NACI said if second doses were stretched to four months across the country, close to 80 per cent of Canadians over 16 could get at least one shot by the end of June. 

But Canada’s chief science adviser, Mona Nemer, has said the decision to delay second doses amounted to a “population level experiment.”

The United Kingdom has delayed second doses by up to three months, but no other country is known to have delayed them by up to four months. Spokespeople from Pfizer and Moderna said they recommend sticking with intervals of three and four weeks for their respective vaccines as studied during clinical trials. 

What can Canadians do after being vaccinated?

Many Canadians are wondering what they can do after getting vaccinated and if they can safely see their families, other vaccinated people or generally feel less at risk from COVID-19 after a year under strict public health measures. 

But the recommendations still haven’t been updated weeks after the change was made — meaning Canadians could be tempted to make up their own rules in the interim.

The U.S. Centers for Disease Control and Prevention released guidelines on March 8 for fully vaccinated individuals, saying they can safely meet indoors without masks or physically distancing with others who had received both shots.

The CDC also said those who have had both shots can visit with unvaccinated people from a single other household who are at “low risk for severe COVID-19,” as well as skipping quarantine and testing if exposed to COVID-19 without showing symptoms. 

But unlike Canada, the U.S. hasn’t delayed second doses by up to four months and answers to those questions have been harder to come by for Canadians weeks after guidelines changed and close to 5 million doses administered.

Canada’s Chief Public Health Officer Dr. Theresa Tam said during a news conference Tuesday that the issue is being actively discussed with the provinces and territories and that while new guidance is coming, the country is in the “early days” of its vaccine coverage.

“For now, the key message is that everyone needs to keep up with their personal protective measures which are wearing a mask, handwashing, watching your distance and avoiding closed, crowded conditions,” she said. 

“I think as more and more people get vaccinated I would expect the advice to evolve as we go along, but it’s a little bit too early.” 

WATCH | ‘Too early’ to update guidelines for vaccinated Canadians: Tam

Canada’s Chief Public Health Officer Dr. Theresa Tam says guidance for Canadians who have been vaccinated will likely evolve as more people get vaccinated, but it’s too early in our roll out to update recommendations yet. 1:35

Tam said the spread of coronavirus variants across Canada amid already high levels of community transmission should factor into “local decisions” on what public health measures need to be put in place or lifted for vaccinated individuals.

She provided no timeframe for when Canadians can expect to see new guidance from the Public Health Agency of Canada on what they can and can’t do after being vaccinated. 

Guidelines for Canadians with only one dose even less clear 

And what about guidelines for Canadians who have only had one dose? 

“It’s maybe not clear to the general public, but it should be clear that you’re only fully vaccinated after two doses,” said Prof. Alyson Kelvin, an assistant professor at Dalhousie University and virologist at the Canadian Center for Vaccinology.

“I can completely sympathize that it’s been a long haul for everybody, but it’s really important that we continue with those public health measures until we have a low level of virus transmission within the community.” 

She says until Canada’s hardest-hit regions have significantly lowered their rates of community transmission, Canadians will have to continue practicing physical distancing, proper hand hygiene, avoiding crowds and wearing masks in public.

“You’re still at risk even though you’re fully vaccinated,” says Kelvin, who is also evaluating Canadian vaccines with the VIDO-InterVac lab in Saskatoon.

“Even with two doses, you can still be infected and transmit the virus — you just might not be as ill as somebody who wasn’t vaccinated.”

A team from Humber River Hospital administer first doses of the Pfizer-BioNTech COVID-19 vaccine to parishioners of St. Fidelis Parish church on March 17, 2021. (Evan Mitsui/CBC)

Until Canada has a large proportion of vaccinated people across the country who can help decrease overall COVID-19 levels, Kelvin says it makes sense for hard-hit regions to hold off on relaxing public health measures. 

Dr. Nathan Stall, a geriatrician at Mount Sinai Hospital in Toronto, says communication from public health officials on what people can do after getting a COVID-19 vaccine has been lacking — especially for older Canadians. 

