Background Two invasive group A streptococcus (iGAS) infection outbreaks occurred in Montreal in 2016 and 2017; one in a long-term care facility (type emm 118) and one in the community, primarily involving homeless people (type emm 74). Objective To describe two recent iGAS outbreaks in Montréal and highlight the challenges in dealing with these outbreaks and the need to tailor the public health response to control them. Methodology All cases of iGAS were investigated and the isolates were sent to the laboratory for emm typing. In both outbreaks, cases of superficial group A streptococcus (GAS) infection were identified, through 1) systematic case detection accompanied by screening for asymptomatic carriers among residents and employees of the long-term care facility and 2) sentinel surveillance among homeless people. Visits were made to community organizations providing homeless services (including shelters) and social networks were analyzed to establish whether there were any links among cases of GAS infection (both invasive and noninvasive) and locations frequented. In both outbreaks, recommendations were made to service providers regarding enhancement of infection prevention and control measures. Results In the long-term care facility, five cases of type emm 118 iGAS were identified over a 22-month period, one of which resulted in death. All residents were screened and no carriers were identified. Among the employees, 81 (65%) were screened and fourcarriers were identified. Of those, one was a carrier of type emm 118 GAS. All carriers were treated, and subsequent follow-up sampling on three carriers (including the one with emm 118) was negative. In the community, 23 cases of type emm 74 iGAS were detected over a 16-month period, four of which resulted in death. Half of the cases (n=12) were described as homeless, and six others were users of services for the homeless. Sentinel surveillance of superficial infections yielded 64 cultures with GAS, chiefly on the skin, including 51 (80%) of type emm 74. An analysis of the social networks revealed the large number and variety of resources for the homeless used by the cases. Visits to the community organizations providing homeless services revealed the heterogeneity and precariousness of some of these services, the difficulties encountered in applying adequate health and hygiene measures, and the high degree of mobility amongst those who use these services. Conclusion The detection and control of iGAS outbreaks in both long-term care establishments and among community organizations providing homeless services are very complex. An outbreak of iGAS can develop in the background over a ...
Décrire la mise en oeuvre des différentes activités proposées dans le guide Prévention, surveillance et contrôle de l'influenza en milieu d'hébergement et de soins de longue durée (CHSLD) au Québec diffusé en l'an 2000 à l'ensemble des CHSLD de Montréal-Centre. Méthode : L'étude a été menée en 2001 auprès de 57 CHSLD (39 établissements publics et 18 établissements privés conventionnés) de la région de Montréal-Centre. Un questionnaire auto-administré portant sur les caractéristiques des centres et les principales activités recommandées dans le guide a été utilisé pour recueillir les données. Les principales activités recommandées ont été regroupées en trois volets : prévention, surveillance et contrôle de l'influenza. Les données ont été saisies et analysées à l'aide du logiciel SPSS 10.0. Une analyse descriptive a été effectuée. Résultats : Le taux de réponse global a été de 81 % (46/57). La proportion de centres ayant réalisé les différents volets est de 35 % (16/46) pour le volet prévention, 41 % (19/46) pour le volet surveillance alors que seulement deux centres avaient réalisé le volet contrôle. Conclusion : Plus de la moitié des CHSLD montréalais n'ont pas mis en oeuvre les volets prévention, surveillance et contrôle de l'influenza. Des lacunes sont notées principalement au niveau de la couverture vaccinale du personnel et de l'accès rapide à la chimioprophylaxie. Plusieurs mesures de contrôle supplémentaires recommandées sont également jugées inapplicables. Il semble important de revoir nos stratégies afin de cerner les obstacles qui empêchent la mise en oeuvre optimale de ces mesures.
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