2012 Health Watch October, 2012

ContentsSummary ........................................1

Our Region .....................................2

Earthquake Preparedness ........3

Communicable Diseases...........4

Injury Surveillance ......................5

Emergency Room Visits .............7

Emergency Management .........8

Boil Water Advisories ..................9

Drinking Water Quality ..............10

Food Service Closures ................12

Air Quality ......................................13

Acknowledgements ...................15

Summary

This month’s health promotion message:

In an earthquake, DROP, COVER and HOLD!

Minimal influenza activity. Flu shots available soon. Currently, no VCH E. coli cases related to the recent Canadian beef recall.

Be prepared: The Great British Columbia Shakeout.

All data herein should only be used with reference to the “2012 Health Watch prepared by Vancouver Coastal Health, Public Health Surveillance Unit”.

2012 Health Watch October, 2012

Our Region

The Vancouver Coastal Health Authority (VCH) is one of five geographically distinct health authorities in British Columbia (BC). The VCH region covers a large geographic area (both urban and rural communities) and is comprised of three health service delivery areas (HSDA), including North Shore/Coast Garibaldi (i.e. Coastal Urban and Coastal Rural), Richmond and Vancouver.

The Vancouver HSDA is further divided into six local health areas (LHA) and the North Shore/Coast Garibaldi HSDA further divided into seven (two LHAs in Coastal Urban and five in Coastal Rural). The estimated VCH population is 1.1 million, approximately 25% of BC’s population.

2012 Health Watch October, 2012

The Great British Columbia Shake Out On October 18, 2012 at 10:18 AM, thousands of British Columbians participated in “Drop, Cover, and Hold On” in The Great British Columbia ShakeOut, the largest earthquake drill in BC history!

All British Columbians were encouraged to participate in the drill.

British Columbia is located in a seismically active region where a few thousand earthquakes occur each year in and adjacent to the province. The threat of a major earthquake in the province is real and all British Columbians must know how to be prepared.

The annual ShakeOut drill is our chance to practice how to protect ourselves, and for everyone to become prepared. The goal is to prevent disasters from becoming catastrophes.

More ‘routine’ events such as wind and snow storms, power outages, transportation disruptions and boilwater orders are far more likely to affect our region. Taking a few simple steps to prepare can significantly reduce risk and lessen the impact of any emergency. To get started:

• Organize an emergency supply kit at home and at work, including a 3-day supply of food andwater, essential medications, fl ashlights, and battery-operated radio. Store the kit in a portablecontainer in an accessible location, in case you need to evacuate your home.

• Designate an emergency out-of-area contact. In the event local communications lines are damaged,it may still be possible to call a friend or family member who lives outside the earthquakezone. Everyone in the family can call the out-of-area contact to check in and let them know theyare okay.

• Conduct a home hazard hunt to mitigate avoidable risks at home and at work.

Visit www.shakeoutbc.ca for more details.

The best way to protect yourself and others from flying and falling debris during an earthquake is toDROP, COVER and HOLD. When the shaking starts:

Drop under a sturdy desk, table or piece of furniture toCover your face, head and neck andHold onto the legs of the furniture and hold this position while counting to 60

2012 Health Watch

Communicable Disease Summary

October, 2012

Investigations

PertussisCases of pertussis (whooping cough) continue to be reported across VCH. Though the number reported each week has decreased. Washington State and Fraser Health Authority continue to see cases; their numbers are also decreasing.

Since January 1, 2012, there have been 244 reportable cases of pertussis identified in VCH (Figure 1). Reportable cases include those with lab confirmation, individuals with symptoms and contact with another confirmed case or individuals having symptoms for greater than two weeks. Five pertussis cases were reported during the same period last year.

Fourteen new cases were reported over the past four weeks. New cases included two school-aged unimmunized VCH residents. No new cases required hospitalization.

The highest rate of cases has been seen in those aged 10-13 years (128 cases per 100,000 population). One hundred and ten cases of pertussis have been reported in 48 VCH schools. Children are back in school and public health is monitoring for reports of transmission within the schools.

VCH has expanded free pertussis vaccine eligibility with the goal of protecting residents and infants too young to be vaccinated against the disease. Anyone who has contact with young children can receive the vaccine for free. Also, all pregnant women and partners, all Aboriginal people, family physicians, pediatricians, obstetricians and their office staff are eligible for free pertussis vaccine.

For more information on pertussis in VCH and where you can get your vaccine, visit the VCH website at: www.vch.ca/about_us/news/the-facts-on-pertussis-or-whooping-cough

Figure 1. Reportable* pertussis cases by epidemiological week (n=256).Vancouver Coastal Health Authority, August 1, 2011 - October 3, 2012

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AUG SEP OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT

2011 12 cases 2012Epi Week

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ProbableConfirmedPrevious 3-week average

Additional cases may have occurred,

especially in past 3 weeks, that are not yet

identified.

