Ottawa Public Health

Risk assessors, managers, and decision-makers are responsible for evaluating diverse human, environmental, and animal health risks. Although the critical elements of risk assessment and management are well-described in national and international documents, the ethical issues involved in risk decision-making have received comparatively little attention to date. To address this aspect, this article elaborates fundamental ethical principles designed to support fair, balanced, and equitable risk-based decision-making practices. Experts and global thinkers in risk, health, regulatory, and animal sciences were convened to share their lived experiences in relation to the intersection between risk science and analysis, regulatory science, and public health. Through a participatory and knowledge translation approach, an integrated risk decision-making model, with ethical principles and considerations, was developed and applied using diverse, contemporary risk decision-making and regulatory contexts. The ten principles - autonomy, minimize harm, maintain respect and trust, adaptability, reduce disparities, holistic, fair and just, open and transparent, stakeholder engagement, and One Health lens - demonstrate how public sector values and moral norms (i.e., ethics) are relevant to risk decision-making. We also hope these principles and considerations stimulate further discussion, debate, and an increased awareness of the application of ethics in identifying, assessing, and managing health risks.

Background and Objectives Concern over variant Creutzfeldt–Jakob disease (vCJD) led to the deferral of donors who had resided in the United Kingdom since January 1980. This deferral was implemented in 1999 and subsequently modified to include other countries. Some deferrals were removed in February 2022; deferrals for the United Kingdom, Ireland and France were removed on 22 November 2023. In this study, we describe efforts made to encourage donation from newly eligible people and the resulting donation gain. Materials and Methods Actions targeted individual donors deferred after 1 January 2012. Marketing included website, social media and general advertising. Staff asked first‐time donors if the criteria change had motivated their donation. Deferred and returning donor data were determined from our donor database. Results In the 12 months post‐implementation, 12.8% of first‐time donors surveyed were newly eligible ( n = 8667) and 7.8% of vCJD risk deferred donors returned ( n = 5159). Eighty‐five percent of deferrals occurred pre‐2017; the return rate was 6.5% in this group. The highest return rate (24%) occurred in donors deferred after 2020. Conclusion Removal of the vCJD deferrals had a major positive impact. The greatest gain was in new donors who had previously self‐deferred. Despite intensive efforts, only one‐quarter of recently deferred donors returned.

Setting The federal health portfolio has had a risk communications framework in place since 2006; however, the COVID-19 pandemic pushed the capacity of this plan and the need for communications resources to new levels. Health communicators in the public service face significant challenges: a fragmented mediascape, changes to how people seek and use information, the proliferation of misinformation and disinformation, declining trust in public institutions, and the politicization of science, to name just a few. It has never been more important for health authorities to communicate clearly, consistently, effectively, and from an evidence-based position. Intervention This report describes one aspect of how the federal health portfolio has been addressing these challenges. As part of a recent capacity-building initiative, 67 public servants working in health communications participated in a four-part, half-day, advanced seminar series at Carleton University in June 2023. Each session featured an interactive presentation from a leading scholar and/or local practitioner with real-world scenario exercises designed to put their learning into practice. The series explored issues in trust and transparency, algorithmic control and mis- and disinformation, media relations, and risk communication for equity-deserving populations. Outcomes At the conclusion of the program, participants were given tools to (1) identify challenges to effective communication brought by a rapidly evolving media environment in which skepticism and misinformation often run rampant; (2) examine how key metrics and behavioural indicators on social media platforms demand different responses from health organizations and agencies who are monitoring and managing social media; (3) consider challenges for health communicators who must serve the public during health crises while also reinforcing public trust in their institutions; and (4) develop successful risk communication strategies for equity-deserving communities by considering specific information needs and tailored dissemination methods to reach the intended audience. Participants expressed high levels of satisfaction in the quality of the training and overwhelmingly reported that it would positively impact their daily work. Implications The training program was an innovative and successful initiative to improve knowledge of current priority topics and best practices in risk communication. It illustrated the benefits of continued professional learning, the importance of university-public service partnerships, and how capacity building requires ongoing resource commitments and engaged support from senior management. The program, along with other risk communication training that is currently being implemented, is part of the investment in long-term professional development of risk communicators in the health portfolio.

