Surveillance and Epidemiology is the public health science centre of the organization. It is the powerhouse behind the Agency’s public health mandate, translating and contextualizing specific content expertise into public health intelligence.
The concentration of public health scientific expertise in this program area includes specialists in public health medicine, biostatistics, epidemiology, veterinary medicine, geospatial analysis, data management, ethics, privacy and research. The individuals concerned have a dual role to work in partnership with other content experts and to provide content expertise in their own field.
The department has cross appointed academics at the University of Toronto (Dalla Lana School of Public Health and Department of Laboratory Medicine and Pathobiology) and McMaster University. Staff are involved in teaching and mentoring graduate students and in supervising practicum students and Community Medicine residents.
Building public health capacity in Ontario
In the space of one year, the Director of the Surveillance and Epidemiology Scientific Program implemented an effective recruitment strategy to build a core team from 3 to 20 staff, plus an additional 10 staff funded for specific research projects. As well, in the last quarter we had our first health unit secondment to PHO. This established a multidisciplinary team to support all program areas of PHO and to engage in partnership building, research, public health leadership, surveillance and epidemiology
|Activities in specific content areas
- Scientific and financial support for the "Ontario Foodborne Outbreak Symposium". Three presentations were made as well as leading the Table Top exercise.
- Enteric Laboratory Surveillance: identified outbreaks of Y. enterocolitica, and S. Enteritidis
- A meeting with the Public Health Agency of Canada (PHAC) was held to discuss roles in outbreak investigations and identify areas for collaboration.
- PHO hosted and disseminated to health units and other stakeholders a presentation by OMAFRA pertaining to “H1N1 and the Swine Industry”.
- Initial collaboration between PHL-T and the Animal Health Laboratory (AHL) to partner on developing testing for Chlamydophila (Psittacosis) in birds.
- Partnership building with the Center for Public Health and Zoonoses (CPHAZ).
Vaccine preventable diseases and vaccine program evaluation
- Assessment of background rates of Guillain Barre Syndrome (GBS) and select conditions for assistance with pandemic vaccine adverse events following immunization (AEFI) assessment. This work will be presented at two upcoming conferences
- Development of a pandemic vaccine consideration document
- Organization of 2009 HPV Dialogue, featuring two Gairdner recipients and a Nobel Laureate.
- Initiation of HPV program evaluation. The Ontario HPV Evaluation Committee has been formed with partners from Cancer Care Ontario, the MOHLTC and ICES, and a HPV Vaccine process evaluation is well underway.
- Provided assistance to the field during a provincial mumps outbreak and conducted a mumps vaccine effectiveness assessment
Respiratory infections and outbreaks including pandemic H1N1
- In response to pandemic influenza H1N1, the program ramped up its staffing in order to support the construction and implementation of a laboratory pandemic H1N1 surveillance system and the development of a Provincial pandemic surveillance strategy in partnership with MOHLTC.
- Our response included fundamental, core support to a number of program areas including providing daily numbers of cases, a weekly laboratory data analysis report, and weekly literature summaries for Communications to distribute, as well as the provision of expert advice to MOHLTC, PHAC and other stakeholders.
- Prepared and submitted a report on CDI-related mortality entitled ‘A Review of Clostridium difficile Infection-Related Deaths’ to the Executive Lead for Patient Safety at MOHLTC
- Carried out an evaluation of Infection Control Resource Teams (ICRTs) and their impact on decreasing rates of CDI.
- Monthly analysis of CDI data obtained through mandatory patient safety indicator reporting
Privacy, data sharing and ethics
- A CIHR operating grant was awarded on the topic “Facilitating access to health information for research and planning in light of laws and ethical norms” Areas of consensus and disagreement among stakeholders on the conditions under which personal information may be used for health research will be identified.
- Participating as co-investigators on a CIHR operating grant on “Developing privacy preserving methods for sharing longitudinal electronic health records”.
- Development of a pan-Canadian streamlined ethics review process for multicentre projects involving public emergencies. A paper describing this pilot project is currently under review.
- Presentation on “Use of data from the electronic health record for health research: Governance challenges in Canada and potential solutions” at an international conference.
Geographic Information Systems
- Mapping support for the second wave of pH1N1 including ring maps for the weekly laboratory reports and geospatial analysis of Seroprevalence study results (showing sample locations) and Sentinel VE Study physician locations
- Building geospatial capacity through software acquisition and obtaining key spatial datasets for application throughout PHO
- Providing GIS support for Surveillance and Epidemiology and many other program areas within PHO including Infectious Disease Prevention and Control (CDAD). Spatial projects fall within all other PHO program areas, such as:
- Surveillance and epidemiology
- Infectious Disease prevention and control
- Environment and occupational health
- Emergency Management
- Providing GIS support to external stakeholders including several public health units (Northwestern, North Bay Parry Sound District, Leeds-Grenville and Lanark District, Wellington-Dufferin-Guelph), LHINs, OHRI and ICES
- A member of MOHLTC GIS Strategy Stakeholder Advisory Group
- Providing assistance with four GIS workshops that were held by Infonaut.
