2019 Vector-Borne Diseases Surveillance and Protection Plan · 2019-06-11 · 70 Joseph Street,...

2019 Vector-Borne Diseases Surveillance and Protection Plan

June 2019

345 Oak Street West, North Bay, ON P1B 2T2 TEL: 705 474 1400

70 Joseph Street, Unit 302, Parry Sound, ON P2A 2G5 TEL: 705 746 5801

myhealthunit.ca

TOLL FREE: 1 800 563 2808

http://www.myhealthunit.ca/en/index.asp

2019 Vector-Borne Diseases Surveillance and Protection Plan

Production Team

Prepared by John Mitchell, Research Assistant, Planning and Evaluation Services

Reviewed and Edited by

Brendan Hatton, Public Health Inspector, Environmental Health Robert A-Muhong, Manager, Environmental Health

Shannon Mantha, Executive Director, Community Services Dr. Jim Chirico, MOH/EO

For more information contact:

Brendan Hatton (705) 474-1400 ext. 5219

Please use the following citation when referencing this report North Bay Parry Sound District Health Unit (2019). 2019 Vector-Borne Diseases Surveillance and Protection Plan. North Bay, ON: North Bay Parry Sound District Health Unit.

TABLE OF CONTENTS

ACKNOWLEDGEMENTS ................................................................................................................ i

EXECUTIVE SUMMARY ................................................................................................................ ii

SECTION 1 - WEST NILE VIRUS .................................................................................................... 1

1.0 Introduction ................................................................................................................. 1

1.1 Surveillance ................................................................................................................. 1

SECTION 2 – EASTERN EQUINE ENCEPHALITIS ............................................................................ 4

2.0 Introduction ................................................................................................................. 4

2.1 Surveillance ................................................................................................................. 4

SECTION 3 – LARVAL AND ADULT MOSQUITO REDUCTION ........................................................ 7

3.0 Larval Mosquito Reduction .......................................................................................... 7

3.1 Adult Mosquito Reduction ........................................................................................... 9

SECTION 4 - LYME DISEASE ....................................................................................................... 11

4.0 Introduction ............................................................................................................... 11

4.1 Surveillance ............................................................................................................... 11

SECTION 5 – DATA COLLECTION AND ANALYSIS - PUBLIC EDUCATION AND COMMUNITY

OUTREACH................................................................................................................................ 13

5.0 Introduction ............................................................................................................... 13

5.1 Data Collection .......................................................................................................... 13

5.2 Data Analysis ............................................................................................................. 13

5.3 Public Education and Community Outreach ............................................................... 14

SECTION 6.0 - APPENDICES ....................................................................................................... 16

6.1 APPENDIX 1 - Mosquito Biology ................................................................................. 16

6.2 APPENDIX 2 - Larval Control Methods ........................................................................ 21

6.3 APPENDIX 3 - Health Protection and Health Promotion Act ........................................ 26

6.4 APPENDIX 4 – Case Definitions ................................................................................... 28

6.5 APPENDIX 5 - Communication Plan for West Nile Virus and Lyme disease .................. 37

6.6 APPENDIX 6 - Glossary of Terms ................................................................................. 44

SECTION 7.0 - REFERENCES: ...................................................................................................... 46

North Bay Parry Sound District Health Unit 2019 – Vector-Borne Diseases - Surveillance & Protection Plan

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ACKNOWLEDGEMENTS The basis for this plan comes from the Region of Peel West Nile virus Prevention and Control Plan, 2004 and the New York City Department of Health’s Comprehensive Mosquito Surveillance and Control Plan. The appendices make use of information from a number of sources, including: Westchester Country’s Environmental Review for the Comprehensive Mosquito-borne Disease Surveillance and Control Plan, the New Jersey Mosquito Biology and Control website, and Municipal Mosquito Control Guidelines authored by R. Ellis.

North Bay Parry Sound District Health Unit 2019 - Vector-Borne Diseases - Surveillance & Protection Plan

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EXECUTIVE SUMMARY Introduction The VBD Surveillance and Protection Plan includes information and activities on three VBD of importance to the North Bay Parry Sound District Health Unit, those being West Nile Virus (WNv), Eastern Equine Encephalitis Virus (EEEv), and Lyme disease (LD). In 2018, the North Bay Parry Sound District Health Unit (NBPSDHU) conducted surveillance activities in the district for WNv, EEEv and LD. The data collected along with the data from past years helped inform the development of this plan. The NBPSDHU VBD Surveillance and Protection Plan includes an outline of the following activities: West Nile and Eastern Equine Encephalitis virus The health unit’s approach to WNv and EEEv control will continue to emphasize personal protective measures and source reduction. The goal of the 2019 VBD Surveillance and Protection Plan is to minimize the impact of WNv and EEEv through district-wide surveillance that directs integrated pest management based mosquito control activities at a level commensurate with the risk of human illness. This means an emphasis on surveillance, public education and source reduction. If the level of WNv and / or EEEv in the district increases, then surveillance, education and control measures will be intensified. Larval mosquito control, such as larviciding, may be considered. Adult mosquito control will only be considered should surveillance findings indicate a significant risk to human health despite the implementation of other control measures. Source reduction will focus on Culex pipiens and Culex restuans mosquitoes, the main amplification vectors of WNv in Ontario, and Culiseta melanura, the main amplification vector of EEEv in Ontario. Adult surveillance, along with the health unit’s messaging of using personal protection measures and source reduction, will be used to enhance mosquito control and education efforts in high risk areas to interrupt the amplification of WNv and EEEv before they have a significant impact on human health. Lyme disease Lyme disease (LD) is both a Reportable and Communicable Disease under the Health Protection and Promotion Act, Regulations 558/91, 559/91 and 199/03 respectively (http://www.canlii.org/on/laws/sta/h-

7/index.html). It also falls under the Infectious Diseases Protocol, 2018, as part of the Ontario Public Health Standards (OPHS). The surveillance of LD is directed by the above laws and by PHO’s Technical report: Update on Lyme disease prevention and control - https://secure.publichealthontario.ca/en/eRepository /Technical_report_update_on_Lyme_disease_prevention_and_control.pdf. Since the NBPSDHU is not an area of high risk of exposure to Ix. scapularis, passive surveillance has been conducted since 2007, where the public is informed to contact the health unit to submit any human acquired ticks they have found. Passive surveillance will continue in 2019. The health unit will only be accepting ticks that were human acquired. Public Education and Community Outreach The NBPSDHU VBD 2019 communication plan will take a passive approach for WNv and a more informative approach for LD. Should there be any VBD increase in our district, a news release will focus on two main messages targeted to the general public, personal protection, and source reduction, offering a common-sense approach to minimizing the risk associated with WNv, EEEv and LD. Contained within this document is a detailed communication plan along with a Social Media plan for LD.

http://www.canlii.org/on/laws/sta/h-7/index.html

http://www.canlii.org/on/laws/sta/h-7/index.html

https://secure.publichealthontario.ca/en/eRepository%20/Technical_report_update_on_Lyme_disease_prevention_and_control.pdf

https://secure.publichealthontario.ca/en/eRepository%20/Technical_report_update_on_Lyme_disease_prevention_and_control.pdf


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Human Surveillance and Health Care Provider Education Physicians and other health care providers will report human WNv and EEEv suspect, probable, and confirmed cases, as per any reportable diseases, to the local medical officer of health (MOH) and the local MOH will report to PHO. The link between physicians, health care providers and PHO plays a critical role in the detection, prevention and clinical management of mosquito-borne diseases. Adult Mosquito Surveillance The NBPSDHU will monitor mosquitoes across the area by collecting only adult mosquitoes to determine the distribution, density and species. Adult mosquito traps will be set up throughout the district. Mosquito surveillance data will be used in decision-making about public education and mosquito reduction activities. Larval and Adult Mosquito Reduction and Control The MOHLTC has provided health units with a table outlining the action response levels where larviciding or adulticiding may be an appropriate intervention following a comprehensive risk assessment. The action levels are contained in O. Reg. 199/03 (See Appendix 3). It is expected that a decision to implement mosquito control measures will be guided by this plan and the provisions of O. Reg. 199/03. With respect to larviciding, PHO will absorb the costs of all larviciding and adulticiding materials and application work, should it be deemed necessary. Equine Surveillance Equine WNv and EEEv cases will be reported to PHO by the Ontario Ministry of Agriculture and Food and Rural Affairs (OMAFRA). The Canadian Food Inspection Agency (CFIA) has made WNv in horses an immediately notifiable disease under its legislation, which requires diagnostic laboratories to report positive test results on a weekly basis. This information is forwarded to the OMAFRA and placed on their web site for public reference. OMAFRA will also notify Public Health Units of positive cases in their respective jurisdictions. Data Collection and Analysis The OPHS (2009) states that ‘the board of health shall develop a local vector-borne management strategy based on surveillance data and emerging trends in accordance with the Infectious Diseases Protocol, 2015 (or as current). Therefore, the NBPSDHU will continue to collect data to better understand mosquito development in the area and how WNv vectors persist in our environment.


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SECTION 1 - WEST NILE VIRUS

1.0 Introduction

West Nile virus (WNv) is a mosquito-borne flavivirus that first made its appearance in North America in 1999. It is a human, horse and bird neuropathogen that can result in encephalitis, meningitis and even death.

In 2018, according to the Public Health Agency of Canada (PHAC), up to December 15th, there were a total of 367 human cases reported, almost double those reported in 2017 (200).

The extent to which WNv causes illness in the district on a consistent basis in the future will determine the need for an ongoing WNv program as part of the overall Vector-Borne Diseases (VBD) program. However, no program will be able to prevent every human case of WNv illness. Evidence suggests that WNv remains in an area over the winter in infected female adult mosquitoes and/or birds. Hence, a small number of infected mosquitoes and/or birds are present within the region during the early spring months. At this time, the virus begins its amplification cycle. As mosquitoes feed on birds, the virus is transmitted back and forth between the vector (mosquitoes) and the reservoir host populations (birds) allowing an increasing number of birds and mosquitoes to become infected. If environmental conditions are optimum for transmission, the virus amplifies. At this point in the amplification cycle, the virus bridges out of the amplification, bird-mosquito cycle via bridge vectors. Bridge vectors are mosquito species that readily feed on humans and other mammals in addition to birds. It is at this point in the season that transmission to humans may occur.

1.1 Surveillance

1.1.1 Human Surveillance

Objective: To reduce the risks of exposure in humans to the illness caused by WNv. Background: According to Public Health Ontario’s (PHO) website (https://www.publichealthontario.ca/-/media/documents/surveillance-reports/infectious/surveillance-report-infectious-diseases-jan-dec-2018.pdf?la=en ), in 2018, there were 138 lab confirmed human cases of WNv in Ontario. In 2018, there was one positive human cases of WNv in the NBPSDHU area.

Reportable Disease Requirements in Ontario: WNv Illness is a Reportable Disease and a Communicable Disease under the Health Protection and Promotion Act, Specification of Communicable Diseases, Regulation 557 (January, 2019), Strengthening Quality and Accountability for Patients Act, 2017 (May 1, 2018), and Control of West Nile virus, Regulation 199/03 (as of Dec 15, 2017). WNv falls within the Infectious and Communicable Diseases Prevention and Control Program Standards (Infectious Diseases Protocol, 2018) in the new Ontario Public Health Standards, 2018. The following provides reporting responsibilities by selected agencies:

Physician/Health Care Professional: Reports human WNv suspect , probable, and confirmed cases, as per any reportable disease, to

the local Medical Officer of Health

Local Medical Officer of Health

https://www.publichealthontario.ca/-/media/documents/surveillance-reports/infectious/surveillance-report-infectious-diseases-jan-dec-2018.pdf?la=en




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All information on human WNv probable and confirmed cases are reported to PHO. PHO – provides a completed WNv questionnaire, which is a reference document for Integrated

Public Health Information System (iPHIS) entry information. Health Unit staff will report probable and confirmed cases through iPHIS.

Planned Activities: Updates to area physicians and other health care providers will be carried out during the season

when deemed necessary. This will be done through a mail out to physicians/health care providers.

NBPSDHU staff will investigate all suspected, probable and confirmed cases as per PHO protocols and Health Unit policies (WI-CDC-026).

Cases that meet the probable or confirmed case definition will be reported to PHO through iPHIS.

Health Unit policies (WI-CDC-026) will be updated accordingly.

**Please see Appendix 4 for Case Definitions.

1.1.2 Mosquito Surveillance

Objective: To collect and identify species of concern for the transmission of WNv and to monitor the location and number of species present.

Background: Adult mosquitoes were collected weekly from mosquito traps at fixed and temporary locations throughout the NBPSDHU from early June to mid-September in 2018. Fixed sites were located in densely populated urban areas and were trapped at more than 5 times during the year. Temporary trap sites were established in other urban areas and trapped less than five times during the year. Collected mosquitoes were sent away for counting, species identification and viral testing. Accurate and timely surveillance data on adult mosquitoes is important for guiding appropriate prevention and control activities. Adult mosquito surveillance and viral testing provide early predictive information about the risk to human populations and the potential for a disease outbreak. There were no positive mosquito pools in 2018.