Introduction Nous avons exploré, chez les personnes ayant survécu à la COVID-19, la prévalence de manifestations nouvelles ou persistantes trois mois ou plus après leur infection initiale, manifestations rassemblées sous le terme de syndrome post-COVID-19 (SPC). Méthodologie Nous avons interrogé quatre bases de données électroniques et les principales sources de littérature grise afin de trouver des études prospectives, des revues systématiques, des rapports faisant autorité et des enquêtes populationnelles. Une méta-analyse à effets aléatoires a permis de mettre en commun les données de prévalence de 22 symptômes et conséquences. L’approche GRADE a été utilisée pour évaluer le degré de certitude des données probantes. Numéro d’enregistrement PROSPERO CRD42021231476. Résultats Sur 20 731 documents recensés, 194 répondaient à nos critères d’inclusion. Dans le cadre de ces études, 483 531 personnes ayant reçu un diagnostic confirmé de COVID-19 ont fait l’objet d’un suivi sur des périodes allant jusqu’à 2 ans. La plupart des études portaient sur des adultes, près des deux tiers ont été menées en Europe et 63 % étaient de qualité élevée ou moyenne. Une recherche complémentaire a permis d’obtenir 17 revues systématiques, 5 rapports faisant autorité et 4 enquêtes populationnelles portant sur la prévalence du SPC. Notre analyse a révélé que plus de la moitié des personnes ayant survécu à la COVID-19 ont présenté un ou plusieurs symptômes du SPC plus d’un an après leur infection initiale. Les symptômes répertoriés les plus courants ont été la fatigue, la dyspnée, des troubles de la mémoire, du sommeil ou de la concentration, la dépression et la douleur. Les limitations en matière de retour au travail ont constitué la conséquence la plus courante. La prévalence s’est révélée généralement plus élevée chez les femmes, les personnes hospitalisées au cours de leur infection initiale et les personnes ayant présenté une forme grave de la COVID-19. Conclusion Le SPC représente un lourd fardeau pour la santé, et certains groupes sont plus touchés que d’autres. Ces renseignements aideront à orienter les politiques et les services du système de soins de santé destinés aux personnes atteintes du SPC et à leurs proches.

Background and Objectives Seasonal vaccinations reduce donor illness and appointment cancellations and ensure plasma products have antibodies to vaccine‐directed strains. We aimed to describe donor influenza and COVID‐19 vaccination history and compare this with the general population. Materials and Methods Two online donor surveys were carried out in 2021 and 2024. Donors were asked about demographics, influenza (2019/2020, 2020/2021 and 2023/2024 seasons) and COVID‐19 (ever and 2023/2024 season) vaccination and reasons for vaccination choices. General population vaccination statistics were extracted from public reports. Percentages of donors receiving vaccination were calculated with 95% confidence intervals. Multiple logistic regression models were fitted with demographics as independent variables. Results In survey 1, 4582 (30.4% response rate) donors completed a questionnaire; in survey 2, 6376 (21% response rate). More donors under age 65 received the influenza vaccine compared with the general population under age 65 (58% vs. 30% in 2019/2020, 63% vs. 28% in 2023/2024, p < 0.0001) and aged 65+ (81% vs. 70% in 2019/2020, 90% vs. 73% in 2023/2024, p < 0.0001). Fewer donors and the general population received the COVID‐19 vaccine in 2023/2024 (under 65 45% vs. 39%; 65+ 76% vs. 67%, p < 0.0001). Most said they were vaccinated to prevent infection and protect others. Conclusion Seasonal vaccination rates are higher in older donors, consistent with public health recommendations. Blood donors are more likely to be vaccinated against seasonal influenza than the general population, but post‐pandemic uptake of the COVID‐19 booster vaccine was low, more similar to the general population.