“I’ve had patients who have showed up at the vaccination clinic expecting to get their second shot and have been turned away, so they are devastated emotionally, I’ve had people who have found out immediately beforehand,” he said. 

“I think their questions are very reasonable, which [are]: ‘Do we have evidence to support this? Am I going to be at higher risk? How does this impact my behavior during the third wave now?'”

WATCH | The science behind delaying the 2nd dose of COVID-19 vaccines

Federal government scientists have put their support behind delayed second doses of COVID-19 vaccines — which several provinces were already doing — and ongoing research shows some of the benefits of the adapted strategy. 2:04

Stall, who is a member of NACI but does not speak on behalf of the committee, said it’s important for public health officials to be transparent about the emerging data on delaying second doses and that the guidelines will likely change.

“I think we need to do a much better job of messaging,” he said. “Because this population [of older seniors] has been living in terrible isolation for a year.” 

Dr. Lynora Saxinger, an infectious diseases physician and an associate professor at the University of Alberta, says updated guidelines will likely come in the near future as new data emerges.

She said it was important to note that the recommendations allowed for a maximum interval of up to four months, though the actual interval between doses could be shorter and the guidelines revised if new data showed certain groups were at higher risk. 

“So the main thing is to kind of stay light on your feet and make changes that make sense to try to protect everyone the best we can,” she said. 

Saxinger said the second dose delay made sense given Canada’s limited vaccine supply, because it allowed for an expanded vaccination rollout and offered protection to a greater number of vulnerable Canadians.

“It really will actually save a great many lives,” she said. 

“But if there’s populations where deferring the second dose will actually make them less likely to be immune in the longer term, then obviously that’s a place that has to be readdressed.”

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Health Canada approves updated Moderna COVID-19 vaccine

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TORONTO – Health Canada has authorized Moderna’s updated COVID-19 vaccine that protects against currently circulating variants of the virus.

The mRNA vaccine, called Spikevax, has been reformulated to target the KP.2 subvariant of Omicron.

It will replace the previous version of the vaccine that was released a year ago, which targeted the XBB.1.5 subvariant of Omicron.

Health Canada recently asked provinces and territories to get rid of their older COVID-19 vaccines to ensure the most current vaccine will be used during this fall’s respiratory virus season.

Health Canada is also reviewing two other updated COVID-19 vaccines but has not yet authorized them.

They are Pfizer’s Comirnaty, which is also an mRNA vaccine, as well as Novavax’s protein-based vaccine.

This report by The Canadian Press was first published Sept. 17, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

The Canadian Press. All rights reserved.

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These people say they got listeria after drinking recalled plant-based milks

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TORONTO – Sanniah Jabeen holds a sonogram of the unborn baby she lost after contracting listeria last December. Beneath, it says “love at first sight.”

Jabeen says she believes she and her baby were poisoned by a listeria outbreak linked to some plant-based milks and wants answers. An investigation continues into the recall declared July 8 of several Silk and Great Value plant-based beverages.

“I don’t even have the words. I’m still processing that,” Jabeen says of her loss. She was 18 weeks pregnant when she went into preterm labour.

The first infection linked to the recall was traced back to August 2023. One year later on Aug. 12, 2024, the Public Health Agency of Canada said three people had died and 20 were infected.

The number of cases is likely much higher, says Lawrence Goodridge, Canada Research Chair in foodborne pathogen dynamics at the University of Guelph: “For every person known, generally speaking, there’s typically 20 to 25 or maybe 30 people that are unknown.”

The case count has remained unchanged over the last month, but the Public Health Agency of Canada says it won’t declare the outbreak over until early October because of listeria’s 70-day incubation period and the reporting delays that accompany it.

Danone Canada’s head of communications said in an email Wednesday that the company is still investigating the “root cause” of the outbreak, which has been linked to a production line at a Pickering, Ont., packaging facility.

Pregnant people, adults over 60, and those with weakened immune systems are most at risk of becoming sick with severe listeriosis. If the infection spreads to an unborn baby, Health Canada says it can cause miscarriage, stillbirth, premature birth or life-threatening illness in a newborn.

