English: Dr. Curtis Russell
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English: Dr. Curtis Russell
- 1. Ontario’s Lyme Disease Surveillance Program Curtis Russell, PhD Senior Program Specialist Enteric, Zoonotic and Vector-Borne Diseases Unit (EZVBD) Communicable Diseases, Emergency Preparedness and Response (CDEPR) Public Health Ontario
- 2. PublicHealthOntario.ca Faculty/presenter Disclosure • Presenter: Curtis Russell • Relationships with commercial interests: - Grants/Research Support: none - Speakers Bureau/Honoraria: none - Consulting Fees: none - Other: employee of Public Health Ontario 2
- 3. PublicHealthOntario.ca Disclosure of Commercial Support • Financial or in-kind support: none • Potential for conflict(s) of interest: None 3
- 4. PublicHealthOntario.ca Mitigating Potential Bias • Not applicable 4
- 5. PublicHealthOntario.ca Presentation Overview • Overview of Public Health Ontario’s (PHO) Lyme Disease Program • Surveillance • Human • Tick • Epidemiology in Ontario • PHO Initiatives 5
- 6. PublicHealthOntario.ca Lyme Disease Program PHO is working closely with the Ministry of Health and Long- term Care to provide updated evidence, resources and guidance on Lyme disease surveillance, prevention and control. PHO’s program consists of the following elements: • Human surveillance • Vector surveillance • Public and Physician education • Research 6
- 8. PublicHealthOntario.ca Roles of Public Health Units • To conduct tick surveillance in an effort to assess the risk of Lyme disease to humans • To conduct local risk assessments based on surveillance data and local ecological factors • To conduct human case investigations • Create local programs based on the results of local risk assessments 8
- 9. PublicHealthOntario.ca The Role of Public Health Ontario • Expert scientific and medical consultative services; including interpretation of Lyme disease testing results • Provide scientific and technical expertise to Ontario’s PHUs • Expert consultation • Documentation that outlines guidelines/best practices • Lyme disease surveillance (provincial level) • Support PHUs to effectively conduct local risk assessments • PHO laboratory provides: • Tick identification • Testing for human Lyme disease cases (Ontario only) 9
- 10. PublicHealthOntario.ca PHO Research • Human pathogens associated with the blacklegged tick Ixodes scapularis: a systematic review. Parasites and Vectors. In Press • Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks Ixodes scapularis and the Lyme Disease Agent Borrelia burgdorferi in Ontario, Canada. Plos One, 2014 • Healthcare costs attributable to Lyme disease: A population- based matched cohort study in Ontario, Ongoing study 10
- 11. PublicHealthOntario.ca Passive Lyme Disease Surveillance in Ontario 11 Physicians and public submit ticks to local PHU PHU forwards to PHO for identification Blacklegged ticks forwarded to National Microbiology Laboratory for Borrelia burgdorferi testing Confirmed and probable human cases (bitten by infected tick) Health units enter cases in Integrated Public Health Information System (iPHIS)
- 12. PublicHealthOntario.ca Active Lyme Disease Surveillance in Ontario 12 Looking for ticks in the environment Tick dragging Small mammal trapping
- 13. PublicHealthOntario.ca Number of Lyme disease cases by municipality of most likely exposure for locally acquired cases: Ontario, 2014 13
- 14. PublicHealthOntario.ca The location and number of blacklegged ticks submitted to Public Health Ontario, based on the submitter’s community of residence: Ontario, 2014 14
- 15. PublicHealthOntario.ca Percentage Borrelia burgdorferi-positivity and total Ixodes scapularis by submitter town of exposure in Ontario, Canada (2008–2012) Nelder MP, Russell C, Lindsay LR, Dhar B, Patel SN, et al. (2014) Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks Ixodes scapularis and the Lyme Disease Agent Borrelia burgdorferi in Ontario, Canada. PLoS ONE 9(8): e105358. doi:10.1371/journal.pone.0105358 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358
- 16. PublicHealthOntario.ca Distribution of ticks submitted for identification in Ontario, Canada (2008–2012) as rates of submission per 100,000 population (based on submitter CSD of residence). Nelder MP, Russell C, Lindsay LR, Dhar B, Patel SN, et al. (2014) Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks Ixodes scapularis and the Lyme Disease Agent Borrelia burgdorferi in Ontario, Canada. PLoS ONE 9(8): e105358. doi:10.1371/journal.pone.0105358 http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358 I. Scapularis Blacklegged tick D. variabilis American dog tick I. cookei Woodchuck tick A. americanum Lone star tick
- 18. PublicHealthOntario.ca Ontario Lyme Disease Case Definition 18 http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/lyme_disease_cd.pdf • New provincial case definition released in 2015 • Risk areas added to the terminology • Erythema migrans can be clinically confirmed without laboratory evidence
- 19. PublicHealthOntario.ca Health Unit Tick Dragging Training 19
- 20. PublicHealthOntario.ca Lyme Disease Standardized Case Investigation Questionnaire 20
- 22. PublicHealthOntario.ca Key Vector-Borne Disease Partners • Ministry of Health and Long-Term Care • Ministry of Agriculture, Food and Rural Affairs • Ministry of Natural Resources and Forestry • Ministry of the Environment and Climate Change • Canadian Wildlife Health Cooperative/Ontario Veterinary College • Public Health Units • Public Health Agency of Canada 22