Ask the Experts

Legionnaires’ Disease is a serious type of pneumonia caused by Legionella bacteria. 

The Middlesex London Health Unit is a great source of information about Legionnaires’: Legionella bacteria occur naturally in soil and water, especially warm water. They grow in environments such as hot tubs, cooling towers, hot water tanks, large plumbing systems, parts of air-conditioning systems in large buildings, and decorative pools or fountains. When systems are not properly cleaned and disinfected, the bacteria can multiply and become aerosolized. People become infected by inhaling this contaminated mist. (Source: Middlesex London Health Unit)

Legionnaires’ Disease does not spread from person to person.

Legionnaires’ Disease often starts 2 to 10 days after contact with legionella bacteria. It often begins with the following symptoms: headache, muscle aches and fever. By the second or third day, other symptoms can start, including: cough (which might bring up mucus and sometimes blood), shortness of breath, chest pain, nausea, vomiting and diarrhea. There may also be confusion or other mental changes.

Legionnaires’ Disease can usually be cured with antibiotics. Treating the disease right away is important.

Your risk of getting Legionnaires’ Disease is the same as anyone in the public and is very low. You would have to breathe in contaminated water.

As an immunocompromised person, you may get sicker with the disease. It is important that you contact your transplant team if you become ill and they can start treatment as needed.

Refer to the Middlesex London Health Unit website for the most current updates: Legionnaires' Disease Outbreak Status Update - July 14, 2025 — Middlesex-London Health Unit

Victoria Hospital remains a safe place. To date, none of the identified case of Legionnaires’ Disease have been confirmed to be linked to Victoria Hospital.  There is no concern with going into Victoria Hospital and you should continue to go to any of your appointments. 

Measles is a highly contagious respiratory virus. Symptoms of measles include fever, a red blotchy rash, red watery eyes and cough.  In Ontario, measles has been rare, owing to the successful elimination of measles in Canada and high immunization coverage. As a result, measles cases have typically been predominantly associated with travel (often referred to as “measles importations”).

Measles usually starts with fever, “flu-like” symptoms, sore throat, and lack of appetite.  Some patients also develop red eyes, sneezing, coughing and then a typical rash.  Red rashes usually start on the face and then spread to form red patches on the body.  Patients start to improve as soon as 1-2 days after the rash starts, but they may still have a cough for many days.  Although there is little data, it is possible that transplant patients may be at higher risk of measles complications of the lungs, ears or brain.

Between October 18, 2024, and March 26, 2025, a total of 557 cases (464 confirmed cases) of measles have been reported in Ontario. Ontario with 62.9% occurring in unimmunized adults and 93.8% in unimmunized children.

Immunization is the best protection against measles by receiving (MMR vaccine) which is a live vaccine and therefore, not considered safe in someone who received a solid organ transplant. 

Make sure close contacts have been vaccinated against measles. Maintain distance from someone with respiratory symptoms particularly if they have a skin rash.

Individuals with measles are considered infectious from 4 days prior to rash onset through to 4 days after rash onset (9 days total). If you come in contact with someone during the infectious period, contact the transplant clinic. Intravenous immunoglobulins are recommended for immunocompromised patients who are exposed to someone with measles.

If not immune to measles (no antibodies to measles) and had a significant exposure.

An example would be speaking to someone or living in the same household with someone who has measles.

No, it is not considered a significant exposure.

Based on guidance from Health Canada and the National Advisory Committee on Immunization (NACI), Ontario’s Chief Medical Officer of Health is recommending high-risk individuals receive their next COVID-19 booster this fall if it has been more than six (6) months since your last COVID-19 vaccine OR since you had a confirmed case of COVID-19.  This updated vaccine is recommended to better protect against the currently circulating variants.

Individuals in the following high-risk groups are recommended to book an appointment for a spring COVID-19 booster.

• Individuals aged 65 years or older
• Residents of long-term care homes, retirement homes, Elder Care lodges and other congregate living settings for seniors;
• Individuals aged 18 years and older living in a congregate setting for people with complex medical care needs;
• Pregnant individuals;
• Individuals aged 18 years and older who are moderately to severely immunocompromised; and
• Individuals aged 55 years and older who identify as First Nations, Inuit or Métis and their non-Indigenous household members aged 55 years and older.

The updated COVID-19 vaccine is now (October 17) available in Ontario for high-risk individuals.  For the general population the updated vaccine will be available on October 28, 2024.

Eligible individuals can book an appointment through public health units, Indigenous-led vaccination clinics, participating health care providers and participating pharmacies.

If you develop cold/flu/COVID or respiratory symptoms and are experiencing moderate to severe shortness of breath, chest pain, or fever (Temperature greater than 38º C) PROCEED TO YOUR LOCAL EMERGENCY ROOM.  Please consider swabbing for COVID in the event you require IV remdesivir treatment for a COVID infection. Many viral respiratory infections are circulating in the community that are NOT COVID. If you become positive for COVID and would like information on treatment, please call the clinic at 519-663-3346 Extension. 2 (Nurse Line available: Mon. - Fri. 8AM-4PM) or After-Hours call 519-685-8500 Extension. '0' and ask the switchboard operator to page the nephrologist on-call for University Hospital and Kidney Transplants.

