Saudi MERS outbreak shows SARS-like features

A long-awaited report on a large and possibly still ongoing outbreak of MERS coronavirus in Saudi Arabia reveals the virus spreads easily within hospitals, at one point passing in a person-to-person chain that encompassed at least five generations of spread.

The study, co-written by Toronto SARS expert Dr. Allison McGeer, also hints there may have been a superspreader in this outbreak, with one person infecting at least seven others.

The study lays out what is known about an outbreak of MERS that erupted this spring in four hospitals in the Eastern Province of Saudi Arabia, in an area whose name translated into English can be spelled Al-Ahsa or Al-Hasa (the study uses the second version). It was reported online on Wednesday by the New England Journal of Medicine.

Superspreaders played a key role amplifying SARS cases during the 2003 outbreak. That, combined with the symptoms patients manifest when they become sick and the long and varied incubation period, paint a picture that is reminiscent of SARS for the authors, several of whom, like McGeer, worked in Toronto to contain that coronavirus.

"This virus is closer to SARS than anything else," McGeer, an infection control expert at Toronto's Mount Sinai Hospital, said in an interview from Cairo, where she was attending a World Health Organization meeting on MERS on Wednesday. She travelled to Al-Hasa to help investigate the outbreak in May and was on a WHO mission to Saudi Arabia earlier this month.

"If you want to think about how you're going to prevent and manage hospital outbreaks, SARS is the place that all of us would start."

The 2003 SARS outbreak infected more than 8,400 people in 31 countries, killing at least 916. In the main it was an outbreak of hospitals, wreaking its devastation on staff, patients and visitors of facilities in which it spread. MERS and SARS are members of the same viral family.

When is it contagious?

McGeer said there are some fortunate distinctions — few health-care workers appear to be getting infected with MERS — as well as some worrisome ones. The high attack rate among patients was "pretty unnerving," she said, as is the fact that it appears people are infectious earlier in their illness than SARS patients were.

SARS cases were contagious mainly late in their illness, which gave health authorities a chance to diagnose and isolate patients before they could make others sick. If MERS is contagious earlier in the course of illness "that's not good," McGeer said. "If it's true, it's a real challenge because identifying cases early with either SARS or MERS is really difficult."

Others too could see similarities to SARS based on the findings of the study.

"Clearly like with SARS the health-care environment is a significant risk factor for ongoing transmission," Michael Osterholm, an infectious diseases expert who has been following MERS closely, said after reading the paper. He was not involved in the work.

"It means that unless the index of suspicion is very high and patients are immediately handled with the highest level of infection control, you could surely expect that you're going to see additional episodes outside of the Middle East like are being seen in the Middle East."

Sustained spread

Osterholm, who is director of the Center for Infectious Diseases Research and Policy at the University of Minnesota, said when cases have arrived undiagnosed in European countries, hospitals there have been relatively quick to figure out what they have on their hands and take measures to protect against spread.

Still, imported cases triggered onward spread in Britain, Italy, Tunisia and France, where transmission took place in a hospital. In all those countries, transmission events ended after a generation or two of spread because of measures taken to isolate patients.

"The issue that we all worry about is what happens if this gets into a country that doesn't have the same level of infection control capability in a health-care setting and what does that mean?" noted Osterholm.

Saudi Arabia, which is one of four countries from which MERS has spread and which has recorded the lion's share of cases, draws millions of religious pilgrims each year from around the Muslim world. The kingdom is also host to many guest workers, people from poorer countries like the Philippines and Pakistan drawn to Saudi Arabia for work. Experts have worried both those patterns of movement could disseminate MERS to parts of the world that might be ill-equipped to battle it.

The study gives details of the first 23 cases in the Al-Hasa outbreak, infections that date from April 1 to May 23. It does not say whether the outbreak in Al-Hasa has ended, and the Saudi ministry of health has been silent on that matter.

The senior author of the New England Journal paper is Dr. Ziad Memish, the kingdom's deputy health minister. Memish has given few interviews on the topic of MERS and he did not reply to an email from The Canadian Press requesting an interview about the journal article and the Al-Hasa outbreak.

Broader testing and pneumonia

However, in the weeks since May 23, the kingdom's health ministry has announced 16 additional cases of MERS. The ministry statements, which offer the barest of details, suggest at least 11 of the new cases were from the Eastern Province.

