April 12, 2001

Invasive Meningococcal Disease (IMD): Ontario
The Middlesex-London Health Unit launched a meningococcal immunization campaign on April 9, 2001. The program targets approximately 40,000 youth aged 15 to 24 years in north London. Four cases of group C IMD have been confirmed, all among residents of north London. Cases occurred over a 4-week period from late February to late March. No deaths have occurred. Cases were aged 7, 20, 20, and 53 years. One case was a student at a local university, and one case had two close contacts at the university. Results of strain typing at the National Reference Laboratory in Winnipeg indicate that three isolates are electrophoretic type (ET) 15, and that to date, two of the London cases have been typed as 2a:p1.1,7. ET 15 has become prominent among group C isolates since it was first identified in Canada in the late 1980s, and has accounted for high rates of disease and clusters in 1989-early1990s. In the past few years, meningococcal and group C activity has been relatively low in Ontario, and to date this year, the number of isolates confirmed by the Provincial Central Public Health Laboratory is comparable to the same time last year. The last cluster of group C meningococcal disease that occurred in Ontario and resulted in vaccination occurred in Haldimand-Norfolk in October 1998; two cases, aged 15 and 17, occurred in one high school and 680 students were immunized. In Waterloo in 1997, 100,000 students were immunized following the occurrence of four cases including one death. In November 1996, 1,500 students were immunized following two cases in 16-year old high school students in Hamilton.
Source: Public Health Branch, Ontario Ministry of Health and Long-Term Care

Human Papillomavirus (HPV) Infection: Canada
HPV infection is now recognized as the main cause of cervical cancer, the role of coexisting factors is better understood, a new cytology reporting terminology has improved diagnosis and management of precursor lesions, and specific treatment protocols have increased survival among patients with early or advanced disease. Current research has focused on the determinants of infection with oncogenic HPV types, the assessment of prophylactic and therapeutic vaccines and the development of screening strategies incorporating HPV testing and other methods as adjunct to cytology. These are fundamental stepping stones for the implementation of effective public health programs aimed at the control of cervical cancer. Nearly 1,500 new cases of cervical cancer were estimated to have been diagnosed in Canadian women in 2000, and an estimated 430 women died from the disease in the same year. The provinces with the highest incidence rates are Nova Scotia, Newfoundland and Prince Edward Island. Cervical cancer takes a particularly heavy toll in North American Aboriginal, black and Hispanic populations. Among the Canadian Inuit, it accounts for nearly 15% of all cancers among women. The proportion is even greater among Aboriginal Canadians in Saskatchewan (29%), with an age-standardized rate 6 times higher than the national average.
Source: Canadian Medical Association Journal, Vol 164, No 7, April 3, 2001

Measles: Australia
South Eastern Sydney Public Health Unit recently investigated a cluster of five cases of measles with onset in December 2000. The index case was a 31-year-old male who presented to his doctor with a rash and fever. The diagnosis was confirmed by a positive measles IgM assay. The illness was thought to have been acquired through occupational exposure in another health area. The second and third cases were siblings aged 18 months and 3 years who were thought to have become infected after a few minutes' contact with the index case in the waiting room of a local family physician. Measles was subsequently transmitted to two other children, aged 5 and 4 years, who were childcare contacts of the second case. All four affected children had documentation of one MMR vaccination at 1 year of age while the 5-year-old had documentation of a second MMR vaccine dose at 4 to 5 years of age. In addition to the index case, laboratory confirmation was obtained for three of the four subsequent cases. In two cases, measles IgM was detected, and in two cases measles antigen was detected in throat swabs by direct immunofluorescence.
Source: Communicable Diseases Intelligence, Vol 25, No 1, January 2001, National Centre for Disease Control/Communicable Diseases Network Australia New Zealand, Australian Department of Health and Aged Care

The details given are for information only and may be very provisional. Where incidents are considered of national importance and are ongoing, the initial report will be updated as new information becomes available.

[Infectious Diseases News Brief]