Vaccines are important in protecting us from many types of bacterial pneumonia, which can lead to serious illness including hospitalization and death. To increase protection, Ontario’s publicly funded pneumonia vaccine program now provides Prevnar 20 to adults 65 years of age and older, as well as high risk adults regardless of age. This replaces the previously funded Pneumovax 23 and Prevnar 13.

What is Prevnar 20?

Prevnar 20 protects against 20 types of bacterial pneumonia (known as Streptococcal pneumonia). This vaccine has been approved by Health Canada since 2022 and is given as a single injection. Until now, many adults have received this vaccine through private coverage or paying out-of-pocket.

Comparison to Other Pneumonia Vaccines

Prior to this new coverage, Prevnar 13 was publicly funded for all adults 65 years of age and older as well as high-risk adults aged 50 years and older. Prevnar 13 protects against 13 types of bacterial pneumonia. The additional 7 types covered by Prevnar 20 cause about 40% of pneumococcal disease cases and deaths.

Pneumovax 23 (Pneumovax) was given 8 weeks after Prevnar 13 to protect against 23 strains of bacterial pneumonia. However, Pneumovax’s effects last approximately 5 years due to the vaccine formulation. Prevnar 20 offers longer protection and a greater immune response because of the newer technology in how the vaccine is prepared.

What if I have already received a pneumonia vaccine?

• If Prevnar 13 alone was given, wait 8 weeks and give Prevnar 20
• If Pneumovax given, wait one year and give Prevnar 20 (can wait 8 weeks then give Prevnar 20 if rapid completion is required).
• If 1 dose of Prevnar 13 and 1 dose of Pneumovax given, wait one year and then give Prevnar 20 (can wait 8 weeks then give Prevnar 20 if rapid completion is required).

The Future of Pneumonia Vaccines

Vaccines continue to evolve to cover even more types of bacterial pneumonia. It is important to receive the best protection that is currently available. Although no booster for Prevnar 20 is suggested, make sure you remain informed on the latest vaccine updates.

Joyce Ayad is a 4th year pharmacy student from the University of Waterloo, currently completing her final rotation at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year. 

Last month we celebrated World Hepatitis Day. At Charlton Health, we are pleased to provide treatment for Hepatitis C and wanted to share more information about this virus.

Hepatitis refers to inflammation of the liver, often caused by a viral infection. The most common types of hepatitis are A, B, C, D, and E. The goal is to reduce new hepatitis cases by 90% and reduce deaths by 65% by 2030. Hepatitis B and C are the most serious, causing the most deaths and health complications.

Testing for hepatitis is very important because many people with the virus don’t have symptoms right away. Usually, hepatitis is found through blood tests. Sadly, over 80% of people with hepatitis can’t get tested or treated, especially in low-income countries. For hepatitis C, it is advised that every adult gets tested at least once, pregnant people get tested with each new pregnancy, and anyone with risk factors gets tested.

There are effective treatments for hepatitis C that can cure over 90% of those infected, but there is no vaccine for hepatitis C. That is why testing and preventing hepatitis C is so crucial. Hepatitis C spreads through infected blood, not through physical contact or sharing food. To lower the risk, don’t share needles or personal items like razors or toothbrushes. If untreated, 75-85% of newly infected people can develop long-term infections and possible liver damage.

Vaccines are available for hepatitis A and B, but there is no cure for long-term hepatitis B. The hepatitis B vaccine also protects against hepatitis D. The initial presentation of hepatitis B often has no symptoms before it becomes a long-term concern and causes liver scarring. Since treatment for hepatitis B is only supportive and only available for initial infection, vaccination is essential, especially for newborns. All infants should get the hepatitis B vaccine within 24 hours after birth.  In Ontario, hepatitis B vaccination is offered to all students in grade 7.  For those that travel outside of North America, a vaccine protecting against both hepatitis A (spreads through infected food) and hepatitis B is suggested, such as Twinrix. 

By raising awareness and improving access to testing, treatment, and vaccination, we can make significant progress in the fight against hepatitis!