The Manual for Surveillance of Events Supposedly Attributable to Vaccination or Immunization in the Region of the Americas represented one of the first steps toward building the regional system for surveillance of events supposedly attributable to vaccination or immunization (ESAVIs) and adverse events of special interest (AESIs). This manual establishes that, after notification and investigation of an event, a national committee of experts should classify the event in accordance with the World Health Organization (WHO) causality classification. The Pan American Committee for Safe Vaccination (COPAVASE) was created in response to the introduction of the new COVID-19 vaccines to support causality analysis of complex regional ESAVI cases and to advise the Pan American Health Organization (PAHO) on strategies for developing safety information and implementing risk mitigation measures. As part of this work, two strategic planning exercises were carried out, one with Committee members and PAHO staff and another that included national authorities and committee members, who contributed ideas on how to strengthen the work both at the regional level and in countries’ surveillance systems. Suggested areas of work included definition of clear guidelines, development of model terms of reference and case presentation guidelines, training, and strategies to ensure committee sustainability. With the strategies identified, PAHO expects to be able to continue strengthening national safe vaccination committees as key institutions for maintaining public trust.

Background Research has shown that perceptions of a mental health need are closely associated with service demands and are an important dimension in needs assessment. Perceived and unmet mental health needs are important factors in the decision-making process regarding mental health services planning and resources allocation. However, few prediction tools are available to be used by policy and decision makers to forecast perceived and unmet mental health needs at the population level. Objective We aim to develop prediction models to forecast perceived and unmet mental health needs at the provincial and health regional levels in Canada. Methods Data from 2018, 2019, and 2020 Canadian Community Health Survey and Canadian Urban Environment were used (n=65,000 each year). Perceived and unmet mental health needs were measured by the Perceived Needs for Care Questionnaire. Using the 2018 dataset, we developed the prediction models through the application of regression synthetic estimation for the Atlantic, Central, and Western regions. The models were validated in the 2019 and 2020 datasets at the provincial level and in 10 randomly selected health regions by comparing the observed and predicted proportions of the outcomes. Results In 2018, a total of 17.82% of the participants reported perceived mental health need and 3.81% reported unmet mental health need. The proportions were similar in 2019 (18.04% and 3.91%) and in 2020 (18.1% and 3.92%). Sex, age, self-reported mental health, physician diagnosed mood and anxiety disorders, self-reported life stress and life satisfaction were the predictors in the 3 regional models. The individual based models had good discriminative power with C statistics over 0.83 and good calibration. Applying the synthetic models in 2019 and 2020 data, the models had the best performance in Ontario, Quebec, and British Columbia; the absolute differences between observed and predicted proportions were less than 1%. The absolute differences between the predicted and observed proportion of perceived mental health needs in Newfoundland and Labrador (−4.16% in 2020) and Prince Edward Island (4.58% in 2019) were larger than those in other provinces. When applying the models in the 10 selected health regions, the models calibrated well in the health regions in Ontario and in Quebec; the absolute differences in perceived mental health needs ranged from 0.23% to 2.34%. Conclusions Predicting perceived and unmet mental health at the population level is feasible. There are common factors that contribute to perceived and unmet mental health needs across regions, at different magnitudes, due to different population characteristics. Therefore, predicting perceived and unmet mental health needs should be region specific. The performance of the models at the provincial and health regional levels may be affected by population size.

Background Longitudinal healthcare worker (HCW) cohorts throughout the COVID-19 pandemic provide a unique opportunity to study the relative contributions of various exposures to infection risk over time. This study aimed to examine how demographic, health, occupational, household and community factors influenced the SARS-CoV-2 infection risk in a cohort of HCWs in Southeastern Ontario, Canada, during the early pandemic and the Omicron waves. We compared the contribution of these factors to infection risk and explored the implications for future epidemic preparedness and the protection of HCWs. Methods We conducted a longitudinal analysis using data from a cohort of HCWs recruited from one acute care hospital and four long-term care homes. The analysis was divided into two periods: the initial phase of the pandemic (period #1) and the first three Omicron waves (period #2). We employed Poisson regression for period #1 and Cox regression for period #2 to examine associations of demographic factors (age, sex, ethnicity, migration status, income insufficiency), health factors (chronic conditions, smoking history, SARS-CoV-2 vaccination status), household factors (exposure to COVID-19), occupational factors (work role, exposure to COVID-19 patients, personal protective equipment access, aerosol-generating procedures) and community exposures (use of masks, distance, hand-washing) with SARS-CoV-2 infection. Results At period #1, 17/208 (8.2%) HCWs reported having had SARS-CoV-2 infection. At period #2, 65/167 (38.3%) reported at least one SARS-CoV-2 infection. In period #1, factors associated with increased risk of infection included working in a long-term care home, exposure to more COVID-19-positive patients, working as a nurse or therapist, and inadequate use of personal protective equipment. In period #2, the hazard of infection was higher among HCWs who had COVID-19-infected children at home, whereas the use of protective measures in the community (maintaining social distance, mask-wearing) and receiving a vaccine booster were associated with reduced risk. Providing care to COVID-19 patients was not associated with the risk of acquiring SARS-CoV-2 infection at period #2. Conclusions During the Omicron wave, community and household exposures, but not occupational exposure to COVID-19 cases, were the primary factors contributing to infection risk in HCWs. This contrasts with the early waves of the pandemic where occupational exposures played a significant role. These findings may be explained by the effectiveness of institutional interventions in reducing the risk of SARS-CoV-2 transmission in healthcare settings, alongside the failure of community-level interventions to mitigate risk during the Omicron period.