Viral Testing: The following table lists WNv vector species of concern in Ontario. These species are listed in order of preference when considering what species to test in the event that a trap contains more than three different vectors. Note that Culex pipiens and Culex restuans should be grouped into Culex pipiens/restuans. The testing order of preference is as follows:

Culex pipiens/restuans (WNv)

Culex salinarius (WNv)

Ochlerotatus japonicus (WNv)

Culex tarsalis (WNv)

Aedes vexans vexans/ Aedes vexans nipponi (WNv)

Ochlerotatus triseriatus (WNv)

Anopheles punctipennis(WNv)

Ochlerotatus trivittatus (WNv)

Anopheles walkeri (WNv)

Ochlerotatus stimulans (WNv)


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Anopheles quadrimaculatus (WNv)

Ochlerotatus canadensis (WNv)

*Culiseta melanura (EEEv)

**Aedes albopictus/Stegomyia albopicta (WNv)

* Since this species is found in low numbers and is the main enzootic vector for EEEv, it is to be tested for EEEv as part of the three pool limit ** Since this species is found in very low numbers and is a highly competent vector, it is suggested that it be tested for WNv as part of the three pool limit.

This list is prepared based on analysis of entomological data of Ontario and other variables. Changes to this list will be made as required, based on new information and analysis of entomological data. All information for viral testing comes from the MOHLTC 2010 Surveillance and Preparedness Plan and PHO’s Vector-Borne Diseases 2016 Summary Report.

Planned Activities: From June to September, the NBPSDHU will collect adult mosquitoes. Mosquitoes will be

collected using CDC light traps. The trapping season may be lengthened or shortened depending on the weather (Degree day analysis) and the results of surveillance activities. Adult mosquitoes will be counted by species and tested for WNv.

Mosquito trapping will include fixed and temporary trap sites across the district. Trapping will be conducted during the day and overnight.

NBPSDHU will share mosquito surveillance data as soon as possible with PHO for analysis, monitoring and for posting on PHO’s website.

Surveillance activities will be heightened around areas where positive mosquito pools are identified until we have three consecutive negative test results. These activities will occur around all positive human cases and equine cases in populated areas.

Surveillance outcomes observed will be interpreted using the MOHLTC West Nile virus Preparedness and Prevention Plan, June 2010; the Municipal Mosquito Control Guidelines, May 2001; the Ontario Public Health Standards, 2018; the Infectious Diseases Protocol, 2018; and all pertinent regulations mentioned above in subsection 1.1.1.

1.1.3 Equine (Horse) Surveillance

Objective: To monitor positive WNv cases in horses in order to identify the presence of WNv as an indicator of potential human exposure.

Background: It is known that WNv in horses often occurs concurrently, or at times, just prior to confirmation of human infection. It is thought that the high intensity of mosquito exposure frequently experienced by horses makes them a useful sentinel species. The 1999 New York experience demonstrated equine cases in advance of human cases and in low populated areas where there was no other non-human evidence. Thus, equine surveillance may be important as an indicator of WNv activity and of human risk. It is recognized that the cost of testing is usually borne by the horse owner and, that together with the increasing vaccination of horses against WNv infection, may limit the usefulness of equine surveillance. In 2018, there were 11 WNv positive equine case in Ontario. There were none in the NBPSDHU area.


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Equine Vaccine: An equine vaccination product is available from veterinary practitioners in North America. The Ontario Ministry of Agriculture, Food and Rural Affairs (OMAFRA) promote the WNv vaccination of horses to veterinarians and the equine industry in Ontario. While there is no federal policy for action on equine WNv, laboratories must notify the Canadian Food Inspection Agency (CFIA) of any positive test result for equine WNv. Planned Activities: Any reported cases of horses testing positive for WNv in the NBPSDHU area will result in

increased adult mosquito (surveillance) trapping around the direct location of the horse, depending on site characteristics.

SECTION 2 – EASTERN EQUINE ENCEPHALITIS

2.0 Introduction

Eastern Equine Encephalitis virus (EEEv) is an arbovirus, and has made its way into southern and eastern Canada. While Canada has a history of EEEv infections in the equine, bird populations and mosquito populations, there have been no human cases reported to date. Disease in birds and horses is the primary indicators of EEEv transmission in Canada.

2.1 Surveillance

2.1.1 Human Surveillance

Objective: To reduce the risk of human exposure to the illness caused by EEEv. Background: Eastern Equine Encephalitis virus was detected for the first time in a mosquito population in Canada (2 positive Culiseta (Cs.) melanura and 2 positive Aedes (Ae.) vexans) in 2009, within the Simcoe Muskoka District Health unit area, on First Nations land (investigated by the First Nations Inuit Health Branch), which borders the NBPSDHU area to the south, and was detected again in 2010. In 2010, a mosquito pool tested positive for EEEv in the Parry Sound area of the NBPSDHU, marking the first time this has occurred in a public health unit area in Canada. There have been no human cases identified in Canada to date. Although it is known as a competent amplification vector, Cs. melanura can also be considered a bridge vector, potentially transmitting EEEv to horses and humans. Birds are still considered the primary means by which EEEv disperses through the population.

Eastern Equine Encephalitis has established itself in Ontario. How much human illness will occur in 2019 is impossible to predict given our limited experience with EEEv. The extent to which EEEv causes illness in the district on a consistent basis in the future will determine the need for, and scale of an ongoing EEEv program as part of the overall VBD program. However, no program will be able to prevent every human case of EEEv illness. Reportable Disease Requirements in Ontario: All reportable diseases are to be reported to Public Health Ontario (PHO). According to their guidelines, while not specifically listed as a reportable disease in Ontario, EEEv falls under the broader category of Encephalitis, including primary viral (including WNv) in the Reportable Diseases List, meaning that surveillance guidelines for humans would be similar to those of WNv.


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The following provides reporting responsibilities by selected agencies:

Physician/Health Care Professional: Reports human EEE suspected , probable, and confirmed cases, as per any reportable disease, to

the local Medical Officer of Health

Local Medical Officer of Health Reports information on human EEE probable and confirmed cases to PHO. Public Health Branch (PHB) – provides a completed EEE questionnaire, which is a reference

document for iPHIS entry information. Health Unit staff will report probable and confirmed cases through iPHIS.

Planned Activities: Updates to area physicians and other health care providers will be carried out during the

season, when deemed necessary. This will be done through a mail out to physicians/health care providers.

NBPSDHU staff will investigate all suspected, probable and confirmed cases as per PHO guidelines.

Cases that meet the probable and / or confirmed case definition will be reported to the Public Health Branch through iPHIS, and as well to Canadian Blood Services, if required.

**Please see Appendix 4 for Case Definitions.

2.1.2 Mosquito Surveillance

Objective: To collect and identify species of concern for the transmission of EEEv and to monitor the location and number of species present.

Background: Adult mosquitoes were collected weekly from mosquito traps at fixed and temporary locations throughout the NBPSDHU from early June to late September in 2018. Fixed sites were located in densely populated urban areas and were trapped at more than 5 times during the season. Temporary trap sites were established in other urban areas and trapped less than five times during the season. Collected mosquitoes were sent away for counting, species identification and viral testing. Accurate and timely surveillance data on adult mosquitoes is important for guiding appropriate prevention and control activities. Adult mosquito surveillance and viral testing provide early predictive information about the risk to human populations and the potential for a disease outbreak.

Viral Testing: PHO recommends that health units use the WNv testing order of preference that is listed in the ministry’s 2010 West Nile virus Preparedness and Prevention Plan. Health units can still opt to keep the EEEv order of testing if they feel they have a compelling reason to continue in their jurisdiction.

Planned Activities: From June to September, the NBPSDHU will collect adult mosquitoes. Mosquitoes will be

collected using CDC light traps. The trapping season may be lengthened or shortened depending on the weather (Degree day analysis) and the results of surveillance activities.

Mosquito trapping will include fixed and temporary trap sites across the district. Trapping will be conducted during the day and night time.

NBPSDHU will share mosquito surveillance data as soon as possible with PHO for analysis, monitoring, and for posting on PHO’s Web site.


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Surveillance activities will be heightened around areas where positive mosquito pools are identified until the collected pools are no longer testing positive. These activities will occur around all positive human cases and equine cases.

Surveillance outcomes observed will be interpreted using the MOHLTC Eastern Equine Encephalitis virus Surveillance and Management Guidelines document, April 2011; the Municipal Mosquito Control Guidelines, May 2001; the Ontario Public Health Standards, 2018; and the Infectious Diseases Protocol, 2018.

2.1.3 Equine (Horse) Surveillance

Objective: To monitor EEEv cases in horses in Ontario to identify the presence of EEEv as an indicator of potential human exposure.

Background: It is known that EEEv in horses can occur concurrently, or sometimes just prior to, confirmation of human infection. It is thought that the high intensity of mosquito exposure frequently experienced by horses makes them a useful sentinel species. Eighty to ninety percent of infected horses develop acute and lethal disease with survivors developing neurologic signs. There are vaccines available to prevent EEEv. Thus, equine surveillance may be important, particularly in rural settings, as an indicator of EEEv activity and of human risk. Thirteen horses tested positive for EEEv in Ontario in 2018.

Equine Vaccine: An equine vaccination product is available from veterinary practitioners in North America. The Ontario Ministry of Agriculture, Food and Rural Affairs promote the EEE vaccination of horses to veterinarians and the equine industry in Ontario. Equine practitioners can send serum or tissue samples to the Animal Health Laboratory in Guelph, or to other private veterinary diagnostic laboratories, for analysis. While there is no federal policy for action on EEEv, laboratories must notify the CFIA of any positive test result for EEEv.

Planned Activities: Depending on site characteristics and location, any EEEv positive horses reported in the

NBPSDHU will result in increased adult mosquito trapping done around the direct location of the positive horse.

The NBPSDHU will continue to communicate with large animal veterinarians in the district to receive reports of equine cases.

Heightened adult mosquitoes surveillance will occur in the area surrounding any positive EEEv horse from the previous year.


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SECTION 3 – LARVAL AND ADULT MOSQUITO REDUCTION

3.0 Larval Mosquito Reduction

Objective: To reduce the abundance of adult mosquitoes that transmit any Vector-Borne Diseases through the use of Integrated Mosquito Management (IMM) practices. Background: All mosquitoes begin their life in water. This offers an opportunity to control mosquitoes in an efficient way before the adult mosquitoes emerge and become widely dispersed. Culex pipiens and Culex restuans are the most important mosquito species in the transmission of WNV. They are known to be one of the most common mosquitoes found in urban and suburban areas. They can develop quickly and use standing or slow-moving water containing decaying organic materials to lay their eggs. Prime development sites include roadside catch basins, ditches, discarded tires left outdoors, poorly maintained bird baths, clogged rain gutters and eaves troughs, puddles in unused swimming and plastic wading pools, containers left outdoors to collect water, and other collections of standing water that last for a week or more. Development of these mosquitoes can be prevented by either eliminating standing water (source reduction), changing the environment to be less hospitable for mosquito breeding, or treating the water with larvicide to prevent mosquitoes from developing. Habitat modification can include changing the physical environment or introducing predators. An integrated mosquito management approach is recommended which makes use of a range of larval control strategies as appropriate to the situation.

Decision-Making and Consultation: The decision to employ mosquito larviciding or adulticiding is established through Regulation 199/03 (Appendix 3). The determination of where to apply the larviciding or adulticiding requires a local risk assessment. The assessment should weigh the level of risk to public health from the mosquito-borne virus based on the most current, available evidence of local WNv and / or EEEv activity in the human population and in non-human species (mosquito pools and/or equines). All of these factors, plus taking into account all other control measures, are incorporated into weighing the expected benefits and risks of pesticide use. The risk assessment should also take into account all of the existing non-pesticide means of mosquito reduction and the measures available to prevent or reduce disease transmission such as personal protective measures against biting mosquitoes. The local Medical Officer of Health / or appointed delegate is the appropriate official to make a decision after receiving the aforementioned information from health unit staff and other municipal or regional agencies and, if necessary, from consultation with provincial, federal or private sector expert authorities. Based on the importance of Culex pipiens and Culex restuans in the transmission of WNv, the following habitats have been identified and possible control strategies listed. Catch Basins: Roadside catch basins are the major habitat in urban and suburban areas for Culex pipiens and Culex restuans, the main vectors of WNv. While each catch basin is small in and of itself, collectively they represent a large area of mosquito breeding habitat, free of natural predators.


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Methoprene is the recommended agent due to its effectiveness against mosquitoes, low anticipated effects on non-target organisms and the availability of formulations that provide sustained control for up to 4 weeks. Information from the MOECC suggests that very strict adherence to regulations (despite the intention of these regulations to apply to nuisance control of mosquitoes) could increase costs for the larviciding program. These requirements would include providing the exact location of every catch basin in which larvicide would be applied prior to the actual application, monitoring of a sample of catch basins before and after treatment, public notification every week that larvicides are in use, and at least 24 hour notification of each site to the MOECC prior to the treatment of any standing water. If required, the NBPSDHU will assess for the presence of mosquito larvae. Artificial containers: Artificial containers are objects such as tires, buckets, birdbaths, etc. that collect rainwater. Besides other sanitation concerns they are ideal mosquito breeding sites for certain species due to the lack of predators and may be especially productive when they are in a heavily vegetated area. Artificial containers will often be located on land that is privately owned. Prime breeding sites here include discarded tires left outdoors, poorly maintained bird baths, clogged rain gutters, unused swimming and plastic wading pools, pots and pans with standing water, and puddles that last for a week or more. Every residential and commercial property owner should regularly inspect their property and buildings to determine if conditions are conducive to mosquito breeding and endeavour to eliminate those conditions. The public education campaign in 2017 (if required) will highlight the need for NBPSDHU residents and commercial/industrial property owners to eliminate mosquito-breeding sites on private property, when necessary.