Joyce Ayad is a 4th year pharmacy student from the University of Waterloo, currently completing her final rotation at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year

Certain autoimmune diseases such as lupus, rheumatoid arthritis, type 1 diabetes, and multiple sclerosis affect minority groups more than others. In addition, up to 50% of all patients with autoimmune diseases experience mental health issues like depression and anxiety which can impact their quality of life.

Minority groups face difficulties when accessing mental health care.

• Statistics show that minority groups visit doctors less often. Many minorities have limited healthcare coverage, making it harder to access mental health services and treatments.
• Cultural stigma about mental health issues can prevent individuals from seeking help.
• Previous bad experiences in healthcare have caused many to lose trust in doctors and nurses.
• There is a lack of cultural variety among mental health professionals. This can make it difficult for patients to find providers who understand their experiences. 

While the exact relationship between autoimmune diseases and mental health problems is not clear, some possible explanations include:

1. Individuals with autoimmune diseases generally have higher levels of chemical signals that promote inflammation, which can affect other signals in the body responsible for regulating mood and energy (serotonin). This can look like depression-related symptoms, including fatigue and disrupted sleep and appetite.
2. The ongoing stress of managing an autoimmune condition can worsen mental health concerns.
3. Complications from autoimmune diseases can reduce the functional ability of patients, leading to difficulties performing daily activities and can affect mental health.

How to prioritize your mental health while managing your immune-mediated condition:

1. Learn About Your Condition: Gain a detailed understanding of your autoimmune disease to better manage its symptoms.
2. Build a Support Network: Surround yourself with supportive family members, friends, or people in similar situations by joining support groups to share your experiences and emotions.
3. Work with your family doctors and specialists to ensure you receive care tailored to your needs.
4. Incorporate Stress-Reduction Techniques: Engage in activities you enjoy, such as playing sports, doing crafts, or mindfulness exercises to alleviate stress and manage the emotional toll of your illness.
5. Seek Professional Help: Explore mental health counseling to address any psychological challenges you may face. Websites like psychologytoday.com provide a wide range of therapists, psychologists, and social workers in your area, including those who may share a similar background as you.

Joyce Ayad is a 4th year pharmacy student from the University of Waterloo, currently completing her final rotation at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year. 

Traveling can be an exciting adventure, but if you’re on biologic medication for an autoimmune condition, it requires some extra planning. Whether you’re heading out for a weekend getaway or embarking on an extended vacation, here are some tips to help you travel smoothly while managing your biologic treatments.

Plan your Doses

Ensure you have enough medication for the entire trip, plus a few extra days’ worth in case of delays. If you’re traveling across time zones, adjust your medication schedule as needed to maintain consistent dosing, if necessary.

Packing your Biologic

To keep your biologic medication at the right temperature (2-8 degrees Celsius), pack it in a cooler bag. Place an ice pack at the bottom, followed by a layer of cardboard or bubble wrap. Next, place your medication on top, add another layer of cardboard or bubble wrap, and finish with another ice pack. This setup should keep your medication cold for 6-8 hours. It would be a good idea to test your cooler using a thermometer and ice packs to mimic the time you will be in transit.

If your trip duration is longer than 6-8 hours, you may request the flight attendant to keep your medication in the airplane’s fridge. However, in case that is not possible, make sure to carry ziplock bags with you to get ice from the attendant.

Always carry your biologic medication in your carry-on bag. Checked luggage can be subjected to extreme temperatures and rough handling, which can damage your medication.

Have Documentation Ready

We will gladly provide you with a travel letter along with a copy of your prescription to help avoid issues at airport security and border crossings.

Store Medication Properly

Once you arrive at your destination, ensure your biologic is stored properly. If it needs refrigeration, confirm that your hotel room has a fridge, or use the hotel’s mini-bar fridge if necessary. Some hotels can provide a medical fridge upon request.

By following these tips, you can ensure that your travels are as smooth and enjoyable as possible while managing your biologic treatment. Bon voyage!

Joyce Ayad is a 4^th year pharmacy student from the University of Waterloo, currently completing her final rotation at Charlton Health. She believes in providing patient-focused care, supported by her previous experience working with specialty drugs, the pharmaceutical industry, and more. Joyce is eager to become a licensed pharmacist this year.