The statements do not say if these new infections are part of the outbreak in the hospitals. Other possibilities are that they are people who caught the virus from its still-unknown source in nature or, potentially, from other infected people outside hospital settings.

McGeer said she does not know if any of the cases reported since May 23 are part of the Al-Hasa outbreak. She also does not know if the outbreak is over, but warned with a disease that has an incubation period as long as MERS — out to nearly 15 days in some cases — it can take a long time to be confident that transmission has been stopped.

She could not rule out the possibility that the chains of transmission in this outbreak might now stretch beyond five generations, saying only that it is possible they extend longer. That type of sustained spread suggests the virus has no difficulty going from person to person, at least in the right settings.

Dr. Trish Perl, another author who went with McGeer to Saudi Arabia, says this virus is capable of sustained spread.

"I think that's one of the more important things that we show, is that there really is ongoing human-to-human transmission. This is not a single generation," said Perl, an infection control expert at Johns Hopkins University in Baltimore, Md.

McGeer, Perl and their fellow authors acknowledged this outbreak may actually have been substantially larger than what it appears to be based on the confirmed cases. Nearly a dozen people were identified as probable cases, based on their exposure histories and their symptoms. They tested negative, but it has been seen elsewhere that some patients only test positive after repeated testing.

"I'm not sure that we effectively identified all of the probable cases outside of the hospital," McGeer said. "I don't think it was twice the size. But it was probably larger."

And some were not tested at all because the hospitals were using the WHO's case definition, which requires pneumonia. So people who were sick with respiratory symptoms and who had had contact with MERS cases but who didn't have pneumonia were not investigated as possible cases.

Perl said it may be time to amend the WHO definition, to encourage broader testing in situations like Al-Hasa.

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New brain map makes neurosurgeons, biologists 'ecstatic'

A new human brain model offers neurosurgeons and researchers a sophisticated and detailed three-dimensional tool, experts say.

Current reference brains just look at the visible parts of the brain based on simple drawings. Thursday's new online atlas, called BigBrain, shows brain anatomy in microscopic detail down to a level that's smaller than the size of a fine strand of hair — 50 times more detailed than before.

Researchers use a special tool called a microtome to cut more than 7,400 sections from a brain preserved in paraffin wax into tiny slivers. (Courtesy Science)

"Our neuroanatomists and neurosurgeons in particular at the Montreal Neurological Institute are absolutely ecstatic," said senior author Alan Evans, a professor at the McGill University institute.

"The surgeons are all running in and out of the room right now trying to get at the data on the very, very big screen that we have on the wall," he told reporters.

Evans said the BigBrain offers a completely new level of insight into the brain's organization. That's important for biologists who seek to relate structure and function of an organ as complex as the brain when probing normal human childhood development and how illnesses like Alzheimer's, Parkinson's or epilepsy occur.

"This allows us to further to examine the interaction between different brain regions, the organization of the brain and how it subserves behaviour," said Evans.

"So we've raised the level of insight orders of magnitude beyond what was possible at the turn of the 20th century."

To build the model, researchers took thin slices from a brain donated by a 65-year-old woman who is anonymous. She had no neurological or psychotic history, said Katrin Amunts, director of the Institute of Neuroscience and Medicine at Research Centre Jülich in Germany and a corresponding author of the study, published in the journal Science.

The 20-micrometre thick sections were stained and prepared in a lab, digitized with a high-resolution flatbed scanner and MRI then painstakingly reconstructed in multiple dimensions with advanced computing techniques for a data set that was on the order of 100,000 times larger than a typical MRI scan that in contrast doesn't offer more information after zooming in.

Atlas for neurosurgeons

The BigBrain offers the ability for doctors and researchers to plug in information such as patient MRI or PET scans.

When patients with Parkinson's for instance have electrodes placed in their brains to control symptoms, surgeons rely on 2D drawings, said Amunts.

"In our BigBrain, this can serve as a new atlas for neurosurgery as well on a much higher spatial resolution and also with much more precision."

Dr. Mojgan Hodaie, a neurosurgeon at the Krembil Neuroscience Centre at University Health Network in Toronto, applauded the researchers for the meticulous work.

"Comparing this to the geography of the Earth, it would be like having one map that includes significant amount of detail of every street and neighborhood, and at the same time and with the same level of precision, tells us where the land masses are arranged and when do we get to the ocean," Hodaie said in an email to CBC News.

