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ISSN 0382-232X
Rapport hebdomadalre des
maladies au Canada
Canada Diseases
Weekly Report
Date of publication: 5 January 1991
Date de publication: 5Janvier1991
Vo l . 17·1
Contenu du present num6ro:
Contained In this lu ue:
First Isolates of Norfloxacin-Resistant Penicillinase-Producing
119/surla gonorrhoelt (PPNG) in Canada
Announcements , . . . • • . . . . . . .
Influenza Activity in Canada
1
3
4·
Premiers isolats caJladiens de Nl/u1rls gonorrhOHJ producteur de
~nicillinase (NGPP) resistant ala nor!loxacine
Ann onces
. • . . • . • . .
Activite grippale au Canada
1
3
4
'-'---
FIRST ISOLATES OF NORFLOXACIN·RESISTANT
PENICILLINASE·PRODUCING NEISSERIA GONORRHOEJE
(PPNG) IN CANADA
Six isolates of Neisseria gonorrhoeae with minimum inhibitozy
concentrations (MICs) of 2.0 mg/L to norfloxacin, a quinolone-type
antimicrobial, have recently been identified in Canada (January 1989 April 1990). Although break points have not been established for the
quinolones, other researchers 5y~)interpreted MICs of 0.5 mg/L to 2
mg/Las indicative ofresistance ' . These isolates were submitted as
part of an on~oing national program for the surveillance of
antibiotic-resistant gonoccocci and were submitted as PPNG isolated
to the National Laboratozy for Sexually Transmitted Diseases
(NLSTD), Laboratozy Centre for Disease Control, Ottawa. In addition
to their resistance to norfloxacin, these 6 isolates displayed reduced
susceptibilit.y to lomefloxacin (MIC 1 - 2 mg/L) and ciprofloxacin
(MIC-0.25 - 0.5 mg/L), and were resistant (MIC~ 2.0 mg/L) to
tetracycline and erythromycin (Table 1). They were SUS£tl.Etible to
spectinomycin (i.e. MIC ~ 128 mg/L) and ceftriaxone (MIC S 0.25
mg/L) (Table 1) .
. Previous studies in Canada have shown that the MIC90 (MIC at
which 90% of the isolates are inhibited) of lomefloxacin was 0.032
mg/L for penicillin-susceptible N. ~F.,rrhoeae isolates, and 0.063
mg/L for penicillin-resistant strains . The high MIC (2.0 mg/L) of
these 6 isolates to norfloxacin represents an increase greater than 30
times the norfloxacin MICs of 1115 other PPNG isolates (MIC90
0.032 mg/L) which were tested in our laboratozy during the same
period.
Characterization of the isolates by auxotype/serovar (NS) typing
(Table 1) showed that they belonged to different NS classes, and were
therefore unrelated. Typing by plasmid content indicated that 5
isolated carried the 4.S megadalton (Mda) B- lactamase-producing
plasmid (Asia-type) and that one of these also carried a transfer
plasmid (24.5 Ma.a); the other isolate carried a 3.05 Mda
B-lactamase-producing plasmid (Toronto-type) and a 24.5 Mda
transfer plasmid. All isolates harboured the cryptic (2.6 Mda) plasmid.
All of the isolates were recovered from male patients who were
infected outside Canada. Two isolates had epidemiologic links to the
Phili~es (isolated in B.C. and Alberta, respectively), and 3 others
were linked to Thailand (2 were isolated in B.C. and 1 in Alberta).
The remaining isolate was taken from a sailor seeking treatment while
his ship was docked in Newfoundland.
