In This Issue - February 2019- UPDATE: Increasing Rates of STIs in Niagara
- Hepatitis C
- Gonorrhea (GC) & Chlamydia (CT)
- Syphilis
- UPDATE: Harm Reduction Strategies
- IPAC REVIEW: Ear Cleaning In Your Clinic Setting
- SURVEILLANCE UPDATE: Influenza A Still Remains High
- HEALTH CANADA ALERT: Heavy Metal Toxicity in Ayurvedics
- MEDICAL ADVISORIES & MEMOS: February 2019
UPDATE: Increasing Rates of STIs in Niagara Hepatitis C There were 221 reported infections of hepatitis C in 2018. Only 7% of these were defined as newly acquired. The 2018 Infectious Disease Protocol defines a Newly Acquired Hepatitis C case (24 months or older) as - Detection of anti-HCV antibody or HCV RNA; AND
- Less than 24 months between current positive and previous negative, OR
- Detection of anti-HCV antibody or
HCV RNA; AND
- Clinically compatible signs and symptoms with no other known cause; AND
- Exclusion of acute hepatitis A and B as follows
- IgM antibody to
hepatitis A virus (IgM anti-HAV) negative AND
- IgM antibody to hepatitis B core antigen (IgM anti-HBc) negative
If you have any questions about treatment or would like to consult with a public health nurse or nurse practitioner please call 905-688-3817 Ext. 7732.
UPDATE: Increasing Rates of STIs in Niagara Gonorrhea (GC) & Chlamydia (CT) - Niagara has seen a 53% increase in the number of GC cases from 2017 (189) to 2018 (295)
- Niagara reported 37 cases of anal and pharyngeal GC cases for 2018
- There were 1638 reported cases of chlamydia (CT) in 2018, representing a 6% increase from 2017
In November 2018 Public Health Ontario updated the Gonorrhea Testing and Treatment Guidelines. First Line Treatment remains unchanged for all infection sites (pharyngeal, anal, genital): 250mg Ceftriaxone IM Single Dose + 1 gm Zithromax po. When to test for Chlamydia and Gonorrhea - Sexually Transmitted
Infection (STI) testing should be completed on all sexually active individuals with signs and symptoms of chlamydia (CT) and gonorrhea (GC) at urogenital sites where they report unprotected sexual exposure
- Offer testing to asymptomatic sexually active individuals with risk factors for CT/GC
- Consider rectal and pharyngeal testing in the following high risk groups, as these infected sites are most often asymptomatic
- Men who have sex with men (MSM)
- People who engage in sex work and their sexual contacts
- Known sexual contacts of cases
- Re-screen 6 months after treatment
How to Test Nucleic Acid Amplification Testing (NAAT) - NAAT is more sensitive than culture for GC and CT
- Rectal NAAT and/or Pharyngeal NAAT can now be done by swabs
- Test of cure 2-3 weeks post treatment is recommended for all pharyngeal cases of GC
Culture: - Has a sensitivity as low as 50%
- Only recommended in specific clinical situations (e.g. test of cure, abx sensitivity required)
Test of Cure - Sexual abuse/assault cases
- Possible treatment failure with ongoing
symptoms
- PID or disseminated GC
- First line treatment not used
- Pregnancy
- Pharyngeal infection
- Re-exposure to untreated partner after treatment
Niagara Region Public Health provides
free medications for the treatment of chlamydia and gonorrhea. - Medication can be ordered online or order can be faxed
- Medications can be picked up at any of our office locations or can be delivered to your office via monthly vaccine delivery
- Up to date treatment guidelines for all STIs are available online, or by downloading the Public Health Agency of Canada’s mobile app on STI guidelines from the Apple App or Google Play store
UPDATE: Increasing Rates of STIs in Niagara Syphilis In the last two years we have seen a rise
in the number of infectious syphilis cases in the Niagara Region. Niagara reported 28 cases of infectious syphilis for 2018, and ranked 2nd in the province for the rate of infectious syphilis in females for 2018. This increase is especially concerning, as in many cases, positive results are being found in individuals other than those typically flagged as high risk (MSM, IV Drug Users, Sex Trade). Testing - A “syphilis screen”
is requested through the Ontario Public Health General Lab Requisition
- The screen will include an initial screen (CMIA), Non-Treponemal Test (RPR) and Confirmatory Assay (TPPA)
Treatment - A syphilis laboratory interpretation and treatment guideline for assistance with the staging/diagnosis of syphilis based on serology results can be ordered on our website
- It is important that the client is staged correctly for correct treatment, testing follow up and
contact-tracing
- Successful treatment is indicated by a four-fold drop in the client’s RPR on follow up syphilis serology
Public health nurses and nurse practitioners are available to consult on any client diagnosed with syphilis. Health care pratitioner offices will be provided with Bicillin to treat syphilis. If you have any questions or to order Bicillin, please call 905-688-3817 Ext. 7732.
