Download Infectious Diseases At A Glance Report

Infectious Diseases At A Glance
Last Updated: June 2016
Highlights
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The rates of all reported infectious diseases combined are highest among youth and young adults aged 15 to 29 years and also among older adults 90 years and older.
The rate of enteric illness is higher in the northern municipalities of Durham Region (Brock, Scugog and Uxbridge combined) in most years while all other municipalities have rates
similar to Durham Region as a whole.
Rates of salmonellosis have been increasing in both Durham Region and Ontario since 2003.
The rate of influenza was higher in the northern municipalities of Durham Region (Brock, Scugog and Uxbridge combined) in 2013, 2014 and 2015 compared to Durham Region as
a whole.
Although chlamydia rates decreased between 2011 and 2013 among both Durham Region and Ontario females and levelled off among Durham Region males, rates
increased again between 2014 and 2015
The rate of chlamydia is higher most years in Ajax, Pickering, and Oshawa than Durham Region as a whole, and lower in Whitby, Clarington, and the northern municipalities
(Brock, Scugog and Uxbridge combined).
Incidence rates of gonorrhea have been increasing since 2009 in both Durham Region and Ontario, especially among males.
The rate of hepatitis C infection is consistently higher in Oshawa than in other Durham Region municipalities, and higher than in Durham Region as a whole.
Rates for all reportable infectious diseases included in the report are either similar or lower in Durham Region compared to Ontario.
Introduction
Ontario's Health Protection and Promotion Act requires that a number of infectious diseases be reported to the local Medical Officer of Health by physicians, nurses, other regulated
health professionals, hospitals, and laboratories.[1] The Durham Region Health Department investigates and manages identified cases and contacts of infectious diseases and enters
them into the integrated Public Health Information System (iPHIS) in accordance with the Ministry of Health and Long-Term Care's Infectious Disease Protocol.[2] The most common
source of case identification is through laboratory notification of confirmed test results. There may be considerable under-reporting of cases because an infected person with mild or no
clinical symptoms may not seek medical care and/or laboratory testing may not be performed. A list of reportable infectious diseases is available at
www.durham.ca/departments/health/disease_prevention/reportableDiseaseList.pdf.
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This report includes confirmed cases, unless otherwise noted, of reportable infectious diseases according to provincial case definitions provided in the Infectious Disease Protocol.[3]
Probable cases are included along with confirmed cases for some diseases (noted in the comments below each graph where relevant) from 2009 onward, to enable comparison to
previous years as a result of changes to case definitions in 2009.
For all indicators, data are analyzed by the residence of the case at time of diagnosis.
This report includes indicators with relevance to public health programming and/or referenced in the Ontario Public Health Standards (OPHS).[4] The current OPHS were published in
2008 by the Ministry of Health and Long-Term Care under the authority of Section 7 of the Health Protection and Promotion Act.[1] Charts and tables are provided for the following
indicators for Durham Region:
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All Reportable Infectious Diseases: Crude Incidence Rate; Age-Specific Incidence Rate.
All Enteric Diseases: Incidence Rate; Age-Specific Incidence Rate; Incidence Rate by Municipality
Campylobacter Enteritis: Age-Standardized Incidence Rate; Incidence Rate by Municipality
Giardiasis: Incidence Rate
Salmonellosis: Incidence Rate; Incidence Rate by Municipality
All Vaccine Preventable Diseases: Incidence Rate
Influenza: Incidence Rate; Age-Specific Incidence Rate; Incidence Rate by Municipality
Pertussis: Incidence Rate; Age-Specific Incidence Rate
Invasive Pneumococcal Disease (IPD): Incidence Rate
All STIs and Bloodborne Infections: Incidence Rate
Chlamydia: Incidence Rate; Age-Specific Incidence Rate; Age-Specific Incidence Rate Among Youth 15-19 Years of Age, Adults 20-24 Years of Age, and Adults 25-29 Years of
Age; Incidence Rate by Municipality
Gonorrhea: Incidence Rate; Age-Specific Incidence Rate; Incidence Rate by Municipality
Syphilis: Incidence Rate
Hepatitis B, Chronic: Incidence Rate
Hepatitis C: Incidence Rate; Incidence Rate by Municipality
Latent Tuberculosis Infection (LTBI): Incidence Rate; Incidence Rate by Municipality
Age-Standardized Incidence Ratios for Selected Reportable Diseases (Males, Females, & Both Sexes Combined)
Number of Confirmed Cases of Selected Reportable Diseases in Durham Among Both Sexes
For more detailed, topic specific reports that include infectious disease data please go to the Health Statistics in Durham Region webpage found at durham.ca/healthstats.
For more information or if you require this information in an accessible format, please contact the Durham Health Connection Line at 905-666-6241 or 1-800-841-2729.
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Definitions
Definition: Age-Standardized Incidence Ratio (SIR)
The ratio of the number of cases observed in the population of interest to the number of cases that would be expected if the population had the same age-specific incidence rates as a
standard population. Ontario is used here as the standard population. Since statistical estimates may be unstable when the number of events is small, confidence intervals (CIs) are
used to determine whether an SIR is statistically different from 1. 95% CIs are represented in the report by upright bars. If these bars cross 1 this means that the Durham incidence
rate is no different from Ontario. An SIR and CIs greater than 1 indicate that the incidence rate is higher in Durham than Ontario, whereas an SIR and CIs less than 1 indicate that
incidence is lower in Durham.
Definition: Incidence Rate
The total number of cases per 100,000 population. This rate depicts the "true" picture of disease in a community.
Definition: Age-Specific Incidence Rate
The total number of cases in a specified age group per 100,000 population in that age group. The numerator and denominator refer to the same age group.
For some indicators, the count of total cases displayed is more than the sum of male and female cases as a result of unspecified or other gender.
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All Reportable Infectious Diseases
All reportable infectious diseases are included in these rates with the exception of adverse vaccine events; chickenpox (varicella); Clostridium difficile infection; gastroenteritis,
institutional outbreaks; & respiratory infection outbreaks in institutions. Institutions include: long-term care homes, hospitals, retirement homes, daycares and schools.
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Figure 1: All Reportable Infectious Diseases Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
251.5
334.3
313.9
412.2
558
746
1,304
1994
250.0
338.3
341.5
421.1
566
773
1,339
1995
249.3
319.8
410.7
447.6
576
746
1,322
1996
233.1
305.1
345.1
363.9
547
725
1,272
1997
182.7
257.7
317.7
333.8
439
627
1,066
1998
246.5
330.7
357.1
375.6
606
823
1,427
1999
178.3
271.5
338.0
357.5
447
690
1,137
2000
176.6
248.2
338.1
363.2
453
646
1,099
2001
191.1
283.9
331.3
345.6
500
755
1,252
2002
225.6
315.5
362.7
392.0
602
856
1,457
2003
290.2
348.3
373.8
397.2
792
967
1,759
2004
264.5
337.4
353.9
374.4
737
958
1,696
2005
303.7
376.8
410.0
430.5
863
1,091
1,955
2006
320.9
379.9
397.3
412.9
928
1,121
2,050
2007
320.1
381.0
405.0
424.0
939
1,145
2,084
2008
334.3
430.6
416.7
470.8
993
1,316
2,312
2009
386.0
481.7
491.6
550.8
1,159
1,492
2,653
2010
340.7
469.0
425.4
495.6
1,037
1,476
2,514
2011
366.8
502.5
452.9
537.1
1,129
1,603
2,736
2012
398.5
511.9
496.8
572.4
1,245
1,657
2,902
2013
409.8
459.1
481.0
512.2
1,298
1,507
2,805
2014
428.5
473.7
535.0
562.1
1,375
1,576
2,951
2015
410.4
484.5
536.0
565.7
1,332
1,630
2,963
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Crude reportable infectious disease incidence rates have been increasing fairly steadily since 2001 in males and females and are higher among females in both Durham Region and
Ontario. Patterns in overall infectious disease rates are influenced most strongly by trends in chlamydia, which has accounted for over half of all reported infectious diseases since
2001 and occurs at a rate of close to two to one among females compared to males.