Objective Artificial intelligence (AI)‐based clinical decision support (CDS) has the potential to augment high‐stakes clinical decisions in the emergency department (ED). However, its current usage and translation to implementation remains poorly understood. We asked: (1) What is the current landscape of AI‐CDS for individual patient care in the ED? and (2) What phases of development have AI‐CDS tools achieved? Methods We performed a scoping review of AI for prognostic, diagnostic, and treatment decisions regarding individual ED patient care. We searched five databases (MEDLINE, EMBASE, Cochrane Central, Scopus, Web of Science) and gray literature sources from January 1, 2010, to December 11, 2023. We adhered to guidelines from the Joanna Briggs Institute and PRISMA Extension for Scoping Reviews. We published our protocol on Open Science Framework (DOI 10.17605/OSF.IO/FDZ3Y ). Results Of 5168 unique records identified, we selected 605 studies for inclusion. The majority (369, 61%) were published in 2021–2023. The studies ranged over a variety of clinical applications, patient populations, and AI model types. Prognostic outcomes were most commonly assessed (270, 44.6%), followed by diagnostic (193, 31.9%) and disposition (115, 19%). Most studies remained in the earliest phase of preclinical development (572, 94.5%) with few advancing to later phases (33, 5.5%). Conclusions By thoroughly mapping the landscape of AI‐CDS in the ED, we demonstrate a rapidly increasing volume of studies covering a breadth of clinical applications, yet few have achieved advanced phases of testing or implementation. A more granular understanding of the barriers and facilitators to implementing AI‐CDS in the ED is needed.

The recent global resurgence of measles in 2023–2024, despite vaccine preventability, underscores a critical public health issue, largely due to reduced vaccination coverage during the SARS-CoV-2 pandemic. In response, Ottawa Public Health intensified vaccination efforts in 2023 and 2024. Additionally, a research initiative began in April 2024 to monitor Ottawa wastewater for measles virus (MeV) using established wastewater and environmental surveillance (WES) protocols. Unexpected positive MeV detections through RT-qPCR in Ottawa wastewater—despite no active regional cases—prompted genotypic and retrospective analyses of archived RNA samples dating back to 2020. The genotypic analysis identified positive detection to belong to genotype A, the progenitor strain of the viral vaccines, marking the first report of MeV vaccine RNA in a large catchment area. Linear regression analysis revealed detections aligned with intensified vaccination efforts by Ottawa Public Health. These findings emphasize the importance of integrating genotypic analysis into WES practices to mitigate possible confounding factors, such as vaccine shedding into wastewater. Additionally, this research highlights potential public health applications using MeV WES as a complementary tool. Implementing the findings of this study for MeV WES, and for other re-emerging viruses, could improve public health response and resource allocation.

