Hastings Prince Edward Public Health
Online Bulletin for Health Care Providers

May 6, 2022

From:
Dr. Ethan Toumishey
Medical Officer of Health and CEO
Hastings Prince Edward Public Health

In this Issue:

  1. Tdap publicly funded in Ontario in every pregnancy
  2. Masking requirements continue in select indoor settings
  3. Memo re: severe acute hepatitis of unknown origin in children
  4. Health care provider tools for prescribing Paxlovid
  5. COVID-19 Dashboard schedule update
  6. Educational Opportunities
  7. New and updated COVID-19 resources

News & updates

Tdap publicly funded in Ontario in every pregnancy

Beginning April 2022, Ontario has expanded its publicly funded Tdap (tetanus, diphtheria, acellular pertussis) immunization program to include a routine dose in every pregnancy, for protection against pertussis.

All pregnant individuals in Ontario are now eligible to receive the vaccine for free in each pregnancy (ideally between 27 and 32 weeks of gestation).

The National Advisory Committee on Immunization (NACI) has reviewed the evidence on pertussis vaccination and recommends that all pregnant individuals should be offered Tdap vaccine in every pregnancy, regardless of previous Tdap immunization history, to help protect the baby against pertussis after birth. Up until now, Tdap vaccine has only been publicly funded in Ontario as a one-time dose in adolescence and a one-time dose in adulthood (to replace one dose of Td, recommended every 10 years).

As part of routine prenatal care, please discuss and offer or refer your patients to receive Tdap vaccine during every pregnancy.

Masking requirements continue in select indoor settings

Provincial masking requirements which were set to expire on April 27, 2022 are being extended in current settings until 12 am on June 11, 2022, including:

  • public transit;
  • health care settings (e.g., hospitals, doctors’ offices, clinics that provide health care services, laboratories, specimen collection centres, and home and community care);
  • long-term care homes;
  • retirement homes; and
  • shelters and other congregate care settings that provide care and services to medically and socially vulnerable individuals.

A complete list of settings where masking requirements continue to apply is available online.

The Chief Medical Officer of Health will also maintain the CMOH Directives currently in effect until June 11, 2022, after which the ministry will issue guidance on personal protective equipment recommendations for infection prevention and control in health care settings.

Two Memos Issued Re: Severe Acute Hepatitis of Unknown Origin in Children

On April 26, 2022 the Office of the Chief Medical Officer of Health issued a memo to primary care providers notifying them that there have been 169 cases of severe acute hepatitis of unknown origin in children reported in Europe, Israel and the United States. The World Health Organization has issued alerts and a case definition.

On May 4, 2022 the Office of the Chief Medical Officer of Health issued a memo to notify of a class 77.6 order issued under the Health Protection and Promotion Act, requiring all public hospitals to report cases of severe acute hepatitis of unknown origin in children to Public Health Ontario (PHO). This is being done out of an abundance of caution, working collaboratively with the Public Health Agency of Canada and PHO. If a patient meets the probable or epi-linked case definition in Appendix A, the health care provider must contact Public Health Ontario at 647-260-7419 and fax the completed case report form to HPEPH at 613-966-1813. Please see the attached Order outlining the requirements for data collection, case definitions for probable and epi-linked cases, case reporting form, and further instructions regarding reporting and sharing information with PHO.

The Office of the Chief Medical Officer of Health is requesting clinicians to be vigilant with infants and children up to 16 years of age presenting with signs and symptoms compatible with acute hepatitis, including new onset of jaundice (yellow skin and/or eyes) and discolouration of urine (dark) and/or feces (pale).

Considering the appropriate clinical context, other symptoms that may be suggestive of hepatitis include:

  • pruritis
  • arthralgia/myalgia
  • fever
  • nausea, vomiting or abdominal pain
  • lethargy and or loss of appetite

For children presenting with symptoms compatible with acute hepatitis, timely laboratory testing is recommended including CBC, AST, ALT, GGT, direct and indirect bilirubin, albumin and INR.

If acute hepatitis is confirmed on laboratory testing, further laboratory work-up is recommended to assess for potential infectious and non-infectious etiologies as relevant to the clinical history. For pediatric patients with severe hepatitis of unknown etiology with AST or ALT > 500 U/L, adenovirus testing should be considered, which may include nasopharyngeal swab, stool and/or blood PCR, depending on laboratory test availability.

Test requisition for hepatitis of unknown origin in children - Public Health Ontario

Health care provider tools for prescribing Paxlovid

Ontario Health has collaborated with partners such as OntarioMD and the eHealth Centre of Excellence to develop and mobilize additional Paxlovid tools, for example:

  1. EMR Searches for Eligible Patients

    Identify high-risk patients based on age, immunocompromised individuals, and those with risk factors such as obesity, diabetes, or hypertension using EMR searches created for the three most common primary care EMRs (Accuro, Oscar and PS Suite).

    Searches that use EMR data to identify patients who meet eligibility criteria for Paxlovid are available here: https://ehealthce.ca/COVID-Therapeutics.htm

    If individuals identified via these searches do not have a recent serum creatinine, providers may consider ordering this for the highest-risk patients while they are well.
     
  2. Adaptable Script for Patient Communication

    Send an email to patients identified during steps 1 and 2 (e.g., using the Ontario College of Family Physicians’ adaptable script).

    The Ontario College of Family Physicians developed an adaptable script that can be sent to patients identified as high risk through the EMR search. This script provides comprehensive information about Paxlovid for patients such as answers to common questions, when to call the doctor’s office, the eligibility self-screening tool and where to find clinical assessment centres and dispensing pharmacies (Note: supply at individual sites may vary).
     
  3. Paxlovid Prescription Form

    Use an optional EMR-integrated prescription form when Paxlovid prescription is indicated.

    A single-page Paxlovid Prescription Form has been developed by Ontario Health Regions. It includes the eligibility criteria for Paxlovid and can be found here for various EMRs. Integration with other EMRs can be supported by OntarioMD. This form is intended as an aid and is not required.

COVID-19 Dashboard schedule update

To align with other public health units in the province our COVID-19 Dashboard update schedule is switching to Tuesdays and Thursdays. Case info will also be removed from the outbreaks table, as case counts are no longer accurate due to the changes in testing.

Educational Opportunities

OMA COVID-19 Town Hall – Paxlovid and Evusheld

Please join us for an online COVID-19 Town Hall on Paxlovid and Evusheld taking place on Tuesday, May 10 from 7:30-9 pm Our panel of experts will address considerations for prescribing Paxlovid for the treatment of COVID-19 and will provide an overview of Evusheld, a new prophylactic treatment for immunocompromised patients. The majority of the session will be dedicated to addressing questions from members.

New and updated COVID-19 resources

Current information on COVID-19 specifically for health care providers can be found at hpePublicHealth.ca, Ontario Ministry of Health and at publichealthontario.ca.

Back to Summary

Contact Information: 

To give us your comments: hart.sara@hpeph.ca

To report communicable diseases:613-966-5500 x349

To report AEFI or DOPHS: Online / Fax: 613-966-1813 or CDCFAX1@hpeph.ca

Hastings Prince Edward Public Health is situated and provides services on the traditional territory of the Anishinaabe, Huron-Wendat and Haudenosaunee people.

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