Understanding Infectious Diseases by Karthik

A SPECIAL INTEREST SECTION BY MEDIAPLANET

Read more at healthinsight.ca

Understanding Infectious Diseases

Q&A with Dr. Vivien Brown Mediaplanet sat down with Dr. Vivien Brown, a Toronto-based family physician, to learn more about ways that Canadians can keep safe this flu season. Why should Canadians get the flu shot this season?

Dr. Vivien Brown Family Physician

We've all learned how important it is to reduce the risk of viral infections. With the flu shot, we reduce risk so that even if we do get the flu, it will be mild, and we won’t need hospitalization, the ICU, or ventilation. This is so important as the risk of exposure to COVID-19 continues. So yes, get immunized for both COVID-19 and the flu.

What are some ways in which Canadians can protect themselves from the flu? As always, immunization is the first line of defence. But last year, we saw

the value of hand-washing, masks, and keeping a safe distance. So, what works for COVID-19 also works for the flu.

Who should not receive the flu shot? We cannot immunize babies under six months of age, as well as people who have had reactions in the past. Those numbers are small, but that makes it even more important for the rest of us to be immunized and to protect those other people by decreasing the risk of exposure.

enza last year. That means very few people have built natural immunity to last year’s variant. As variants may be similar, going into this year’s flu season, we're not protected — we don't have any advantage from last year. Bottom line, with our population aging and managing many chronic diseases such as diabetes and asthma, let’s protect ourselves, our families, and each other by decreasing influenza in the community. We'll all benefit.

Many are saying this flu season will be significantly worse than last year's. Why is this the case?

When is the best time to get vaccinated?

Well, we saw very few cases of influ-

Right now!

Inclusive Health Care Is Crucial for This Year’s Flu Season

Zahir Hirji, President, Infection Prevention & Control Canada (IPAC Canada)

hile Canadians are grappling with increasing COVID-19 cases across the country, many health care workers are already wondering about and planning for the impending influenza season. The overwhelming focus on health care over the past 18 months has highlighted many health care inequities and disparities across Canada. As a country, we will be remiss if we don’t learn and apply the lessons from COVID19 vaccine distribution, uptake, and acceptance and apply them to the flu campaign. Specifically, we must focus on the polarizing effects of COVID-19 on Black and Indigenous communities in Canada. Influenza vaccines have traditionally had lower effectiveness than what has been achieved with the current COVID-19 vaccines. With current

surveillance systems that don’t track influenza cases with the same clarity and the lack of race-based information, many questions remain. The minimal influenza season of 2020 to 2021 may leave a higher level of susceptibility in Canadians, further supporting the rationale to get vaccinated. The value of being vaccinated has been well-illustrated in some of Canada’s most vulnerable populations, like long-term care residents. Great work is being done in many jurisdictions to develop equity-centered health care practices that are informed by culturally-safe guidance. In particular, building trusting relationships requires time and patience. Health care workers need to be aware of and acknowledge past traumatic experiences. In a 2012 study, researchers reported lower

vaccinations rates amongst Black people in Canada compared to other ethnic groups. In 2021, the situation remains unchanged. A recent report from Public Health Ontario highlights the disproportion in COVID-19 cases amongst Black people in Canada compared to the overall population. We have a unique opportunity, right now while Canadians are listening, to offer access to resources, to leverage local successes with COVID-19 vaccine programs, to bolster influenza vaccination initiatives, and to build structures that will continue to prioritize the health care needs of Black people, Indigenous folks, and people of colour in Canada. We know that flu vaccinations remain one of the best ways to protect yourself and your loved ones against the flu and its potentially serious complications.

Disclaimer: The IPAC Canada Diversity, Equity and Inclusion Working Group has collaborated on this article. References: 1. Public Heath Ontario Learning Exchange: COVID-19 vaccine uptake and equity considerations 2. Public Health Ontario Health Equity and COVID-19 3. Eissa, A., Lofters, A., Akor, N., et al. Increasing SARS-CoV2 vaccination rates among Black people in Canada. CMAJ 2021 Aug 9: 193(31):E1220-E1221. 4. Quach, S et al. Influenza vaccination coverage across ethnic groups in Canada. CMAJ 2012 Oct 16: 184(15): 1673-1681.

Publisher: Natalie Jacome Strategic Account Manager: Madison Trajkovski Business Development Manager: Chelsea Siemon Country Manager: Nina Theodorlis Content and Production Manager: Raymond Fan Designers: Lauren Livingston, Kylie Armishaw Web Editor: Karthik Talwar All images are from Getty Images unless otherwise credited. This section was created by Mediaplanet and did not involve the Toronto Star or its editorial departments. Send all inquiries to ca.editorial@mediaplanet.com.

