#Population-level #impact and #herd effects following the introduction of #HPV #vaccination programmes: updated systematic review and meta-analysis (Lancet, abstract)

[Source: The Lancet, full page: (LINK). Abstract, edited.]

Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis

Mélanie Drolet, PhD, Élodie Bénard, MSc, Norma Pérez, MSc, Prof Marc Brisson, PhD  on behalf of theHPV Vaccination Impact Study Group

Published: June 26, 2019 / DOI: https://doi.org/10.1016/S0140-6736(19)30298-3




More than 10 years have elapsed since human papillomavirus (HPV) vaccination was implemented. We did a systematic review and meta-analysis of the population-level impact of vaccinating girls and women against human papillomavirus on HPV infections, anogenital wart diagnoses, and cervical intraepithelial neoplasia grade 2+ (CIN2+) to summarise the most recent evidence about the effectiveness of HPV vaccines in real-world settings and to quantify the impact of multiple age-cohort vaccination.


In this updated systematic review and meta-analysis, we used the same search strategy as in our previous paper. We searched MEDLINE and Embase for studies published between Feb 1, 2014, and Oct 11, 2018. Studies were eligible if they compared the frequency (prevalence or incidence) of at least one HPV-related endpoint (genital HPV infections, anogenital wart diagnoses, or histologically confirmed CIN2+) between pre-vaccination and post-vaccination periods among the general population and if they used the same population sources and recruitment methods before and after vaccination. Our primary assessment was the relative risk (RR) comparing the frequency (prevalence or incidence) of HPV-related endpoints between the pre-vaccination and post-vaccination periods. We stratified all analyses by sex, age, and years since introduction of HPV vaccination. We used random-effects models to estimate pooled relative risks.


We identified 1702 potentially eligible articles for this systematic review and meta-analysis, and included 65 articles in 14 high-income countries: 23 for HPV infection, 29 for anogenital warts, and 13 for CIN2+. After 5–8 years of vaccination, the prevalence of HPV 16 and 18 decreased significantly by 83% (RR 0·17, 95% CI 0·11–0·25) among girls aged 13–19 years, and decreased significantly by 66% (RR 0·34, 95% CI 0·23–0·49) among women aged 20–24 years. The prevalence of HPV 31, 33, and 45 decreased significantly by 54% (RR 0·46, 95% CI 0·33–0·66) among girls aged 13–19 years. Anogenital wart diagnoses decreased significantly by 67% (RR 0·33, 95% CI 0·24–0·46) among girls aged 15–19 years, decreased significantly by 54% (RR 0·46, 95% CI 0.36–0.60) among women aged 20–24 years, and decreased significantly by 31% (RR 0·69, 95% CI 0·53–0·89) among women aged 25–29 years. Among boys aged 15–19 years anogenital wart diagnoses decreased significantly by 48% (RR 0·52, 95% CI 0·37–0·75) and among men aged 20–24 years they decreased significantly by 32% (RR 0·68, 95% CI 0·47–0·98). After 5–9 years of vaccination, CIN2+ decreased significantly by 51% (RR 0·49, 95% CI 0·42–0·58) among screened girls aged 15–19 years and decreased significantly by 31% (RR 0·69, 95% CI 0·57–0·84) among women aged 20–24 years.


This updated systematic review and meta-analysis includes data from 60 million individuals and up to 8 years of post-vaccination follow-up. Our results show compelling evidence of the substantial impact of HPV vaccination programmes on HPV infections and CIN2+ among girls and women, and on anogenital warts diagnoses among girls, women, boys, and men. Additionally, programmes with multi-cohort vaccination and high vaccination coverage had a greater direct impact and herd effects.


WHO, Canadian Institutes of Health Research, Fonds de recherche du Québec – Santé.

Keywords: HPV; Vaccines; Cancer; Canada.



#Polio-like #Manifestation of #Powassan Virus #Infection with Anterior Horn Cell Involvement, #Canada (Emerg Infect Dis., abstract)

[Source: US Centers for Disease Control and Prevention (CDC), Emerging Infectious Diseases Journal, full page: (LINK). Abstract, edited.]

Volume 25, Number 8—August 2019 / Research Letter

Polio-like Manifestation of Powassan Virus Infection with Anterior Horn Cell Involvement, Canada

Christopher Picheca1, Vignan Yogendrakumar1  , James I. Brooks, Carlos Torres, Elizabeth Pringle, and Jocelyn Zwicker

Author affiliations: University of Ottawa, Ottawa, Ontario, Canada



Evidence of spinal cord involvement in Powassan virus infection is largely limited to mouse models. We report a case of a polio-like illness caused by Powassan virus infection in a 62-year-old man in Canada. Magnetic resonance imaging showed T2 hyperintensities in the anterior horns of the cervical spinal cord.

Keywords: Powassan virus; Acute flaccid paralysis; Canada.