Most people are aware that pneumonia is an infection of the lungs that can cause cough, thick discoloured mucus, shortness of breath and fever.  It can be caused by a bacteria, virus or fungi.   What is not commonly known is that bacterial pneumonia (called streptococcus pneumoniae), can go beyond the lungs. This is called invasive pneumococcal disease.  When the infection enters the bloodstream, it is known as bacteremia.  When the infection reaches the tissue covering the brain and spinal cord, it is called pneumococcal meningitis. These are very serious infections requiring hospitalization.   Even pneumococcal pneumonia, affecting just the lungs causes 150,000 hospitalizations in the United States each year.

There are about 100 types of pneumococcal bacteria.  The newest pneumonia vaccine approved in the United States protects against 21 of those types.  The great news is that the 21 strains chosen for the vaccine,  actually protect against 84% of invasive pneumococcal disease.  This is the greatest level of protection available in a pneumococcal vaccine to date.  It will be a single dose that is expected to provide long-term protection. The name of the vaccine is Capvaxive and it is produced by Merck.  We look forward to this vaccine coming to Canada soon. 

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

With summer around the corner, time spent outside enjoying the warmth is to be expected.  Therefore, it is time to revisit an important topic that we posted last year: drug-induced sun sensitivity reactions.

At least 387 different medications can cause sun sensitivity reactions. It is important to take precautions when seeing an auxiliary label on your prescription warning of sun exposure. These colourful warning labels put on your prescription are important. The sun warning label is usually bright yellow with an image of a sun.  Anti-inflammatory medications fall in this group with naproxen likely to have the greatest impact. Other medications used by many of our blog followers that are part of this sun-sensitivity category include pirfenidone, sulfasalazine, and hydroxychloroquine. Interestingly, methotrexate can cause a reaction known as radiation recall, causing irritation in areas where you have had a past sunburn.

Protecting yourself from the sun calls to mind the famous phrase: SLIP, SLAP, and SLOP.  Slip on a long sleeve shirt and pants that protect you from the sun, slap on a wide-brimmed hat, and slop on sunscreen with an SPF 30 or greater. Broad-spectrum sunscreens that protect the skin from both UVA and UVB are preferred, although most drug-related sun sensitivity reactions are caused by UVA. This is because UVA radiation penetrates much deeper into the skin compared to UVB. Sunscreen should be applied at least 15-30 minutes before going out in the sun and needs to be reapplied throughout the day, especially after swimming or excessive sweating.  We advise looking for sunscreens that have been endorsed by the Canadian Dermatology Association, which will be evident on the label. Of course, seeking out shade is key, especially during the peak sun hours of 11AM – 4PM. Lastly, tanning beds should be used cautiously or avoided all-together, as their UV radiation can significantly increase the risk of skin cancer. (read more here.)

If you experience a sun sensitivity reaction, please seek medical attention as prescription medications may be needed to manage the reaction.

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Carolyn Whiskin is the Pharmacy Manager for Charlton Health. Carolyn specializes in the treatment of autoimmune diseases, pharmaceutical compounding, women’s health, pain, and smoking cessation. Carolyn has won provincial and national awards for her commitment to patient care and public service.

Inflammatory bowel diseases (IBD) have a major impact on an individual’s life. The number of individuals living with IBD in Canada is growing rapidly. In their 2023 report, Crohn’s and Colitis Canada found that roughly 0.8% (322,600 people) of the Canadian population lived with IBD and this number was expected to rise to 1.1% (470,000) in 2035. The number of new diagnoses is rising most rapidly in children under the age of 6. Read more about the report here.

Lately, many advancements have been made in the treatments for ulcerative colitis. One of the latest updates includes a new oral treatment, called etrasimod (Velsipity). Etrasimod is thought to work by preventing the movement of immune cells from the lymphatic system, a collection of organs and tissues that defend the body against diseases. This should reduce the number of immune cells circulating in the body, therefore, reducing the amount of cells that reach the intestine. It is meant to be taken as one tablet once daily. Given that the number of treatments available in tablet-form are quite limited when managing ulcerative colitis, etrasimod is an exciting new option available to patients if deemed appropriate. We at Charlton Health are excited to work with physicians to get our patients started on the newest therapies in Canada.

