Advancing knowledge and increasing capacity to address climate-driven infectious diseases in Canada.

Preconception care represents a crucial aspect of healthy pregnancy as it aims to optimize the health status of women and men before conception by mitigating the modifiable individual and environmental risk factors and providing education, counseling, and timely interventions. The aim of this study was to review and compare the most recently published influential guidelines on prepregnancy counseling and management of chronic medical conditions. A descriptive review of guidelines from the American College of Obstetricians and Gynecologists (ACOG), the Royal Australian and New Zealand College of Obstetricians and Gynecologists (RANZCOG), and the Public Health Agency of Canada (PHAC) on preconception care was carried out. There is a consensus among the reviewed guidelines that a detailed personal and family history and risk factor assessment and counseling against smoking, alcohol, and substance abuse are the main areas to focus when providing preconception care. In addition, assessment of immunization status and screening for intimate partner violence and sexual coercion, as well as screening for human papillomavirus and cervical cancer, are unanimously recommended. All medical societies also agree that counseling on diet, body mass index, and physical activity should be routinely offered along with a review of supplements and advice on folic acid supplementation. Furthermore, the need of medication review for potential teratogenic effects and the importance of assessing for environmental and occupational exposure to teratogens are underlined by all guidelines. Moreover, ACOG and PHAC recommend a discussion regarding contraception, support an optimal interpregnancy interval of at least 18 months, and underline that screening for sexually transmitted infections should be offered only in cases with existing risk factors. ACOG and RANZCOG also suggest that patients should be offered guidance on proper food handling and traveling restrictions to prevent certain infectious diseases. Finally, ACOG and PHAC provide guidance on the preconception management of chronic medical conditions, whereas RANZCOG, although mentioning that all preexisting medical conditions should be optimized before achieving pregnancy, provides no further guidance. Preparing for a healthy pregnancy not only drives favorable perinatal outcomes, but is also associated with long-lasting benefits for the offspring. Health care professionals are ideally positioned to offer clear, accurate, and timely counseling to the parents-to-be, screen for and act upon any potential impediments to a successful outcome, support the decision-making process, and offer referral to relevant services when required. Therefore, the development of consistent international guidelines on preconception care to guide clinical practice seems of insurmountable importance.

Due to increasing CO2 emissions and other greenhouse gases, accelerated global warming is predicted by the Intergovernmental Panel on Climatic Change (IPCC). These climate changes are anticipated to have a long-term impact on marine and terrestrial ecosystems. Rising sea levels are predicted to flood low-lying coastal regions, and fresh water resources could become scarce leading to development of desert-like regions. This will greatly affect the survival of fragile plant species, wild animals, and other ecosystems all of which could directly or indirectly affect survival and or spread of pathogens and their vectors. Although these changes will undoubtedly have an impact on human health, the uncertainties in climate models, as well as predictive epidemiology, hamper accurate predictions on the impact of global warming on public health. In addition, the absence of experimental models that demonstrate dose dependent effects between climate change and disease gives ammunition to those in doubt. As a joint Institute of Medicine/National Academy of Science Committee concluded in 2001, we know that there is a relationship between climate change and infectious disease, but these links are disease specific and location specific, and we cannot yet predict these impacts at anything other than coarse temporal and spatial scales. Thus, the impact on human health is still unclear, and climate change may increase the prevalence of particular infectious diseases in some regions, while decreasing the prevalence in others. There are currently 137 publications in PubMed using the keywords “infectious diseases” and “global warming.” The majority of which were published in the last few years, and this attests to the increasing interest in this aspect of public health. However, most data so far are observational, and the predictive understanding of the impact of disease is based on mathematical modeling. Other sources of data include retrospective time-series analyses in specific locations, or use the periodic El Nino Southern Oscillation (ENSO) phenomenon as a surrogate for long-term change. Since controls are usually historical and data are now collected in a more biased fashion than before, there is a concern that some of our conclusions reflect an observational bias that is common when data collection is initiated on new problems that were not previously under rigid observation. To tackle global warming, coordinated efforts will have to be taken that do not only span countries and cultures but also require many fields of scientific expertise. Effects of global warming are multifactorial and occur at a time when many other important confounding variables constantly change. Beyond global warming, increasing global mobility, genetic modification of agricultural products, and usage of reagents that inhibit pathogens can all have a significant impact on spread and prevalence of infectious diseases. This will make it difficult to establish causality between global warming and impact of infectious diseases. Rigorous scientific conclusions call for experimental models that examine impact of temperature under controlled conditions. Finally, global warming occurs in the general setting of climate change—temperature is not the only variable that is changing. Rather, rainfall patterns, wind patterns, and other climatologic variables are changing at the same time. As much as we all wish to act fast, and as much as we cry out for an enlightened public consciousness that would be required to press for policy changes that ameliorate the effects of global warming and limit the emission of greenhouse gases, our most imminent problem is that we do not have a true scientific understanding of the matter yet. In this special issue, Interdisciplinary Perspectives on Infectious Diseases solicited cross-cutting interdisciplinary articles that took new and broad perspectives ranging from what we might learn from previous climate changes on disease spread to integrating evolutionary and ecologic theory with epidemiologic evidence in order to identify key areas for study in order to predict the impact of ongoing climate. These studies present interesting results and analysis of available data. They also highlight how difficult it is to interpret data at present. Future studies should increase retrospective surveys of museum specimens from previous times, long lasting unbiased data mining and true experimental work on disease manifestation under higher temperatures. Moreover, predictive climate models and predictive epidemiology both need to advance, and become coupled together. This research will likely not meet current output criteria of short-term grant proposals. This problem needs meticulous patient intelligent researches like Darwin to devote their life to answering these pressing questions. Without such efforts, the current generation will inevitably benefit at the cost of generations to come. Bettina C. Fries Jonathan Mayer