#Genomic #investigation of the emergence of invasive #MDR #Salmonella Dublin in #humans and #animals in #Canada (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Genomic investigation of the emergence of invasive multidrug resistant Salmonella Dublin in humans and animals in Canada

Chand S. Mangat, Sadjia Bekal, Brent P. Avery, Geneviève Côté, Danielle Daignault, Florence Doualla-Bell, Rita Finley, Brigitte Lefebvre, Amrita Bharat, E. Jane Parmley,Richard J. Reid-Smith, Jean Longtin, Rebecca J. Irwin, Michael R. Mulvey
and on behalf of the Canadian Integrated Program for Antimicrobial Resistance Surveillance Public Health Partnership

DOI: 10.1128/AAC.00108-19



Salmonella enterica subsp. enterica serovar Dublin (S. Dublin) is a zoonotic pathogen that often leads to invasive bloodstream infections in humans that are multidrug resistant. Described here are the results of Canadian national surveillance of S. Dublin from 2003 – 2015 in humans and bovines, principally collected through the Canadian Integrated Program for Antibiotic Resistance Surveillance (CIPARS). An increase in human infections due to multidrug resistant (MDR) S. Dublin was observed in 2010, many of which were bloodstream infections. Phylogenomic analysis of human and bovine isolates revealed a closely-related network that differed by only 0-17 single nucleotide variants (SNVs) suggesting some potential transmission between humans and bovines. Phylogenomic comparison of global publically available sequences of S. Dublin showed that Canadian isolates clustered closely with those from the United States of America. A high correlation between phenotypic and genotypic antimicrobial susceptibility was observed in Canadian isolates. IS26 replication was widespread amongst U.S. and Canadian isolates and caused the truncation and inactivation of the resistance genes strA and blaTEM-1B. A hybrid virulence and MDR plasmid (pN13-01125) isolated from a Canadian S. Dublin isolate was searched against NCBI SRA data of bacteria. The pN13-01125 coding sequences were found in 13 Salmonella serovars but S. Dublin appears to be a specific reservoir. In summary, we have observed the rise of invasive MDR S. Dublin in humans in Canada and found that they are closely related to bovine isolates and to American isolates in their mobile and chromosomal content.

© Crown copyright 2019.

The government of Australia, Canada, or the UK (“the Crown”) owns the copyright interests of authors who are government employees. The Crown Copyright is not transferable.

Keywords: Antibiotics; Drugs Resistance; Bovine; Human; Canada; Samonella enterica.


#Canadian #Pandemic #Influenza #Preparedness: #Antiviral strategy (Can Commun Dis Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Can Commun Dis Rep. 2019 Jan 3;45(1):38-43. doi: 10.14745/ccdr.v45i01a05. eCollection 2019 Jan 3.

Canadian Pandemic Influenza Preparedness: Antiviral strategy.

Henry B1,2.

Author information: 1 Canadian Pandemic Influenza Preparedness Task Group, Chair. 2 Office of the Provincial Health Officer, Victoria, BC.



Antiviral medications are the only influenza-specific pharmaceutical intervention that can be used to mitigate the impact of a pandemic until a vaccine becomes available. The Canadian Pandemic Influenza Preparedness: Planning Guidance for the Health Sector (CPIP) outlines how federal, provincial and territorial governments will work together to ensure a coordinated and consistent health sector approach to pandemic influenza preparedness and response. This article summarizes Canada’s pandemic influenza antiviral strategy as described in the recently updated CPIP Antiviral Annex. The antiviral strategy builds on lessons learned during the 2009 H1N1 pandemic. Key elements of the strategy include ensuring equitable, timely and coordinated access to antivirals through government stockpiles; having regulatory mechanisms in place that facilitate timely access to antivirals; providing timely and evidence-based clinical guidance; maintaining effective stockpile management practices; and monitoring antiviral utilization, effectiveness and safety. Since the CPIP is an evergreen document, this Annex will be updated as new information warrants.

KEYWORDS: antivirals; influenza; pandemic; public health

PMID: 31015817 PMCID: PMC6461127 DOI: 10.14745/ccdr.v45i01a05

Keywords: Pandemic Preparedness; Pandemic Influenza; Antivirals; Canada.


