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British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 17-36 (Sep 21, 2012)

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  • British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 17-36 (Sep 21, 2012)

    BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN 2011-12: Number 1, Weeks 40-43 October 2 to October 29, 2011

    Sporadic Detections of Influenza in BC

    Summary

    During weeks 40-43 (October 2 ? October 29, 2011), influenza surveillance indicators suggested sporadic influenza activity in BC although the influenza-like illness (ILI) rate was higher than expected for this time of year based on sentinel physician and MSP reports, each of which have shown gradual increase. However, no lab-confirmed influenza outbreaks were reported and among 341 specimens tested, rhino/enteroviruses have so far predominated (133/341; 39%). Influenza was detected in a small proportion of submitted specimens (1.8%, 6 out of 341), which brought the total accumulated influenza positive cases since 1 September 2011 to eleven, including nine A(H3N2) in adults, and 2 influenza B (one child and one adult).

    Full report:
    Nov 3, 2011 [PDF 500 KB]
    http://www.bccdc.ca/NR/rdonlyres/849...Correction.pdf


    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

  • #2
    Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 44-45

    BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
    2011-12: Number 2, Weeks 44-45
    October 30 to November 12, 2011

    Influenza activity in BC remains low; sporadic detection of A/H3N2

    Summary

    During weeks 44-45 (October 30 ? November 12, 2011), influenza activity remained low. The influenza-like illness (ILI) rate was 0.34% and within the expected range for this time of year. The MSP influenza illness proportion was below the 10 year median at the provincial and most Health Authority (HA) levels. No lab-confirmed influenza outbreaks were reported. Among 187 specimens tested, 5 (2.7%) submitted specimens were positive for influenza A(H3N2). Rhino/enteroviruses continued to be the predominant viruses detected (55/187; 29%). Other respiratory viruses were also sporadically detected.

    Report disseminated November 17, 2011
    - 1 -
    Contributors: Helen Li, Lisan Kwindt, Naveed Janjua, Danuta Skowronski

    Full report:
    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
    -Nelson Mandela

    Comment


    • #3
      Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 46-49

      BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
      2011-12: Number 3, Weeks 46-49
      November 13 to December 10, 2011
      Prepared by BCCDC Influenza &
      Emerging Respiratory Pathogens Team

      Sporadic influenza detections and facility outbreaks; increase in influenza activity in BC anticipated

      Summary

      During weeks 46 to 49 (November 13 ? December 10, 2011), most influenza indicators in BC remained low. The influenza-like illness (ILI) rate reported by sentinel physicians was below 0.35% and within the expected range for this time of year. The MSP influenza illness proportion was around the 10-year median at the provincial and Health Authority (HA) levels. However, recent reports of facility outbreaks during weeks 48-50 may signal imminent increase in influenza activity levels as we enter the holiday period.

      Two lab-confirmed influenza A/H3 outbreaks were reported from long term care facilities: one in Vancouver Coastal HA in week 48 and one in Vancouver Island HA in week 49. In addition, two ILI outbreaks were reported in Fraser HA in the first half of week 50: one lab-confirmed influenza A/H3, and one as yet not confirmed by lab testing. Since week 46 and to mid-week 50 there have also been 13 school ILI outbreaks, primarily from Interior HA but also from Vancouver Coastal and Fraser HAs.
      Among 387 specimens tested at the provincial laboratory during week 46 to 49, 18 (4.7%) were positive for influenza, including 17 A/H3N2 and 1 influenza B. Rhino/enteroviruses continued to be the predominant viruses detected (76/387; 20%). Other respiratory viruses were also sporadically detected.

