Infectious disease

In Nunavik, the battle against bacterial sexually transmissible and blood-borne infections (STBBIs) has become increasingly urgent. In the wake of mass interventions in the 1990s, and despite more recent efforts, the region has been unable to lower its incidence curves, particularly for gonococcal infection, which has reached epidemic proportions since fall 2007. In this context, and spurred by the renewed interest of medical teams on the ground, the Direction de santé publique (department of public health: DSP) of the Régie régionale de la santé et des services sociaux du Nunavik / Nunavik Regional Board of Health and Social Services (NRBHSS) has asked the Institut national de santé publique (Québec's national public health institute: INSPQ) to support a group of experts in an attempt to optimize the regional program for clinical prevention of STBBIs. Accordingly, a meeting was held on October 2010. In attendance were representatives of the two CSSS organizations (physicians, a con…

Every year, over 3 million patients, including many cases of transmissible infections, arrive at Québec's emergency departments on foot or by ambulance. In Québec, reference documents are available on emergency department organization and design. However, at present, there are few recommendations for infection prevention and control (IPC) in the literature that focus on practice in an emergency care setting.

This document has been prepared in connection with Action 8 of the Ministère de la Santé et des Services sociaux' (MSSS) Plan d'action sur la prévention et le contrôle des infections nosocomiales 2010-2015 [2010-2015 Action plan for healthcare-associated infections prevention and control]. Its purpose is to make recommendations for IPC in the emergency departments of Québec's hospitals. The recommendations are primarily intended for general and specialized hospital centres. They will have to be adapted according to the facility's mission, the patien…

In 2007, the Comité sur l’immunisation du Québec (CIQ) recommended an extended schedule exclusively for immunization against the human papilloma virus (HPV) starting in grade 4 (0, 6, 60 months); the committee also stated that the third dose should be administered “if judged necessary.” Since the introduction of the Québec HPV immunization program in 2008, similar programs (two doses administered six months apart and a possible third dose if necessary) have been introduced in Mexico and British Columbia. In 2012, the committee of immunization experts in Switzerland recommended for pre-adolescents a schedule comprising two doses administered six months apart. In recent years, a number of studies have been published on the immunogenicity of HPV vaccines administered according to alternative schedules and other studies are presently underway to document the efficacy of one, two, or three doses administered at different intervals.

The present advisory report, which is based…

The human papillomavirus (HPV) belongs to the Papillomaviridae family, which includes at least 100 genotypes affecting the skin and mucous membranes. Of these, about 40 affect the anogenital area in particular, and approximately 15 are oncogenic. Genotypes 16 and 18 are responsible for 70-76% of cervical cancer cases worldwide. Genotypes 6 and 11 are non-oncogenic but are responsible for most cases of condyloma (anogenital warts [AGW]).

HPV prevalence and incidence data are estimated on the basis of epidemiological studies and are better documented in women than men. HPV prevalence varies widely by geographic region, age, the selected subpopulation and HPV detection method. In women, the overall age-adjusted prevalence of genital infections worldwide is estimated at 11.7%. It peaks in young women aged 20-24 and declines subsequently with age. The risk of acquiring HPV infection is particularly high in the first few years after sexual activity begins. Ac…

Divider curtains are often used in health care settings to surround patient’s bed and provide privacy. Many factors contribute to the concern that these curtains are a potential source for the transmission of pathogenic microorganisms: 1) caregivers and patients touch curtains frequently; 2) in some settings, curtains are not often cleaned or changed; 3) health care workers and patients who handle curtains do not necessarily cleanse their hands before (or after) touching them.

In May 2011, the Comité sur les infections nosocomiales du Québec (CINQ) was asked to provide its opinion on the frequency of cleaning and the precautions to be taken to ensure the safe handling of divider curtains. The purpose of this document is to review the evidence on the role of divider curtains in the transmission of pathogens in health care settings and to provide recommendations for the cleaning and handling of divider curtains.

The live attenuated influenza virus vaccine (LAIV), Flumist®, administered by intranasal spray, is approved for people aged 2-59 years. The National Advisory Committee on Immunization (NACI) recommended in its statement for the 2011-2012 season that, given its efficacy and immunogenicity, LAIV should be used preferentially for healthy children and adolescents aged 2 to 17 years. NACI also indicates that LAIV can be used for children with chronic diseases, other than immune compromising conditions or severe asthma, but that there were insufficient data to recommend the preferential use of LAIV over trivalent inactivated vaccine (TIV). The Comité sur l'immunisation du Québec (CIQ) also recommended, at its June 2011 meeting, that LAIV should be used preferentially in healthy children aged 2-17 years, particularly among household contacts of people at high risk for complicated influenza infection.

At the December 2011 CIQ meeting, the question of LA…

This collection of 11 case studies extracted from existing documents or research proposals is part of a larger project on ethics during a pandemic currently being undertaken by the National Collaborating Centre for Healthy Public Policy (NCCHPP), and is intended to contribute to one of our larger core objectives, which is to provoke reflection on the use of ethical analysis in public health practice and for the development of healthy public policy.

The general aim of this series of cases is to illustrate a wide range of pandemic and infectious disease control scenarios in which professional roles and responsibilities generate ethically complex situations. Covering issues related to the powers and duties of public health officials and health care providers, and designed to place ethical issues related to preparing and responding to outbreaks in practical contexts, the cases aim to assist in the development and application of moral reasoning through concrete examples. Suc…

In 2002, the Table de coordination nationale de maladies infectieuses tasked a multisectoral working group with the development of a professional practice and intervention guide for persons who work with nonhuman primates. In 2010, the Table asked the Institut national de santé publique du Québec (INSPQ) to publish the guide and make it available to the public.

This guide is intended primarily for public health professionals, clinicians, emergency physicians, veterinary physicians, and occupational health and safety physicians who work in the organizations concerned with the exposure to nonhuman primates (including physicians responsible for occupational health in the public system).

Since 2000, the resurgence of syphilis in Québec has led to increased screening and resulted in a greater number of reported cases, particularly in the Montréal area. To meet the growing demand for laboratory testing, some medical diagnostic laboratories have introduced an enzyme immunoassay (EIA) test into their syphilis detection algorithm. This situation raised concerns among general practitioners, microbiologists and infectious disease specialists with regards to the interpretation of screening results and the diagnosis and confirmation of syphilis infections.

In response to these concerns, the Comité sur les infections transmissibles sexuellement et par le sang (CITSS) of the Institut national de santé publique du Québec (INSPQ) established the Sous-comité Épreuves de détection de la syphilis whose mandate was to make recommendations for optimizing syphilis diagnosis in Québec.

To fulfill its mandate, the subcommittee:

• conducted a literature revie…

Given that certain questions have been raised regarding the results of studies on the effects of SISs, the Institut national de santé publique du Québec (INSPQ) has taken the initiative of carrying out a critical analysis of these studies.

The objective of this report is to evaluate the relevance of establishing supervised injection sites in the province of Québec. It is based on a critical analysis of the scientific research carried out to date on the effects of SISs and on a review of the literature on the related ethical and legal issues as well as on acceptability and operational factors related to such sites.