Joint #modelling of #resistance to six #antimicrobials in #urinary #Escherichia coli isolates in #Quebec, #Canada (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Joint modelling of resistance to six antimicrobials in urinary Escherichia coliisolates in Quebec, Canada

Jean-Paul R. Soucy, Alexandra M. Schmidt, Charles Frenette, Patrick Dolcé, Alexandre A. Boudreault, David L. Buckeridge, Caroline Quach

DOI: 10.1128/AAC.02531-18



Empirical treatment of urinary tract infections should be based on susceptibility profiles specific to the locale and patient population. Additionally, these susceptibility profiles should account for correlations between resistance to different types of antimicrobials. We used hierarchical logistic regression models to investigate geographic, temporal, and demographic trends in resistance to six antimicrobials in community-acquired and nosocomial urinary E. coli isolates from three communities in the province of Quebec, Canada procured between April 2010 and December 2017. A total of 74,986 community-acquired (age ≥ 18) and 4,384 nosocomial isolates (age ≥ 65) were analyzed. In both community-acquired and nosocomial isolates, we found geographic variation in the prevalence of resistance. Male sex (community-acquired hierarchical mean OR = 1.24, 95% credible interval: 1.02–1.50; nosocomial hierarchical mean OR = 1.16, 95% CI: 0.92–1.41) and recent hospitalization (community-acquired hierarchical mean OR = 1.49, 95% CI: 1.33–1.66; nosocomial hierarchical mean OR = 1.31, 95% CI: 0.99–1.78) were associated with a higher risk of resistance to most types of antimicrobials. We found distinct seasonal trends in both community-acquired and nosocomial isolates, but only community-acquired isolates showed a consistent annual pattern. Ciprofloxacin resistance increased sharply with patient age. We found clinically relevant differences in antimicrobial resistance in urinary E. coli isolates between locales and patient populations in the province of Quebec. These results could help inform empirical treatment decisions for urinary tract infections. In the future, similar models integrating local, provincial, and national resistance data could be incorporated into decision-support systems for clinicians.

Copyright © 2019 Soucy et al. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International license.

Keywords: Antibiotics; Drugs Resistance; E. Coli; Ciprofloxacin; Canada; UTI.


#Report on two #hypervirulent #Klebsiella pneumoniae producing a #blaKPC-2 carbapenemase from a #Canadian patient (Antimicrob Agents Chemother., abstract)

[Source: Antimicrobial Agents and Chemotherapy, full page: (LINK). Abstract, edited.]

Report on two hypervirulent Klebsiella pneumoniae producing a blaKPC-2carbapenemase from a Canadian patient

Laura F. Mataseje [(M.Sc)], David A. Boyd [(M.Sc)], Michael R. Mulvey [(Ph.D)], Yves Longtin [(MD, FRCPC)]

DOI: 10.1128/AAC.00517-19



This report describes two hypervirulent Klebsiella pneumoniae producing KPC identified from a rectal swab and urine culture upon hospital admission. The patient had recent travel to Greece where he was hospitalized. The isolates were sequence type 86, contained an IncHI1B, IncFIB(K) hypervirulent plasmid and an IncFII(K) plasmid harbouring KPC.

Copyright © 2019 American Society for Microbiology. All Rights Reserved.

Keywords: Antibiotics; Drugs Resistance; Carbapenem; Klebsiella pneumoniae; Canada; Greece.


#Genome Organization of Canada #Goose #Coronavirus, A Novel #Species Identified in a Mass Die-off of Canada Geese (Sci Rep., abstract)

[Source: US National Library of Medicine, full page: (LINK). Abstract, edited.]

Sci Rep. 2019 Apr 11;9(1):5954. doi: 10.1038/s41598-019-42355-y.

Genome Organization of Canada Goose Coronavirus, A Novel Species Identified in a Mass Die-off of Canada Geese.

Papineau A1,2, Berhane Y1, Wylie TN3,4, Wylie KM3,4, Sharpe S5, Lung O6,7.

Author information: 1 National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada. 2 Department of Biological Sciences, University of Manitoba, Winnipeg, MB, Canada. 3 Department of Pediatrics, Washington University School of Medicine, St. Louis, St. Louis, MO, USA. 4 McDonnell Genome Institute, Washington University School of Medicine in St. Louis, St. Louis, MO, USA. 5 Faculty of Veterinary Medicine, University of Calgary, Calgary, AB, Canada. 6 National Centre for Foreign Animal Disease, Canadian Food Inspection Agency, Winnipeg, MB, Canada. Oliver.Lung@canada.ca. 7 Department of Biological Sciences, University of Manitoba, Winnipeg, MB, Canada. Oliver.Lung@canada.ca.



The complete genome of a novel coronavirus was sequenced directly from the cloacal swab of a Canada goose that perished in a die-off of Canada and Snow geese in Cambridge Bay, Nunavut, Canada. Comparative genomics and phylogenetic analysis indicate it is a new species of Gammacoronavirus, as it falls below the threshold of 90% amino acid similarity in the protein domains used to demarcate Coronaviridae. Additional features that distinguish the genome of Canada goose coronavirus include 6 novel ORFs, a partial duplication of the 4 gene and a presumptive change in the proteolytic processing of polyproteins 1a and 1ab.

PMID: 30976080 DOI: 10.1038/s41598-019-42355-y

Keywords: Coronavirus; Gammacoronavirus; Canada Goose Coronavirus; Canada; Wild Birds.