In this issue - March 2026

Program Updates
• Reporting Adverse Events from Immunizations
• Discontinuation of Tobacco Hotline
• Oral Cancer Awareness and Early Detection
• Rethinking Thrush in Lactating Parents: When Pain is not Candida

Announcement
• Welcome Dr. Meghani!
• Respiratory Surveillance

Educational Opportunities

Public Health Alerts
• Measles Testing and Reporting Reminders
• Specimen Collection Material Ordering Update
• Immunization Record Review Deadlines, Actions and Support

As we welcome spring, we are pleased to share a range of updates as part of our ongoing commitment to keeping providers informed and connected.

In this issue, you’ll find information on reporting adverse effects following immunization as well as resources available to support patients seeking cessation options with the discontinuation of the tobacco hotline.

With Oral Health Month underway, it is an opportunity to bring awareness to oral cancer and the importance of early detection. We’re also taking a moment to revisit common assumptions about thrush, highlighting emerging perspectives that may be useful in clinical conversations.

Lastly, we are thrilled to share the announcement of Dr. Hamidah Meghani as Associate Medical Officer of Health!

Thank you for your continued commitment and dedication to ensuring the health and well-being of our Niagara community.

Dr. Azim Kasmani
Medical Officer of Health
Niagara Region Public Health and Emergency Services

Reporting Adverse Events from Immunizations (AEFIs)

You should report a side effect following a patient’s immunization, even if you are unsure whether or not it's necessary.

To discuss a potential AEFI or seek guidance, call 905-688-8248 or 1-888-505-6074 ext. 7396.

Patients, or their parent or guardian, can also report adverse events to Public Health without notifying their health care provider. Public Health may follow up regarding any forms they submit.

Resources

Report Adverse Events After Immunization webpage
Public Health Ontario’s Visual summary of AEFIs reported in Ontario administered in 2024
- PDF version
- Web version (to access, click the “Vaccine Safety” tab)

Discontinuation of Tobacco Hotline

Due to changes in operations and strategic directions in health promotion, the Niagara Region Tobacco Hotline will be permanently discontinued as of April 30, 2026.

Please direct your patients to any of the following resources and programs for smoking cessation:

STOP on the Net is an online program offering free nicotine replacement therapy (NRT) to eligible participants - stoponthenet.ca
Ottawa Model for Smoking Cessation (OMSC) is a phone program that will mail free NRT products and provide counselling for individuals in Ontario. Interested patients can call 1-888-645-5405
Niagara Region Public Health - niagararegion.ca

Action Required:

Please remove and dispose of any remaining Quit Smoking posters, tear-offs, and Tobacco Hotline business cards by April 30, 2026. Updated materials will be made available soon.

Oral Cancer Awareness and Early Detection

A quick look in the mouth can reveal more than just a smile, it can help catch early signs of oral cancer.

Oral cancer often develops without obvious symptoms in its early stages, which is why opportunities for early detection are so important. When identified sooner, treatment is often less invasive and outcomes are improved. Health care providers play an important role in supporting patients, recognizing concerns, and encouraging timely follow-up.

Take a moment to check in with patients, especially those who use tobacco or alcohol or have HPV exposure. Encourage routine assessments with a dental professional, where oral cancer screening is often part of care, and remind patients to watch for changes such as:

Sores or ulcers that do not heal
Red or white patches in the mouth
Difficulty swallowing
Oral pain lasting more than two weeks

Throughout April, Niagara Region Public Health is partnering with the Niagara Peninsula Dental Association to promote oral cancer awareness during Oral Health Month.

Learn more about dental program information and referral resources.

Rethinking Thrush in Lactating Parents: When Pain is not Candida

Emerging evidence is offering new insight into "thrush-like" symptoms in lactating parents. Shiny or scaly nipple-areolar complex (NAC) skin, and nipple pain without flu-like symptoms, may have a range of causes. Studies reveal a higher occurrence of bacterial pathogens like Staphylococcus and Streptococcus, whereas Candida is detected infrequently.

In many cases, a poor latch can contribute to inflammation or temporary narrowing of the ducts, which may create radiating pain or give the impression of low milk supply. NAC irritation or excess moisture can also prompt histamine release, sometimes resulting in pink, flaky skin.

Because these symptoms can overlap across different conditions, relying on appearance or pain alone to diagnose mammary candidiasis may lead to treatments that don’t fully address the underlying issue. A broader assessment can help ensure that families receive the most effective and targeted support for their feeding experience.

Recommendations for Health Care Providers:

Assess latch and positioning, check for signs of inflammation (including radiating or burning pain that may indicate ductal narrowing)
Manage inflammation with supportive measures, such as cold compresses and short courses of anti-inflammatory medication
Evaluate for bacterial infection when clinically indicated and reserve antibiotics or antifungals for cases with clear clinical justification
Refer patients to Niagara Parents for additional feeding support via Family Health Referral

Selected References:

Douglas, P. (2021). Evidence review on mammary candidiasis and the limited role of Candida albicans. Women’s Health.
Jimenez et al. (2017). Scientific evaluation of mammary candidiasis diagnosis. PLoS ONE.

Dr. Meghani joins Niagara Region Public Health as AMOH

Niagara Region Public Health is pleased to share that Dr. Hamidah Meghani has joined our team as Associate Medical Officer of Health (AMOH).

Dr. Meghani started with Niagara Region Public Health in August 2025 as a part-time Public Health Physician and has quickly become a valued member of the team. In her new role as AMOH, she will continue to support the delivery of public health programs and services that promote and protect the health and well-being of Niagara residents.

Bringing extensive experience at both the local and provincial levels of public health, Dr. Meghani has served as Deputy Chief, Medical and Systems Support at Public Health Ontario; Commissioner and Medical Officer of Health for Halton Region; and Associate Medical Officer of Health for the City of Hamilton Public Health Services.

Dr. Meghani holds a Doctor of Medicine from McMaster University, a Master of Public Health from Columbia University, and a Master of Management from McGill University’s International Masters for Health Leadership Program. She is passionate about public health leadership, improving health systems, and advancing health equity.

Please join us in congratulating her as she steps into this new role!

Respiratory Surveillance

Public Health Ontario’s most recent respiratory laboratory surveillance data indicates activity for influenza is low
Provincially, seasonal human coronavirus is the most commonly circulating virus (based on percent positivity); regionally, respiratory syncytial virus is the most commonly circulating virus.
In Niagara, there have been 1,593 cases of influenza this season; 35,280 across Ontario

Niagara reports flu activity surveillance information weekly on Fridays.

For more details on the 2025 to 2026 respiratory season, please visit Public Health Ontario’s page for the Ontario Respiratory Virus Tool.

Visit the Professional Development Opportunities page for in-person and online opportunities available to health care professionals in Niagara.

Medical Advisories and Memos

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MEMO: March 16 - Measles Testing and Reporting Reminders
MEMO: March 12 - Specimen Collection Material Ordering Update
MEMO: March 9 - Immunization Record Review Deadlines, Actions and Support

Your monthly update from Niagara Region Public Health

Welcome to Public Health Pulse! Formerly known as the Physicians’ Newsletter, the publication was given a fresh name in January 2025 to better reflect our commitment to supporting Niagara’s physicians, primary care providers, and allied health professionals with essential public health updates.

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