None of these cases were treated with quinolone drugs. Primary
treatment consisted of spectinomycin and tetracyclir•~ (1 case);
ampicillin (plus probenecid) and doxycycline (2 cases); ceftriaxone
alone (1 case); and ceftriaxone and tetracycline (1 case). The 2 cases
treated with ampicillin and doxycycline were treatment failures (the
I Secaid C am
I.I
Mal !!o<j11ra11on No. 6670
Health and Welfare
Canada
PREMIERSISOLATS CANADIENS DE NEISSERIA GONORRHOEIE
PRODUCTEUR DE PENICILLINASE (NGPP) RESISTANT ALA
NORFLOXACINE
Recemment (de janvier 1989 aavril 1990), on a obtenu au Canada 6 isolats
de Neisseria gonorrhoeae al'egard desquels la concentrationminimale
inhibitrice (CMI) de norfloxacine (un antimicrobien de type quinolone) est de
2,0 m~. Siles seuils n'ont pas ete determines pour les quinolones, mais des
~~ ~~!~he:s~ 1~~ t?s 6f!1~:::::l~/~6:;~~a~~l~ti~~::NG~P
au Laborntoire national pourles maladies transmises sexuellement (LNMTS)
du Laboratoire de lutte contre la maladie, aOttawa, dans le cadre de la
surveillance nationale permanente des gonocoques anb"bioresistants. Outre la
resistance ala norfloxacine, ils affichent une sensibilite faible ala
lomefloxacine (CIM de 1 a2 mg/L) et a la ciprofloxacine (CIM de 0,25 a
0,5 mg/L), ainsi qu 'une resistance (CIM ~ 2,0 mg/L) ala tetracycline et a
l' erythromycine. Ils sont sensibles ala spectinomycine (CIM S 128 mg/L) et a
la ceftriaxone (CIM S 0,25 mg/L) (tableau 1).
Les travaux anteneurs menees au Canada ont montre que la CIM90 (soit la
CIM alruJEelle 90 % des isolats sont inhib6s) de lomefloxacine est de
0,032 mg/L pour Jes isolats de N. go1Wrrhoeae seIJi>ble ala penicilline, et de
0,063 mg.IL pour les souches penicillinoresistantes . La CIM elevee
(2,0 mg/L) de norfloxacine al'egard des 6 isolats faisant !'objet du present
rapport represente une multi.plication par plus de 30 des valeurs obtenues pour
1 115 autres isolats de NGPP (CIM90 de 0,032 mg/L) analyses dans notre
laboratoire au cours de la meme periode.
Il ressort de la caracterisation par auxotype/serovar (NS) (tableau 1) que
nos isolats appartiennent adiverses classes NS et ne sont done pas apparentes.
Au typage par profil plasmidique, 5 isolats sont porteurs du J?lasmide de 4,5
megailaltoris (Mda) producteur de beta-lactamase (type asiatique); l'un de ces
isolats est aussi porteur d'un plasmide de transfert (24,5 Mda); le sixieme
isolat est poiteur d'un plasmide de 3,05 Mda producteur de beta-lactamase
(type Toronto) ainsi que d'un plasmide de transfert de 24,5 Mda. Le plasmide
cryptique (2,6 Mda) est present dans tous les isolats.
Les 6 isolats proviennent tous de malades masculins ayant ete infectes a
l'etranger. Les donnees epidemiolo~iques en mettent 2 (obtenus en C.-B. et en
Alberta) en rapport avec Jes Phili~es et 3 autres (2 de la C.-B. et 1 de
l' Alberta), avec la Thai1ande. Le m.ieme provient d 'un marin ayant consulte
un medecin pendant que son bateau etait aquai aTerre-Neuve.
Aucun de ces sujets n'aete traite par des quinolones. On a d'abord recouru
aux antibiotiques suivants: spectinomycine et tetrac,Yline (1 cas); ceftriaxone
seule (I cas); ceftriaxone et tetracycline (1 cas); ampicilline (plus prob6necide)
et doxycycline (2 cas). Dans ces 2 derniers cas on a enregistre des echecs
therapeutiques, les souches etant NGPP et presentant une resistance
chromosomique ala tetracycline. Chez ces malades, un traitement secondaire a
I Courl,.
