Infectious Diseases & Clinical Care

infectious-diseases-clinical-care, science-brief
 | May 28, 2021

Ivermectin to Prevent Disseminated Strongyloides Infection in Patients with COVID-19

Ivermectin, an antiparasitic agent, is currently not recommended for prophylaxis or treatment of COVID-19. Inappropriate use of ivermectin for COVID-19 may make it unavailable for patients who could benefit from its use (i.e., patients with serious parasitic infections) and reduce the already limited supply of ivermectin in Canada. However, patients with COVID-19 who receive immunomodulatory therapies (e.g., corticosteroids including dexamethasone, interleukin-6 inhibitors including tocilizumab) may be at risk of dissemination/hyperinfection syndrome from Strongyloides stercoralis, which can be fatal. We have developed a strategy to safely manage strongyloidiasis risk and infection in the setting of ivermectin shortage. Patients admitted to hospital with COVID-19 and at high epidemiologic risk for strongyloidiasis should be screened with serology. If a patient’s strongyloides serology is reactive or indeterminate, these patients should receive ivermectin to avoid the potential for parasitic dissemination/hyperinfection.
infectious-diseases-clinical-care, science-brief
 | May 11, 2021

Risk of Vaccine-Induced Thrombotic Thrombocytopenia (VITT) following the AstraZeneca/COVISHIELD Adenovirus Vector COVID-19 Vaccines

Published estimates of the risk of vaccine-induced thrombotic thrombocytopenia (VITT) from countries with moderate to high data quality range from 1 case per 26,500 doses to 1 case per 127,300 doses of AstraZeneca/COVISHIELD administered (Table 1). The risk of VITT in Canada as of April 28, 2021 has been estimated to be approximately 1 per 100,000 doses, but several possible cases are still under investigation.
infectious-diseases-clinical-care, science-brief
 | May 7, 2021

Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT) Following Adenovirus Vector COVID-19 Vaccination

This Science Brief provides information for health care professionals about Vaccine-Induced Immune Thrombotic Thrombocytopenia (VITT), also known as Vaccine-Induced Prothrombotic Immune Thrombocytopenia (VIPIT) and Thrombotic Thrombocytopenia Syndrome (TTS). This is a rare adverse event following adenovirus vector COVID-19 vaccines, including the AstraZeneca/COVISHIELD and Janssen/Johnson & Johnson COVID-19 vaccines. This brief describes the pathophysiology, presentation, diagnostic work-up and treatment of VITT.
infectious-diseases-clinical-care, science-brief
 | May 6, 2021

Remdesivir for Hospitalized Patients with COVID-19

Remdesivir, a direct-acting antiviral agent, may reduce mortality and progression to mechanical ventilation in moderately ill patients hospitalized with COVID-19 on supplemental low-flow oxygen. The benefits of remdesivir for critically ill patients requiring supplemental oxygen via high-flow nasal cannula or mask, or non-invasive mechanical ventilation, is uncertain. Remdesivir does not benefit and may harm critically ill patients already receiving mechanical ventilation or requiring extra-corporeal membrane oxygenation (ECMO), and it does not provide substantial benefit for hospitalized patients who do not require supplemental oxygen. Remdesivir appears to have comparable effects when used for 5 days or 10 days, and does not appear to be associated with significant adverse effects. Remdesivir is recommended in moderately ill hospitalized patients with COVID-19 requiring supplemental oxygen (Figure 1). Remdesivir may be considered for patients requiring oxygen supplementation via high-flow nasal cannula or mask, or non-invasive mechanical ventilation. It should not be used in critically ill patients on mechanical ventilation or those receiving ECMO. Remdesivir should not be used in patients who do not require supplemental oxygen.
infectious-diseases-clinical-care, science-brief
 | April 19, 2021

Strategies to Manage Tocilizumab Supply During the COVID-19 Pandemic

Tocilizumab is an anti-inflammatory medication that acts by inhibiting interleukin-6 (IL-6) and is shown to improve outcomes including mortality in patients hospitalized with COVID-19 requiring supplemental oxygen. Ontario supply of tocilizumab is limited, and tocilizumab demand in Ontario will likely exceed supply in the near future. A strategy that includes using a fixed, single intravenous dose of 400 mg for eligible patients, use of a provincial dashboard to help monitor and allocate use, and estimating supply-to-demand adequacy will optimize tocilizumab use. Sarilumab, another IL-6 inhibitor, can be considered as a substitute. As a default, a centralized allocation lottery system should be employed as soon as predicted demand exceeds supply. Other aspects may need to be taken into account for allocation, as appropriate.
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