Burden of disease analyses can quantify the relative impact of different exposures on population health outcomes. Gastroenteritis where the causative pathogen was not determined and respiratory illness resulting from exposure to opportunistic pathogens transmitted by water aerosols have not always been considered in waterborne burden of disease estimates. We estimated the disease burden attributable to nine enteric pathogens, unspecified pathogens leading to gastroenteritis, and three opportunistic pathogens leading primarily to respiratory illness, in Ontario, Canada (population ~14 million). Employing a burden of disease framework, we attributed a fraction of annual (year 2016) emergency department (ED) visits, hospitalisations and deaths to waterborne transmission. Attributable fractions were developed from the literature and clinical input, and unattributed disease counts were obtained using administrative data. Our Monte Carlo simulation reflected uncertainty in the inputs. The estimated mean annual attributable rates for waterborne diseases were (per 100 000 population): 69 ED visits, 12 hospitalisations and 0.52 deaths. The corresponding 5th–95th percentile estimates were (per 100 000 population): 13–158 ED visits, 5–22 hospitalisations and 0.29–0.83 deaths. The burden of disease due to unspecified pathogens dominated these rates: 99% for ED visits, 63% for hospitalisations and 40% for deaths. However, when a causative pathogen was specified, the majority of hospitalisations (83%) and deaths (97%) resulted from exposure to the opportunistic pathogens Legionella spp., non-tuberculous mycobacteria and Pseudomonas spp. The waterborne disease burden in Ontario indicates the importance of gastroenteritis not traced back to a particular pathogen and of opportunistic pathogens transmitted primarily through contact with water aerosols.

Setting Toronto (Ontario, Canada) is a large urban centre with a significant population of underhoused residents and several dozen shelters for this population with known medical and social vulnerabilities. A sizeable men’s homeless shelter piloted a facility-level SARS-CoV-2 wastewater surveillance program. Intervention Wastewater surveillance was initiated at the shelter in January 2021. One-hour composite wastewater samples were collected twice weekly from a terminal sanitary clean-out pipe. The genetic material of the SARS-CoV-2 virus was extracted from the solid phase of each sample and analyzed using real-time qPCR to estimate the viral level. Wastewater results were reported to facility managers and Toronto Public Health within 4 days. Outcomes There were 169 clients on-site at the time of the investigation. Wastewater surveillance alerted to the presence of COVID-19 activity at the site, prior to clinical detection. This notification acted as an early warning signal, which allowed for timely symptom screening and case finding for shelter managers and the local health unit, in preparation for the declaration of an outbreak. Implications Wastewater surveillance acted as an advanced notification leading to the timely deployment of enhanced testing prior to clinical presentation in a population with known vulnerabilities. Wastewater surveillance at the facility level is beneficial, particularly in high-risk congregate living settings such as shelters that house transient populations where clinical testing and vaccination can be challenging. Open communication, established individual facility response plans, and a balanced threshold for action are essential to an effective wastewater surveillance program.

Knowledge Translation (KT) is increasingly a requirement for scholars and non-academics working in applied settings. However, few programs provide explicit training in KT. In this article we systematically explore our experiences as a multi-disciplinary group of course facilitators and students in a newly redeveloped graduate course in Evidence Based Practice and Knowledge Translation. The course was designed to emphasize hands-on learning, collaboration and community engagement. We reflect on the challenges we faced and the skills, knowledge and opportunities that students gained as they developed and implemented community-based KT strategies relating to refugee resettlement, young carers, and consumer attitudes, behaviour and values around food purchasing decisions. We conclude by providing recommendations for instructors and institutions for implementing learning experiences in KT that are designed for real-world impact. L’application des connaissances (AC) est devenue une exigence de plus en plus fréquente pour les chercheurs et les personnes qui travaillent dans les milieux non universitaires. Toutefois, peu de programmes offrent une formation explicite en AC. Dans cet article, nous explorons systématiquement nos expériences en tant que groupe pluridisciplinaire formé de responsables de cours et d’étudiants dans un cours de cycle supérieur nouvellement remanié portant sur la pratique fondée sur les données probantes et l’application des connaissances. Le cours a été conçu pour mettre en valeur l’apprentissage pratique, la collaboration et l’engagement communautaire. Nous réfléchissons aux défis auxquels nous avons été confrontés ainsi qu’aux compétences, aux connaissances et aux opportunités que les étudiants ont acquis en développant et mettant en pratique des stratégies d’AC en milieu communautaire sur les thèmes de la réinstallation des réfugiés, des jeunes aidants et des attitudes, comportements et valeurs des consommateurs en matière d’achat de produits alimentaires. En conclusion, nous présentons des recommandations à l’intention des enseignants et des établissements pour la mise en pratique d’expériences en AC qui soient conçues pour avoir un effet dans le monde réel.

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