March 2022 Board of Health Meeting

Meeting held via video

SUBMITTED BY:

Infectious Disease Prevention

DATE:

March, 2022

SUBJECT:

2021 Summary – Infectious Disease Prevention Department

BACKGROUND

The Health Protection and Promotion Act 1990 (HPPA), R.S.O., 1990, and Ontario Reg. 135/18, outlines the requirements for physicians, practitioners, and institutions to report any disease of public health significance (DOPHS) to the Medical Officer of Health (MOH). The Ontario Public Health Standards (OPHS) describe the mandatory programs and services that are to be delivered by the board of health, which includes infectious and communicable diseases prevention and control.

The Windsor-Essex County Health Unit (WECHU) Infectious Disease Prevention (IDP) department includes a multidisciplinary team of professionals including Public Health Nurses (PHNs), Health Promotion Specialist, Infection Control Practitioner (ICP) and clerical support. The IDP team delivers programs and services addressing sexually transmitted blood-borne infections (STBBI)/Sexual Health Clinic; tuberculosis (TB); and communicable diseases (CD).

STBBI/Sexual Health:

Results of the 2020 Syphilis Survey Report, released in 2021 via the Sexual Advisory Committee, identified a gap in both knowledge and awareness of syphilis amongst the general population and local healthcare practitioners (HCPs).  Case numbers for the human immunodeficiency virus (HIV) in WEC in the 1st quarter of 2021 increased from previous years. Nine cases of HIV were reported in WEC from January 1 to March 31, 2021 compared to an average of 4.6 cases in the first quarter of the previous 5 reporting years. The HIV rate in WEC leveled as 2021 progressed to a total of 17 HIV cases. A comparison of the previous 5 years showed a yearly average of 21.8 HIV cases per year in WEC.  While the HIV rate in WEC was lower in 2021 than previous years, the crude rate averaged 4.0 HIV cases per 100,000 residents in WEC whereas the provincial crude rate was 3.7.

In response to the increased incidences of HIV cases that were observed in the initial part of 2021, a HIV Alert was posted on the Canadian Network for Public Health Intelligence (CNPHI) website, operated by the Public Health Agency of Canada in April of 2021. A comprehensive social media campaign was consequently developed to improve sexual health and well-being within WEC. The communication campaign included the development of syphilis awareness posters, banners, billboards, and social media messaging. Syphilis awareness banners were adapted and published in the WE Pride magazine (2021/2022) and as part of the 2021 WEC Pride Fest. Additionally, billboards were also posted in three WEC locations that shed light on the spread of STIs and promoted the use of condoms.

In order to engage our community, social media platforms, Facebook, Grindr, and Instagram were also utilized to increase STI awareness. PHNs were also involved in Pozitive Pathways podcasts (two episodes: syphilis and gonorrhea) and as AM800 guest speakers (two events: oral sex and syphilis).

PHNs continue to support resources, capacity building efforts for HCPs and community partners to support the appropriate diagnosis, treatment, and knowledge dissemination as it pertains to STIs. As a result of the change to the WECHU service delivery model, updates were made to our syphilis reporting form, and WECHU website. WECHU’s STI Guide was also updated to align with provincial/national STI guidelines and provides information about ordering STI medications. HCPs are able to request Bicillin-LA and other STBBI medications from the WECHU (free of charge).

Tuberculosis:

In 2021, there was a total of 17 active TB cases, and 146 cases of Latent TB Infections (LTBI) in WEC, as well as a TB cluster investigation identified at a local farm, crossing two sites and 4 cases. Services for both active and latent TB cases were delivered at either the client’s home, in-person at the WECHU clinic, or virtually. To increase awareness of TB, and TB reporting requirements among community partners (e.g. Shoppers Drug Mart, Tecumseh Medical Clinic), an outreach campaign was undertaken in 2021. Communication outlining updated HIV testing recommendations for individuals with active TB and LTBI, and a revised TB reporting form was distributed to physicians and pharmacists in WEC. Reminder magnets were also included to compliment the letter (Appendix A). The reminder magnets highlighted the need to call the health unit before dispensing TB medication and informing the health unit if a positive TB skin test has been identified.