I
Santa et Bien-litre social
Canada
do b dolodtlmo clauo • Erreglr1unurn n' 6670
Canada
I
Table 1fTableau 1
CharacterlsUc11 of Norfloxacln-Reslstant Ne/e~rfs gono"hoeae Isolates In Canada
Caracterlstlques d'lsolatt de Nels~s gono"hoeas resistant ala norfloxacloo obtenue au Canada
MIC\mg/L~~
NLSTD
ti,O.
N du
LNMTS
CIM mg/L
NORFb LOME
NORfb LOME
2942
3931
4201
4421
4440
4682
b
c
a
b
c
2c
2c
2c
2
2
2
1c
1
1c
1
1
1
CIPRO
CIPRO
0.25c
0.25
0.25b
0.25
0.25
0.25
PEN
PEN
TET
TET
ERV
ERV
128
4
4
4
4c
2c
2c
2c
~56
>256
>128
128
16
4
2
SPEC
SPEC
4
2
1
32
32
32
16
32
32
PLASMID
PROFILE
PROFIL
PLASMIDIQUE
A/S
CLASS
CLASSE
A/S
2.6, 4.5, 24.5
2.6, 3.05, 24.5
2.6,4.5
2.6,4.5
2.6,4.5
2.6,4.5
NR/IB-3
NR/IB-1
P/IB-4
P/IB-1
P/IB-5
P/IB-19
CEFT
CEFT
0.008
0,016
0.008
0.008
0.008
0.008
MIC was repeated at least 3 times; chromosomal resistance is defined by an MIC~ 2.0 mg/L for PEN, and ERV and~ 128 mg/L for SPEC(7).
Break points defining resistance to ceftriaxone and norfloxacin have not been established.
Abbreviations: NLSTD =National Laboratory for Sexually Transmitted Diseases; NORF = norfloxacin· LOME= lomefloxacin; CIPRO=
ciprofloxacin; PEN= penicillin; TET = tetracycline; ERV= erythromycin; SPEC':' spectinomycin; CEFT = ceftriaxone; A/S = auxotype/serovar.
MIC varied 2-fold (higher) on some repeats.
La cMtermination de la6JIM a ate repetee au moins 3 fois. La resistance chromosomique est cMfinie ~rune CIM ~ 2,0 mg/L pour PEN et ERV,
~128 mg/L pour SPEC . Les seuils caracterisant la resistance ala ceftriaxone n'ont pas ate determinees.
Abreviations : LNMTS = Laboratoir:q national pour les_maladies transmises sexuellement; NORF = norfloxacine; LOME= lomefloxacine; CIPRO=
ciprofloxacine; PEN = penicilline; TET =tetracycline; ERV= erythromycine; SPEC= spectinomyclne; CEFT = oeftriaxone ; A/S = auxotype/
s~rovar.
·
Dans certaines des nouvelles determinations de la CIM, la valour obtenue etait 2 fois plus elevee quo la premi~re.
isolates were PPNG and chromosomally resistant to tetracycline).
Seco!Jdary tr~tment of these patients with either cefuiaxone or
spectinomycm was successful.
Travel is a risk factor for the acquisition of infections due to
pet!icillinase-producing gonococci. Isolation of N. goTWrrhoeae
ISolates with reduced susceptibility to the quinolon~ 1~s has been
reported in the Philippines, Great Britain and ~ain ' ' . This is the
fiist report of such isolates in North America. {.lllinolones are not
currently reconunended for the treatment of gonococcal infections
in Canada. Although most gonococcal PPNG isolates screened to
date in Canada are susceptible to the quinolones, these data suggest
that susceptibility to these drugs should be monitored. Norfloxacin
resistance undoubtedly does exist in those countries where
treatment regimens are likely to include quinolones. Current
treatment recommendations for cases of ~onococcal infections
acquired in PPNG-endemic areas should m~!~de ceftriaxone with
concurrent therapy for Chlamydia infection •
Acknowltdgement1
We thank Dr. I.A. Smith, Ms. C. Shaw, Dr. M. Rekart (British
Columbia); Dr. B. Romanowski, Dr. W. Albritton, Ms. J. Green,
Ms. R. Sutherland, Dr. C.M. Anand, Ms. J. Kaezmer (Alberta); Dr.