Roadside Ditches: Where standing water was present Culex mosquitoes were often found. The most effective way to prevent breeding is to eliminate the standing water through improved grading and drainage. This can be an expensive venture and should only be undertaken if the site is large and likely to be a problem on a continual basis.

Natural Areas: Natural areas such as swamps, marshes, creeks, and their floodplains, breed many mosquitoes of many different types. However, it is areas where there are temporary pools that are believed to be most important. Areas of open or flowing water do not make good mosquito breeding habitats. Natural areas present special challenges and concerns for mosquito control. Any intervention in these areas must take care not to unnecessarily disrupt the existing ecosystem. And while many mosquitoes are present, many may not be important vectors of WNv. For example, the large number of Aedes mosquitoes that emerge in the spring are thought to play little if any role in WNv transmission. Another difficulty is that many areas of standing water that produce mosquitoes are present for only a week or so following a rain. Control of these sites requires knowledge of their behaviour that can only be gained over a number of years and a large program capable of quick response. Response will be based on these assessment results and may involve improving natural controls, altering water flows if it does not damage the natural ecosystem. If required, the NBPSDHU will assess for the presence of mosquito larvae. Application of larvicide may be considered if other measures are insufficient to control mosquito breeding and only if other risk measures warrant such action (WNv and / or EEEv in mosquitoes and humans).


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Planned Activities: Larval surveillance is no longer conducted by the health unit. Public education will ask residents and property owners to eliminate mosquito breeding sites on

private property should the risk of WNv and / or EEEv become high in the NBPSDHU area. The NBPSDHU will assist local municipalities in the development of and implementation of plans

for potential larviciding and adulticiding mosquito control programs should the need arise.

3.1 Adult Mosquito Reduction

Objective: To reduce the abundance of adult mosquitoes in areas of elevated risk to human health from Vector-Borne Diseases (VBD) through the judicious use of pesticides. Background: The application of chemicals to kill adult mosquitoes by ground or aerial application is called adulticiding. Adulticide is typically applied as an Ultra-Low Volume (ULV) spray where small amounts of insecticide are dispersed either by truck-mounted equipment or from fixed-wing or rotary aircraft. For good adult mosquito reduction, the fine ULV droplets must drift through the habitat and impinge on flying mosquitoes. Adulticiding is usually the least efficient mosquito control technique – adult mosquitoes are widely dispersed and the pesticide has to make contact with the mosquito in order to kill it. Nevertheless, adulticiding, based on surveillance data, is an extremely important part of any Integrated Pest Management program (IPM). If an outbreak of a VBD in the human population is occurring or imminent, it means that large numbers of VBD infected adult mosquitoes are present. This risk can only be mitigated in the short term through adult mosquito reduction. PHO will retain the services of a licensed applicator to adulticide using truck mounted equipment in response to a significant risk to human health. Aerial application is not being considered at this time. The agent of choice will be malathion. Prior to applying adulticides, a number of factors must be considered in the context of mosquito and VBD biology to assess the level of risk to human health: Mosquito species distribution, density and trends – to see if mosquito populations are those

known to transmit VBD and if they are present at a high or low level. The level of VBD present in mosquitoes – the presence of VBD in a high proportion of

mosquitoes, especially those known to bite humans, is of greatest concern. Density and proximity of human populations to mosquitoes. The time of year – human cases of VBD typically are greatest in the last two weeks of August

and the first two weeks of September. Therefore indications of high VBD activity prior to this time are of much greater concern than those past it.

Weather – certain conditions are necessary in order for adulticides to be applied effectively and some forecasts may predict a rapid decline in mosquito numbers, making adulticiding unnecessary.

The distribution of human cases in the district and in adjacent jurisdictions in the current year compared to past experience.

Community and stakeholders’ attitudes towards the risk posed by the VBD versus the likely benefits and risks of larviciding or adulticiding.

The relative effectiveness and safety of the pesticide product, as evaluated by federal authorities, and the regulatory requirements of provincial and federal authorities.


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Because of the large number of factors, the decision to larvicide or adulticide will be made on a case by case basis. Effort will be made to target this intervention to specific areas of risk and not an entire city or the entire district, and only when deemed necessary. Planned Activities: Adulticiding decisions will be made on a case by case basis according to the level of human risk

of VBD. PHO will retain the services of a licensed applicator with the ability to adulticide. The public will be notified of adulticiding locations and schedules in advance, which will allow

sufficient time to take any necessary precautions to reduce pesticide exposure. Information will be released at least 48 hours in advance through the media, the NBPSDHU Web

site and the Ontario Regional Poison Control Centre in accordance with MOECC requirements. Hospitals and the Ontario Regional Poison Control Centre will be notified regarding the

adulticiding schedule. Information on the pesticide that will be used will be provided to the public, physicians and other health care providers

The NBPSDHU will monitor and assess control activities for any potential environmental and health effects through several measures that may include pre and post-spray environmental sampling and addressing pesticide exposure public complaints received by the health unit.

Adult mosquito control will be scheduled when mosquitoes are active and when weather conditions are conducive to its success.

**Please note that the use of VBD in the above section includes West Nile virus and Eastern Equine Encephalitis virus.


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SECTION 4 - LYME DISEASE

4.0 Introduction

Lyme disease (LD) is an infection caused by the bacterium Borrelia (B.) burgdorferi. This bacterium is spread to humans through the bite of the blacklegged tick, Ixodes (Ix.) scapularis. Lyme disease is the most common vector-borne disease in North America. Ix. scapularis ticks infected with B. burgdorferi have been collected in most regions of Ontario. These ticks are most commonly found along the North Shore of Lake Erie. This includes Long Point, Rondeau Provincial Park and Turkey Point. Recently, Ix. scapularis ticks have been found in the St. Lawrence Islands National Park.

In 2018, according to Public Health Ontario’s website, 573 confirmed positive human cases of LD were reported in Ontario, at the time of reporting. This represents a decrease in the number of positive human cases reported in 2017 (908). Since the NBPSDHU is not an area of high risk of exposure to Ix. scapularis, passive surveillance is conducted.

4.1 Surveillance

4.1.1 Human and Passive Tick Surveillance

Objective: To reduce the risk of human exposure to Lyme disease. Background: According to PHO’s Infectious Diseases query tool, at the time this report was updated, there were 624 confirmed (57) and probable (51) cases in Ontario in 2018. This represents a decrease in the number of confirmed and probable cases from 2017 (1005). Since the NBPSDHU is not an area of high risk of exposure to Ix. scapularis, passive surveillance is conducted. In 2018, 51 ticks were submitted through human exposure for identification, 30 ticks were identified as Ix. scapularis, the species of concern for the transmission of LD. There were no human cases identified in the health unit area. Passive surveillance will continue in 2019. Reportable Disease Requirements in Ontario: Lyme disease is both a Reportable Disease and a Communicable Disease under the Health Protection and Promotion Act, Regulation 557 as of January, 2019. Lyme disease falls within the Environmental Health Program Standards (Health Hazard Prevention and Management – Disease Prevention/Health Protection) in the Ontario Public Health Standards, 2018. The following provides reporting responsibilities by selected agencies: Physician/Health Care Professional: Reports human LD suspect , probable, and confirmed cases, as per any reportable disease, to

the local Medical Officer of Health Local Medical Officer of Health Reports information on human LD probable and confirmed cases to PHO. Public Health Branch (PHB) – provides a completed LD questionnaire, which is a reference

document for iPHIS entry information. Health Unit staff will report probable and confirmed cases through IPHIS.


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Planned Activities: Updates to area physicians and other health care providers will be carried out during the season

when deemed necessary. This will be done through a mail out to physicians/health care providers.

Human acquired ticks brought in to the NBPSDHU are to be submitted for identification and possible testing (WI-EH-061).

Any suspect human cases will be followed up as per Work Instruction (WI-CDC-058). Surveillance outcomes observed will be interpreted using the MOHLTC West Nile virus

Preparedness and Prevention Plan, June 2010; the Lyme Disease Surveillance and Management Guidelines, May 2011; the Ontario Public Health Standards, 2018; and the Infectious Diseases Protocol, 2018.

Any cluster of positive Ix. scapularis for Lyme disease, as indicated by passive surveillance, in our district may result in possible tick dragging in and around the location.

**Please refer to Appendix 4 for Case Definitions


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SECTION 5 – DATA COLLECTION AND ANALYSIS - PUBLIC EDUCATION AND COMMUNITY OUTREACH

5.0 Introduction

Mosquito surveillance provides an early warning of potential risk to human health and helps to guide control and public education interventions. Appropriate and timely response to surveillance data is important in preventing human cases associated with VBD. If virus activity is detected in the mosquito population, responses may include effective mosquito control and public education. An Environmental Technician in the Environmental Health program collects adult mosquitoes weekly throughout the surveillance season. The Public Health Inspector (PHI) supervisor, and their designated PHI backup, will fill in when necessary. All data collected will help inform the development of the VBD Prevention and Control Plan for 2020.

5.1 Data Collection

Global Positioning Systems (GPS) equipment will be utilized to collect geographic coordinates for adult mosquito surveillance sites, WNv and EEEv positive mosquito pools, WNv positive human cases, and WNv positive equine cases, where and when necessary. The data collected with the GPS equipment will be analyzed using Geographic Information Systems (GIS) software. The GIS software will assist in making decisions regarding surveillance and prevention and control activities. Adult mosquito surveillance data is tracked using a Microsoft Excel comparative data workbook. The Adult Mosquito Surveillance workbook contains mosquito sample information including location type, date of sample, adult mosquito collection numbers, survey type (light trap), and species classification. This spreadsheet is used to perform data analysis for reporting purposes. The reportable diseases database (iPHIS integrated Public Health Information System) will report the symptoms of WNv disease in humans and will report cases to the PHO. In the event of a positive equine case, OMAFRA notifies the CFIA and the local health unit. This information is kept on OMAFRA’s website.

5.2 Data Analysis

Analysis of the VBD surveillance data will provide information regarding the growth and density of infected WNv and EEEv mosquitoes with the resultant transfer of each virus to human populations. Data analysis will also include mapping of mosquito trapping sites. The data will better inform the number, location, and species of mosquito populations allowing for educated interpretation and decisions pertaining to the potential risk of infection to humans. Data collection will help identify the species of mosquito important in WNv and EEEv amplification and transmission in the NBPSDHU area. The analysis of our northern weather patterns (i.e. Degree days) and the location, growth, and density of mosquitoes, will identify potential high risk areas and times during the season for source reduction and public education. All data collected will be compared to data from previous years to assess trends and possible risks to the human population, as well as assess species of concern for other diseases.

Adult mosquito analysis will include number and percentage of female adult mosquitoes collected by species, locations of adult trapping sites, proportions of amplification and bridge vector mosquitoes at each trap site, trends in amplification and bridge vector mosquitoes over time, and number of amplification and bridge vector mosquitoes collected each week. Analysis of Lyme disease data will provide information regarding the location and distribution of human acquired tick submissions. Analysis of the data may also include the mapping of tick locations. Data will better inform the location of tick populations and if any trends exist in the distribution of ticks throughout


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the NBPSDHU area. This allows for better decision-making with regard to the potential risk of infection to humans. Equine surveillance analysis will include the identification, location, and results of WNv horse cases in the NBPSDHU area. Adult mosquito surveillance will be enhanced once a positive human case has been identified in the NBPSDHU area and data will be analysed to determine if the species of concern (Culex species) is present in high numbers.

5.3 Public Education and Community Outreach

Objective: To increase public awareness and knowledge of: WNv, EEEv, and LD as vector-borne diseases; the surveillance activities and control techniques that are underway; to emphasize personal protective measures needed for individuals to consider in order to reduce the risk of exposure to each VBD.

Background: Based on our key learning’s from VBD awareness activities conducted over the last few years, the NBPSDHU VBD 2019 communication plan will take a passive approach. Should any VBD increase in our district, media releases will focus on two main messages, offering a common-sense approach to minimizing the risk associated with any VBD: The most important precaution all residents and business owners in the district can take is to

ensure that potential mosquito breeding sites are eliminated from their properties. Reducing the mosquito population reduces the risk of WNv and EEEv to human populations.

Personal protective measures become more important as the season progresses. Avoid mosquito bites and ticks by wearing long-sleeved tops and long pants, socks and shoes. Stay away from areas with high mosquito populations, and avoid being outdoors at dusk and dawn, when mosquito activity is higher. Use an insect repellent containing DEET, and follow Health Canada recommendations for its use, especially on children.

Also, cover up if you think you might be entering an area where you may be exposed to ticks. Wear closed-toe shoes, long-sleeved shirts and pants. Pulling your socks over your pant legs prevents ticks crawling up your legs. Light-coloured clothing makes spotting ticks easier.