The Canadian Press spoke to 10 people, from the parents of a toddler to an 89-year-old senior, who say they became sick with listeria after drinking from cartons of plant-based milk stamped with the recalled product code. Here’s a look at some of their experiences.

Sanniah Jabeen, 32, Toronto

Jabeen says she regularly drank Silk oat and almond milk in smoothies while pregnant, and began vomiting seven times a day and shivering at night in December 2023. She had “the worst headache of (her) life” when she went to the emergency room on Dec. 15.

“I just wasn’t functioning like a normal human being,” Jabeen says.

Told she was dehydrated, Jabeen was given fluids and a blood test and sent home. Four days later, she returned to hospital.

“They told me that since you’re 18 weeks, there’s nothing you can do to save your baby,” says Jabeen, who moved to Toronto from Pakistan five years ago.

Jabeen later learned she had listeriosis and an autopsy revealed her baby was infected, too.

“It broke my heart to read that report because I was just imagining my baby drinking poisoned amniotic fluid inside of me. The womb is a place where your baby is supposed to be the safest,” Jabeen said.

Jabeen’s case is likely not included in PHAC’s count. Jabeen says she was called by Health Canada and asked what dairy and fresh produce she ate – foods more commonly associated with listeria – but not asked about plant-based beverages.

She’s pregnant again, and is due in several months. At first, she was scared to eat, not knowing what caused the infection during her last pregnancy.

“Ever since I learned about the almond, oat milk situation, I’ve been feeling a bit better knowing that it wasn’t something that I did. It was something else that caused it. It wasn’t my fault,” Jabeen said.

She’s since joined a proposed class action lawsuit launched by LPC Avocates against the manufacturers and sellers of Silk and Great Value plant-based beverages. The lawsuit has not yet been certified by a judge.

Natalie Grant and her seven year-old daughter, Bowmanville, Ont.

Natalie Grant says she was in a hospital waiting room when she saw a television news report about the recall. She wondered if the dark chocolate almond milk her daughter drank daily was contaminated.

She had brought the girl to hospital because she was vomiting every half hour, constantly on the toilet with diarrhea, and had severe pain in her abdomen.

“I’m definitely thinking that this is a pretty solid chance that she’s got listeria at this point because I knew she had all the symptoms,” Grant says of seeing the news report.

Once her daughter could hold fluids, they went home and Grant cross-checked the recalled product code – 7825 – with the one on her carton. They matched.

“I called the emerg and I said I’m pretty confident she’s been exposed,” Grant said. She was told to return to the hospital if her daughter’s symptoms worsened. An hour and a half later, her fever spiked, the vomiting returned, her face flushed and her energy plummeted.

Grant says they were sent to a hospital in Ajax, Ont. and stayed two weeks while her daughter received antibiotics four times a day until she was discharged July 23.

“Knowing that my little one was just so affected and how it affected us as a family alone, there’s a bitterness left behind,” Grant said. She’s also joined the proposed class action.

Thelma Feldman, 89, Toronto

Thelma Feldman says she regularly taught yoga to friends in her condo building before getting sickened by listeria on July 2. Now, she has a walker and her body aches. She has headaches and digestive problems.

“I’m kind of depressed,” she says.

“It’s caused me a lot of physical and emotional pain.”

Much of the early days of her illness are a blur. She knows she boarded an ambulance with profuse diarrhea on July 2 and spent five days at North York General Hospital. Afterwards, she remembers Health Canada officials entering her apartment and removing Silk almond milk from her fridge, and volunteers from a community organization giving her sponge baths.

“At my age, 89, I’m not a kid anymore and healing takes longer,” Feldman says.

“I don’t even feel like being with people. I just sit at home.”

Jasmine Jiles and three-year-old Max, Kahnawake Mohawk Territory, Que.

Jasmine Jiles says her three-year-old son Max came down with flu-like symptoms and cradled his ears in what she interpreted as a sign of pain, like the one pounding in her own head, around early July.

When Jiles heard about the recall soon after, she called Danone Canada, the plant-based milk manufacturer, to find out if their Silk coconut milk was in the contaminated batch. It was, she says.