      Full report:
      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment


      • #4
        Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 50

        BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN

        2011-12: Number 4, Week 50
        December 11 to 17, 2011

        Prepared by BCCDC Influenza &
        Emerging Respiratory Pathogens Team

        Increase in A/H3N2 detection in BC

        Summary

        In week 50 (December 11 ? 17, 2011), the influenza-like illness (ILI) rate reported by sentinel physicians was 0.19%, below the expected range for this time of year. The MSP influenza illness proportion was at or below the 10-year median at the provincial and Health Authority (HA) levels, but showed an increasing trend in Vancouver Coastal and Fraser HAs. The ILI consultation rate at the BC Children?s Hospital ER increased over the previous week. Two ILI outbreaks were reported from long term care facilities in Fraser HA including one lab-confirmed as A/H3N2. Four schools in Vancouver Coastal and Interior HAs also reported ILI outbreaks in week 50. At least 20% of respiratory specimens tested at the provincial laboratory in week 50 were positive for influenza (all A/H3N2), a significant increase from previous weeks. Rhino/enteroviruses continued to be the predominant non-influenza viruses detected (16/146; 11%). Other respiratory viruses were also sporadically detected.

        Full report:
        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
        -Nelson Mandela

        Comment


        • #5
          Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 51-52

          BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
          2011-12: Number 5, Weeks 51-52
          December 18 to 31, 2011

          A/H3N2 continues to predominate among influenza detections in BC

          Summary

          The holiday period may introduce instability in regular surveillance indicators so that further monitoring for a consistent pattern over the coming weeks is needed. In weeks 51-52 (December 18 ? 31 2011) most, but not all, surveillance indicators suggested an increase in influenza activity in BC. The influenza-like illness (ILI) rate reported by sentinel physicians was 0.2%, similar to previous weeks and below the expected range for this time of year. The MSP influenza illness proportion increased to above the ten year median at the provincial level and in most HAs except Northern HA. The ILI consultation rate in BC Children?s Hospital ER was higher than the previous week but at the expected level for this time of year. Three out of four influenza-like illness (ILI) outbreak reports received from long term care facilities were lab-confirmed influenza outbreaks, including two A/H3N2 in Fraser HA (week 51) and Interior HA (week 52), and one influenza A in Vancouver Island HA (week 52) for which subtype is still pending. Among 231 specimens tested at the provincial laboratory in weeks 51-52, 51 (22%) were positive for influenza, similar to the previous week, including 47 A/H3N2, 1 influenza A (subtype pending), and 3 influenza B. Other significant respiratory virus detections included rhino/enterovirus (14%, 32/231) and human metapneumovirus (10%, 24/231). Other respiratory viruses were also sporadically detected. RSV continues to increase and dominate among respiratory viruses detected at BC Children?s Hospital.

          Full report:
          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
          -Nelson Mandela

          Comment


          • #6
            Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 1

            BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
            2011-12: Number 6, Week 1

            January 1 to 7, 2012
            Prepared by BCCDC Influenza &
            Emerging Respiratory Pathogens Team

            Continued moderate level influenza activity in BC

            Summary

            In week 1 (January 1-7, 2012), influenza surveillance indicators in BC returned to the pre-holiday level. The influenza-like illness (ILI) rate reported by sentinel physicians remained low and below the expected range for this time of year. The MSP influenza illness proportion declined throughout BC, though remaining above the 10-year median level for this time of year at the provincial level and within most HAs. The ILI consultation rate in BC Children?s Hospital ER was lower than the previous week and consistent with the expected level for this time of year. Two lab-confirmed influenza outbreaks were reported from long term care facilities, including one A/H3N2 in Interior HA and one influenza B in Vancouver Coastal HA. Among 174 specimens tested at the provincial laboratory in week 1, 29 (16.7%) were positive for influenza, lower than previous weeks, including 25 A/H3N2 and 4 influenza B. Other significant respiratory virus detections included human metapneumovirus (21/174, 12.1%) respiratory syncytial virus (13/174, 7.5%) and rhino/enterovirus (12/174, 6.9%). In addition, RSV continued to increase and dominate among respiratory viruses detected at BC Children?s Hospital.

