Download Infectious Diseases Within the HKPR District REPORT JULY 2010

Infectious Diseases Within the HKPR District
REPORT
JULY 2010
Executive Summary……………………………………………………...
Introduction………………………………………………………………
Campylobacteriosis………………………………………………………
Chlamydia………………………………………………………………...
Cryptosporidiosis………………………………………………………...
Giardiasis…………………………………………………………………
Hepatitis C………………………………………………………………..
Influenza………………………………………………………………….
Salmonellosis……………………………………………………………..
Streptococcal Pneumoniae Disease……………………………………..
Glossary…………………………………………………………………..
2-3
4
5-7
8-10
11-13
14-16
17-19
20-22
23-25
26-28
29-31
Any questions, suggestions, or requests for further information pertaining to this report
may be directed to:
Department of Epidemiology and Evaluation Services,
Haliburton, Kawartha, Pine Ridge District Health Unit
200 Rose Glen Road
Port Hope, Ontario
L1A 3V6
Tel: (905) 885 9100
Email: mailto:[email protected]
Website: http://www.hkpr.on.ca/
1
Executive Summary
Introduction
Infectious diseases can easily be spread among people, resulting in mild to severe illness
for infected individuals. Because of the contagious nature of these illnesses, health care
providers, laboratories and long-term care homes in Ontario are required by law to report
infectious diseases to the public health unit in their area.
As part of its mandate, the Haliburton, Kawartha, Pine Ridge (HKPR) District Health
Unit investigates cases of infectious diseases and works with other agencies to control
outbreaks. This service is one of the many public health programs provided by the HKPR
District Health Unit to residents of Haliburton County, Northumberland County and the
City of Kawartha Lakes. The HKPR region, with its approximate 170,000 population,
encompasses a large part of Central Ontario.
The HKPR District Health Unit has prepared this report, Infectious Diseases Within the
HKPR District, to outline incidence rates of eight most common infectious diseases
within its region between 2000 and 2008. Statistics for the HKPR region are also
compared with disease data for all of Ontario and Canada.
Key Findings
A list of infectious diseases included in this report, as well as a snapshot of their rates
over the past decade in the HKPR region, are provided below:
Campylobacteriosis
•
Between 2000 and 2008, the campylobacteriosis rate for the HKPR region was
much lower than the provincial number. However, 2005 is an exception, and this
might have may resulted from two campylobacteriosis outbreaks reported in the
area that year.
Chlamydia
•
Rates of chlamydia have been increasing in the HKPR region since 2000. This
rising trend is reflected in rates for Canada between 1989 and 2004, and for
Ontario from 2000 to 2008.
2
Cryptosporidiosis
•
Over the past decade, cryptosporidiosis rates in the HKPR region peaked in 2006,
then declined during the subsequent two years. Rates for Ontario have remained
consistent from 2000 to 2008.
Giardiasis
•
In recent years, cases of giardiasis have been in steady decline across Ontario and
Canada. A similar trend was observed in the HKPR region from 2000 to 2004,
with slight variations in giardiasis rates during the subsequent four years.
Hepatitis C
•
Since 2002, the rate of Hepatitis C in the HKPR region has remained slightly
above the provincial rate. This may be due in part to the presence of large
correctional facilities in this area.
Influenza
•
A marked increase in influenza cases within the HKPR region was recorded
during the 2004/05, 2006/07 and 2007/08 flu seasons, reflecting a similar jump in
rates for Canada and Ontario in those years.
Salmonellosis
•
Between 2000 and 2008, the number of salmonellosis cases reported in the HKPR
region tended to mirror the provincial rate for the same time period. Locally, a
peak in salmonellosis cases was observed in 2006, although a common source of
infection was not identified.
Streptococcal Pneumoniae Disease
•
Streptococcal pneumoniae Disease or Invasive Pneumococcal Disease (IPD) was
added to the list of reportable diseases in 2002. From 2003 to 2008, the provincial
rate remained relatively stable. Within the HKPR region, the IPD cases in the
HKPR region have gone up and down between 2002 and 2008, with numbers
peaking in 2007.
More detailed statistics and graphs for each of these infectious diseases are provided in
the full report.
