• Canadian Critical Care Trials Group
    The Canadian Critical Care Trials Group (CCCTG) is a highly collegial group that is dedicated to the pursuit of excellence and advancement of critical care research in Canada.
  • Canadian Critical Care Trials Group
    The CCCTG has are more than 30 research programs underway and over 100 peer-reviewed publications to its credit, with direct impact on clinical practice in critical care.
  • Canadian Critical Care Trials Group
    The Canadian Critical Care Trials Group (CCCTG) is a national organization of more than 300 individuals with research interests in the management of the critically ill patient.
  • Canadian Critical Care Trials Group
    Endorsement by the CCCTG communicates our full commitment to ensure that the work is undertaken in a rigorous and ethical manner, and communicated in a timely and effective way.

Outbreaks about respiratory illness and critical care challenges worldwide

The CCCTG highlights in this page the recent outbreaks about respiratory illness and critical care challenges worldwide.

There have been an increasing number of cases of Avian-Origin Influenza A (H7N9) in China. The preliminary case studies have been reported in the attached links, and characterize patients of ages range from 4 to 87 years,  a presentation with fever, cough and dyspnea, evolving severe hypoxic respiratory illness and ARDS within approximately 7 days of the onset of symptoms. There have been blood elevations of CK and LDH. Recommended specific treatment includes early neuraminidase inhibitors. IVIG has been used and is being evaluated. The case fatality rate appears very high, although denominators of all those with clinical infection and illness are unclear. Person-to-person spread is uncertain and most patients have had exposure to suspected non-human reservoirs. As of April 13 2013, 49 confirmed cases of human infection with avian influenza A(H7N9) virus have been reported to WHO by the China National Health and Family Planning Commission, and 11 persons have died.

There have been a waning number of cases of novel coronavirus (nCoV), centered in the Middle East but with cases scattered throughout Europe, most commonly in travellers from the Middle East. Clinical presentation has included serious respiratory illness, accompanied with fever, cough, shortness of breath, evolving severe hypoxic respiratory illness and ARDS. To date, the WHO has been informed of a global total of 17 confirmed cases of human infection with nCoV, including 11 deaths. Person-to-person transmission appears to be present but this is based upon a small number of cases. Treatments include best practices for severe ARDS and critically illness. Specific medical treatments are uncertain. IVIG has been used and is being evaluated.

As it happens (but not because of these outbreaks), the CCCTG is conducting a PHAC supported feasibility surveillance study for severe respiratory illness, possibly associated with travel/occupational/or animal contact, among critically ill patients in a small number of ICUs in Canada. The goal of this study is to determine feasibility of screening and limited reporting in real-time for such illnesses, in the event that there is a higher baseline likelihood of exposure. Although we may not see H7N9 or nCoV in our ICUs this season, it is likely that with increasing frequency, micro-organisms will be able to move across the world, and it is also likely a good idea to work out some of the challenges of real-time reporting.

Please find below a few resources for recent global outbreaks and would point to the WHO, ISARIC and InFACT websites which have excellent epidemiological, clinical and treatment-related resources.

World Health Organization
Global Alert and Response
H7N9 Influenza
Novel Corona virus Novel CoV

Public Health Agency of Canada
International Severe Acute Respiratory and Emerging Infection Consortium (ISARIC)
International Forum for Acute Care Trialists

Recent Publications on H7N9 Influenza
http://www.nejm.org/doi/pdf/10.1056/NEJMoa1304459
http://www.nejm.org/doi/pdf/10.1056/NEJMp1304661
http://www.nature.com/emi/journal/v2/n4/full/emi201322a.html
http://www.nature.com/emi/journal/v2/n4/full/emi201318a.html