In This Issue - May 2023

UPDATE:
- Primary Care Engagement Advisor
- Detection of Ceftriaxone Non-Susceptible Neisseria Gonorrhoeae in Ontario
- When You Receive Exposed Vaccine as Part of Your Order
- Extended Eligibility for Herpes Zoster (Shingles) Vaccine
REVIEW:
- Benefits of Long Acting Injectable (LAI) Antipsychotics for Schizophrenia
- Food-Borne Illness Investigations
- Adverse Childhood Experiences
MEDICAL ADVISORIES AND MEMOS
EDUCATIONAL OPPORTUNITIES
- FREE WEBINAR: How to Talk to Clients About Their Mental Health - The Right Way

UPDATE: Primary Care Engagement Advisor

Rachel Sam will be covering for Jennifer Ryder while Jennifer is on maternity leave. To contact Rachel, email rachel.sam@niagararegion.ca.

**UPDATE: Detection of Ceftriaxone Non-Susceptible Neisseria Gonorrhoeae in Ontario**

In March 2023 Public Health Ontario Laboratory identified an isolate of Neisseria gonorrhoeae from a urethral specimen that was non-susceptible to cefixime and ceftriaxone. It was also resistant to ciprofloxacin, penicillin, and tetracycline.

The Chief Medical Officer of Health is recommending collecting swabs for culture AND specimens for NAAT testing from ALL potentially exposed sites (eg., urethral/cervical, pharyngeal, rectal) in the following situations:

Symptomatic patients (eg. discharge)
Test of Cure
PID
Pregnancy
Sexual abuse or sexual assault

NAAT is more sensitive and culture allows assessment for drug sensitivity.

Treat suspected or confirmed gonorrhea cases as per the current recommendations in the Ontario Gonorrhea Testing and Treatment Guide. Please note that Ontario’s guidelines are currently under review.

For questions related to testing or treatment, please contact the Sexual Health Centre STI Team by calling 905-980-6000 ext. 7723

UPDATE: When You Receive Exposed Vaccine as Part of Your Order

In the event Niagara Region Public Health receives exposed vaccine from the Ontario Government Pharmaceutical and Medical Supply Services, your future vaccine orders may contain some of this previously exposed inventory.

If you are receiving vaccine that is labelled “exposed”, it means stability has been determined and the vaccine is safe for ongoing use. Always use previously exposed vaccine first regardless of expiry dates.

If any publicly funded vaccine, including previously exposed inventory, is stored at temperatures outside the +2⁰C to +8⁰C range, do not use the vaccine, and keep it quarantined in your vaccine fridge. Contact Public Health immediately to report the excursion and to receive further instructions.

See niagararegion.ca/health/professionals for Handling a Cold Chain Incident or contact the Vaccine Preventable Disease program at 905-688-8248 or 1-888-505-6074 ext. 7396.

UPDATE: Extended Eligibility for Herpes Zoster (Shingles) Vaccine

Primary care providers are encouraged to identify eligible patients and offer the Shingrix® vaccine. Shingrix® is publicly funded for individuals who are 65 to 70 years of age (series must be completed prior to their 71 birthday), provided they have not previously received a publicly funded shingles vaccine (e.g. Zostavax®). Additionally, until the end of this year, the Ministry has extended eligibility.

Extended eligibility criteria

Adults born from 1949 to 1952 who missed the opportunity to receive the publicly funded shingles vaccine are eligible to receive Shingrix® and complete the 2-dose series by December 31, 2023
- Provided they have not previously received a publicly funded shingles vaccine (e.g. Zostavax®).

Immunization Schedule

Shingrix® is a 2 dose immunization series, with the second dose given 2-6 months after the first

More Information

REVIEW: Benefits of Long Acting Injectable (LAI) Antipsychotics for Schizophrenia

Long Acting Injectable antipsychotics (LAI APs) have shown to be an effective way to treat patients living with schizophrenia or bipolar disorder who relapse due to non-adherence. LAIs are considered for patients with recent-onset schizophrenia and those with risk factors for medication non-adherence including history of non-adherence, severe symptoms, comorbid substance use, cognitive impairment, ambivalence or negative attitudes towards medications, and poor insight.

There are many advantages to LAIs including:

Maintains steady levels of medication in the blood
Ensures regular appointments with their primary care provider – allows provider to follow up on other physical needs
Reduces hospitalization, relapse, criminal offences, and incarceration
Reduces mortality associated with schizophrenia
Improves outcomes by preventing subsequent episodes

The Early Psychosis Intervention (EPI) and Assertive Community Treatment (ACT) teams at Niagara Region Mental Health provide injections to clients at the office or in the community.

If you have questions about these services, or would like more information, please call 905-688-2854, ext. 7242. If you have a patient who would benefit from Niagara Region Mental Health services, please complete an online referral form.

REVIEW: Food-Borne Illness Investigations

Summertime activities bring a spike in reports of food-borne gastro-intestinal (GI) illnesses. Food-borne illness is often a result from consuming contaminated food or water and some can spread from person to person.

Public Health investigates incidences of suspect and confirmed GI illnesses related to consumption of food from restaurants, special events and other food premises, as well as food-borne illness from dining at home. Public health advises symptomatic clients to connect with their physician for testing and treatment where necessary.

Symptoms of food-borne illness can include

Nausea
Vomiting
Diarrhea
Fever
Stomach cramps

If you have a patient presenting with GI illness symptoms and you suspect they have a food-borne illness that may be associated with a food premise, please have them contact Niagara Region Public Health at 905-688-8248 ext 7590.

To report suspected or confirmed cases of food-borne illness to Public Health call

905-688-8248 ext. 7330
Toll free: 1-888-505-6074
Emergency after-hours: 905-984-3690

Learn more about enteric and food-borne illness.

REVIEW: Adverse Childhood Experiences

Adverse Childhood Experiences (ACEs) are a critical risk factor for a number of poor health outcomes, such as cardiovascular disease, substance use, and mental health challenges. The Canadian Paediatric Society (CPS) recently prepared a position statement on how physicians can mitigate the risk of poor health outcomes through relational health approaches.

Relational health is a framework that explores the role of early relationships and experiences in healthy development throughout the childhood and adolescent years. As such, mitigating risks associated with the parent-child interactions can have profound impacts to the child across the lifespan.

Physicians are a trusted source of information, and therefore have an opportunity to connect parents to services like Niagara Parents to support their needs and improve parent-child interactions.

FREE WEBINAR: How to Talk to Clients About Their Mental Health - The Right Way

When: June 29, 2023 12:00PM - 1:00PM (EST)

Where: Live Webinar (Zoom)

Register: How to Talk to Clients About Their Mental Health - The Right Way

The goal of this 1-hour webinar is to equip and empower attendees to have meaningful conversations about mental health with their clients. We’ll do this by sharing what to look out for, how to start and steer a conversation, and how to recommend external support to a client — all while maintaining your own boundaries.

This webinar is for you if…

You’re a healthcare provider or in a supporting role at a healthcare practice
You want to become more aware of your client’s mental well being
You want to understand the steps to refer your client to sources of support
You need overflow support for mental healthcare services

MEDICAL ADVISORIES AND MEMOS

June 9 MEMO: Final Notices for Students Born 2006-2018
June 1 MEMO: Increased iGAS in Ontario