3
Introduction
Health units in Ontario are required by law to track the spread of infectious diseases
within their regions, including trends and the risk to public health. According to the
Health Protection and Promotion Act, health care providers, laboratories and long-term
care homes must report certain infectious diseases to their local Health Unit. Staff with
the Health Unit will investigate these cases and work with other agencies to control any
outbreaks. The Health Unit is also responsible for reporting these diseases to the Ontario
Ministry of Health and Long-Term Care.
The Haliburton, Kawartha, Pine Ridge (HKPR) District Health Unit is continuously
tracking and investigating infectious diseases in Haliburton County, Northumberland
County and the City of Kawartha Lakes. This report, Infectious Diseases Within the
HKPR District, provides an overview and statistics of certain diseases reported in the
region between 2000 and 2008. It also compares disease data for this region with national
and provincial rates.
An analysis of the following reportable diseases is provided:
•
•
•
•
•
•
•
•
Campylobacteriosis
Chlamydia
Cryptosporidiosis
Giardiasis
Hepatitis C
Influenza
Salmonellosis
Streptococcal Pneumoniae Disease
Note: When interpreting this data, consider that the number of cases of a disease reported
to the Health Unit may not reflect its true extent. For many reportable diseases, only a
small percentage of individuals who have symptoms seek medical attention and receive
testing in the lab.
Those diseases with fewer than 5 cases reported annually were not included in this
report.
4
Campylobacteriosis
Description
Campylobacteriosis is the most common bacterial infection in the world. People can
become ill from it when they eat undercooked meat, drink contaminated water and
consume unpasteurized milk. Campylobacteriosis can also be spread to humans when
they come in contact with infected animals (including pets) and contaminated surfaces
such as cutting boards, counters and utensils. Children under the age of five years and
young adults have the highest occurrence of this infection. People with compromised
immune systems are also at a greater risk.
Symptoms
Symptoms of campylobacteriosis include diarrhea, abdominal pain, fatigue, fever, nausea
and vomiting. These symptoms usually appear between two and 10 days after initial
exposure to the bacteria. Symptoms can range from mild to severe, and may be recurring.
Complications from the disease may occur, including typhoid-like syndrome, arthritis,
convulsions, and meningitis (inflammation of the lining of the brain). Another
complication is Guillain-Barré Syndrome, a potentially life-threatening illness that causes
progressive weakness and paralysis.
Prevention and Control
To reduce the risk of campylobacteriosis, thoroughly cook meat and poultry. In the
kitchen, clean work surfaces to ensure raw or undercooked meat does not come into
contact with ready-to-eat foods. People who work with domestic animals should also use
proper hand hygiene at all times.
Data Trends
In Canada from 1989 to 2004, campylobacteriosis was the most frequently reported
enteric illness. However during this time period, there was a decreasing trend in the
illness provincially and across Canada. The following graph shows the number of cases
of campylobacteriosis in the HKPR District Health Unit region between 2000 and 2008.
The HKPR rate shows a similar trend, except for the year 2005 when the incidence rate
peaked locally at 45 cases per 100,000 population.
5
Number of Campylobacter enteritis cases in HKPR District Health Unit
region, 2000-2008
Number of confirmed cases
100
80
60
40
20
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
The following graph compares the local and provincial rates of campylobacteriosis cases
between 2000 and 2008. In most years, the rate for the HKPR region is much lower than
the provincial number. However, 2005 is an exception, and this may result from two
campylobacteriosis outbreaks reported in the HKPR region that year.
Incidence rates of Campylobacter enteritis in HKPR District Health
Unit region in comparison to Ontario rates
50.0
45.0
40.0
35.0
Rate
30.0
25.0
20.0
15.0
10.0
HKPR rate
5.0
0.0
ON rate
2000
2001
2002
2003
2004
2005
2006
2007
2008
HKPR rate
31.0
40.8
29.5
34.3
27.6
45.2
25.7
33.1
27.7
ON rate
42.0
44.0
38.0
33.2
32.8
29.5
30.0
30.1
29.2
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
6
While further analysis by age, gender and seasonality was not completed, the number of
reported cases of campylobacteriosis peaks during the warmer months. This is due to
people having greater contact with environmental sources of contamination and increased
exposure to high-risk foods at this time of year.
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.81-84.
Public Health Agency of Canada. Campylobacteriosis –Notifiable Diseases On-Line.