Hodaie said the atlas allows comparisons of the detailed arrangement of fine structures in the brain to understand questions such as where lobes begin and end with more accuracy. "The BigBrain atlas is free and available to all researchers. Allowing others to benefit from this work is in itself an immense value and a large service to the scientific community."

The BigBrain also provides a common basis for scientific discussions, said study co-author Prof. Karl Zilles from the Institute of Neuroscience and Medicine in Jülich, Germany.

In April, U.S. President Barack Obama announced a related North American project to record and map the interaction of brain cells. A similar billion Euro initiative is underway in Europe.

The atlas is available at https://bigbrain.loris.ca/main.php.

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Type 2 diabetes mortality risk declining

Death rates among people with Type 2 diabetes have fallen sharply in Canada and the United Kingdom since the mid-1990s, researchers say.

The excess mortality risk among those with diabetes compared with those without the condition decreased over time in both Canada and the U.K., Dr. Lorraine Lipscombe, an endocrinologist at Women's College Hospital in Toronto, said in Thursday's issue of Diabetologia, the Journal of the European Association for the Study of Diabetes.

Nearly 2.4 million Canadians were living with diagnosed diabetes in 2008-09, according to federal statistics. (Steve Yeater/Associated Press)

The excess risk of mortality estimated during 2009 was 51 per cent in Ontario compared with 90 per cent in 1996.

"The hypothesis is that the mortality rates for diabetes have gone down in part because we're taking better care of our diabetes patients," Lipscombe said.

The risk declined by a similar degree for men and women over the study period.

In 2008-09, nearly 2.4 million Canadians aged one year and older were living with diagnosed diabetes, either Type 1 or Type 2, according to the Public Health Agency of Canada.

The researchers cautioned it's possible there are now more newly diagnosed patients who have had diabetes for a shorter period, since recent guidelines focus on screening high-risk groups.

In the last 10 years, guidelines have stressed aggressive control of blood pressure, cholesterol and hyperglycemia in people with diabetes, so patients may now be receiving more intensive care.

The prevalence of diabetes was higher in Ontario than in the U.K., where the risk fell to 65 per cent in 2009 compared with 114 per cent in 1996.

It's not clear why, but factors such as screening programs, ethnicity, eating habits or physical activity patterns could be contributing, the researchers speculated. Ontario's population was also relatively constant over time while the U.K. group increased.

Factors that influence death rates, such as cardiovascular disease and smoking, were not explored. Lipscombe hopes to check if there is a similar trend for cardiovascular disease in the province.

The study was funded by Ontario's Ministry of Health and Long-Term Care and an unrestricted grant from AstraZeneca and Novo Dordisk Scandinavia.

With files from CBC's Kas Roussy

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First Nations reserve opens fitness centre

Residents of Abegweit First Nation, east of Charlottetown, have a new fitness centre.

The new gym opened this month in the old band office. It includes stationary bikes, weights and work-out equipment.

Community leaders say the facility will help reduce diseases such as diabetes and heart disease. Trudy MacNeill, who works on the reserve as a dietitian, said fitness programs address special needs in native communities.

"Type 2 diabetes in First Nation communities is two to three times higher than it is generally speaking in Canadians," she said.

"Having a spot where they can go to do physical activity is very beneficial because they get instruction so they're working out safely and it's beneficial to their health so they get the whole package."

The Abegweit band has hired a fitness instructor to work with residents. It said it intends to get programs going for youth and elders this summer.

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Fredericton teen attends prom despite serious allergies

A Fredericton high school student went to her prom on Tuesday night, despite the threat that one waft of perfume could have serious consequences.

Taylor Bidlake had her shoes, dress and purse picked out and ready for her prom. But the Leo Hayes High School graduate also had to set aside a bag of magnesium power, EpiPen and an air purifier for the big night.

Bidlake has been diagnosed by doctors with vocal cord dysfunction and is seriously allergic to scents, such as perfumes and body spray.

'I'm hoping that especially tonight that they do put announcements on because girls and guys like to wear to stinky stuff, apparently, to impress others people but I think it just stinks.— Taylor Bidlake, Leo Hayes High School graduate

She said she was determined to go to her high school prom despite a difficult year.