P. Ferdy, Dr. Patel and Ms. B. Stratton (Newfoundland), for
submitting the PPNG isolates for characterization as well as the
~pidemiologic data on each isolate. We also thank M. Pauze and S.
Hickey (NLSTD) for typing the isolates.
Referencu
1. Gransden WWR, Warren CA, Phillips I, Hod!les M, Barlow D.
·D_ecreased ~usceptibility ofNelsseria gonorrhoeae to
c1profloxacm. Lancet 1990;335:51.
2. Wagenvoort JH, van der Willigen AH, van Vliet HJ, Michel
MF, Van Klingeren B. Resistance ofNelsseria gonorrhoeae to
enoxacin. J Aritimicrob Chemother 1986;18:429. Letter.
3. Romanowski B, Talbot H. In vitro activity of lomefloxacin
against Nelsserlagonorrhoeae and Chlamydia trachomatls.
In: Program of International Society for Sexually Transmitted
Diseases Research, 8th meeting, 1989, Copenhagen, Denmark.
Abstract 98.
4. Health and Welfare Canada.1988 Canadian guidelines for the
treatment of sexually transmitted diseases in neonates,
children, adolescents and adults. CDWR 1988;14S2:1-20.
la cefuiaxone OU S la spectinomycine Sera efficace.
Les voyages constituent W1 facteur de risque pour !'infection par des
gonocoques producteurs de penicillinase. La mise en evidence de N.
gonorrlioeae presentant une faible sensibilit6 aux q~ones a et6 signalee
aux Philippines, en Grande-Bretagne et en Bsp11~ ' • • Les isolats decrits
ici sont les premiers obtenus en Amerique du Nord. Au Canada, les
quinolones ne sont pas recommandes actuellement pour trailer l'infection
~onococciq.ue. Bien que la plupmt des isolats de NGPP etudies auJ>ays
jUSqU' ace JO\lr Soient sensibles aux quinolones, les donnees du present
article donnent aJ?C31Ser qu 'il serait bon de surveiller l' evolution de cette
sensibilite. La reststance ala norfloxacine existe bel et bien dans les pays
ou des quinolones sont s~bles de figurer clans les schemas
lh6rapeutiques; il conviendrait done d'inclure la ceftriaxone et \Dle therepie
concomitante anti-Chlamydia clans les recommendations actuelles
concemant le traitement de l'infecti~<lfonocoocique conl:ractee dans une
region OU les NGPP sont end6miques •
Rtmtrcllments
Nous tenons aremercier le 11 J.A. Smith,~ C. Shaw le 11 M.
Rekart (Colombie-Britannique); le 11 B. Romanowski, le [)t W. Albritton,
Mme I. Green, MDIII R. Sutherl!IJl(I, le 11 C.M. Anand, M'11° J. Kaezmer
(Alberta); le IY P. Pardy, le 11 Patel et Mmo B. Strauon (Terre-Neuve), qui
ont presente les isolats de NGPP pour caracterisation, ainsi que les donnees
epide.mi~l~gi~es sur chaque isolat. Nous remercions aussi M. Pauze et S.
Hickey (LNMTS) pour le typage des isolats.
RMlirencea
1. Gransden WWR, Warren CA, Phillips I, Hodges M, Barlow D.
Decreased suscrtibilizy ofNeisserfa wnorrhoeqe to cipmfloxacin,
Lancet 1990;33 :51.