“My son is very small, he’s very young, so I asked what we do in terms of overall monitoring and she said someone from the company would get in touch within 24 to 48 hours,” Jiles says from a First Nations reserve near Montreal.

“I never got a call back. I never got an email”

At home, her son’s fever broke after three days, but gas pains stuck with him, she says. It took a couple weeks for him to get back to normal.

“In hindsight, I should have taken him (to the hospital) but we just tried to see if we could nurse him at home because wait times are pretty extreme,” Jiles says, “and I don’t have child care at the moment.”

Joseph Desmond, 50, Sydney, N.S.

Joseph Desmond says he suffered a seizure and fell off his sofa on July 9. He went to the emergency room, where they ran an electroencephalogram (EEG) test, and then returned home. Within hours, he had a second seizure and went back to hospital.

His third seizure happened the next morning while walking to the nurse’s station.

In severe cases of listeriosis, bacteria can spread to the central nervous system and cause seizures, according to Health Canada.

“The last two months have really been a nightmare,” says Desmond, who has joined the proposed lawsuit.

When he returned home from the hospital, his daughter took a carton of Silk dark chocolate almond milk out of the fridge and asked if he had heard about the recall. By that point, Desmond says he was on his second two-litre carton after finishing the first in June.

“It was pretty scary. Terrifying. I honestly thought I was going to die.”

Cheryl McCombe, 63, Haliburton, Ont.

The morning after suffering a second episode of vomiting, feverish sweats and diarrhea in the middle of the night in early July, Cheryl McCombe scrolled through the news on her phone and came across the recall.

A few years earlier, McCombe says she started drinking plant-based milks because it seemed like a healthier choice to splash in her morning coffee. On June 30, she bought two cartons of Silk cashew almond milk.

“It was on the (recall) list. I thought, ‘Oh my God, I got listeria,’” McCombe says. She called her doctor’s office and visited an urgent care clinic hoping to get tested and confirm her suspicion, but she says, “I was basically shut down at the door.”

Public Health Ontario does not recommend listeria testing for infected individuals with mild symptoms unless they are at risk of developing severe illness, such as people who are immunocompromised, elderly, pregnant or newborn.

“No wonder they couldn’t connect the dots,” she adds, referencing that it took close to a year for public health officials to find the source of the outbreak.

“I am a woman in my 60s and sometimes these signs are of, you know, when you’re vomiting and things like that, it can be a sign in women of a bigger issue,” McCombe says. She was seeking confirmation that wasn’t the case.

Disappointed, with her stomach still feeling off, she says she decided to boost her gut health with probiotics. After a couple weeks she started to feel like herself.

But since then, McCombe says, “I’m back on Kawartha Dairy cream in my coffee.”

This report by The Canadian Press was first published Sept. 16, 2024.

Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.

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B.C. mayors seek ‘immediate action’ from federal government on mental health crisis

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VANCOUVER – Mayors and other leaders from several British Columbia communities say the provincial and federal governments need to take “immediate action” to tackle mental health and public safety issues that have reached crisis levels.

Vancouver Mayor Ken Sim says it’s become “abundantly clear” that mental health and addiction issues and public safety have caused crises that are “gripping” Vancouver, and he and other politicians, First Nations leaders and law enforcement officials are pleading for federal and provincial help.

In a letter to Prime Minister Justin Trudeau and Premier David Eby, mayors say there are “three critical fronts” that require action including “mandatory care” for people with severe mental health and addiction issues.

The letter says senior governments also need to bring in “meaningful bail reform” for repeat offenders, and the federal government must improve policing at Metro Vancouver ports to stop illicit drugs from coming in and stolen vehicles from being exported.

Sim says the “current system” has failed British Columbians, and the number of people dealing with severe mental health and addiction issues due to lack of proper care has “reached a critical point.”

Vancouver Police Chief Adam Palmer says repeat violent offenders are too often released on bail due to a “revolving door of justice,” and a new approach is needed to deal with mentally ill people who “pose a serious and immediate danger to themselves and others.”

This report by The Canadian Press was first published Sept. 16, 2024

The Canadian Press. All rights reserved.

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