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ISSN 0382-232X
Canada Diseases
Rapport hebdomadalre des
maladies au Canada
Weekly Report
Date of publication: 2 February 1991
Contenu du present numero:
Contained In this Issue:
25
26
Mycobacterium haemophilum Infection in Canada
Ethics and Epidemiology
. . .
Notifiable Diseases Summary
Announcements . . . . . .
Internationally Quarantinable Diseases
27
29
30
Infection aMycobacterium haemophilum au Canada
Ethique et epidamiologie . . . . . . . . .
Sommaire des maladies adaclaration obligatoire .
Annonces . . . . . . . . .
Maladiesquarantenaires internationales
Two new cases of M1cobacterium haenwphilum infection in June
1989 and January 1990 m Quebec led us to conduct a survey to find
out if M. haerrwphilum has been isolated in other provinces and
territories.
As yet, M. haerrwphilum has been identified in only 2 :{l!ovinces:
Ontario, with 2 cases (1981~82) and Quebec, with 4 cases (1987-90).
Since so few cases· have been encountered, the information gathered
through this survey is essentially limited to the isolation procedures in
. ,use for this microorganism.
The 2 strains from Ontario (identified as "res"embling •
•.1. haerrwphilum"), isolated from a foot lesion in one eek and a groin
abscess in the other case, grew on Lowenstein-Jensen (hJ)
supplemented with2% ferric ammonium citra~~ (FAC).'
The isolates of the first 2 cases to be repor~d in Canada grew from
cutaneous lesions of the legs and the right han~; a lymph node and the
vitreous of the right eye of a 55-year-old male with AIDS and from~)
submandibular adenopathy in an otherwise healthy 3~year-old girl ' .
The strains of the more recent cases were isolated in BACTEC12B
medium from a bone curettage in a 54-year-old diabetic male with
chronic osteomyelitis of the external condyle of humerus ~
hospitalier universitaire de Sherbrooke) and from a biopsy of the
tissue of a sinus tract in the left knee of a 35-year-old male with AIDS
(Montreal General Hospital). Growth had been detected at 30'C and
was confirmed by Ziehl-Neelsen stain. The Laboratojre de sante
fjbli~ue du Q:uebec recovered M. haerrwphilum from subcultures on
S% PAC, chotolate agar, Middlebrook 7H10 agar+ X-factor
disk and in Middlebrook 7H9 broth at 32'C.
Antimicrobial testin~ results, includin~ ours, indicate that M.
haerrwphilum is susceptible to rifampin, nfabutin, erythromycin,
ciprofloxacin, irnipenem and clofazirnine but resistant to isoniazid,
ethambutol and streptomycin. Results with arnikacin,
sulfEa,~oxazole and para-arninosalicylic acid vary from strain to
strain . Our understanding of the significance of these in vitro
results is very limited. There is very little data on therapeutic outcome
in such infections. The lymphaderutis and osteomyelitis cases
mentioned in the above paragraph were treated by excision of the
affected tissues. As for the 2 AIDS patients, the therapy was stopped
before the effectiveness could be ascertained.
The incidence ofM. haerrwphilum is unknown. The requirement
of an added iron source for growth explains4)at least partly, why this
organism, which was first reported in 1978l , is rarely isolated from
patients. Until recently, ithas been associated with a variety of
cutaneous and subcutaneous lesions usually multiple and of the
extremitif3'! mainly in immunocompromised patients. The findings in
Australia indicate that infection with M. haerrwphilum might be
more prevalent than the current literature would suggest. Ten of the
25 Australian cases, recorded to late 1989, as well as 2 of the 4
+
I Secaid COOi Mol !le!jrnalon No.
I.I
&170
Health and Welfare
Canada
25
26
27
29
30
INFECTION A MYCOBACTERIUM HAEMOPHILUM AU CANADA
MYCOBACTERIUM HAEMOPHILUM INFECTION IN CANADA
(
Date de publication: 2 Fevrier 1991
. Vol. 17·5
Deux nouveaux cas queoocois d'infection "iiMl,cobacterium haerrwphilum
9uin 1989 etjanvier 1990) nous ont amenes averifier si M. haerrwphilum a
ere isole ailleurs au Canada.
Acejour, on a identifieM. haerrwphilum dans 2provinces: enOntaiio, 2
cas (1981-1982) et au Quebec, 4 cas (1987-1990). Vu le tres faible nombre de
cas, l' information recueillie par noire sondage se lirnite essentiellement aux
methodes d'isolement en usage pour ce microorganisme.
Les 2 souches ontariennes (identifiees comme «ressemblant a .
M. haerrwphilum»), isolees sur milieu Lowenstein-Jensen (Ll) additionne de
citrate de fer ammoniacal (CFA) a2 %, proviennent d 'une lesion au pied et
d'un abces inguinal.
Les souches des 2 premiers cas rappartes au Canada ont ete isolees des
lesions cutanees aux jambes et ala mam droite, d 'un ganglion lymphati~ue et
du co:rps vitre de l'oeil droit d'un sideen de 55 ans, ainsi que d'un gangH'.W
sous-mandibulaire chez une fillette de 3 ans par ailleurs en bonne sanre ' .
Dans les 2 cas plus recents, M. haerrwphilum a ete isole en BACTEC 12B d'un
curetage du coude droit chez un diabetique de 54 ans souffrant d'une
osteom:yelite chronique du condyle externe de I 'humerus (Centre hospitalier
univers1taire de Sherbrooke), et d'une biopsie d'une fistule au genou gauche
d'un sideen de 35 ans (Hopital general de Montreal). Un frottis colore au
Ziehl-Neelsen avait confirme la croissance detecree a30 'C. Le Laboratoire de
sanre publique du Quebec a isole les souches en sous-culture sur Ll + 2,5 %
CFA, gelose-chocolat, gelose Middlebrook 7H10 + facteur X en disque et en
bouillon Middlebrook 7H9 a 32 'C.