Communication vehicles to be used in 2019 include, where required; news releases and alerts; paid newspaper, radio advertising and Facebook advertising; physician newsletters; website updates; fact sheets and posters; newspaper articles; displays; and Facebook and Twitter updates (See APPENDIX 5).

Planned Activities: The existing WNv information on the NBPSDHU website, www.myhealthunit.ca will have up-to-

date information on WNv transmission and personal protection along with the most recent surveillance data as well as information on EEEv and LD.

Media relation activities will include media briefings and / or news conferences, if needed. Ongoing news releases to the local and specialty media and interviews with the Medical Officer of Health/designate will occur as required.

Print ads containing information on VBD were included in the City of North Bay’s blue box calendar and North Bay’s Sport and Culture Guide.

Social Media will be used at the appropriate time throughout the 2019 surveillance season. Main Messaging for Local Source Reduction Mosquito populations can be diminished significantly by reducing or eliminating their typical aquatic development habitats, a preventive strategy known as source reduction. The major vectors of WNv

http://www.myhealthunit.ca/


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in Ontario are the species of Culex that tend to develop in natural or artificial containers of standing water. Other vectors of WNv, such as certain species of Aedes and Ochlerotatus, prefer to develop in temporary floodwaters or semi-permanent pools of water, respectively. Culiseta melanura, the main vector for EEEv, develops in large swamps and flooded land depressions. Wetlands must not be drained or altered in any way, unless there is an exceptional

circumstance of significant human health risk from disease-vector mosquitoes. Consultation with, and permission from, the MNR and the appropriate conservation authority will be required.

Store tires inside a garage or shed or other water-protected situation. Discarded tires left outside collect water after each rainfall and create perfect development sites for female mosquitoes in which to lay their eggs. Tires that have a function, such as anchors for tarps, should have several holes drilled in them to allow drainage.

Flush or vacuum storm drains and catch basins frequently and ensure that ditches drain properly to remove stagnant water.

Promote mosquito development source site reduction by having fact sheets available should one be requested.

Every effort and initiative must be considered to eliminate mosquito development sites on public and private property, both residential and commercial land.


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SECTION 6.0 - APPENDICES

6.1 APPENDIX 1 - Mosquito Biology

Introduction A thorough understanding of mosquito biology as it pertains to WNv and EEEv is essential to ensuring that control measures are as effective and cost-efficient as possible with minimal impact on the environment. Understanding mosquito and WNv/EEEv biology allows control efforts to be directed only to those sites breeding mosquitoes important in WNv/EEEv transmission, using the best method for that site and at the right time. The Mosquito Life Cycle All mosquitoes have four stages of development that in order are: egg, larva, pupa, and adult. The larval and pupal stages of mosquitoes are in water. The females of some mosquito species deposit eggs on moist surfaces, such as mud or fallen leaves that may be near water but dry. Later, rain or run-off re-flood these surfaces and stimulate the eggs to hatch into larvae. The females of other species deposit their eggs directly on the surface of still water in such places as ditches, roadside catch basins, tire tracks, streams that are drying up, and fields or excavations that hold water for some time. This water is often stagnant and close to homes in discarded tires, ornamental pools, unused wading and swimming pools, tin cans, bird baths, plant saucers, and even gutters and flat roofs. The eggs deposited on such waters soon hatch into larvae. In the hot summer months, larvae grow rapidly, become pupae, and emerge one week later as flying adult mosquitoes. A few important spring species have only one generation per year. However, most species have many generations per year, and their rapid increase in numbers becomes a problem. When adult mosquitoes emerge from the aquatic stages, they mate, and the female seeks a blood meal to obtain the protein necessary for the development of her eggs. The female of a few species may produce a first batch of eggs without their first blood meal. After a blood meal is digested and the eggs are laid, the female mosquito again seeks a blood meal to produce a second batch of eggs. Depending on her stamina and the weather, she may repeat this process many times without mating again. The male mosquito does not take a blood meal, but may feed on plant nectar. He lives for only a short time after mating. Most mosquito species survive the winter, or over winter, in the egg stage, awaiting the spring thaw, when waters warm and the eggs hatch. Other mosquito species, particularly the Culex species important in WNv transmission, spend the winter as adult, mated females, resting in protected, cool locations, such as cellars, sewers, crawl spaces and well pits. With warm spring days, these females seek a blood meal and begin the cycle again. Only a few species can survive over winter as larvae. Vector-Borne Disease Transmission Cycle WNv and EEEv survive by circulating between the bird and mosquito population. It is incidentally spread to humans by the bite of an infected mosquito (see Figure 1). A mosquito becomes infected after biting a bird that carries the virus. Wild birds are the principal reservoirs of the virus. Mosquitoes feed on the infected birds, picking up the virus with the blood meal. The virus may circulate in the blood of the mosquito for a few days. After laying their eggs, the infected mosquito may then transmit the virus to other birds, mammals and humans when they take their next blood meal. WNv and EEEv are present in the mosquito’s salivary glands. During the blood feeding, the virus may be injected into the new host where it may multiply and cause illness. One of the keys to the prevention of WNv and EEEv is the suppression of the vector (i.e. mosquito) populations. Culex mosquitoes are the most important maintenance vectors of the WNv primarily because of their preference for feeding on birds. Culex restuans appears to be important in initiating the WNv transmission among birds in early summer. Culex pipiens appears to have a greater role in amplifying the virus later into summer to early fall. When


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there is a significant amplification in the bird population, sufficient numbers of “bridge vector” mosquitoes – mosquitoes other than Culex pipiens and restuans that bite both humans and birds become infected in mid to late summer and then pose an infection threat to humans. Current best practice in WNv control is to aggressively control Culex pipiens and restuans to disrupt the primary cycle of transmission between bird and mosquitoes. If successful, this keeps the level of WNv in a community at a low enough level so that there is little “spill-over” of WNv into bridge vector mosquitoes and therefore humans. The same philosophy exists for maintaining populations of Culiseta melanura, the main vector for EEEv, in check. Figure 1: The West Nile virus and Eastern Equine Encephalitis virus Transmission Cycle

Mosquito Development Habitat Types There are two general categories within which mosquito development habitats exist: natural mosquito development habitats and man-made mosquito development habitats. Female mosquitoes lay their eggs either on water or on soils that are periodically flooded. These development areas can be found in habitats that exist naturally, such as within a pond or flood plain, or in habitats that have been created by humans, such as bird baths, water-filled tires, or catch basins. Mosquitoes can breed in a wide variety of locations, and the discussion below provides a description of the general types of habitats where mosquitoes are known to breed. Natural Mosquito Development Habitats Temporary Woodland Pools: Shallow, temporary pools are common in woodland areas during the spring and wet summers in low lying areas or in small depressions where a variety of mosquito species will breed, most commonly Aedes canadensis and Aedes vexans. These mosquitoes lay their eggs along the edges of the pool and when rainwater or melting snow fills these pools the larvae hatch. Freshwater Ponds: The larvae of Anopheles are found primarily in small ponds among the emergent vegetation. Ponds clogged with vegetation can breed large numbers of mosquitoes because of the vast amounts of organic matter available to mosquito larvae for feeding and because fish and other aquatic predators cannot readily feed on the larval mosquitoes.

Amplification Mosquitoes

(Culex pipiens/restuans)

Birds

Bridge Vector

Mosquitoes Amplification Mosquitoes

(Culex pipiens/restuans)

Birds

Humans,

Horses

Primary Cycle


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Streams and Floodplains: Streams with running water often do not produce large numbers of mosquitoes, if any. However, mosquitoes need to be near water in order to lay their eggs. Anopheles and Culex mosquitoes are two types of species that can sometimes be found in isolated pockets, adjacent streams or within floodplain areas that undergo only periodic flooding. Tree Holes and Other Natural Containers: Tree holes and other natural containers, such as pitcher plants or water trapped in or on plant leaves, can also serve as development habitats for mosquitoes, such as Aedes triseriatus. Frequent rainfalls maintain standing water within these types of microhabitats and can breed mosquitoes throughout the summer. Freshwater Marshes and Swamps: Mosquitoes such as Cq. perturbans and Cs. melanura (main vector for EEEv) breed in freshwater marshes and swamps consisting of emergent vegetation. These types of habitats can occur in both woodland and open field habitats. Cq. perturbans larvae attach themselves to the stems and roots of the vegetation to obtain oxygen, and do not need to swim up and down in the water column to feed and to breath. Due to this adaptation, these larvae can avoid exposure to predatory fish. Man-made Mosquito Development Habitats Storm water/Wastewater Detention: A catch basin (a.k.a. storm drain inlet, curb inlet) typically includes a curb inlet where storm water enters the basin to capture sediment, debris and associated pollutants. Similarly, detection/retention basins that perform similar functions for other types of wastewaters, such as waste treatment settlement ponds, provide a similar type of development habitat to that of the storm water catch basin. These detection basins provide development habitat for urban mosquito species, such as Culex pipiens. Moisture and organic debris captured within the detention basin can aid in development and provide nutrients for growing larvae. Roadside Ditches: Roadside ditches are the suitable habitat for many species of Culex mosquitoes. The larvae of Culex pipiens and Culex restuans, for example, can survive in waters with high organic content. Culex mosquitoes will lay their eggs directly on the water’s surface; therefore, ditches that hold water for extended periods of time can breed large numbers of mosquitoes. Artificial Containers: Artificial containers left out to collect rainwater such as tires, bottles, buckets, and birdbaths can provide an excellent mosquito-development habitat free from any predators. Many tree-hole mosquitoes have learned to adapt to using these man-made mosquito nurseries. The abundance of organic debris, which can also collect in these containers, allows for the proliferation of mosquito development during a season. Specific Mosquito Information: There are 57 species of adult mosquitoes found in Ontario. In 2016, the NBPSDHU identified 25 different species of mosquitoes distributed throughout the district. Each species of mosquito has a different habitat, behavior and preferred source of blood. Culex pipiens and Culex restuans (considered the primary vector of WNv), Aedes vexans vexans, Ochlerotatus canadensis and Ochlerotatus triseriatus are all implicated in the transmission of WNv and Culiseta melanura is implicated in the transmission of EEEv. Culex pipiens and Culex restuans are responsible for maintaining WNv in an area by biting and infecting birds. The other mosquito species mentioned above are “bridge vector” which transmit WNv to humans after biting an infected bird.


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Culex pipiens: Culex pipiens over-winters as adult females and deposit their eggs in rafts on the water’s surface in the late spring. Larvae are found in waters with high organic content such as catch basins and roadside ditches and polluted pools of sewage. Culex pipiens breeds throughout the summer, peaking in mid-summer and gradually declining until the first frost. Females feed primarily on birds but also on mammals, which may include humans. Culex restuans: Culex restuans are found in a variety of habitats including roadside ditches, polluted pools, and discarded tires and containers. Like all species of Culex, they lay their eggs in rafts on the surface of the water. In warm temperatures it takes 7 to 10 days for immature to develop to the adult stage. Females preferably feed on birds but also, to some extent, on mammals, possibly including humans. Adults are morphologically very similar to Culex pipiens and it can be difficult to distinguish between them. The Life Cycle of Culex pipiens and restuans and Implications for Timing of Larvicides: Culex mosquitoes survive the winter as adults and leave their over-wintering sites when the average daily temperature reaches 18.3°C (usually late May). They lay their eggs in habitats with high organic content that contain water for an extended period of time. These habitats are typically storm water catch basins, swimming pool covers and small containers such as bird baths and rain barrels. Culex pipiens and Culex restuans normally have three major generations in Southern Ontario. Eggs from the first generation are laid from late May to mid June, the 2nd from mid June to mid July, and the 3rd from mid July to early August. A small 4th generation occurs in August. The 3rd generation of Culex pipiens and the 2nd generation Culex restuans are usually the largest. Very little information is available regarding the number of generations in North eastern Ontario. Culiseta melanura: Culiseta melanura larvae are most numerous in large swamps. Alternate habitats include mature stands of Red Maple that remain flooded well into the summer. This species may be found anywhere that acid water conditions provide optimal larval habitat. Aedes vexans vexans: Aedes vexans is a flood water species that lays its eggs in small depressions which are subject to flooding. The females are persistent biters and most active in the early evening. The adults are known to fly great distances and are readily attracted to light. Ochlerotatus canadensis: Ochlerotatus canadensis larvae are usually found in cool, temporary pools with scattered shade, especially near coniferous forests and sometimes hardwood swamps and sphagnum bogs. The females bite any time during the day or evening in wooded or shaded areas and in open areas at night. Females feed mostly on mammals and sometimes on birds. Ochlerotatus triseriatus: Ochlerotatus triseriatus breeds in a wide variety of natural and artificial containers and can have several generations per year. Suitable development sites for this species include holes in trees, rain barrels, cans, buckets and tires. Females feed in the morning and early evening. This species seems to be indiscriminate in its feeding habits, feeding on mammals, birds, reptiles and amphibians.