2. Wagenvoort JH, van der Willi~en AH, van Vliet HJ, Michel MF, van
Klliigeren B. Resistance <fNeisseria e;norrhoeqe to enoxacin. J
Antirnicrob Chemother 1 86;18:429. ttre
3. Romanowski, B, Talbot H. In vitro activia qflomdJoxacin a~ainst
Neis"{la,wporrhoe~
:ffi~ft::fd!:Cfi;~o~= Tire du pro~ramme
dela8 reumondel' t ________ c;>_ _ al~Transrrutted
Diseases Reseiirch, 1989, Copenhague, annemark. ~brege 98.
4. Sante etBien-etre social Canada. Lignes directrices canadiennes pour
le traitement des maladies transmises sexuellement chez /es
TUJuveau-nes, les enfants, les adolescems et les adultes • 1988. RHMC
1988;14S2:1-22.
2
5.
~ce MP,
Ayling BB, Vaughan OH, et al. In vitro sensitivity
Nelsserla gonorrhoeae to quinolone anJibiotics in the
public ofthe Philippines. Iri: Program of Sixth International
Pathogenic Neisseria Conference, 1988, Atlanta, GA. Abstract
El9.
6. Jephoott AE, Turner A. Ciprofloxacin resistance in gonococci.
Lancet 1990;335:165.
7. National Committee for Clinical Laboratory, Standards.
Met hods for dilution antimicrobial susceptibility tests for
bacteria that grow aerobically. Document M7-A2,
1990;10(8):1-31.
Source: KH Yeung,PhD,JR Dillon, PhD, The National
Laboratory for Sexually Transmitted Diseases, LCDC,
Ottawa, Ontario.
Announcements
5.
6. Jephcott AE, Turner A. CiprqJloxacin resiS{ance jn go11QCocci. Lancet
1990;335:165.
7. National Committee for Clinical Laboratory Standards. Methods for
dilution an.timjcrobjal suruptjbj~ tests for bacteria that graw '
aerobica]/y, DocumentM7-A2, 1 0;10(8):1-31.
Source :KH Yeung, PhD ,JR Dillen, PhD, Laboratoire national pour /es
maladies transmises sexuellement, lLCM, Ottawa.
Anno neea
ATELIER SUR LES METHODES PERMETIANT D'ISOLER
ESCHERICHIA COU 0157:H7 ETD' AUTRES GERMES
VEROTOXIGENES DANS LES ALIMENTS
Coparraine par la Direction generale de la protedion de la sanle el le
WORKSHOP ON METHODS TO ISOLATE ESCHERICHIA COU
0157:H7 AND OTHER VEROTOXIGENIC ORGANISMS
FROM FOODS
Sponsored jointly by the Health Protection Branch and the
Canadian Meat Council
18-19 March, 1991
S~ John Carling Building, Agricutture Canada,
Experimental Farm, Ottawa, Ontario
The object of this Workshop Is to assess the present methods to
detect E.coli 0157:H7 and other verotoxi~enic organisms from
food; plan further methodology research, mcluding collaborative
studies; and recommend the best procedures for detection of these
patho~ens. Overviews on the mode of infection and sources of the
orgarusms are also being planned.
E.coli 0157:H7, since its discovery as a human foodbome
pathogen in 1982, has been recognized as a disease agent causing
hemorrhagic colitis, hemolytic uremic syndrome and thrombotic
thrornbocytopenic purpura. Since E.coli 0157:H7 is a more
environmentally sensitive organism than other E. coli strains, and
since foods containing low numbers of cells have caused illness,
there have been difficitlties in isolating and identifying the
organism from food. Cultural methods alone have not been
sufficiently sensitive and newer methods depend on very specific
antibody-antigen reactions. Methods at the experimental stage
include a modified Petrifilm (3M) approach using an affinity
purified antibody to the 0157 antigen. a sandwich ELA
(enzyme-linked antibody) procedure withpolyclonal antibodies to
the organism, a cultural method based on MacConkey sorbitol agar
with BCIG and other biochemical test, and an HGMF ELA method
involving monoclonal antibodies to E.coli 0157. Since verotoxins
are believed to be major factors in disease causation, any organisms
produciilg these are potential pathogens. These would include E.
coli 0157:H7 and other E.coli serotypes producing Vft and/or
VT2 and.possibly other verotoxins. Methods to detect these toxins
include Vero cell line testing, ELA tests, DNA probes and
polymerase chain reaction procedures.
