Background: Human immunodeficiency virus (HIV) is a global public health issue, with an estimated 36.9 million people living with HIV in 2017. HIV has been reportable in Canada since 1985 and the Public Health Agency of Canada (PHAC) continues to monitor trends in new HIV diagnoses. Objective: The objective of this surveillance report is to provide an overview of the epidemiology of all reported diagnoses of HIV in Canada since 1985 with a focus on 2018 overall, and by geographic location, age group, sex, and exposure category. Methods: PHAC monitors HIV through the national HIV/AIDS Surveillance System, a passive, case-based system that collates nonnominal data that is voluntarily submitted by all Canadian provinces and territories. Descriptive epidemiological analyses were conducted on national data and those relating to specific populations provided by Immigration, Refugees and Citizenship Canada and the Canadian Perinatal HIV Surveillance Program. Results: In 2018, a total of 2,561 HIV diagnoses were reported in Canada, an increase of 8.2% compared with 2017. The national diagnosis rate increased to 6.9 per 100,000 population in 2018 from 6.5 per 100,000 population in 2017. Saskatchewan reported the highest provincial diagnosis rate at 14.9 per 100,000 population. The 30-39 year age group continued to have the highest HIV diagnosis rate at 15.4 per 100,000 population. Overall, the diagnosis rate for males continued to be higher than that of females (9.8 versus 4.0 per 100,000 population, respectively); however, females experienced a larger increase in reported cases and diagnosis rate. The gay, bisexual and other men who have sex with men (gbMSM) exposure category continued to represent the highest proportion of all reported adult cases (41.4%), though the proportion has decreased over time. Five perinatal HIV transmissions were documented, three where related to the mother not receiving perinatal antiretroviral therapy prophylaxis. Conclusion: The number and rate of reported HIV cases in Canada increased in 2018, gbMSM continued to account for the largest exposure category and the number and rate of reported HIV cases among women increased. PHAC will continue to work with its national partners to refine the collection, analysis and publication of national data to better understand the burden of HIV in Canada.

Background: Human immunodeficiency virus (HIV) is a global public health issue. HIV has been nationally notifiable in Canada since 1985. The Public Health Agency of Canada (PHAC) monitors trends in new HIV diagnoses. Objectives: The objective of this surveillance report is to provide an overview of the epidemiology of reported HIV cases in 2019 in Canada. The report highlights 10-year trends (2010–2019). Data on HIV diagnosed through Immigration Medical Exams (IME) and trends in perinatal transmission of HIV are also presented. Methods: PHAC monitors HIV through the HIV/AIDS Surveillance System, a passive, case-based system that collates non-nominal data submitted voluntarily by all Canadian provinces and territories. Descriptive analyses were conducted on national data. IME data were obtained from Immigration, Refugees and Citizenship Canada (IRCC), and data on HIV-exposed pregnancies were obtained through the Canadian Perinatal HIV Surveillance Program. Results: In 2019, a total of 2,122 HIV diagnoses were reported in Canada (5.6 per 100,000 population). Saskatchewan reported the highest provincial diagnosis rate at 16.9 per 100,000 population. The 30 to 39-year age group had the highest HIV diagnosis rate at 12.7 per 100,000 population. While the rates for both males and females fluctuated in the past decade, since 2010 the rates among males decreased overall, while the rate among females increased slightly. As in previous years, the diagnosis rate for males in 2019 was higher than that for females (7.9 versus 3.4 per 100,000 population, respectively). The highest proportion of all reported adult cases with known exposure were gay, bisexual and other men who have sex with men (gbMSM, 39.7%), followed by cases attributed to heterosexual contact (28.3%) and among people who inject drugs (PWID, 21.5%). The number of migrants who tested positive for HIV during an IME conducted in Canada was 626. The one documented perinatal HIV transmission related to a mother who had not received antepartum or intrapartum antiretroviral therapy prophylaxis. Conclusion: The number and rate of reported HIV cases in Canada has remained relatively stable over the last decade, with minor year-to-year variations. As in previous years, the gbMSM and PWID populations represent a high proportion of HIV diagnoses, although a sizable number of cases were attributed to heterosexual contact. It is important to routinely monitor trends in HIV in light of pan-Canadian commitments to reduce the health impact of sexually transmitted and blood-borne infections by 2030.

