Understanding Infectious Disease
Why the Canadian Foundation for Infectious Diseases Needs Your Support
Support for the Canadian Foundation for Infectious Diseases helps to improve the health of Canadians and people worldwide.
Tania Amardeil
Infectious diseases impact us all, from longstanding challenges from waterborne and foodborne illnesses, to emerging global outbreaks like the global Mpox or the Zika virus, to completely new highly communicable diseases like COVID-19. Pathogens including viruses, bacteria, parasites, and fungi are continually spreading around the world, wreaking havoc on human health. Many Canadians may be shocked to learn that infectious diseases remain a leading cause of death worldwide.
“We continue to see infectious diseases taking a forefront on a global level,” says Dr. Larissa Matukas, President of the Canadian Foundation for Infectious Diseases (CFID). “We need to continue to be vigilant around understanding disease transmission, how to prevent it, how to
diagnose it, and how to treat it.”
This is the mission of the CFID, a charitable organization aimed at promoting essential research in infectious diseases and medical microbiology. To promote this research, the CFID works in close collaboration with medical specialists, strategic partners, and supporters. It also supports students and trainees through grants and awards, facilitates knowledge dissemination through webinars and events, and engages with the public through education and advocacy.
Stronger together
“Receiving a CFID award really helped solidify my interest in gut microbiome research,” shares medical trainee award recipient, Dr. Emma Finlayson-Trick. “It also gave me the chance to work with two amazing researchers who are very
passionate about this subject and who ultimately inspired me to continue with this important work in my career.”
Fundraising is vital to support CFID’s mission and goals. “As a notfor-profit organization, our board of director members are volunteers,” says Dr. Matukas. “Our main goal is to raise funds to support our awards and grants, to make them more impactful on the research that can be performed by new investigators in the field.”
Donations also support the CFID’s educational initiatives including workshops and webinars.
The CFID is encouraging donations and participants for its chief fundraising event, the 10th annual Bug Run.
This year's Bug Run will be held in multiple cities across Canada in April 2024 with options for both running and walking routes to ensure inclusivity.
Publisher: Olivia Delbello
Dr. Larissa Matukas President, Canadian Foundation for Infectious Diseases
Updated Testing Guidelines Will Help Providers Identify HIV Sooner
A shorter testing window, quicker linkage to care, and improved awareness of risks and symptoms will reduce HIV transmission in Ontario.
Tania Amardeil
HIV (the Human Immunodeficiency Virus) attacks the body’s immune system and, if untreated, can lead to AIDS, a life-threatening condition. While incredible progress has been made in the fight against HIV, there were still 485 new cases in Ontario in 2021, concentrated in a few populations.
“Where it once was a death sentence, HIV has become a chronic, manageable condition,” says Dr. Kevin Woodward, Executive and Medical Director of HQ, a sexual and mental health clinic in Toronto. “Today, most people living with HIV in Canada are diagnosed, virally suppressed — meaning they cannot pass on the virus to others — and on a treatment plan of one pill a day, with minimal side effects. But there are still people we are not reaching in time.”
In spring of 2023, the Ontario Guidelines for Providers Offering HIV Testing was published, providing crucial guidance to health care practitioners about how to close the gap by catching infections early.
explains, “We have to make sure that more people who are living with HIV get diagnosed early and on treatment quickly. We believe the updated guidelines will help make this happen.”
Identifying undiagnosed HIV
We have to make sure that more people who are living with HIV get diagnosed early and on treatment quickly. We believe the updated guidelines will help make this happen.
Jean Bacon, Executive Director of the Ontario HIV Treatment Network — a key collaborator on Ontario’s new guidelines —
To diagnose people early, health care workers must be able to recognize the signs and symptoms of both acute and chronic HIV infection, offer testing, connect people who test positive quickly to care, and connect those who test negative and are at high-risk to HIV prevention options.
“Because HIV is not the health crisis it once was, it may not be top of mind when practitioners are assessing a patient,” says Bacon.
