In This Issue - April 2022

• PHYSICIANS' CORNER
• UPDATE:

  • Primary Care Advisory & Liaison Group

  • Managing Early Lyme Disease

  • May 7 is International Harm Reduction Day

• ​REVIEW:

  • Prescription Drug Drop-Off Day

  • Postpartum Depression Program for New Mothers

  • Respiratory Surveillance

• EDUCATIONAL OPPORTUNITIES
  • CME: Syphilis - The Comeback No One Wanted
  • CME: Prostate Cancer Screening & ADT Management
• MEDICAL ADVISORIES & MEMOS​

Physicians' Corner

Welcome to April's Physicians' Corner Broadcast with Dr. Hirji, Niagara Region Public Health's Medical Officer of Health (Acting). This month is all about COVID-19 treatment. View the video below or click here.

As a reminder, Public Health issued a medical advisory earlier this month on Patient access to outpatient therapies for COVID-19 which includes a link to the Niagara Health Referral form.

Paxlovid is now available for patients much more easily with a prescription from primary care, with the medication then being dispensed in pharmacies. This improves access, and allows you to treat you patients with COVID-19 the same way you would treat other illnesses.  Review the Ontario Science Table’s guidelines which outline who will best benefit from Paxlovid.

Below are links to EMR forms that automate the prescription form and faxing processes. These resources will help with Paxlovid prescriptions and referrals

• South West Digital Coalition’s Forms Repository
• eHealth Centre of Excellence

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: Primary Care Advisory & Liaison Group

The Niagara Region Public Health Primary Care Advisory and Liaison (PCAL) Group is made up of Public Health representatives, family physicians and a nurse practitioner. This group strives to support improved two-way communication between Niagara Region Public Health and Niagara's primary care sector as well as collaboration. In particular, PCAL provides clinical expertise and guidance on public health issues that impact Niagara residents, seeking ways to improve patient access, resource sharing and knowledge exchange. 

Representing specific areas of Niagara, the members strive to equitably represent and be inclusive of all family physicians and nurse practitioners who practice in Niagara's diverse communities. 

Interested in getting involved?

• Public Health is looking to welcome two more family physicians to join the PCAL group. Preference will be given to those working in west Niagara, Welland, Port Colborne and Pelham.
  • Theses are limited-term paid positions
  • The time commitment is approximately 5 hours per month
• For more information on how to get involved, email HCP Engagement

UPDATE: Managing Early Lyme Disease

With warmer temperatures, Niagara residents may encounter ticks while engaging in outdoor activities. Blacklegged ticks can transmit Lyme disease: see information on tick identification. For information on symptoms for Lyme disease as well as laboratory testing, see our Lyme Disease web page for health care professionals.

Clinical Diagnosis of Early Lyme Disease

In patients with a potential blacklegged tick exposure in a Lyme risk area, including Niagara Region, one or more lesion(s) consistent with erythema migrans (EM) greater than 5 cm in diameter is sufficient to diagnose early Lyme disease.  Most patients with a single EM lesion are seronegative at the time of presentation, so early Lyme disease should be treated without laboratory testing.

Report all clinical diagnoses of early Lyme disease to the Medical Officer of Health by the next working day.

Treatment for Early Lyme Disease

The preferred first line treatment of patients with early Lyme disease is

• Adults: Doxycycline 100 mg twice a day for 10 days
• Children: Doxycycline 4.4 mg/kg per day (maximum of 100 mg per dose) in two divided doses for 10 days. Counsel patients and their guardians that there is a growing consensus that doxycycline use is safe in young children, but that additional safety data are still being collected.

For more information on treatment for Lyme disease, please review the Infectious Diseases Society of America (IDSA) Clinical Practice Guidelines or call the Infectious Disease program at 905-688-8248 or 1-888-505-6074 ext. 7330.

UPDATE: May 7 is International Harm Reduction Day

Substance use stigma in the health system represents a barrier to good health and wellbeing among people who use substances. Harm reduction refers to policies, programs and practices that aim to minimize negative health, social and legal impacts associated with drug use, drug policies and drug laws. It focuses on positive change and on working with people without judgement, coercion, or discrimination.