Cited July 3rd, 2009 from
<http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/diseases/camp-eng.php>
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Campylobacteriosis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July
3rd, 2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=086&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
7
Chlamydia
Description
Chlamydia trachomatis infections are one of the most common sexually transmitted
infections (STIs). These infections occur around the world, and are spread through sexual
intercourse.
Symptoms
Most infected people show no symptoms of chlamydia. Up to 70 per cent of women, and
10 to 25 per cent of men, may be unaware they are infected with it. The main symptom of
chlamydia in men is urethritis, while among females it is cervical infection. Chlamydia
has similar symptoms to gonorrhea, such as moderate or small amounts of discharge,
itching in the urethra and a burning sensation when urinating. Women may also
experience lower abdominal pain and abnormal vaginal bleeding between periods. If left
untreated in women, chlamydia infections can lead to pelvic inflammatory disease,
problematic pregnancies, infertility and chronic pain in the pelvic area. Chlamydia rates
among sexually-active youth can range from 15 to 25 per cent.
Prevention and Control
Practising safer sex, using condoms and limiting the number of sexual partners are all
important ways to prevent chlamydia. Young women should be screened regularly for
chlamydia, especially when they become pregnant. Early diagnosis and treatment is key
to controlling the infection, as is notifying any sexual partner who could be at risk.
Data Trends
Genital chlamydia is the most commonly reported STI, with rates rising steadily across
Canada between 1989 and 2004, and in Ontario from 2000 to 2008. The HKPR region
has seen a similar increase since 2000, as shown in the following graph.
8
Number of Chlamydia cases in HKPR District Health Unit
region, 2000-2008
Number of confirmed cases
220
200
180
160
140
120
100
80
60
40
20
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
The incidence rate of chlamydia varies significantly between age groups. This makes age
standardization necessary to compare local and provincial rates.
Age standardization is used to compare incidence rates of disease between populations
with different age distributions. For example, STIs such as chlamydia are more common
among 15-to-24 year olds. Consequently, a population with a higher proportion of this
age group will have a higher overall incidence rate of STIs. To determine which
population has a higher incidence rate regardless of age distribution, the rates must be age
standardized.
Using age standardization rates as shown below, the HKPR region has a lower chlamydia
rate than the rest of Ontario since 2000.
9
Age-Standardized Incidence rates
(Per 100,000 population)
Age Standardized Incidence Rate of Chlamydia in HKPR District Health
Unit region and Ontario, 2000-2008
250
200
150
100
50
ON
0
2003
2004
2005
HKPR
2000
2001
2002
2006
2007
2008
ON
140.5
152.4
170.9
180.2
189.7
195.4
199.2
201.9
226.5
HKPR
40.7
63.7
96.2
126.4
157.9
168.7
179.9
162.3
160.1
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.100-103.
Public Health Agency of Canada. Genital Chlamydiosis –Notifiable Diseases On-Line.
Cited July 3rd, 2009 from
< http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/diseases-maladies/chlamyd-eng.php>
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Genital Chlamydiosis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July
3rd, 2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=138&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
10
Cryptosporidiosis
Description
Cryptosporidiosis is a condition caused by a parasite known as Cryptosporidium parvum.
A person can develop this condition by ingesting food or water that has become
contaminated with feces. This ‘fecal oral route’ is one of the main ways that people get
sick from cryptosporidiosis. Direct person-to-person, or animal-to-person transmission,
may also occur. Outbreaks of cryptosporidiosis are often linked to consuming unsafe
drinking water or swallowing contaminated water from a lake, river or swimming pool.
People who are at a greater risk of cryptosporidiosis include very young children,
travelers, animal handlers, people with compromised immune systems and men who have
sex with men.
Symptoms
Diarrhea is a major symptom, and is usually combined with cramping and abdominal
pain. Other symptoms include weight loss, anorexia and nausea. In certain cases, no
visible symptoms may be present.
Prevention and Control
Proper handwashing is the most effective way to prevent the spread of cryptosporidiosis.
Boiling drinking water is advisable if there is a concern about water quality. Individuals
who show symptoms of cryptosporidiosis should stay home, especially if they work with
children or prepare food. To reduce person-to-person and animal-to-person transmission,
personal hygiene and the safe disposal of feces should be emphasized.
