Correctional facilities face increased risk of communicable disease transmission and outbreaks. We describe the progression of an influenza outbreak in a Canadian remand facility and suggest strategies for preventing, identifying and responding to outbreaks in this setting. In total, six inmates had laboratory-confirmed influenza resulting in 144 exposed contacts. Control measures included enhanced isolation precautions, restricting admissions to affected living units, targeted vaccination and antiviral prophylaxis. This report highlights the importance of setting specific outbreak guidelines in addressing population and environmental challenges, as well as implementation of effective infection prevention and control (IPAC) and public health measures when managing influenza and other communicable disease outbreaks.

One of the most useful strategies to control the spread of tuberculosis is treating latent tuberculosis infections. Certain populations at higher risk for tuberculosis infection, such as homeless individuals, are also at increased risk for treatment nonadherence. This article describes the treatment completion rate for latent tuberculosis infections at a health clinic in Edmonton, Alberta, including an assessment of the correlates of noncompletion as well as potential means to improve treatment adherence.

I n low TB incidence countries such as Canada, TB disease remains concentrated in urban settings with outbreaks involving homeless and under-housed populations that continue to challenge TB control programs. While the incidence of TB in Canada declined to 4.7/100,000 in 2009, the burden of TB cases continues to be diagnosed among foreign-born (FB) individuals. 1 In Alberta, the rate of TB among the FB is 17.7/100,000, compared to the Canadian-born (CB) population at 1.7/100,000. 1 Other descriptions of homeless and under-housed populations in Canadian urban centres have reported that disease remains concentrated among CB-Aboriginal (CB-AB) populations, 2 though the rise in the proportion of FB cases among homeless populations has been noted. 3 Although cases of TB in the FB represent the majority of cases in Alberta, there had previously been little documented transmission to other FB or to CB individuals. 4 The objective of this study is to describe the transmission of TB from FB populations to CB populations through shelterbased locations in the inner city of Edmonton, Alberta. METHODS Study population Edmonton is a northern Canadian city with a population of 1,024,820; 18.5% of the population are immigrants. 5 The homeless population is estimated to be 3,079 and is concentrated in the inner city of Edmonton. 6 All cases of TB in the province are centrally reported to TB Services. Between May 2008 and December 2009, 103 cases of active TB were reported within Edmonton (mean annual rate for 2008 and 2009 was 7.9/100,000); 19 cases were linked to three locations (one apartment building and three homeless shelters) within a one-block area of the inner city. Demographic and clinical characteristics A retrospective review of these 19 cases was completed by extracting demographic, clinical, treatment and contact tracing data from iPHIS. All TB cases were culture-confirmed at the Provincial Laboratory for Public Health (Edmonton, Alberta). Contacts were identified through social networking interviews and through resident lists of shared communal-living locations. Contact investigation was limited to chest x-ray (CXR), sputum for acid-fast bacilli (AFB) analysis and symptom inquiry.

Purpose - Facility-based Varicella zoster virus (VZV) transmission is reported in a Canadian youth offender correctional centre (YOCC). Transmission occurred from an immunocompetent youth offender (YO) with localized Herpes zoster to another immunocompetent single dose vaccinated YO, resulting in Varicella zoster (VZ) breakthrough disease. The purpose of this paper is to identify infection prevention and control (IPAC) measures utilized in this setting. Design/methodology/approach - A retrospective chart and immunization record review was conducted for two VZV cases and 27 exposed YO contacts in order to obtain demographic, clinical and immunization data. Descriptive data analysis was performed. Findings - All VZV cases and exposed contacts were male with an average age of 14.2 and 15.6 years for cases and contacts, respectively. Both cases shared the same living unit in the YOCC. There were 28 identified YO contacts, of whom 70 percent were single dose vaccinated with univalent vaccine, followed by 22 percent with a previous history of Varicella disease. All cases and contacts were born in Canada. No foreign-born populations were involved with this event. Infection control measures included additional precaution management, enhanced surveillance and environmental cleaning. As such, no hospitalizations or post-exposure immunizations were required. Originality/value - This report highlights the role that VZ breakthrough disease could play in fueling an outbreak in a high-risk environment without rapid recognition and implementation of preventative measures. It also underscores the importance of IPAC presence and public health immunization programs within correctional centers to avoid infectious disease threats.