Public Health Updates | Hastings Prince Edward Public Health

Public Health Updates

Health Updates

Hastings Prince Edward Public Health provides regular, time-sensitive public health updates to community health care providers. Listed below are the most recent public health updates:

Public Health Notice – Outbreak of E. coli infections linked to romaine lettuce (December 2017)

The Public Health Agency of Canada is collaborating with provincial public health partners, the Canadian Food Inspection Agency and Health Canada to investigate an outbreak of Escherichia coli O157, commonly called E. coli. Based on the investigation findings to date, exposure to romaine lettuce has been identified as the source of the outbreak, but the cause of contamination has not been identified. The outbreak appears to be ongoing, as illnesses linked to romaine lettuce continue to be reported to the Public Health Agency of Canada. These illnesses indicate that contaminated romaine lettuce may still be on the market (including in restaurants, grocery stores and any establishments that serve food). At this time, the investigation evidence suggests that there continues to be a risk of E. coli infections associated with the consumption of romaine lettuce.

Because of the ongoing risk in eastern Canada, the Public Health Agency of Canada is advising individuals in Ontario, Quebec, New Brunswick, Nova Scotia, and Newfoundland and Labrador to consider consuming other types of lettuce, instead of romaine lettuce, until more is known about the outbreak and the cause of contamination.

For more information about this outbreak, visit the Government of Canada website.

First Influenza Cases (November 2017)

Hastings Prince Edward Public Health has received notice of its first two laboratory confirmed Influenza A cases for the 2017-2018 season. Both cases were tested as a part of an ongoing Long Term Care Home respiratory outbreak. Information on influenza prevention strategies can be found in this memo.

Pertussis (November 2017)

On Wednesday November 21, Hastings Prince Edward Public Health (HPEPH) received notification of one laboratory confirmed case, and one epidemiologically-linked case of Bordatella pertussis in the Centre Hastings school area. As a result, you may see children and adults presenting with pertussis-like symptoms. If so, we encouraged you to test, to treat and to immunize for pertussis. For more information, please see Dr. Gemmill's memo.  The HPEPH Pertussis Fact Sheet is also available to the public.

Mumps (March 2017)

Mumps virus continues to circulate in Ontario in individuals 14-38 years of age.  As of March 8th, 42 cases of mumps (40 confirmed, 2 probable) have been reported in Ontario. Cases have been reported in 13 different public health units.  No cases have been reported in HPEPH at this point, however, cases have been reported in neighbouring health units.  Click here for Dr. Kieran Moore's memo and here to see diagnostic testing recommendations.

Seoul Virus (March 2017)

The Ministry of Health and Long-Term Care, in collaboration with public and animal health partners at a variety of government levels, are investigating three human cases of Seoul virus infection in Ontario. All three individuals had prolonged contact with rats. No serious health outcomes have been reported for the cases.  Click here to see the CMOH memo.

Influenza (November 2016)

Hastings Prince Edward Public Health reports their first two lab confirmed influenza cases.  Click here to see the memo.

PHO has recently released two influenza fact sheets for health care providers:

Information on 2016-2017 recommendations for influenza vaccines for children and adolescents
Antiviral medications for influenza: Information for health care providers

These fact sheets will help to support health care providers to support decision-making and answer patient questions about influenza vaccination and treatment.

Pertussis Advisory - North Hastings (May 2016)

5 confirmed cases of pertissus have been identified in Bancroft.  Click here to see the advisory to Health care providers.

FOOD RECALL WARNING (April 22nd)

New post-exposure prophylaxis guidelines associated with this food recall have been issued to reflect the newly released recommendations from National Advisory Committee on Immunization (NACI).

Please click here for a revised Hep A Post-Exposure Prophylaxis for Management of of Hepatitis A Outbreak Associated with Recalled Costco Frozen Berries.

FOOD RECALL WARNING (April 2016)

An investigation has led to a recall of Nature’s Touch Organic Berry Cherry Blend of frozen berries sold at Costco, due to concerns of Hepatitis A.

Hastings Prince Edward Public Health will be offering publicly funded Hepatitis A vaccination to those who consumed the recalled product within the last 14 days. Costco is currently contacting customers who purchased the recalled product.

To book an appointment to receive the Hepatitis A vaccine, please call Hastings Prince Edward Public Health at (613) 966-5500 ext. 313.

To view the Statement from Chief Medical Officer of Health on Hepatitis A, click here.

