In This Issue - May 2022

PHYSICIANS' CORNER
UPDATE:
- Prenatal Packages
- Vaccine Preventable Disease Program
REVIEW:
- Respiratory Surveillance
- Suicide Prevention
- Postpartum Psychosis
- Syphilis CME Success!
EDUCATIONAL OPPORTUNITIES
- PHO: Community of Practice Series
- Prostate Cancer Screening & ADT Management
MEDICAL ADVISORIES & MEMOS

Physicians' Corner

Fourth doses (second boosters) for specific populations

A note on terminology: it is becoming preferred to refer to doses beyond the original two as the third, fourth, and fifth doses since the “booster” terminology implies to some that it is an optional add on, rather than necessary to achieve a base level of immunity.

Currently, the following groups are eligible to receive a fourth dose:

Individuals 60 years of age and older
First Nation, Inuit and Metis individuals and their non-Indigenous household members aged 18 and over
Residents of high-risk congregate settings

These groups have been identified for a fourth dose due to the vulnerability they face presenting as higher risk for severe outcomes of COVID-19.

For eligible individuals who are also moderately to severely immunocompromised, and receive a three dose primary series, their second booster would be their fifth dose. This follows the recommendation that individuals who are moderately or severely immunocompromised should receive a three dose primary series and follow the relevant first and second (if eligible) booster dose recommendations based on age.

Eligible patients are recommended to get their fourth and/or fifth dose six months after their last dose (may be given as early as three months).

Learn more.

Our COVID-19 Frequently Asked Questions for Health Care Professionals webpage has been updated! Here you will find information about primary care testing/referrals, assessment, vaccination, infection control and variants of concern.

Don't see the response to your question on the FAQ page? Call our COVID-19 Health Care Professionals information line Monday - Friday, 8:30 a.m. - 4:15 p.m. at 905-688-8248, press 7 then press 1.

UPDATE: Prenatal Packages

Niagara Region Public Health has recently mailed out prenatal packages and office materials to some health care providers that provide care to pregnant individuals.

The prenatal packages were created to support expectant parents as they prepare to welcome baby. Each Prenatal Package includes

Prenatal Postcard
Labour at a Glance Postcard
Breastfeeding Hand Expression Card
Prenatal Resource Card
Postpartum Depression Resource
Pregnancy Complication Warning Signs Resource
Vaccine Hesitancy during Pregnancy Resource

If your office is interesting in having these available to pregnant patients the prenatal packages, request this resource by

placing an order on our resource order page (located under maternal, child health)
contact the Physician and Primary Care Engagement Advisor

Update: Vaccine Preventable Disease Program

Hepatitis B Immunization Program:

Unfortunately, due to school closures and limited Public Health capacity over the last two years, many students in grade 7 are missing their Hepatitis B vaccines.
- As of the 2022-2023 school year, the eligibility period for the hepatitis B publicly funded school-based (grade 7) immunization program will be expanded until the end of grade 12 to allow students to complete their hepatitis B immunization series.
Please note that students who are 16 years of age or older, will need a three dose series rather than the 2 dose series for those younger than age 16. Public Health plans to deliver the full suite of school vaccinations in 2022-23, and hopes to help with catch-up efforts for children who missed their grade 7 vaccinations.
Learn more

Tdap Maternal Program:

Ontario’s Tdap immunization program has expanded to include a dose in every pregnancy
- Pregnant individuals are eligible to get a free pertussis (whooping cough) vaccine in every pregnancy to help protect the baby after birth with a maximum number of maternal antibodies
The pertussis vaccine is given as part of the tetanus, diphtheria, pertussis (Tdap) vaccine. Tdap vaccine is provided as either Adacel® and/or Boostrix®
More Information:
- Tdap fact sheet (for patients)
- National Advisory Committee on Immunization; Update on immunization in pregnancy with Tdap vaccine
- Ontario’s Publicly Funded Immunization Schedule

REVIEW: Respiratory Surveillance

Surveillance Update: Unusual Influenza Season

In the past few weeks, Public Health Ontario’s respiratory laboratory surveillance alert system suggest that the influenza season may be starting now, which is not typical of past influenza seasons
In Niagara, since October 2021, 43 influenza cases have occurred, with 17 cases occurring since the start of May
Of the 43 influenza cases in Niagara, 69.8% are among those under 10 years old

Niagara resumes reporting of flu activity surveillance information weekly on Tuesdays.