Background: Canada's population is aging, with nearly forty percent of Canadians aged 50 years or more. As the population ages, unique challenges related to health are becoming evident, including increasing rates of sexually transmitted and bloodborne infections. Understanding the epidemiology of HIV in older adults is important to guide prevention and control programs. Objective: To assess trends in newly diagnosed cases of HIV in Canada among those aged 50 years and older (≥50 years) and those aged less than 50 (<50 years), and to compare their basic demographic characteristics and exposure categories for the period of 2008 to 2017. Methods: National surveillance of HIV is conducted by the Public Health Agency of Canada through voluntary submission of data by provincial/territorial public health authorities. Descriptive analyses were conducted on reported cases of HIV between January 1, 2008, to December 31, 2017 to compare the demographic profiles and exposure category for the two age groups. Results: Between 2008 and 2017, the proportion of newly diagnosed HIV cases among those ≥50 years increased from 15.1% to 22.8%. The HIV diagnosis rates for both older males and older females increased over time, with a relatively higher increase for females. A higher proportion of newly diagnosed HIV cases were male in the older group (81.2%) compared to the younger group (74.6%). Among both older and younger males, the most common exposure category for HIV was being gay, bisexual and other men who have sex with men (gbMSM), followed by heterosexual contact and injection drug use; however, the relative proportions varied by age with the gbMSM category being higher in the <50 group. Conclusion: In Canada, over 20% of all newly diagnosed cases of HIV are now in people 50 years of age and older. HIV testing and prevention initiatives, historically aimed at younger populations, may not have the same impact for older populations. These data can be used to inform future public health actions designed to address HIV in older populations.

The purpose of national HIV surveillance is to track and summarize trends in newly diagnosed cases as an indicator of HIV transmission within Canada, and supports the development and evaluation of programs and policies for prevention, testing and delivery of care. Accurately capturing and interpreting trends in HIV diagnoses within national surveillance becomes complicated when there is movement of people within a country or when individuals are diagnosed with HIV prior to migrating to a new country. This has been identified as an issue in other countries, including Australia, New Zealand and Switzerland. The Public Health Agency of Canada (PHAC) recently assessed this in Canada after noting a rise in new HIV cases in Canada between 2014 to 2017. An environmental scan was conducted to better understand how new and previously diagnosed cases of HIV were recorded by and reported to PHAC from provincial and territorial (PT) public health authorities. It was discovered there was variation with respect to the reporting of cases who had received a new diagnosis of HIV within the province or territory, but who had previously received an HIV diagnosis from another PT or another country. Five PTs included cases previously diagnosed in another Canadian PT within the HIV surveillance data reported to PHAC and nine PTs included people who were diagnosed with HIV outside of Canada. The provincial and territorial public health authorities then reviewed HIV surveillance data from 2007 to 2017 to identify cases using a common definition of "previous HIV-positive test result". This included any case who gave a history, or had laboratory evidence, of an HIV-positive result from another PT or another country before presenting for care in the province or territory where they now resided. When these cases were subtracted from the total, a revised number of new HIV diagnoses was calculated for Canada. Re-analysis of surveillance data using this common definition for 2007 to 2017 explained more than half of the increase in HIV cases that had been documented in Canada over the last four years. In the future, national surveillance data will be calculated adopting this new common definition of a previous positive test result, in order to more accurately describe the trends in HIV transmission occurring in Canada.

SURVEILLANCECas de VIH nouvellement diagnostiqués chez les personnes de 50 ans et plus, comparativement aux personnes de moins de 50 ans : Résumé Contexte : La population canadienne vieillit et près de 40 % des Canadiens sont âgés de 50 ans et plus. Avec le vieillissement de la population, des problèmes uniques liés à la santé commencent à se manifester, notamment le nombre croissant d'infections transmissibles sexuellement et par le sang. Comprendre l'épidémiologie du VIH chez les personnes plus âgées est important en vue d'orienter les programmes de prévention des maladies et de lutte contre celles-ci. Objectif : Évaluer les tendances en matière de cas de VIH nouvellement diagnostiqués au Canada chez les personnes de 50 ans et plus (≥ 50 ans) et celles de moins de 50 ans (< 50 ans), puis comparer leurs caractéristiques démographiques de base et leurs catégories d'exposition pour la période de 2008 à 2017. Méthodes : La surveillance du VIH à l'échelle nationale est menée par l'Agence de la santé publique du Canada par l'entremise de la communication (à titre volontaire) de données par les autorités de santé publique provinciales et territoriales. Des analyses descriptives ont été menées sur les cas de VIH signalés entre le 1 er janvier 2008 et le 31 décembre 2017 afin de comparer les profils démographiques et les catégories d'exposition pour les deux groupes d'âge. Résultats : Entre 2008 et 2017, la proportion des cas de VIH nouvellement diagnostiqués chez les 50 ans et plus est passée de 15,1 % à 22,8 %. Les taux de diagnostic du VIH chez les hommes et les femmes plus âgés ont augmenté avec le temps, et une augmentation relativement plus élevée a été constatée chez les femmes. Une proportion plus élevée de cas de VIH nouvellement diagnostiqués étaient des hommes dans le groupe des plus âgés (81,2 %) par rapport au groupe plus jeune (74,6 %). La catégorie d'exposition la plus courante regroupait les groupes jeunes et plus âgés d'hommes gais, bisexuels et autres hommes ayant eu des relations sexuelles avec des hommes (gbHARSAH). Viennent ensuite les catégories de contacts hétérosexuels et de consommation de drogues injectables; cependant, les proportions relatives variaient selon l'âge, puisque la catégorie de gbHARSAH était plus élevée dans le groupe des moins de 50 ans. Conclusion : Au Canada, plus de 20 % de tous les cas de VIH nouvellement diagnostiqués concernent maintenant des personnes âgées de 50 ans et plus. Les initiatives de dépistage et de prévention du VIH visent depuis toujours les populations plus jeunes et pourraient ne pas avoir la même incidence sur les populations plus âgées. Ces données peuvent être utilisées pour orienter les futures mesures de santé publique qui seront conçues pour lutter contre le VIH chez les populations plus âgées.Affiliation

