Introduction Several regions in Canada have recently experienced sharp increases in opioid overdoses and related hospitalizations and deaths. This paper describes opioid-related mortality and disability from opioid use disorder in Canada from 1990 to 2014 using data from the Global Burden of Disease (GBD) study. Methods We used data from the GBD study to describe temporal trends (1990–2014) in opioid-related mortality and disability from opioid use disorder using common metrics: disability-adjusted life years (DALY), deaths, years of life lost (YLL) and years lived with disability (YLD). We also compared age-standardized YLL and DALY rates per 100 000 population between Canada, the USA and other regions. Results The age-standardized opioid-related DALY rate in Canada was 355.5 per 100 000 population in 2014, which was higher than the global rate of 193.2, but lower than the rate of 767.9 in the United States. Between 1990 and 2014, the age-standardized opioid-related YLL rate in Canada increased by 142.2%, while globally this rate decreased by 10.1%. In comparison with YLL, YLD accounted for a larger proportion of the overall opioid-related burden across all age groups. Health loss was greater for males than females, and highest among those aged 25 to 29 years. Conclusion The health burden associated with opioid-related mortality and disability from opioid use disorder in Canada is significant and has increased dramatically from 1990 to 2014. These data point to a need for public health action including enhanced monitoring of a range of opioid-related harms.

Introduction Plusieurs régions du Canada ont récemment connu de brusques hausses de surdoses d’opioïdes ainsi que des hospitalisations et des décès connexes. Cet article traite de la mortalité liée aux opioïdes et de l'invalidité découlant d'un trouble de consommation d’opioïdes au Canada entre 1990 et 2014, à la lumière des données de l’Étude sur la charge mondiale de morbidité (ÉCMM). Méthodologie Nous avons utilisé les données de l’ÉCMM pour décrire l'évolution (1990 à 2014) en matière de mortalité liée aux opioïdes et d’invalidité découlant d’un trouble de consommation d’opioïdes en calculant les années de vie ajustées du facteur invalidité (AVAI), les décès, les années de vie perdues (AVP) et les années vécues avec invalidité (AVI). Nous avons également comparé les taux d’AVP et d’AVAI pour 100 000 au Canada, aux États-Unis et dans d'autres régions. Résultats Le taux normalisé selon l’âge d’AVAI lié aux opioïdes au Canada était de 355,5 par 100 000 en 2014, soit un taux supérieur au taux mondial de 193,2 mais inférieur au taux de 767,9 aux États-Unis. Entre 1990 et 2014, le taux normalisé selon l’âge d’AVP attribuables aux opioïdes a augmenté de 142,2 % au Canada alors qu’il a diminué de 10,1 % à l’échelle mondiale. Les AVI ont contribué à une plus grande proportion du fardeau global lié aux opioïdes que les AVP, et ce, dans tous les groupes d’âge. La perte de santé a été plus importante chez les hommes que chez les femmes, et particulièrement marquée chez les 25 à 29 ans. Conclusion Le fardeau sur la santé dû à la mortalité liée aux opioïdes et à l’invalidité découlant d’un trouble de consommation d’opioïdes au Canada est important et s’est considérablement alourdi entre 1990 et 2014. Ces données révèlent la nécessité d’agir en santé publique, notamment par le renforcement de la surveillance des divers méfaits liés aux opioïdes.

Background Respiratory diphtheria is a potentially fatal toxin-mediated disease that is rare among highly vaccinated populations. Cutaneous infections with toxigenic Corynebacterium diphtheriae are most commonly linked to travel to an endemic region. Corynebacterium ulcerans has emerged as a predominant, locally acquired cause of respiratory and cutaneous diphtheria in Western Europe. Recently, public health agencies from several highly vaccinated regions expanded their guidelines to investigate toxigenic cutaneous diphtheria regardless of travel history. With relatively unknown epidemiology of C diphtheriae in North America, and increasing diphtheria toxin testing over the last decade, this change could lead to substantial increases in public health investigations with unclear benefits. Methods This study examined the diagnostic and public health benefits of toxigenic cutaneous diphtheria investigations in the highly vaccinated population of Alberta, Canada, where travel history is not required for cutaneous diphtheria investigations. All C diphtheriae isolates collected between 2010 and 2019 were reviewed for specimen source, toxigenicity, biovar, and associated clinical and public health data. Results Of these, 5% of C diphtheriae isolates were toxigenic and 82% were isolated from cutaneous sites. Three cases of toxigenic cutaneous disease were identified, none from patients with recent travel. Contact tracing identified asymptomatic C diphtheriae colonization among 0%–26% of close contacts, with identical isolate profiles among colonized contacts and primary cases. Conclusions Cutaneous diphtheria in nonendemic regions warrants public health investigation regardless of travel history and overall vaccination levels. This study underscores the importance of including C ulcerans in public health guidelines to assess the overall prevalence and epidemiology of toxigenic corynebacteria.

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Background Classical diphtheria is a potentially fatal respiratory disease mediated by the diphtheria toxin of Corynebacterium diphtheriae. Due to high vaccination rates against this toxin in Canada, the national incidence of respiratory diphtheria is near zero, and the toxin plays no recognized role in cutaneous diphtheria. Therefore, in this study, we assessed the diagnostic and public health benefits of diphtheria toxin testing and cutaneous diphtheria investigations in a highly vaccinated population. Methods Over the last 10 years, we retrospectively determined: the number of C. diphtheriae isolates identified in the province of Alberta, Canada; the disease state of each individual tested (disease vs asymptomatic carrier); the source (cutaneous vs respiratory); and the number of toxin tests performed. Results In 10 years, zero cases of respiratory diphtheria and three cases of toxigenic cutaneous diphtheria were identified. Despite zero cases of respiratory disease, diphtheria toxin testing significantly increased (p = 0.0001), with 86% of toxin tests performed on cutaneous isolates. Subsequent public health investigations of each case of toxigenic cutaneous diphtheria mandated the collection of 315 total specimens from 92 individuals, revealing low rates of C. diphtheriae colonization among contacts and no further cases. Conclusions This study challenges the value of reflexive diphtheria toxin testing in uncomplicated cutaneous diphtheria among highly vaccinated populations. Cutaneous diphtheria investigations demanded disproportionate public health and laboratory resources and demonstrated a discrepancy between toxin pathophysiology and disease. Therefore, we recommend stewarding diphtheria toxin tests for toxin-mediated disease forms and ensuring adequate vaccination. This approach would spare public health and laboratory resources by customizing responses around the role of the diphtheria toxin in each form of disease. Key messages Investigations for cutaneous diphtheria increased demand for toxin testing in Alberta, Canada, though the toxin plays no role in this form of disease. In populations with high vaccination rates against diphtheria toxoid, cutaneous diphtheria cases do not require additional laboratory testing for the presence of the diphtheria toxin.