“Many of the symptoms of HIV are also symptoms of other viral illnesses. As a result, many people with HIV are diagnosed late in the course of infection when they are very ill — and when the virus has
already damaged their immune system and possibly been passed unknowingly to other people.”
Providers should also be aware that new HIV diagnoses are concentrated in a small number of Ontario populations, including: gay, bisexual, and other men who have sex with men; African, Caribbean, and Black communities; Indigenous communities; newcomers; people who use drugs; and cis and trans women, including those from the communities above, who face systemic and social inequities and are more likely to be exposed to HIV through a sexual or drug-using partner. Not everyone in these populations is at risk, so it’s important for providers to help people understand and assess their own risk, and decide how frequently they should be tested.
The updated testing guidelines are rooted in Ontario’s commitment to the United Nations’
WHAT IS HIGH-RISK EXPOSURE?
High-risk exposure has occured when all of the following “3Ps” are true:
Partner(s) Practices Protection
The client’s sexual partner(s) are HIV-positive and viremic OR of unknown HIV status AND from a population with a high prevalence of HIV.
95-95-95 targets (that by 2030, 95 per cent of people living with HIV are diagnosed, 95 per cent of those diagnosed are on treatment, and 95 per cent of those on treatment are virally suppressed).
“These targets challenge Ontario to close the gaps in HIV testing, care and treatment,” says Bacon. “To meet the targets, we have to be much more proactive in finding people with undiagnosed HIV — which means more frequent testing for people at high risk.”
The guidelines also explain the “3Ps” of risk assessment (partners, practices, and protection). These state that a high-risk exposure has occurred when all the following are true:
The client’s practices include anal or vaginal sex, and/or injecting drugs.
There may have been a gap, including no or delayed condom use, a removed or broken condom, or the sharing of injection drug equipment.
Learn more about the updated HIV Testing Guidelines at: hivtestingontario.ca
Partners: a client’s sexual partners are HIV-positive and viremic OR of unknown HIV status and from a population with high prevalence of infection;
Practices: when a client’s practices include anal or vaginal sex and/or injecting drugs; and
By identifying both new and chronic undiagnosed HIV infections in the population, we can effectively eliminate new HIV transmissions in Ontario.
WHAT IS HIGH-RISK EXPOSURE?
Protection: when a client may have had a gap in protection, including no or delayed condom use, a removed or broken condom, or the sharing of injection drug equipment.
High-risk exposure has occured when all of the following “3Ps” are true:
Partner(s) Practices Protection
Understanding risk and prevention options
People at increased risk of HIV should be tested at regular intervals. The guidelines recommend annual testing for anyone who is sexually active and a member of a population with higher rates of HIV. For people who are assessed as high-risk (i.e., having frequent unprotected sex with one or more partners whose HIV status is unknown), the guidelines recommend testing every three months.
“The guidelines ask clinicians to encourage members of at-risk populations to understand the risks, take steps to reduce them, and test frequently,” says Bacon. These strategies will help bring down the prevalence of HIV in the most impacted communities.
approach to counselling, which considers a client’s culture and comfort levels when discussing sexual and drug-using practices. While there is no one-size-fitsall approach, the guidelines do provide insight into what a culturally-responsive approach might look like.
The client’s practices include anal or vaginal sex, and/or injecting drugs.
The client’s sexual partner(s) are HIV-positive and viremic OR of unknown HIV status AND from a population with a high prevalence of HIV. There may have been a gap, including no or delayed condom use, a removed or broken condom, or the sharing of injection drug equipment.
The importance of HIV testing
At any of these intervals, a person may be prescribed pre-exposure prophylaxis or “PrEP,” a daily pill which drastically reduces one’s risk of HIV infection. Clinicians interested in learning more about PrEP should visit ontarioprep.ca.
The updated guidelines advocate for HIV testing as the gateway to both treatment and prevention services. People who test positive can be quickly linked to care and treatment — ideally within 72 hours of diagnosis. People who test negative and are at high-risk can be linked to prevention tools, such as PrEP.