Background Ensuring widespread COVID-19 vaccine uptake is a public health priority in Canada and globally, particularly within communities that exhibit lower uptake rates and are at a higher risk of infection. Public health units (PHUs) have leveraged many resources to promote the uptake of recommended COVID-19 vaccine doses. Understanding barriers and facilitators to vaccine uptake, and which strategies/resources have been used to address them to date, may help identify areas where further support could be provided. We sought to identify the strategies/resources used by PHUs to promote the uptake of the first and third doses of the COVID-19 vaccine among priority groups in their jurisdictions. We examined the alignment of these existing strategies/resources with behavioral science principles, to inform potential complementary strategies/resources. Methods We reviewed the online and in-person strategies/resources used by three PHUs in Ontario, Canada to promote COVID-19 vaccine uptake among priority groups (Black and Eastern European populations, and/or neighbourhoods with low vaccine uptake or socioeconomic status). Strategies/resources were identified from PHU websites, social media, and PHU liaison. We used the Behaviour Change Techniques (BCT) Taxonomy – which describes 93 different ways of supporting behaviour change – to categorise the types of strategies/resources used, and the Theoretical Domains Framework – which synthesises 14 factors that can be barriers or facilitators to decisions and actions – to categorise the barriers and facilitators addressed by strategies/resources. Results PHUs operationalised 21 out of 93 BCTs, ranging from 15 to 20 BCTs per PHU. The most frequently operationalised BCTs were found in strategies/resources that provided information about COVID-19 infection and vaccines, increased access to COVID-19 vaccination, and integrated social supports such as community ambassadors and engagement sessions with healthcare professionals. Identified BCTs aligned most frequently with addressing barriers and facilitators related to Knowledge, Environmental context and resources, and Beliefs about consequences domains. Conclusion PHUs have used several BCTs to address different barriers and facilitators to COVID-19 vaccine uptake for priority groups. Opportunities should be pursued to broaden the scope of BCTs used (e.g., operationalizing the pros and cons BCT) and barriers/facilitators addressed in strategies/resources for ongoing and future COVID-19 vaccine uptake efforts among general and prioritised populations.

Background and Objectives Despite screening procedures, a few blood donors confirm positive for transfusion‐transmissible infections and are deferred. Effective notification of laboratory results is essential to ensure that donors are advised of confirmed results and to seek medical care. Here we report results from post‐notification interviews of Canadian Blood Services donors. Materials and Methods Over 17 years, 2006–2022, all donors with confirmed positive results for hepatitis B virus (HBV), hepatitis C virus (HCV), human T‐cell lymphotropic virus (HTLV) and syphilis were notified by registered mail of their result and advised to see a physician. In a separate communication, all donors were later invited to participate in a scripted interview asking whether they tested positive for an infection; if yes, which one, what their reaction was, whether they consulted a physician and whether public health contacted them. Frequencies of responses were calculated. Results Of 2654 donors with confirmed positive test results, 876 (33%) participated; 90% said they were informed of a positive test result. Of these, about a quarter did not know for which infection they were positive. Most were surprised, and some were sad or disappointed. Most saw a physician after notification (77%). About two‐thirds with HBV or HCV said they were contacted by public health, slightly fewer (58%) with syphilis, 27% of those with HTLV. Conclusion Most donors recalled being notified and were aware of their positive test, but details of the infection were sometimes not understood or recalled, and not all donors consulted a physician about the infection.

Background: Recent advancements in omics and benchmark dose (BMD) modeling have facilitated identifying the dose required for a predetermined change in a response (e.g. gene or protein change) that can be used to establish acceptable dose levels for hazardous exposures. Adverse Outcome Pathways (AOPs) describe the causal links between toxicants and adverse effects through key events (KEs). Integrating omics data within the AOP framework quantitatively links early molecular events to later phenotypic effects. In this study, we use omic-based BMD analyses in an in vitro blood model exposed to radiation to identify point of departure (POD) values across KEs to acute myeloid leukemia (www.aopwiki.org/aop/432). Methods: Isolated white blood cells were cultured and X-irradiated (1 Gy/minute, 0-6 Gy). Transcriptomic and proteomic changes were assessed 24 h post-exposure. BMD modeling was applied and significantly perturbed genes/proteins and pathways were identified. Those pathways relevant to KEs outlined in AOP 432 were grouped and a POD was determined. Results: BMD modeling identified 1294 genes and 167 proteins with median BMD lower confident limit (BMD) values of 1.35 and 0.32 Gy, respectively. Pathway analysis identified biological processes related to DNA damage/repair, oxidative stress, cell cycle regulation, immune responses, and cancer development. These findings aligned with the KEs in AOP 432. The BMDL values of canonical pathways associated with these KEs were generally below 0.5 Gy with specific genes (e.g. GADD45A) displaying BMDLs <0.05 Gy. Conclusions: This work provides insights into predictive radiation induced mechanisms and associated dose of activity that can be taken into consideration for low dose (< 0.1 Gy) risk analysis.