CD:

The WECHU reported zero cases of influenza in 2021. IDP PHNs noted an increase of uncommon diseases reported in 2021, including Creutzfeldt-Jakob Disease (CJD), Echninococcus, and Acute Flaccid Paralysis. In addition, the IDP PHNs worked with the ICP in a number of outbreak situations (gastroenteritis and respiratory) in institutions and hospitals.

Refer to Appendix B for the DOPHS [diseases of public health significance] 2021 case numbers that were retrieved from iPHIS.

Appendix A: TB Reminder Magnets

Appendix B: DOPHS 2021 Case Numbers

Note: The table below includes the number of confirmed cases (and probable cases, depending on the DOPHS) from 2021. The date of extraction from iPHIS was on February 16, 2022.

SUBMITTED BY:

Environmental Health

DATE:

March, 2022

SUBJECT:

Zoonotic and Vector-borne Diseases Report

BACKGROUND

The Environmental Health Department conducts annual monitoring and testing of tick and mosquito populations in Windsor and Essex County (WEC) as part of the Windsor- Essex County Health Unit’s (WECHU) Zoonotic and Vector-borne Diseases Program. The program is required under the Health Protection and Promotion Act and provides the community with an early warning system for disease transmission through ticks and mosquitoes known as vector-borne diseases. Due to our geography and local climate, the WEC region is more susceptible to vector-borne diseases, as the ecological conditions influence transmission and distribution.

Upon the completion each VBD program season, the WECHU prepares an annual report which highlights surveillance information related to Lyme disease and West Nile Virus (WNV) Illness in WEC. The 2021 Annual VBD report is available on our website Vector-Borne Diseases - WE - 2021 and a high level summary of these findings is included below.

Ticks and Lyme Disease

In the last three years, surveillance data indicated an increase in black-legged ticks (Ixodes scapularis) in WEC. The black-legged tick is the primary vector for Borrelia burgdorferi, the bacteria that causes Lyme Disease. Environmental Health staff conduct active field surveillance at public parks and trails frequently used by residents twice a year to identify areas in WEC that have populations of black-legged ticks.

In 2021, active surveillance was conducted at four sites that included,

1. Ojibway Prairie Nature Reserve,
2. Chrysler Greenway,
3. Gesstwood Camp and Education Centre and
4. Ruscome Shores Conservation Area

A total of 33 black-legged ticks were found through tick dragging, with nine of these carrying the infectious agent that causes Lyme disease.

In 2021, there were seven cases of Lyme Disease in WEC.  All laboratory-confirmed cases are interviewed to determine activities and locations where exposure may have occurred. This information drives targeted tick awareness initiatives from the health unit.

Mosquito Surveillance and Testing

The WECHU has one of Ontario’s most comprehensive mosquito surveillance programs, including the West Nile Virus Program and Enhanced Mosquito Surveillance initiatives. In 2021, mosquito surveillance began in May and ended in early October. Species-specific traps were deployed in various locations throughout WEC to capture mosquitoes for testing and identification to determine the presence of West Nile, Eastern Equine Encephalitis (EEE) Virus, and Zika Virus in our region. Invasive mosquito species Aedes aegypti (Yellow Fever Mosquito) and Aedes albopictus (Asian Tiger Mosquito) were also monitored. These species are known carriers of Zika, Dengue, and Chikungunya diseases. The health unit monitors mosquitoes at different stages in their life cycle to determine prevention and control initiatives for the program.

In 2021, the weekly mosquito surveillance data is available on the WECHU’s Mosquito Surveillance Dashboard. The data is updated weekly during the season and is open to the public. During last year’s season:

• Total number of traps deployed per week: 47
• Total number of mosquitoes trapped: 187,918
• Total number of pools tested: 2,291
• Number of positive pools for West Nile virus : 17
• Number of positive pools for Zika virus: 0
• Number of positive pools for EEE virus: 0

Positive pools for WNV were reported in the following municipalities: City of Windsor (11), Town of Essex (3), Municipality of Leamington (2), and the Town of Amhestburg (1).  