            Full report:
            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
            -Nelson Mandela

            Comment


            • #7
              Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 2

              BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
              2011-12: Number 7, Week 2
              January 8 to 14, 2012

              Prepared by BCCDC Influenza &
              Emerging Respiratory Pathogens Team

              Low-level influenza activity in BC

              Summary

              In week 2 (January 8-14, 2012), most influenza surveillance indicators suggested a decrease in influenza activity in BC compared to the previous few weeks. The influenza-like illness (ILI) rate reported by sentinel physicians remained low and below the expected range for this time of year (0.29%). The MSP influenza illness proportion was at or below the 10-year median level for this time of year throughout the province. The ILI consultation rate in BC Children?s Hospital ER was lower than the previous week and consistent with the expected level for this time of year. Three lab-confirmed A/H3N2 influenza outbreaks were reported from long term care facilities in Fraser, Vancouver Coastal, and Vancouver Island Health Authorities. The rate of influenza detections at the provincial laboratory declined for the second consecutive week; among 151 specimens tested in week 2, 18 (11.9%) were positive for influenza (all A/H3N2). Other significant respiratory virus detections included human metapneumovirus (14/151, 9.3%), RSV (11/151, 7.3%) and rhino/enterovirus (11/151, 7.3%). In addition, RSV continued to increase and dominate among respiratory viruses detected at BC Children?s Hospital.

              Full report:
              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

              Comment


              • #8
                Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 3

                BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                2011-12: Number 8, Week 3
                January 15 to 21, 2012
                Prepared by BCCDC Influenza &
                Emerging Respiratory Pathogens Team

                Low-level influenza activity in BC

                Summary

                In week 3 (January 15-21, 2012), most influenza surveillance indicators suggested that influenza activity in BC remained low. The influenza-like illness (ILI) rate reported by sentinel physicians was low and below the expected range for this time of year (0.34%). The MSP influenza illness proportion continued to be at or below the 10-year median level for this time of year throughout the province. The ILI consultation rate in BC Children?s Hospital ER remained low and consistent with the expected level for this time of year. One lab-confirmed influenza B outbreak was reported from a long term care facility in Vancouver Coastal Health Authority; five ILI outbreaks from schools were further reported from the Interior and Northern Health Authorities. Of one hundred thirty-six specimens tested at the provincial laboratory in week 3, twenty-five (18.4%) influenza positives were detected, higher than the previous week, including 24 (17.6%) influenza A/H3N2 and 1 (0.7%) influenza A(H1N1)pdm09. Other significant respiratory virus detections included rhino/enterovirus (18/136, 13.2%), RSV (12/136, 8.8%), and human metapneumovirus (9/136, 6.6%). In addition, RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                Full report:
                "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                -Nelson Mandela

                Comment


                • #9
                  Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 4

                  BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                  2011-12: Number 9, Week 4
                  January 22 to 28, 2012

                  Prepared by BCCDC Influenza &
                  Emerging Respiratory Pathogens Team

                  Low-level activity but greater mix of contributing influenza types and subtypes in BC compared to previous weeks

                  Summary

                  In week 4 (January 22-28, 2012), most influenza surveillance indicators suggested that influenza activity in BC remained low. The influenza-like illness (ILI) rate reported by sentinel physicians was low and below the expected range for this time of year (0.21%). The MSP influenza illness proportion continued to be below the 10-year median for this time of year throughout the province. The ILI consultation rate at BC Children?s Hospital ER remained low and consistent with the expected level for this time of year. However, to date 9 school ILI outbreaks have been reported since the start of week 4; in addition three long term care facilities reported ILI outbreaks for which test results remain unavailable or pending from Vancouver Island, Fraser and Interior Health Authorities. In week 4, A/H3N2 positive detections continued to predominate at the BC Public Health Microbiology & Reference Laboratory, PHSA, though the proportions of influenza A(H1N1)pdm09 and influenza B detection increased compared to the previous weeks. Of one hundred and forty-one specimens tested at the provincial laboratory in week 4, twenty-seven (19.1%) influenza positives were detected, similar to the previous week, including 17 (12.1%) influenza A/H3N2, 4 (2.8%) influenza A(H1N1)pdm09, and 6 (4.3%) influenza B. Other significant respiratory virus detections included human metapneumovirus (19/141, 13.5%), rhino/enterovirus (17/141, 12.1%), and respiratory syncytial virus (10/141, 7.1%). Other respiratory viruses were also detected sporadically. In addition, RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                  Full report:
                  "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                  -Nelson Mandela

                  Comment


                  • #10
                    Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 5

                    BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                    2011-12: Number 10, Week 5
                    January 29 to February 4, 2012