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Table 1: Mosquito species and vector type

Species Amplification Vector

Bridge Vector Development Habitat

Culex pipiens + +/- Catch basins, ground pools, ditches, eutrophic sites

Culex restuans + +/- Temporary pools, edge of swamps, tires, catch basins, road side ditches

Culiseta melanura + +/- Swamps, marshy areas and flooded areas

Aedes vexans + Rain pools, tire ruts, storm water basins, ditches, woodland pools, floodplains

Ochlerotatus canadensis

? Temporary pools with shade, swamps and bogs

Ochlerotatus triseriatus + Tires, tree holes and artificial containers


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6.2 APPENDIX 2 - Larval Control Methods

Integrated Pest/Mosquito Management Integrated Pest Management (IPM) is the guiding philosophy behind a well-run mosquito control program. IPM as it pertains to organized mosquito control can be defined as: An effective and environmentally sensitive approach to manage mosquitoes, relying upon a combination of scientific knowledge and common sense. The practice of an integrated mosquito control program requires that a number of parameters must be included in the decision making process, including: Current, comprehensive information about the life cycles of the numerous mosquito species inhabiting a given

area, and the interaction of those mosquitoes with people, other animals, the surrounding environment and WNv.

Knowledge of mosquito Best Management Practices (BMP’s), including but not limited to, source reduction, mosquito habitat modification and the use of biological and/or chemical products to control larval and adult mosquitoes.

Mosquito control decision based upon surveillance results, habitat inspections and a rigorous sanitation program.

A strong educational component for staff members and the community at large that emphasizes the elimination of potential sources of public health nuisances and possible disease transmission.

This knowledge is applied to effectively control mosquitoes by the most professionally effective, economically viable methodology while also minimizing the potential for negative impact on people, other organisms and the environment with adherence to and compliance to all applicable Federal laws, Provincial regulations and local by-laws and ordinances. Often this mosquito specific control process is called Integrated Mosquito Management (IMM). Larval Mosquito Control Strategies: Mosquito larvae can be controlled by non-pesticide means or by pesticide means. Non-chemical means such as water management and source reduction (improved draining, filling and leveling in areas, improved sanitation, and habitat modification) are the most effective and economical means of providing long-term mosquito control. Existing biological controls are important in keeping mosquito numbers down. However, natural mosquito predators can only be increased in specific situations to achieve the level of additional mosquito control necessary to impact WNV transmission. Where non-pesticide means are ineffective or impractical, then mosquito larvae can be controlled by larvicides such as Bacillus thuringiensis israelensis or methoprene. Non-Pesticide Mosquito Control Water Management: Because of the temporary nature and small size of many mosquito floodwater habitats, they often can be altered to prevent or minimize mosquito production (see section on source reduction below). However, there are laws and policies regulating alterations of larger habitats such as wetlands. Major projects should only be undertaken after thorough consultation with the relevant authorities including the local conservation authority and the Ministry of Natural Resources. Although compromises must be made, it is usually possible to reduce larval mosquito sources and at the same time preserve wetlands and other desirable habitats. In some instances, water management can even enhance certain types of wetland habitats. For example, it is possible to change many very temporary, scattered pools into more permanent wetland habitats. Landscape planners should consider carefully the kinds of mosquito habitats they may be creating when wetlands are integrated into landscape or neighbourhood designs or when designs are made for storm water management ponds, sewage lagoons, or ornamental ponds.


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Source Reduction Prevents Mosquitoes: Ideally, mosquito control should be based on a preventive program. This is simply the removal of mosquito development sites. Many development sites (e.g. marshes, sewage dairy lagoons, storm water retention ponds, farm dug-outs) can be made unsuitable for mosquito development. This is done through a combination of good design, water level manipulation, and emergent vegetation management. Sometimes, the easiest way to prevent mosquitoes is to alter their development sites to make them unsuitable for egg laying. In the case of shallow depressions or unnecessary ditches, this usually equates to improved drainage or filling with clean soil. Even scraping sediment from the bottom of roadside ditches every few years can make the ditches unattractive for mosquito development. Ditches that are slow to drain form a series of pocket pools, and support lush grasses or weeds are prime larval development sites. Regular mowing, every two weeks or so during the summer months, will reduce mosquito development. When considering ditch draining improvements, conducting a larval survey after a heavy rain will assist in determining which ditches should receive highest priority for maintenance. Often ditches along main roads and highways are quite wide. They form broad, expansive development sites. One way to restrict the size of the habitat and reduce the surface area that must be treated with a mosquito larvicide is to run a narrower, deeper ditch through the centre of the broader ditch. There may be patches of flooded land (occupied by trees, shrubs and weedy vegetation) that are adjacent to roadside ditches. The stagnant water in these depressions can usually be drained into the roadside ditch, eliminating the difficult-to-treat woodland development site. If development occurs in the roadside ditch, it is at least more accessible. In other situations, it may not be possible to drain an open development site. However, it may be possible to fill it with soil, bringing it up to the level of the surrounding land, and eliminating the standing water. Managing or eliminating larval development sites can be an economical and effective means of preventing mosquitoes. When mosquito source reduction is being considered, it is advisable to consult local wildlife officials before starting. They can determine if the planned water management projects are acceptable from a wildlife habitat point-of-view. Source reduction of larval mosquitoes may involve: Installation of a catchment. Installation of tile leading to a catchment or drain. Modification of grade to permit drainage. Filling and leveling of small water-filled depressions. Conversion of a mosquito-producing area to a non-mosquito producing body of water, such as an ornamental

pond, water hazard, or permanent wetland. Improved sanitation, including tire removal, cleaning of empty lots and elimination of artificial development

containers (critical for control of Culex species). Management of emergent vegetation around storm-water retention ponds making them less suitable for

mosquito development and more suitable for mosquito predators. Biological Control: Mosquitoes are affected by a host of natural enemies, including a wide variety of parasites, predators, and pathogens. These natural controls help keep mosquito numbers down. However, natural mosquito predators can only be increased in specific situations to achieve additional levels of mosquito control. Commonly mentioned biological control methods are the introduction or encouragement of natural mosquito predators such as fish (larvae eating), bats, dragonflies and birds. Unfortunately, because mosquito numbers can explode after the spring


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snowmelt or a heavy summer rainfall, natural enemies do little to keep mosquitoes at a tolerable level when this happens. There is also concern about non-native species that are introduced for mosquito control competing with indigenous species and creating an ecological imbalance. There are exceptions to this rule. There have been cases where, in individual development sites, a parasite (e.g. certain kinds of nematodes) or a predator (e.g. fathead minnows) has kept mosquitoes to a low level. However, the general success of mosquitoes serves to underscore their ability to adapt to widely divergent natural phenomena. Some examples of natural mosquito predators are: Mosquito Fish, Gambusia affinis. These fish are used to control mosquito larvae in closed water bodies.

Gambusia are more effective in some situations than others. They generally work quite well in unused swimming pools, abandoned sewage lagoons, mine pits, and permanent flooded storm water facilities. Certain mosquito species may evade Gambusia when emergent vegetation provides them harborage. Mosquito fish are not without their drawbacks. They are extremely aggressive and are indiscriminate feeders of tadpole, zooplankton, aquatic insects and other fish. Their introduction poses a risk of competition with native species and ecological imbalance.

Dragonfly larvae (naiads) are another predator that consumes mosquito larvae. Dragonflies normally occur in permanent waters where targeted mosquito populations may not be present. Dragonflies usually occur at low densities and therefore may be of limited effectiveness. There are no sources of dragonflies for release to control mosquitoes.

Native birds (swallows, warblers, purple martins, vireos, etc.) eat adult mosquitoes. Normally, birds do not specialize solely on one pest species and their impact on mosquito population is small.

Bats: Most bats feed on flying insects but studies have shown that only about 15 percent of their diet would include mosquitoes and other flies. Like birds their impact on mosquito populations is small. The introduction of bats is not without concern, as they are known vectors for Rabies in Ontario.

While the role of any one species in controlling mosquitoes is limited, biological controls collectively play an important role in keeping the ecosystem in balance and help to keep mosquito numbers low. Biological controls are an important tool in mosquito control, especially in areas where they are already operating and can be augmented, but they are likely not sufficient by themselves for effective WNV prevention.

Electronic Repellers and Bug Zappers: Electronic repellers are devices that produce a high frequency sound to repel mosquitoes. Different reasons are given as to the mechanism of action but some of the more common claims are that the sound mimics that of male mosquitoes or dragonflies. Scientific studies repeatedly have shown that electronic mosquito repellers do not prevent host mosquitoes from biting. Mated female mosquitoes do not flee from amorous males and mosquitoes do not vacate an area hunted by dragonflies. Electronic mosquito repellers do little in the way of reducing mosquito annoyance. Bug zappers are devices that attract insects with ultraviolet light to an electrocuting device, which kills insects with a resounding pop or zap. These devices kill a lot of insects but very few are pests, most are night flying moths. Biting insects have been found to be less than one percent of insects killed in zappers. Comparison trapping has also shown no significant difference in mosquito populations in yards with and without a bug zapper. One unfortunate effect of these devices is the larger number of beneficial and harmless insects caught by these traps that would otherwise serve as food for wildlife. Mosquito Larviciding: Larviciding is used for areas that produce mosquitoes that cannot be controlled by any of the methods listed above. Many people think that the best time to begin a mosquito control program is when the numbers of biting female mosquitoes reach an intolerable level. However, the best time to begin a mosquito management program is before


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the mosquitoes emerge. Prevention should begin immediately after the mosquito eggs have hatched, the pool has been inspected, and the numbers of larvae present justify the use of an insecticide. The larvae are most efficiently and economically destroyed when they are concentrated in their development site. Preventing the larvae from becoming adult mosquitoes minimizes the area that would have to be treated. Larviciding can reduce overall insecticide use in a mosquito control program by reducing or eliminating the need for ground or aerial application of insecticides to kill widespread adult mosquitoes. Overview of Larval Control Products: There are a number of agents licensed for larval control in Ontario (see Figure 1). They fall into three main classes: Biopesticides are derived from such natural materials as animals, plants, bacteria, and certain minerals. The

only such agent licensed for mosquito control in Canada is Bti. Biorational pesticides are not directly toxic to mosquitoes but work by disrupting the life processes of insects

such as molting or maturing from the pupal stage to the adult. Methoprene and diflubenzuron are the only two birational pesticides licensed for use in Ontario.

Chemical pesticides or insecticides are directly toxic to mosquito larvae and work by killing them. These agents tend to be less specific for mosquitoes and can at high doses affect humans.

Figure 1: Larvicidal Agents Available in Ontario

Common Name

Larvicide Type

Trade Names

Bacillus thuringeniesis Israelensis (Bti)

Biopesticide Aquabac, Teknar, Vectobac

Chlorpyrifos Insecticide Dursban, Klor, Pyrate

Diflubenzuron Biorational pesticide Dimilin

Fenthion Insecticide Baytex Spray, Entex Spray,

Malathion Insecticide Cythion

Methoprene Biorational pesticide Altosid

Methoxychlor Insecticide Methoxyl

Temephos Insecticide Abate

There are two main agents under consideration for the control of larval mosquitoes in Ontario, methoprene and Bacillus thuringeniesis (Bti). These two agents are widely used for control of mosquito larvae in Canada and the United States. Methoprene: Methoprene acts like an insect growth hormone in mosquito larvae and prevents them from developing into adults (a biochemical pesticide). It is effective for mosquito control at very low concentrations (as low as 2 parts per billion). There has been substantial experience with methoprene for mosquito larval control, and it has been widely studied and recommended as an effective larvicide with low environmental health impact. Methoprene is non-toxic to humans and other mammals and virtually non-toxic to birds. There is some evidence of toxicity to fish, amphibians and freshwater invertebrates. However, most of these effects are at levels of methoprene higher than seen in normal use. Field studies of methoprene have demonstrated that there is little effect on non-target organisms including dragonflies, water boatmen and fairy shrimp. The NBPSDHU expects that the levels of methoprene in the “natural environment” locally would be much lower than that seen in these studies, since its application would be restricted to catch basins.


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Methoprene appears to pose little risk to the water supply. It is rapidly broken down in water by light and by microbes within a few days. It rapidly binds to and is broken down in soil and is unlikely to reach groundwater. Methoprene has a number of good features for mosquito control. It is highly effective against mosquitoes such as Culex pipiens and restuans with efficacy rates of 80% or better (usually 90%). Methoprene is also effective during all stages of larval development. It can be in pellets and granules that limit human exposure and makes application discrete. Sustained release formulations are available so that application in catch basis would only be necessary on a monthly basis. Bacillus thuringiensis israelensis (Bti): Bti is a bacteria commonly found in many environments. It produces a toxin that disrupts the gut of mosquito and black fly larvae, killing them. In order to work the toxin must be ingested, something restricted to filter feeding insects. The toxin is active in conditions usually only found in the gut of mosquitoes and black flies. Bti is toxic to a specific and limited number of insects. It is essentially non-toxic to almost all animals including humans, other mammals, birds and fish. The toxicity of Bti appears limited to mosquitoes, black flies and a few other insect species closely related to mosquitoes such as midges. Bti does not appear to persist in the environment. The toxins produced by Bti are rapidly degraded by sunlight. Bti rapidly binds to particulate matter in water and settles to the bottom. Bti may remain in soil for several months. Although highly specific and effective given the right circumstance, Bti has a number of limitations. Bti is believed to be less effective against Culex mosquitoes (the main animal vector of WNV) that methoprene. The toxin in Bti rapidly settles and loses its effectiveness. Organic matter in the water further compromises the effectiveness of Bti. This would further compromise the effectiveness of Bti in catch basins. Because sustained release Bti products are not available, reapplication would be required every one to two weeks. Bti is only effective against larvae in the 3rd and 4th instar stage, necessitating careful monitoring of mosquito populations and timely application, which may not be possible on a wide scale. Other Agents: A number of agents other than methoprene or Bti are licensed in Ontario for the control of mosquito larvae. The active ingredients of these agents are diflubenzuron, malathion, fenthion, temephos, chlorpyrifos and methoxychlor. Diflubenzuron is a biorational pesticide; methoxychlor is an organochlorine pesticide while the other agents are organophosphate pesticides. Diflubenzuron has a number of disadvantages – it is difficult to handle, no sustained release formulation is available in Canada and it affects other arthropods such as crustaceans. The remaining agents are not preferred since they are not as specific to mosquitoes and can have effects, especially at doses higher than normally used, on people, birds and fish. For specific circumstances (e.g. roadside ditches) these agents can be valuable tools for mosquito larval control due to their effectiveness and low cost. Some, such as temephos, are widely used in the United States and Canada. Another consideration is that malathion is one of the few products available for adult mosquito control. In order to preserve its effectiveness for this purpose, it is best to use a mosquito control agent from a different class of chemicals for larval control.