Over 118,000 treatments of larvicide were applied to roadside catch basins and standing water sites last year to control mosquito populations. All municipalities in WEC have standing water by-laws that municipalities enforce that are an important activity to reduce breeding habitats. Furthermore, property standards enforcement from municipalities continues to be a key factor in controlling invasive mosquito populations in our region, as these mosquitoes are container breeders (mosquitoes that lay eggs in containers).

The WECHU follows up on all reported human cases of WNV. Cases are investigated to assess if additional targeted mosquito control activities are required. In 2021, there were three confirmed cases of WNV in WEC. There have been no human cases of Zika Virus identified in our community to date.  

CURRENT INITIATIVES

As previously reported, the WECHU was the successful receipient of  the Public Health Agency of Canada’s grant (August 2019 – March 2022) to study the effects of climate change and mosquito populations in our local communities.  The final report  for the project will be released in March and will include information regarding the types of mosquito species (including invasive species) in the region, the impact of climate change on mosquito-borne diseases, and information regarding the populations in our community that are more vulnerable to these health impacts. The WECHU will begin surveillance and monitoring activities for ticks and mosquitoes in May 2022. In addition to these activities, the WECHU will be launching our annual Fight the Bite public awareness campaign. This campaign will focus on the prevention of mosquito breeding sites, information on tick removal, signs and symptoms of WNV and Lyme disease, and personal protection. Messages and promotional materials will be developed to reach priority populations and inform the public of hot spots identified through previous monitoring efforts.

SUBMITTED BY:

Healthy Schools Department

DATE:

March, 2022

SUBJECT:

Student Immunization Catch-Up Plan

BACKGROUND

In Ontario, the Immunization of Schools Pupils Act (ISPA) R.S.O.1990 requires children and adolescents attending primary or secondary school to be appropriately immunized against measles, mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, Conscience or Religious Belief exemption on file at the Health Unit. As outlined in the Ontario Public Health Standards (OPHS), local public health units collect and assess immunization records for every student attending school, and provide provincially funded immunization programs through school-based clinics.

Due to the ongoing COVID-19 pandemic and the impact on local resources, the Windsor-Essex County Health Unit (WECHU) was unable to implement immunization clinics at every school setting as in previous years. In order to support widespread availability of publicly-funded vaccines to protect children from Hepatitis B, Human Papilloma Virus (HPV), and Meningococcal Disease (Men-C-ACYW135), the WECHU has been working collaboratively with local healthcare providers to ensure students continue to have access to these vaccines.

As of January 27, 2022 there are 7,953 ISPA based vaccines overdue for administration in the birth cohort years of 2004, 2008, and 2009. The overdue vaccinations for those in the 2004 birth cohort year (1,910) are of particular significance for catch-up before June 2022 due to the pending graduation from the secondary school making follow-up after this school year more difficult.

CURRENT INITIATIVES

The WECHU began hosting catch-up immunization clinics for eligible students on Tuesday, March 8, 2022 to service families with children born between 2004 and 2009 that were not able to receive their immunizations at a school-based immunization clinic in the fall, or through their primary healthcare provider. Appointments for booking are available during the day, afternoons, evenings and weekends at Sears-Devonshire Mall (3100 Howard Avenue) or WECHUs Leamington office (33 Princess Street).

 As part of this strategy, the WECHU prepared tailored communications to update students, families, and school board administrators regarding options available to students who are overdue and eligible for vaccinations. The catch-up clinics in March are the first set of student immunization clinics that the WECHU has planned for the year.

In May 2022, the WECHU will be re-visiting high-risk schools that received the first round of vaccines in the fall. Furthermore, additional community-based and in-house catch-up clinics are being planned for the summer to give families the opportunity to have eligible students immunized before the beginning of the 2022/2023 school year.

As part of this work, the WECHU will also be assessing immunization records for every student in Windsor and Essex County in the beginning of the 2022/2023 school year. Under the ISPA, the Medical Officer of Health may issue suspension orders to students who fail to become immunized and are not exempt as well as those who do not have up to date immunizations. With the successful implementation of this catch up plan, the WECHU is looking forward to returning to schools in the fall of 2022 to complete a single cohort of school-based immunizations.

