Toronto Public Health (TPH) is the public health unit in Toronto, Ontario. It is responsible for delivering public health programs and services, enforcing public health regulations and advising Toronto City Council on health issues. The current unit was formed in 1998, when the former Metropolitan Toronto and its constituent municipalities of Toronto, York, North York, Scarborough, Etobicoke, and East York amalgamated into the current city of Toronto..
Canada's National Advisory Committee on Immunization (NACI) marked its 60th anniversary in 2024, representing six decades of reliable advice supporting Canada's immunization programs. Over the past decade, NACI expanded its mandate to include ethics, equity, feasibility, acceptability, and economic considerations, while adapting its methods to align with international standards and responding to urgent public health needs such as the COVID-19 pandemic. Enhanced collaboration with provinces, territories, Indigenous partners, and global peers has strengthened both the relevance and reach of NACI guidance. With an expanding vaccine landscape, NACI continues to evolve as a trusted national and global resource supporting equitable, evidence-informed immunization policy and practice in Canada.
Background: Beaches are popular summertime destinations in Canada. However, they can be affected by specific fecal pollution sources, increasing the risk of recreational water illness. Objectives: This study was conducted to determine the risks of acute gastrointestinal illness (AGI) among Canadian beachgoers and to evaluate the influence of different fecal indicator bacteria (FIB) and other water quality measures on assessing these risks. Methods: In a prospective cohort design, beachgoers were recruited at sites across Canada from 2023 to 2025. Sociodemographic characteristics and exposures were determined through an on-site survey, with a 7-day follow-up survey to determine risks of AGI. Bayesian mixed-effects logistic regression models were fitted to evaluate the effects of an ordinal water contact variable (no contact, minimal contact, body immersion, and swallowed water) on the incident risk of AGI, with an interaction included for water quality indicators. The levels of six FIB and water quality measures were assessed: Escherichia coli, enterococci DNA, three microbial source tracking DNA markers (human HF183/BacR287, human mitochondria, seagull Gull4), and turbidity. Results: A total of 4085 participants were recruited, with 67.6% completing the follow-up survey. The overall incident risk of AGI was 2.6%. Both swallowing water and body immersion increased AGI risks compared to no water contact: median of 20 excess cases (95% Credible Interval [CrI]: 4, 64) and 5 excess cases (95% CrI: 1, 19) of AGI predicted per 1000 beachgoers, respectively. Escherichia coli and seagull DNA marker levels were associated with AGI among those who had water contact, particularly among those who reported swallowing water. Discussion: While the overall burden of AGI due to beach water contact in Canada was low, increased risks are associated with E. coli levels particularly among those who swallow water. This could be related to fecal contamination from seagulls. However, there is substantial uncertainty in the predicted effect sizes. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Protocols ### Funding Statement This work was supported by the Canadian Institutes of Health Research (CIHR), grant numbers PJT 185894 and PJT 192023 (P.I. Young) ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The Toronto Metropolitan University Research Ethics Board gave ethical approval for this work (REB# 2023-043). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present study are available upon reasonable request to the authors [https://github.com/iany33/Beach\_cohort\_AGI][1] [1]: https://github.com/iany33/Beach_cohort_AGI
Importance:Both invasive group A streptococcal (iGAS) infections and the number of persons experiencing homelessness (PEH) are increasing. Protection of PEH from the burden of iGAS infections requires understanding of its epidemiology. Objective:To assess whether the resurgence of iGAS infections after the COVID-19 pandemic included PEH. Design, Setting, and Participants:This cross-sectional study of population-based iGAS surveillance used Canada's National Microbiology Laboratory for emm typing and Statistics Canada and point-in-time counts to identify denominators. Participants included 503 persons with iGAS infections from January 1, 2022, to December 31, 2023, in the Toronto and Peel Region, Canada (population, 4.5 million). Main Outcomes and Measures:The main outcome was disease incidence among PEH over time and compared with housed persons. Secondary outcomes were differences in risk factors, presentation, disease severity, and infecting emm types between PEH and housed persons. Results:Ninety iGAS cases occurred among PEH (median age, 47.0 years [IQR, 37.7-59.5 years]; 66 men [73.3%]) and 413 occurred among housed adults (median age, 58.9 years [IQR, 42.1-73.3 years]; 259 men [62.7%]). iGAS incidence among PEH increased from 270.4 (95% CI, 184.5-383.2) per 100 000 per year in 2022 to 451.2 (95% CI, 348.2-575.7) per 100 000 per year in 2023 (incidence rate ratio [IRR], 1.67; 95% CI, 1.06-2.69), not significantly different than the increase from 3.4 to 7.0 per 100 000 per year among housed persons (IRR, 2.05; 95% CI, 1.67-2.52). iGAS incidence overall was 70.7-fold higher (95% CI, 56.3-fold to 88.7-fold) among PEH than housed persons. Compared with housed adults, PEH were less likely to be immunocompromised (adjusted odds ratio [AOR], 0.29; 95% CI, 0.11-0.73) and were more likely to be persons who inject drugs (AOR, 5.06; 95% CI, 2.79-9.19), to have nonintact skin (AOR, 4.16; 95% CI, 2.45-7.04), and to have iGAS presenting as soft tissue infection (AOR, 1.64; 95% CI, 1.02-2.64). PEH were less likely to die of iGAS than housed adults (AOR, 0.33; 95% CI, 0.12-0.95). Overall, emm1 and emm12 caused 33.7% of iGAS cases (137 of 406) among housed persons, but only 2.2% (2 of 90) among PEH; in contrast, isolates with emm types 49, 74, 80, 82, and 92 caused 77.8% of iGAS cases (70 of 90) among PEH, but only 34.2% (139 of 406) among housed persons (P < .001). The emm types frequently causing iGAS infections among PEH also caused iGAS infections among housed persons and were too highly clonal to assess transmission risk. Conclusions and Relevance:In this cross-sectional study, the post-COVID-19 pandemic resurgence of iGAS infections occurred among both PEH and housed adults, although the incidence among PEH was 70.7-fold greater. Risk factors, clinical presentations, outcomes, and infecting strains were very different. Improved iGAS protection for PEH, such as vaccines, is needed.
To describe the demographic and health profiles of Black people in the African Caribbean Track Study (A/C Study) who consented to linkage to administrative databases, examine variations in healthcare use, and compare these patterns to those observed in the general population to inform efforts to reduce health disparities. Using a matched cohort design, participants who consented to administrative data linkage in the A/C Study were matched 1:10 to general population controls based on age (± 5 years), sex, and census metropolitan area. We compared sociodemographic characteristics, HIV prevalence, and healthcare use using descriptive statistics and logistic regression. Of the 1380 A/C Study participants, 309 provided consent and 115 (8.3
Background: Digital sexually transmitted and blood-borne infection (STBBIs) testing services are used to improve testing access, but might replicate existing social inequities. Previous research has shown that the digital STBBI testing service GetCheckedOnline has improved access to testing in British Columbia (BC), Canada. As part of the program's continuous evaluation, we examined awareness and use of the service in 5 urban, suburban, and rural communities where the program has expanded. Objective: This study aimed to determine if social location is associated with differences in awareness and use of the service in 5 communities outside Vancouver, BC. Methods: From July to September 2022, we conducted a cross-sectional survey recruiting (in-person and online) sexually active people aged 16 years or older in 5 urban, suburban, and rural communities where GetCheckedOnline had sample collection sites available at the time. We examined differences in awareness and use by age, gender identity, sexual identity, race/ethnicity, education, and income using logistic regression models informed by the Health Equity Measurement Framework. Results: Of the 1658 participants (n=1058, 63.8% in-person and n=600, 36.2% online), 35.3% (586/1658) were aware of GetCheckedOnline and 19.5% (324/1658) had used it. Awareness and use were lower in the first and last age quartiles compared to the second quartile (>38 years: awareness odds ratio [OR] 0.23, 95% CI 0.17-0.32; use OR 0.19, 95% CI 0.12-0.28; <25 years: awareness OR 0.39, 95% CI 0.28-0.53; use OR 0.28, 95% CI 0.18-0.41). Awareness and use were also lower in the lowest income group compared to the highest (awareness OR 0.39, 95% CI 0.24-0.65; use OR 0.36, 95% CI 0.20-0.65). Awareness and use were higher among genderfluid, genderqueer, and nonbinary participants compared to men (awareness OR 2.27, 95% CI 1.63-3.18; use OR 1.97, 95% CI 1.36-2.84), transgender compared to cisgender participants (awareness OR 2.17, 95% CI 1.54-3.06; use OR 2.15, 95% CI 0.46-3.13), and nonheterosexual compared to heterosexual participants (awareness OR 2.37, 95% CI 1.89-2.97; use OR 2.53, 95% CI 1.91-3.38). People of color had higher awareness and use vs White participants (awareness OR 1.74, 95% CI 1.34-2.26; use OR 2.01, 95% CI 1.48-2.72). Indigenous participants had higher awareness than White participants (OR 1.65, 95% CI 1.19-2.20) but no difference in use. Women had similar awareness but lower use compared to men (OR 0.68, 95% CI 0.50-0.92). Conclusions: GetCheckedOnline is an equitable means of access to STBBI testing for some but not all equity-owed groups in BC. Further adaptations should consider factors such as differences in material circumstances to improve its accessibility for all.