*Indicates confirmed (lab-confirmed or clinical, epi-linked) and probable cases.Source: Vancouver Coastal Health, Public Health Surveillance Unit (Enhanced Surveillance). Data as of October 3, 2012.Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

2012 Health Watch

Communicable Disease Summary

October, 2012

Recalls

BC’s Provincial Health Officer says there has been one case of illness in BC connected with the recall of beef from Alberta’s XL Foods, Inc. Dr Perry Kendall is urging consumers to check the recall list on the Canadian Food Inspection Agency’s (CFIA) website. The beef recall began on September 28th, when CFIA announced the meat may be contaminated with E. coli O157:H7. Public health authorities have confirmed a number of recent illnesses in Canada linked to consuming XL Foods Inc. beef. To date, there have been three cases in BC and fifteen cases in Canada.

Meanwhile, the provincial government is preparing to take over responsibility for inspecting meat slaughtered and sold in the province. That responsibility currently belongs to CFIA but is being handed back to B.C., as well as Saskatchewan and Manitoba. The transition is expected to be complete by January. While the CFIA has provided meat inspection services to those provinces for a number of years, in other parts of the country, the services are provided by provincial governments.

Updated recall information: http://www.inspection.gc.ca/about-the-cfia/newsroom/food-recalls-and-allergy-alerts/eng/1299076382077/1299076493846

There was an increase in the number of VCH ER visits related to illicit drug overdoses during this reporting period (Figure 2). A dramatic increase was seen in week 39 and may have been related to the distribution of the monthly income assistance cheque during that week.

The number of overdoses at the Insite injection room was above the historical average but near the previous 3-week average (Figure 2).

Injury Surveillance

Illicit drug overdoses

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ER visits ER previous 3-week average ER historical average (2008-2011)

Figure 2. Number of ER and Vancouver Insite* visits related to illicit drug overdose† by epidemiological week.VCHA, 2012

*Supervised injection site. †Illicit drugs related visits in ER are monitored through ICD-9 codes 304.0, 304.2-304.9, 305.2-305.9, 760.72, 760.73, 760.75, 965.00-965.02, 965.09, 968.5, E850.0, E935.0, and ICD-10 codes F119B, F149, F159, F169, F199, T40, T439A, T509A, T509D, T509E and T509F and a keyword search where illicit drugs related terms were indicated in presenting complaint, discharge diagnosis, nature of injury and mechanism of injury.Data sources: 1. Emergency room visits: Vancouver Coastal Health, CareCast System (Richmond Hospital, UBC Hospital, Vancouver General Hospital), Eclipsys System (Mount Saint Joseph Hospital, St. Paul's Hospital) and McKesson System (Lions Gate Hospital, Pemberton Health Centre, Squamish General Hospital, Whistler Health Care Centre). 2. Insite visits: Insite, Vancouver Coastal Health, HIV/AIDS & Harm Reduction Programs.Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

2012 Health Watch October, 2012

Emergency Room Visit Volume

Emergency room visit volume is monitored for nine of 13 acute care hospitals in the region. Emergency room volumes were at historical average for the majority of VCH hospitals during the past five weeks.

ER visit volumes exceeded the historical 95% confidence interval at both Mount Saint Joseph Hospital and Squamish General Hospital in weeks 36 and 38, Pemberton Hospital in week 38, St. Paul’s Hospital in weeks 36, 38 and 39 (Figure 3), Richmond Hospital in week 36 and Vancouver General Hospital in weeks 36-39 (Figure 4).

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*Determined by the patient's postal code at the time of visit. Non-BC residents include those with an unknown postal code at time of visit. †Includes data since 2006. Source: Emergency Department Visits from Eclipsys System (Mount Saint Joseph Hospital, St. Paul's Hospital).Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

Figure 3. Number of ER visits by resident location* and epidemiological week.St. Paul's Hospital, 2012 compared to historical average and 95% confidence limits†

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*Determined by the patient's postal code at the time of visit. Non-BC residents include those with an unknown postal code at time of visit. †Includes data since 2006. Source: Emergency Department Visits from CareCast System (Richmond Hospital, UBC Hospital, Vancouver General Hospital).Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

Figure 4. Number of ER visits by resident location* and epidemiological week.Vancouver General Hospital, 2012 compared to historical average and 95% confidence limits†

2012 Health Watch October, 2012

Emergency Room Visit Volume

ER visit volumes exceeded the historical 95% confidence interval at Whistler Health Care Centre in weeks 36 and 39 (Figure 5).