@MediaplanetCA

facebook.com/HealthInsight

Please recycle

A SPECIAL INTEREST SECTION BY MEDIAPLANET

Pavithra Ravinatarajan Registered Pharmacist

Read more at healthinsight.ca | 2

Enjoy a Safe Return to Travel by Taking These Precautions After a long pause, international travel is coming back. Here’s how you can enjoy the trip while staying safe.

anadians are eager to travel again. After months of isolation, confinement, and working from home, the thought of getting away to relax at a resort, explore far-off lands, or simply visit friends and family is wondrously appealing. “With all this remote working, the lines between work and home have become blurred,” says Pavithra Ravinatarajan, a registered pharmacist based in Kitchener, Ont. “As a result, many of us are looking for a change of scenery to reset our minds, which isn’t a bad thing because it can help with burnout. But we need to make sure that we take the right steps to do it safely.”

What to consider as you plan your trip

Anne Papmehl

tion and QR code, if necessary, to enter that country,” says Dr. Darin Cherniwchan, a physician at the Fraser Valley Travel Clinic in Chilliwack, B.C. The timing of the COVID-19 test is also crucial. “For most major centres in the world, it’s required 72 hours prior to boarding the plane, but in some countries, these rules and regulations can change on a weekly basis,” says Dr. Cherniwchan. For countries that aren’t accessible by direct flight from Canada, that testing period may be extended up to 120 hours. “It has to be calculated based on your personal itinerary, and that can get complicated if you’re travelling through several countries to get to your destination country. It can also be challenging to get timely test results if you’re leaving on a weekend, especially on a long weekend, so all these elements need to be considered,” says Dr. Cherniwchan.

The first step is making yourself aware of the risks — COVID-19 and otherwise. “If you’re not sure where you want to go yet, you may want to take a look at the Health Canada recommendations as well as Immunization for common the Canadian Travel Restrictions on the travel-related diseases risks and vaccination requirements for In addition to protecting against COVIDdifferent locations,” says Ravinatara19, it’s important to protect against other jan. Along with that, you’ll want to find travel-related illnesses. “The last thing out what the COVID-19 protocols are you want is to have your vacation ruined for various locations, such as masking by something that could have been and distancing, and which activities avoided,” says Ravinatarajan. or services may The pre-travel be temporarily visit with your health care prorestricted, so you Many of us are looking for a can choose your vider is a good change of scenery to reset destination confitime to ensure you our minds, which isn't a bad dently and prepare discuss which desthing because it can help accordingly. tination-specific with burnout. But we need to make sure that we take the vaccines you The next step right steps to do it safely. may need, such is making sure as yellow fever, you’re vaccinated against COVID-19 hepatitis A, hepa— and potentially having a valid, negatitis B, malaria, Japanese encephalitis, tive COVID-19 test — and ensuring that or rabies. “Ideally, this should be done a good six to eight weeks before deparyou have supporting documentation in order. It’s important to be aware that ture,” says Dr. Cherniwchan. This is also not every country accepts all types of a good time to ensure your non-travel routine vaccinations, such as tetanus COVID-19 tests. “The best thing to do is to go to a place that provides COVIDand diphtheria, are up to date. “No 19 PCR testing or rapid antigen testing matter where you are on the planet, specifically for travel, because they will you’re at risk for those illnesses,” says Dr. Cherniwchan. provide you with the proper documenta-

CARIBBEAN DREAMS? Visit DukoralCanada.com and ask your healthcare professional about DUKORAL®.

Food- and water-related illnesses like traveller’s diarrhea also need to be factored into your protection plan. You can prevent these by avoiding tap water for drinking and tooth-brushing, and by eating only foods that are boiled, cooked, or peeled. “There are immunizations available to help prevent against cholera and diarrhea caused by a specific strain of enterotoxigenic E. coli (ETEC) bacteria,” says Dr. Cherniwchan, who advises having a treatment plan in place before you leave, just in case. “That includes hydration, medication, and knowing who to call if you get sick. The last thing you want to do is start looking for help when you’re ill.” Protection against mosquitoes and ticks is also paramount. “Mosquitoes are disease vectors that can spread diseases such as malaria, dengue fever, Zika, Japanese encephalitis, yellow fever, chikungunya, and West Nile virus,” says Dr. Cherniwchan. The best way to protect yourself is through a combination of insect repellent on exposed skin and wearing permethrin-treated clothing. “The two work synergistically to provide higher protection, so when you wear the two together, the likelihood of getting bitten is very remote,” says Dr. Cherniwchan. This is especially important if you’re hiking or in wooded areas. You may also want to consider packing a travel health kit. “Many pharmacies will actually set up a kit for people or you could put one together yourself,” says Ravinatarajan.

