english: dr. curtis russell

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

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

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http://www.publichealthontario.ca/


Disclosure of Commercial Support • Financial or in-kind support: none

• Potential for conflict(s) of interest: None

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Mitigating Potential Bias • Not applicable

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Presentation Overview • Overview of Public Health Ontario’s (PHO) Lyme Disease

Program

• Surveillance • Human • Tick

• Epidemiology in Ontario

• PHO Initiatives

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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

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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

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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)

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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

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Passive Lyme Disease Surveillance in Ontario

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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)



Active Lyme Disease Surveillance in Ontario

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Looking for ticks in the

environment Tick dragging Small mammal

trapping



Number of Lyme disease cases by municipality of most likely exposure for locally acquired cases: Ontario, 2014

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The location and number of blacklegged ticks submitted to Public Health Ontario, based on the submitter’s community of residence: Ontario, 2014

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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


http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358


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


http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358

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Ontario Lyme Disease Case Definition

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• New provincial case definition released in 2015

• Risk areas added to the terminology

• Erythema migrans can be clinically confirmed without laboratory evidence



Health Unit Tick Dragging Training

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Lyme Disease Standardized Case Investigation Questionnaire

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Surveillance Methods Literature Reviews

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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

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Webpages

www.publichealthontario.ca

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QUESTIONS?

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english: dr. curtis russell

Health & Medicine