This report contains selected excerpts, presented as a summary, from a public workshop sponsored by the American Association of Tissue Banks (AATB) held to discuss West Nile Virus (WNV) and scientific considerations for tissue donors. The daylong workshop was held 9 July 2010 at the Ritz-Carlton Hotel at Tyson’s Corner in McLean, Virginia, United States (U.S.). The workshop was designed to determine and discuss scientific information that is known, and what is not known, regarding WNV infection and transmission. The goal is to determine how to fill gaps in knowledge of WNV and tissue donation and transplantation by pursuing relevant scientific studies. This information should ultimately support decisions leading to appropriate tissue donor screening and testing considerations. Discussion topics were related to identifying these gaps and determining possible solutions. Workshop participants included subject-matter experts from the U.S. Food and Drug Administration, the Centers for Disease Control and Prevention, U.S. Department of Health and Human Services, Health Canada, the Public Health Agency of Canada, AATB-accredited tissue banks including reproductive tissue banks, accredited eye banks of the Eye Bank Association of America, testing laboratories, and infectious disease and organ transplantation professionals. After all presentations concluded, a panel addressed this question: “What are the scientific considerations for tissue donors and what research could be performed to address those considerations?” The slide presentations from the workshop are available at: http://www.aatb.org/2010-West-Nile-Virus-Workshop-Presentations.

More than 3 million children 10 million child deaths annually throughout the world [World Health Organization (WHO) 2005]. Some factors of susceptibility, including race, ethnicity, and socioeconomic status, are generally not well understood in the context of risk assessment. For children’s environmental health the focus is almost exclusively on age-related differences and exposure hazards, without much discussion of the myriad additional factors including nutritional status, preexisting health status, multiple exposures, and gender differences that can affect the life course of a child.