Les etudes de sensibilire aux antibiotiques, incluant les noires, indiquent
que M. haerrwphilum est sensible ala rifampine, la rifabutine, l' erythromycine,
la ciprofloxacme, l'irnipenem et ala clofazimine, mais resistant al'isoniazide,
l'ethambutol et ala streptomycine. Les resultats obtenus avec l'arnikacine, le
sulf~%oxazole et l' acide para-arninosalicylique varient d'une souche a
l'autre . La signification de ces resultats obtenus in vitro n'est pas vraiment
connue. Tres peu de donnees cliniques sur les effets du traitement de ces
infections sont disponibles. Les cas de lymphadenite et d'osreomyelite
mentionnes au paragraphe precedent ont ete traire par exerese des tissus
affecres. Quant aux 2 sideens, l' antibiotherapie entreprise a ere interrompue
trop tOt pour que l' on puisse en cons tater l' efficacite.
Nous ne connaissons pas I' incidence des infections aM. haerrwphilum. Le
besoin d'une source additionnelle de fer pour sa croissance expbi~ue en partie
que ce microorganisme, rapporte paur la premiere fois en 1978 , soit
rarement isole d' echantillons clini~ues. Jusqu 'a recemment, on l' a associe a
des lesions cutanees et sous-cutanees diverses, generalement multiples et
situees aux extremites, S&jtout chez des patients immunocomprolTilS. D'apres
les donnes australiennes , la prevalence de !'infection aM. haerrwphilum
serait plus elevee que ce que 1 ensemble des autres rapports suggere. Dix des
25 cas recenses en Australie jusqu 'en 1989, tout comme 2 des 4 cas du
I
I Courl6< da la dau>!llme ciaSl9 Santa et
Canada
Bien-~tre
social
25
Ertegls1remenl n• 6670
Canada
I
Quebec cases, had no apparent evidence of immunologic
deficiency. Six of these cases related to lymphadenitis in infants.
M. haemophilum must be re~arded as a pathogen. Because it
cannot be isolated on most routme media, it is probablr being
missed in many laboratories. An added medium, providing the
required iron (PAC, hemin or hemolysed blood), should be
inoculated from appropriate specimens in which mycobacteria are
sought (material from superficial lesions including lymph nodes
and joint fluids) from all patients, immunocompromised or not.
This culture requires incubation at 30-32°C for at least 6 weeks.
Although 3 of our isolates have been detected in BACTEC 12B
medium without additional iron, the recovery of M. haemophilum
in the radio~etric system is enhanced by the addition of an iron
supplement .
Quebec, ne sont pas relies a une deficience irrununitaire, du moins pas de
fayon evidente. Six de ces cas etaient des aderutes chez de jeunes enfants.
Il faut presentement considerer M. haemophilum comme un pathogene.
Etant donne qu 'on ne peut pas le faire cro1tre sur les milieux generalement
utilises en primo-culture, plusieurs laboratoires ne l'isolent pas. On devrait
ajouter un milieu contenant une source de fer (CPA, hemine ou sang
hemolyse) pour Jes echantillons pertinents dans lesquels on recherche des
mycobacteries (prelevements de lesions superficielles incluant ganglions et
liquides articularres), que le patient soit irrununocompromis ou non. Ce
milieu doit etre incuoo a 30-32 ·c pendant au mains 6 semaines. Bien que
3 de nos souches aient ere obtenues en BACTEC 12B sans fer additionnel,
I' ajout d 'une source de fer augmente les(gjiances d' isolement de M.
haemophilum en systeme radiometrique .
Acknowledgements
Remerclements
The cooperation of Drs. Mark Miller, Montreal General
Hospital, Raymond Duperval and Derek Younge, Centre hospitalier
unjyersitaire de Sherbrooke. all Provincial Mycobacteriology
Laboratories, and especially of Ms. Mary Howes of the
Laboratories Services Branch, Ontario Ministry of Health, Toronto,
is greatly appreciated.
Je tiens a remercier de leur collaboration le 11 Mark Miller de l'Hopital
general de Montreal, les 118 Raymond Duperval et Derek Younge du
Centre hospitalier universitaire de Sherbrooke, ainsi que tousles
laboratoires provinciaux de mycobacreriologie et en particulier Mme Mary
Howes de la Direction des services de laboratoire, Ministere de la sanre de
!'Ontario, Toronto.
References
1. Thibert L, Lebel F, Martineau B, Chicoine L. Mycobacterium
haemophilum in Quebec. CDWR 1988;14:196.
2. Thibert L, Lebel F, Martineau B. Two cases of Mycobacterium
haemophilum in Canada. J Clin Microbiol 1990;28:621-3.
3. Dawson DJ. A review of infection with Mycobacterium
haemophilum in Australia. In: Program of the Annual Meeting
Reterences
of the American Society for Microbiology, 13-17 May 1990,
Anaheim, Ca. Abstract U-64.
4. Sompolinsky D, Lagziel A, N av eh D, Yankilevitz T.
Mycobacterium haemophilum sp. nov., a new pathogen of
humans. Int J SystBacteriol 1978;28:67-75.
5. Damato JJ, Collins MT. Radiometric studies with gas-liquid
and thin~layer chromatography for rapid demonstration of
heroin de:r,endence and characterization of Mycobacterium
haemoph1lum. J Clin Microbiol 1984;20:515-8.
Source: L Thibert, MSc, Laboratoire de sante publjque du Ouebec,
Ste-Anne-de-Bellevue, Quebec.
1. Thibert L, Lebel F, Martineau B, Chicoine L. Mycobacterium
haemophilum au Quebec. RHMC 1988;14:196.
2. Thibert L, Lebel F, Martineau B. Two cases ofM~cobacterium
haemaahilum in Canada J Clin Microbiol 1990; 8:621-3.
