Background:In 2024-25, Quebec implemented a universally publicly funded infant nirsevimab program. We estimated effectiveness, number-needed-to-immunize (NNI) and impact against severe respiratory syncytial virus (RSV) outcomes. Methods:A test-negative study estimated adjusted effectiveness among nirsevimab-eligible children RSV-tested during emergency room (ER) consultation or hospitalization between October 2024 and March 2025. Eligible children were born during the RSV season (at-birth group) or <6- to <19-month-olds healthy, preterm, with chronic conditions or living in remote regions (catch-up groups). We used 2023-24 respiratory hospitalization rates, RSV-positivity from a systematic hospital-based surveillance network, and Quebec 2024-25 coverage estimates to derive the theoretical NNI and averted hospitalizations. Findings:Effectiveness analyses included 3172 specimens linked to ER consultations (1775 [56·0%] from male and 1397 [44·0%] from female participants; 668 [21·1%] RSV-positive) and 1758 linked to hospitalizations (988 [56·2%] from male and 770 [43·8%] from female participants; 549 [31·2%] RSV-positive). Effectiveness was 86% (95% CI: 82-90) against ER consultation, 89% (95% CI: 84-92) against hospitalization (79% (95% CI: 60-89) for those with chronic diseases and 93% (95% CI: 83-97) for preterm infants), and 88% (95% CI: 58-97) against ICU admission. We estimated 41 at-birth and 58 catch-up immunizations needed to avert one RSV-associated hospitalization. We estimated that 72% (at-birth group) and 59% (catch-up group with 64% coverage by November) of RSV-associated hospitalizations were prevented, potentially increasing to 82% for a hypothetical coverage of 90% by October. Interpretation:Nirsevimab is highly effective and could more substantially impact the RSV burden through broad and timely administration to healthy-term and high-risk infants. Funding:Ministère de la santé et des services sociaux du Québec.
Background: Assisted reproductive technology has been linked to an increased risk of pregnancy-related cardiovascular complications, but the long-term cardiovascular outcome is poorly understood. This study aimed to assess whether women who use ART have an elevated long-term risk of adverse cardiovascular outcomes. Methods: We conducted a systematic review and meta-analysis to examine the association between ART and long-term cardiovascular outcomes after pregnancy. We systematically searched MEDLINE, Embase, and the Cochrane Library for studies published by January 2026. We evaluated the methodological quality of included studies using the Newcastle-Ottawa Scale. We used random effects models to calculate pooled adjusted risk ratios (aRR) with 95% confidence intervals (CI) for the association of ART with cardiovascular outcomes. Results: We included thirteen studies comprising 553,331 patients who used ART and 37,826,591 patients who conceived spontaneously. All women achieved a live birth. Mean duration of follow-up after delivery was 8.4 ± 8.3 years. In models adjusted for age, parity, and comorbidity, ART was associated with a small increase in the risk of cardiovascular disease compared with spontaneous conception (aRR 1.18, 95% CI 1.03-1.35), but the association was attenuated when studies that had only 42 days of follow-up were excluded (aRR 1.13, 95% CI 0.99-1.29). ART was not associated with cardiac complications (aRR 0.94, 95% CI 0.82-1.08), stroke (aRR 1.20; 95% CI 0.93-1.55), hypertension (aRR 1.02; 95% CI 0.72-1.44), or venous thrombosis (aRR 1.27, 95% CI 0.97-1.67). Conclusions: Our findings suggest that women who achieve a live birth following ART do not appear to have an increased long-term risk of adverse cardiovascular outcomes. These results provide reassuring evidence for patient counseling regarding the long-term cardiovascular safety of ART among women with successful pregnancies. Further research that includes women who do not achieve a live birth is warranted to more fully characterize the potential long-term cardiovascular effects of ART across the entire spectrum of treatment outcomes.