SUBMITTED BY

Communications Department

DATE

March, 2022

SUBJECT

January 15 – February 15, 2022 - Communications Update

Metrics

Media Exposure Overview

Website Overview

Social Media Growth

Current Notable Projects

• Maintaining marketing and communication efforts regarding ongoing vaccine rollout in the region by public health and our partners. In particular, the numerous pop up clinics in the community and closures of mass vaccination sites at the Grovedale Arts and Culture Centre in Kingsville and Hôtel-Dieu Grace Healthcare
• Responding to media and public inquiries through multiple channels including emails, calls, and web form submissions. Social media direct messages are currently redirected to the wechu.org web form.
• Significant website updates to mirror provincial easing of public health restrictions.

Data Notes:

1. Media requests received is a compiled list of documented requests we captured for interviews, data clarification, or general request for information from the media. Given the volume of requests during COVID-19, many exchanges with the media through text messages or quick phone calls to answer questions may not be captured. In many instances, each request led to multiple interactions with reporters.
2. YouTube Live videos started on June 23, 2020. Prior Public Health Update videos on YouTube were exported videos recorded through Facebook Live. In July 2021, YouTube Live broadcasts were scaled down to Fridays only from a Monday, Wednesday, and Friday rotation. In September 2021, media briefings were increased to Monday, Wednesdays and Fridays and streamed live. On September 20, 2021, media briefings were recorded and then posted to YouTube.
3. Website analytics are provided by Siteimprove. The metric provided is for page views to wechu.org. Previously, we were reporting on the local-updates webpage only.
4. Email subscribers are those individuals who signed up to receive promotional emails from the Windsor-Essex County Health Unit. The analytics are provided through Mailchimp for last 30 days.
5. Social media metrics are provided through Hootsuite.
6. Media exposure information in this report were generated using Meltwater Media Monitoring Solution. News stories may be duplicates or missing as the platform is currently being optimized to better track Windsor-Essex County Health Unit mentions in the media landscape.

SUBMITTED BY

Chronic Disease and Injury Prevention

DATE

March, 2022

SUBJECT

Ontario Active School Travel Grant – Update and Final Activities

BACKGROUND

Supported by a grant from Green Communities Canada (GCC), the Windsor-Essex County Health Unit in partnership with school boards, transportation services, municipalities, and police services has been developing policies, enviromental supports, and programming to promote active school travel in Windsor and Essex County amidst staff and resource allocation during the pandemic response. The Ontario Active School Travel (OAST) grant was awarded to the health unit in the amount of $60,000 to be used between January 2021 and June 2022. In order to operationalize this grant funding, the health unit created an Active School Travel (AST) Regional Committee which oversees the implementation of activities and use of the OAST grant funds to promote active travel in schools across the City of Windsor and Essex County.

PREVIOUS AND CURRENT INITIATIVES:

To date, funding has supported the hiring of an Active Travel (AT) Planner to assist schools and boards in implementing plans and coordinating community education and outreach. The AT Planner has assisted in the creation of the AST Regional Committee, identification of the initial six pilot schools, and establishing “champions” at each school to liaise with project staff on the implementation of interventions. The AT Planner has created an orientation package for school representatives, conducted a baseline asssessment of active transportation behaviours amongst students in each school, and serves as the Chair for individual school planning meetings.

In addition to maintaining the collaborative functions mentioned above, the AT Planner has also conducted a review of best practices for implementing active school travel interventions and has determined areas of opportunity for policy enhancement through a review of AT policies at the school board and municipal levels. As this is the third round of funding for the OAST grant, the AT Planner reviewed previously developed resources which could be repurposed and distributed to local pilot schools and board representatives. This process also helped to identify gaps which could be addressed through locally developed education materials. These materials (e.g., web based toolkits and seasonal AT safety promotions) were subsequently developed and shared with school board representatives and shared with all local schools.

As part of the grant activities, Windsor Police Service led walk-ability and bike-ability assessments at each pilot school during the 2021 school year. Several members of the AST Regional Committee along with principals, teachers, and parents were present for these assessments. The assessments helped to identify safe and accessible routes to and from school considering the built environment, traffic, and different modes of transportation as contributing factors in promoting active school travel. At the time of writing this report, summaries which highlight the results of these assessments and include tangible suggestions for intervention are being developed to be shared with each of the pilot schools.