As a frontline primary health care provider, you reflect on the patients encountered during your last emergency medicine rotation. Many of the injuries seen were related to baby products, and you wonder whether this was also the case in other areas of the country. To obtain further data on the types of incidents seen in Canada on this important question, the Canadian Paediatric Surveillance Program (CPSP) sent a one-time survey on injuries associated with baby products to all CPSP participants (1). The survey focused on the frequency and extent of injuries associated with baby walkers, cribs and strollers. In addition, information on the dissemination and knowledge transfer of the bans/advisories and recalls issued on these products was obtained. The survey was designed in partnership with the Public Health Agency of Canada, the Consumer Product Safety Bureau at Health Canada and the Canadian Paediatric Society. • The response rate to the CPSP one-time survey on baby products was 27% (658 responses of 2466 eligible participants). Three per cent of participants reported seeing injuries associated with strollers, baby walkers or cribs. • Overall, there were 92 reported incidents associated with baby products including some serious injuries: Strollers - Concussions = 4 Skull fractures = 1 Upper extremity fractures = 2 Lower extremity fractures = 1 Abrasions / lacerations = 16 Minor injuries = 34 Baby walkers - Concussions = 1 Skull fractures = 0 Upper extremity fractures = 0 Lower extremity fractures = 2 Abrasions / lacerations = 5 Minor injuries = 11 Cribs - Concussions = 1 Skull fractures = 3 Upper extremity fractures = 1 Lower extremity fractures = 1 Abrasions / lacerations = 2 Minor injuries = 7 • In January 2010, Health Canada issued a recall notice for certain stroller models after reports of finger amputations and lacerations were identified in association with specific models. In addition, an advisory was also issued reminding Canadians to exercise caution when using strollers with hinge mechanisms. Awareness of all respondents to these measures was indicated in the survey as follows: Approximately 53% (352) were aware of the stroller recall; 43% (285) were aware of the stroller advisory; 36% (238) were aware of both the stroller recall and advisory. Just over 75% of respondents who reported how they learned of the recall and/or the advisory indicated that it was through news media reports (ie, newspaper, radio, television and Internet). •Baby walkers are banned in Canada. Health Canada's Consumer Product Safety Bureau investigated reports of serious head injuries associated with falls while in baby walkers, which ultimately led to a ban on baby walkers. Since April 2004, it is illegal to import, advertise for sale or sell baby walkers in Canada. It is also illegal to sell baby walkers at garage sales, flea markets or on street corners. - 83% (544) of respondents indicated that they were aware of the prohibition of baby walkers. -Approximately 40% of those respondents who reported how they learned of the ban indicated that it was through the news media. Language: en

Emerging infectious diseases pose an important challenge to public health globally. The identification of an etiologic pathogen responsible for an emerging infection in humans can be a major task. The time required to isolate and characterize a new infectious agent sufficiently to adopt control measures and, when possible, to select and make available curative and preventive treatments can be considerable and take years. If the novel pathogen exhibits rapid pathogenesis, causing serious illness and death in a significant percentage of infected individuals, in addition to efficient transmission and spread, serious consequences for the human population can be readily observed. The race between the spread of a high-consequence pathogen and the deployment of adequate public health measures can hardly be satisfactory from a public perspective, because it is a reactive chain of events to the initial spread of the infectious agent. Predicting the emergence of infectious diseases months or years in advance would be a perfect solution but for now has remained a theoretical concept. Improved surveillance systems to detect emerging infectious diseases and new technologies using algorithms specifically developed to isolate and identify causative infectious agents have been emphasized to minimize public health emergencies related to emerging infections. Enhanced surveillance and detection is one of the most significant improvements to regional and global public health of the past several decades. For example, several regional or national networks, such as the Global Public Health Intelligence Network in Canada and the Global Disease Detection program of the Centers for Disease Control and Prevention network in the United States, are informing and cooperating with international networks, such as the Global Outbreak Alert and Response Network developed by the World Health Organization [1–3]. Unfortunately, surveillance and detection methods are region specific, and many regions are currently not being actively monitored. Regions under surveillance oftenmake use of different technologies and approaches that are not yet standardized, thus creating many potential holes in the global network intended to detect new pathogens before they cause damage. More work will be required before these newly developed systems are ideal, but the recognition of their importance and usefulness is a critical step toward enhanced preparedness and response and ultimately prevention. Viruses are responsible for a significant proportion of emerging infectious diseases, the numbers of which may be on an increasing trend overall [4, 5]. It is clear that surveillance and identification of unknown pathogens has greatly improved in the past decade, which has resulted in the concomitant rise in the number of new pathogens being discovered each year. Again, this increase has occurred despite the fact that the detection and identification of previously unknown pathogens currently depends on heterogeneous surveillance systems of variable sensitivity and precision. Regardless, heightened surveillance, detection, and identification of emerging pathogens are currently active and prolific fields of research. Whether there exists a real or apparent increase in the number of viruses emerging in the past 50 years, compared with the number that emerged 50 or 100 years earlier, there is certainly an increasing number of viruses being detected and identified in recent years. A PubMed search using the term “emerging viruses” revealed that the number of scientific articles published on the subject of emerging viruses has jumped from <10 per year in the early 1990s to nearly 70 in the early 2000s and up to 220 per year during 2011–2012, reflecting a Received and accepted 6 November 2013; electronically published 14 November 2013. Correspondence: Gary Kobinger, Special Pathogens Program, National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington St, Winnipeg, Manitoba, R3E 3R2 (gary.kobinger@phac-aspc.gc.ca). The Journal of Infectious Diseases 2014;209:811–2 © Crown copyright 2013. DOI: 10.1093/infdis/jit604