                    Low-level activity, mix of influenza types and subtypes continue in BC

                    Summary

                    In week 5 (January 29 ? February 4, 2012), most influenza surveillance indicators suggested that influenza activity in BC remained low. The influenza-like illness (ILI) rate reported by sentinel physicians was low and below the expected range for this time of year (0.45%). The MSP influenza illness proportion was below the 10-year 25th percentile level for this time of year throughout the province. The ILI consultation rate at BC Children?s Hospital ER remained low and slightly lower than the expected level for this time of year. In week 5, eight school ILI outbreaks were reported from Interior and Vancouver Coastal HAs; in addition one lab-confirmed influenza A outbreak was also reported from a long term care facility in Vancouver Island HA. In week 5, influenza A/H3N2 positive detections continued to predominate at the BC Public Health Microbiology & Reference Laboratory, PHSA, though influenza A(H1N1)pdm09 and influenza B were also detected in low proportions. Of one hundred and forty-nine specimens tested at the provincial laboratory in week 5, thirty-three (22.1%) influenza positives were detected, slightly higher compared to the previous week, including 21 (14.1%) influenza A/H3N2, 3 (2.0%) influenza A(H1N1)pdm09, 3 (2.0%) influenza A (subtype pending), and 6 (4.0%) influenza B. Other significant respiratory virus detections included rhino/enterovirus (20/149, 13.4%), respiratory syncytial virus (15/149, 10.1%), coronavirus (10/149, 6.7%), and human metapneumovirus (9/149, 6.0%). RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                    Full report:
                    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                    -Nelson Mandela

                    Comment


                    • #11
                      Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 6-8

                      BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                      2011-12: Number 11, Weeks 6-8
                      February 5 to 25, 2012


                      Low-level influenza activity in BC

                      Summary

                      In weeks 6-8 (February 5-25, 2012), most influenza surveillance indicators, including sentinel physician reporting, MSP claims and ER consultations at BC Children?s Hospital, pointed to only low-level influenza activity in BC. Fourteen school ILI outbreaks were reported from Interior and Vancouver Coastal Health Authorities and two lab-confirmed outbreaks were reported from long term care facilities, one in Vancouver Island HA in week 6 (A/H3N2) and one in Fraser HA in week 8 (influenza A, subtype pending). Of four hundred and nineteen specimens tested at the BC Public Health Microbiology & Reference Laboratory, PHSA, during this period, 48 (11.5%) influenza positives were detected, including 32 (7.6%) influenza A/H3N2, 9 (2.1%) influenza A(H1N1)pdm09, 2 (0.5%) influenza A (subtype pending), and 6 (1.4%) influenza B. Other respiratory viruses made greater contribution to laboratory detections than influenza including rhino/enterovirus (54/419, 12.9%), respiratory syncytial virus (47/419, 11.2%), human metapneumovirus (30/419, 7.2%), and coronavirus (24/419, 5.7%). RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                      Full report:
                      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                      -Nelson Mandela

                      Comment


                      • #12
                        Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 9-10

                        BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                        2011-12: Number 12, Weeks 9-10
                        February 26 to March 10, 2012

                        Prepared by BCCDC Influenza &
                        Emerging Respiratory Pathogens Team

                        Continued low-level influenza activity in BC; increasing contribution of influenza B

                        Summary

                        In weeks 9-10 (February 26 to March 10, 2012), influenza surveillance indicators including the sentinel physician reporting, MSP claims and ER consultations at BC Children?s Hospital, pointed to only low-level influenza activity in BC. In weeks 9-10, four ILI outbreaks were reported from schools. Of three hundred and twenty-four specimens tested at the BC Public Health Microbiology & Reference Laboratory, PHSA, during this period, 68 (21.0%) were positive for influenza, including 31 (9.6%) influenza A/H3N2, 14 (4.3%) influenza A(H1N1)pdm09, 5 (1.5%) influenza A (subtype pending), and 18 (5.6%) influenza B. Other significant respiratory virus detections included rhino/enterovirus (51/324, 15.7%), respiratory syncytial virus (46/324, 14.2%), human metapneumovirus (22/324, 6.8%), and coronavirus (17/324, 5.2%). Other respiratory viruses were also sporadically detected. RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                        Full report:
                        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                        -Nelson Mandela