With sustainability of the interventions enabled by this funding as a primary priority of both the funding agencies and the health unit, one of the most impactful initiatives contained and actioned as part of this grant was the creation of a Active School Travel Charter (ASTC). The ASTC was developed to serve as a statement of principles to guide schools, school boards, municipalities, student transportation services, and other community partners in decision-making around the built environment. As the ASTC has already been endorsed by the Board of Health and the City of Windsor, the AST Regional Committee will also be seeking endorsement from the County of Essex in the coming weeks.

FUTURE INITIATIVES:

As the project approaches the end of its funding cycle, remaining project activities will be completed prior to June of this year. Project funding will be allocated toward the purchase of new bike racks and other forms of equipment storage so that students attending pilot schools can feel confident that their equipment will be safe during the school day. Pilot schools will be engaging students through a crosswalk painting event to highlight and enhance school crosswalks. Cycling safety and training sessions will be provided through partnership with Bike Windsor-Essex (a local cycling advocacy agency) to teach students proper biking skills and techniques, and a media launch event will also be held concurrently with these sessions in order to acknowledge the activities supported through the grant and implemented through engagement with the schools.

Once all project activities have been completed, the AST Regional Committee will develop the sustainability plan for AST within the community beyond what could be offerred through the one-time grant funding. Post-intervention assessments will also measure changes in attitudes and behaviour toward AT in the pilot schools relative to the baseline assessment as a way in which to detemined the effectiveness of these interventions.

SUBMITTED BY:

Epidemiology and Evaluation Department

DATE:

March, 2022

SUBJECT:

COVID-19 Surveillance and Epidemiology – February, 2022

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Due to the recent surge in Omicron cases and changes in eligibility for testing, testing capacity is limited and case, contact, and outbreak management has been modified to focus on high-risk settings. As a result, case counts in the report are an underestimate of the true number of individuals with COVID-19 in Windsor-Essex County and may impact data completeness. Please interpret these data accordingly. Due to these changes, data from before December 31, 2021 should not be compared to data after the testing changes.

Trends

In the month of February, the health unit reported 2,751 confirmed high-risk cases of COVID-19. As the weeks progressed in February, the weekly high-risk incidence rate decreased from 228.1 cases per 100,000 population (Week 5) to 130.3 cases per 100,000 population (Week 8).  

In-Patient and ICU Admissions

In February, in-patient COVID-19 hospitalizations continued to decrease in Windsor-Essex County up until the third week of the month. Since then, COVID-19 related hospitalizations has started to trend upwards. However, COVID-19 related ICU admissions has continued to decline throughout the month of February.

Percent Positivity

Locally, Windsor-Essex County continued to experience a week-over-week decline in percent positivity in February. As the month drew to a close, the local percent positivity rate for COVID-19 stabilized to approximately 13.6% in the last week of the month. It is also important to note that these were for high-risk individuals that were eligible for testing.

Wastewater Surveillance

For the month of February, viral signal for COVID-19 in wastewater declined from levels experienced in the previous month. Current levels are beginning to reach levels observed prior to onset of the recent Omicron wave in December 2021.  

Outbreaks

In the month of February, 24 outbreaks were declared in high-risk settings. In comparison, 105 outbreaks were declared in January (a 77% decline in February). This includes nine outbreaks in long-term care and retirement homes, two in hospital settings, five in the agriculture sector and eight in other congregate settings. As of February 28, 2022, there were 20 active outbreaks in comparison to 77 active outbreaks at the end of January.

Deaths

For the month of February 2022, 29 deaths were reported that were attributed to COVID-19. This represents a 45% decline in comparison to the deaths reported in January.

CURRENT INITIATIVES

With the changes in testing eligibility, and guidance with case, contact and outbreak management, the health unit has modified its public reporting to better understand the burden of illness locally. New indicators, such as wastewater data, have been included as a proxy indicator for COVID-19 case counts, which are underestimated. The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Aldo DiCarlo, Judy Lund, Robert Maich, Ed Sleiman

Board Member Regrets:

Gary Kaschak