The workshop will last 2 days, the first day being devoted to E.
coli 0157:H7 methodology, the second to verotoxin detection
procedures. A visit to the Health Protection Branch (HPB) and
Laboratory Centre for Disease Control (LCOC) laboratories to
examine the HPB approaches can be arranged on 20 March, if there
is sufficient interest About 12 speakers from the United States and
Canada will be participating in this workshop.
The registration fee is $200. The facilities will accommodate
120 people, and there will be simultaneous translation available.
For additional information, contact Dr. E. Todd, Bureau of
Microbial Hazards, Food Directorate, Health Protection
Branch, Sir Frederick G. Banting Research Centre, Tunney's
Pasture, Ottawa, Ontario, KIA OL2. Registration deadline:
15February,1991.
Conseil des viandes du Canada
Les 18 et 19 mars 1991
lmmeuble Sir.John.Carling, Agricutture Canada,
Ferme experimentale, Ottawa (Ontario}
L' atelier a pour objet d 'evaluer !es methodes qui servent actuellement a
mettre en evidence E.coli 0157:H7 et d'autres germes verotoxigenes dans
des aliments; de planifier d 'autres recherches methodologiques, notarnment
des etudes de collaboration; et de recommander les meilleures techniques de
detection pour ces pathogenes. Des syntheses sur le mode d'infection et les
sources des microorganismes sont aussi prevues.
Depuis que l'on a decouvert, en 1982, qu'il s'agissait d'unpathogene
humain atransmission alhnentaire, E. coli 0157:H7 a ete reconnu comme un
agent causal de la colite Mmorragique, du syndro111e hemolytique uremique,
et du purpura thrombocytopCnique thrombotique. Etant donne ~u'il est plus
sensible aux facteurs environnementaux que cl' autres souches d E. coli et
que la maladie a ete causee par la r.resence dans des aliments de faibles
nombres de cellules, il a ete difficile d'isoler et d'identifier E.coli 0157:H7
a,Partir d' aliments. Appliquees seules, les methodes de culture se sont
revelees insuffisamment sensibles; quant aux methodes plus recentes, elles
reposent sur des reactions anticorps-antigene tres s!)kifiques. Parmi les
methodes exp&imentales, notons : une technique Fetrifilm (3M) modifiee
qui recourt aun anticorps purifie par affinite et dirige contre I' antigene
0157; une methode ELA (anticorps lie aune enzyme) en sandwich qui
utilise des anticorps polyclonaux contre le microorganisme; une methode de
culture sur gelose sorbitol de MacConkey avec BCIG et d •autres epreuves
biochimiques; et lllle methode ELA HGMF qui fait intervenir des anticorps
monoclonaux anti-E. coli 0157:H7. Puisque les verotoxines sont
considerees comme d 'importants facteurs de causalite dans la maladie, tout
microorganisme Pf!Jducteur est un pathogene potentiel. Se classent dans ce
groupe E. coli0157:H7 etd'autres serotypes d'E. coli qui produisent la VT1
ou la Vf2. voire d'autres verotoxines. La detection de ces substances
s 'effectue entre autres par des analyses de la lignee cellulaire Vero, des
6preuves ELA, des sondes d' ADN et des techniques de reaction en chaine
de la polymerase.
L'atelier durera 2 jours; le premier sera consacre aux methodes
.
s'appliquant aE.coli 0157:H7 et le deuxieme, aux. techniques de detection
de la verotoxine. S 'il y a assez d'interesses, une visite des laboratoires de la
Direction generale de la IJIOtection de la sante (OOPS) et du Laboratoire de
lutte contre la maladie (LLCM) sera organisee le 20 mars ades fins de
dem9nstration des demarches de la OOPS. Une douzaine de conferenciers
des Etats-Unis et du Canada participeront al' atelier.
