Background: From March 2020 to January 2021, Newfoundland and Labrador experienced 408 coronavirus disease 2019 (COVID-19) cases (incidence 78 per 100,000).In February and March 2021, a community outbreak of the B.1.1.7 (Alpha) variant occurred in the Eastern Regional Health Authority.This article describes the epidemiology of this variant of concern outbreak, identifies settings that likely contributed to spread and informs recommendations for public health measures (PHMs).Methods: Provincial surveillance data were linked with case interview data and a school class roster.Descriptive epidemiological methods were used to characterize the outbreak.Secondary attack rates (SAR) were calculated for households and classrooms.Results: This outbreak involved 577 laboratory-confirmed and 38 probable cases.Whole genome sequencing determined cases were B.1.1.7.The median age was 31 years and the highest proportion of cases were in the 15 to 19-year age group (29%); 293 (51%) were female and 140 (24%) were asymptomatic upon identification.Early cases were linked to a high school, sports activities, a restaurant and social gatherings.As the outbreak progressed, cases were associated with household transmission, a daycare, healthcare settings and a workplace.The unadjusted SAR estimate among laboratory-confirmed cases was 24.4% for households and 19.3% for classroom exposures.When adjusted for other potential exposures, SAR estimates were 19.9% for households and 11.3% for classrooms. Conclusion:This outbreak demonstrated how B.1.1.7 spread rapidly through a community with previously low COVID-19 transmission and few preventative PHMs in place.Implementation and compliance with school and community-based PHMs is critical for preventing transmission during outbreaks.
Web-based sexual health resources are typically evaluated in terms of their efficacy. Information is lacking about how sexual health promotion websites are perceived and used. It is essential to understand website use to address challenges with adherence and attrition to Web-based health interventions. An existing theoretical framework for examining loyalty to electronic health (eHealth) interventions has been not yet been applied in the context of sexual health promotion nor has the association between e-loyalty and intended intervention efficacy outcomes been investigated.The objectives of this study were to investigate users' loyalty toward a sexual health website (ie, e-loyalty), measure user perceptions of the website, and measure the association between e-loyalty and perceived knowledge increase and intent to change behavior.Over 4 months, website users (clients and health care providers) participated in an open, online, cross-sectional survey about their user experiences that measured e-loyalty, user perceptions, and intended website efficacy outcomes. Relationships between user perceptions and e-loyalty were investigated using structural equation modeling (SEM). Associations between e-loyalty and website efficacy outcomes were tested using Spearman rank correlation.A total of 173 participants completed user perception questions and were included in the analysis. E-loyalty was high for both clients and providers and was significantly correlated with clients' perceived knowledge increase (ρ(171)=.30, P<.001), their intent to have safer sex (ρ(171)=.24, P=.01), and their intent to get tested for sexually transmitted infections (ρ(171)=.37, P<.001). The SEM showed that trustworthiness, overall experience, active trust, and effectiveness were directly related to e-loyalty. Finding the website "easy to understand" was significantly related to active trust (ie, participants' willingness to act upon information presented on the website).E-loyalty may be related to the efficacy of the selected website in improving one's sexual health and was significantly associated with all three intended knowledge and behavioral outcomes. To increase e-loyalty, trustworthiness and active trust are important user perceptions to deliberately engender. Our findings indicate that understanding a website contributes to active trust, thereby highlighting the importance of considering eHealth literacy in designing health promotion websites. Our study confirms the relevance of e-loyalty as an outcome for evaluating the antecedents of the use and efficacy of online public health interventions across disciplines by adapting and validating an existing e-loyalty framework to the field of sexual health promotion. Our findings suggest that e-loyalty is positively associated with measures of website efficacy, including increased knowledge and intent to change behavior. Longitudinal research with larger samples could further investigate the relationships between e-loyalty, website understandability, and outcomes of online health interventions to determine how the manipulation of website characteristics may impact user perceptions and e-loyalty.
