Sexually transmitted and blood-borne infections

Expedited Partner Therapy for Chlamydia Trachomatis and Neisseria Gonorrhoeae Infections

Given the desire to harmonize medical and nursing practices in the field of sexually transmitted infections (STIs) and the need to provide better guidance on the intervention known as expedited partner therapy (EPT), the Institut national de santé publique du Québec received a request from the Collège des médecins du Québec and the Ministère de la Santé et des Services sociaux. The purpose of this request was to issue a scientific opinion, including recommendations, on the effectiveness, benefits and drawbacks of the EPT strategy for Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) infections, the best practice to endorse as well as the conditions required to promote its appropriate use.

In Québec, two STI preventive interventions targeted for infected people and their partner are recommended for people infected with a sexually transmitted infection and their partners, that is:

  • the passive approach, whereby infected persons personall…

Advisory report on the Human Papillomavirus (HPV) Vaccination Schedule

A lot of new data on the immunogenicity, efficacy and effectiveness of fewer than three doses of HPV vaccine have become available since the publication of the CIQ report on the 2012 knowledge update. The two-dose schedule has become a standard that is widely accepted around the world. Such schedules are currently in use in more than half (48/82) of the countries offering HPV vaccination programs. The same schedule has been approved and recommended by the World Health Organization (W HO) and the Global Alliance for Vaccines and Immunization (GAVI).

A number of clinical and ecological studies have even come up with some interesting and promising results in terms of the immunogenicity and efficacy of single-dose HPV vaccination. Immunogenicity studies have shown that sero-conversion rates after a single dose of vaccine are often in excess of 95%, although with considerably lower geometric mean titers (GMTs) than those observed after two or three doses. However, antibody titers…

Comité sur l'immunisation du Québec

Expert Consensus: Viral Load and the Risk of HIV Transmission

A more recent publication based on new studies has just been issued by the Ministère de la Santé et des Services sociaux. This update is titled «L'effet du traitement des personnes vivant avec le VIH sur le risque de transmission sexuelle de l'infection» (The impact of treating people living with HIV on the risk of sexual transmission of the infection) can be found here: http://publications.msss.gouv.qc.ca/msss/document-002173/ (french only).

The CITSS working group was mandated to assess the effect of undetectable viral load on HIV transmission risk in order to support updating the Estimation du risque associé aux activités sexuelles , a resource designed to help guide risk-reduction counselling and to support the assessment of STBBI reports according to section 95 of Québec's Public Health…

Sous-comité Charge virale et risque de transmission du VIH

Updated program for combating sexually transmissible and blood-borne infections Nunavik: clinical intervention section

In Nunavik, the battle against bacterial sexually transmissible and blood-borne infections (STBBIs) has become increasingly urgent. In the wake of mass interventions in the 1990s, and despite more recent efforts, the region has been unable to lower its incidence curves, particularly for gonococcal infection, which has reached epidemic proportions since fall 2007. In this context, and spurred by the renewed interest of medical teams on the ground, the Direction de santé publique (department of public health: DSP) of the Régie régionale de la santé et des services sociaux du Nunavik / Nunavik Regional Board of Health and Social Services (NRBHSS) has asked the Institut national de santé publique (Québec's national public health institute: INSPQ) to support a group of experts in an attempt to optimize the regional program for clinical prevention of STBBIs. Accordingly, a meeting was held on October 2010. In attendance were representatives of the two CSSS organizations (physicians, a con…

HPV Immunization of Quebec Pre-Adolescents: Two or Three Doses?

In 2007, the Comité sur l’immunisation du Québec (CIQ) recommended an extended schedule exclusively for immunization against the human papilloma virus (HPV) starting in grade 4 (0, 6, 60 months); the committee also stated that the third dose should be administered “if judged necessary.” Since the introduction of the Québec HPV immunization program in 2008, similar programs (two doses administered six months apart and a possible third dose if necessary) have been introduced in Mexico and British Columbia. In 2012, the committee of immunization experts in Switzerland recommended for pre-adolescents a schedule comprising two doses administered six months apart. In recent years, a number of studies have been published on the immunogenicity of HPV vaccines administered according to alternative schedules and other studies are presently underway to document the efficacy of one, two, or three doses administered at different intervals.