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Figure 2: All Reportable Infectious Diseases Age-Specific Incidence Rates, Durham Region and Ontario, 2011-2015 Combined
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
0-4
287.7
216.0
413.8
350.9
259
187
446
5-9
124.3
84.2
189.6
157.2
120
78
198
10-14 15-19 20-24 25-29 30-34
68.5 476.9 1274.6 958.7 514.1
96.9 1395.0 2135.9 1006.4 533.8
119.4 536.6 1365.3 1117.6 748.0
118.9 1527.7 2163.4 1121.6 646.1
71
576
1,506
949
492
96
1,598 2,413
992
553
167
2,175 3,920 1,943 1,045
35-39
373.9
350.1
518.9
415.5
381
385
766
40-44
273.1
258.6
421.8
284.6
303
303
607
45-49
278.9
192.0
367.9
220.2
360
258
618
50-54
261.1
158.4
304.4
197.1
357
217
574
55-59
242.4
171.7
284.1
191.7
266
193
459
60-64
252.8
170.3
266.7
182.5
218
154
372
65-69
209.8
163.4
240.4
185.6
140
118
258
70-74
237.6
173.0
250.4
201.4
107
89
196
75-79
337.2
214.9
324.2
268.1
110
87
197
80-84
398.0
252.2
433.3
379.1
90
81
171
85-89 90+
538.3 661.9
455.0 785.7
652.6 1170.5
593.7 982.5
64
33
100
99
164
132
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department, April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
The rates of all reported infectious diseases are highest among youth and young adults aged 15 to 29 years and also among older adults 90 years and older. As with overall rates, this
distribution is influenced most strongly by the age distribution of chlamydia, which accounted for over half of all reported infectious diseases between 2011 and 2015.
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Enteric Diseases
Enteric diseases are diseases that affect the stomach and intestines. Reportable enteric diseases in Ontario include: amebiasis; botulism; brucellosis; Campylobacter enteritis; cholera;
cryptosporidiosis; cyclosporiasis; food poisoning, all causes; giardiasis; hepatitis A; listeriosis; paralytic shellfish poisoning; paratyphoid fever; salmonellosis; shigellosis; trichinosis;
typhoid fever; verotoxin-producing Escherichia coli (VTEC) infection; and yersiniosis. Probable cases are included along with confirmed cases for all enteric diseases with the
exception of listeriosis, paratyphoid fever and typhoid from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009.
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Figure 3: All Enteric Diseases Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
128.5
115.6
157.4
138.1
285
258
543
1994
125.0
120.8
154.8
137.4
283
276
559
1995
123.8
117.9
145.6
128.2
286
275
561
1996
104.0
90.0
130.9
110.1
244
214
458
1997
89.5
89.2
125.9
107.5
215
217
432
1998
77.7
87.6
126.3
109.1
191
218
409
1999
51.1
48.0
100.0
85.6
128
122
250
2000
73.3
60.7
117.1
104.3
188
158
346
2001
78.4
70.3
110.6
88.7
201
187
388
2002
89.3
81.1
106.8
90.6
229
220
449
2003
77.6
59.8
91.0
73.6
199
166
365
2004
75.2
62.3
88.7
71.6
193
177
370
2005
71.7
60.4
97.4
78.4
184
175
359
2006
75.6
66.4
90.9
74.7
194
196
390
2007
89.3
61.9
97.2
77.1
229
186
415
2008
78.7
56.0
93.1
75.6
202
171
373
2009
75.2
54.9
83.6
68.8
193
170
363
2010
70.9
60.4
89.9
71.8
182
190
372
2011
78.7
61.8
87.3
70.7
202
197
399
2012
92.8
64.9
93.5
77.7
238
210
448
2013
89.7
68.8
91.4
72.9
230
226
456
2014
96.7
59.5
93.4
72.8
248
198
446
2015
86.1
55.3
89.4
72.3
221
186
407
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Rates of enteric diseases decreased between 1992 and 1999 in both Durham Region and Ontario, remained relatively stable since 2003. Rates are higher in males than females in
most years.
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Figure 4: All Enteric Diseases Age-Specific Incidence Rates, Durham Region and Ontario, 2011-2015 Combined
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
0-4
116.6
97.0
153.8
134.2
105
84
189
5-9
73.5
43.2
95.2
79.9
71
40
111
10-14
46.3
35.3
66.3
43.5
48
35
83
15-19
59.6
51.5
76.6
58.0
72
59
131
20-24
55.0
74.4
92.5
85.2
65
84
149
25-29
82.8
77.1
102.6
88.0
82
76
158
30-34
70.0
64.7
91.6
73.3
67
67
134
35-39
58.9
56.4
82.4
61.2
60
62
122
40-44
64.9
52.1
78.6
54.5
72
61
133
45-49
70.5
71.4
79.9
58.5
91
96
187
50-54
78.3
61.3
75.3
57.1
107
84
191
55-59
63.8
58.7
71.7
59.5
70
66
136
60-64
89.3
77.4
74.6
62.0
77
70
147
65-69
70.4
65.1
74.3
61.6
47
47
94
70-74
93.3
62.2
70.5
59.4
42
32
74
75-79
95.0
56.8
71.8
60.7
31
23
54
80+
76.0
43.5
62.1
48.8
30
29
59
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department, April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Many enteric illnesses occur more frequently in infants and young children compared to adults. Rates are higher among males than females in most age groups.
Page 9 of 47
Figure 5: All Enteric Diseases Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
43.4
42.5
47.0
38.2
34.3
53.8
61.2
2009
60.5
55.0
59.5
50.7
43.0
96.2
58.4
2010
49.7
49.7
61.3
54.4
49.5
105.4
59.4
2011
68.2
37.7
78.7
64.2
42.0
87.8
63.0
2012
66.8
77.1
61.1
61.2
71.6
100.5
70.0
2013
82.9
73.8
65.0
58.4
84.6
68.3
70.6
2014
65.7
61.2
52.4
71.8
78.1
100.7
68.4
2015
71.7
46.1
59.6
51.2
78.0
90.0
62.0
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
The rate of enteric illness is higher in North Durham (Brock, Scugog and Uxbridge combined) in most years while all other municipalities have rates similar to Durham Region as a
whole.
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Figure 6: Campylobacter Enteritis Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994
Durham Male Rate
62.7 65.4
Durham Female Rate
58.3 69.6
Ontario Male Rate
65.7 71.8
Ontario Female Rate
61.1 65.6
Durham Male Cases
139 148
Durham Female Cases 130 159
Durham Total Cases
269 307
1995
66.2
67.3
59.5
56.4
153
157
310
1996
44.8
43.8
52.3
44.7
105
104
209
1997
38.3
46.4
48.3
44.3
92
113
205
1998
38.6
42.2
51.1
42.9
95
105
200
1999
26.7
27.1
37.8
33.2
67
69
136
2000
37.4
28.8
45.6
39.2
96
75
171
2001
46.8
37.2
46.7
37.5
120
99
219
2002
37.8
28.4
41.2
34.6
97
77
174
2003
35.5
26.7
37.2
29.3
91
74
165
2004
32.7
29.2
35.8
28.5
84
83
167
2005
30.0
21.8
34.9
26.3
77
63
140
2006
30.8
25.8
34.2
27.9
79
76
155
2007
32.4
24.0
35.2
27.4
83
72
155
2008
35.5
21.3
34.1
26.8
91
65
156
2009
30.0
22.3
28.7
23.7
77
69
146
2010
21.8
22.6
30.5
23.8
56
71
127
2011
29.2
21.3
31.9
24.6
75
68
143
2012
44.0
21.9
34.5
28.1
113
71
184
2013
42.1
26.5
35.7
27.8
108
87
195
2014
40.1
26.8
34.5
26.4
103
89
192
2015
28.5
16.6
29.3
23.5
73
56
129
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Campylobacter enteritis is one of the leading causes of enteric disease in Ontario and occurs primarily in the summer months.[5] Probable cases of Campylobacter enteritis are
included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Rates of Campylobacter enteritis
decreased between 1994 and 2005 in both Durham Region and Ontario, then increased between 2009 and 2012 but have been decreasing again in recent years.
Page 11 of 47
Figure 7: Campylobacter Enteritis Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
19.6
16.1
19.0
17.1
14.2
19.7
25.5
2009
29.2
18.3
21.7
20.2
18.6
44.5
23.5
2010
17.3
15.4
19.9
20.7
19.6
33.9
20.3
2011
21.7
7.0
29.9
28.2
15.9
34.0
22.6
2012
26.9
32.0
21.7
28.0
28.0
44.8
28.8
2013
34.0
29.7
26.8
25.4
37.4
34.1
30.1
2014
31.8
24.3
20.5
30.9
30.4
52.2
29.5
2015
23.2
16.5
17.4
14.4
22.4
36.0
19.6
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Probable cases of Campylobacter enteritis are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case
definition in 2009. Rates of Campylobacter enteritis are higher in the northern Durham Region municipalities (Brock, Scugog and Uxbridge combined) in most years, while all other
municipalities have rates similar to Durham Region as a whole.
