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Human respiratory syncytial virus (HRSV) is the main cause of acute lower respiratory infections in children under 2 years of age and causes repeated infections throughout life. We investigated the genetic variability of RSV-A circulating in Ontario during 2010-2011 winter season by sequencing and phylogenetic analysis of the G glycoprotein gene.Among the 201 consecutive RSV isolates studied, RSV-A (55.7%) was more commonly observed than RSV-B (42.3%). 59.8% and 90.1% of RSV-A infections were among children ≤12 months and ≤5 years old, respectively. On phylogenetic analysis of the second hypervariable region of the 112 RSV-A strains, 110 (98.2%) clustered within or adjacent to the NA1 genotype; two isolates were GA5 genotype. Eleven (10%) NA1-related isolates clustered together phylogenetically as a novel RSV-A genotype, named ON1, containing a 72 nucleotide duplication in the C-terminal region of the attachment (G) glycoprotein. The predicted polypeptide is lengthened by 24 amino acids and includes a23 amino acid duplication. Using RNA secondary structural software, a possible mechanism of duplication occurrence was derived. The 23 amino acid ON1 G gene duplication results in a repeat of 7 potential O-glycosylation sites including three O-linked sugar acceptors at residues 270, 275, and 283. Using Phylogenetic Analysis by Maximum Likelihood analysis, a total of 19 positively selected sites were observed among Ontario NA1 isolates; six were found to be codons which reverted to the previous state observed in the prototype RSV-A2 strain. The tendency of codon regression in the G-ectodomain may infer a decreased avidity of antibody to the current circulating strains. Further work is needed to document and further understand the emergence, virulence, pathogenicity and transmissibility of this novel RSV-A genotype with a72 nucleotide G gene duplication.

Although rates of blastomycosis in Canada remain low outside of historically endemic areas, the range for Blastomyces now includes Quebec, Manitoba, Saskatchewan, Ontario -- the Kenora area has the highest global rates -- and the eastern US. Changes in climate and land use are hypothesized to be causing the expansion. Although a travel and exposure history remains important to differential diagnosis, cases are increasingly described in patients who have not traveled to traditional endemic areas. Blastomyces grows in soil and decaying vegetative material. Blastomycosis is typically acquired through inhalation of spores from the disrupted environment and, occasionally, through cutaneous inoculation; it does not spread person-to-person. Indigenous people have a higher incidence of disease. Other mammals, including domestic dogs, are susceptible.

Explore how previous work during the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak affects the psychological response of clinical and non-clinical healthcare workers (HCWs) to the current COVID-19 pandemic. A cross-sectional, multi-centered hospital online survey of HCWs in the Greater Toronto Area, Canada. Mental health outcomes of HCWs who worked during the COVID-19 pandemic and the SARS outbreak were assessed using Impact of Events-Revised scale (IES-R), Generalized Anxiety Disorder scale (GAD-7), and Patient Health Questionnaire (PHQ-9). Among 3852 participants, moderate/severe scores for symptoms of post- traumatic stress disorder (PTSD) (50.2%), anxiety (24.6%), and depression (31.5%) were observed among HCWs. Work during the 2003 SARS outbreak was reported by 1116 respondents (29.1%), who had lower scores for symptoms of PTSD (P = .002), anxiety (P < .001), and depression (P < .001) compared to those who had not worked during the SARS outbreak. Multivariable logistic regression analysis showed non-clinical HCWs during this pandemic were at higher risk of anxiety (OR, 1.68; 95% CI, 1.19-2.15, P = .01) and depressive symptoms (OR, 2.03; 95% CI, 1.34-3.07, P < .001). HCWs using sedatives (OR, 2.55; 95% CI, 1.61-4.03, P < .001), those who cared for only 2-5 patients with COVID-19 (OR, 1.59; 95% CI, 1.06-2.38, P = .01), and those who had been in isolation for COVID-19 (OR, 1.36; 95% CI, 0.96-1.93, P = .05), were at higher risk of moderate/severe symptoms of PTSD. In addition, deterioration in sleep was associated with symptoms of PTSD (OR, 4.68, 95% CI, 3.74-6.30, P < .001), anxiety (OR, 3.09, 95% CI, 2.11-4.53, P < .001), and depression (OR 5.07, 95% CI, 3.48-7.39, P < .001). Psychological distress was observed in both clinical and non-clinical HCWs, with no impact from previous SARS work experience. As the pandemic continues, increasing psychological and team support may decrease the mental health impacts.