Data Trends
Cryptosporidiosis rates in Canada remained steady between 2000 and 2004, with one
exception. In 2001, a spike in cases was attributed to a waterborne cryptosporidiosis
outbreak in Saskatchewan. In Ontario, the rate has remained consistent from 2000 to
2008. Cryptosporidiosis rates in the HKPR region peaked in 2006, and then declined
during the subsequent two years. The following graph provides more detail on local
cryptosporidiosis cases.
11
Number of confirmed cases
Number of Cryptosporidiosis cases in HKPR District Health Unit
region, 2000 - 2008
20
16
12
8
4
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
In the graph below, a comparison of local and provincial cryptosporidiosis rates is
provided.
Incidence rates of Cryptosporidiosis in HKPR District Health Unit
region in comparison to Ontario rates
10
9
8
7
Rate
6
5
4
3
2
1
0
HKPR rate
ON rate
2000
2001
2002
2003
2004
2005
2006
2007
2008
HKPR rate
1
4.3
4.7
5.8
5.7
5.2
8.6
5.0
4.0
ON rate
2
2
2
2.2
2.4
2.1
3.1
3.1
2.6
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
Cryptosporidiosis rates in the HKPR region were consistently higher than the provincial
numbers (further analysis based on age, sex or seasonality was not completed). A jump in
local cases during 2006 reflects the increase in cryptosporidiosis cases reported that year
in Ontario. Using early warning data, a provincial investigation into cryptosporidiosis
found an increase in reported cases during August 2006. However, a common exposure
or risk factor was not identified.
12
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.138-141.
Public Health Agency of Canada. Cryptosporidium parvum – Material Safety Data Sheet
(MSDS). [Online] Cited July 3rd, 2009 from
http://www.phac-aspc.gc.ca/msds-ftss/msds48e-eng.php
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Cryptosporidiosis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July 3rd,
2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=176&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
Dalloo A, Lacroix C. (2007) Cryptosporidiosis Investigation in Ontario – October 2006.
Canadian Field Epidemiology Program. Ottawa, ON.
13
Giardiasis
Description
Giardiasis is caused by the parasite Giardia lamblia. While this parasite can be found in
animal and human feces, it also thrives in warm, still bodies of water such as ponds and
stagnant lakes. The infection is mainly spread when an object such as food or water
becomes contaminated with feces, and is then ingested by an individual. Giardiasis
occurs worldwide in areas of poor sanitation. In North America, it is common in
childcare centres where children are not yet toilet-trained.
Symptoms
Symptoms include chronic diarrhea, abdominal cramps and bloating, fatigue and weight
loss. Complications such as arthritis and damage to cells that line the intestine can also
result from giardiasis, especially in cases of prolonged infection.
Prevention and Control
Proper hand hygiene and avoiding contaminated water sources are the best ways to
prevent giardiasis. If individuals show symptoms of the infection, they should not use
swimming pools, water slides, hot tubs and other recreational water settings frequented
by others. If drinking water supplies are exposed to human or animal fecal contamination,
they should be filtered, cleaned and chlorinated before use to reduce the risk of infection.
Data Trends
In recent years, cases of giardiasis have been in steady decline across Ontario and
Canada. A similar trend was observed in the HKPR region from 2000 to 2004, with slight
variations in giardiasis rates during the subsequent four years. However, the number of
giardiasis cases reported in the HKPR region in 2008 is significantly lower when
compared to the year 2000. The following graph provides more details on local rates of
the infection.
14
Number of confirmed cases
Number of Giardiasis cases in HKPR District Health Unit
region, 2000-2008
50
45
40
35
30
25
20
15
10
5
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
In the graph below, incidence rates for giardiasis are compared between Ontario and the
HKPR region. Because of the variability in local rates, it is difficult to determine whether
the trend is significantly different than the Ontario rates.
Incidence rates of Giardiasis in HKPR District Health Unit region
in comparison to Ontario rates
30.0
25.0
Rate
20.0
15.0
10.0
5.0
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
HKPR rate
24.0
24.1
9.4
10.5
12.6
14.9
9.7
19.4
13.0
ON rate
17.0
18.0
16.0
13.2
12.6
12.7
12.1
12.5
12.1
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
15
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.229-231.
Public Health Agency of Canada. Giardiasis –Notifiable Diseases On-Line. Cited July
3rd, 2009 from
<http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/diseases/giar-eng.php>
Public Health Agency of Canada. Giardia lamblia – Material Safety Data Sheet (MSDS).