- Attendance at the Geoconnections Peel Public Health application meetings, providing feedback on the spatial, epidemiologic and modelling components of the application. Future work in this area will be performed once the application is more complete.
- Outbreaks where PHO has provided support include Yersinia enterocolitica, Salmonella Enteritidis, and mumps.
- Provided advice on a cluster of Listeria cases.
- Provided ongoing field epidemiology support on ICRT visits to hospitals
- Ongoing - Provide epidemiological support for G8/G20 planning
- S&E (along with IDPC) has been accepted as a tier one Canadian Field Epidemiology Program (CFEP) training site and as the first CFEP Practicum site.
- Provision to host a University of Toronto Epidemiology Graduate Student for a field epidemiology practicum funded by CFEP.
Health Promotion, Chronic Disease and Injury Prevention
- Co-chair of the Ontario Childhood Healthy Weights Surveillance Steering Committee, with the Association of Local Public Health Agencies (alPHa), tasked to develop a preferred approach to “Monitoring Heights and Weights of Ontario School Children”.
- Provided scientific and technical support to the Ontario Childhood Healthy Weights Surveillance Steering Committee including the completion of a draft guidance document on “Monitoring Heights and Weights of Ontario School Children” which will be used for an initial pilot within two health units starting in April 2010.
- Establishment of a funded project on Chronic Disease Population Health Assessment Development to provide scientific and technical advice and recommendations related to the development of an electronic dashboard interface for key chronic disease indicators to the Ministry of Health Promotion to inform future decision making.
- Formation of Ontario Risk and Behaviour Surveillance System (ORBSS) Advisory Committee tasked with providing advice to PHO on the development of a sustainable province-wide system, centrally supported by PHO, that produces provincial-level estimates of health behaviours, attitudes, socio-economic and other risk factors and supports local health units to fulfill the requirements of the Ontario Public Health Standards.
- Strategic funding and development of Rapid Risk Factor Surveillance System (RRFSS) pH1N1 related modules including assessment of population-level pH1N1 vaccination coverage rates in collaboration with RRFSS and additional sample collection in those geographic areas not currently covered by RRFSS.
- Continued support of the RRFSS through module development support related to pH1N1, in-kind contribution of teleconferencing and preparation for RRFSS website hosting transfer to PHO.
- Environmental scan on population-level diabetes and related risk factors for diabetes data bases in Ontario.
- Provision to host a University of Toronto Epidemiology Graduate Student to assess where PHO can add value to the use of the Early Development Instrument within public health in Ontario.
- PHO participates in the Neurotrauma Prevention Surveillance Steering Committee, established in October 2009.
Other Partnership building
- Participation in a meeting with the Chiefs of Ontario followed by participation in the FNIH-PTO Working Group and Pandemic Technical Working Group Meeting
- Participation in a lunch and learn session with the MOHLTC HP&P Branch on Key Activities for Surveillance, Environmental Health and Infectious Disease Prevention
- Participation in a meeting with Association of Public Health Epidemiologists in Ontario (APHEO) and agreement on shared interests reached.
- Participating in a provincial working group looking at the epidemiology of repeat STI infections in Ontario.
Infectious Diseases Surveillance
- Surveillance and Epidemiology continue to work on building a new laboratory surveillance system with our partners in the PHL and IT. While this work is ongoing, interim systems are being used to look for trends and share data with MOHLTC, especially on respiratory viruses (with weekly reports) and enteric infections (teleconferences).
- A data sharing agreement was completed with EMS with respect to syndromic surveillance and data analysis has started in partnership with Toronto Public Health to evaluate the utility of EMS dispatch data for tracking influenza.
Substantial progress has been made on the Ontario Burden of Infectious Diseases (ONBOIDS) report, although production is delayed into 2010 because of the impact of the pandemic.
Knowledge translation/training/partnership working
- March 4. Pandemic H1N1 in Ontario. Research Seminar Series. Dalla Lana School of Public Health. University of Toronto, Toronto, Ontario.
- February 23. Pandemic H1N1 in Ontario. ICES/CEU Conjoint Rounds Institute for Clinical Evaluative Sciences. Toronto, Ontario
- Feb 5th. Microbiology 101 course in Ottawa (Ottawa Regional Public Health Lab).
- February 11th. Aberration detection algorithms. Dalla Lana School of Public Health, University of Toronto.
- Feb 11/12th. Systematic Review and Meta Analysis workshop in Halifax
- PHO Journal Club established
- Ongoing – Co-chair and organizing committee member – 2010 Canadian Immunization Conference
- Ongoing – organizing committee member, Public Health Workshop: Vaccines – 26th Annual International Papillomavirus Conference and Clinical Workshop
- Ongoing – organizing committee member, APHEO 2010 Workshop on Ontario Public Health Standards
- Ongoing – committee member, MOHLTC Indicator Technical Advisory Committee.
- 23rd September: OHA Patient Safety Indicators Workshop - Presentation on Trends in reporting Clostridium difficile infections in Ontario.