Diphtheria is a disease with a range of clinical manifestations and types. It is classified according to both anatomic site of infection and whether it is toxin producing or not. Respiratory diphtheria is caused by toxigenic strains of the gram-positive bacteria C. diphtheriae or, more rarely, by other toxigenic species (C. ulcerans and C. pseudotuberculosis). Initial symptoms of pharyngeal or tonsillar diphtheria typically include fever, pharyngitis, hoarse voice and enlarged cervical lymph nodes, progressing to upper airway obstruction and acute respiratory distress. Two classic signs of toxigenic respiratory diphtheria include a greyish-white membrane on the tonsils and significant swelling of the uvula, tonsils, cervical lymph nodes, anterior neck and submandibular area, resembling a \"bull neck.\" Here, Cholewa et al examine the case of a 69-year-old visitor to Canada with diphtheria.

Background: While testing healthcare workers (HCWs) for SARS‐CoV‐2 is important to reduce transmission within healthcare settings, understanding the self‐reported patterns of testing is important for interpreting vaccine effectiveness and other COVID‐19‐related information. Objective: Using longitudinal data from the COVID‐19 cohort study, this study described trends in SARS‐CoV‐2 testing among Canadian HCWs between June 2020 and November 2023. Methods: HCWs completed an illness report for each instance of SARS‐CoV‐2 testing and episodes of symptoms compatible with COVID‐19 even if untested. Overall rates of testing among the participating cohort were calculated. Rates were stratified by province, reason for testing and COVID‐19 vaccination status using 4‐week intervals to smooth estimates. For episodes of symptomatic illness (only), the median time between symptom onset and first test was calculated, along with the percent of episodes initially receiving a negative result for SARS‐CoV‐2 that were reported as being retested. Results: Rates of testing for SARS‐CoV‐2 generally mirrored rates of hospitalisation for COVID‐19 among Canadians. Rates of testing were highest during the Omicron BA.1 wave (11.9 participants tested at least once per 1000 person‐days) and varied by province; vaccination status did not impact rates. The most common reason for testing was for symptoms. Testing for known exposure or routine reasons greatly decreased after the Omicron BA.1 wave. In participants who were tested for episodes of symptomatic illness, the median time between symptom onset and first test was 1 day (interquartile range 0–2). Reported retesting after an initial negative result remained low throughout the study period. Conclusions: Understanding testing behaviours is important for public health decision‐making including the analysis and interpretation of case data and vaccine effectiveness studies. It can also highlight possible missed case–finding opportunities in healthcare settings.

Introduction: This study explores the relationship between emotional support, perceived risk and mental health outcomes among health care workers, who faced high rates of burnout and mental distress since the beginning of the COVID-19 pandemic.Methods: A cross-sectional, multicentred online survey of health care workers in the Greater Toronto Area, Ontario, Canada, during the first wave of the COVID-19 pandemic evaluated coping strategies, confidence in infection control, impact of previous work during the 2003 SARS outbreak and emotional support. Mental health outcomes were assessed using the Generalized Anxiety Disorder scale, the Impact of Event Scale – Revised and the Patient Health Questionnaire (PHQ-9).Results: Of 3852 participants, 8.2% sought professional mental health services while 77.3% received emotional support from family, 74.0% from friends and 70.3% from colleagues. Those who felt unsupported in their work had higher odds ratios of experiencing moderate and severe symptoms of anxiety (odds ratio [OR] = 2.23; 95% confidence interval [CI]: 1.84–2.69), PTS (OR = 1.88; 95% CI: 1.58–2.25) and depression (OR = 1.88; 95% CI: 1.57–2.25). Nearly 40% were afraid of telling family about the risks they were exposed to at work. Those who were able to share this information demonstrated lower risk of anxiety (OR = 0.58; 95% CI: 0.48–0.69), PTS (OR = 0.48; 95% CI: 0.41–0.56) and depression (OR = 0.55; 95% CI: 0.47–0.65).Conclusion: Informal sources of support, including family, friends and colleagues, play an important role in mitigating distress and should be encouraged and utilized more by health care workers.

