Download Communicable Disease Control Report

Communicable Disease Control Report
October 2015
Annual report for health care providers on infectious diseases of public health importance in the NBPSDHU region
;
Contact Information
For further information or
to report Sexually
Transmitted Infections,
please contact The Clinic
Tel: 705-474-1400 ext. 2289
Toll Free: 1-800-563-2808
Parry Sound: 705-746-5801
For further information or
to report all other
reportable and
communicable diseases,
please contact the
Communicable Disease
Control Program
Tel: 705-474-1400 ext. 2229
Toll Free: 1-800-563-2808
Fax: 705-474-2809
Contents of this Issue:
Emerging Infectious Disease - Chikungunya ..............................................................................1
Reportable Respiratory Diseases in Focus ............................................................................. 1-3
New Mobile App- Canadian Guidelines on Sexually
Transmitted Infections .............................3
Counts and Age-Standardized Rates of Reportable Diseases ....................................................4
References .................................................................................................................................4
Emerging Infectious Disease - Chikungunya
Since 2014, there has been an increase in travel-related chikungunya cases reported in
Canada. Chikungunya virus is transmitted by mosquitoes and occurs in Africa, the
Americas, Asia, the Caribbean, the Pacific Islands, and the Indian subcontinent. In 2014
local transmission was identified in Florida, Puerto Rico, and the U.S. Virgin Islands.1
The incubation period is typically 3–7 days (range, 1–12 days).2 The disease is
characterized by acute onset of fever and polyarthralgia. Other symptoms may include
headache, myalgia, arthritis, conjunctivitis, nausea/vomiting, or maculopapular rash.
Dengue and chikungunya viruses are transmitted by the same mosquitoes and have
similar clinical features. It is important to rule out dengue virus infection because proper
2
clinical management of dengue can improve outcomes.
Reportable Respiratory Diseases in Focus
Next to influenza, the most common reportable diseases spread through contact with
respiratory droplets or secretions in the North Bay Parry Sound District over the past three
years included: invasive streptococcus pneumoniae, invasive group A streptococcal disease
and pertussis (whooping cough). Varicella (chickenpox) was also commonly reported among
children less than 10 years of age but was rarely confirmed by laboratory testing.
There were no confirmed cases of measles, mumps, rubella, or diphtheria reported in the
North Bay Parry Sound District over the past three years. Routine childhood vaccination for
these diseases has made them a less frequent cause of infection, complications and death.
Over the last 50 years, immunization has saved more lives than any other health intervention
and remains vital to disease prevention.3
For data analysis inquiries
please contact the Planning
and Evaluation Department
Tel: 705-474-1400 ext. 2201
Toll Free: 1-800-563-2808
To protect children from disease outbreaks in schools, the Immunization of School Pupils Act
(ISPA) now requires all students in Ontario to have proof of immunization against tetanus,
diphtheria, polio, mumps, measles, rubella, meningococcal disease, pertussis, and varicella to
attend school. (Note: varicella immunization is only a requirement for children born in 2010 or
later.)4
The requirements for complete immunization status are indicated in Ontario’s Immunization
Schedule.5 Please see: http://www.health.gov.on.ca/en/pro/programs/immunization
Disclaimer: This report is for health care providers and is not for dissemination.
myhealthunit.ca
1
Reportable Respiratory Diseases in Focus
Invasive pneumococcal disease is caused by Streptococcus pneumoniae bacteria and most often presents as bacteremia
among children 2 years of age and younger. Bacteremic pneumonia is the most common presentation among adults and is a
common complication following influenza.6
Number of Confirmed Cases
Figure 1. Number
and AgeStandardized Rates
of Confirmed
Streptococcus
Pneumoniae Cases,
by Accurate Episode
Year, NBPSDHU
Region & Ontario,
2010-2014
18
14
16
12
14
10
12
10
8
8
6
6
4
4
2
2
0
2010
2011
2012
2013
2014
NBPSDHU Cases
13
16
17
11
5
NBPSDHU Age-Standardized Rate
8.4
9.3
12.3
5
3.1
Ontario Age-Standardized Rate
8.1
8.2
8
6.4
6.7
Rate per 100,000 Population
The age-standardized incidence rate for confirmed invasive streptococcus pneumoniae was significantly lower in the NBPSDHU
region compared to Ontario in 2014 (see Figure 1). Since 2012, the age-standardized incidence rate has decreased in the
NBPSDHU region. The most frequent risk factors reported include having chronic illness/underlying medical condition, being
unimmunized, and immunocompromised.