For more detail on the 2021 to 2022 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory Pathogen Bulletin.

REVIEW: Suicide Prevention

Health care providers play an important role in creating a suicide-safer Niagara.

Research shows that up to 50% of patients who died by suicide had contact with their primary care provider in the month before they died, and many of those visits were not mental-health related.

Talk openly about suicide with all patients. Asking directly about thoughts of suicide can help to reduce the stigma that many people feel about the topic, and can open up a life-saving line of communication.
Empower yourself to address suicide with your patients through a 2 hour online module (2.0 Mainpro+ credits): Suicide: Facing the Difficult Topic Together

Suicide care is life-saving healthcare.

REVIEW: Postpartum Psychosis

Research has shown that postpartum psychosis (PPP) impacts approximately 1 to 2 out of every 1,000 women. It typically occurs within the first two weeks postpartum, and the risk of recurrence with each subsequent delivery is 30 to 50 percent.

Symptoms:

Depression
Irritability
Disorganization
Confusion
Delusions
Hallucinations
Mania

Risk Factors:

Diagnosis of bipolar disorder/family history
Sleep deprivation
Prior episode of PPP

Screening and Referrals:

Due to the wide range of signs and symptoms, there is currently no standardized screening tool for PPP.
- One out of every three women who experience PPP will have a psychiatric history, so it is important to ask patients about their personal or family history, to assess for risk factors, symptoms, and thoughts of harm to self or baby.

If you suspect your patient might be experiencing postpartum psychosis, please use the online or fax referral form to refer them to the Early Psychosis Intervention Team or send them directly to hospital if imminent risk is present.

REVIEW: Syphilis CME Success!

We are pleased to report the success of our Syphilis education event with great presentations and excellent questions during our panel discussion! If you were unable to join us (or if you would like to watch it again), you can view the recording.

To support your practice, you can view the Syphilis Reference Guide outlining staging and treatment guidelines. Order copies of the guide for your office on our resource order page (under sexual health).

The first-line treatment for syphilis is injectable BICILLIN (benzathine Penicillin G, 2.4 million units IM LA (long acting).
- The number of doses required depends on stage of infection
Bicillin can be ordered for free from the Sexual Health Centre or by calling 905-688-3817 ext. 7723
Note that short-acting Penicillin G is not a treatment for syphilis

PHO: Community of Practice Series

Public Health Ontario (PHO) is hosting a community of practice series that will review key concepts and support resources for Infection Prevention and Control (IPAC) in Primary Care settings. This series is intended for those who oversee or implement IPAC in Primary Care settings.

The Primary Care IPAC Community of Practice series will be held over four sessions. The topics include

IPAC risk assessments
Attributes of physical space that support IPAC best practices
Workflow and processes that support IPAC best practices in clinical settings
Auditing IPAC to monitor and sustain best practices

Register for these sessions.

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FREE CME: Prostate Cancer Screening & ADT Management

You are invited to a CME accredited program: Prostate Cancer Screening & ADT Management.

When: June 2, 2022 at 12:00 p.m.

Presenter: Dr. Patrick McGarry, Urologist, Niagara Health

By participating in this program, health care providers can expect to

Gain insight into the rationale for prostate cancer screening
Review the current recommendations for the management of elevated PSA
Discuss the adverse side effects of ADT for the treatment of prostate cancer

Register for this program.

MEDICAL ADVISORIES & MEMOS

Memo - May 19: Expiring Medical Exemptions for COVID-19 Vaccination
Memo - May 18: Excursion Reporting and Cold Chain Reminders
Memo - May 10: VPD Program Updates

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