Les droits d'inscription sontde 200 $et lacapacite d'accueil, de 120
personnes. Des services de traduction shnultanee seront offerts. Pour plus
amples renseignements, s' adresser au Dr E. Todd, Bureau des dangers
mlcroblens, Direction des aliments, Direction generate de ta protection
de Ia sante, Centre de recherche Sir-Frederlck·G.-Banting, Pre Tunney,
Ottawa (Ontario), KIA OL2. La date limlte d'lnscrlption est le
15 fevrler 1991.
INFECTION CONTROL PRACTITIONER COURSE 1
This course, sponsored jointly by Centennial College and
CHICA-CANADA, is designed to teach basic infection control to
newly aP.p<?inted infection control personnel in Canadian healthcare facilities. It can also be used to provide basic infection control
SPECIALISTE DE LA LUTTE ANTl-INFECTIEUSE. COURS 1
Coparraine l?ar le Centennial College et CHICA-CANADA, le cours a
pour but d'ense1gner les pratiques anti-infectieuses fondamentales aceux et
Cel!es CJ,Ui Viennent d'etre nommes aun paste de J>!aticien de la lutte contre
!'infection dans un etablissement de soins canadien. n peut aussi servir a
3
information to others who may be involved in the control of
communicable diseases, e.g., community health programs, day-care
centres, and penitentiaries.
Course Offered: Tuesday evenings: 18:00 h to 22:00 h, from 12
February to 25 June 1991.
For further information and registration, contact
Joanna Bernstein, Centennial College, P.O. Box 631, Station
"A", Health Sciences, Scarborough, Ontario HlK SE9 (tel:
(416) 694-3241, ext. 3391)
communiquer des renseignements de base ades personnes appelees aintervenir
dans le controle des maladies transmissibles (p.ex., programmes de sante
communautaire, garderies, prisons).
Le cours sera donne le mardi soir, de 18 a22 h, du 12 fevrier au 25 juin 1991.
Pour en savoir plus et pour s 'inscrire, s' adresser aJoanna Bernstein,
Centennial College, C.P. 631, Succursale "A", Sciences de la sent~,
Scarborough (Ontario) HlK SE9 (tel. : 416· 694-3241, poste 3391).
INFLUENZA ACTIVITY IN CANADA • For the WNk ending 4 January 1991 (cumulative total from 25 Sept&mber 1990)
ACTIVITE GRIP PALE AU CANADA· Pour la aomalne eo tormlnant le 4 )11nvl11r 1991 (cumulatlf du 211 Mptembre 1 ll90)
Province/Territory
Provlnce/Terrltolre
NHd.
T.-N.
P.E.I.
1.-P.·E.
N.S.
N.·E.
N.B.
N.·B.
Que.
Qu6.
Ont.
Man.
+
0
0
0
0
+
+
Extent of lnfluenza-llke Illness/
Alta.
Alb.
Sask.
B.C.
c.-e.
YUKON N.W.T.
T.N.-0.
0
+
Ampleurde l'attelnte pseudo-grlppale
TOTAL
Laboratory Evidence/ Slgnee blologlqu&11
Type
Subtype/
Sous-Type
A
NS
I
D
s
(1)
I
H3N2
(1)
(1)
1(1)
1(2)
(2)
(2)
1(4)
1(1!)