A Chinese family immigrated to Canada in early 2008. One week after their arrival, the parents brought their nine-month-old son to the emergency department because of fever and unexplained crying. He refused solids, drank small amounts of a commercial iron-fortified formula and had few episodes of vomiting without diarrhea. His parents noticed that his urine was darker than normal with a strong smell, without macroscopic hematuria. On physical examination, the infant was feverish but not toxic, and crying with slight pallor. He was not clinically dehydrated, and his blood pressure was 90/60 mmHg. The physician elicited suprapubic and left flank pain on palpation and questioned the possibility of a urinary tract infection. The laboratory test results revealed a white blood cell count of 9.0×109/L and a hemoglobin level of 95 g/L, and urinalysis revealed pyuria and microscopic hematuria. The child also had hypercalciuria. The urine culture obtained by catheterization confirmed an Escherichia coli infection; his blood culture was negative. The abdominal ultrasound revealed a left hydronephrosis, and a plain radiograph of the abdomen confirmed the presence of a radiopaque renal stone at the pelviureteric junction. The parents were concerned and asked whether their son’s disease could be related to the outbreak of kidney disease stemming from melamine-contaminated milk in China. LEARNING POINTS In late 2008, the United States Food and Drug Administration and the World Health Organization reported an outbreak of renal stones and/or acute renal failure occurring in very young children in China, which was associated with the consumption of powdered milk products contaminated with melamine, and that led to a few deaths. Public interest rose when other dairy products, such as frozen yogurts, chocolate cookies and toffee candies, made in China and exported to other areas such as Australia, Europe, the United States and Canada, were found to contain melamine. Infant formula manufactured in China is not approved for sale in Canada. Health Canada also confirmed with the four major manufacturers of infant formula sold in Canada that they do not use any milk ingredients that come from China . In light of this public health priority and to obtain national epidemiological data, the Public Health Agency of Canada commissioned the Canadian Paediatric Surveillance Program (CPSP), in October 2008, to conduct an emergency survey to assess whether any presentations of renal stones and/or acute renal failure in Canadian children may have been caused by a melamine outbreak. The CPSP survey was issued within 10 days to 2475 actively practicing paediatricians and paediatric subspecialists. The response rate was 47%. Fortunately, no cases of melamine-associated renal diseases were reported. Of the 1153 respondents, 12 cases of renal stones were reported and one of these also had acute renal failure, all presenting in the previous 12 months. The main causes identified so far are urinary tract infections, hydronephrosis and hypercalciuria. Interestingly, nearly 10% of respondents mentioned that parental concerns were voiced to them, especially from those who worked in international adoption clinics. Parents of the clinical vignette were reassured that their son’s renal stone and urinary tract infection were not related to melamine contamination, because his renal stone was radiopaque in the presence of hypercalciuria, and he did not have any exposure to powdered milk and other milk products from China. A list of products with melamine levels higher than interim standards is accessible at . The CPSP emergency-response preparedness exemplifies the excellent added value of investing in a national network of active surveillance, well connected with front-line paediatricians and public health officials.