Page 12 of 47
Figure 8: Giardiasis Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
25.4 21.5 15.5 18.8 18.8 11.1 9.7
6.8
6.4 11.2 8.9 10.0 6.8 10.6 7.7
9.6
8.9
6.1
6.2
8.6
7.9
8.4
8.0
Ontario Rate
28.6 25.0 24.7 23.0 21.2 18.6 17.2 17.1 17.2 15.7 13.2 12.6 13.2 12.3 13.0 12.9 12.1 11.3 10.4 10.9 11.1 10.6 11.2
Durham Male Cases
63
57
32
47
52
23
24
15
16
29
31
34
19
29
32
34
29
23
23
31
22
41
36
Durham Female Cases
50
41
40
42
39
32
25
20
18
31
18
22
20
33
14
24
25
15
16
24
29
14
17
Durham Total Cases
113
98
72
89
91
55
49
35
34
60
49
56
39
62
46
58
54
38
39
55
51
55
53
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Giardiasis is common in Ontario, especially in institutions and daycare centers where children are not yet toilet trained.[5] Probable cases of giardiasis are included along with
confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Due to small numbers, male and female cases are
combined to create more stable rates. Rates of giardiasis decreased between 1991 and 2011 in Ontario but have remained relatively stable since; in Durham Region rates decreased
between 1992 and 2001 but have remained relatively stable since then.
Page 13 of 47
Figure 9: Salmonellosis Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994
Durham Male Rate
23.0 22.5
Durham Female Rate
22.0 21.4
Ontario Male Rate
29.8 25.9
Ontario Female Rate
29.3 25.9
Durham Male Cases
51
51
Durham Female Cases
49
49
Durham Total Cases
100 100
1995
21.6
18.4
26.4
25.6
50
43
93
1996
22.6
17.3
24.0
23.8
53
41
94
1997
19.6
14.4
23.3
23.2
47
35
82
1998 1999 2000
17.1 8.8 19.5
22.1 6.7 14.6
28.3 19.9 19.7
30.2 20.0 20.5
42
22
50
55
17
38
97
39
88
2001
19.9
19.9
21.8
20.6
51
53
104
2002
21.8
24.3
20.2
20.2
56
66
122
2003
18.3
15.8
16.1
16.3
47
44
91
2004
15.6
16.6
17.1
16.8
40
47
87
2005
22.2
21.1
23.8
23.8
57
61
118
2006
18.7
21.4
19.4
18.5
48
63
111
2007
30.8
24.6
22.9
22.4
79
74
153
2008
18.3
20.9
19.7
18.8
47
64
111
2009
21.0
19.4
18.2
19.5
54
60
114
2010
25.3
23.2
22.3
21.9
65
73
138
2011
25.3
22.6
20.6
21.1
65
72
137
2012
27.7
24.4
24.9
25.3
71
79
150
2013
23.4
23.8
20.0
20.3
60
78
138
2014
26.1
22.2
25.1
24.6
67
74
141
2015
30.0
22.9
22.8
23.8
77
77
154
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Salmonellosis is the second most common enteric infection in Ontario but it is estimated that only 1% of all infections are ever clinically recognized.[5] Probable cases of salmonellosis
are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Rates of salmonellosis
decreased between 1991 and 2003 in both Durham Region and Ontario but have been increasing since then.
Page 14 of 47
Figure 10: Salmonellosis Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
11.9
14.2
13.2
10.5
15.4
7.2
18.2
2009
15.1
17.4
21.7
19.5
9.3
26.7
18.3
2010
21.6
19.9
23.9
18.8
19.6
32.1
22.0
2011
20.6
16.7
29.9
21.2
19.3
17.9
21.6
2012
19.4
28.6
20.9
20.4
28.0
25.1
23.5
2013
20.2
23.8
20.7
20.9
22.0
19.8
21.3
2014
12.7
22.6
19.0
27.7
22.8
21.6
21.6
2015
33.7
17.3
21.1
20.0
31.0
21.6
23.4
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Salmonellosis is the second most common enteric infection in Ontario but it is estimated that only 1% of all infections are ever clinically recognized.[5] Probable cases of salmonellosis
are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. The rate of salmonellosis is
similar in the Durham Region municipalities to Durham Region as a whole.
Page 15 of 47
Vaccine Preventable Diseases
Vaccine Preventable Diseases (VPDs) are infectious diseases that can be prevented by routine vaccinations, mostly given during childhood. Reportable VPDs include: diphtheria;
Haemophilus influenzae B disease, invasive; hepatitis A; hepatitis B; measles; meningococcal disease, invasive; mumps; pertussis; poliomyelitis, acute; rabies (human); rubella;
rubella, congenital syndrome; Streptococcus pneumoniae, invasive (invasive pneumococcal disease); and tetanus. Probable cases of invasive pneumococcal disease, measles,
mumps, pertussis and rubella are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009.
Page 16 of 47
Figure 11: All Vaccine Preventable Diseases Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
16.9 29.7 29.9 27.3 21.9 20.4 12.7 7.2
7.4
4.5 13.6 18.1 15.5 15.2 18.2 13.8 11.3 10.7 11.3 13.7 9.0 11.0 10.0
Ontario Rate
20.7 33.7 51.7 18.2 16.7 21.4 15.2 9.9
7.7 12.6 14.2 17.0 18.1 21.4 18.2 20.8 16.9 13.8 15.4 21.0 12.8 13.1 15.7
Durham Male Cases
43
67
73
63
54
47
25
19
17
10
44
40
40
48
64
44
36
29
38
44
35
42
29
Durham Female Cases
32
68
66
66
52
54
39
18
22
14
31
62
49
41
44
39
33
37
33
43
23
30
37
Durham Total Cases
75
135 139 129 106 101
64
37
39
24
75
102
89
89
108
83
69
66
71
87
58
72
66
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
All Vaccine Preventable Diseases excludes influenza, due to the sporadic nature of cases, and chickenpox (varicella) due to underreporting issues. Due to small numbers, male and
female cases are combined to create more stable rates. Probable cases of invasive pneumococcal disease, measles, mumps, pertussis and rubella are included along with confirmed
cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Large measles outbreaks occurred in Ontario in 1991-92 and 199495 which explains the peaks for those years.
Page 17 of 47
Figure 12: Influenza Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
5.8
1.8
4.7 11.4 5.0 26.7 24.8 6.6
8.5 17.1 32.5 4.6 30.7 15.6 17.0 24.4 87.9 11.6 14.4 32.1 35.7 68.9 34.0
Ontario Rate
14.4 8.4 16.1 9.9
7.7 21.6 31.2 13.3 6.6 22.4 40.4 9.9 43.8 23.2 24.6 38.2 117.8 15.6 33.9 67.7 57.5 97.1 78.5
Durham Male Cases
14
5
7
21
12
62
63
17
23
46
89
16
88
56
53
73
264
32
47
96
121 201
93
Durham Female Cases
12
3
15
33
12
70
62
17
22
46
90
10
87
35
48
74
270
40
43
108 109 248 249
Durham Total Cases
26
8
22
54
24
132 125
34
45
92
179
26
176
91
101 147 536
72
90
204 230 450 225
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Influenza is an acute respiratory illness. In Canada, the influenza season usually runs from November to April. Due to small numbers, male and female cases are combined to create
more stable rates. The large number of cases for Ontario and Durham Region in 2009 is due to the H1N1 Pandemic in addition the past couple of seasons have also had large
numbers of influenza cases. Influenza rates fluctuate from year to year but in general follow the same pattern in Durham Region and Ontario. A summary of influenza activity for each
influenza season is provided on the Flu Surveillance page at durham.ca.
Page 18 of 47
Figure 13: Influenza Age-Specific Incidence Rates, Durham Region and Ontario, 2011-2015 Combined
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
0-4
106.6
85.5
185.3
152.2
96
74
170
5-9
43.5
30.2
69.7
54.0
42
28
70
10-14
12.5
17.2
29.0
23.4
13
17
30
15-19
14.1
9.6
17.7
20.1
17
11
28
20-24
13.5
15.9
14.4
22.3
16
18
34
25-29
16.2
25.4
18.6
31.2
16
25
41
30-34
19.9
19.3
25.0
39.9
19
20
39
35-39
23.6
20.9
26.6
36.5
24
23
47
40-44
21.6
24.7
28.7
32.3
24
29
53
45-49
19.4
20.1
26.3
28.8
25
27
52
50-54
19.0
24.1
29.9
34.0
26
33
59
55-59
31.9
26.7
35.6
41.2
35
30
65
60-64
37.1
29.9
49.1
46.2
32
27
59
65-69
27.0
38.8
56.2
59.3
18
28
46
70-74
53.3
36.9
85.6
79.7
24
19
43
75-79
107.3
86.5
154.0
142.6
35
35
70
80-84
181.3
124.5
259.7
250.4
41
40
81
85-89
277.5
327.6
466.9
465.5
33
72
105
90+
441.2
674.5
950.4
855.8
22
85
107
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department, April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Influenza is an acute respiratory illness. In Canada, the influenza season usually runs from November to April. In general, young children and the elderly have higher incidence rates of
influenza.