D
s
TOTAL A
(1)
TYPES
I
3(11)
(1)
(1)
16(60)
(4)
6(16)
1(3)
1(7)
(1)
D
s
21(62)
(4)
6(18)
TOTALB
3(11)
1(4)
1(9)
22(80)
(1)
27(104)
TOTAL
3(12)
1(4)
1(9)
23{84)
(1)
28(109)
0
+
++ "
+++ "'
=
D
S
NS
=
"
=
D'apres las rapports des services provinciauxlterritoriaux de sante
Aucun cas signale
Cas sporadiques
Poussees localisees
Poussees etendues
Donnees non-disponibles
Identification par cullure tissulaire
Detection du virus dans le sp6cimen par d'autres methodes comma Jes anlicorps fluorescents
Confirmation par augmentation de~ 4 dilutions du tib'e selon n'importe quelle methode
Non sous-type
Based on reports from provincial/territoriial health departments
No reported cases
Sporadic cases
Localized outbreaks
Widespread
Data unavailable
Identification 11,t growth in tissue culture
Deteclion of virus In specimen by other methods such as fluorescent activity
Confirmation 11,t <? four-fold rise in seroiogic tib'e by any method
Not subtyped
Tho Canada DiJ<ucl Wool<ly Ropatp=ont> current lnl'onm.tiononlnl'cctkm and other~
fot 111M>lllmcc PUlJ>O'C' and it availJhle Croo of charao upon reqtlOll. Mmy of tho article>
conWn pmlimhwy lnfmmatlon and furthor coofumalim IIlloY bo obtained from tho 1our<ca
quot><!. Tho Dop.utmontofHoallhandWclf.aro cl= notlllUI!l:I roipomibilhy for o=iraoy er
autbontlclty. Cmtributi001111M wclcanod (in tho offu:W 1mauagc of your cholco) from myono
womng In thoboallh fiold ml will not p<ecludo publlcatiancllowlmo.
SclonliflcAdvil<:ry Board:
Dr.J,Spib.
Dr.A.c..rtzir
Dr. K.Razoc
lldlta:
Dcak1op Publilhina
Clm!latlon:
Blconar Paubon
BuroauofCmimimk&bleDitcuoBpldomlolo~
Laborllay Clontro fur Diteuo Control
'I'wmo)I'• Puture,
rYfTAWA. Onllrlo
100DDO Roa;nlcr
Clcrtrudo Ta.rdlff
(613) 9S7-4243
(613) 9S7-1339
(613) 9Sl-1329
(613) 9S7-1788
(613) 9S1-7845
(613) 9S1-0842
Lo Rapport hcbdooadairo de• malldlos au Canula, qui fournit des doim6c1 pcrtincnto1111r !OJ malldlos lnl'cctloUSO> ot
lea autrol mala.dic1 dam lo but do Ucililm lour IU1'Yolllmoo, pout 8tro oblmlu graluilomon! IW' domando. Un grand
nombro d' artic!e1 no coD!ionnont quo do1 dotm6oJ IOIIlill&hel mall des·..,,,..,igJJomoDI> comp!6wontlim pcuwnl 8tro
obtmus on 1'addnmlllll ll!Jl •oon:e> ci!6or. Lo minil1M do la Sant6natiOO>loot du Blon-8tro 100itl no pout 8tro
roipomablo do l'euctitudc,ni dol'authonlicit6 des articlN. Tou!<opcnomo oouvnnt dim l.o danAino do unl6 est
invil6o. collaborcr (dsm alanguo officicllo do Im choix) ct la p.i.blication d'unlrtlc!o dam lo pnl>onl !Upportn'cn
omp8cbo pu la publicaticn ailloun.
a
Groupe do COPJOi1Joll ~lontifiqUOI:
D' J.Splka
D' A.Ou!m
D'K.Rozoo
R6dactrko on choe
IW.tiquo:
B1cmor Pauhan
Dlltributim:
Clmtru.do Tardiff
Buro au d '6pld6midoelo dol msl&dio1 trammit.tlblco
Labcntoiro do luuo CODlrD a maladio
l'mTomioy
OITAWA (Ontario)
4
IOOIIDO Regnier
(613) 9S7-4243
(613) 9S7-1339
(613) 9S7-1329
(613) 9S7-1788
(613) 975-7~
(613) 9S7-0842
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