(Online) Cited July 3rd, 2009 from <http://www.phac-aspc.gc.ca/msds-ftss/msds71eeng.php>
Public Health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Giardiasis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July 3rd, 2009
from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=043&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
16
Hepatitis C
Description
Hepatitis C Virus (HCV) is a bloodborne infectious disease. While Hepatitis C cases
occur around the world, its existence was only proven conclusively in 1989. HCV can
cause inflammation of the liver and, over time, lead to cirrhosis (extensive scarring that
affects liver function). Exposure to blood or blood products infected with HCV is the
main way it is spread to others. Injection drug users, hemophilia patients and
hemodialysis patients have a higher risk of infection. Rates of HCV infection were also
higher among recipients of blood, tissues and other organs prior to 1990. Since then, a
major improvement in screening procedures used to detect the infection in blood products
has been implemented. In Canada, 10 to 20 new cases of HCV per 100,000-population
are reported each year.
Symptoms
The majority of people with HCV show no symptoms. Those who do will typically
experience symptoms six to seven weeks after infection. Jaundice (yellowing of the skin
and eyes) can occur in 20 to 30 per cent of HCV cases. Other symptoms can include
feeling of uneasiness, loss of appetite, stomach pain, fatigue and dark urine.
Approximately one-quarter of individuals who are infected with acute Hepatitis C
recover without the need for treatment. Annually, one per cent to five per cent of people
who are infected will HCV die from chronic liver disease, liver damage and liver cancer.
Prevention and Control
Limiting exposure to contaminated blood or blood products and encouraging the use of
sterile needles are the best ways reduce the risk of HCV. Equipment used for tattoos,
body piercing and acupuncture should be sterilized. Homemade or reused equipment such
as needles and ink should be avoided.
Data Trends
National rates of HCV decreased from 1998 to 2004. In Ontario, HCV rates dropped
from 49 cases per 100,000-population in the year 2000 to 35 cases per 100,000population in 2008. In the HKPR region, Hepatitis C cases rose slightly from 2000 to
2004, and have since been in decline. The following graph gives a detailed year-by-year
breakdown of local HCV rates for the 2000 to 2008 period.
17
Number of confirmed cases
Number of Hepatitis C cases in HKPR District Health Unit region,
2000-2008
150
135
120
105
90
75
60
45
30
15
0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
The graph below compares the HCV rates for the HKPR region and the rest of Ontario
from 2000 to 2008. Since 2002, the local rate of HCV has remained slightly above the
provincial rate, and this may be due to the presence of large correctional facilities in this
area.
Incidence rates of Hepatitis C in HKPR District Health Unit region
in comparison to Ontario rates
120.0
100.0
Rate
80.0
60.0
40.0
20.0
HKPR rate
ON rate
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
HKPR rate
36.0
43.9
51.0
65.0
71.0
59.0
54.8
57.0
45.1
ON rate
49.0
48.3
45.0
44.0
42.8
36.1
29.5
35.1
35.5
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
Note: Increased lab testing for HCV between 2000 and 2008 resulted in a significant rise
in the number of cases reported in Ontario. These represent 'newly-diagnosed' cases, both
acute cases (infection has been acquired within a few weeks) and chronic cases (infection
has been present for several months or years). Figures in the graph do not reflect the
18
under-reporting and newly-infected cases of Hepatitis C. As a result, these numbers
should be interpreted with caution.
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.261-264.
Public Health Agency of Canada. 2003. Hepatitis C Fact Sheet – Bloodborne pathogens
Section, Blood Safety Surveillance and Health Care Acquired Infections Division.
[Online] Cited on July 3, 2009 from
< http://www.phac-aspc.gc.ca/hcai-iamss/bbp-pts/hepatitis/hep_c-eng.php>
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Campylobacteriosis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July
3rd, 2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=173&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
19
Influenza
Description
Influenza, also known as the ‘flu,’ is a serious respiratory infection that begins in a
person’s nose and throat. It is highly contagious and spreads rapidly from person-toperson through coughing or sneezing, and by touching contaminated surfaces such as
doorknobs, telephones and eating utensils. Influenza, which is caused by the A, B or C
types of influenza virus, usually occurs on a seasonal basis, typically in Canada between
November and April. The influenza virus can also mutate so that is becomes more
virulent, and this can result in an epidemic or a more widespread pandemic.