Page 19 of 47
Figure 14: Influenza Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
15.2
12.3
16.5
9.9
61.5
21.5
24.0
2009
92.9
84.4
89.3
66.4
120.8
64.1
86.2
2010
10.8
9.9
6.4
11.0
16.1
0.0
11.5
2011
7.6
7.9
13.4
12.2
11.4
7.2
14.2
2012
30.1
21.6
20.9
32.5
57.0
39.5
31.9
2013
28.7
31.4
35.2
36.8
34.1
53.9
35.5
2014
46.6
55.3
62.3
73.0
86.8
111.5
69.0
2015
27.4
18.9
16.6
46.2
39.5
77.4
34.2
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Influenza is an acute respiratory illness. In Canada, the influenza season usually runs from November to April. The rate of influenza was higher in Clarington in 2008, 2009 and 2012
and higher in the North Durham (Brock, Scugog and Uxbridge combined) in 2013, 2014 and 2015, while all other municipalities have rates similar to Durham Region as a whole.
Page 20 of 47
Figure 15: Pertussis Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
5.6 21.5 19.8 19.7 18.2 16.8 11.1 5.2
5.3
2.0
4.4
8.5
7.1
9.1
8.6
5.5
1.3
0.0
0.6
3.1
1.1
2.0
2.6
Ontario Rate
8.6 21.0 18.8 6.5
9.3 16.4 10.6 6.1
3.9
4.4
2.9
5.1
5.2 10.1 7.4
6.7
3.2
1.0
2.2
8.3
2.2
2.3
5.6
Durham Male Cases
15
47
43
42
44
37
22
12
10
3
15
14
16
27
27
17
3
0
4
5
4
6
5
Durham Female Cases
10
51
49
51
44
46
34
15
18
8
9
34
25
26
24
16
5
0
0
15
3
7
12
Durham Total Cases
25
98
92
93
88
83
56
27
28
11
24
48
41
53
51
33
8
0
4
20
7
13
17
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Pertussis, or whooping cough, is an acute bacterial infection that is characterized by violent coughing which may include a high pitched inspiratory whoop.[5] A booster of Tdap
vaccine, which protects individuals against tetanus, diphtheria and pertussis, was added to the Ontario routine immunization schedule for 14-16 year olds in 2003.[6] Probable cases of
pertussis are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Due to small numbers,
male and female cases are combined to create more stable rates. Rates of pertussis have fluctuated over time with Durham Region and Ontario typically showing a similar pattern.
Page 21 of 47
Figure 16: Invasive Pneumococcal Disease Incidence Rates, Durham Region and Ontario, 2003-2015
Rates and Cases
Durham Rate
Ontario Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
2003
7.3
8.1
26
14
40
2004
8.4
8.5
23
24
47
2005
7.7
7.4
24
20
44
2006
4.1
7.6
12
12
24
2007
7.7
7.6
30
16
46
2008
7.1
8.5
22
21
43
2009
8.4
10.0
27
24
51
2010
9.0
9.6
25
31
56
2011
8.9
10.1
29
27
56
2012
9.0
10.2
35
22
57
2013
7.0
8.3
26
19
45
2014
7.3
8.7
29
19
48
2015
6.5
8.1
20
23
43
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2003-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2003-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2003-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Invasive pneumococcal disease (IPD) is caused by the bacterium Streptococcus pneumoniae and can cause serious illnesses such as pneumonia, blood infection, and meningitis.[5]
The pneumococcal conjugate vaccine was added to the routine immunization schedule in 2005 for children less than 2 years old and high-risk children less than 5 years old.[6]
Probable cases of IPD are included along with confirmed cases from 2009 onward to enable comparison to previous years as a result of a change in case definition in 2009. Due to
small numbers, male and female cases are combined to create more stable rates. Data prior to 2003 are excluded due to inconsistent reporting. Rates in both Durham Region and
Ontario increased slightly between 2005 and 2012 and have decreased since.
Page 22 of 47
Sexually Transmitted and Bloodborne Infections
Sexually transmitted infections (STIs) and bloodborne infections are transmitted primarily from person-to-person through sexual contact, needle use, blood transfusion, and perinatally
from mother to infant.[7] Reportable STIs and bloodborne infections in Ontario include: chlamydial infections; gonorrhea; group B streptococcal disease, neonatal; hepatitis B; hepatitis
C; human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS); ophthalmia neonatorum; and syphilis. HIV data is not available for Ontario prior to 2005 so
only AIDS data is included in all STI and Bloodborne Infection totals for those years.
Page 23 of 47
Figure 17: All Sexually Transmitted and Bloodborne Infections Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
90.6
196.7
120.5
240.8
201
439
640
1994
83.5
183.0
139.0
242.9
189
418
607
1995
89.2
166.8
194.3
252.6
206
389
595
1996
87.4
170.0
177.1
227.0
205
404
609
1997
60.3
138.1
155.9
201.2
145
336
481
1998
116.8
188.0
180.5
219.1
287
468
755
1999
84.6
179.4
181.3
223.4
212
456
668
2000
84.6
169.8
185.2
232.7
217
442
659
2001
93.6
188.8
191.8
242.6
240
502
742
2002
119.3
205.3
205.5
261.4
306
557
863
2003
166.1
238.4
215.9
267.5
426
662
1,088
2004
182.8
244.7
227.9
277.1
469
695
1,165
2005
208.5
263.9
240.6
275.1
535
764
1,299
2006
240.9
284.7
252.4
288.2
618
840
1,459
2007
223.7
282.8
257.9
301.2
574
850
1,424
2008
256.1
331.2
263.6
337.0
657
1,012
1,672
2009
254.1
327.0
276.4
359.3
652
1,013
1,665
2010
298.2
378.1
306.3
405.9
765
1,190
1,956
2011
315.7
409.4
322.0
434.2
810
1,306
2,120
2012
321.6
393.2
327.5
428.0
825
1,273
2,098
2013
331.3
341.5
334.2
394.9
850
1,121
1,971
2014
332.9
319.8
363.3
410.1
854
1,064
1,918
2015
370.7
369.4
390.3
434.9
951
1,243
2,195
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
The rates of sexually transmitted and bloodborne infections have been increasing in Durham Region and Ontario since 1997. Although there was a decrease between 2011 and 2013
among Durham Region and Ontario females, rates have begun to increase again since.
Page 24 of 47
Figure 18: Chlamydia Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998
Durham Male Rate
52.7 50.8 39.0 36.2 33.3 48.8
Durham Female Rate
171.2 152.3 126.5 134.7 118.8 140.6
Ontario Male Rate
67.3 61.7 53.9 47.7 50.3 66.1
Ontario Female Rate
197.4 187.5 164.1 143.2 136.6 150.4
Durham Male Cases
117 115
90
85
80
120
Durham Female Cases 382 348 295 320 289 350
Durham Total Cases
499 463 385 405 369 470
1999
54.7
154.2
74.8
156.6
137
392
529
2000
53.4
143.3
83.4
166.7
137
373
510
2001
62.8
162.8
92.3
179.1
161
433
594
2002
83.0
174.3
104.5
195.9
213
473
686
2003
88.5
190.5
111.9
199.8
227
529
756
2004
100.2
197.6
122.0
210.0
257
561
818
2005
121.2
208.6
129.6
218.4
311
604
915
2006
140.7
224.7
132.8
223.7
361
663
1,024
2007
132.1
226.3
138.1
232.6
339
680
1,019
2008
162.9
261.1
148.4
268.0
418
798
1,218
2009
170.3
271.5
163.2
295.0
437
841
1,278
2010
208.5
324.4
190.9
341.8
535
1,021
1,556
2011
224.1
356.7
207.7
371.1
575
1,138
1,714
2012
235.4
342.3
215.3
366.1
604
1,108
1,712
2013
239.3
293.3
215.7
336.3
614
963
1,577
2014
233.1
266.6
226.9
345.8
598
887
1,485
2015
263.1
313.9
249.5
371.2
675
1,056
1,731
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Chlamydia infection is frequently asymptomatic.[5] In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate is higher among females and has been
rising. Although the rates decreased between 2011 and 2013 among both Durham Region and Ontario females and a levelled off among Durham Region males, rates increased again
between 2014 and 2015. More detailed information on chlamydia in Durham Region is available in the Snapshot on Chlamydia, 2011 available at www.durham.ca/healthstats.