0
Antimicrobial resistance
among some pneumococci
strains makes prevention
through the use of
vaccines important.7
The pneumococcal vaccine
is included in the Ontario
Publicly Funded
Immunization Schedule for
infants, seniors and
persons of all ages at high
risk for infection.5
In 2014, the age-standardized incidence rate for invasive group A streptococcal disease (iGAS) did not differ statistically when
compared to Ontario (see Figure 2). In 2012, an outbreak of iGAS occurred among a high risk population in the district; this
outbreak accounted for 21% of cases reported that year.
One quarter of all iGAS cases reported in 2014 occurred in January. At the same time the Influenza A H1N1 pandemic strain
(pdm09) was circulating in the district and activity was high.8 Research has found that invasive bacterial secondary or
coinfections with group A streptococci, Staphylococcus aureus, Streptococcus pneumoniae, and others may occur with
influenza and are important contributors to morbidity and mortality.9
12
14
10
12
8
10
8
6
6
4
4
2
2
0
NBPSDHU Cases
2010
2011
2012
2013
2014
8
11
14
7
12
NBPSDHU Age-Standardized Rate
6.2
7.4
11.2
4.6
8.6
Ontario Age-Standardized Rate
4.1
4.9
4.1
4.2
5.0
Disclaimer: This report is for health care providers and is not for dissemination.
Rate per 100,000 Population
16
Number of Confirmed Cases
Figure 2. Number
and AgeStandardized
Rates of
Confirmed iGAS
Cases, by Accurate
Episode Year,
NBPSDHU Region
& Ontario, 20102014
Adults 40 years of
age or older
accounted for
almost threequarters (73.1%) of
iGAS cases in the
NBPSDHU region in
2010-2014.
0
myhealthunit.ca
2
Reportable Respiratory Diseases in Focus
8
9
7
8
6
7
6
5
5
4
4
3
3
2
2
1
1
0
2010
2011
2012
2013
2014
1
2
7
5
0
NBPSDHU Age-Standardized Rate
1.2
2.1
8.4
5.9
0
Ontario Age-Standardized Rate
0.9
1.9
7.0
1.9
2.1
Confirmed Cases
Rate per 100,000 Population
Figure 3. Number
and AgeStandardized Rates
of Confirmed
Pertussis Cases, by
Accurate Episode
Year, NBPSDHU
Region & Ontario,
2010-2014
Number of Confirmed Cases
There were no confirmed cases of Pertussis (whooping cough) in the NBPSDHU region in 2014. Pertussis activity peaked in
2012 coinciding with a provincial outbreak of the disease (Figure 3).10 Due to the cyclical nature of the disease, outbreaks
typically occur approximately every four years.11 Evidence suggests that waning immunity associated with the acellular
pertussis vaccine that was implemented in 1997 may have contributed to the provincial outbreak in 2012.10
0
Adult Pertussis Immunization
Adults are considered a significant source of transmission to infants who are not yet fully protected, and for this reason, a
single dose adult pertussis immunization program was introduced in Ontario.12
A dose of Tdap vaccine
should be given to:
Who
Adolescents
Adults and seniors
When
14-16 years of age
When next Td dose is due, or at earliest opportunity.
Disclaimer: This report is for health care providers and is not for dissemination.
myhealthunit.ca
3
Counts and Age Standardized Rates of Reportable Diseases
Table 1: Counts and Age-Standardized Rates of Reportable Diseases†, NBPSDHU Region & Ontario, 2014
Disease
NBPSDHU:
NBPSDHU AgeOntario: Number
Number of
Standardized Rate (per
of Confirmed Cases
Confirmed Cases 100,000 Population)
Campylobacter enteritis
15
10.9 (↓)
3781
Chlamydial infections
385
398.1 (↑)
35956
Cryptosporidiosis
2
1.8
361
Giardiasis
15
12.0
1286
Gonorrhea (All types)
13
12.7 (↓)
5838
Group A Streptococcal Disease, Invasive
12
8.6
729
Hepatitis B
2
2.2
104
Hepatitis C
62
56.1 (↑)
4218
Influenza
282
196.4 (↑)
11743
Listeriosis
2
0.9
52
Malaria
2
2.3
191
Meningitis (All Types)
4
3.0
125
Ophthalmia neonatorum
1
1.2
4
Paratyphiod fever
1
0.4
25
Salmonellosis
33
27.5
3041
Shigellosis
1
1.0
285
Streptococcus pneumoniae, Invasive
5
3.1 (↓)
1083
Syphilis (All Types)
2
1.7 (↓)
1455
Tuberculosis, Latent Infection (LTBI) α
36
Not available
Not available
Yersiniosis
1
0.4
146
Ontario AgeStandardized Rate (per
100,000 Population)
27.6
304.4
3.1
10.0
49.3
5.0
0.7
30.5
80.6
0.3
1.4
1.0
0.1
0.2
23.6
2.2
6.7
10.7
Not available
1.2
† - Counts and rates for reportable diseases were excluded from the table if there were no confirmed cases reported in the NBPSDHU region in 2014
α
Counts based on reported date, rather than accurate episode (symptom onset) date.