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Objective: To create a scoping review on enterovirus D-68 (EV-D68) that will serve as a useful tool to guide future research with the aim of filling critical information gaps and supporting the development of public health preparedness activities.Introduction: EV-D68 is a non-polio enterovirus, primarily resulting in respiratory illness, with clinical symptoms ranging from mild to severe. Infection has also been associated with severe neurological conditions like acute flaccid myelitis (AFM). EV-D68 was first discovered in 1962, with infrequent case reports until 2014 at which point a widespread multi-national outbreak mostly affecting the pediatric population occurred across North America, Europe, Southeast Asia and Africa. This outbreak was associated with an increase in AFM, with cases being reported in Canada, the United States, Norway, and France. With this new and emerging threat, public health and other organizations were called upon to implement response measures such as establishment of case definitions, surveillance mechanisms, and recommendations for clinical and public health management. The response to the 2014 outbreak in Canada highlighted several important EV-D68 evidence gaps including a lack of risk factor and clinical information available for non-severe cases, and uncertainty around seasonal, cyclical and secular trends. Given the increased reporting of EV-D68 cases associated with severe outcomes, it's critical that public health establishes what is known about EV-D68 in order to support decision-making, education and other preparedness activities and to highlight priority areas for future research to fill critical knowledge gaps. Scoping reviews provide a reproducible and updateable synthesis research methodology to identify and characterise all the literature on a broad topic as a means to highlight where evidence exists and where there are knowledge gaps. In order to systematically characterise the EV-D68 knowledge base, a scoping review was conducted to map the current body of evidence.Methods: A literature search of published and grey literature on EV-D68 was conducted on May 1, 2017. A standardized search algorithm was implemented in four bibliographic databases: Medline, Embase, Global Health and Scopus. Relevant grey literature was sought from a prioriidentified sources: the World Health Organization, United States Centers for Disease Control and Prevention, the Public Health Agency of Canada, the European Centre for Disease Prevention and Control, and thesis registries. Two-level relevance screening (title/abstract followed by full-text) was performed in duplicate by two independent reviewers using pretested screening forms. Conflicts between the reviewers were reconciled following group discussion with the study team. English and French articles were included if they reported on EV-D68 as an outcome. There were no limitations by date, publication type, geography or study design. Conference abstracts were excluded if they did not provide sufficient outcome information to characterize. The articles were then characterized by two independent reviewers using a pretested study characterization form. The descriptive characteristics of each article were extracted and categorized into one of the following broad topic categories: 1) Epidemiology and Public Health, 2) Clinical and Infection Prevention and Control (IPC), 3) Guidance Products, 4) Public Health Surveillance, 5) Laboratory, and 6) Impact. The Epidemiology and Public Health category contained citations describing prevalence, epidemiological distribution, outbreak data and public health mitigation strategies. Clinical and IPC citations included details regarding symptoms of EV-D68 infection, patient outcomes, clinical investigation processes, treatment options and infection prevention and control strategies. The Guidance category included citations that assess risk, provide knowledge translation or provide practice guidelines. Public Health Surveillance citations provided details on surveillance systems. Citations in the laboratory category included studies that assessed the genetic characteristics of circulating EV-D68 (phylogeny, taxonomy) and viral characteristics (proteins, viral properties). Lastly, the Impact category contained citations describing the social, economic and resource burden of EV-D68 infection. Each broad topic category was subsequently characterised further into subtopics.Results: The search yielded a total of 384 citations, of which 300 met the inclusion criteria. Twenty-six of forty-three potentially relevant grey literature sources were also included. Preliminary literature characterization suggests that the majority of the published literature fell under the topic categories of Epidemiology, Clinical, and Laboratory. There were limited published articles on public health guidance, IPC, surveillance systems and the impact of EV-D68. The grey literature primarily consisted of webpages directed towards the public (what EV-D68 is, how to prevent it, what to do if ill, etc.). This scoping review work is presently underway and a summary of the full results will be presented at the 2018 Annual Conference.Conclusions: The body of literature on EV-D68 has increased since the 2014 outbreak, but overall remains small and contains knowledge gaps in some areas. To our knowledge, this scoping review is the first to classify the entirety of literature relating to EV-D68. It will serve as a useful tool to guide future research with the aim of filling critical information gaps, and supporting development of public health preparedness activities.