3
· Pua;;~a~!: D~vb:;!:~t3tc;~~aY&f!bti:o¥f/~:fC1:"m
Society for Microbiology, 13-17 mai 1990, Anahelffi, Ca. Abstract
U-64.
4. Sompolinsky D, Lagziel A, Naveh D, Yankilevitz T. ~l9obacteriwn
haemophilum liP· noy .. a new pathogen of humans. Int Syst Bacterial
1978;28:67-75.
5. Damato JJ, Collins MT. Radiometric studies wjth gas-liqµjd and
thin-layer chromatography for rapid demonstration of heroin
dmiendence and characterization of M.ycobacteriwn haemophilum. J
Clin Microbiol 1984;20:515-8. ·
Source L Thibert, MSc, Laboratoire de sante publique du Quebec,
Ste-Anne-de-Bellevue(Quebec).
ETHICS AND EPIDEMIOLOGY
ETHIQUE ET EPIDEMIOLOGIE
The ethical dilemmas linked to epideffiiology, whether in
research or application, have been discussed afan international
workshop on Ethics, Health Policy and Epidei:h,iology, held at the
University of California, Los Angeles, on 3-5' Au~st 1990, just ·
before the Xllth scientific meeting of the .International
Epidemiological Association. This workshop attracted about 80
practitioners of epidemiology and experts on ethics from about 25
countries.
The workshop covered many topics among which were:
the balance between the safe~arding of confidentiality and the
use of irllormation for analysis and action;
the extent to which epidemiolo~isi:s should communicate results
of research and surveillance activities to the communities and
persons studied;
conflicts of interests;
data ownership and ownership of analyses;
intercultural approaches;
ethical review procedures.
It also discussed the component parts of possible guidelines on
,,, ethics for epidemiologists.
The case was made for epidemiology to recognize the health
needs and demands of disempowered populations, and to enlarge its
concerns and attitudes to the problems of developing countries and
urban ghettos. An example was given of how epidemiologists and
social scientists iriBrazil are addressing this problem when dealing
with traditional cultures through the development of a code of
community rights. Other specific concerns have been voiced
concerning the relationships between epidemiology and industry,
and the specific ethics of epidemiological research.
Un atelier international sur I' ethique, la politique sanitaire et
l' epidemiologie s est tenu al 'Universire de Californie a Los Angeles du 3
au 5 aout 1990, jlJSte avant la :x:IT' reunion scientifique de l' Association
internationale d Epidemiolo~ie, pour examiner Jes problemes d'ethique lies
aJ'epidemioJogie, que Ce SOlt clans les domaines de Jarechercbe OU CeUX de
l' aPI?lication. Cet atelier a reuni environ 80 praticiens en epiderniologie et
specialistes de l'ethique venus de 25 pays.
I
L' atelier a porte sur differentes sujets, parmi lesquels:
l' equilibre entre la protection de la confidentialite et I'utilisation de
!'information a des fins d'analyse OU d'action;
la mesure clans l~uelle les epidemiologistes devraient communiquer !es
resultats d' activites de recherche et de surveillance aux personnes et aux
communaures etudiees;
Jes conflits d'interets;
les droits de propriere sur les donnees et sur !'analyse de ces dernieres;
Jes approches interculturelles;
les modalites d'examen sur le plan de l'ethique.
Les participants ont egalement examine les elements qui pourraient
eventuellement servir a elaborer des principes directeurs en matiere
d'ethique a !'intention des epidemiologistes.
On afait valoir que l'epidemiologie devait tenir compte des besoins en
matiere de sante et des exigences des populations les plus demunies et
elargir son champ de preoccupation aux problemes des pays en
developpement et des ghettos urbains. Les :participants ont ainsi pu prendre
connaissance de I' exem:ple du Bresil, ou ep1demiologistes et specialistes
des sciences sociales qm sont confronres a des cultures traditionnelles ont
pris conscience du probleme et ont elabore un code des droits de la
communaure. Les particir,ants ont egalement exprime leur preoccupation au
sujet des relations entre 1 epidemiologie et l'industrie et des criteres
d ethique particuliers applicables a la recherche epidemiologique,
Le Conseil des Organisations internationales des Sciences medicales a
(CIOMS) elabore un projet de principes directeurs internationaux
I
The Council for International Organizations of Medical
Sciences (CIOMS) developed proposals for international guidelines
(
26
(
"1EALTH AND WELFARE CANADA· SANTE ET lllEN·!TRE SOCIAL CANADA
Notlft11ble DIH&llfllfll Summary· Somm11lre d11111 m11l11dlfllfll ii d6el11.,.tlon obllg111tolre
New C11111n Reported for the Month Ending November 30, 1900
Nouvnu 011111 d6el11m pour le mole SN t11rmlnant le 30novembfe1900
fl~"!>!IMI
~le
ICD·9
CIM·9
Canada
Cur.
Cou.
AIDS-Sida
Amoeblasl1 • Amblasa
Botuli1m • Botuliame
Bruoalloels • Brucelloaa
0arr4>ylobaalerioel1 •
0arr4>ylobaaltlrioaa
Chlokenpox • Varioalle
Cholera· Cholera
(
006
24
74
Cur.
Cou.
1
8
5
4
9
-
Cum.
90
Cum.•
89
Cur,
Cou.
Cum.
90
Cum.•
89
Cur.
Cou.