Symptoms
People who get influenza can suffer from fever, chills, cough, runny eyes, stuffy nose,
sore throat, headache, muscle aches, extreme weakness and fatigue. The cough is often
severe and prolonged. In more severe cases, influenza can lead to pneumonia and even
cause death. People who are at greater risk of influenza include elderly people and those
with compromised immune systems.
Prevention and Control
Getting immunized each year is the best defence against influenza, as it can provide 70 to
80 per cent protection against infection. The effectiveness of the influenza vaccine may
vary based on the age of the person being immunized, the immunity level of the recipient,
and how well the vaccine matches the strain of influenza circulating in the community
that year. Educating people, especially health care workers, about the importance of
regular and thorough hand washing, covering up coughs and sneezes, and staying home
from work when sick are also effective ways to help reduce the spread of influenza.
Data Trends
Note: Because most influenza cases occur from November to April in Canada,
surveillance data is compiled annually from September 1 to August 31 of the following
year. This is the time period referred to in the following statistics and graphs.
Between 2000/01 and 2007/08, influenza activity in the HKPR District Health Unit
region showed a wide variation. A marked increase in local influenza cases was recorded
during the 2004/05, 2006/07 and 2007/08 flu seasons, reflecting a similar jump in rates
for Canada and Ontario in those years. The increased influenza activity for these years
may reflect only a partial match between the circulating virus strain and the vaccine
available in that flu season.
20
The following graph shows the number of lab-confirmed influenza cases reported in
HKPR District Health Unit region between 2000-01 and 2007-2008.
Number of Influenza cases reported at HKPR District Health Unit region,
2000 - 01 to 2007- 08
Number of confirmed cases
160
140
120
100
80
60
40
20
0
2000-01
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
The graph below compares influenza rates between Ontario and the HKPR District
Health Unit region from 2000/01 to 2007/08. After 2002/03, the local incidence rate of
influenza is consistently higher than the rest of the province. During the last three flu
seasons in the HKPR region, children under 14 years of age and individuals aged 65
years and older were most frequently diagnosed with influenza.
21
Incidence rates of Influenza rates in HKPR District Health Unit region in
comparison to Ontario rates, 2000- 01 to 2007- 08
90.0
80.0
70.0
Rate
60.0
50.0
40.0
30.0
20.0
10.0
0.0
HKPR rate
ON rate
2000-01
2001-02
2002-03
2003-04
2004-05
2005-06
2006-07
2007-08
HKPR rate
9.5
6.8
6.5
68.7
80.5
60.8
80.0
77.6
ON rate
8.1
19.4
8.3
43.1
47.0
19.9
22.5
41.7
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
Data Notes:
The proportion of people 65 years and older living in HKPR District Health Unit region
compared to Ontario is different. This maybe one of the reasons for an increased rate
when compared to Ontario, as the majority of cases occurring in HKPR District Health
Unit region are 65 years and older. Age standardization is necessary to compare
incidence rates of disease between populations with different age distributions. Due to the
unavailability of the provincial data by age group, comparison of the age-standardized
rates was not possible. Hence the interpretation of the comparison with the provincial rate
should be done with caution, understanding the variability in the age distribution.
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.281-287.
Public Health Agency of Canada. 2008-2009 FluWatch. [online] Cited July 3rd, 2009
from <http://www.phac-aspc.gc.ca/fluwatch/index-eng.php>
Public Health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Influenza, laboratory confirmed, both Sexes Combined, All Ages, Canada 1989 – 2004.
Cited July 3rd, 2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=058&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
22
Salmonellosis
Description
Salmonellosis is caused by bacteria from the Salmonella family, and is mainly
transmitted through contaminated food. This can occur if someone eats undercooked
poultry, raw milk and eggs, or food that becomes contaminated during preparation.
Another way that salmonellosis can be spread is by people coming into direct or indirect
contact with certain animals, including common pets such as birds, reptiles, turtles and
tortoises.
Symptoms
Symptoms of salmonellosis include the onset of headache, abdominal pain, diarrhea, and
nausea. These symptoms usually occur 12 to 48 hours after someone eats contaminated
food or drinks. Dehydration, especially among young children, elderly people and
individuals with compromised immune systems, can be severe and result in people being
hospitalized.