Mumps remains endemic in North America despite routine use of the measles, mumps, and rubella (MMR) vaccine. In 2016, an outbreak of mumps in British Columbia, Canada, provided an opportunity to determine the diagnostic utility of laboratory testing methods. Specimens from patients with clinical mumps were tested for infection using a commercial enzyme-linked immunosorbent assay (ELISA) for antibody detection and an in-house reverse transcriptase PCR (RT-PCR) targeting viral fusion and small hydrophobic (SH) genes. Viral genotyping was performed by SH gene sequencing. Laboratory data was linked with epidemiologic case data. Of the 139 confirmed cases, 94 (68%) had reported or documented history of MMR vaccination. Specimens were typically collected 1 day (for buccal and IgM tests) or 2 days (for urine tests) after symptom onset. Most confirmed cases (69%) were confirmed by buccal swab RT-PCR. Among cases tested by multiple methods, the percent positivity for buccal swab RT-PCR was 90% (96/107) compared to 43% (30/69) for both IgM ELISA and urine RT-PCR. Mumps IgM detection was higher in confirmed cases with no history of vaccination than in those with history (64% versus 34%,
Contexte : De mars 2020 à janvier 2021, Terre-Neuve-et-Labrador a enregistré 408 cas de maladie à coronavirus 2019 (COVID-19) (incidence 78 sur 100 000 personnes).En février et mars 2021, une éclosion communautaire du variant B.1.1.7 (Alpha) s'est produite dans la région de l'Eastern Regional Health Authority.Cet article décrit l'épidémiologie de ce variant préoccupant de l'éclosion, identifie les milieux qui ont probablement contribué à sa propagation et fournit des recommandations pour les mesures de santé publique (MSP).Méthodes : Les données de surveillance provinciales ont été associées aux données des entrevues avec les cas et à une liste de classes d'école.Des méthodes épidémiologiques descriptives ont été utilisées pour caractériser l'éclosion.Les taux d'attaque secondaire (TAS) ont été calculés pour les ménages et les salles de classe.Résultats : Cette éclosion a impliqué 577 cas confirmés en laboratoire et 38 cas probables.Le séquençage du génome entier a déterminé que les cas étaient liés au variant B.1.1.7.L'âge médian était de 31 ans et la plus grande proportion de cas se situait dans la tranche d'âge de 15 à 19 ans (29 %).293 (51 %) étaient des femmes et 140 (24 %) étaient asymptomatiques au moment de l'identification.Les premiers cas étaient liés à une école secondaire, à des activités sportives, à un restaurant et à des rencontres sociales.À mesure de l'évolution de l'éclosion, des cas ont été associés à la transmission domestique, à une garderie, à des établissements de santé et à un lieu de travail.L'estimation non ajustée de la TAS parmi les cas confirmés en laboratoire était de 24,4 % pour les ménages et de 19,3 % pour les expositions en classe.Après ajustement pour d'autres expositions potentielles, les estimations de la TAS étaient de 19,9 % pour les ménages et de 11,3 % pour les salles de classe. Conclusion :Cette éclosion a démontré comment le variant B.1.1.7 s'est propagé rapidement dans une communauté où la transmission de la COVID-19 était auparavant faible et où peu de MSP étaient en place.La mise en oeuvre et le respect des MSP à l'école et dans la communauté sont essentiels pour prévenir la transmission pendant les éclosions.
Abstract Among close contacts of patients with invasive group A streptococcal (iGAS) infection, the benefits and harms of chemoprophylaxis are uncertain. We conducted a systematic review of studies that reported on persons who, after being exposed to a case of laboratory-confirmed or probable iGAS, received any antibiotic prophylaxis for the prevention of GAS infection or carriage. Thirty-seven studies including 26 outbreak investigations and 11 case series or reports were included with predominantly descriptive information that suggested that antibiotic prophylaxis may be effective in preventing GAS infection or GAS carriage, with very few serious adverse events. However, current available evidence is scant (with limited information on contacts of iGAS cases) and largely based on studies with weak design and small sample size. Therefore, definitive conclusions on effectiveness of antibiotic prophylaxis cannot be drawn. Well designed prospective studies are required to establish the benefit-harm profile of antibiotic prophylaxis for secondary prevention of GAS disease among close contacts of iGAS cases.
Influenza can be potentially fatal to vulnerable populations, particularly those in the hospital. Canada’s National Advisory Committee on Immunization recommends that health-care workers (HCW) be immunized against influenza partly to avoid infecting high-risk populations. However, influenza immunization rates among HCW remain suboptimal. In 2012, health authorities across British Columbia (B.C.) implemented a province-wide influenza prevention policy requiring HCW to either be immunized or wear a mask when in patient-care areas during the influenza season. This paper describes the second of two studies focused on what was learned from years 2 and 3 of the policy. A case study approach was used to examine this policy implementation event. Qualitative data were collected through key documents and key informant interviews with members of leadership teams responsible for policy implementation. Framework analysis and Prior’s approach were used to analyze data from interviews and documents, respectively. Policy implementation varied by geographic region and gaps persist in immunization tracking and discipline for noncompliance. Debate regarding the scientific evidence used to support the policy fuels resistance from particular groups. Despite these challenges, findings suggest that the policy has been habituated, largely due to consistent policy objectives. This study emphasizes the importance of ongoing inter-professional and cross-sectoral program evaluation. While adherence may be routine for many, implementation processes must continue to respond to contextual issues to narrow the gap in policy implementation and to continue to engage stakeholders to ensure compliance.