But testing only works if people feel comfortable meeting with their providers and being honest about their risks. The guidelines advocate for a “culturally-responsive”
New testing technologies have also significantly reduced the window period between when an exposure occurred and when a lab test can detect an HIV infection — it was previously three months but is now only six weeks. This shorter window period means that people can know their status more quickly, reducing anxiety.
Learn more about the updated HIV Testing Guidelines at: hivtestingontario.ca
For a person who tests positive, it means they can start treatment, curb the risk of onward transmission, and get back to living a healthy life.
“By identifying both new and chronic undiagnosed HIV infections in the population, we can effectively eliminate new HIV transmissions in Ontario.”
This article was sponsored by the Ontario HIV Treatment Network
Don't Let Your Southern Dream Vacation Become a Gastric Nightmare
To get maximum enjoyment out of your southern vacation, know the risks for traveller’s diarrhea and take appropriate precautions. Anne Papmehl
As the weather cools, Canadians are planning their winter escapes to warmer southern climes like the Caribbean and Latin America. But travellers beware! “These areas also have high levels of Enterotoxigenic Escherichia coli (ETEC) bacteria, one of the most common causes of traveller’s diarrhea,” says Dr. Vivien Brown, Family Doctor, and Assistant Professor in the Department of Family and Community Medicine at the University of Toronto.
Prevention starts with what you drink and eat
People contract ETEC mostly from contaminated water and food. ETEC is estimated to cause 200 million diarrheal episodes annually and approximately 380 ,000 deaths worldwide. Common symptoms include diarrhea, vomiting, cramping, and loss of appetite. “Most cases will go away without treatment in three to five days, but it can disrupt a trip. In severe cases where patients have fever and blood in the stools, they need to see a healthcare professional immedi-
ately,” says Michael Bovin, Pharmacist Educator in Barrie, Ontario. Prevention starts with being careful with what you drink and eat. Avoid drinking beverages with ice cubes or crushed ice and brushing your teeth with tap water. “I recommend my patients go with carbonated or sparkling water because that way you know it’s not recycled. If drinking alcohol, a beer out of a bottle is a safer bet than a cocktail mixed by a bartender that may have crushed ice added to it,” says Dr. Brown. Travellers should also avoid salads, uncooked fish, meat, vegetables, and eating fresh fruits which cannot be peeled. It's important that vegtables and fruit are washed in potable water. If not, it's best to avoid.
A drinkable dose of prevention
Another way travellers can reduce their risk of diarrhea when travelling is through an oral vaccine that protects against cholera and a particular strain of bacteria called heat-labile toxin producing Enterotoxigenic Escherichia coli (LT-producing ETEC). Available without prescription in most provinces, “The oral vaccine causes your
body to produce its own protection against cholera and LT-producing ETEC diarrhea. After getting the vaccine, your body will create antibodies which fight the cholera and LT-producing ETEC bacteria and toxins. If a vaccinated person comes into contact with cholera or LT-producing ETEC bacteria the body is usually ready to destroy it.” says Boivin.
It is a drinkable vaccine that’s taken two weeks ahead of their trip. “It’s a relatively simple vaccine that’s has to be taken with a powder and water mixture and drink, and it decreases your risk significantly,” says Dr. Brown.
While nothing is 100 per cent guaranteed to prevent you from getting LT-producing ETEC, your doctor or pharmacist can make you aware of the risks, the precautions to take, what to do if you do get sick, and when to seek medical attention. The ideal time to consult with a healthcare provider is six to eight weeks before departure. “Your healthcare provider can help you make the most of your vacation without getting ill. The last thing you want is to be stuck in the bathroom for several days feeling miserable,” says Dr. Brown.
Dr. Vivien Brown Family Doctor & Assistant Professor, Department of Family and Community Medicine, University of Toronto
Pharmacist Educator To learn more, please talk to your health care provider.
Michael Boivin