"Last year, I had two concussions because I passed out in the hallway and hit my head on the floor," she said.

Even though her school of 1,700 students has a scent-free policy, more than once, the smell of perfume has crippled her. In December, seizures sent her to hospital.

As she prepared for her prom, Bidlake said she wished the school had done more to enforce its scent-free policy. But she credited the school for allowing her to enter into a co-op program, so she could finish her year working in a scent-free environment.

Taylor Bidlake attended her prom on Tuesday night even though a serious scent allergy caused her to avoid her school for the final months of Grade 12. (CBC)

The teen said she was hoping her fellow graduates were mindful of her serious allergy at the prom.

"I'm hoping that especially tonight that they do put announcements on because girls and guys like to wear stinky stuff, apparently, to impress others people but I think it just stinks," she said.

"I don't like it."

As the prom preparations moved forward ahead, Bidlake's mom and stepfather were filled with a mixture of elation and concern for their daughter.

Miles Pinsent said he would like to see scent-free policies at schools enforced as strongly as peanut and other food allergies.

"When a student's health is being put at risk and their education is being affected, then they need to be able to follow through and make sure that policy is being enforced," Pinsent said.

"I'm not going to pretend that's an easy thing to do, but they do have that responsibility."

Determined to attend prom

Miles Pinsent and Lori Bidlake-Pinsent were hoping their daughter, Taylor, and her date would enjoy their high school prom considering their individual health challenges. (CBC)

Although her final year in high school has presented many challenges, Bidlake said she was determined to attend her prom.

She also picked a date, who could empathize with her struggle.

Bidlake attended the prom with Bryson Dunham, who has had his own battle with cerebral palsy.

Krista Dunham said her son also had serious health challenges this year.

"He got very ill in the spring and we almost lost him in January. And he's here, he is here. I'm very proud of him," Dunham said.

Lori Bidlake-Pinsent said she also hopes the two teens have a memorable evening.

"I just hope she and her date, Bryson, have a fantastic night, that people respect the policies and that everyone has a good time," she said.

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Obesity now recognized as a disease

In order to fight what it described as an "obesity epidemic," the American Medical Association has voted to recognize obesity as a disease and recommended a number of measures to fight it.

The association voted on the measure Tuesday at its annual meeting in Chicago. The AMA noted that obesity rates in the United States have "doubled among adults in the last 20 years and tripled among children in a single generation" and that the World Health Organization, the U.S. Food and Drug Administration and Internal Revenue Service already recognize the condition as a disease.

Ashley Potter, left, an exercise physiologist in Huntington, W.Va., measures the waistline of a participant in a heart disease prevention program. (Howie McCormick/Associated Press)

According to "F as in Fat: How Obesity Threatens America's Future 2012," a study released by the Robert Wood Johnson Foundation in September last year, adult obesity rates in 2011 exceeded 30 per cent in 12 U.S. states. The study projected that "if rates continue to increase at the current pace, adult obesity rates could exceed 60 per cent in 13 states, and all states could have rates above 44 per cent by 2030."

In 2010, Statistics Canada reported that 19 per cent of males and 21 per cent of females aged 20 to 39 years were classified as obese. By age 60 to 69 years, the percentage was about one-third.

The Canadian Medical Association said Wednesday that while it doesn't officially label obesity a disease, it is recognized in the medical community as such.

"The real question is how we treat it," a spokeswoman said in an email to CBC News. "This is why we need to transform our system for better management of chronic conditions."

The CMA suggested physicians and other health professionals work with their patients to reduce obesity through education, proper nutrition and regular exercise.

Obesity is associated with a variety of diseases, including Type 2 diabetes, cardiovascular disease and some cancers.

The AMA's recommendations accompanying the vote included urging physicians and insurance companies to "recognize obesity as a complex disorder," encouraging national efforts to educate the public "about the health risks of being overweight and obese."

The AMA also recommended the creation of National Obesity Awareness Month to highlight the benefits of exercise and to warn about the risks of obesity.

With files from CBC News

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Preventive health care for unhealthy could save billions

Billions of dollars could be saved in Canada's health-care system with the introduction of preventive programs that focus on those individuals in poor health, says a study by the School of Public Policy at the University of Calgary.

"Canadian medicare with its focus on illness treatment has made illness and disease a growth industry," lead author Herb Emery told reporters Wednesday.