Parvinder Sahota is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

Kunal Bhatt, RPh, PharmD, HBSc is a staff pharmacist for Charlton Health. As a 2020 PharmD graduate from the University of Toronto, Kunal possesses a diverse range of experiences from working in hospital and community pharmacy settings. Kunal was heavily invested in contributing to the efforts against COVID-19 by administering upwards of 5000 COVID-19 vaccines at William Osler Health System’s vaccination clinics. 

Ankylosing Spondylitis Awareness Month, observed each year in May, is one of several health promotion events celebrated and endorsed by Health Canada and serves as a crucial opportunity to shed light on a chronic inflammatory disease that affects thousands of people in Canada. Ankylosing Spondylitis (AS) is a form of arthritis that primarily impacts the spine, causing pain, stiffness, and in some cases, fusion of the vertebrae. It can also affect the knees, hips, eyes, and the gastrointestinal tract, significantly impacting quality of life.

Through efforts of raising awareness, Ankylosing Spondylitis Awareness Month is aimed to increase the general understanding of the disease among the public and healthcare professionals, reducing diagnostic delays and ensuring timely access to treatment. Awareness fosters growth in the Spondyloarthritis community, advocating for new and improved advanced therapies, and improving patient quality of life.

Charlton Health Pharmacy is proud to support patients with AS through a multidisciplinary approach, working with allied health care professionals and ensuring our patients receive care of the highest quality. Some of these services include counselling on advanced therapies (ex. biologics), reimbursement navigation support, and providing access to infusion clinics across Ontario. Ultimately, Ankylosing Spondylitis Awareness Month is an opportunity to showcase the resilience of patients living with AS. Please see the Canadian Spondyloarthritis Association (CSA) for more information, resources, and support groups for people living with AS and their caregivers.  

Parvinder Sahota is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

Saphnelo (anifrolumab) is a one-of-a-kind therapy by AstraZeneca for the treatment of moderate to severe systemic lupus erythematosus (SLE). In December of 2023, Saphnelo was approved for coverage under the Ontario Exceptional Access Program (EAP).

SLE is an autoimmune condition in which the immune system creates widespread inflammation in many parts of the body. This leads to a variety of symptoms which include rashes, fever, and pain in the joints. Saphnelo works by blocking the activity of the type 1 interferon receptor, stopping the signaling (the type 1 interferons) that would lead to inflammation. As a result, the immune system can control the inflammation, and improve symptoms and the quality of life for patients with SLE.

Saphnelo is given as an intravenous infusion over 30 minutes, every 4 weeks. Currently, it is only approved to be used in adults.

The Charlton Health team is excited to work with specialists to bring Saphnelo to our patients with lupus.

Parvinder Sahota is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.  

On December 4, 2023, Health Canada approved Pfizer’s Litfulo (ritlecitinib). Litfulo is a once-daily oral capsule used for the treatment of patients over 12 years old with severe alopecia areata.

Alopecia areata is an autoimmune condition, where the immune system produces inflammation at the body’s hair follicles. This results in partial to complete loss of body hair. Litfulo reduces the excess signaling to the immune system and lowers inflammation in the hair follicles.

Similarly, Olumiant (baricitinib), developed by Eli Lilly, was also approved as a once-daily oral treatment for severe alopecia areata in adults earlier this year. This is in addition to its current use for treating rheumatoid arthritis.

The introduction of new treatments like Litfulo and the approval of using existing treatments in new conditions is exciting for us at Charlton, as a growing variety of treatments can be considered for patients with the greatest needs. It is important to note that the best treatment option for each individual can vary, and this decision should be made in collaboration with your specialist.

Parvinder Sahota is a clinical pharmacist and a recent graduate from the University of Toronto. He enjoys learning about the ever-evolving field of autoimmune conditions and their treatment options.