-
1
-
1
12
12
20
13
-
-
-
-
180
138
-
-
-
-
8794
36324
10
26
126
1368
107
1122
3
84
99
-
-
-6
-
-
2
7642
37
45
18
-
7
4106
-
-
(1)
(2)
(3)
(4)
(5)
(6)
Queboo
Ouilbeo
-
Diphtheria· Diphterle
032
Glardlaala • Giardiasa
007.1
Gonocoocal Infections •
lnfectionu gonooocciquool 11
098
Gonocoocal Ophthalmla ntlonatorum •
Ophtalmia gonococcique du nouveau-no 098.4
H. lnfluenzae B (Invasive) • Infection
(Invasive) a H. Influenza& B
320.0,038.41
070.0,070.1
Hepatitis A· Hi!patlte virale A
070.2,070.3
Hepatitis B • Hi!patlte vlrale B
Hepatitis other and unapeoKled viral·
Hi!patlte virale, autreG & aana precisionlll
482.41
Legionellotl1 • Legionelloaa
Leprosy • Lepre
030
Malaria· Paludlame
084
055
Measles· Rougeole
Pneurnococcal menlngltle •
Meninglte l pneumocoqueelll
320.1
091
090,092-097
037
124
010-018
002.0
060
NlllW Brunuwlck
Nouveau·Brunawlck
-
3482
18726
004
Cum.'
89
923
281
001
003
Cum.
90
1847
4
8
008.41
062
001
Other bacterial meningitis •
AU!rea rneningltea bacltlrienneal'I
Viral meningitis • Mtlninglte vlraJel5l
lngoooccal Infections·
038
, _Allion• l rnenlngocoquea
072
Mur!ll8 • Orelllon1
Paratyphoid· ParatyphoTde
002.1-002.9
033 .
Pertussis • Coqueluche
Plague· Pesta
020
Polio1T¥elitil • Poliomyellte
045
071
Rablet • Rage
Rubella· Rubeole
058
Congenital Rubella·Rubeole congenttale
771.0
Cur.
Cou.
883
-
472
Cum•
89
732
1
13
006.1
023
Salmonellosis • SalmonellosellJ
Shlgelloals • Shigellose
Syphllls:
Early, Symptomatic·
SyrJlllomatlque, rtloente
Other Syphllil • Autres syphilis
Tetanus • Tetanos
Trichinosis· Trichinose
Tuberouloail • Tuberculeuao
Typhoid· Typholde
Yellow Fever· FJevre jaune
(
042-044
Cum.
90
Nouvelle-~ooase
Prince Edward Inland
11<!1-du·_Prince-~douard
Newfoundland
Terre-Ne1M1
-
-
-
-
Now.Soolia
88
77
11
98
16
276
393
2
41
100
-
-
-
-
11
2
5
55
7
4
58
1
2
-1
-1
-
-
-
-
-
-
-
-
15
113
92
134
1123
1213
278
1432
1846
2
8
4
8
8
8
24
-
2
1
1
1
-
-
-
-
5
3
104
6
5
143
30
2
1
11
11
182
18
6
149
188
68
38
-1
-1
1
1
2
4
180
882
-
-
6
78
112
8
19
43
167
-
-
2
105
384
-
2
2
255 J
437
2
1
,p
15
23.
1
287
107
22t
JS
52·1}
1438
-
-
-
' :...
-
15
145
-
1193
-
-1
--
-
-
-
258
62
3075
618
7954
1316
1
17
62
167
1
14
270
16
129
848
2
7
1380
-1
60
-
-
-
-2
10
-
-
11
-
-
11
22
-
SIGNES
• Not reportable
.. Not available
_ No cases reported
• Adi§olaratlon non ol)ligatolre
.. Non disponible
Aucun cas dtlclar8e
8
3
1
-4
-
112
1
268
1
-
-1
-
1
Includes all 098 categorlee except 098.4
Includes 070.4 to 070.9 and un1pecified
Includes encephalitis
'"
All other categories except Haemophilus 320.0, Meningococcal 036 and Tuberculosis 013.0 ·
All categories except Measles 055, Poliomyelltlo 045, Rubella 056 and Yellow Fever 060
Excludes Typhoid 002.0 and Paratyphoid 002.1 to 002.9
SYMBOLS
1
-
-
-
1
2
1
-
69
-
-
1
-3
-
11
-
-
13
1
-
-
-
3
-
-1
-1
1
60
5
-
-
2
2
8
4
5
14
4
4
-
-
1
2
8
-
-
5
27
2ll
-
-
-
-
-
-
-
-
(1)
(2)
(3)
(4)
(5)
(6)
-
27
-
-
-
7
6
-
-
-
-
35
1
-
4
154
-
-
-
-
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88
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69
3
39
2
30
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20
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258
52
191
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18
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420
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..
..
.
..
.
..
..
-
-
-
-
-
-
-
-
-
.
-
..
-
.
-
..
..
..
..
.
.
.
-
-
-
-
Comprend toutea let rubriques 096, •auf 098.4
Comprend 070,4 et sane precilion
Comprend en~hallte . _
Toutel! Jes autres rubriques sauf Haemophillua 320,0, mtlnlngocoques 038 et tuberculeuae 013,0
Toutea Jes rubriquea aauf rougeole 055, poliomy911te 046, rubeole ()56 et fJevre jaune 060
Saul typholde 002,0 et paratyphoTdo 002, 1 002,9
a
a
a
SOURc;E:
Diviaion of Biometrics
Laboratory Centre for Disease Control
Health and Welfare Canada
Otlawa, Ontario K1 A OL2
Tel.:(613)957-0334
SOURCE:
Division de la Biometrle
Laboratolre de lutte oontre la maladle
Santti et Bien·blre 10Cial du Canada
Ottawa(Ontario) K1A OL2
Tel.:(613)957-0334
•NOTE: Starting this year, the reporting period for the Notttiable Diseases Summary Is based on each calendar month Instead of 4week periods as In the past. Consequently, there will be a discrepancy when
oomparlng data In 1990 with thoee in 1989 and earlier years.
bTA: Aoompter de cette ann6e, la ptlriode de declaration appllqu6e pour le somrnaire des maladies l dtlclaration obllga\oire est t0nd6e 1ur les mols du calendrler et non plus aur des series do quatre sernaines
comme auparavant. La OOlflXU'alson dea donnlls de 1990 et de oalles de 1989 ou dea annes anterieuree ne cadrera done pas tout a!alt.