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6.3 APPENDIX 3 - Health Protection and Health Promotion Act

ONTARIO REGULATION 199/03

CONTROL OF WEST NILE VIRUS Determination if action required

1. A medical officer of health shall make a determination whether action is required by a municipality to decrease the risk of West Nile Virus to persons either inside or outside the health unit served by the medical officer of health, based upon a local risk assessment. O. Reg. 231/03, s. 1; O. Reg. 322/04, s. 1; O. Reg. 413/06, s. 1; O. Reg. 422/07, s. 1; O. Reg. 229/08, s. 1; O. Reg. 241/09, s. 1.

Notice to municipality

2. (1) Where the medical officer of health has determined that action is required, he or she may give notice to the municipality of the required action. O. Reg. 199/03, s. 2 (1).

(2) In determining required actions under subsection (1), the medical officer of health shall have regard to, (a) the guidelines published by the Minister under section 7 of the Act; and (b) the generally accepted practices in the field of public health with regard to decreasing the risk of West Nile virus to

persons. O. Reg. 199/03, s. 2 (2); O. Reg. 241/09, s. 2.

Must comply

3. A municipality shall comply with any requirements set out in the notice. O. Reg. 199/03, s. 3.

What may be required

4. Action required under this Regulation may include, without being limited to, (a) requirements respecting source reduction measures; (b) requirements respecting surveillance; (c) requirements respecting public awareness campaigns about personal protection; (d) requirements respecting the control measures for larviciding and adulticiding; and (e) requirements respecting the time within which the action shall be taken. O. Reg. 199/03, s. 4.

Addendum to Appendix 7 (O. Reg. 322/04) Implementation Aspects related to Ontario Regulation 322/04 The West Nile virus Preparedness and Prevention Plan for Ontario, and the attendant risk assessments made by local medical officers of health (Section I of the Regulation), seek to reflect this evolving body of scientific knowledge. Moreover, the evolving epidemiology of the virus requires enhancements or adjustments in the capacity of the public health system to engage in, or facilitate, the necessary surveillance, prevention and control measures. These two general factors – “the state of the science” and “the state of capacity” – guide the “generally-accepted practices in the field of public health” (Section 2 of the Regulation). Section 4 of the Regulation states those actions that “may” be included in the notices given by the Medical Officers of Health to municipalities. The numerous and sometimes unique local factors to be considered in making the risk assessments preclude the institution of an a priori, centrally-mandated, fixed set of responses for each local jurisdiction. Whatever decisions are taken, however, they should be recorded, with the accompanying rationale. With regard to Subsection 4 (d) and the accompanying “Table 1” (“Larviciding and Adulticiding in Ontario”), the following elaborations or clarifications apply: (1) When a health unit or municipality “moves” to a different “status” of West Nile virus findings in the current year (far

left column of Table 1), the recommended action does not preclude actions taken or started during the prior status.


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For example, when “non-human” evidence of the virus is found, and larviciding around a “hot spot” is indicated, this action would be in addition to any prior larviciding that was indicated before evidence of the virus was found.

(2) A “hot spot” is defined as a collection of two or more local positive findings in dead birds, mosquito pools or mammals

that indicate either epizootic transmission or persistent amplification transmission – as distinct from “isolated” findings in such non-human hosts or vectors. The indication for larviciding is thus for the “hot spot”, not an isolated finding. The other prerequisites for larviciding include establishment of the presence of the larvae and their development sites, the appropriate timing and seasonality, and the overall assessment of West Nile virus risk to the local population.

(3) The main goal of larviciding is the reduction of the local amplification vector population in their identified development

sites (e.g. catch basins, other container structures, etc.) (4) With regard to adulticiding, the 3 kilometre (km) radius “zone” size is not a “hard and fast” rule. The actual physical

extent of adulticide application is pre-eminently governed by the need to reduce the risk from epizootic or bridging vector populations near the local human population, while minimizing any unintended application (e.g. through drift) to non-target areas, species or populations.

Footnote #1 states that “Medical Officers of Health may increase the Zone size to be treated …” They may also

decrease the zone size if an application of 3 km radius is not necessary to protect the local human population. For example, the “target area” may be on the outskirts of a town, where there are no persons residing beyond the town boundary for several kilometres. Or there may be an adjacent industrial area with no evidence of flying mosquitoes or development sites. Or if a 3 km zone would overlap an adjacent area that is already being, or has recently been, treated with adulticide.

(5) In the asterisked (*) footnote, the stated “high risk indicators of transmission to humans” may be present before there

is confirmation of a human case locally; this would mean that these are indicators of an increased risk of transmission to humans. More than one of these high risk indicators should be evident before the decision is made to adulticide, in the absence of a human case.

(6) “Human case” means confirmed human case, according to the “Case Definition for Ontario”, as stated in the main body

of this document. (7) Table 1 indicates that an adulticiding action may correspond to the finding of one human case (or “a few in a space-

time cluster”). The operative word is “may” – refer to the wording of Section 4 (“…may include, without being limited to”). Thus it is possible that adulticiding may not be ordered after the detection of every human case, for reasons of timing, prior treatment decisions, and the overall assessment of the risks versus benefits of that action.


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6.4 APPENDIX 4 – Case Definitions

6.4.1 - Provincial Surveillance for West Nile virus Illness

1.0 Provincial Reporting Confirmed and probable cases of disease 2.0 Type of Surveillance Case-by-case 3.0 Case Classification 3.1 Confirmed WN virus Neurological Syndrome (WNNS) Case Clinical criteria AND AT LEAST ONE of the confirmed case diagnostic test criteria (See Section 4.1.1) 3.2 Probable WNNS Case Clinical criteria AND AT LEAST ONE of the probable case diagnostic test criteria (See Section 4.1.2) 3.3 Suspect WNNS Case Clinical criteria IN THE ABSENCE OF OR PENDING diagnostic test criteria (See Section 4.1.1) AND IN THE ABSENCE of any other obvious cause. 3.4 Confirmed WN virus Non-Neurological Syndrome (WN Non-NS) Case Clinical criteria AND AT LEAST ONE of the confirmed case diagnostic test criteria (See Section 4.1.1) 3.5 Probable WN Non-NS Case Clinical criteria AND AT LEAST ONE of the probable case diagnostic test criteria (See Section 4.1.2) 3.6 Suspect WN Non-NS Case Clinical criteria IN THE ABSENCE OF OR PENDING diagnostic test criteria (See Section 4.1.1) AND IN THE ABSENCE of any other obvious cause. 3.7 Confirmed WN virus Asymptomatic Infection (WNAI)1 Case Confirmed case diagnostic test criteria (See Section 4.1.1) IN THE ABSENCE of clinical criteria 3.8 Probable WNAI Case Probable case diagnostic test criteria (See Section 4.1.2) IN THE ABSENCE of clinical criteria 4.0 Laboratory Evidence 4.1 Laboratory Confirmation Any of the following will constitute a confirmed case of WN virus: •Positive West Nile virus culture •Positive for West Nile virus antigen in tissue •Positive for West Nile virus-specific nucleic acid •Positive for West Nile virus-specific antibody •Diagnostic rise in West Nile virus antibody titre 4.1.1 Confirmed Case Diagnostic Test Criteria Confirmed Case Diagnostic Test Criteria (e.g. by PRNT on serum or IgM detection in CSF) should be used to confirm the initial three locally acquired cases within each health region each year. For subsequent cases within that health


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region, health units may use the Probable Case Diagnostic Test Criteria to classify cases in their area as “Confirmed”. AT LEAST ONE of the following: • A significant (i.e., fourfold or greater) rise in WNV neutralizing antibody titres (using a PRNT or other kind of neutralization assay) in paired acute and convalescent sera, or cerebrospinal fluid (CSF)2 OR • Isolation of WNV from, or demonstration of WNV antigen or WNV- specific genomic sequences using an assay verified for clinical testing in tissue, blood, CSF or other body fluids OR • Demonstration of flavivirus antibodies in a single serum sample using a WNV immunoglobulin M (IgM) enzyme-linked immuno-sorbent assay (ELISA)3, 4 , confirmed by the detection of WNV specific antibodies using a PRNT (acute or convalescent serum sample) OR • Demonstration of WNV antibodies in a single CSF sample using a WNV immunoglobulin M (IgM) enzyme-linked immuno-sorbent assay (ELISA)2, 3, 4 OR • A significant (i.e., fourfold or greater) rise in flavivirus haemagglutination inhibition (HI) titres in paired acute and convalescent sera or demonstration of a seroconversion using a WNV Immunoglobulin G (IgG) ELISA3, 4 AND the 3 Health and Long-Term detection of WN specific antibodies using a PRNT (acute or convalescent serum sample). 4.1.2 Probable Case Diagnostic Test Criteria AT LEAST ONE of the following:

•Detection of flavivirus antibodies in a single serum sample using a WNV IgM ELISA3 without confirmatory neutralization serology (e.g., PRNT) OR • A significant (i.e., fourfold or greater) rise in flavivirus HI titres in paired acute and convalescent sera or demonstration of a seroconversion using a WNV IgG ELISA3 OR • A titre of >1:320 in a single WNV HI test, or an elevated titre in a WNV IgG ELISA, with a confirmatory PRNT result OR • Demonstration of Japanese encephalitis (JE) serocomplex-specific genomic sequences in blood by nucleic acid amplification test (NAAT) screening on donor blood, by Blood Operators in Canada. 4.2 Approved/Validated Tests •Standard culture for WN virus •NAAT for WNV verified for clinical testing1 •WN virus antigen detection in tissue •WN virus IgM antibody detection •WN virus HI, PRNT and/or IgG/IgM immunoassays 4.3 Indications and Limitations •Sensitivity of NAT testing is approximately 50% when used on plasma / serum samples collected less than 8 days after symptoms are detected. •Individuals infected with WN virus display a low level of viremia (on average several thousand genome copies) for approximately one week after symptom onset. The use of NAT testing on acute serum / plasma samples can complement IgM testing when used together to assay "early" acute specimens


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5.0 Clinical Evidence 5.1 West Nile virus Neurological Syndrome (WNNS) Clinical Criteria: •History of exposure in an area where WN virus (WNV) activity is occurring 4 OR •History of exposure to an alternative mode of transmission 5 AND •Fever AND NEW ONSET OF AT LEAST ONE of the following: •Encephalitis (acute signs of central or peripheral neurologic dysfunction), OR •Viral meningitis (pleocytosis and signs of infection e.g., headache, nuchal rigidity) OR •Acute flaccid paralysis (e.g., poliomyelitis-like syndrome or Guillain-Barré-like syndrome) 6 OR •Movement disorders (e.g., tremor, myoclonus) OR •Parkinsonism or Parkinsonia-like conditions (e.g., cogwheel rigidity, bradykinesia, postural instability) OR •Other neurological syndromes 8 5.2 West Nile virus Non-Neurological Syndrome (WN Non-NS) Clinical Criteria: •History of exposure in an area where WN virus activity is occurring 5 OR •History of exposure to an alternative mode of transmission AND AT LEAST TWO of the following 8: •fever •myalgia9 •arthalgia •headache •fatigue •lymphadenopathy •maculopapular rash 6.0 ICD Code(s) ICD 10 Code A923 7.0 Comments

1. This category includes asymptomatic blood donors whose blood is screened using a nucleic acid amplification test (NAAT), by Blood Operators (i.e. Canadian Blood Services or Hema-Quebec) and is subsequently brought to the attention of public health officials. The NAAT that is currently used by Blood Operators in Canada is designed to detect all viruses in the Japanese encephalitis (JE) serocomplex. The JE serocomplex includes WN virus and nine other viruses, although from this group only WNV and St Louis encephalitis virus are currently endemic to parts of North America. The NAAT test used by Blood Operators is not approved for clinical diagnostic testing but can be used for surveillance case classifications, and would result in a classification of probable case.