Page 25 of 47
Figure 19: Chlamydia Age-Specific Incidence Rates, Durham Region and Ontario, 2011-2015 Combined
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
10-14 15-19 20-24
0.0
353.5 1020.7
20.2 1192.5 1880.9
2.5
368.2 1013.3
25.7 1313.9 1862.9
0
427
1,206
20
1,366 2,125
20
1,793 3,331
25-29
691.0
786.3
709.4
857.6
684
775
1,460
30-39
233.3
276.3
292.3
324.1
461
590
1,051
40-49
82.1
83.5
103.7
95.3
197
210
407
50-59
28.8
20.9
35.5
29.8
71
52
123
60+
7.0
3.7
7.2
3.7
19
12
31
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department, April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
The rate of chlamydia is higher among females in most age groups. Reported rates are highest among youth and young adults aged 15 to 29 years. Rates among those less than 10
years of age are excluded due to small counts.
Page 26 of 47
Figure 20: Chlamydia Incidence Rates in Youth 15-19 Years of Age, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
243.1
1202
183.1
1148
37
172
209
1994
218.3
1116
155.9
1053
34
163
197
1995
132.4
762.5
132.5
931.3
21
114
135
1996
110.3
983.1
109.3
790.6
18
151
169
1997
101.4
794.4
111.2
762.4
17
126
143
1998
103.3
978.4
146.8
864.4
18
162
180
1999
206.1
1106
154.5
849.1
37
192
229
2000
174.3
928.6
184.9
916.1
33
169
202
2001
131.8
957.3
192.3
963.9
26
181
207
2002
201.4
1034
205.4
1023
41
200
241
2003
167.5
1006
219.3
1055
35
199
234
2004
170.7
978.2
234.0
1055
37
200
237
2005
245.4
1152
241.4
1073
55
246
301
2006
309.7
1282
228.5
1036
72
286
358
2007
264.8
1172
245.8
1032
63
268
331
2008
300.2
1323
272.8
1171
73
311
385
2009
357.3
1313
319.2
1259
88
313
401
2010
370.8
1468
352.5
1425
92
350
442
2011
357.0
1516
370.7
1477
89
361
450
2012
359.9
1229
378.6
1372
89
288
377
2013
313.6
1052
345.3
1219
76
241
317
2014
366.9
999
361.9
1223
87
224
311
2015
371.1
1147
384.6
1269
86
252
338
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Chlamydia infection is frequently asymptomatic.[5] In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate is higher among females ages 15 to 19
than males and increased between 1995 and 2011 in Durham Region and Ontario. Although rates decreased between 2011 and 2013 among both Durham Region and Ontario
females 15 to 19 years of age and levelled off among males, rates have begun to increase again among both Durham Region and Ontario females 15 to 19 years of age since 2014.
Page 27 of 47
Figure 21: Chlamydia Incidence Rates in Young Adults 20-24 Years of Age, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
276.0
1055
370.2
1075
40
149
189
1994
290.8
825.4
338.7
1048
42
115
157
1995
304.1
890.9
289.2
930.9
44
124
168
1996
186.9
738.0
258.3
824.2
27
101
128
1997
268.1
797.3
270.3
780.7
40
112
152
1998
420.7
908.7
355.6
851.5
64
129
193
1999
286.4
939.5
388.9
924.8
45
136
181
2000
329.4
860.6
427.4
944.9
53
128
181
2001
366.0
1152
484.7
1047
61
179
240
2002
485.3
1034
554.0
1147
84
168
252
2003
480.7
1169
602.5
1169
87
199
286
2004
610.0
1261
672.0
1232
113
223
336
2005
657.2
1291
671.7
1278
127
235
362
2006
777.7
1396
684.7
1311
155
260
415
2007
669.6
1355
707.2
1326
136
260
396
2008
749.3
1408
753.7
1488
153
274
428
2009
841.1
1513
834.1
1573
175
300
475
2010
1061
1877
965.3
1826
226
384
610
2011
1009
2095
1028
1953
221
442
663
2012
1063
2095
996.1
1927
245
460
705
2013
1016
1761
975.8
1748
244
403
647
2014
970.6
1567
989.4
1750
239
368
607
2015
1047
1919
1077
1942
257
452
709
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Chlamydia infection is frequently asymptomatic.[5] In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate is higher among females ages 20 to 24
than males and increased between 1997 and 2011 in Durham Region and Ontario. Although rates decreased between 2011 and 2013 among both Durham Region and Ontario
females age 20 to 24 and levelled off among males, rates have begun to increase again among both Durham Region and Ontario males and females 20 to 24 years of age since 2014.
Page 28 of 47
Figure 22: Chlamydia Incidence Rates in Young Adults 25-29 Years of Age, Durham Region and Ontario, 1993-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
1993
78.1
199.4
169.4
340.5
14
37
51
1994
125.1
195.3
160.2
341.6
21
34
55
1995
81.6
199.3
150.2
311.0
13
33
46
1996
137.6
279.9
145.4
285.9
21
45
66
1997
73.1
198.9
145.6
286.6
11
31
42
1998
131.4
205.8
205.3
316.8
20
32
52
1999
169.8
219.8
228.8
336.2
26
34
60
2000
185.6
262.9
245.1
370.9
29
41
70
2001
258.6
278.4
293.7
394.2
41
43
84
2002
251.9
338.4
334.2
435.2
40
53
93
2003
346.5
494.5
371.2
442.9
56
79
135
2004
318.4
433.0
384.2
462.5
53
71
124
2005
410.1
388.5
431.9
498.9
69
65
134
2006
334.0
382.1
426.3
507.0
57
65
122
2007
431.4
514.7
462.9
557.5
75
90
165
2008
516.8
560.4
477.4
632.5
91
101
192
2009
440.6
564.1
518.8
705.8
78
104
182
2010
562.9
688.5
601.4
789.2
103
129
232
2011
685.8
824.1
661.6
862.6
128
156
285
2012
671.6
862.5
686.7
855.3
129
166
295
2013
736.5
827.0
693.6
810.8
145
162
307
2014
648.5
712.9
716.0
853.7
133
144
277
2015
712.2
713.6
786.1
904.1
149
147
296
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Chlamydia infection is frequently asymptomatic.[5] In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate is higher among females ages 25 to 29
than males and increased between 1997 and 2011 in Durham Region and Ontario. Although rates decreased between 2012 and 2014 in Durham Region females and between 2013
and 2014 in Durham Region males, rates have levelled off among Durham Region females and begun to increase again among Durham Region males 25 to 29 years of age.
Page 29 of 47
Figure 23: Chlamydia Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
219.4
252.4
158.2
220.5
152.7
102.2
199.2
2009
208.4
265.1
204.3
242.7
124.3
82.0
205.5
2010
331.7
284.5
203.0
261.1
172.7
160.7
248.5
2011
326.9
337.4
227.5
305.6
180.6
123.6
270.7
2012
277.8
355.0
237.6
320.6
171.1
145.3
267.6
2013
248.6
286.0
212.7
305.1
171.4
158.1
243.7
2014
246.8
275.7
192.2
276.4
160.6
147.5
227.8
2015
294.1
297.9
209.0
314.0
213.7
198.1
263.0
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Chlamydia infection is frequently asymptomatic.[5] In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate of chlamydia is higher most years in
Pickering, Ajax, and Oshawa than Durham Region as a whole, and lower in Whitby, Clarington, and the northern municipalities (Brock, Scugog and Uxbridge combined).
Page 30 of 47
Figure 24: Gonorrhea Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994
Durham Male Rate
18.9 19.9
Durham Female Rate
21.5 26.3
Ontario Male Rate
31.9 35.2
Ontario Female Rate
24.6 25.4
Durham Male Cases
42
45
Durham Female Cases
48
60
Durham Total Cases
90
105
1995
16.0
18.9
31.7
22.8
37
44
81
1996
13.2
15.6
23.9
18.0
31
37
68
1997
12.1
12.7
20.5
13.5
29
31
60
1998
14.6
15.7
24.0
15.6
36
39
75
1999
15.6
16.1
23.5
15.9
39
41
80
2000
14.0
16.1
29.4
19.3
36
42
78
2001
15.2
16.9
30.5
19.0
39
45
84
2002
12.9
19.5
31.4
19.4
33
53
86
2003
20.3
17.3
33.7
21.0
52
48
100
2004
18.3
16.2
34.7
21.8
47
46
93
2005
21.8
20.0
33.6
19.6
56
58
114
2006
30.8
23.7
39.2
22.3
79
70
149
2007
39.4
23.6
37.8
25.5
101
71
172
2008
36.3
31.1
36.1
25.7
93
95
189
2009
24.9
27.4
32.0
24.7
64
85
149
2010
29.2
24.8
35.5
27.9
75
78
153
2011
32.7
26.6
38.8
28.4
84
85
170
2012
26.5
27.5
38.6
26.9
68
89
157
2013
32.7
22.2
46.1
26.5
84
73
157
2014
44.0
29.8
61.6
31.9
113
99
212
2015
47.9
34.8
63.7
31.3
123
117
240
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Like chlamydia, gonorrhea infections are frequently asymptomatic.[5] In Ontario, gonorrhea is a commonly reported sexually transmitted infection. In Ontario and Durham Region rates
of gonorrhea are higher among males compared to females. Rates of gonorrhea increased in both Durham Region and Ontario from 1997 to 2006, remained relatively stable between
2006 and 2009 and have been increasing again since 2009, especially among males.