27
NotlH11bl• Dh1111111Go Summ111ry (Concluded)· Somm11lre dH m11l11dles Ii decl11r11tlon obllgatolre (Hn)
Month Ending Nov•mlMlr 3-0, 1990 • Pilrlod111eetormlmint11113-0 nov111mbr111990
DlaellSfj
Maladie
ICD-9
CIM-9
AIDS-Sida
Amoeblaal• • Ami:>iaae
Botuliom • Botuliame
Bruoellosia • BrucelloBe
Carrpylobaaterlooi• •
CarrpylobaaterloBe
Chlokenpox • Varloelle
Cholera· Cholera
Diphtheria· Diphhlris
a
(1)
(2)
(3)
(4)
(6)
(6)
Saako:!chewan
Aberta
Cur.
Cou.
Cur. Cum. Cum.•
89
Cou.
90
Cur.
Cou.
Cur.
Cou.
032
320.1
166
..
..
..
..
..
..
..
..
..
..
001
482.41
030
084
055
Cum. Cum.'
90
89
-..
008.41
062
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
036
004
091
090,092·097
037
124
010-018
002.0
060
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
..
-
400
1122
2
3
-6
-
6672
21086
-
3765
8010
-
13
37
1
8
8
67
7
73
18
26
88
120
61
113
-
-
-
-
-
-
-
16
281
1284
266
1291
-
-
-
-4
-
-
-
66
65
762
1390
-
Cum. Cum.'
90
89
6
46
-
-
Cum. Cum.'
90
89
British Colurrbla
· Yukon
NorthwestTerritorJ~
/
Colorrbla·
Territolrea du I
Britannlgue
Nord-Oueat
\
Cur. Cum. Cum.' Cur. Cum. Cum.' Cur. Cum. Cum.'
Cou.
90
90
89 Cou.
89 Cou. 89
90
_,
37
178
491
-1
-
-
796
88
908
820 13135 10737
123
33
-
1
161
469
-
-
-
-
-
-
1739
1630
1413
1334
1
26
10
136
3
63
2
-1
-
-
-
-
--
1
-4
12
1
3
309
3
330
-
-
-
-
41
29
58
696
702
161
1220
1224
209
1962
1612
3
36
25
5
46
810
898
105
1155
1762
130
1394
1319
6
73
88
35
-
-
-
-
-
-
16
1
6
17
1
3
-3
1
2
2
-
-
1
12
2
3
(
-
-
-
-
-
-
-
-
-
-
..
..
118
451
562
21
5
5
76
33
10
33
30
3
29
6
18
258
50
26
114
112
8
32
10
59
251
93
61
206
110
2
31
56
18
523
856
21
610
801
..
31
-
-
-
-
3
22
12
26
157
19
-
1
-
-
6
1
8
-1
1
-1
3
1
2
-
-
16
18
2
6
3
1
102
39
94
137
-
-
1
-1
1
-
3
6
-
-
-
-
-
-
-
-1
-
-
-
-
-
.. 24
.. 6
.. 118
.. 612
.. 45
.. 54
.. 156
.. 164
.. '198
.. 13
.. ·;'-.380
.. .. ' ..
.. 156- '
.. .. 4791
.. 630
1
1
-
-
..
..
Mu"l>G • Oreillon1
072
002. 1-002.9
Paratyphoid· Paratypho!de
Pertuuia • Coqueluche
033
Plague· Peale
020
Poliomyelttia • Pollomyelite
045
071
Rabiel • Rage
Rubella· Rubeole
056
Congenital Rubella-Rubeole oongenitale 771
Salmonellotia • Salmonellooelll
003
ShigellOila • Shigellose
Syphilis:
Early, SY1T4>tomallo •
Sytllllomalique, reoente
Other Syphilis • Autres syphilia
Tetanu1 • Tetanos
Trlohinoti• • Trlchinose
Tuberoufosfs_,. Tuberculeuse
Typhoid· Typholde
Vellow Fever· Fievre jaune
Manitoba
042-044
006
005.1
023
007.1
Glardlaais • GiardillSfj
Gonocoocal Infections·
lnlectiona gonooocclqueDl'I
096
Gonococcal Ophthalmia noonatorum •
Ophtalnie gonococcique du nouveau-ne 098.4
H. Influenzas B (invasive). Infection
(invasive) a H. lnfluenzae B
320.0,038.41
070.0,o70.1
Hepatitis A· H~tite virale A
Hepatitia B • Hepalite virale B
070.2,070.3
Hepatiti1 other and unapecffied viral·
H~tite virala, aulrea & aano precision'"
Leglonelloola • LeglonelloBe
Leproay • Lepre
Malaria· Paludisme
Measles· Rougeole
Pneomococoal meningitis·
Meningite pneumoooquesl'l
Other bacterial meningttia •
Aulree meningltes bacteriennesl•I
Viral meningitis· Meningite viraJel'I
Meningococoel Infections·
Infections ll meningocoques
Ontario
-
-
6
7
2
14
9
3
8
3
30
24
-
9
4
-
4
4
2
15
20
2
42
33
4
6
16
4
1
5
25
8
24
1
15
17
70
21
11 5
-
3
36
6
51
1
13
.-f
---
10
6
-
6
4
3
32
26
6
28
21
2
10
1
2
14
17
BO
-
115
1
317
63
-
104
1
4588
12
-
8
1
224
16
-
-
-
11
86
78
1
899
904
16
196
203
1
-
-1
1
1
10
-2
-
-
-
-
-1
-
-
-
403 1237
..
..
..
..
..
..
..