Introduction Urgent, tailored and equitable action is needed to address the alarming rise in syphilis rates in Canada. In the last decade, the rates of infectious syphilis have increased by 345% in Ontario, Canada. Underserved populations—people who use drugs, un(der)housed individuals and those living in rural and remote areas—face unique social and healthcare challenges that increase their vulnerability to syphilis infections and hinder their access to timely diagnosis and treatment. This study assesses the real-world implementation and effectiveness of using a recently approved syphilis point-of-care test in conjunction with public health outreach to break barriers and bring services to the population at the highest risk. Methods and analysis The Syphilis Rapid Point-of-Care Testing and Immediate Treatment Evaluation (SPRITE) study includes eight public health units in Ontario, Canada. Implementation and evaluation of this rapid ‘test and treat’ outreach model of care will be assessed using the Practical, Robust Implementation and Sustainability Model (PRISM)/Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) Framework, following a community-based participatory approach. Network models will be used to estimate the population-level impact of implementing this model of care to curb transmission. Knowledge mobilisation will be assessed using the Reciprocity, Externalities, Access, and Partnership (REAP) Self-Assessment Model. Ethics and dissemination The SPRITE study was approved by the Queen’s University Research Ethics Board (REB) and is to be conducted in accordance with the Canadian Tri-Council Policy Statement V.2 and the latest Seoul revision of the Declaration of Helsinki. Knowledge generated from this study will be mobilised through community-based organisations and the broader public health community.

Background The practice of patient self-collected swab specimens for Neisseria g onorrhoeae and Chlamydia trachomatis is supported in the literature. Local problem Health care providers observed that patients sometimes performed their self-swabs incorrectly resulting in cancelled or invalid specimens. Methods The clinic's outdated visual aids were replaced with new visual aids. The goal was to improve health care provider proficiency in providing the health teaching and to reduce the clinic's number of cancelled or invalid swab specimens. Staff evaluated the visual aids using an online pretest and post-test survey. The percentage of invalid swabs was calculated before and after project implementation. Intervention The posters were designed and printed. In-person teaching on the project and using the new visual aids was provided. Results There was no change in the reported proficiency of staff in providing health teaching for self-collected swab specimens. There was a reduction in staff observed self-swabbing errors. Three percent of rectal swabs were reported as invalid in the 2 weeks before project implementation, and 1.4% of rectal swabs were invalid in the 2 weeks after. Conclusions Providing patient health teaching using verbal instructions combined with visual diagrams can improve patients' ability to retain health information.

Background and Objectives Canadian Blood Services defers donors during and for 4 months after oral pre‐exposure or post‐exposure prophylaxis (PrEP/PEP) for human immunodeficiency virus (HIV) because of concerns about altered viral kinetics. We assessed the impact of the switch from a time‐based deferral for men who have sex with men (MSM) to sexual risk behaviour criteria on PrEP/PEP deferrals. Materials and Methods Data on PrEP/PEP deferral codes were extracted from our National Epidemiology Database for the 22 months before (Period 1) and after (Period 2) the criteria change. Results PEP deferrals remained stable (2.3 vs. 1.7 per 100,000 donations in Periods 1 and 2, p = 0.2892), about 45% and 33%, respectively, of these donors who reported a recent needle stick injury. PrEP deferrals increased from 5.9 to 12.4 per 100,000 ( p = 0.0001); approximately 30% of donors in both periods had other HIV risk factor deferrals. Donors deferred for PrEP use alone were more likely to be male, first‐time users and younger than other donors. Conclusion The switch to sexual risk behaviour led to a small increase in deferrals for PrEP. We may not be measuring the full impact of deferral criteria because potential donors may self‐defer and PrEP use is increasing.