The emergence of antimicrobial resistance (AMR) in Neisseria gonorrhoeae is a worrying global phenomenon, with major implications for public health. This study, a cross-sectional analysis of an open cohort, explored the risk factors associated with multidrug-resistant (MDR) gonococcal infections in the province of Québec, Canada, using data from the sentinel surveillance network from 2017 to 2019. The data comprised sociodemographic, epidemiological, and clinical information, collected through self-administered questionnaires, direct case interviews and chart reviews coupled with laboratory AMR data for five antibiotics: azithromycin, tetracycline, ciprofloxacin, cefixime, and ceftriaxone. Missing data were handled using multiple imputation with chain equations (MICE); generalized estimating equations (GEE) were used to assess correlates of MDR. The analysis included 714 participants with a total of 775 cases. We observed very frequent resistance to ciprofloxacin (74.3%), while resistance to tetracycline and azithromycin was 19.9% and 21.3%, respectively. MDR was found in 12.5% of cases. Multivariate analysis indicated that having five or more sexual partners in the past two months (aPR=1.61, 95%CI: 1.07-2.41) was associated with MDR. In conclusion, our results show an association between the number of sexual partners and MDR, supporting the hypothesis that resistance can develop more rapidly in dense sexual networks. It is crucial to address the issue of circulating resistant strains through ongoing surveillance, research, and targeted interventions to manage and contain them before they become widespread.
ABSTRACT No regulatory agency-approved nucleic acid amplification tests (NAATs) exist for detecting Chlamydia trachomatis (CT) or Neisseria gonorrhoeae (NG) in conjunctival samples, necessitating validation, including performance analysis. This is challenging due to case rarity and the absence of a gold standard. This retrospective case series evaluated the performance of the Roche cobas CT/NG NAAT on conjunctival samples using microbiological and clinical data. Clinical records of patients with positive CT/NG NAAT conjunctival samples processed in our laboratory between 2013 and 2023 were reviewed, along with matched negative controls. Positive results were confirmed using a stepwise algorithm: (i) positive NG culture (NG only); (ii) confirmatory CT/NG NAAT performed at the Laboratoire de santé publique du Québec (LSPQ); (iii) CT/NG NAAT from other anatomical sites; or (iv) clinical presentation compatible with CT/NG conjunctivitis. Negative controls were confirmed based on clinical information. Sixty-five positive conjunctival samples were included (53 CT-positive, 12 NG-positive). Of the 53 CT-positive samples, 52 were confirmed (21 by LSPQ testing, five by a concomitant genital sample, and 26 by a compatible presentation). Of 53 CT-negative controls, 45 were clinically confirmed as true negatives. Among the 12 NG-positive samples, 11 were confirmed (seven by culture, four by LSPQ testing). Of 12 NG-negative controls, 11 were clinically confirmed. Sensitivity and specificity were 87% and 98% for CT, and both were 92% for NG. Given sufficient data, the Roche cobas CT NAAT assay on conjunctival samples does not require confirmatory testing. However, confirmation of NG-positive results should continue until more data are available. IMPORTANCE Chlamydia trachomatis (CT) conjunctivitis has been increasingly observed in adults and neonates. If untreated, it can cause local complications and, in adults, contribute to ongoing transmission. Neisseria gonorrhoeae (NG) conjunctivitis is rarer, but its hyperacute presentation can lead to severe outcomes, such as orbital cellulitis or globe rupture. Conventional diagnostic methods for CT are either unavailable or highly resource-consuming, and NG culture lacks sensitivity, underscoring the need for rapid and reliable diagnostic methods. Nucleic acid amplification tests (NAATs) are considered the gold standard for detecting CT and NG in urogenital, pharyngeal, and rectal sites, due to their high sensitivity and specificity. Despite widespread use on conjunctival specimens, no NAAT is approved by regulatory agencies. Evaluation of the Roche cobas CT/NG assay is crucial to establish its performance on conjunctival specimens and to provide clinicians with accurate, timely diagnostic results.
Le programme de surveillance des souches de Neisseria gonorrhoeae résistantes aux antibiotiques a été mis en place en 1988 dans la province de Québec. Le présent rapport fait état des résultats des analyses effectuées par le Laboratoire de santé publique du Québec (LSPQ) sur les souches de Neisseria gonorrhoeae isolées au cours des années 2023 et 2024 et décrit l’évolution temporelle de la résistance. Il a été élaboré à la demande du ministère de la Santé et des Services sociaux du Québec dans le cadre d’un mandat de surveillance. Ce rapport de surveillance présente les résultats obtenus en 2023 et 2024 et compare ceux-ci avec certains résultats obtenus depuis 2015. Il s’adresse principalement aux microbiologistes-infectiologues, aux cliniciens du réseau et aux professionnels des directions de santé publique. Il vise à soutenir les cliniciens ainsi que les intervenants dans le domaine des infections transmissibles sexuellement et par le sang.