78
743
-
641
32
-
-
-
-
1
5
1
2
7
6
-
-
-
26
208
-
11
-
22
-
111
85
13
-
12
-
-
297
217
13
290
466
- - -4 66- 313- 742- 87172
7
33
49
21
222
250
14
97
148
-
3
6
6
27
-
-
-
17
69
-
17
24
-
11
16
-
-2
-
-
-
-
69
1
-
95
1
8
29
6
-
251
6
-
-
-
-
-
5
-
84
-
-
-
87
4
6
-
-
lncludea all 098 oategonea except 098.4
lncludea 070.4to070.9and unspecified"' lncludea enoephalitie
All other oategoriea except Ha.emophilu1 320.0, Meningoooccal 036 and Tuberoulotia 013.0
All oategoriee exoept Meaalee 066, Poliomyelttia 045, Rubella 056 and Yellow Fever 060
Excludea Typhoid 002.0 and Paratyphoid 002.1 to 002.9
SYMBOLS
SIGNES
• Not reportable
•• Not available
_ No oases reported
• A. declaration non obligatolre
65
54
-
-
-
-6
135
-
-
-
-
-
-
40
-
-
-
-
-
1
(1)
(2)
(3)
(4)
(6)
(6)
-
2
180
-
-
-
-
-
-
48
5
87
-
-
6
3
1
-
-
169
--
654
-
-
-
-
-
-
1
-1
7
-1
82
27
2
-
-
-
2
-
-6
-
2
1
-
-
-
2
10
-
-
~
-
-
-
-
27
-
-
6
21
6
52
-
-
-
-
Comprend toulea lei rubriquee 098, eauf 098,4
Comprend 070,4 et sane precision
Comprend enoephallte
Toules les aulres rubriquea aauf Haemophlllua 320,0, menlngocoques 036 et tuberculeuae013,0
Toulee lea rubriquea aauf rougeole 066, polipmylilite 046, rubBole 066 et llllVre jaune 060
Saul typholde 002,0 et paratypholde 002, 111002,9
a
SOURCE:
Divialon of 810111(1trlca
Laboratory Centre for Disease Control
Health and WeHare Canada
Ottawa. Ontario K1 A OL2
Tel.:(613)957-0334
.. Non disponible
_ Aucun oas deolarea
163
7
-
2
6
-
1
3
-
-
-
-
-
I.'
,
-
a
SOURCE:
Division de la Biom!trle
Laboratoire de Jutte oontre la maladis
Sante et Bisn·6tre social du Canada
Ottawa(Ontario) K1AOL2
Ttll.:(613)957-0334
*NOTE: Starting this year, the reporting period for the Notttiable D i s - Summary ia based on each oalendw month Instead of 4 week periods aa In the past. Consequently, there will be a diaCl'epanoy when
oomparing data In 1990with thoee In 1989 and earlier year1.
*NOTA: A. oompter de oette annee, la p<lriode de d&claration eppliqu&e pour le sommaire des maladisa d&claration obligatoire Mt fondee eur lea mols du oalendrier et non plus eur dea aeri119 de qualre Bemainea
comme auparavant. La oomparaison dea donnea de 1990 et de oellea de 1989 ou dee anneo anterieurea ne cadrera done pas toul fait.
a
28
a
Source: WHO Weekly Epidemiological Record, Vol 65, No 38,
1990.
cortcernant la pratique et larecherche epic!emiologiques, ui ont ere
examines en novembre 1990. De nombreaux problemes d8ethique sont
univeisels mais il importe que les epidemiologistes etudient localement en
permanence les questions d'ethique et les facteurs culturels, sociaux ou
pplitiques particuliers qui s 'y rattachent. L' existence de principes directeurs
ne devra ras empecher la sensibilisation aces 9uestions et l' examen attentif
des problemes delicats auxquels sont confrontes les epidemiologistes, les
universitaires, les gestionnarres, les responsables des politiques et les
praticiens.
Source: Re/eve epidemiologique hebdomadaire de /'OMS, Vol 65, n° 38,
1990.
Announcements
An nonces
for epidemiological practice and research that were discussed in
November 1990. Many ethical issues are universal, but there is a
need for continuing and local discussion of ethics in epidemiology
in relation to specific cultural, social and political factors.
Guidelines will not be a substitute for awareness and careful
discussion of the dilemmas that challenge epidemiologists,
.academics, managers, policy-makers and health practitione~s.
INFECTION CONTROL 1991
PRINCIPLES AND PRACTICES
du 13au17mal1991
Unlverslte McMaster, Hamilton (Ontario)
INFECTION CONTROL 1991
PRINCIPLES AND PRACTICES
13-17May1991
McMaster University, Hamilton; Ontario
This course, designed for newly appointed infection control
practitioners, wiµ ena~le participants to plan, im:(>lement, manage
and evaluate an infection control program. Specifically, at the end
of the course, participants should be able to perform or assist in
performing the following functions:
1. Conducting a detailed assessment cif infection control needs
·
and practices in a hospital;
2. Developing goals and objectives for an infection control
program and selecting appropriate measures to meet them;
3. Establishing a program to carry out these measures including:
a) identifying, recording, analyzing andreporting infections
.
. ,
within the facility;
b) developing education programs for all staff to ensure
knowledge of and compliance with the facility's infection
·
control policy;
4. Evaluating and revising the program as necessary.
Registration is $385.
.·.
For additional information and re.gistratioft', please c;ontact:
Continuing Education, Faculty of llealth Sciences,J\fcMaster
University, Room 1M7, 1200 Main Street West, Hamilton, .
Ontario,.L8N ~ZS, Tel: (416) S2S-9140, E{~. 2219or 2223;
: ..
FAX: (416) S2S-9140, Ext. 2908.
Con~u pour les praticiens de la lutte contre !'infection qui viennent
d'entrer en fonction, ce cours expliquera comment planifier, mettre en
oeuvre, diriger et evaluer un programme dans ce c!Omaine et, plus
precisement, comment remplir OU aider a remplir les taches suivantes : .