Pandemic portal: Health Canada has launched a new Web site to serve as a “one-stop source of information” about pandemic influenza. The site, [www.pandemicinfluenza.gc.ca][1], compiles information provided by the Public Health Agency of Canada and other federal departments, and includes the

Objectives: Since information on biological factors in the workplace are currently lacking, I wanted to create a handbook of these factors that would be viewable at a glance as a means to more effectively prevent occupationally-infected diseases. Proper information on biological hazards in the workplace allowing the appropriate recognition of the harmful factors is desperately needed. Methods and Results: In this study, I intended to create a high-utility handbook of biologically hazardous agents in the workplace. To ensure its effectiveness, information and references about biologically hazardous agents in the workplace were analyzed and classified and pathogen safety data sheets(PSDS) sourced from the Public Health Agency of Canada were included. I intended to make it accessible from the point of view of workers and their employers. A more effective classification system of occupational infectious diseases is presented, and biologically hazardous agents were classified according to occupations, industries, infectious diseases, and so on. The handbook consists of 60 major kinds of biologically infectious occupational factors that are expected to be generated in workplaces in Korea, and are focused on practical utility. The pathogen safety data sheets(PSDS) of 192 species were also included. To allow more effective management, domestic and foreign laws and regulations are presented. Conclusions: This case report presents general information on the history and contents of the handbook and PSDS, it will also be useful in workplaces if download from the homepage of OSHRI, KOSHA(oshri.kosha.or.kr/bridge?menuID=901).

Conséquences de l'épidémie de SRAS sur le système hospitalier de l'Ontario

IntroductionSyndromic surveillance is an alternative type of public healthsurveillance which utilises pre-diagnostic data sources to detectoutbreaks earlier than conventional (laboratory) surveillance andmonitor the progression of illnesses in populations. These systems areoften noted for their ability to detect a wider range of cases in under-reported illnesses, utilise existing data sources, and alert public healthauthorities of emerging crises. In addition, they are highly versatileand can be applied to a wide range of illnesses (communicable andnon-communicable) and environmental conditions. As a result, theirimplementation in public health practice is expanding rapidly. Thisscoping review aimed to identify all existing literature detailing thenecessary components in the defining, creating, implementing, andevaluating stages of human infectious disease syndromic surveillancesystems.MethodsA full scoping review protocol was developeda priori. Theresearch question posed for the review was “What are the essentialelements of a fully functional syndromic surveillance system forhuman infectious disease?” Five bibliographic databases (Pubmed,Scopus, CINAHL, Web of Science, ProQuest) and eleven websites(Google, Public Health Ontario, Public Health England, Public HealthAgency of Canada, Centers for Disease Control and Prevention,European Centre for Disease Prevention and Control, InternationalSociety for Disease Surveillance, Syndromic Surveillance Systems inEurope, Eurosurveillance, Kingston Frontenac, Lennox &amp; AddingtonPublic Health (x2)) were searched for peer-reviewed, government,academic, conference, and book literature. A total of 1237 uniquecitations were identified from this search and uploaded into thescoping review softwareCovidence. The titles and abstracts werescreened for relevance to the subject material, resulting in 142documents for full-text screening. Following this step, 55 documentsremained for data extraction and inclusion in the scoping review. Twoindependent reviewers conducted each step.ResultsThe scoping review identified many essential elements in thedefining, creating, implementing, and evaluating of syndromicsurveillance systems. These included the defining of “syndromicsurveillance”, classification of syndromes, data quality andcompleteness, statistical methods, privacy and confidentialityissues, costs, operational challenges, management composition,collaboration with other public health agencies, and evaluationcriteria. Several benefits and limitations of the systems were alsoidentified, when comparing them to other public health surveillancemethods. Benefits included the timeliness of analyses and reporting,potential cost savings, complementing traditional surveillancemethods, high sensitivity, versatility, ability to perform short- andlong-term surveillance, non-specificity of the systems, ability to fillin gaps of under-reported illnesses, and the collaborations whichare fostered through its platform; limitations included the potentialresources and costs required, inability to replace traditional healthcareand surveillance methods, the false alerts which may occur, non-specificity of the systems, poor data quality and completeness, timelags in analyses, limited effectiveness at detecting smaller-scaleoutbreaks, and privacy issues with accessing data.ConclusionsOver the past decade, syndromic surveillance systems have becomean integral part of public health practice internationally. Their abilityto monitor a wide variety of illnesses and conditions, detect illnessesearlier than traditional surveillance methods, and be created usingexisting data sources make them a valuable public health tool.The results from this scoping review demonstrate the benefits andlimitations and overall role of the systems in public health practice.In addition, this study also shows that a complete set of key elementsare required in order to properly define, create, implement, andevaluate these systems to ensure their effectiveness and performance.