(↑) –Age-standardized rate is significantly higher compared to the Ontario rate
(↓) – Age-standardized rate is significantly lower compared to the Ontario rate
Data Sources:
1)
2)
3)
4)
NBPSDHU counts: Integrated Public Health Information System (iPHIS), extracted 2015/04/17.
NBPSDHU population estimates: Statistics Canada 2005-2013, IntelliHEALTH Ontario, Ministry of Health and Long-term Care, extracted 2015/4/17.
Ontario counts: Infectious Diseases Query, Public Health Ontario, extracted 2015/05/29.
Ontario population estimates; Statistics Canada 2005-2013, IntelliHEALTH Ontario, Ministry of Health and Long-term Care, extracted 2015/4/17.
References
1.
Public Health Agency of Canada. Chikungunya Global Update. http://www.phac-aspc.gc.ca/tmp-pmv/notices-avis/notices-avis-eng.php?id=120
Updated June 26, 2015. Accessed July 27, 2015.
2. Centers for Disease Control and Prevention. Chikungunya Clinical Evaluation and Disease. http://www.cdc.gov/chikungunya/hc/clinicalevaluation.html
Updated February 10, 2015. Accessed July 27, 2015.
3. Public Health Agency of Canada. Canadian Immunization Guide, Part 1- Benefits of Immunization. http://www.phac-aspc.gc.ca/publicat/cig-gci/p0102-eng.php Updated November 29, 2013. Accessed July 27, 2015.
4. Ontario Ministry of Health and Long-Term Care, Public Health Division. Immunization requirements for school attendance: information for health care
providers. http://www.health.gov.on.ca/en/pro/programs/immunization/ispa.aspx Updated April 17, 2014. Accessed July 27, 2015.
5. Ministry of Health and Long-Term Care. Ontario’s Publicly Funded Immunization Schedules.
http://www.health.gov.on.ca/en/pro/programs/immunization Updated May, 27. 2015. Accessed July 27, 2015.
6. Public Health Agency of Canada. Canadian Immunization Guide, Part 4- Active Vaccines, Pneumococcal Vaccine. http://www.phacaspc.gc.ca/publicat/cig-gci/p04-pneu-eng.php Updated March 24, 2015. Accessed July 27, 2015.
7. Public Health Agency of Canada. Invasive Pneumococcal Disease, for Health Professionals. http://www.phac-aspc.gc.ca/im/vpd-mev/pneumococcalpneumococcie/professionals-professionnels-eng.php Updated June 30, 2015. Accessed July 27, 2015.
8. North Bay Parry Sound District Health Unit. Influenza Summary: 2013/14 Season.
http://www.myhealthunit.ca/en/partnerandhealthproviderresources/Infectious-Diseases-Reports.asp Published January 2015. Accessed July 27, 2015.
9. Harper S.A., et al. Seasonal Influenza in Adults and Children—Diagnosis, Treatment, Chemoprophylaxis, and Institutional Outbreak management:
Clinical Practice Guidelines of the Infectious Diseases Society of America. Clinical Infectious Diseases; 2009; 48: 1003 -1032.
10. Deeks SL, Lim GH, Walton R, et al. Prolonged pertussis outbreak in Ontario originating in an under-immunized religious community. Canada
Communicable Disease Report CCDR; 2014; 40(3).
th
11. Heymann DL. 2015. Control of Communicable Diseases Manual, 20 Ed. Washington, DC: American Public Health Association.
12. Ontario Ministry of Health and Long-Term Care. Tetanus, diphtheria and pertussis (Tdap) vaccine: Q&A for health care providers. Catalogue No.
019406. 2014: Queen’s Printer for Ontario. http://www.health.gov.on.ca/en/pro/programs/immunization/resources.aspx
Disclaimer: This report is for health care providers and is not for dissemination.
myhealthunit.ca
4