1. Faire l' evaluation detaillee des besoins et des pratiques d 'un hOpital
relativement ala prevention des infections;
.
2. Fixer les buts et les objectifs d 'un programme de lutte contre I 'infection, .
et choisir les mesures qui permettront de les atteindre;
3. Mettre sur pied un programme pour appliquer ces mesures, c'est-a-dire :
a) reconnaitre, recenser, analyser et declarer les cas d'infection dans
l' etablissement;
b) elaborer des programmes ooucatifs pours' assurer que tousles
membres du personnel connaissent la politique de prevention des·
-h infections en vigueur dans l 'etablissement et qu. i1s s 'y conforment;
4. nvaluer le programme et le modifier au besoin.
Les droits d'inscription sont de 385 $.
Pour en savoir plus et pour s'inscrire, s'adresser a:~
1
·
fi\\7~YJ-0i·ij~~ fir~WN*¥• t!:fig;N&Wt!tlYLoom
(tel. : 416-52S-9140, poste 2219 ou 2223; FAX : 416-525-9140, poste
2908).
.
INFECTION CONTROL IN LONG-TERM CARE
Introductory Workshop •
SOPIC Spring Seminar
INFECTION CONTROL IN LONG-TERM CARE
Introductory Workshop •
Colloque du prlntemps de la SOPIC
The Southwestern Ontario Practitioners of Infection Control
Chapter (SOPIC - a Chapter of CHICA - Canada) will be holding
its spring seminar on 11 May 1991 at the Lamplighter Inn in
London, Ontario. The ,Program will include presentations on
surveillance, outbreak mvestigations and urinary tract infections.
The registration fee is $50, which includes lunch. Deadline for
.
registration is 1 April. For additional information and registration,
·
please contact Jackie Daley, University Hospital, London,
Ontario, N6A SAS, Tel: (519) 663-3379 or FAX: (S19) 663-3743.
Le colloque du printemps de la SQElC (Southwestern Ontario
Practitioners of Infection Control Cha;iter), une section de
.
.
CHICA - Canada, aura lieu le 11 mai . 991 au Lamplighter Inn de London
(Ontario). Le programme comprendra des exposes sur la surveillance, les
. .
enquetes epidemiologiques et les infections urinaires. Les droits
d 'inscription sont de 50 $, dejeuner compris; et la date limite d'inscription a
ere fixee au ler avril. Pour en savoir plus et pour s'inscrire, s'adresser a
Jackie Daley, University Hospi~I, London (Olitarlo), N6A SAS,
tel.: (519) 663-3379 ou FAX: (519) 663-3743:
·
"HACCP IN ACTION"
Ontario. Food Protection Assoclatlc:m
Annual Spring Technical Workshop
"HACCP IN ACTION" ·
Atelier technique annuel du prlntemps
de !'Ontario Food Protection Association
The Ontario Food Protection Association, a nori-profit
educational assopiation which is affiliated with the International . .
Associ!ltion of Mille, Food and Environmental Sanitarians I:n:c., will
be holding this workshop on 24 April 1991 at the Skyline Hotel in
Rexdale, Ontario. For further details, please contact either Sherry
Haglno (416) 922-SlOO or Karen BeaudC)ln (416) 793-8250.
L'atelier sera presenre le 24 avril 1991 al'Hotel Skyline de Rexdale
(Ontario) par I 'Ontario Food Protection Association, un organisme sans but
lucratif vocation educative qui est affilie I 'International Association of
. Milk:. Food and Environniental Sanitarians Inc. Pour plus de
.
renseignements, communiquer avec Sherry Haglno (416-922-SlOO) ou
·Karen Beaudojn (416-793-82SO).
a
(
\
29
a
Internationally Quarantlnable Disease/Maladies quarantenalres lnternatlonales
For the 6-week period ending 25January1991/pour une periooe de 6 .semaines ~e terminant le 25Janvier1991
Yellow Fever/Fievre Jaune
Infected Areas
Regions infectees
Cholera/Cholera
·Infected Areas
Regions infectees
Algerla/Algerle
Angola
Burundi
Cameroon/Cameroun
Federated States of Micronesia/
Etats Federes de Micronesia
Ghana
. Guinea/Guinea
India/Inda
Indonesia/Indonesia
Ivory Coast/COte-d'lvolre
Kenya
Liberia
Malawi
(
Bollvla/Bollvle
Brazil/Brasil
Madagascar
Peru/Perou
Tanzania/Tanzania
Vietnam Soc Rep/Repub
soc du Vl~t-Nam
Zaire/ZaYre
Angola
Bolivla/Bollvle
Brazil/Brasil
Cameroon/Cameroun
Colombia/Colombia
Gambia/Gambia
Guinea/Guinea
Mall
Nigeria
Peru/Perou
Sudan/Soudan
Zaire/ZaYre
Malaysla/MalaJsle
Mall
Mauritania/Mauritania
Morocco
· Mozambique
Nepal
Niger
Nigeria
Sao Tome and Principe
Tanzania/Tanzania
Vietnam So.c Rep/Repub
soc du Vl~t-Nam
Zaire/ZaYre
Zambia
Notes
1. Cholera In Africa: Ghana (WHO) has reported an outbreak in and
around Accra. There have been a total of 666 suspected cases,
including 94 confirmed cases, with 19 deaths, reoOrted to 7 December.
Plague/Pesta
Infected Areas
Regions infectees
Notes
1. Cholera en Afrlque - Epidemie signalee au Ghana (OMS), clans.la ville
d'Accra et ses alentours; bilan au 7 decembre: 666 cas suspects; dont94 cas
confirmes, et 19 deces. Zamble (OMS, CAB) : nouvelle ep.idemie ayant fait
1 000 cas et 166 deres recensee pendant la JJr6sente Saison i:les pluies; atteindra
·
probablement bientot Lusaka. Tanzanle (CAE) : nouvelle epidemie,
notamment Dar es-Salaam; interdiction de vendre des aliments dans la rue.