UPDATE: Harm reduction strategies In 2017, the Ministry of Health and Long-term Care provided funding to health units to enhance harm reduction efforts in the region. One objective of this initiative is to increase access points for naloxone kits by collaborating with community agencies that provide services for people who use drugs. To date, over 2000 kits have been distributed to 24 eligible organizations across the region for staff to
train their clients on how to avoid, recognize and ultimately respond to an opioid overdose by administering naloxone. Public Health has been conducting harm reduction presentations and naloxone trainings for interested organizations and groups who have an interest in learning more. Contact Rhonda Thompson to request a session for your office. If you have a patient who is concerned about a loved ones' drug use, please recommend they obtain a naloxone kit.
IPAC REVIEW: Ear Cleaning In Your Clinic Setting Ear syringe nozzles, ear cleaning equipment, ear curettes and otoscope tips are classified as semi-critical medical equipment according to Spaulding’s Classification of Medical Equipment/Devices. “Hear” are a few IPAC items: - The manufacturer of the ear cleaning equipment/device that you have purchased for clinic use must provide detailed information on the intended use
- Ear cleaning equipment should be single-use or dedicated to a
single patient, client owned or identified as multi-patient reusable
- Disposable/single-use tips must be discarded after use
- Equipment used for manual cleaning, at a minimum, is to be cleaned and disinfected with a high level disinfectant (HLD) or sterilized between patients
- Reprocess multi-patient ear cleaning equipment/device according to the validated manufacturer’s instructions for use (MIFU) or if validated MIFU is unavailable, reprocess according to Spaulding’s Classification of Medical Equipment/Device Required Level of Reprocessing
- Use Routine Practices for all patients at all times
For more detailed information on Reprocessing Semi-Critical Equipment/Devices refer to PIDAC Best Practice Document.
SURVEILLANCE UPDATE: Influenza A Still Remains High - Public Health Ontario’s most recent respiratory laboratory surveillance data (Feb. 2, 2019) indicates that Influenza A (solid dark blue) and RSV (solid magenta) levels remain elevated near peak levels
- Rhinovirus (broken light blue) and Coronavirus (broken black) remain circulating but have continued to decrease in prevalence
- Parainfluenza virus (solid teal), adenovirus (solid yellow), and metapneumovirus (broken green) have continued to hover at low values
- Influenza B (solid green) remains at near non-existent levels, although this may change come
spring
- For more information, please visit Public Health Ontario’s page for the Ontario Respiratory Pathogen Bulletin
Health Canada Alert: Heavy Metal Toxicity in Ayurvedics Health Canada recently issued an alert regarding products sold at A1 Herbal Ayurvedic Clinic Ltd. in Surrey BC, with an affiliated clinic in Brampton, Ontario. There was one case of heavy metal toxicity in BC; none reported in Ontario. Health Canada inspectors have seized products, ingredients and equipment from these clinics and laboratory testing has confirmed the presence of lead and mercury. The seized products were unauthorized health products which are illegal to sell in Canada. Authorized health products require a
license from Health Canada and have an eight-digit Drug Identification Number (DIN), Natural Product Number (NPN), or Homeopathic Drug Number (DIN-HM). Full details from Health Canada - see here.
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