- 11 November. University of Toronto Undergraduate course in Population Health & Epidemiology on Epidemiology in Action
- 20th November TIBDN on H1N1
- 27th November. University of Toronto, Community Medicine Resident rounds. Vaccine Preventable Disease and Adverse Event Surveillance in Australia
- 30 November, PHO GIS Workshop #2 – Presentation on Ring Maps: A Useful Visualization Technique for Pandemic H1N
- 14th December. Chief Medical Officer of Health/Medical Officer of Health Conference call. Events Occurring in Temporal Association to pH1N1 Influenza Immunization –and immunity to pandemic H1N1
- 18th January Public Health Epidemiologists MOHLTC Meeting- Preliminary analysis from a seroprevalence study of pandemic H1N1 influenza among Ontarians
- 28 January, University of Toronto Graduate course in Health Trends and Surveillance – Presentation on GIS fundamentals and applications in public health
- 9th February Increasing trend in human Salmonella enteritidis cases in Ontario to representatives from the Poultry Industry on behalf of the “Ontario Multi-Agency Salmonella Enteritidis Working Group”.
- 28th February. University of Toronto Graduate course in Health Trends and Surveillance – Presentation on Syndromic Surveillance
- World Health Organization, Technologies and Logistics Advisory Committee (TLAC); Member
- National Advisory Committee on Immunization; Member
- Designed and carried out a large-scale urgent case control study, completed the analysis and disseminating the preliminary findings in < 6 weeks (with support from MOHLTC)
- Secured $500K from the Public Health Agency of Canada in funding to carry out 6 H1N1 research projects into 2010-11
- Successful in getting four influenza research CIHR grants funded (with impressive rankings), with principal investigators on two and as co-investigators on two grants.
- Host the team for the PHAC CIHR Influenza Research Network (PCIRN) coverage theme, which has delivered an impressive array of studies during the pandemic; including continued progress on Canada-wide on-site assessment of pandemic immunization data collection approaches (electronic, paper, hybrid) in public health and health care settings, and design of an economic evaluation of data collection approaches
- Lead, in partnership with our Laboratory colleagues, the Ontario component of a 4 province study of influenza vaccine effectiveness
- Conducting a seroprevalence study: the first phase to determine pandemic H1N1 seropositivity rates following the first wave of the pandemic is completed. Additional testing is underway to determine pandemic H1N1 seropositivity rates following the second wave
- Assessment of secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009
- Completed the rapid development of mulitple RRFSS modules on influenza
- Statistical guidance and support in the modeling and analysis of the Time and Motion of Study for the CIHR funded vaccine coverage project
- Statistical guidance/consultation in the design and sample size calculations of the Ontario Childhood Healthy Weights Surveillance and consultation on sample size related issues in the RRFSS project
- Ongoing methodological/research advances in a number of areas some at the manuscript submission stage. For example, an extension of the Lawely-Hotelling trace test to the Growth Curve Model - which is very useful for analyzing short time series data and a second manuscript on a novel method for integrating heterogeneous data sets.
Other research in 2009/10
- Data Fusion - first meeting (2 day) of a collaborative research project with the NRC and the Ottawa Heart Institute
- Primary Care and Public Health Collaboration McMaster University: a three day meeting on Primary Care and Public Health Collaboration which aimed to build synergies through research capacity and knowledge translation.
- Submitted a CIHR research grant proposal entitled “Immunity of Canadians and Risk of Epidemics (iCARE): Serologic immunity of Canadians to measles, mumps, rubella and varicella zoster virus- impact of immunization and implications for future control”
|Reports and Publications for 2009-10
- Association between the 2008-09 seasonal influenza vaccine and pandemic H1N1 illness during Spring-Summer 2009: four observational studies from Canada. Skowronski DM, De Serres G, Crowcroft NS, Janjua NZ, Boulianne N, Hottes TS, Rosella LC, Dickinson JA, Gilca R, Sethi P, Ouhoummane N, Willison DJ, Rouleau I, Petric M, Fonseca K, Drews SJ, Rebbapragada A, Charest H, Hamelin ME, Boivin G, Gardy JL, Li Y, Kwindt TL, Patrick DM, Brunham RC; Canadian SAVOIR Team. PLoS Med. 2010 Apr 6;7(4):e1000258.
- Why collect individual-level vaccination data? Kwong JC, Foisy J, Quan S, Heidebrecht C, Kolbe F, Bettinger JA, Buckeridge DL, Chambers LW, Crowcroft NS, Dhalla IA, Sikora CA, Willison DJ, Pereira JA. CMAJ. 2010 Jan 18. [Epub ahead of print]
- Seasonal vaccine and H1N1. Selection bias explains seasonal vaccine's protection. Janjua NZ, Skowronski DM, Hottes TS, De Serres G, Crowcroft NS, Rosella LC. BMJ. 2009 Nov 24;339:b4972. doi: 10.1136/bmj.b4972.
- Epidemiological summary of pandemic influenza A (H1N1) 2009 virus – Ontario, Canada, June 2009. Savage R, Whelan M, Deeks S, Badiani T, Gubbay J, Akwar H, Foisy J, Lee B, Winter A and Crowcroft N. Weekly Epidemiological Record. 2009 Nov 20. 84(47): 485–492.