Mozamblgue (ill2Sfil: 1 240 cas (58 deces) en date d'octobre. Algerle
(QllW : epideiiUeeilcours dans les provinces du nord, notamment en
banlieue d I Alger. Les voyageurs destination d 'une region OU sevit une .
epidemie de cholera doivent prendre des precautions rigoureuses en ce qui
conceme les aliments et l' eau.
·
Zambia (WHO, FEC): New outbreak rel?orted during this rainy
season, with 1000 cases and 166 deaths; it is considered likely that the
outbreak may soon reach Lusaka. Tanzania (FEC ): New outbreak,
including in Dar es Salaam; street vendinE of food has been banned.
Mozambique (GDSR): 1,240 cases (58 fatal) as of October. Algeria
(GDSR): Current outbreak in northern provinces, including outskirts
of Algiers. Travellers to areas with cholera outbreaks shoiild adhere to
strict food and water precautions.
a
a
Yellow fever (WHO): Cameroon has re~d an outbreak in the
northern part of the country, with 108 cases (81 deaths) from
September to 20 November. Ecuador has reported 4 cases (2 deaths)
in Zamora Chinchipe province. Travellers to areas widi yellow fever
activity should be immunized.
.
,
:·
2.
3.
Menlngococcal menln~ltls, Tanzania (GDSR): Cilrrent outbreaks in
central and northern regions, thought to be due to group A Travellers
should be immunized (LCDC).
,
3.
Menlnglte menlngococclque - Tanzanle (QllW : Epidemies qui seraient
dues au groupe A en cours dans les regions du centre et du nord. Vaccination
recommandee pour les voyageurs (LLCM).
4.
Plague, Tanzania (FEND): Outbreak has been reported in area of
Lushoto, and there have pwportedly been 3 cases acquired in Dar es
Salaam, with cases ofbOih oubOnic and pneumonic plague.
4.
Peste - Tanzanle (NDAE) : Epidemie signalee dans la region de Lushoto;
acquisiti~n probable de 3 cas Dar es-Salaam (peste bubcinique et
pneumomque).
2.
5. Typhoid fever, Jamaica (GDSR): An outbreak was reported in
a
'f"
-
SclontificAdviJJory Board:
Bditar:
De1klop Publillhing
Circulation:
Bureau of Communicable DiBcuc Epidemiology
Laboratory Centxo for Di>ouo Control
Tunncy'1 Puturo,
CYITAWA, Ontario
Canada KIA OL2
Dr.1.Spika
Dr. A. Cartor
Dr.K.Rouc
Bloanor PaullOil
10llDDt> Regnier
Gortrudo Tardiff
(613) 957-4243
(613) 957.1339
(613) 957-1329
(613) 957-1788
(613) 957-7845
(613) 957-0842 .
a
5. 'fypholde - Jama'ique <ill2SID : Bilan d 'une epidemie signalee a .
Savanna-la-Mar, une
(4deces).
Savanna-la-Mar, a town on southwest coast, with 163 cases (4 fatal)
up to 20 October.
Tho Canada Diseases Weekly RDportpteSODlll curmnt information an infectious nnd otbor di!C11JJC1 for
BUJVcillanoc pwposos and iJJ aVllilnblc froo of charge upoo mquollt. Many of tho ai:ticlo1 i:onlAin
proliminnry infonnation arid furthor coofirmatian may bQ obtained from tho rolirtes quolOd. Tho
Department ofHonlth and Wolf.arc does not u1111JDC tcipansibility for accuracy or autbaJticit)..
Cantrlbutians arc wolcomod (in tho of!iclnl language of your choice) from anyono working in tho
honlth fiold and will not procludc publication·ol"'whcrc.
Flllvrejaune (OMS) - Epidemie signalee dans la region nord du Cameroon
ayant fait 198 c~ (81 deres) de septembre au 20 nove~b~. Province de
.-Zamora Chinchipe (E<Iuateur): 4 cas (2 deces). Vaccination recommandee f
pour l~s voyageurs destination d 'une region enregistrant une activite de
\
.
·
fievre Jaune.
villede1ii cClte sud-ouest, en date du 20 octobre : 163 cas
Le Rapport hobdomadairc des maladlos au Canada, qui foumit dos donn6cs potlimn!os rur los maladlos
infocticUJOJ ctlcs autxos maladlo1 dam le but do ficiliter icur 1UIVcillanai;pout 8txo obtonu gruuitementtur
domando. Un grand nambro d 'articlc1 no conticnncnt quo do1 donn6c1 100unalrc1 mais dC1 rom<>igncmontJ
comp!6mcntairo1 pouvont 8txo obtenw en 1' tddniB1ant aux rourcos cit6o1. Le rniniJtrc do la Sant6 nati<malc ct du
Blon.atrc 1oclnl no pout Stxo re'P"IlJ•blc do l'oxactitudo, ni do l'authonticit6 do1 articlot. Tonlo por>OmlC
ocuvrant dam lo domainc do la 1ant6 est invit6o & cdlaboror (dam la languo officiollc do son choix) ct la
publication d'1m article dam le pn\IODI Rapport n'cncmp&chc pu Ja publicatiw aillcun.
Groupe do canscillor11ciontifiquos:
D' 1. Spika
(613) 957-4243
D' A. Carter
(613) 957-1339
D' K. Roz.cc
(613) 957·1329
B!cancrPaul1an
(613) 957-1788
R6dactricc on chef:
llditiquo:
1ouim Regnier
(613) 975-7845
DiJJtrlbuticm:
GortrudoTardiff
(613) 957·0842
Buro au d'6pid6miqlogio doll maladies tra,mmi11iblc1
Laboratoirc do Jutte contrc la maladlo
PI6Tunncy
CYITAWA (Onlario)
Canada KIA OL2
30
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