Jennifer Geduld

Reemergence of the HIV epidemic among men who have sex with men in North America, Western Europe, and Australia, 1996-2005.

PURPOSE To describe and contextualize changes in rates of human immunodeficiency virus (HIV) notifications in men who have sex with men (MSM) in eight countries (Australia, Canada, France, Germany, Netherlands, Spain, United Kingdom, and United States) from 1996-2005. METHODS We analyzed trends in HIV notification rates from 1996-2000 and 2000-2005 by generalized linear regression and estimated annual percentage change (EAPC) in rates of HIV notifications. To interpret trends, we visually examined graphs of primary and secondary syphilis reports among MSM and the prevalence of recent HIV testing. RESULTS The rate of HIV notifications among MSM declined 5.2% per year (95% confidence interval [CI]: -5.8%, -4.7%) from 1996-2000, and increased 3.3% per year (95% CI: +2.9%,+3.7%) from 2000-2005. During the period of increasing HIV diagnoses, increases in primary and secondary syphilis diagnoses occurred among MSM, but recent HIV testing among MSM did not seem to increase. CONCLUSIONS After declining in the second half of the 1990s, HIV notification rates for MSM increased beginning in 2000. Increased HIV notifications in MSM are not wholly explained by changes in HIV testing. Urgent efforts are required to develop effective HIV prevention interventions for MSM, and implement them broadly in these countries.

Surveillance report of Zika virus among Canadian travellers returning from the Americas

BACKGROUND: Widespread transmission of Zika virus in the Americas has occurred since late 2015. We examined demographic and travel-related characteristics of returned Canadian travellers with Zika infection acquired in the Americas to illuminate risk factors for acquisition and the clinical spectrum. METHODS: We analyzed demographic and travel-related data for returned Canadian travellers who presented to a CanTravNet site between October 2015 and September 2016 for care of Zika virus acquired in the Americas. Data were collected with use of the GeoSentinel Surveillance Network data platform. RESULTS: During the study period, 1118 travellers presented to a CanTravNet site after returning from the Americas, 41 (3.7%) of whom had Zika infection. Zika infection from the Americas was diagnosed at CanTravNet sites as often as dengue (n = 41) over the study period. In the first half of the study period, Zika virus burden was borne by people visiting friends and relatives in South America. In the latter half, coincident with the increased spread of Zika throughout the Caribbean and Central America, Zika virus occurred more often in tourists in the Caribbean. Forty (98%) of the travellers with Zika infection acquired it through probable mosquito exposure, and 1 had confirmed sexual acquisition. Congenital transmission occurred in 2 of 3 pregnancies. Two (5%) of those with Zika had symptoms resembling those of Guillain–Barré syndrome, 1 of whom also had Zika viral meningitis. INTERPRETATION: Even in this small cohort, we observed the full clinical spectrum of acute Zika virus, including adverse fetal and neurologic outcomes. Our observations suggest that complications from Zika infection are underestimated by data arising exclusively from populations where Zika is endemic. Travellers should adhere to mosquito-avoidance measures and barrier protection during sexual activity.

Combining data sources to monitor the HIV epidemic in Canada.

&NA; This article describes the methods, results and future perspectives of four information sources used to monitor the HIV epidemic in Canada: AIDS case surveillance, HIV case surveillance, HIV sentinel serosurveillance, and behavioral surveillance. Synthesizing data from these multiple sources provides a more comprehensive picture of the HIV epidemic than any one source alone could provide. In Canada, there has been a shift over time from an epidemic dominated by men who have sex with men to one where more than half of new infections are attributed to other groups, such as injection drug users and non‐injecting heterosexuals. The available evidence also suggests increasing HIV infections among Aboriginal persons and among women. Surveillance data have been used in Canada to guide prevention and care programs and to formulate policy. In particular, these data have been used to support the development of an HIV testing program in pregnancy, to re‐direct community work toward injection drug users and the young, and to demonstrate the effectiveness of new treatments for HIV. The main challenge now is to continue to improve the monitoring of the shifting HIV epidemic with more accurate data and to use the resulting information to inform appropriate prevention and care responses.

Severe malaria in Canada, 2001-2013.

BackgroundImported malaria is the principal, preventable, life-threatening infection among Canadians travelling abroad. The Canadian Malaria Network supplies information and parenteral malaria therapy to healthcare providers treating severe and complicated malaria and gathers surveillance information on these cases.MethodsData were collected on the characteristics, risk factors, and clinical outcomes of severe malaria cases in Canada from June 2001 to December 2013.ResultsThe need for parenteral therapy in Canada has increased in the last decade. The vast majority of cases are reported from Ontario and Quebec and occur among travellers to and from Africa. Regardless of country of birth, all persons originating from endemic and non-endemic countries are at a similar risk of malaria-related complications. Overall use and appropriateness of pre-travel advice and chemoprophylaxis remains low. Most cases result from patient delays in recognizing symptoms and seeking appropriate medical attention. Although some healthcare delays occurred in a select number of cases, the majority of patients were diagnosed quickly and were appropriately treated with parenteral therapy within a few hours of diagnosis.ConclusionsData from the Canadian Malaria Network provide insight into the characteristics of imported severe and complicated malaria infections in Canada. Improved understanding of this population can help target risk reduction strategies and interventions to limit personal susceptibility and healthcare treatment delays.

The changing landscape of travel health services in Canada

Canadians are increasingly travelling to areas that would necessitate a pre-travel consultation. Changes in professional regulations in Canada allow greater autonomy of nurses and pharmacists, resulting in shifts in provision of travel health services. We surveyed 824 Canadian travel clinics, 270 (33%) of whom responded. Private clinics were most common, and more likely to offer extended hours and drop-in appointments. In one province, pharmacies dominated. Half the services were relatively new and a similar proportion saw fewer than 10 patients weekly; 1/3 had a single provider. The increased spectrum of services may increase convenience for travellers but the large proportion seeing low numbers of clients will challenge providers to maintain competence.

Response to “Selection bias”

We thank Dr. Jansz[1][1] for his interest in our surveillance report.[2][2] We recognize that understanding the intricacies of the CanTravNet data would be difficult without first-hand experience of our network and its patient population. CanTravNet is a consortium of post-travel (not pretravel)