This study was conducted to investigate the prevalence of common parasitic and infectious diseases of goat at Babugonj upazilla, Barisal, Bangladesh. The study was performed in Veterinary Clinic, ANSVM, PSTU and Upazilla Veterinary Hospital, Babugonj, Barisal during June, 2014 to May, 2015. The diseases were diagnosed on basis of clinical signs, owner’s statement, general clinical examinations and laboratory diagnosis. A socio-economic survey of 200 destitute women and marginal/poor farmers of Barisal district was also done using a semi-structured questionnaire on their household. 70% of the respondents were females while 30% were males. 65% respondents were involved in agriculture, 13% in own business, 3% in shared business, 2% in govt. service and 17% in non-govt. service. 39% respondents had knowledge about signs of health of goat followed by management (74%), goat diseases (24%), veterinary drugs (20%), animal vaccine (14%) and biosecurity (13%). 53% animal houses were kacha followed by tin (41%) and pukka (2%). Goat received feed from own fodder areas (52%), purchase concentrate (5%) and both (43%). Respondents used tube-well (24%), river (18%), canal (26%) and ponds (32%) as the source of water for their goat. The prevalence of parasitic diseases was 41.33% followed by infectious diseases (39.34%) in goat. The prevalence of parasitic diseases was highest in rainy season 51.28% followed by autumn (41.61%), summer (40.37%) and winter (27.98%). The prevalence of infectious diseases was highest in winter 52.60% followed by autumn (37.55%), summer (37.47%) and rainy season (32.42%). Among viral diseases, prevalence of PPR was highest 8.52% followed by FMD (6.81%), goat pox (2.68%), contagious ecthyma (1.76%) and rabies (0.25%). The prevalence of peste des petits ruminants (PPR) was highest in winter (15.86%). The prevalence of pneumonia was highest 8.71% in whole year among the bacterial diseases. The prevalence of fungal disease (ringworm) was 1.44% in goat. The prevalence of trematodiasis was 12.60% followed by nematodiasis (11.27%), babesiosis (2.18%), tape worm infection (2.03%) and coccidiosis (1.19%). The prevalence of ecto-parasitic diseases was 12.06% .The prevalence of trematodiasis was highest in rainy season (18.01%). The prevalence of babesiosis was highest in summer (3.81%) and coccidiosis in winter (3.81%). The prevalence of ecto-parasitic diseases was lowest in winter (8.88%). The results of the present study will be helpful for scientists, extension service providers and veterinary practitioners for designing appropriate control measures for such diseases of goat.Asian J. Med. Biol. Res. December 2015, 1(3): 449-456