Emergency Management

On the morning of September 20, 2012, construction workers ruptured a gas line affecting several buildings near Cambie and Broadway. Fortis BC found two significant leaks and worked on repairing them until the early afternoon when the situation was resolved. A combination of VCH, PHC and PHSA staff were affected in offices near the leak.

A PHSA Emergency Operations Centre (EOC) was established at City Square with Emergency Planners and representatives from Vancouver Fire and Rescue Services and Fortis BC. In the early afternoon the City of Vancouver established their EOC. The Chief Medical Health Officer was provided updated situation reports.

No injuries were reported and all nearby offices were reopened by the end of the day.

False Creek Gas Leak

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*Determined by the patient's postal code at the time of visit. Non-BC residents include those with an unknown postal code at time of visit. †Includes data since week 41 of 2006. Source: Emergency Department Visits from McKesson System (Lions Gate Hospital, Pemberton Health Centre, Squamish General Hospital, Whistler Health Care Centre).Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

Figure 5. Number of ER visits by resident location* and epidemiological week.Whistler Health Care Centre, 2012 compared to historical average and 95% confidence limits†

2012 Health Watch October, 2012

Environmental Health

Boil Water Advisory

VCH Health Protection staff are responsible for conducting surveillance and monitoring of drinking water systems. Information on water quality is obtained from regularly scheduled routine monitoring inspections and evaluations that are undertaken on all regulated drinking water systems.

Water suppliers are required to make water quality information available to the public. Water suppliers must provide notice when a drinking water supply system shows an increased risk to health during such conditions as: a temporary treatment failure, a change in turbidity of source water due to increased rainfall or landslides, the presence of pathogens as demonstrated through water quality test results or when there is no form of water treatment being undertaken.

A Boil Water Advisory (BWA) is issued when there is a potential health risk associated with drinking water consumption (e.g. unacceptable levels of disease-causing bacteria, viruses or parasites in the water system). A BWA advises water users to boil their water before consuming it.

The treatment options for addressing BWAs are as follows:

• Boil water (full boil minimum 2 minutes).• Add two drops of household bleach per 1 litre warm water (double dose for cold water), shake, and

allow to stand for 30 minutes before using.• Add chlorine or iodine tablets and follow manufacturer’s instructions.

New advisories (August 31, 2012 to September 27, 2012)

For more information on boil water advisories, visit the Vancouver Coastal Health website at: www.vch.ca/your_environment/water_quality/drinking_water/advisories/boil_water_advisories

For more information on disinfecting drinking water, visit the Vancouver Coastal Health website at: www.vch.ca/media/How%20to%20disinfect%20Drinking%20Water_HealthLinkBC.pdf

Source: Vancouver Coastal Health, Environmental Health.

As of September 27, 2012 there are 53 boil water advisories in place for the VCH region (all in the Coastal area).

Date of BWA Location Reason for advisoryAugust 31, 2012 South Pender Harbour Water Service Area,

Sunshine CoastExcessive turbidity compromising treatment and water quality.

August 31, 2012 Copeland Island Marine Estates, Sunshine Coast Positive E. coli sample and excessive turbidity compromising treatment and water quality.

September 19, 2012 Medvy Creek Water System, Hagensborg Non compliance with water potability standards.

September 26, 2012 Mount Seymour Resorts Water System, North Vancouver

Positive E. coli sample.

Removed advisories (August 31, 2012 to September 27, 2012)

Date of BWA removal

Location Reason for advisory

September 12, 2012 Squamish Valley Campground and RV Park,Squamish, Sea to Sky

Contamination of total coliform bacteria accross water system.

September 27, 2012 Gillies Bay Improvement District Water System,Texada Island

High turbidity and total coliforms and some over grown’s in samples.

2012 Health Watch October, 2012

Environmental Health

Drinking Water

*Turbidity measures the degree to which water loses its transparency due to the presence of suspended particulates. Turbidity levels above 1 NTU (Nephelometric Turbidity Units) prompt increased disinfection levels as a safety precaution.

Watershed average daily turbidity* readings after primary treatment, Metro Vancouver, September 1 - 30, 2012

*Chlorine is used for primary and secondary disinfection of water. Maintaining a measurable level of chlorine residual throughout the distribution system helps ensure continuous water quality from source to tap.

Watershed average daily chlorine residual* readings after primary disinfection, Metro Vancouver, September 1 - 30, 2012

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Capilano Seymour Coquitlam

Note: Capliano source is removed from service between October and April.Note: Capliano source is removed from service between October and April.

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Note: Capliano source is removed from service between October and April.Note: Capliano source is removed from service between October and April.