As mentioned in our last update, RSV is the Respiratory Syncytial Virus that cause infections of the respiratory tract. It is contagious, affects all ages and is seen more during winter. It usually presents as a common cold but can be more serious and result in pneumonia in both the elderly and the immunocompromised including transplant patients.

Arexvy is a Health Canada approved vaccine to help protect against RSV. Because transplant recipients were not included in the study, it is not yet known whether the vaccine would be as effective in transplant recipients as it is in the general population.

Anyone over the age of 60 is able to receive the vaccine. Individuals at high-risk, such as transplant recipients who are 60 years of age and older, qualify for a publicly funded vaccine and can receive it at no-cost.

For awareness, the high-risk groups include individuals 60 years and older in the following populations:

• Transplant recipients
• Dialysis patients
• Individuals experiencing homelessness
• Hospital ALC patients
• Indigenous individuals, including urban dwelling

For now, a single dose is recommended. We do not know at this time if additional doses will be needed for transplant recipients. There are on-going studies happening to help guide this decision.

The Ministry of Health recently announced that this vaccine is now covered for the transplant recipients 60 years old or greater.

You can get the vaccine as soon as possible. If you have recently received your transplant, we recommend that you wait one month post-transplant before getting the vaccine.  It is recommended that the RSV vaccine be administered at least 2 weeks before or after any other vaccine.  

Side effects can include pain, redness and swelling where the shot is given, fatigue (feeling tired), fever, headache, nausea, diarrhea and muscle or joint pain.

As noted above, transplant patients over the age of 60 qualify for publicly-funded RSV vaccination. To obtain the vaccine at no-cost, you will need to see your primary health care provider, specialist or hospital program where you are receiving care to receive it.

Researchers at the University of Alberta have started a 12-week online wellness program. This research study, “EMPOWER,” aims to improve mental health in recipients of an organ transplant by giving them access to a fun, 12-week online wellness program with weekly movement, breathwork, meditation, education from clinicians, and psychology skills.

To learn more about this voluntary study opportunity, you can get more information through the links below: 

More information: Watch this video to learn more about EMPOWER!
Study website: https://empower-program.com/
You can connect with the study team at the University of Alberta through email: empower@ualberta.ca

Products: 

• Dextromethorphan Brands available: Robitussin cough gels, Robitussin DM (contains guaifenesin)

Product: 

• Acetaminophen

Product: 

• Guaifenesin

Product: 

• Pseudoephedrine - Patients with uncontrolled and high blood pressure should avoid pseudoephedrine.

Products: 

• Chlorpheniramine
• Diphenhydramine
• Cetirizine 
• Loratadine

Products: 

• Acetaminophen
• Menthol 
• Benzocaine

Yes! You should get the high dose. This is a one-time dose shot. If the high dose is not available, you will need to get 2 doses of the regular dose, 1 month apart.

You do NOT need to wait for any time period before or after your COVID-19 vaccine to get your flu shot.

The flu shot is available, now, for free, in Ontario, for those in the high-risk category. The high-risk category includes:

• People 65 years old and older
• Residents, staff and care providers of congregate living settings (such as chronic care facilities, retirement homes)
• People with underlying health conditions, such as asthma, heart disease or diabetes.

The flu shot will be available to the general public as of October 28, 2024.  The flu shot is available through your doctor or participating pharmacy.  Some workplaces may also provide a vaccine clinic during the fall season. 

Monkeypox is a rare disease caused by infection with the monkeypox virus. Monkeypox symptoms are similar to smallpox symptoms, but much milder, and monkeypox is rarely fatal.

The smallpox vaccine ACAM2000 is contraindicated as this is live replicating virus. Transplant recipients should NOT receive this.

There is a modified vaccine Ankara (MVA) that does not have replicating potential and is safe to give to transplant recipients. It is only being offered to the high risk population. Immunocompromised patients are not considered a high risk population. For eligibility criteria, refer to Ontario Health’s Monkeypox Vaccine (Imvamune®) Guidance for Health Care Providers.

All patients should wear the best mask they have access to, excluding cloth masks which are very low in effectiveness. Surgical masks that are sold now in drug stores etc, are generally of good quality. N95 masks are actually 'respirators' and not masks. They offer the best protection but need to be fitted properly as to filter. A poorly fitting N95 is no better than a poorly fitting surgical mask. In Canada, N95 respirators should have a "NIOSH" label and an approval number stamped on the device.  Similarly for the popular KN95 versions.

Infectious Diseases Society of America masking evidence

The CDC in the US is also an excellent source of reliable information and it recommends that you a wear a mask to protect both yourself and others. Cloth masks are poor for protection unless double layered with a filter layer between. It is best to use proper medical masks that are widely available now. N95/KN95 are considered the 'best' masks but work only when well fitting without big gaps from the face. And of course any mask below the nose loses all protection. Plastic face shields should not be considered protective. 

Remember:

• Masking is a critical public health tool.
• Wear the most protective mask you can that fits well and that you will wear consistently.
• Wearing a well-fitted mask along with vaccination, self-testing, and physical distancing, helps protect you and others by reducing the chance of spreading COVID-19.