                        Comment


                        • #13
                          Re: British Columbia Influenza Surveillance Bulletin 2011-12 Weeks 11-13

                          BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                          2011-12: Number 13, Weeks 11-13
                          March 11 to 31, 2012

                          Prepared by BCCDC Influenza &
                          Emerging Respiratory Pathogens Team

                          Continued low-level influenza activity in BC

                          Summary

                          In weeks 11-13 (March 11 to 31, 2012), influenza surveillance indicators including the sentinel physician reporting, MSP claims, and ER consultations at BC Children?s Hospital suggested low-level influenza activity in BC. In weeks 11-13, four lab-confirmed influenza outbreaks were reported from long term care facilities in Vancouver Island HA (3) and Interior HA (1), including 3 associated with influenza A/H3N2 and one associated with influenza B. Of three hundred and eighty-three specimens tested at the BC Public Health Microbiology & Reference Laboratory, PHSA, during this period, seventy-four (19.3%) were positive for influenza, including 41 (10.7%) influenza A/H3N2, 13 (3.4%) influenza A(H1N1)pdm09, 1 (0.3%) influenza A (subtype pending), and 20 (5.2%) influenza B. Other significant respiratory virus detections included rhino/enterovirus (65/383, 17.0%) and respiratory syncytial virus (44/383, 11.5%). Other respiratory viruses were also sporadically detected. RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                          Full report:
                          "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                          -Nelson Mandela

                          Comment


                          • #14
                            Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 14

                            BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                            2011-12: Number 14, Week 14
                            April 1 to 7, 2012


                            Prepared by BCCDC Influenza &
                            Emerging Respiratory Pathogens Team

                            Continued low-level influenza activity in BC

                            Summary

                            In week 14 (April 1-7, 2012), most influenza surveillance indicators suggested that influenza activity continues at low levels in BC. Compared to previous weeks, a slight increase was observed in some indicators such as Sentinel ILI and MSP II rates, though it was less remarkable when compared to rates expected for this time of year. In week 14, one lab-confirmed influenza outbreak was reported from a long term care facility in Vancouver Island HA, associated with influenza B. Of ninety-four specimens tested at the BC Public Health Microbiology & Reference Laboratory, PHSA, during this period, twenty-two (23.4%) were positive for influenza, including 7 (7.4%) influenza A/H3N2, 4 (4.3%) influenza A (subtype pending), and 11 (11.7%) influenza B. Other significant respiratory virus detections included rhino/enterovirus (21/94, 22.3%) and respiratory syncytial virus (8/94, 8.5%). Other respiratory viruses were also sporadically detected. RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                            Full report:
                            "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                            -Nelson Mandela

                            Comment


                            • #15
                              Re: British Columbia Influenza Surveillance Bulletin 2011-12 Week 15

                              BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN
                              2011-12: Number 15, Week 15
                              April 8 to 14, 2012


                              Continued low-level influenza activity in BC

                              Summary

                              In week 15 (April 8-14, 2012), most influenza surveillance indicators suggested that influenza activity continues at low levels in BC. The proportion of patients with influenza-like illness among those presenting to sentinel physicians was 0.21%, similar to previous weeks and within the expected range for this time of year. Throughout the province, influenza illness as a proportion of all submitted BC MSP claims remained at or below the 10-year median for this time of year. In week 15, one lab-confirmed influenza outbreak was reported from a long-term care facility in Interior Health Authority, associated with influenza A/H3N2. Of the one hundred and ten specimens tested at the BC Public Health Microbiology & Reference Laboratory, PHSA, during this period, 20 (18.2%) were positive for influenza, including 14 (12.7%) influenza A/H3N2, 3 (2.7%) A(H1N1)pdm09, 2 (1.8%) influenza A (subtype pending), and 1 (0.9%) influenza B. Other significant respiratory virus detections included rhino/enterovirus (16/110, 14.5%), human metapneumovirus (8/110, 7.3%), and respiratory syncytial virus (8/110, 7.3%). Other respiratory viruses were also sporadically detected. RSV continued to dominate among the respiratory viruses detected at BC Children?s Hospital.

                              Full report:
                              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                              -Nelson Mandela

                              Comment

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