In Niagara, opioid-related emergency department visits, hospitalizations and deaths continue to rise.  The COVID-19 pandemic has exacerbated this crisis. The Preliminary Patterns in Circumstances Surrounding Opioid-Related Deaths in Ontario during the COVID-19 Pandemic report from the Ontario Drug Policy Research Network identifies some of the factors contributing to the increase in drug-related deaths.

Opioid-related stigma is poorly understood and negatively impacts individuals’ interactions with health care providers. Of the people who died from an opioid related overdose 50% had seen a health care provider in the 30 days prior to their death (25% in the 7 days prior). Health Canada’s Primer to Reduce Substance Use Stigma in the Canadian Health System offers insight and strategies to support health care professionals in meaningfully and sustainably addressing this pressing public health problem.

REVIEW: Postpartum Depression Program for New Mothers

Postpartum depression (PPD) affects one in five mothers, but only 15 percent can access evidence-based treatment due to long waitlists and availability of affordable care.

Public health nurse-delivered cognitive behavioural therapy shows reductions in postpartum depression and anxiety among new mothers. A study conducted in Niagara is the first to show that public health nurses with no prior psychiatric training can deliver cost-effective group psychotherapy for mothers with PPD.

• Niagara Region Public Health (NRPH) now offers this intervention as a Prenatal/Postpartum Depression Group (nine-week intervention) for expectant parents and parents with infants up to 18 months of age who are feeling depressed, down, or anxious
• The series is currently being offered virtually due to COVID-19 restrictions
• Patients who have recently had a baby and are experiencing any depressive symptoms can be referred to this program by having them contact Niagara Parents. They can also sign up online.

New Research Study

NRPH has partnered with McMaster University to explore Public Health Nurse-Delivered 1-Day CBT-Based Workshops for individuals with symptoms of Postpartum Depression (PPD).  Read more about this study and how your patients can get involved.

REVIEW:  Respiratory Surveillance

Surveillance Update: Influenza Activity Low but Increased

• Public Health Ontario’s most recent respiratory laboratory surveillance data (April 22, 2022) indicates Influenza A and B activity remains low but have increased in the past month
• Provincially, entero/rhinovirus and non-pandemic human coronaviruses continue to be the most commonly-circulating viruses, while other virus activity remains lower
• Niagara is reporting 7 cumulative sporadic influenza infections this season, which is higher than in the 2020-2021 season (no cases reported). In the five years preceding the pandemic, (2015-2019), there were approximately 709 cases of influenza per year. In 2020, there were 932 cases of influenza, all of which were part of the 2019-2020 season.

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

FREE CME: Syphilis - The Comeback No One Wanted

Syphilis rates have seen a precipitous rise in Niagara. Given the increasing incidence and shift in populations affected, Niagara Region Public Health is offering a free, virtual, accredited* educational event to support all interested health care professionals in recognizing sexual risk behaviours and to explain diagnosis and treatment recommendations. Participants will have the opportunity to explore the increase in syphilis and learn practical tips to incorporate into their daily clinical care. 

Tues., May 3, from 1:30 – 3:30 p.m.

Don’t wait! Registration deadline is this Fri., April 29. Register online or call 905-688-8248 or 1-888-505-6074 ext. 7707. 

*This one-credit-per-hour Group Learning program has been certified by the College of Family Physicians of Canada and the Ontario Chapter for up to 1.5 MainPro+® credits. This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the SOGC. You may claim a maximum of 1.5 hours (credits are automatically calculated).

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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 in advance for this program

MEDICAL ADVISORIES & MEMOS

• Medical Advisory - April 12: Evaluation, Management and Reporting of Myocarditis and Pericarditis Following mRNA COVID-19 Vaccination

• Medical Advisory - April 8: Fourth Doses (Second Booster) of COVID-19 Vaccines  

• Medical Advisory - April 7: Increase in Influenza A activity

• Medical Advisory - April 6: Patient Access to Outpatient Therapies for COVID-19    

• Medical Advisory - April 5:  Information on the use of Novavax Nuvaxovid COVID-19 vaccine and preferential recommendations

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