FAST FACTS:  2015 Reportable Diseases in Hastings & Prince Edward Counties (March 2016)

To see 2015 case counts of reportable diseases in Hastings & Prince Edward Counties, along with a 5-year average, click here.

Zika Virus Update - March 2016

Public Health Ontario has updated their testing protocols. PCR testing for Zika virus and serological testing for viral antibodies are available via the Public Health Ontario Laboratory (PHOL) and the National Microbiology Laboratory. Patients with symptom onset while in endemic areas or within 2 weeks of departure from an endemic area may be considered for testing. Asymptomatic pregnant women with potential Zika virus exposure during their pregnancy may be tested using serology. Testing is not indicated in non-pregnant patients after recovery from a self-limiting illness. PHOL specimen requirements can be found here.

Public Health Agency of Canada recommends that all pregnant women and those who are considering attempting to get pregnant discuss their travel plans with their health care provider and consider postponing travel to areas in the Americas affected by the ZIKA outbreak.

The risk to Ontarians remains low as mosquitoes known to transmit the virus are not established in Canada.

To access Hastings Prince Edward Public Health (HPEPH) fact sheet, click here.

Syrian Refugees Update - March 2016

CFB Trenton is no longer a designated Interim Lodging site for Syrian Refugees. We will continue to see privately sponsored refugees arriving over the next year. It is recommended that all children and adults lacking written documentation of immunization should be started on a primary immunization schedule as appropriate for their age. Refer to the Publicly Funded Immunization Schedule for Ontario – “Catch-up Schedule”. Additional copies of the Publicly Funded Immunization Schedule are available when picking up vaccine and can be found here.

The Ministry of Health and Long-Term Care (MOHLTC) has developed the temporary, multi-lingual, Refugee HealthLine (1-866-286-4770 (toll-free) to connect refugees to health care providers for transitional health care and services. Providers who have come forward to provide care to refugees should be encouraged to contact the Refugee HealthLine as soon as possible to register their availability.

The MOHTLC has also developed a support tool for primary care providers to be used in their early assessments and care of Syrian refugees (vaccination information and routine testing information can be found within this document).

Food Recall Warning - Dole Fresh Vegetables (January 2016)

The Canadian Food Inspection Agency (CFIA) issued a warning that Dole Fresh Vegetables Inc. is recalling various pre-packaged chopped salads, salad blends and kits, and leafy green products from the marketplace due to possible Listeria monocytogenes contamination.

This recall applies to all products manufactured from the Dole facility located in Springfield, OH. Affected product can be identified with a product code beginning with the letter "A" in the upper right-hand corner of the package.  A complete listing of products is available here.  We are asking all facilities with food services to check for recalled products.  Recalled products should be thrown out or returned to the store where they were purchased.

Food contaminated with Listeria monocytogenes may not look or smell spoiled but can still cause illness. Listeria typically incubates from 2 to 3 weeks, however cases have occurred up to 70 days after a single exposure to a contaminated product.  Symptoms can include vomiting, nausea, persistent fever, muscle aches, severe headache and neck stiffness. Pregnant women, the elderly and people with weakened immune systems are particularly at risk. Although infected pregnant women may experience only mild, flu-like symptoms, the infection can lead to premature delivery, infection of the newborn or even stillbirth. In severe cases of illness, people may die.

Testing Specimen Collection for Foodborne Illness

Individuals who have eaten suspect food only require laboratory testing if they have symptoms of meningitis and invasive disease.  Specimens for Listeria monocytogenes should not be collected on asymptomatic patients.                                                                                                                                                                                

If the patient has invasive disease symptoms such as fever or meningitis:  

Specimens to be submitted to a local diagnostic laboratory:

  • Blood cultures
    • Two sets of blood cultures should be taken from different sites. A third set of blood cultures should be drawn if and only if endocarditis is suspected. Collect another set of blood cultures after 48hrs if the previous cultures are negative and there is ongoing concern of invasive infection with Listeria monocytogenes.
  • Cerebrospinal fluid (CSF)
  • Sterile site fluids and tissues such as joint fluid, cord blood and placental tissue

Specimens to be sent to the Public Health Laboratories (PHL):

  • All Listeria monocytogenes isolates from diagnostic laboratories
  • Stool specimens for culture of Listeria monocytogenes
    • Acceptance of stools specimens for culture for Listeria monocytogenes testing requires the presence of all three of the following criteria:  

1) symptomatic;

2) high risk - including immunocompromised, pregnant, neonate;

3) with ingestion of implicated food.