Page 31 of 47
Figure 25: Gonorrhea Age-Specific Incidence Rates, Durham Region and Ontario, 2011-2015 Combined
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
15-19
31.5
127.5
45.6
106.7
38
146
184
20-24
134.6
131.0
151.5
130.8
159
148
308
25-29
86.9
74.1
150.9
71.5
86
73
159
30-39
48.6
30.0
89.9
29.6
96
64
160
40-49
26.2
8.3
44.7
10.5
63
21
84
50+
5.6
1.4
10.2
1.9
29
8
37
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department, April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Reported rates of gonorrhea are highest among young adults ages 20 to 24 years and among females ages 15 to 19 years in both Durham Region and Ontario and also among
Ontario males ages 25 to 29. Rates are higher in Ontario males than Durham Region males for all age groups. Rates are similar in Ontario and Durham Region females with the
exception of Durham Region females ages 15 to 19 who have higher rates than Ontario females 15 to 19. Rates among those ages 14 years and younger are excluded due to small
counts.
Page 32 of 47
Figure 26: Gonorrhea Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
33.7
34.0
26.4
46.7
11.8
5.4
30.9
2009
23.8
36.7
18.5
31.9
9.3
12.5
24.0
2010
37.8
40.6
16.7
25.3
6.9
5.4
24.4
2011
36.8
27.2
22.0
33.4
13.6
12.5
26.9
2012
30.1
35.5
17.8
33.8
10.1
5.4
24.5
2013
25.5
33.1
19.9
31.7
13.2
9.0
24.3
2014
40.3
33.5
21.3
50.4
21.7
10.8
32.5
2015
40.1
46.1
26.4
48.1
29.9
10.8
36.5
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Like chlamydia, gonorrhea infections are frequently asymptomatic.[5] In Ontario, gonorrhea is a commonly reported sexually transmitted infection. The rate of gonorrhea is higher most
years in Pickering, Ajax, and Oshawa than Durham Region as a whole, and lower in Whitby, Clarington and the northern municipalities (Brock, Scugog and Uxbridge combined).
Page 33 of 47
Figure 27: Syphilis Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
2.5
1.3
1.7
1.5
1.2
1.2
1.4
1.7
1.9
3.5
1.5
1.2
4.9 12.8 7.6
6.8
9.0
9.2
7.7
7.5
6.2
4.4
6.1
Ontario Rate
5.7
3.9
3.4
2.8
2.3
2.2
2.5
2.6
2.5
4.6
5.4
6.2
9.8 17.7 14.5 12.9 14.1 12.6 12.2 12.5 10.6 11.9 13.2
Durham Male Cases
2
1
1
2
1
1
0
2
3
4
2
3
2
4
4
5
12
21
13
20
14
12
17
Durham Female Cases
9
5
7
5
5
5
7
7
7
15
6
4
26
71
41
36
43
36
35
28
26
17
23
Durham Total Cases
11
6
8
7
6
6
7
9
10
19
8
7
28
75
45
41
55
57
48
48
40
29
40
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Syphilis is a serious sexually transmitted bacterial infection. The early stages of syphilis, primary, secondary, and early latent are considered infectious. [5] The rate of syphilis had
been going down in Ontario until 2001 when it began to increase again, especially among the population of men who have sex with men (MSM). Although rates decreased again
between 2006 and 2013 in both Durham Region and Ontario, rates have increased since 2013 in Ontario and 2014 in Durham Region. Due to small numbers, male and female cases
are combined to create more stable rates.
Page 34 of 47
Figure 28: Chronic Hepatitis B Incidence Rates, Durham Region and Ontario, 1993-2015
Rates and Cases
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Durham Rate
16.9 15.8 10.8 12.5 4.1
5.5
1.6
7.2
9.1 10.6 9.6 13.0 11.9 7.4
7.6
8.5
7.4
5.7
5.4
5.3
6.0
5.4
4.5
Ontario Rate
63.3 54.1 51.3 44.0 34.9 33.9 35.6 36.7 39.2 41.5 36.9 40.0 36.1 32.1 30.0 26.2 25.6 23.3 23.2 20.1 19.6 18.7 15.8
Durham Male Cases
41
32
25
28
8
17
6
25
32
35
35
39
39
26
28
31
31
16
27
17
22
23
16
Durham Female Cases
34
40
25
31
12
10
2
12
16
22
18
34
28
17
17
20
14
19
7
17
17
12
13
Durham Total Cases
75
72
50
59
20
27
8
37
48
57
53
73
68
43
45
51
45
35
34
34
39
35
30
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 1993-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (1993-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Hepatitis is a disease of the liver most commonly caused by a virus. The hepatitis B virus can initially cause an acute infection which may not cause symptoms. If the virus remains in
the blood for more than six months it is considered a chronic infection.[8] Rates of infection are decreasing over time for both Durham Region and Ontario. Due to small numbers, male
and female cases are combined to create more stable rates.
Page 35 of 47
Figure 29: Hepatitis C Incidence Rates, Durham Region and Ontario, 2003-2015
Rates and Cases
Durham Male Rate
Durham Female Rate
Ontario Male Rate
Ontario Female Rate
Durham Male Cases
Durham Female Cases
Durham Total Cases
2003
50.7
28.5
56.6
31.3
130
79
209
2004
57.3
28.5
56.4
29.4
147
81
229
2005
56.9
28.7
47.7
25.4
146
83
229
2006
48.3
22.0
41.5
23.0
124
65
190
2007
36.6
25.6
45.2
28.8
94
77
171
2008
45.2
28.5
45.5
29.8
116
87
203
2009
42.1
21.3
45.7
28.2
108
66
174
2010
40.5
22.9
45.6
26.7
104
72
177
2011
44.0
19.4
41.1
25.6
113
62
177
2012
40.5
19.5
40.6
26.4
104
63
167
2013
40.5
21.3
42.5
24.7
104
70
174
2014
41.3
19.2
42.6
25.1
106
64
170
2015
40.1
17.8
42.4
25.4
103
60
163
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2003-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2003-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2003-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Hepatitis is a disease of the liver most commonly caused by a virus. Hepatitis C is primarily transmitted by blood-to-blood contact.[5] In Ontario hepatitis C is reported more for
prevalence than incidence. Most cases are reported some months/years following infection so higher or lower rates can be misleading. Cases of hepatitis C are seen more often
among men compared to women. Data prior to 2003 are excluded due to inconsistent reporting. Rates of hepatitis C have remained relatively stable in both Durham Region and
Ontario since 2007 and are higher among males than females.
Page 36 of 47
Figure 30: Hepatitis C Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
29.3
13.2
25.5
54.0
10.7
30.5
33.2
2009
14.0
15.6
15.3
52.7
20.9
21.4
28.0
2010
11.9
23.5
19.1
57.0
15.0
23.2
28.3
2011
13.0
17.5
21.3
58.4
22.7
12.5
28.0
2012
17.2
12.1
20.1
52.3
20.1
17.9
26.1
2013
18.1
17.8
13.8
57.7
17.6
19.8
26.9
2014
10.6
14.2
16.7
54.2
23.9
19.8
25.8
2015
14.8
12.3
17.4
52.4
19.2
16.2
24.8
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
Hepatitis is a disease of the liver most commonly caused by a virus. Hepatitis C is primarily transmitted by blood-to-blood contact.[5] In Ontario hepatitis C is reported more for
prevalence than incidence. Most cases are reported some months/years following infection so higher or lower rates can be misleading. The rate of hepatitis C infection is consistently
higher in Oshawa than in other Durham Region municipalities, and higher than in Durham Region as a whole.
Page 37 of 47
Tuberculosis
Tuberculosis (TB) presents itself in two different forms: active TB disease and latent tuberculosis infection (LTBI). The majority of individuals infected have LTBI and about 10% will
eventually develop active disease.[9] Appropriate completion of treatment for LTBI can considerably reduce the lifetime risk of developing active TB disease.