Dr. Darin Cherniwchan Physician, Fraser Valley Travel Clinic

Seek proper advice Dr. Cherniwchan advises Canadians who plan to travel internationally to consult with a travel medicine specialist to ensure that everything they need is in place. “It’s one thing for someone to look it up on the internet, but it’s another to know what’s really happening on the ground,” he says. Getting the right advice ensures your trip is that much smoother and safer.

Consult with your health care provider to receive travel-related health advice up to eight weeks prior to departure.

2 weeks before you travel!

A SPECIAL INTEREST SECTION BY MEDIAPLANET

3 | Read more at healthinsight.ca

COVID-19 Persists, Despite the Widescale Vaccine Rollout JN Nova and Biodextris have teamed up to produce a new COVID-19 therapeutic solution. John Mukherjee

Dr. Nathan Yoganathan Chief Scientific Officer, JN Nova Pharma Inc.

Dr. John Gillard CEO, Chief Product Development Officer, JN Nova Pharma Inc.

John Mukherjee Director of Business Development & Marketing, Biodextris

N Nova Pharma Inc. is a biotechnology company headed up by Dr. John Gillard and Dr. Nathan Yoganathan. The firm is partnered with the National Research Council Canada (NRC) Human Health Therapeutics Research Centre team and various academic collaborators who discovered a promising and novel COVID-19 therapeutic drug platform, JN2019. JN2019 has been found to be a potent coronavirus-neutralizing agent that’s potentially active against all current and emergent viral variants. JN2019 can trap the virus and block its entry into the lungs and other vulnerable organs by acting as an angiotensin-converting enzyme 2 (ACE2) decoy. ACE2 is a membrane-bound protein present in many organ tissues that serves as the entry point for the COVID-19 virus and it's widely implicated, so once compromised (by the virus), it interferes with immune and hypertension modulation in the cell.

Treatment and prevention combined JN2019 is an exciting discovery as it’s able to replace ACE2 activity. This is important as COVID-19 infections cause ACE2 function to be impaired or lost, leading to severe disease, particularly for vulnerable patients with diabetes or kidney,

heart, or lung disease. “JN2019 could be the world’s first COVID-19 therapeutic and prophylactic that could address current COVID -19 variants as well as any future variants, systemically replacing lost ACE2 enzyme activity to protect the kidneys and lungs,” says Dr. Yoganathan, Chief Scientific Officer of JN Nova. The possible implications of regaining ACE2 activity as a post-infection therapeutic are substantial. “We’re also evaluating the potential of this molecule in a different form to support people who have slow recovery from COVID-19,” says Dr. Gillard, JN Nova’s CEO and Chief Product Development Officer.

R&D to clinical trials With a lot of front-end research by the aforementioned consortia and R&D funding from the NRC Industrial Research Assistance Program (NRC-IRAP), a pilot batch and biomanufacturing processes were established in the NRC laboratories. Biodextris then joined to develop a robust manufacturing process. Biodextris, a spin-off of the former Laval, QU-based GSK vaccine division, has much experience in process and analytical development as well as early-stage clinical batch manufacturing. In choosing its contract development and manufacturing organization

pa r t ner, the JN Nova team considered many factors, including expertise, facilities, and capacity. “Biodextris has been an outstanding partner and we’re looking forward to seeing our product enter the clinical manufacturing process in the coming year,” says Dr. Yoganathan. Biodextris has managed many COVID-19-related projects this year, from therapeutics to vaccines. “These have been unprecedented times, where both the private sector and governments have joined together to produce life-saving solutions in an expedited manner,” says John Mukherjee, Director of Business Development and Marketing at Biodextris. “We’ve been doing as many of these projects as possible to support Canadian innovation and solutions to ultimately build an infrastructure for the future.”

For further information on the services at Biodextris, visit biodextris.com. To get involved with JN Nova, visit jnnova.com. This article was sponsored by Biodextris and JN Nova Pharma Inc.