Stool cultures will not be accepted without the prior approval of a PHL Medical Microbiologist (please contact 416‐526‐5441). If approved, these samples will be forwarded to the Listeriosis Reference Service, Bureau of Microbial Hazards, Health Canada in Ottawa.

  • Food samples
    • Must be forwarded through public health units. Acceptable foods are those that have been ingested and are suspected of containing Listeria monocytogenes.  

For further testing information:

• Contact the PHL Customer Service Centre at 416‐235‐6556 or toll free at 1‐877‐ 604‐4567, or via email at customerservicecentre@oahpp.ca  

• For the PHL Specimen Collection Guide and previous Labstracts, click here.

 For further information on Listeria contact Hastings Prince Edward Public Health, Communicable Disease Program at 613-966-5500 x349.

Travel Health Notice - Zika Virus (January 2016)

In 2015, Zika virus was reported for the first time in a number of countries in Central and South America, as well as in Mexico. Past outbreaks of Zika virus infection have been reported in Africa, Asia and the Oceanic Pacific region.  There have been travel-related cases of Zika virus reported in Canada in returned travellers from countries where the virus is known to circulate.  There have been no reported cases of locally acquired Zika virus in Canada.

For the latest updates on countries affected by Zika virus, please visit the  World Health Organization’s website. For the latest map of confirmed cases in the Americas visit the Pan American Health Organization’s website.

Zika virus infection is caused by a virus which is spread by the bite of an infected mosquito. Symptoms can include fever, headache, conjunctivitis (pink eye) and rash, along with joint and muscle pain. The illness is typically mild and lasts only a few days.

In Brazil, there has recently been a significant increase in number of babies born with birth defects (congenital malformations), such as infants born with an abnormally small head and microcephaly (an underdeveloped brain). The Ministry of Health of Brazil recently identified a possible relationship between Zika virus infection and the increase in the number of microcephaly cases. An investigation to better understand the relationship between Zika virus infection and increased risk for microcephaly is ongoing.

It is recommended that pregnant women and those considering becoming pregnant discuss their travel plans with their health care provider to assess their risk and consider postponing travel to areas where the Zika virus is circulating in the Americas.  If travel cannot be postponed then strict mosquito bite prevention measures should be followed to protect themselves against bites.

The Public Health Agency of Canada recommends that all travellers protect themselves from mosquito bites when travelling to areas where Zika virus is circulating. There is no vaccine or medication that protects against Zika virus infection.

Please visit Public Health Ontario's website for more information.

Surveillance of Enterovirus 68 (EV-D68) (September 2015)

In early fall 2014, there was an increase of EV-D68 infections in North America, with some patients presenting with severe respiratory symptoms. Rare cases of acute flaccid paralysis (AFP) were also reported that were likely related to EV-D68 infection. In Ontario, the total number of respiratory specimens tested for EV-D68 at Public Health Ontario (PHO) in 2014 was 1,121, and of these, 100 (8.9%) tested positive for the virus. Of cases where AFP was documented and entered into the integrated Public Health Information System (iPHIS), two were confirmed positive for EV-D68, both in children less than 15 years of age.

As you are aware, EV-D68 is not a reportable disease in Ontario. In 2014, to ensure that any potential cases of AFP associated with EV-D68 were captured, the Ministry of Health and Long-Term Care (the ministry) temporarily removed the upper age limit of 15 years on the case definition for AFP. The age limit for reporting of AFP was subsequently returned to less than 15 years of age in April 2015.

As the 2015-2016 respiratory season approaches, we want to share with you some proactive planning that has been done to monitor transmission and potential severity of infection associated with EV-D68, in any age group, should the virus circulate this season:

  • PHO has established linkages with a key hospitals, such as the Hamilton Regional Laboratory and has requested to be notified when EV-D68 is diagnosed;
  • PHO Laboratories started testing for EV-D68 on August 3, 2015. Health care providers (HCPs) ordering enterovirus/EV-D68 testing are required to complete a Clinical Summary Form and a General Test Requisition Form;
  • PHO has also updated their EV-D68 webpage with general information on the virus and how to contact the laboratories when submitting specimens for EV-D68 testing.

For more information, please contact the Communicable Disease Intake line at 613-966-5500, ext. 349.

First Confirmed Case of MERS-CoV in Thailand (June 2015)

The first case of MERS-CoV was reported in Thailand in a 75-year old man who travelled from Oman to Thailand to seek medical care.