The Canadian Childhood Cancer Surveillance and Control Program (CCCSCP) was launched in January 1992 under the Federal Government's “Brighter Futures Initiative.” The Program was designed as a nationally integrated system with two aims: to reduce the morbidity and mortality caused by childhood cancer in Canada; and to improve the lives of affected children and families 1. The cornerstone of the Program was the establishment of a national surveillance system for childhood cancer, to be used to develop and evaluate cancer control activities relating to Canada's children. One of the fundamental strengths of the CCCSCP is that it was designed and implemented through extensive collaboration involving most Canadian organizations concerned with childhood cancer. These included Health Canada (now the Public Health Agency of Canada), pediatric oncology centers, provincial cancer registries and agencies, universities, voluntary agencies, and support groups. The purpose of this report is to provide a brief review and update of the Program. The CCCSCP was designed originally to include four main components, encompassing the cancer continuum spectrum: Etiology; Treatment and Outcome Surveillance; Tumor Bank; and Late Effects. This design enabled the evaluation of cancer control across every phase of the disease from susceptibility and development through to diagnosis, treatment, and short- and long-term outcomes. The Treatment and Outcome Surveillance (TOS) component is the mainstay of the CCCSCP. All children and adolescents diagnosed with cancer in Canada before 20 years of age were to be included in TOS which included diagnostic, treatment and short-term outcome information for subjects from diagnosis for a period of 5 years. From the TOS study base, a sample of subjects was to be included in the Etiology study which consisted of a self-report questionnaire completed by the subjects' parent(s) regarding exposure to a variety of agents and conditions from 6 months pre-conception through to the time of diagnosis. Normal and tumor tissue samples were to be stored in a Tumor Bank network for every subject registered in TOS to evaluate molecular events related to causal mechanisms and treatment of the disease. Finally, once subjects in TOS had survived 5 years from diagnosis they would be enrolled in the Late Effects Study to allow for the examination of their health related quality of life, including physical limitations as well as educational and social achievements. National data for TOS were collected between 1995 and 2001. During that time information on 5,200 children and 900 adolescents with cancer was included in the database. The Etiology Study was limited to one province (Quebec) and the two most common types of tumors in children (acute lymphoblastic leukemia (ALL) and brain tumors). Detailed exposure information was gathered from 300 cases of ALL and 150 cases of brain tumors, diagnosed in Quebec between 1994 and 1999, and an equal number of sex and age matched population controls. As the subjects in TOS had not reached 5 years from diagnosis, the first phase of the Late Effects Study was a national retrospective survey of survivors who had been diagnosed with cancer before 20 years of age between 1981 and 1990. Data were collected via self-report questionnaire from 2,200 survivors and 2,500 frequency-matched population controls between 1997 and 2000. To date, one award winning monograph 2, two government reports 3, 4 and 15 peer-reviewed articles have been published by the CCCSCP 1, 5-18. The data have also been presented at numerous scientific conferences, are being used by graduate students, and have been included in proposals for research funding, one of which was successful. Data collection was suspended in 2001 due to insufficient funds. Since then proposals for funding have been submitted, data continues to be analyzed, and study documents are being updated in the anticipation of funding renewal. In particular, a data entry tool was developed to allow centers to submit and manage their surveillance data (TOS) using a remote, on-line data access tool. In Canada, incidence and mortality data on all Canadians diagnosed with cancer in Canada (including children) are collected via the provincial/territorial cancer registries and collated at the Canadian Cancer Registry, Statistics Canada. Most pediatric cancer patients are also enrolled in clinical trials that maintain study specific datasets. However, in-depth, pan-Canadian, population-based surveillance data are not available outside the CCCSCP. To allow for population based examination of treatment and outcome patterns in children with cancer across the country, variations in health care delivery and utilization, such as in waiting times, stage at diagnosis or enrolment in clinical trials the CCCSCP is essential, providing a unique resource for these purposes.

As part of a partnership arrangement with the Joint United Nations Programme on HIV/AIDS and the Public Health Agency of Canada, Health Canada hosted an International Policy Dialogue on HIV/AIDS and Disability from 11 to 13 March 2009 in Ottawa, Canada. The dialogue provided a forum for stakeholders from governments, academia, and non-governmental and multilateral organizations to explore the issues and evidence related to HIV/AIDS and disability, and to chart a way forward in terms of policy and programme development. This meeting report outlines the participants, objectives and high-level outcomes.

The Public Health Agency of Canada (the Agency) has an important role to play in collaboration with its provincial/territorial partners to advance preparedness for emerging and re-emerging high-consequence infectious diseases. During the 2014 Ebola outbreak, the Agency established Ebola Virus Disease (EVD) Rapid Response Teams that were available to any requesting provincial/territorial jurisdiction with a laboratory confirmed case of EVD. Working with provincial and territorial officials, a Rapid Response Team Concept of Operations was developed which outlined the process for Rapid Response Team engagement as well as the suite of technical expertise available. The Concept of Operations was refined further following a series of face-to-face advance planning meetings with individual provincial and territorial jurisdictions. This led to a consensus agreement that the Agency's Rapid Response Team should be available to support management of both confirmed and suspected EVD cases. There was also unanimous support from provincial and territorial jurisdictions that the concept and operationalization of the Agency's Rapid Response Team should be broadened to provide surge-capacity support to the provinces and territories to include any event with significant public health consequences. The Agency will continue to engage with domestic and international partners regarding best practices to maintain a highly skilled and nimble Rapid Response Team that is operationally ready to support both domestic and international public health emergencies.