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2. Whenever submitting a CSF for testing, a serum sample should be submitted for parallel testing. Although PRNT can be performed on CSF, this testing is usually not required, as the presence of IgM in CSF, which has excellent specificity in the acute setting, is sufficient for case confirmation. 3. Both CDC and commercial IgM / IgG ELISAs are now available for front line serological testing. Refer to appropriate assay procedures and kit inserts for the interpretation of test results. Due to high serological cross reactivity among flaviviruses, travel history should be obtained to determine if other flaviviruses should be tested for (e.g. Dengue virus, St. Louis Encephalitis and Japanese Encephalitis). 4. Early in infection the immune system generates antibodies that bind relatively weakly to viral antigen (low avidity). As the infection proceeds, an increasing percentage of newly generated IgG antibody displays higher binding affinity to virus antigen and thus avidity also rises (Note: avidity is usually measured based upon the ability of IgG to dissociate from antigen preparations after incubation with a solution of urea). As long as high avidity IgG is not yet detected in the serum it can be assumed that the individual was exposed to the viral agent during a recent exposure. With respect to WNV infection it has not been precisely determined when (i.e. post-exposure) high avidity antibodies reach levels in serum that can be accurately detected by serological assays (there may be significant variation depending on the individual). However, it has been shown that > 95% of sera collected from individuals exposed to WNV 6-8 months previously will have IgG antibodies that bind strongly to viral antigen and will give high avidity scores using both indirect fluorescent antibody (IFA) and ELISA testing formats. Note: Avidity testing will not replace confirmatory neutralization testing, non-WNV flavivirus IgG antibody (e.g., dengue, St Louis encephalitis [SLE]) may bind to the antigen preparations used in avidity assays. Note: WNV IgM antibody may persist for more than a year and the demonstration of IgM antibodies in a patient’s serum, particularly in residents of endemic areas, may not be diagnostic of an acute WN viral infection. Seroconversion (by HI, IgG ELISA or PRNT assays) demonstrates a current WNV infection. Therefore, the collection of acute and convalescent sera for serologic analysis is particularly important to rule out diagnostic misinterpretation early in the WNV season (e.g. May, June) and to identify initial cases in a specific jurisdiction. However, it should be noted that seroconversions may not always be documented due to timing of acute sample collection (i.e. titres in acute sera may have already peaked). If static titres are observed in acute and convalescent paired sera, it is still possible the case may represent a recent infection. To help resolve this, the use of IgG avidity testing may be considered to distinguish between current and past infection. The presence of both IgM antibody and low avidity IgG in a patient’s convalescent serum sample are consistent with current cases of viral associated illness. However test results that show the presence of IgM and high avidity IgG are indicative of exposures that have occurred in a previous season. Immunocompromised individuals may not be able to mount an immune response necessary for a serological diagnosis. WNV diagnostic test criteria for these individuals should be discussed with a medical microbiologist. 5. History of exposure when and where WNV transmission is present, or could be present, or history of travel to an area with confirmed WNV activity in mosquitoes, birds, horses, other mammals or humans. 6. Alternative modes of transmission, identified to date, include: laboratoryacquired; in utero; receipt of blood components; organ/tissue transplant; and, possibly via breast milk. 7. A person with WNV-associated acute flaccid paralysis may present with or without fever or mental status changes. Altered mental status could range from confusion to coma with or without additional signs of brain dysfunction (e.g. paralysis, cranial nerve palsies, sensory deficits, abnormal reflexes, generalized convulsions and abnormal movements). Acute flaccid paralysis with respiratory failure is also a problem. Note: A significant feature of WNV neurological illness may be marked muscle weakness that is more frequently unilateral, but could be bilateral. WNV should be considered in the differential diagnosis of all suspected cases of acute flaccid paralysis with or without sensory deficit. WNV- associated weakness typically affects one or more limbs (sometimes affecting one limb only). Muscle weakness may be the sole presenting feature of WNV illness (in the absence of other neurologic features) or may develop in the setting of fever, altered reflexes, meningitis or encephalitis. Weakness typically develops early in the course of clinical infection. Patients should be carefully monitored for evolving weakness and in particular for acute neuromuscular respiratory failure, which is a severe manifestation associated with high morbidity and mortality. For the purpose of WNV Neurological Syndrome Classification, muscle weakness is characterized by severe (polio-like), non-transient and prolonged symptoms. Electromyography (EMG) and lumbar puncture should be performed to differentiate WNV paralysis from the


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acute demyelinating polyneuropathy (Guillain-Barré syndrome). Lymphocytic pleocytosis (an increase in WBC with a predominance of lymphocytes in the cerebrospinal fluid [CSF]) is commonly seen in acute flaccid paralysis due to WNV. Other emerging clinical syndromes, identified in 2002 included, but were not limited to the following: myelopathy, rhabdomyolysis (acute destruction of skeletal muscle cells), peripheral neuropathy; polyradiculoneuropathy; optic neuritis; and acute demyelinating encephalomyelitis. Ophthalmologic conditions including chorioretinitis and vitritis were also reported. Facial weakness was also reported. Myocarditis, pancreatitis and fulminant hepatitis have not been identified in North America, but were reported in outbreaks of WNV in South Africa. “Aseptic” meningitis without encephalitis or flaccid paralysis occurring in August and September when WNV is circulating may be due to non-polio enteroviruses circulating at the same time. This should be considered in the differential diagnosis. 8. It is possible that other clinical signs and symptoms could be identified that have not been listed and may accompany probable case or confirmed case diagnostic test criteria. For example, gastrointestinal (GI) symptoms were seen in many WNV patients in Canada and the USA in 2003 and 2004. 9. Muscle weakness may be a presenting feature of WNV illness. For the purpose of WNV Non-Neurological Syndrome classification, muscle weakness or myalgia (muscle aches and pains) is characterized by mild, transient, unlikely prolonged symptoms that are not caused by motor neuropathy. 8.0 Sources Advisory Committee on Epidemiology; Health Canada. Case definitions for diseases under national surveillance. Can Commun Dis Rep. 2000;26 Suppl 3:i-iv, 1-122. Available from: http://publications.gc.ca/site/eng/9.559511/publication.html Ontario Ministry of Health and Long-Term Care West Nile virus preparedness and prevention plan. Toronto, ON: Queen’s Printer for Ontario; 2008. Available from: http://www.health.gov.on.ca/en/common/ministry/publications/reports/wnv_plan_2008/w nv_plan_2008.aspx

Date of Last Revision: March 2017

6.4.2 – Provincial Surveillance for Encephalitis Encephalitis –including primary viral (including WNv) 1.0 Provincial Reporting Confirmed and probable cases of disease 2.0 Type of Surveillance Case-by-case 3.0 Case Classification 3.1 Confirmed Case Laboratory confirmation of infection with clinically compatible signs and symptoms of encephalitis: Isolation of organism from an appropriate clinical specimen (e.g., cerebrospinal fluid, stool) OR Detection of nucleic acid from appropriate clinical specimens (e.g., cerebrospinal fluid, stool) OR Detection of specific antigen OR Serologic confirmation of infection with an organism known to cause encephalitis

http://www.health.gov.on.ca/en/common/ministry/publications/reports/wnv_plan_2008/w%20nv_plan_2008.aspx

http://www.health.gov.on.ca/en/common/ministry/publications/reports/wnv_plan_2008/w%20nv_plan_2008.aspx


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3.2 Probable Case Clinically compatible signs and symptoms of encephalitis in the absence of laboratory confirmation of a causative organism 4.0 Laboratory Evidence

Given the variability of etiological organisms, consult with laboratory about appropriate specimens and testing methodologies 5.0 Clinical Evidence Clinically compatible signs and symptoms are characterized by fever, headache, and altered mental status ranging from confusion to coma with or without additional signs of brain dysfunction (e.g., paresis or paralysis, cranial nerve palsies, sensory deficits, abnormal reflexes, generalized convulsions, and abnormal movements). 6.0 ICD Code(s) 6.1 ICD 10 Code G05.1 Primary, viral 6.2 ICD 10 Code G04.9 Unspecified Infectious Diseases Protocol, 2015 – Appendix B 7.0 Comments Exclusionary Criteria for Meeting the Case Definition Encephalitis due to Haemophilus influenza b, Neisseria meningitidis, Streptococcus pneumoniae (IPD), Tuberculosis, West Nile virus, or Listeria monocytogenes should be reported under the corresponding diseases. Post-infectious encephalitis due to measles, rubella, mumps or varicella should be reported under the respective condition as a complication of the illness Post-vaccine encephalitis should be reported as an Adverse Event Following Immunization (AEFI) West Nile virus was reported under Encephalitis between January 2003 and July 2004. As of July 2004, West Nile virus encephalitis should be reported as West Nile virus. 8.0 References

National Notifiable Diseases Surveillance System. Case Definitions. [Internet]. Neuroinvasive and Non-Neuroinvasive Domestic Arboviral Diseases; 2004. Atlanta, GA: Centers for Disease Control and Prevention (CDC); 2008. [cited 2009 Feb 12]. Available from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5453a1.htm

Ministry of Health and Long-Term Care, Public Health Division. iPHIS manual. Toronto, ON: Queen’s Printer for Ontario; 2005.

Date of Last Revision: November 2008

6.4.3 - Provincial Surveillance for Lyme Disease (Case Definitions)

Lyme Disease 1.0 Provincial Reporting Confirmed and probable cases of disease 2.0 Type of Surveillance Case-by-case

http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5453a1.htm


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3.0 Case Classification 3.1 Confirmed case •Clinician-confirmed erythema migrans (EM) greater than 5 cm in diameter with a history of residence in, or visit to, a Lyme disease endemic area or risk area (see section 7.0, comments #1, #4 and #5);

OR

• Clinical evidence of Lyme disease (see section 7.0, comment #2) with laboratory confirmation by PCR or culture (see section 7.0, comment #3);

OR

• Clinical evidence of Lyme disease with laboratory support by serological methods (see section 7.0, comment #3), and a history of residence in, or visit to, an endemic area or risk area (see section 7.0, comments #4 and #5).

3.2 Probable case • Clinical evidence of Lyme disease with laboratory support by serological methods (see section 7.0, comment #3), but with no history of residence in, or visit to an endemic area or risk area (see section 7.0, comments #4 and #5); OR

• Clinician-confirmed erythema migrans (EM) greater than 5 cm in diameter but with no history of residence in, or visit to an endemic area or risk area (see section 7.0, comments #1, #4 and #5). 4.0 Laboratory Evidence 4.1 Laboratory Confirmation Any of the following will constitute a confirmed case of Lyme disease: •Isolation of B. burgdorferi from an appropriate clinical specimen •Positive nucleic acid amplification test (NAT) for B. burgdorferi •Serological evidence using the two-tier enzyme-linked immuno-sorbent assay (ELISA) and Western Blot criteria (Serological evidence alone is not confirmatory: positive predictive value is greater provided that the patient has EM or objective symptoms of disseminated Lyme disease, and has had contact with a region endemic for Lyme disease.) 4.2 Approved/Validated Tests •Standard culture for B. burgdorferi •Commercial B. burgdorferi Immunoglobulin M (IgM) and Immunoglobulin G (IgG) tests (ELISA and Western Blot) •NAT for B. burgdorferi 4.3 Indications and Limitations •Only serum samples are acceptable for serology •Initial negative serological tests in patients with skin lesions suggestive of EM should have testing repeated after four weeks •Sera that are screened negative for antibodies using an EIA should not be subjected to Western blot testing •EIA tests presently in use lack the specificity necessary to base a diagnosis of Lyme disease on an unconfirmed result •The possibility of false-positive Western blot results should not be ignored •When patients are treated very early in the course of illness, antibodies may not develop 5.0 Clinical Evidence •A systemic, tick-borne disease with protean manifestations, including dermatologic, rheumatologic, neurologic, and cardiac abnormalities. The best clinical marker for the disease is erythema migrans (EM), the initial skin lesion that occurs in 60%-80% of patients. Secondary lesions may also occur.