Background. Human immunodeficiency virus (HlV)-related facial lipoatrophy is a devastating adverse effect of antiretroviral therapy. At this time, the most viable treatment option is cosmetic surgery with synthetic fillers. Bio-Alcamid has many advantages over other fillers, and has become widely used. The objective of this study was to determine the incidence rate of infectious complications associated with Bio-Alcamid facial filler in patients with HIV-related facial lipoatrophy (FLA). Methods. This retrospective study identified patients who had received treatment with Bio-Alcamid, and reviewed their long-term outcomes. Results. Two hundred sixty-seven patients with Bio-Alcamid were reviewed. Infectious complications were documented in 56 (19%) patients. The incidence rate of infection was 0.07 per patient-year of follow-up. Among patients with infections, the median time from first Bio-Alcamid treatment to infection was 32 months (interquartile range, 21-42). We did not find an association between the development of infection and the level of immune suppression by HIV. Surgical drainage in addition to antibiotics was required for the majority of patients. Potential risk factors for infection include severity of FLA and a preceding history of facial manipulation, including Bio-Alcamid touch-up treatments, cosmetic surgery, facial trauma, and dental work. Conclusions. Bio-Alcamid treatment of HIV-related FLA was associated with a high rate of infectious complications, often presenting years after treatment. Antibiotic prophylaxis should be considered in patients with Bio-Alcamid prior to dental work or facial manipulation.

Introduction. Cette étude explore la relation entre le soutien émotionnel, le risque perçu et les résultats en matière de santé mentale chez les travailleurs de la santé, qui font face à des taux élevés d’épuisement professionnel et de détresse mentale depuis le début de la pandémie de COVID‑19.Méthodologie. Une enquête transversale a été menée en ligne au cours de la première vague de la pandémie de COVID‑19 auprès de travailleurs de la santé de divers centres de la région du Grand Toronto (Ontario, Canada) pour évaluer les stratégies d’adaptation, la confiance dans les mesures de lutte contre les infections, l’impact du travail antérieur lors de l’épidémie de SRAS survenue en 2003 et le soutien émotionnel. Les résultats en matière de santé mentale ont été évalués au moyen de l’échelle du trouble d’anxiété généralisée (GAD-7), de l’échelle d’impact des événements – révisée (IES‑R) et du questionnaire sur la santé des patients (PHQ-9).Résultats. Sur les 3 852 participants, 8,2 % ont eu recours à des services professionnels en santé mentale, 77,3 % ont reçu du soutien émotionnel de la part de membres de leur famille, 74,0 % de la part d’amis et 70,3 % de la part de collègues. Les personnes qui ne se sont pas senties soutenues dans leur travail présentaient des probabilités plus élevées d’éprouver des symptômes d’anxiété modérés et sévères (rapport de cotes [RC] = 2,23; intervalle de confiance [IC] à 95 % : 1,84 à 2,69), de trouble de stress post-traumatique (TSPT) (RC = 1,88; IC à 95 % : 1,58 à 2,25) et de dépression (RC = 1,88; IC à 95 % : 1,57 à 2,25). Près de 40 % avaient peur de parler à leur famille des risques auxquels ils étaient exposés au travail. Ceux qui ont pu partager cette information faisaient état d’un risque plus faible d’anxiété (RC = 0,58; IC à 95 % : 0,48 à 0,69), de TSPT (RC = 0,48; IC à 95 % : 0,41 à 0,56) et de dépression (RC = 0,55; IC à 95 % : 0,47 à 0,65).Conclusion. Les sources informelles de soutien, en particulier la famille, les amis et les collègues, jouent un rôle important dans l’atténuation de la détresse et devraient être encouragées et utilisées davantage par les travailleurs de la santé.