Public Health

Post-immunization titres to determine immunity following a complete vaccine series are often not necessary. For example, anti-HBs titres following completed hepatitis B virus vaccination series are unnecessary in the general population. Similarly, serologic testing for measles, mumps and rubella immunity following two doses of MMR is not necessary.

Sources:

Naus, M. Immunization of those with no or inadequate immunization records and the role of serological testing. BCMJ. 2016 May;58 (4):232-238.

Public Health Agency of Canada. Hepatitis B vaccine: Canadian Immunization Guide. [Internet] 2017.

Public Health Agency of Canada. Measles vaccine: Canadian Immunization Guide. [Internet] 2015.

Rabies post-exposure prophylaxis (including rabies vaccine and immunoglobulin) should only be offered to individuals with known or highly probable contact with the saliva of a potentially infected animal. Risk assessment should be based on type of exposure, local rabies epidemiology, symptoms of the animal, ability to test or observe the animal for rabies, prior rabies immunization of the animal and exposed person, and if necessary, consultation with local public health officials. In general, the risk of rabies from domestic animals (e.g., pets) is extremely low.

Sources:

Canada Immunization Guide. Rabies vaccine. [Internet]. 2015. [Cited Feb 5 2020]

De Serres, G et al. Bats in the bedroom, bats in the belfry: reanalysis of the rationale for rabies postexposure prophylaxis. Clin Infect Dis. 2009 Jun 1;48(11):1493-9. PMID: 19400689.

Middleton D et al. Human rabies postexposure prophylaxis and rabid terrestrial animals in Ontario, Canada: 2014-2016. Can Commun Dis Rep. 2019 Jul 4;45(78):177-182. doi: 10.14745/ccdr.v45i78a02. PMID: 31355826.

Public Health Agency of Canada. For Health Professionals: Rabies. [Internet]. 2019. [Cited Feb 5 2020]

World Health Organization. International Travel and Health: Vaccines: Rabies. [Internet] [Cited Feb 5 2020]

Understanding a patient’s perspective with a thorough social history will provide valuable information about their determinants of health, which is critical for nuanced diagnoses and a better adapted management plan. As barriers are identified and addressed management plans can be re-evaluated in collaboration with the patient.

Sources:

Canadian Medical Association. Health Equity and the Social Determinants of Health: A Role for the Medical Profession.  [Internet]. 2018.

Public Health Agency of Canada. Social determinants of health and health inequalities. [Internet]. 2019.

Senate of Canada. Population Health Policy: Issues and Options. [Internet]. 2008.

Pre-placement TSTs should not be a universal requirement of employees and volunteers in settings where healthcare services are not delivered. Workplace TB screening policies should only be implemented based on the findings of an organization-specific TB risk assessment. If implemented, workplace TB screening should avoid universal TST/IGRA testing by screening for individual TB risk factors first. TSTs should not be used on patients suspected of having active disease as they are unhelpful and unnecessarily delay diagnosis.

Sources:

California Tuberculosis Controllers Association. CTCA Position on TB testing of school-age children. [Internet]. 2012.

California Tuberculosis Controllers Association. Latent Tuberculosis Infection Guidance for Preventing Tuberculosis in California. [Internet]. 2019.

Public Health Agency of Canada. Canadian Tuberculosis Standards 7th Edition: 2014. [Internet]. 2014.

Antibiotic prophylaxis for iGAS is currently offered routinely for household and other close contacts of those infected with severe iGAS. However, it may not be necessary for all such contacts. Individuals in which prophylaxis should be considered are those who are immunocompromised or may be more susceptible to infection, particularly neonates. Prevention and monitoring measures should be discussed with all household and close contacts of confirmed iGAS cases.

Sources:

Centers for Disease Control and Prevention. Group A Streptococcal (GAS) Disease. [Internet]. 2018.

Health Protection Agency, Group A Streptococcus Working Group. Interim UK guidelines for management of close community contacts of invasive group A streptococcal disease. Commun Dis Public Health. 2004 Dec;7(4):354-61. PMID: 15786581.