Prevention and Control
Salmonellosis infection can be prevented when you wash your hands well and follow safe
food practices. Food safety includes chilling food properly, washing produce thoroughly,
separating raw foods from other foods, and cooking foods to safe internal temperatures.
Data Trends
From 1989 to 2004, salmonellosis rates in Canada showed a gradual decline. The
following graph shows the number of salmonellosis cases reported in the HKPR District
Health Unit region between 2000 and 2008. Locally, a peak was observed in 2006,
although a common source of infection was not identified.
23
Number of Salmonellosis cases in HKPR District Health Unit region,
2000 - 2008
Number of confirmed cases
50.0
40.0
30.0
20.0
10.0
0.0
2000
2001
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
In the graph below, the incidence rates of salmonellosis in the HKPR region is compared
with the rest of Ontario for the years 2000 to 2008. The two rates tend to mirror each
other over time, although the local numbers remain slightly lower than the provincial
rate.
Incidence rates of Salmonellosis in HKPR District Health Unit region
in comparison to Ontario rates
50.0
45.0
40.0
Rate
35.0
30.0
25.0
20.0
15.0
10.0
5.0
0.0
HKPR rate
ON rate
2000
2001
2002
2003
2004
2005
2006
2007
2008
HKPR rate
26.0
27
16
15
16.7
21.8
25.2
12.0
11
ON rate
20.0
22.0
20.0
16.2
17.0
23.32
18.50
21.92
18.4
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth, July 2009
24
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.469-473.
Public Health Agency of Canada (2001). Material Safety Data Sheet: Salmonellosis.
[Online] Cited July 3, 2009 from:
< http://www.phac-aspc.gc.ca/msds-ftss/msds135e-eng.php>
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Salmonellosis, both Sexes Combined, All Ages, Canada 1989 – 2004. Cited July 3rd,
2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=108&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
25
Streptococcal Pneumoniae Disease, Invasive
Description
This is a severe respiratory illness also known as Invasive Pneumococcal Disease (IPD).
The disease is caused by a type of bacteria called Streptococcus pneumoniae, and can be
deadly for infants and elderly people. Bacteria that cause IPD can live at the back of the
nose and throat without causing symptoms. The bacteria are spread through droplets in
the air when an infected person coughs or sneezes. Bacteria can also be transmitted
through the saliva of an infected person who shares common items such as bottles, straws
and eating utensils.
Symptoms
Symptoms of IPD include the sudden onset of a high fever, chills, headache, tiredness,
coughing, and chest pain/discomfort. Among infants and young children, fever, vomiting
and convulsions are initial signs of IPD. The bacteria that cause IPD can also result in
pneumonia (lung infection), bacteraemia (infection of the blood) and meningitis
(infection of the lining of the brain and spinal cord). These conditions can be deadly and
may cause long-lasting complications such as deafness, especially in people with existing
medical conditions.
Prevention and Control
Vaccination is the best way to protect people from Invasive Pneumococcal Disease. As
part of its publicly-funded immunization program, Ontario provides vaccine free of
charge to children under six years of age, as well as to individuals of all ages with
specified medical conditions. Free vaccination is also available to those 65-years-of-age
or older, and individuals who live in nursing homes, homes for the aged, and chronic-care
facilities or wards. Crowded living quarters in large institutions or barracks should be
discouraged, as this contributes to the spread of disease. In some cases, the use of
antibiotics can make individuals less infectious.
Data Trends
While there was a sharp decline in the national rate of Streptococcal Pneumoniae
Invasive Disease in 2001, numbers increased from 2002 to 2004. In Ontario, the disease
was added to the list of reportable diseases in 2002 and, between 2003 and 2008, the
provincial rate remained relatively stable. From 2002 to 2008, the number of invasive
Streptococcal pneumonia cases in HKPR region disease has had multiple peaks and
valleys, as reflected in the graph below.
26
Number of Streptococcus pneumoniae invasive cases in HKPR
District Health Unit region, 2002 - 2008
Number of confirmed cases
25
20
15
10
5
0
2002
2003
2004
2005
2006
2007
2008
Calendar year
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
The next graph compares the rate of invasive Streptococcal pneumoniae in the HKPR
region and Ontario from 2002 to 2008. In most years, the local rate was slightly higher.
