Eleni Galanis

Web-based Surveillance and Global Salmonella Distribution, 2000–2002

Surveillance improves control of Salmonella infections.

Spread of Cryptococcus gattii in British Columbia, Canada, and Detection in the Pacific Northwest, USA

Cryptococcus gattii, emergent on Vancouver Island, British Columbia (BC), Canada, in 1999, was detected during 2003–2005 in 3 persons and 8 animals that did not travel to Vancouver Island during the incubation period; positive environmental samples were detected in areas outside Vancouver Island. All clinical and environmental isolates found in BC were genotypically consistent with Vancouver Island strains. In addition, local acquisition was detected in 3 cats in Washington and 2 persons in Oregon. The molecular profiles of Oregon isolates differed from those found in BC and Washington. Although some microclimates of the Pacific Northwest are similar to those on Vancouver Island, C. gattii concentrations in off-island environments were typically lower, and human cases without Vancouver Island contact have not continued to occur. This suggests that C. gattii may not be permanently colonized in off-island locations.

Spread of Cryptococcus gattii into Pacific Northwest Region of the United States

This organism should be recognized as an emerging pathogen in the United States.

Epidemiology of Cryptococcus gattii, British Columbia, Canada, 1999–2007

Incidence is high, but the predominant strain does not seem to cause greater illness or death than do other strains.

Risk Factors for Cryptococcus gattii Infection, British Columbia, Canada

To determine whether particular environmental, medical, or behavioral risk factors existed among Cryptcoccus gattii–infected persons compared with the general population, we conducted a sex-matched case−control study on a subset of case-patients in British Columbia (1999–2001). Exposures and underlying medical conditions among all case-patients (1999–2007) were also compared with results of provincial population–based surveys and studies. In case−control analyses, oral steroids (matched odds ratio [MOR] 8.11, 95% confidence interval [CI] 1.74–37.80), pneumonia (MOR 2.71, 95% CI 1.05–6.98), and other lung conditions (MOR 3.21, 95% CI 1.08–9.52) were associated with infection. In population comparisons, case-patients were more likely to be >50 years of age (p<0.001), current smokers (p<0.001), infected with HIV (p<0.001), or have a history of invasive cancer (p<0.001). Although C. gattii is commonly believed to infect persons with apparently healthy immune systems, several immunosuppressive and pulmonary conditions seem to be risk factors.

Cost Effectiveness of Herpes Zoster Vaccine in Canada

Background: Herpes zoster (HZ), or shingles, results from reactivation of latent varicella zoster virus in the sensory ganglia of adults, and results in significant morbidity in the elderly, including the development of postherpetic neuralgia (PHN). The lifetime risk of HZ is about 20–30% and the incidence increases with age. The protective effect of the HZ vaccine has been shown in a large clinical trial; however, the effectiveness of the vaccine decreased with age of vaccination.Objective: We sought to compare the incremental cost and health benefits of HZ vaccine over status quo (no HZ vaccine) from the perspective of the Canadian healthcare payer.Methods: We developed a discrete-event simulation model comparing the costs and QALYs accrued to patients receiving HZ vaccine to those who did not. The effect of the vaccine on the (i) incidence of severe, moderate or mild HZ; (ii) severity and duration of HZ; (iii) incidence of PHN among patients with HZ; (iv) duration of PHN; and (v) costs associated with treating HZ and PHN were modelled. Data from published literature, including the Shingle Prevention Study, were used for transition probabilities. Health resource utilizations were estimated using administrative data retrieved from the British Columbia Medical Services Plan and hospital separation databases in British Columbia from 1994 to 2003. Utility estimates were obtained from various published sources. Canadian 2008 costs were used and both cost and QALYs were discounted at a 5% annual rate in the base-case analyses.Results: On average, receiving the vaccination lowered mean direct medical costs (excluding the vaccine costs) by

Clinical presentation, diagnosis and management of Cryptococcus gattii cases: Lessons learned from British Columbia.

Can35 per person. The incremental cost and QALYs per person receiving the vaccine versus no vaccination were

Where's the pump? Associating sporadic enteric disease with drinking water using a geographic information system, in British Columbia, Canada, 1996-2005

Can115 and 0.0028 QALYs, respectively, resulting in an incremental cost-effectiveness ratio of

Outbreak of Diarrhetic Shellfish Poisoning Associated with Mussels, British Columbia, Canada

Can41 709 per QALY gained for a cohort of elderly subjects aged ≥60 years. Results were robust in probabilistic and univariate sensitivity analyses. Expected value of perfect information was estimated at

Multiple clusters of norovirus among shellfish consumers linked to symptomatic oyster harvesters.

Can47.72 per person, reflecting the expected monetary losses that could be avoided by having perfect information on all model parameters.Conclusion: HZ vaccination of adults, especially for individuals aged 60–75 years, seems to be a cost-effective intervention and might be considered by Canadian decision makers.