New Workshop Trains Influencers to Talk About Vaccines COVID-19 Resources Canada taps into the knowledge of top experts and new digital tools to help community leaders have difficult conversations around vaccines.

accines are a hot topic in Canada. Everyone has an opinion, but not everyone has the facts. To help fill the knowledge gap, COVID-19 Resources Canada (C19) has introduced a free, new 120-minute Vaccine Conversations Online Workshop & Resource Guide. They are focused on teaching Canadians how to talk about vaccines with various groups within their community. The workshop aims to provide education on the safety and efficacy of vaccines that influencers can share with their peers, communities, families and faith groups. Leading experts

will teach them how to navigate difficult conversations with members of the groups they influence.

Digital tools for better health choices “Everyone's an influencer, whether you're the CEO of an organization, the facilitator of a community group, or a faith leader, or the head of your family," says Dr. Tara Moriarty, infectious diseases researcher at the University of Toronto and co-founder of COVID-19 Resources Canada. “This workshop gives leaders the language and tools they need to have important conversations and help those in their communities make informed decisions.”

COVID-19 Resources Canada began in March 2020 to help facilitate Canada’s response to the COVID-19 pandemic and is made up primarily of volunteers, including multidisciplinary Canadians with expertise ranging from biomedical research to web development and business analysis. Its goals are to serve as a reliable source of information and expertise for Canadian COVID-19 research. Get the conversation started. Register for the Vaccine Conversations workshop from COVID-19 Resources Canada online. The organization also continues to host live drop-in Q&A sessions twice a week for individuals with questions about COVID-19 vaccines.

For more information, see covid19 resources.ca/ vaccineqa. This article was sponsored by COVID-19 Resources Canada.

Why It's Important to Keep Up with Routine Vaccinations Although most adults believe they’ve received all necessary vaccines, they may not actually be up to date. Here’s why keeping up with routine vaccinations is an important part of staying safe.

hink grown-ups don’t need to keep up with their routine vaccinations? Think again! The protection offered by routine childhood vaccinations against common diseases doesn’t last forever — booster doses are often needed to help us avoid infection.1 With age, our natural immunity weakens, reducing the body’s defences against the pathogens around us. And chronic health conditions such as heart or lung conditions, diabetes, obesity, and weakened immune systems can increase the severity of symptoms of many diseases.2, 3 According to a recent survey, although most adults felt they had

received all the vaccines they needed, less than one in 10 were actually up to date with their vaccinations.2 In addition to the flu shot, Health Canada recommends that older adults receive booster shots for pneumococcus, which can cause severe pneumonia in seniors; tetanus, which enters the body through a small cut or scrape; diphtheria, which is spread between people sharing the same air space; and pertussis (whooping cough), which is generally mild in adults but can be deadly for infants who catch it.2 If you received the three-in-one Tdap vaccine for tetanus, diphtheria, and pertussis as a child, stay protected by having a Td (tetanus-diphtheria)

booster every 10 years. 3, 4 The Advisor y Committee on Immunization Practices (ACIP) recommends adults have a booster of the three-in-one MMR vaccine against measles, mumps, and rubella, and vaccination for individuals without evidence of immunity, those who work in health care settings or live or work with immunocompromised individuals or in shared accommodations, and international travellers. 5, 6 Don’t be caught unprepared as people regroup — be sure you have the immunizations you need to stay safe. If you aren’t sure of your vaccination status, ask your doctor or check with your local public health office.2

Why do adults need vaccines? immunizebc.ca/why-do-adults-need-vaccines Not just for kids: An adult guide to vaccination canada.ca/en/public-health/services/publications/healthy-living/just-kids-adult-guide-vaccination.html COVID-19: Who's at higher risk of serious symptoms? mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-who-is-at-risk/art-20483301 4 Adult Vaccines: Protect Yourself Against Tetanus and More webmd.com/vaccines/ss/slideshow-adult-vaccines?ecd=wnl_spr_020121&ctr=wnl-spr-020121&mb=DmyALzkBR4ydX60RHMt7xilSD vRUtFhzCt7vllyesBY%3d_Support_Description_2 5 What vaccines do adults need? immunizebc.ca/what-vaccines-do-adults-need 6 Recommended Immunizations for Adults immunize.ca/recommended-immunizations-adults Additional source: You May Not Be Immune Forever — Why Boosters Are Important! passporthealthusa.com/2016/06/why-boosters-are-important/ 1

This information should not be used as a substitute for the medical care and advice of your doctor. There may be variations in treatment that your physician may recommend based on individual factors and circumstances. This article was brought to you by vaccines411.ca — know where to go for your vaccinations.

A SPECIAL INTEREST SECTION BY MEDIAPLANET