"It's one of the fastest growing parts of our public system.... Where we see retraction in education and other areas, we're seeing continual five per cent growth per year in treating illness and we can't keep up with demand."

The report evaluates the costs and benefits of an alternative approach by examining the preventive health-care program run by Pure North S'Energy Foundation, a not-for-profit organization that pays for and provides personalized, preventative health-care services.

It includes lifestyle counselling, dietary supplements and dental services for Albertans from groups of people who tend to be in poor health.

The report found the annual health-care bill for a Canadian in poor health is more than $10,000 higher than for someone in good health.

The Pure North program achieved positive health outcomes at a cost of $2,300 per participant — far less than treating people once they become sick.

Health care costs unstable

"People in poor health tend to use more health care," Emery said. "The minority of the population, 20 per cent, is generating 80 per cent of the costs and these are generally people who are in poor health."

Individuals who are healthy tend to stay in good health, and those in poor health tend to stay that way, said Emery.

"What we're really talking about is chronic conditions ... diabetes, cardiovascular disease and cancer. If we can intervene sooner, we can change lifestyles, we can change health. We can potentially restore the fiscal sustainability of the health care."

Emery said about 250,000 Albertans describe themselves as being in poor health. If even 45 per cent of that number showed an improvement, it would cut the number of their days in hospital by 25 per cent. He said that would save the system $500 million a year.

Emery said if that was expanded across Canada, the savings would be "in the billions."

"I think the interest in making people healthier and avoiding chronic diseases is Canada-wide. Everyone agrees that if you can figure out how, it has a higher return for the medicare system. The piece that is missing out there is how do you make people healthier?"

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Public health approach to bullying and suicide prevention urged

Bullying is a public health problem that can be prevented to improve the health of young people, researchers say.

In today's online supplement to the Journal of Adolescent Health, experts from the U.S. Centers for Disease Control and Prevention reviewed studies on the links between bullying, depression and suicide in youth.

Allan Hubley advocates for more front-line services for bullied children after his 15-year-old son Jamie committed suicide after years of bullying. The openly gay boy also had depression. (Fred Chartrand/Canadian Press)

Between 20 and 56 per cent of young people are involved in bullying annually, as either a victim or perpetrator, or both, the review estimated.

"It is not inevitable that bullying results in suicide; nor is it inevitable that bullying will occur in the first place," editor Marci Feldman Hertz of the CDC concluded.

They suggested that teachers, school administrators and health experts "consider broadening their focus beyond just providing services to those who are already involved in bullying or suicide-related behaviours, but also in implementing strategies to preventing bullying and suicidal behaviours from occurring in the first place."

Last month, mental health experts writing in the Canadian Medical Association Journal about student suicide called for school-wide interventions rather than focusing on the close friends of the suicide victim.

The journal's editors said three key themes emerged from the international research:

• Bullying among youth is a significant public health problem.
• There is a strong association between bullying and suicide-related behaviours, but that other factors such as depression and delinquency are also connected.
• Public health strategies can be applied to prevent both bullying and suicide.

Strengthening social connectedness such as supportive home and school environments, boosting individual coping skills and ensuring access to caring adults may pay dividends in both bullying and suicide, they said.

They noted poor mental and physical health among victims and perpetrators of bullying and those who experience both.

Studies suggest that bullying can have long-lasting, harmful effects, such as depression, anxiety, abdominal pain and tension months or even years later.

Lesbian and gay youth are more commonly victims, with 60 per cent reporting victimization during the past 30 days in one survey compared with 28.8 per cent of heterosexual youth.

In one study, people who witnessed bullying but were not directly involved were more likely to report systems such as hurt feelings, inferiority and helplessness.

As for the question of whether youth who are bullied become depressed or if depressed youth are more likely to be bullied, a Dutch study suggested the answer may be both.

Victims of bullying were much more likely to develop new psychosomatic and psychosocial problems over a school year compared with children who were not bullied, but those with pre-existing depressive symptoms or anxiety were also more likely to be victimized for the first time.

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Sexually transmitted oral cancers screened with early blood test

Antibodies to a high-risk type of a virus that causes mouth and throat cancers when transmitted via oral sex can be detected in blood tests many years before onset of the disease, according to a World Health Organization-led team of researchers.

