Outbreaks & Infectious Disease

 

 

Antibiotic resistant organisms (such as MRSA and VRE)

  • MRSA and VRE are becoming increasingly common both in health care and community settings and require special considerations in the provision of care.

See also: Antibiotic Resistant Organism (ARO) Risk Factor-Based Screening Guidance for All Health Care Settings Screening Checklists (June 2024, PDF 303 KB).

Avian influenza

Bed bugs

  • Although bed bugs do not carry or transmit disease, they can result in an infestation. Certain precautions can be taken to halt their spread.

Candida auris

  • Candida auris: Now designated Disease of Public Health Significance by Public Health Ontario. Cases must be reported to your local public health unit.

More information on Candida auris is available from Public Health Ontario. See also: Antibiotic Resistant Organism (ARO) Risk Factor-Based Screening Guidance for All Health Care Settings Screening Checklists (June 2024, PDF 303 KB).

COVID-19

In May 2022, the CANCOVID-Preg team published a surveillance study including 6012 completed pregnancies between March 2020 and October 2021. Among the 6,012 cases of COVID-19 in pregnancy, 466 (7.75 per cent) required hospitalization and 121 (2.01 per cent) were admitted to an ICU. Compared with cases of infection in non pregnant, reproductive aged individuals, those who were pregnant were more likely to be hospitalized (relative risk, 2.65; 95% CI, 2.41-2.88), and more likely to need care in the ICU (relative risk, 5.46; 95% CI, 4.50-6.53). The data also demonstrated an increased risk of early labour for those who were infected with COVID-19 in pregnancy (relative risk, 1.63; 95% CI, 1.52-1.76). 

Results from the 4th report of the CANCOVID-Preg study largely show positive pregnancy outcomes. Of 1821 reported pregnancy outcomes affected by COVID-19, there were 19 (1%) stillbirths and < 6 newborns who were tested for COVID-19 received a positive result. Importantly, in this sample, stillbirth rates were 10.6 per 1000 compared to 5.44 per 1000  in the general population (derived from CIHI-DAD 2020 data). Although the stillbirth estimate in our COVID-19 positive cases is slightly higher than the general population, the absolute numbers are still quite small. (Money 2021) 

Of the 1769 cases with delivery and gestational age data, 87.1% occurred at term and 12.9% at preterm gestation. Of the 228 (12.1%) preterm infants, 34.6% were medically indicated preterm deliveries and 39.9% were spontaneous. This preterm birth rate is twice the rate of preterm birth in the general pregnant population. This is likely associated with severity of infection. (Money 2021; SOGC 2021) 

Ebola virus disease

Influenza 

  • Influenza, including H1N1 and varying other strains is an annual concern and pregnant persons and newborns are at an increased risk of complications. The Public Health Agency of Canada influenza awareness resources can be displayed and shared in midwifery clinics.

  • See the Ontario Respiratory Virus Tool for surveillance data.

Measles

Measles has become more common globally, and as a result Ontario has seen an increase in measles rates and exposures. 

More information on measles is available from Public Health Ontario, including surveillance reports and a regularly updated list of exposure sites.

Clients with febrile and/or respiratory rash illness should be screened for risk factors over the phone (no/unknown immunity, contact with a known case, recent travel). Consider conducting any physical evaluation offsite or in a negative pressure room to minimize exposures. At a minimum, care providers should wear an N95 face mask and adhere to other IPAC best practices outlined in the technical brief.

Vaccination is the best way to prevent measles spread. The Canadian Immunization Guide contains details for pregnant and postpartum individuals. Refresh your clinic's vaccination resources using materials from the Canadian Association of Midwives (CAM). CAM members can log in to view the recorded webinar addressing vaccine hesitancy. Find more resources on client counselling from Immunize Canada.

Middle East Respiratory Coronavirus (MERS CoV) & Avian Influenza (H7N9)

Mpox (Monkeypox) 

Oropouche virus disease (OVD)

OVD is a disease caused by the Oropouche virus. Similar to Zika, it spreads to people through bites from an infected small fly called a midge (sometimes called no-see-ums) or possibly some type of mosquitos. Vertical transmission is being investigated in potential cases related to fetal deaths and newborn microcephaly. See:

Zika virus (ZIKV)