The present advisory report, which is based…

Comité sur l'immunisation du Québec

HPV Vaccination in Québec: Knowledge Update and Expert Panel Proposals

The human papillomavirus (HPV) belongs to the Papillomaviridae family, which includes at least 100 genotypes affecting the skin and mucous membranes. Of these, about 40 affect the anogenital area in particular, and approximately 15 are oncogenic. Genotypes 16 and 18 are responsible for 70-76% of cervical cancer cases worldwide. Genotypes 6 and 11 are non-oncogenic but are responsible for most cases of condyloma (anogenital warts [AGW]).

HPV prevalence and incidence data are estimated on the basis of epidemiological studies and are better documented in women than men. HPV prevalence varies widely by geographic region, age, the selected subpopulation and HPV detection method. In women, the overall age-adjusted prevalence of genital infections worldwide is estimated at 11.7%. It peaks in young women aged 20-24 and declines subsequently with age. The risk of acquiring HPV infection is particularly high in the first few years after sexual activity begins. Ac…

Comité sur l'immunisation du Québec

Report of the Subcommittee Épreuves de détection de la syphilis: Highlights

Since 2000, the resurgence of syphilis in Québec has led to increased screening and resulted in a greater number of reported cases, particularly in the Montréal area. To meet the growing demand for laboratory testing, some medical diagnostic laboratories have introduced an enzyme immunoassay (EIA) test into their syphilis detection algorithm. This situation raised concerns among general practitioners, microbiologists and infectious disease specialists with regards to the interpretation of screening results and the diagnosis and confirmation of syphilis infections.

In response to these concerns, the Comité sur les infections transmissibles sexuellement et par le sang (CITSS) of the Institut national de santé publique du Québec (INSPQ) established the Sous-comité Épreuves de détection de la syphilis whose mandate was to make recommendations for optimizing syphilis diagnosis in Québec.

To fulfill its mandate, the subcommittee:

  • conducted a literature revie…

Report on the relevance of supervised injection sites: critical analysis of the literature

Given that certain questions have been raised regarding the results of studies on the effects of SISs, the Institut national de santé publique du Québec (INSPQ) has taken the initiative of carrying out a critical analysis of these studies.

The objective of this report is to evaluate the relevance of establishing supervised injection sites in the province of Québec. It is based on a critical analysis of the scientific research carried out to date on the effects of SISs and on a review of the literature on the related ethical and legal issues as well as on acceptability and operational factors related to such sites.

Advice of the Institut national de santé publique du Québec on human papillomavirus vaccines

In October 2007, the Comité sur l'immunisation du Québec (CIQ) tabled a report entitled “Prévention par la vaccination des maladies attribuables aux virus du papillome humain au Québec” [Prevention of diseases caused by human papillomaviruses through vaccination]. At the time that report was being drafted, only one vaccine – Gardasil – was authorized for sale in Canada. The report did not directly compare the Gardasil and Cervarix vaccines.

Given the likelihood that the Cervarix vaccine would be approved, the Direction générale de la santé publique (MSSS) submitted a request to the Institut national de santé publique du Québec (INSPQ) on December 19, 2007, asking the latter to produce an advice with respect to the following question: “Do the two HPV vaccines have an equivalent ability to achieve the stated goal of the immunization program, which is to reduce the incidence of and mortality associated with cervical cancer?”

This document seeks to compare the performanc…

Comité sur l'immunisation du Québec

Nunavik Inuit Health Survey 2004 : Women's Health and Preventive Sexual Behaviour Among Men and Women

This paper describes the state of health of Nunavik Inuit women and the sexual health profile of men and women as reported during the Nunavik Inuit Health Survey 2004. The results focus on the preventive attitude among women such as screening techniques of cervical and breast cancer and also on women’s behaviour during pregnancy and their bone health status. It also concentrates on preventive sexual behaviours among men and women such as the number of sexual partners in the preceding year and the use of contraceptives.

More than four out of five Inuit adult women had a Pap test in the two years before the survey (82%), and 60% of them had one in the previous 12 months. The use of the Pap test is less frequent among adult women with lower levels of education. Among those who had never had a Pap test or had one two or more years before the survey, 41% of them claimed that this examination was not offered to them by their doctor. In terms of breast cancer examination, 43% of wo…