In a study in the Journal of Clinical Oncology, the researchers said their findings may in future lead to people being screened for human papillomavirus (HPV) antibodies, giving doctors a chance to find those at high risk of oral cancers.

Since Harald zur Hausen, German winner of the Nobel Prize for Medicine, proved strains of HPV cause cervical cancer, researchers have been looking for ways to prevent and treat other cancers associated with the virus. (Thomas Kienzle/Associated Press)

"Up to now, it was not known whether these antibodies were present in blood before the cancer became clinically detectable," said Paul Brennan, of the WHO's International Agency for Research on Cancer (IARC), who led the study and described the findings as "very encouraging".

"If these results are confirmed, future screening tools could be developed for early detection of the disease," he said.

While HPV is better known for causing cervical and other genital cancers, it is also responsible for an increasing number of cancers of the mouth and throat, particularly among men.

The issue was highlighted earlier this month by Hollywood actor Michael Douglas, who said his throat cancer was caused by HPV transmitted through oral sex.

Oral, head and neck cancers are traditionally associated with heavy smoking and alcohol consumption, but over the past few decades rates of the diseases have increased dramatically, especially in Europe and North America.

Brennan said this is probably due to HPV infections because of changing sexual practices, such as an increase in oral sex.

According to IARC data, about 30 per cent of all oral cancers are estimated to be HPV-related, and the main type of HPV associated with these tumours is HPV16.

Testing accuracy questions

A study in the British Medical Journal in 2010 also found rates of head and neck cancer linked to HPV were rising rapidly, prompting calls from some doctors for boys as well as girls to be offered vaccinations to protect them against HPV.

Two vaccines — Cervarix, made by GlaxoSmithKline, and Gardasil, made by Merck & Co — can prevent some HPV infections.

This new study, by scientists from IARC as well as the German Cancer Research Center and the U.S. National Cancer Institute, used data from a large study known as EPIC, which involves 500,000 people from 10 European countries who were recruited in the 1990s and have been followed up since.

Researchers found that of the 135 people in the study who developed oral cancers, 47, or about one third of them, had HPV16 E6 antibodies up to 12 years before the onset of disease.

In a telephone interview, Brennan said early detection would also allow doctors to track patients with antibodies and intervene early if tumours develop. "The earlier the detection, the better the treatment and the greater the survival," he said.

The antibody test used in the study was relatively simple and cheap and could be developed as a tool for more widespread screening within about five years if these results are confirmed in future studies, he added.

He cautioned, however, that more work was needed to improve the tests' accuracy, since in this research there were about 1 in 100 "false positives" — where a person with the HPV16 antibodies did not go on to develop an oral cancer. Brennan said another significant finding of the study was that patients with oral cancers linked to HPV16 were three times more likely to be alive five years after their diagnosis than oral cancer patients whose tumours were not HPV-related and may have been linked to other risks such as smoking or drinking.

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Parents in dark about teens tanning, study suggests

Dr. Brent Friesen, a medical officer of health for AHS, says new research suggests parents are in the dark about their teens' tanning habits. (CBC)

New research into the use of indoor tanning salons by Alberta teenagers suggests their parents are clueless about it.

In a recent survey, Alberta Health Services (AHS) wanted to know what parents knew about their teens' use of indoor tanning.

Dr. Brent Friesen, a medical officer of health for AHS, said the results were surprising.

"Three per cent of parents on a random telephone survey indicate that ... they thought their children tanned or their children had used indoor tanning," he said.

"That was quite a bit different figure from the study we'd conducted earlier."

That previous study found among 15 to 17 year olds, one out of every five had tried indoor tanning.

Friesen says it suggests parents may simply be out of touch, which is unfortunate given that young people are especially vulnerable to the dangers of indoor tanning.

He said research has shown tanning before age 35 increases a person's risk for developing skin cancer by 75 per cent.

"The younger you are, that you are exposed to the UV radiation, the more easily your skin gets damaged, and the greater the risk in the future of developing skin cancer," Friesen said.

Zain Velji, a public policy analyst with the Canadian Cancer Society, said it also suggests what's being done now to stop tanning isn't working.

"We know that parental consent has also not been working. So, we know that the only way to get this done is with a comprehensive ban for individuals under 18 in our province."

British Columbia, Quebec and Nova Scotia are the only provinces with bans in place for people under 18.

Alberta health officials created a science advisory committee to look into the issue last year.

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