Capliano source is

2012 Health Watch

Environmental Health

Drinking Water

October, 2012

*pH measures the acidity or alkalinity level of the water. Maintaining pH between 6.5 and 8.5 ensures water taste and quality. Capilano watershed pH readings are measured once per week on a grab sample.

Notes: 1. Water from the Seymour system is filtered.2. People with compromised immune systems should always use drinking water that has been boiled or treated to the same level as boiling.

For more information on drinking water, visit: www.metrovancouver.org

Source: Metro Vancouver, Quality Control Division.

Watershed average daily pH level* readings, Metro Vancouver, September 1 - 30, 2012

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Note: Capliano source is measured once per week on a grab sample. Capliano source is removed from service between October and April.

2012 Health Watch

Environmental Health

Food Service Establishment Closures

The following table lists new food service establishment closures in the region since the report of August 2012 (updated as of October 3, 2012).

October, 2012

Richmond

Coastal Rural

Coastal Urban

Vancouver

Date Closed Reopened Establishment Reason

September 5, 2012 September 6, 2012 THE BUTE CORDOVA BISTRO310 Bute St

Pest infestation. Unsanitary conditions.

September 10, 2012 September 12, 2012 RYU SUSHI3079 Main St

Pest infestation. Unsanitary conditions.

September 12, 2012 September 13, 2012 GUANACO SALADORAN CUISINE419 Industrial Ave

Lack of hot water.

View food establishment closures online at: www.vch.ca/your_environment/food_safety/restaurant_closuresTo contact us with a compliment, complaint or query: environmental.health@vch.ca

Source: Vancouver Coastal Health, Environmental Health.

No new closures.

Date Closed Reopened Establishment Reason

September 20, 2012 September 20, 2012 GEN SUSHI1933 Lonsdale Ave

Unsanitary conditions.

No new closures.

2012 Health Watch

Environmental Health

Air Quality Health Index (AQHI) Daily Maximum Value

October, 2012

AQHI, Metro Vancouver NW, September 1 - 30, 2012 AQHI, Metro Vancouver NE, September 1 - 30, 2012

AQHI, Metro Vancouver SW, September 1 - 30, 2012 AQHI, Metro Vancouver SE, September 1 - 30, 2012

AQHI, Whistler Meadow Park Air Quality Station, September 1 - 30, 2012

AQHI Value Health Risk

1 to 3 Low

4 to 6 Moderate

7 to 10 High

10+ Very high

AQHI Health Risk Categories

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Note: Data for Whistler station were not available May 20 - 23, 2012 due to technical issues.

Notes:1. The Air Quality Health Index reports a number from 1 to 10+ indicating the air quality. The higher the number, the greater the health risk associated with the air quality. Index readings from 1 - 3 indicate a low health risk from air pollution. Readings from 4 - 6 indicate a moderate risk to health, especially for those with pre-existing health conditions. Readings between 6 and 10 indicate a high risk to health. When the amount of air pollution is very high, the number will be reported as 10+.

2. AQHI for Metro Vancouver areas reflect readings taken at a number of stations throughout each area. The reading for Whistler is taken at a single station.

For more information on the AQHI, visit: www.airhealthbc.ca and www.bcairquality.ca

Source: BC Ministry of Environment.

2012 Health Watch

Environmental Health

October, 2012

The Health Watch began during the 2010 Olympic and Paralympic Games to provide Games organizers, public health partners and the public with a report on the health of the region.

Following the Games, the Health Watch appears monthly and is available online at:www.vch.ca/your_health/disease_surveillance/health_watch

To be added to the email distribution list or for questions/comments, please contact theVCH Public Health Surveillance Unit at: phsu@vch.ca

Acknowledgements

2012 Health Watch

British Columbia Centre for Disease Control, Epidemiology Services British Columbia Centre for Disease Control, Public Health Microbiology and Reference LabBritish Columbia Ministry of EnvironmentBritish Columbia Ministry of HealthHealthLink BC, British Columbia Ministry of HealthMetro VancouverVancouver Coastal Health and Providence Health Care emergency rooms

• Lions Gate Hospital• Mount St Joseph Hospital• Pemberton Health Centre• Richmond Hospital• St Paul’s Hospital• Squamish General Hospital• UBC Hospital• Vancouver General Hospital• Whistler Health Care Centre

Vancouver Coastal Health • Communicable Disease offices • Environmental Health• Medical Health Officers• Mental Health and Addiction Services• Health Emergency Management• Employee Health and Wellness

Vancouver Coastal Health, Providence Health Care and Provincial Health Services Authority Integrated Management Information Systems

October, 2012