Globally, there has been 1,333 laboratory confirmed cases of MERS-CoV, including at least 471 associated deaths since 2012.  At least 217 of these confirmed cases have been Health Care Workers.

As of June 9th, 2015, the International Health Regulation (IHR) WHO Emergency Committee have concluded that the conditions for a Public Health Emergency of International Concern (PHEIC) have not been met.  Based on the current information available, there is no public health justification for implementing any measures to prevent the spread of this disease by restricting travel or trade.

Increased vigilance and heightened awareness should take place in the event of severe acute respiratory illness in a person with links to affected areas in the two weeks prior to symptom onset.  In the event of a SUSPECT or CONFIRMED case of MERS-CoV, Health Care Practitioners should notify the Communicable Disease Team at the Public Health Unit by calling 613-966-5500 ext. 349.

The Public Health Agency of Canada has posted guidance documents that can be found here.

An Update from Public Health's Secual Health Clinic: Gonorrhea...A growing Concern (June 2015)

The number of cases of gonorrhea among residents of Hastings & Prince Edward Counties is on the rise.  In order to support local health care providers to effectively identify and manage cases and contact of gonorrhea, please refer to our Quick Guides. Health care providers can now order a supply of publicly-funded STI medications through the recently update Vaccine/STI Medication Order Form.

New Ebola Directive Released and Changes Made to CMOH Directive for Paramedic Services (December, 2014)

The Ministry of Health and Long - Term Care released Directive #3: Precautions and Procedures for Primary care Settings.

The Ministry of Health and Long - Term Care also released a revised version of Directive #2: Paramedic Services Land and Air Ambulances and First Responder Practices and Procedures.

First Influenza Cases Reported for 2014/2015 Season (December, 2014)

This year’s first two local cases of Influenza (“flu”) were confirmed in December, both involving unimmunized residents of the Bancroft area. These individuals were seen and released from the hospital Emergency Department. Click here for our influenza fact sheet.

Influenza Surveillance

The predominant influenza virus circulating to date in Ontario is the influenza A/H3N2. This strain is associated with moderate to severe disease, higher morbidity and mortality, as well as increased numbers of institutional outbreaks. Early data is suggesting the 2014/2015 influenza vaccine may be mismatched to this predominant circulating strain.

Recommendations for Health Care Providers

  1. Continue to offer the influenza vaccine. Despite the potential vaccine mismatch, it is still important to offer immunization as it may provide cross protection that can lead to milder illness and fewer influenza related complications. The current vaccine will provide protection against the two non-drifted influenza strains.
  2. Prepare for an increased demand for health care services and outbreaks.
  3. Offer early antiviral treatment to recommended recipients presenting with influenza symptoms, regardless of immunization status as per the AMMI Canada Treatment Guidelines. (link to Guidelines - http://www.ammi.ca/guidelines)

Antivirals are recommended for:

  • Those with influenza-like illness severe enough to require hospitalization; and
  • Individuals with influenza-like illness at higher risk of complications from influenza infection as follows:
    - children aged 1 to 5 years;
    - adults 65 years of age and older;
    - persons with chronic pulmonary (including asthma), cardiovascular (except hypertension      alone), renal, hepatic, hematological (including sickle cell disease), or metabolic disorders (including diabetes mellitus), or neurologic and neurodevelopment conditions;
    - persons with immunosuppression, including that caused by medications or by HIV infection;
    - women who are pregnant or postpartum (within 4 weeks after delivery);
    - aboriginal people;
    - persons aged younger than 18 years of age who are receiving long-term aspirin therapy; and
    - persons who are morbidly obese (e.g., body-mass index is equal to or greater than 40).

Be aware of current antiviral recommendations for staff of long-term homes, retirement homes, and hospitals. In light of the potential vaccine mismatch, it is currently recommended that during outbreaks of Influenza A, antivirals be offered to all staff, regardless of immunization status, until the outbreak is declared over.

It is important to be prepared ahead of time for the rapid provision of antivirals to all residents and all staff in the event of an Influenza A outbreak.

The Ministry of Health and Long-Term Care will reimburse long-term care homes and retirement homes for the cost of antiviral drugs for vaccinated staff providing the following conditions have been met:

- Hastings Prince Edward Public Health has confirmed an Influenza A outbreak;
- The number of staff requiring the antiviral for prophylaxis has been determined by Public Health;
- The staff member recommended to receive the antiviral does not have health insurance to cover the expense; and
- The process for reimbursement at this time is through the High Intensity Needs Fund.