Page 38 of 47
Figure 31: Latent Tuberculosis Infection Incidence Rates, Durham Region and Ontario, 2006-2015
Rates and Cases
2006 2007 2008 2009 2010 2011 2012 2013
Durham Male Rate
23.7 28.3 35.0 28.4 24.8 17.2 26.3 18.9
Durham Female Rate
50.2 44.9 53.3 43.3 48.9 40.4 42.3 41.4
Ontario Male Rate
63.3 71.7 79.2 74.2 75.1 74.9 61.3 55.7
Ontario Female Rate
80.1 86.5 84.3 77.8 75.3 76.7 73.6 71.5
Durham Male Cases
70
85
107
88
78
55
85
62
Durham Female Cases 148
135
163
134
154
129
137
136
Durham Total Cases
218
220
270
222
234
186
222
198
2014
26.2
52.3
48.2
72.9
87
174
263
2015
24.4
59.4
44.1
67.7
82
200
283
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2006-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2006-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2006-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
Latent tuberculosis infection (LTBI) rates have remained fairly stable in both Durham Region and Ontario although rates have decreased among Ontario males since 2011. LTBI rates
are consistently higher among Durham Region females than males and have been increasing since 2013 but remain lower than Ontario rates.
Page 39 of 47
Figure 32: Latent Tuberculosis Infection Incidence Rates, Durham Region by Municipality, 2008-2015
Rates by Municipality
Pickering
Ajax
Whitby
Oshawa
Clarington
North Durham
Durham Region
2008
44.5
61.5
34.6
39.5
22.5
17.9
44.2
2009
37.8
62.4
27.4
33.8
13.9
5.3
35.7
2010
32.4
46.1
44.6
38.2
16.1
16.1
37.4
2011
39.0
34.2
26.0
29.5
14.8
16.1
29.4
2012
31.2
54.5
38.7
33.1
19.0
17.9
34.7
2013
38.2
45.0
32.9
31.1
13.2
7.2
30.6
2014
27.5
75.4
38.0
49.7
11.9
9.0
40.3
2015
47.4
76.5
39.2
46.8
13.9
9.0
43.0
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2008-2015, extracted by Durham Region Health Department April 2016;
and Population Estimates, Durham Region Planning & Economic Development Committee, Commissioner’s Report 2013-P-23, February 19, 2013 and Commissioner’s Report 2015-P-55, September
9, 2015.
The rate of latent tuberculosis infection is consistently higher in Ajax than in Durham Region as a whole, while rates are lower in Clarington and the northern municipalities (Brock,
Scugog and Uxbridge combined). Pickering, Whitby and Oshawa have rates similar to Durham Region as a whole.
Page 40 of 47
Age Standardized Incidence Ratios for Selected Reportable Diseases
An age standardized incidence ratio (SIR) is the ratio of the number of cases observed in the population of interest to the number of cases that would be expected if the population had
the same age-specific incidence rates as a standard population. Ontario is used here as the standard population. Since statistical estimates may be unstable when the number of
events is small, confidence intervals (CIs) are used to determine whether an SIR is statistically different from 1. 95% CIs are represented in the following graphs by upright bars. If
these bars cross 1 this means that the Durham incidence rate is no different from Ontario. An SIR and CIs greater than 1 indicate that the incidence rate is higher in Durham than
Ontario, whereas an SIR and CIs less than 1 indicate that incidence is lower in Durham.
Page 41 of 47
Figure 33: Age-Standardized Incidence Ratios for Selected Reportable Diseases, Durham Region Males, 2011-2015 Combined
SIR and
Confidence
Intervals
SIR
Lower
Confidence
Interval
Upper
Confidence
Interval
Enteric
Disease
Campylobacter
All STIs * &
Salmonellosis Giardiasis
Enteritis
Bloodborne
Chlamydia
Gonorrhea
Chronic
Hepatitis B
Hepatitis
C
VDPs * Minus
Influenza
Influenza
Pertussis
LTBI *
IPD *
0.85
0.97
1.01
0.77
0.84
0.93
0.65
0.40
0.87
0.79
0.64
0.41
0.42
0.99
0.80
0.89
0.90
0.65
0.82
0.90
0.59
0.32
0.80
0.68
0.59
0.24
0.37
0.83
0.90
1.06
1.12
0.90
0.87
0.97
0.71
0.48
0.95
0.90
0.70
0.57
0.46
1.16
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
* STI = Sexually Transmitted Infection; VPD = Vaccine Preventable Disease; LTBI = Latent Tuberculosis Infection; IPD = Invasive Pneumococcal Disease
Durham Region males had significantly lower incidence rates for all enteric diseases, giardiasis, all STIs and bloodborne diseases, chlamydia, gonorrhea, hepatitis B carriers, hepatitis
C, all VPDs (excluding influenza), influenza, pertussis, and latent tuberculosis infection as compared to Ontario. Incidence rates were similar in Durham Region and Ontario males for
Campylobacter enteritis, salmonellosis, and IPD.
Page 42 of 47
Figure 34: Age-Standardized Incidence Ratios for Selected Reportable Diseases, Durham Region Females, 2011-2015 Combined
SIR and
Confidence
Intervals
SIR
Lower
Confidence
Interval
Upper
Confidence
Interval
Enteric
Disease
Campylobacter
All STIs * &
Salmonellosis Giardiasis
Enteritis
Bloodborne
Chlamydia
Gonorrhea
Chronic
Hepatitis B
Hepatitis
C
VDPs * Minus
Influenza
Influenza
Pertussis
LTBI *
IPD *
0.92
0.96
1.09
0.80
0.93
0.94
1.04
0.31
0.84
0.77
0.62
0.53
0.65
0.96
0.87
0.86
0.98
0.64
0.91
0.91
0.94
0.24
0.75
0.65
0.57
0.36
0.61
0.78
0.98
1.05
1.20
0.96
0.96
0.96
1.13
0.39
0.93
0.89
0.67
0.70
0.70
1.13
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
* STI = Sexually Transmitted Infection; VPD = Vaccine Preventable Disease; LTBI = Latent Tuberculosis Infection; IPD = Invasive Pneumococcal Disease
Durham Region females had significantly lower incidence rates for all enteric diseases, giardiasis, all STIs and bloodborne diseases, chlamydia, hepatitis B carriers, hepatitis C, all
VPDs (excluding influenza), influenza, pertussis, and latent tuberculosis infection as compared to Ontario. Incidence rates were similar in Durham Region and Ontario females for
Campylobacter enteritis, salmonellosis, gonorrhea, and IPD.
Page 43 of 47
Figure 35: Age-Standardized Incidence Ratios for Selected Reportable Diseases, Durham Region, 2011-2015 Combined
SIR and
Confidence
Intervals
SIR
Lower Confidence
Interval
Upper Confidence
Interval
Infectious
Syphilis
NonInfectious
Syphilis
Hepatitis A
VTEC *
Yersiniosis
Amebiasis
Shigellosis
IMD *
Group A
Streptococcus,
Invasive
TB *
0.37
0.85
0.54
0.83
0.69
0.56
1.04
0.48
0.39
1.31
0.68
0.42
0.29
0.70
0.25
0.57
0.45
0.40
0.70
0.38
0.24
0.50
0.55
0.32
0.46
0.99
0.84
1.10
0.93
0.72
1.39
0.58
0.54
2.12
0.81
0.53
Cryptosporidiosis Cyclosporiasis
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 2011-2015, extracted by Durham Region Health Department April 2016;
iPHIS, Ontario, 2011-2015, Public Health Ontario, Accessed April 2016; and Ontario Population Estimates/Projections (2011-2015), Ontario Ministry of Health and Long-Term Care, Accessed April
2016.
* VTEC = Verotoxin-producing Escherichia coli; IMD = Invasive Meningococcal Disease; TB = Tuberculosis
Durham Region residents had significantly lower incidence rates for infectious syphilis, non-infectious syphilis, hepatitis A, yersiniosis, cryptosporidiosis, amebiasis, shigellosis,
invasive group A streptococcus and TB as compared to Ontario. Incidence rates were similar in Durham Region and Ontario for verotoxin-producing Escherichia coli, cyclosporiasis
and invasive meningococcal disease.