Incidence rates of Streptococcus pneumoniae invasive in HKPR
District Health Unit region in comparison to Ontario rates
Incidence Rate
per 100,000 population
15.0
10.0
5.0
0.0
2002
2003
2004
2005
2006
2007
2008
HKPR rate
7.7
9.3
9.8
10.3
6.3
12.6
10.2
ON rate
5.10
8.1
8.5
7.31
7.40
7.35
8.08
Data Sources: integrated Public Health Information System (iPHIS), extracted July 2009
Reportable disease data posted on Public Health Ontario Portal
Population estimates and projections. 2000-08. Ontario MOHLTC, extracted from Intellihealth July 2009
References
Heymann DL. (2004). Control of Infectious Diseases Manual, 18th edition. Washington,
DC: American Public Health Association. P.413-417.
27
Public Health Agency of Canada. Streptococcus pneumoniae – Material Safety Data
Sheet (MSDS). [Online] Cited July 15, 2009 from <http://www.phac-aspc.gc.ca/msdsftss/msds147e-eng.php>
Public health Agency of Canada. Notifiable Diseases On-Line – Chart Query Result:
Invasive pneumococcal disease, both Sexes Combined, All Ages, Canada 1989 – 2004.
Cited July 3rd, 2009 from
< http://dsol-smed.phac-aspc.gc.ca/dsol-smed/ndis/cgibin/ndischart2?DATA_TYPE=R&YEAR_FROM=89&YEAR_TO=04&CAUSE=182&
AREA=00&AGE=0&SEX=3&CTIME1=View+Chart>
Publicly funded immunization schedules for Ontario, January 2009.
28
GLOSSARY
Age Standardized Incidence Rate
The incidence rate that a population would have if it had a standard age distribution. Age
standardization is used to compare incidence rates of disease between populations with
different age distributions. E.g. Sexually transmitted infections (STIs) such as chlamydia
are more common among 15-to-24 year olds, so a population with a higher proportion of
this age group will have a higher overall incidence rate. In order to determine which
population has a higher incidence rate regardless of age distribution, the rates must be age
standardized.
Bacteria
Single cell microorganisms, some of which cause infections and disease in humans.
Database
A collection of data arranged for ease and speed of retrieval.
Disease
An unhealthy condition of the body or mind, such as an illness or sickness.
Epidemic
This occurs when new cases of a certain disease, in a given human population, and during
a given period, substantially exceeds what is "expected” based on recent experience (the
number of new cases in the population during a specified period of time).
Immunity
State of being protected against infectious disease.
Incidence
The number of new cases of disease occurring during a defined time period in a defined
population.
Incidence Rate
The rate at which new cases of disease occur in a defined population during a defined
time period. The incidence rate is the number of new cases of disease relative to the
total population at risk, and is usually expressed as number of cases per 100,000 people.
Infection
This describes the entry and development, or multiplication, of an infectious organism in
the body. A person can become infected, but not experience any disease.
29
Infectious Agent
An organism that is capable of causing infection (E.g. bacteria, viruses or parasites).
Invasive
Penetrates sites such as tissues, blood or cerebrospinal fluid.
Microorganism
An organism of microscopic or submicroscopic size.
Outbreak
An increase in incidence of a disease above expected levels.
Pandemic
A pandemic is an epidemic of infectious diseases that is spreading through human
populations across a large region, such as a continent or around the world.
Pathogen
This is a microorganism that causes disease, including bacteria, viruses, or parasites.
Pneumonia
It is an inflammation or infection of the lungs most commonly caused by a bacteria or
virus.
Prevalence
The number of existing cases of disease or health condition at a particular time and in a
defined population.
Reportable Disease
Reportable diseases are defined in Ontario's Health Protection and Promotion Act as
infectious diseases (or suspected occurrences of these diseases) that must be reported
to local health units by health care providers, laboratories and administrators of
institutions such as long-term care homes. Health units must in turn report these diseases
to the Ministry of Health and Long-Term Care.
Sexual Contact
Sexual intercourse or other intimate sexual contact.
Significant
Unlikely to have occurred by chance.
Vaccination
The introduction of vaccine into the body for the purpose of inducing immunity.
30
Vector
Organisms that transmit human disease or play an essential role in the life cycle of a
pathogenic agent.
Virus
Microorganism consisting of DNA or RNA and a protein coat. Viruses invade host cells
to survive and can cause infection and disease in humans.
31