Page 44 of 47
Number of Confirmed Cases of Selected Reportable Diseases in Durham Region
Reportable Disease
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Acute Flaccid Paralysis
---------------------1
0
Adverse Events Following
-------------12
40
27
85
41
54
48
64
77
80
Immunization (AEFIs)
Amebiasis *
4
8
8
9
3
7
3
6
1
13
13
20
7
6
10
10
13
21
15
13
19
24
19
Botulism *
0
0
0
0
0
0
0
0
0
0
0
0
0
2
1
0
0
0
0
0
0
0
0
Brucellosis *
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
1
0
1
Campylobacter enteritis *
269 307 310 209 205 200 136 171 219 174 165 167 140 155 155 156 146 127 143 184 195 192 129
Chlamydia trachomatis
499 463 385 405 369 470 529 510 594 686 756 818 915 1,024 1,019 1,218 1,278 1,556 1,714 1,712 1,577 1,485 1,731
infections
Cholera
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
0
Creutzfeldt-Jakob Disease, all
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
0
1
2
0
0
types
Cryptosporidiosis *
0
0
0
2
5
6
10
5
4
6
12
6
10
15
12
8
4
10
8
9
6
10
14
Cyclosporiasis *
0
0
0
0
0
0
0
0
0
1
0
6
6
2
1
5
3
4
9
5
5
6
10
Encephalitis – Primary, viral *
5
13
4
6
9
8
6
4
7
1
11
7
1
0
0
0
0
0
0
1
2
0
1
Encephalitis – Unspecified *
0
2
1
4
2
4
4
4
2
1
2
1
0
0
1
0
0
0
0
1
0
0
0
Encephalitis/Meningitis *
1
1
1
1
0
5
4
4
11
5
8
8
7
7
12
7
4
11
12
0
0
0
0
Food poisoning, all causes *
0
0
0
0
0
0
0
0
0
0
0
0
1
0
0
2
1
6
18
4
8
0
1
Giardiasis *
113
98
72
89
91
55
49
35
34
60
49
56
39
62
46
58
54
38
39
55
51
55
53
Gonorrhoea
90 105
81
68
60
75
80
78
84
86 100
93 114 149 172 189 149 153 170 157 157 212 240
Group A Streptococcal Disease,
1
0
3
10
10
11
7
9
11
20
27
11
18
11
15
18
10
19
23
15
19
25
18
invasive (iGAS)
Group B Streptococcal disease,
0
0
0
4
4
2
2
2
3
4
4
2
1
3
0
2
1
2
4
1
6
1
3
neonatal
Haemophilus influenzae type b
2
1
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
1
0
disease, invasive
Hemorrhagic fevers - other viral
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
causes
Hepatitis A *
4
3
10
16
7
13
3
6
0
7
9
4
3
5
2
2
3
6
3
4
3
2
1
Hepatitis B - acute cases
8
2
10
6
2
0
0
1
0
2
1
1
0
5
5
1
0
0
0
1
1
6
2
Hepatitis B - carriers
75
72
50
59
20
27
8
37
48
57
53
73
68
43
45
51
45
35
34
34
39
35
30
Hepatitis C
----------- 209 229 229 190 171 203 174 177 177 167 174 170 163
HIV/AIDS
31
29
15
16
9
15
8
10
7
10
10
14
9
13
12
17
8
10
7
12
16
15
16
Influenza
26
8
22
54
24 132 125
34
45
92 179
26 176
91 101 147 536
72
90 204 230 450 225
Legionellosis *
2
2
0
4
3
5
4
0
2
1
7
1
3
5
2
5
3
8
14
12
21
8
12
Leprosy
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
0
1
0
1
0
0
0
0
Listeriosis
3
0
3
0
0
1
0
1
0
0
1
2
1
0
1
0
1
0
4
2
2
1
3
Page 45 of 47
Reportable Disease
Lyme Disease *
Malaria
Measles *
Meningitis - bacterial
Meningitis - other
Meningitis - viral
Meningococcal disease,
invasive *
Mumps *
Paratyphoid Fever
Pertussis (Whooping Cough) *
Q Fever
Rubella *
Salmonellosis *
Shigellosis *
Streptococcus pneumoniae,
invasive *
Syphilis, infectious
Syphilis, non-infectious
Tuberculosis - active cases
Tuberculosis - latent TB
infection (LTBI)
Tuberculosis - medical
surveillance cases
Tularemia *
Typhoid Fever
Verotoxin producing E. coli
including Haemolytic Uraemic
Syndrome (HUS) *
West Nile Virus Illness *
Yersiniosis *
1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
1
2
18
3
0
0
1
1
11
2
0
0
0
5
12
5
0
0
1
2
3
8
0
0
1
0
1
4
0
0
0
2
0
1
0
0
1
0
0
4
0
0
0
3
2
3
0
0
0
1
0
3
0
0
0
2
0
2
0
0
0
0
0
0
0
0
1
2
0
2
0
0
0
4
0
0
0
0
1
3
0
0
0
3
6
1
0
0
0
0
0
3
2
0
0
0
1
0
0
0
0
0
4
6
0
0
0
0
1
4
0
0
0
0
3
8
1
1
0
16
12
12
0
3
0
10
14
8
0
4
0
6
17
6
0
0
1
11
2
6
3
8
2
4
2
0
6
3
1
1
1
2
4
2
5
3
1
3
1
2
3
8
1
25
0
7
100
15
7
0
98
0
7
100
10
9
1
92
1
3
93
13
2
0
93
2
1
94
5
5
0
88
0
1
82
14
1
0
83
0
0
97
9
3
0
56
0
0
39
3
1
0
27
0
0
88
7
3
0
28
0
0
104
4
1
0
11
0
0
122
45
0
1
24
1
0
91
9
1
0
48
0
0
87
6
0
1
41
1
0
118
6
0
0
53
0
0
111
6
0
0
51
1
0
153
12
0
1
33
0
0
111
3
2
0
8
1
0
114
8
1
0
0
0
0
138
6
7
1
4
1
0
137
7
1
1
20
3
0
150
4
0
1
7
1
0
138
6
0
0
13
5
0
141
6
0
2
17
4
0
154
3
--
--
--
--
--
--
--
--
--
--
40
47
44
24
46
43
51
56
56
57
45
48
43
2
9
3
1
5
8
1
7
12
2
5
10
1
5
8
1
5
15
0
7
14
2
7
9
3
7
18
4
15
9
2
6
11
3
4
11
2
26
6
4
71
7
4
41
14
5
36
15
12
43
12
21
36
9
13
35
15
20
28
7
14
26
9
12
17
12
17
23
17
--
--
--
--
--
--
--
--
--
--
--
249
246
218
220
270
222
234
186
222
198
263
283
17
24
11
22
42
37
33
40
48
49
62
54
58
59
64
50
50
55
59
49
48
51
59
0
1
0
0
0
0
0
0
0
0
0
1
0
0
0
0
0
1
0
2
1
0
0
0
0
1
0
0
0
2
0
5
0
0
0
0
0
3
0
3
0
3
0
3
0
0
18
14
26
18
14
11
4
19
13
11
7
8
18
12
13
9
8
11
8
8
13
1
8
0
15
0
19
0
25
0
16
0
11
0
9
0
3
0
8
0
8
2
8
0
8
0
8
0
8
0
14
1
7
1
3
0
7
1
5
2
4
8
6
3
6
0
5
2
10
Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iPHIS) database, 1993-2015, extracted by Durham Region Health Department, April 2016.
* Probable cases included along with confirmed cases for these diseases from 2009 onward to enable comparison to previous years as a result of changes to case definitions in 2009.
-- indicates data not available
Reportable diseases with no cases reported in Durham Region since 1993 include: chancroid; diptheria; Ebola virus disease; hantavirus pulmonary syndrome; Lassa Fever; Marburg
virus disease; paralytic shellfish poisoning; plague; poliomyelitis, acute; psittacosis/ornithosis; rabies (human); rubella, congenital syndrome; Severe Acute Respiratory Syndrome
(SARS); smallpox; tetanus; trichinosis; and yellow fever.
Page 46 of 47
References
1. Health Protection and Promotion Act, RSO 1990, c H7. Available from: http://www.e-laws.gov.on.ca/html/statutes/english/elaws_statutes_90h07_e.htm
2. Ontario Ministry of Health and Long-Term Care. Infectious Diseases Protocol, 2015. Toronto, ON: Queen’s Printer for Ontario, 2015. Retrieved May 10, 2016. Available from:
http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/infdispro.aspx
3. Ontario Ministry of Health and Long-Term Care. Infectious Diseases Protocol, 2015. Appendix B: Provincial Case Definitions. Toronto, ON: Queen’s Printer for Ontario, 2015.
Retrieved May 10, 2016. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/infdispro.aspx
4. Ontario Ministry of Health and Long-Term Care. Ontario Public Health Standards 2008. Toronto, ON: Queen’s Printer for Ontario, 2015. Retrieved May 10, 2016. Available from:
http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/default.aspx
5. Ontario Ministry of Health and Long-Term Care. Infectious Diseases Protocol, 2015. Appendix A: Disease-Specific Chapters. Toronto, ON: Queen’s Printer for Ontario, 2015.
Retrieved May 10, 2016. Available from: http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/infdispro.aspx
6. Public Health Ontario. Immunization coverage report for school pupils: 2010/11 school year. Toronto, ON: Public Health Ontario, 2012.
7. Toronto Public Health. Communicable Diseases in Toronto 2014. City of Toronto: Toronto, Canada. February 2016. Retrieved May 10, 2016. Available from :
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