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•For most patients, the expanding EM lesion is accompanied by other acute symptoms, particularly fatigue, fever, headache, mildly stiff neck, arthralgia, or myalgia. These symptoms are typically intermittent. The diagnosis of EM must be made by a physician. Laboratory confirmation is recommended for persons with no known exposure6 •For purposes of surveillance, late manifestations include any of the following when an alternate explanation is not found: •Nervous system: Any of the following, alone or in combination: lymphocytic meningitis; cranial neuritis, particularly facial palsy (may be bilateral); radiculoneuropathy; or, rarely, encephalomyelitis. Headache, fatigue, paresthesia, or mildly stiff neck alone are not criteria for neurologic involvement. •Musculoskeletal system: Recurrent, brief attacks (weeks or months) of objective joint swelling in one or a few joints, sometimes followed by chronic arthritis in one or a few joints. Manifestations not considered as criteria for diagnosis include chronic progressive arthritis not preceded by brief attacks and chronic symmetrical polyarthritis. Additionally, arthralgia, myalgia, or fibromyalgia syndromes alone are not criteria for musculoskeletal involvement. •Cardiovascular system: Acute onset of high-grade (2nd-degree or 3rd-degree) atrioventricular conduction defects that resolve in days to weeks and are sometimes associated with myocarditis. Palpitations, bradycardia, bundle branch block, or myocarditis alone are not criteria for cardiovascular involvement. 6.0ICD Code(s) ICD 10 Code A69.2 7.0 Comments 1. EM is a pathognomonic sign of Lyme disease. It is defined as a skin lesion that typically begins as a red macule or papule and expands over a period of days to weeks to form a round or oval expanding erythematous area. Some lesions are homogeneously erythematous, whereas others have prominent central clearing or a distinctive target-like appearance. A single primary lesion must reach ≥ 5 cm in size across its largest diameter. On the lower extremities, the lesion may be partially purpuric. EM represents a response to the bacterium as it spreads intradermally from the site of the infecting tick bite. It appears 1-2 weeks (range 3-30 days) after infection and persists for up to 8 weeks, by which time the bacterium leaves the skin and disseminates haematogenously. An erythematous skin lesion that presents while a tick vector is still attached or which has developed within 48 hours of detachment is most likely a tick bite hypersensitivity reaction (i.e., a non-infectious process), rather than EM. Tick bite hypersensitivity reactions are usually < 5 cm in largest diameter, sometimes have an urticarial appearance, and typically begin to disappear within 24 to 48 hours. Signs of acute or chronic inflammation are not prominent. There is usually little pain, itching, swelling, scaling, exudation or crusting, erosion or ulceration, except that some inflammation associated with the tick bite itself may be present at the very centre of the lesion. 2. Clinical evidence of Lyme disease are those symptoms described in the 2006 clinical practice guidelines of the Infectious Diseases Society of America and listed on the Public Health Agency of Canada’s Lyme disease webpage. Other symptoms that are, or have been suggested to be associated with Lyme disease (including symptomatology that is sometimes referred to as “chronic Lyme disease” or “post Lyme disease syndrome”) are considered too non-specific to define cases for surveillance purposes, whether or not they may be caused by B. burgdorferi infection. 3. PCR and serological methods on cerebrospinal fluid (CSF) are investigational only. PCR (or more appropriately NAAT) testing should be limited to CSF, joint fluid, or tissue samples as there is limited data to support its use on blood and/or urine samples. Culturing for B. burgdorferi is a low-yield procedure and is not encouraged; if performed, it should be done only on biopsies from EM lesions and synovial or spinal fluid. 4. An endemic area is defined here as a census subdivision in which a reproducing population of Ixodes scapularis or Ixodes pacificus tick vectors is known to occur, which has been demonstrated by molecular methods to support transmission of B. burgdorferi at that site. 5. A risk area is defined here as a location where one blacklegged tick was found during three person-hours of drag sampling at a location, between May and October. (Ogden et al, 2014)


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8.0 Sources Advisory Committee on Epidemiology; Health Canada. Case definitions for diseases under national surveillance. Can Commun Dis Rep. 2000;26 Suppl 3:i-iv, 1-122. Available from: http://publications.gc.ca/site/eng/9.559511/publication.html Canadian Public Health Laboratory Network. The laboratory diagnosis of Lyme borreliosis: guidelines from the Canadian Public Health Laboratory Network. Can J Infect Dis Med Microbiol. 2007;18(2):145-8. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533539/ Public Health Agency of Canada. For Health Professionals: Lyme disease. [cited 5 October 2016]. Available from: http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/diseasemaladie/lyme/professionals-professionnels/index-eng.php#a2 Ontario Agency for Health Protection and Promotion (Public Health Ontario), Sider D, Patel S, Russell C, Jain-Sheehan N, Moore S. Technical report: update on Lyme disease prevention and control. Toronto, ON: Queen’s Printer for Ontario; 2012. Available from: https://www.scribd.com/document/87601769/PHO-Technical-ReportUpdate-on-Lyme-Disease-Prevention-and-Control-Final-030212 Wormser GP, Dattwyler RJ, Shapiro ED, Halperin JJ, Steere AC, Klempner MS, et al. The clinical assessment, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2006;43(9):1089-134. Ogden NH, Koffi JK, Pelcat Y, Lindsay LR. Assessment of a screening test to identify Lyme disease risk. Can Commun Dis Rep. 2014;40(5):83-7. Available from: 5 Health and Long-Term Care http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-05/dr-rm40-05-2- eng.php Date of Last Revision: March 2017

http://publications.gc.ca/site/eng/9.559511/publication.html

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533539/

http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/diseasemaladie/lyme/professionals-professionnels/index-eng.php#a2

http://www.healthycanadians.gc.ca/diseases-conditions-maladies-affections/diseasemaladie/lyme/professionals-professionnels/index-eng.php#a2

https://www.scribd.com/document/87601769/PHO-Technical-ReportUpdate-on-Lyme-Disease-Prevention-and-Control-Final-030212

https://www.scribd.com/document/87601769/PHO-Technical-ReportUpdate-on-Lyme-Disease-Prevention-and-Control-Final-030212

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-05/dr-rm40-05-2-%20eng.php

http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/14vol40/dr-rm40-05/dr-rm40-05-2-%20eng.php


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6.5 APPENDIX 5 - Communication Plan for West Nile Virus and Lyme disease

West Nile virus

Implementation Date: When the risk for WNv increases (Summer/Fall)

Main Objectives:

To communicate the risks of WNv.

How to avoid exposure to mosquitos.

To increase awareness of WNv activity in the community by increasing media coverage when there is an increase in positive adult mosquito species.

Key messages:

We will follow the messaging from Public Health Ontario and the Public Health Agency of Canada.

Total Budget: $500

Influencers:

Adults 50+

Story-telling, emotional connection.

Tell them what they CAN do – empowerment.

Seniors homes/apartments.

Retail – Gardening, boating, sports stores, Farmers Markets.

Immunocompromised

More likely to use computer to find information.

Users of health care system – doctor’s offices, hospitals, walk-in clinics.

Travelers

Travel agencies.

Chambers of Commerce, Travel Information centres, sports organizations.

Outdoor stores.

Networks

Municipalities, libraries, doctors’ offices, walk-in clinics, veterinarians.

Background:

WNv has been around for a while and has not been much of an issue over the last few years. E.g. only one positive mosquito pool since 2004, few Culex mosquitoes, no human case.

Want to ensure people do not get complacent to mosquito exposure.

Will affect those over 50 yrs of age, immunocompromised, and those who travel to Southern Ontario and

further south where WNv is more prevalent.


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Target Audience: Adults 50+, Immunocompromised, Travelers Communication Vehicle/Channel

Accountable Person

Timeline Target Audience Communication Objective Evaluation and Key Metrics

News Release

Spokesperson: __________

Public Relations Specialist

As required

To communicate presence of:

First positive Mosquito pool

First positive human case

# media stories

Rack Cards & Posters

$400


Digital Media Coordinator

EH

June To increase awareness of WNv risks

To increase awareness of personal protection methods to prevent mosquito bites

# of rack cards distributed

# of posters distributed

Facebook Posts

- Develop posts - Repost MOHLTC &

PHAC info


June - Oct General Public To increase awareness of WNv risks


# of FB posts

Facebook Ads (If necessary)

$100



July-Sept General Public To increase awareness of WNv risks


# of boosted posts

# of views

# of web page visits

Website Pages Web editor


ongoing General Public To increase awareness of WNv risks



Target Audience: Municipalities, veterinarians, health care professionals, Travel Information Centres, Travel Agencies, Farmers Markets, Chambers of Commerce, Sport organizations, retail stores (gardening, boating, sports),

Communication Vehicle/Channel

Accountable Person

Timeline Target Audience

Communication Objective Evaluation and Key Metrics

News Release



As required

Retail, health care professionals, partners, etc.

To communicate the prevention of WNv


# of media stories

Website Pages Website editor

ongoing Retail, health care professionals, partners, etc.

To increase awareness of WNv risks



Twitter

- Develop & post tweets

SMR


June-Oct Partners To increase awareness of WNv risks

# of Tweets

# of retweets


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- Retweet MOHLTC & PHAC


Lyme disease Overview Lyme disease is an illness that is spread by the bite of an infected blacklegged tick. It can have severe and long-term complications, but it’s also easy to prevent, and to treat when caught early. With a primary focus on immunocompromised populations, and also the general public, the Health Unit’s goal is to communicate risk reduction and tick detection. The campaign will be operational throughout the early summer to early fall. The focus of the messaging in May and June will be on the preventative measures, and will be supported by detection messaging throughout July and August. Primary Audience

Immunocompromised populations

Older adults 50+

Pregnant women

Secondary Audience General population

Healthcare professionals

Budget $500 Key Messages 1 - Protection Preventative measures can reduce risk of tick exposure

Clothes

Wear light coloured clothes; long sleeve shirts and pants; tuck pants into socks; tuck shirt into pants;

closed-toe shoes

Put your dry outdoor clothes in a dryer on high heat for 10 minutes to kill any remaining ticks

Keep up with yard work

Wear bug spray with DEET or Icaridin

Shower or bathe within two hours of being outdoors

Do a daily full body check for ticks on yourself, your children, and your pets

Walk on cleared paths or walkways

Do your research before travelling – what are the tick risks?


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2 - Detection How to find ticks, and what to do if you get bitten

Full body check for ticks on yourself, your children, and your pets

What to do if you get bit:

Using clean tweezers, grasp head and pull straight out

If part of tick breaks off and remains in skin, remove with tweezers

Wash bite with soap and water or disinfect with alcohol-based hand sanitizer

Save the tick in a sealed container and record the date of the bite, and where you believe the tick

was acquired

See a healthcare provider right away

Tick collection – bring sealed container with tick to Health Unit. Be forthcoming about where you acquired

the tick. The Health Unit is interested in ticks found within our districts.

Symptoms:

Mild skin rash or fever, chills, headache, fatigue, swollen lymph nodes, muscle and joint aches

Consult a healthcare provider if you develop any of the symptoms listed after being bitten by a tick

or having been in areas where they are known to be present

If caught early, Lyme disease can be effectively treated with 2-4 weeks of antibiotics

Protection – May until end of June, reiterate in early September Preventative measures can limit tick exposure


Accountable Person

Timeline Measurement Notes

News release Alex, supported by Brendan

In time for May Long

# media stories

Communicate preventative measures prior to the long weekend, as well as part of Lyme disease awareness month, if time permits

Draft news release and social media post

Alex and Brett, supported by Brendan

Late May, early June

Draft news release and social media post prepared in case of positive tick

Posters/ rack cards/ brochures

EH mid- June, prepared prior to July push

# of materials distributed

Communications to review the Lyme disease brochure

Distribute materials to routine locations across our districts

Will use ministry materials as well as previously designed HU materials

Information kits EH/ Supported by Communications

Mid-June, prior to July push

# of materials distributed

Make a list of healthcare practitioners, long-term care homes and golden age clubs across our districts

Draft targeted letter, explaining the importance of taking preventative measures to limit tick exposure for older adults and pregnant mothers

Mail letter with additional materials (brochures, rack cards)

Webpage Brett, supported by EH

Early/mid-June

# hits to the website

Review of content, edits and updates completed before July push

Social media plan (see attached)

Brett Mid-June, prepared for July push

Reach and engagement

Develop local/timely social media posts, as well as repost prepared ministry materials

Video component explored


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Lyme Disease Social Media Strategy Core objectives:

Propel Lyme disease messaging to our audience, focusing on prevention and detection

Engage with followers to educate

Increase hits to the Lyme disease page on the Health Unit website

Position Health Unit as Lyme disease experts

Channels: Facebook

Twitter

Youtube

Instagram (through paid advertisement)

Strategy: Create local, timely content to increase engagement

Share Ministry materials when appropriate

Create new social media content such as videos

Connect with community partners and groups

Use targeting methods to reach our target audience

Prevention – May - June

Date Message Media Audience Rationale

May 16 Facebook: Lyme disease is spread through the bite of an infected blacklegged tick. A bullseye rash is the most common sign of Lyme disease, but many people never develop a rash. Visit our website to learn about the signs and symptoms of Lyme disease. www.myhealthunit.ca/Lyme Twitter: Lyme disease is spread through the bite of an infected blacklegged tick. A bullseye rash is the most common sign of Lyme disease, but many people never develop a rash. Visit our website to learn about the signs and symptoms of Lyme disease. www.myhealthunit.ca/Lyme

LD Symptom infographic

General

Inform public of the symptoms to be aware of

June 13 Facebook: With spring comes the return of ticks. Follow these tips while doing your spring yard work to eliminate tick habitat around your home. https://www.gov.mb.ca/health/publichealth/factsheets

Infographic showing yard tick proofing steps

General / Senior homeowners

To illustrate proactive steps to discourage ticks in outdoor living space

Detection – July and August, reiterate in late September How to find ticks, and what to do if you get bitten


Accountable Person Timeline Measurement Notes

News release Alex, supported by Brendan

August 1, 2018

# media stories Communicate detection practices prior to the long weekend

Social media plan (see below)

Brett Mid-June, prepared for July push

Reach and engagement

Develop local/timely social media posts, as well as repost prepared ministry materials Video component explored

https://www.myhealthunit.ca/en/health-topics/lyme-disease.asp


https://www.gov.mb.ca/health/publichealth/factsheets/landscapetips.pdf


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/landscapetips.pdf https://www.cdc.gov/lyme/prev/in_the_yard.html

Twitter: With spring comes the return of ticks. Follow these tips while doing your spring yard work to eliminate tick habitat around your home. https://www.gov.mb.ca/health/publichealth/factsheets/landscapetips.pdf https://www.cdc.gov/lyme/prev/in_the_yard.html

July 4 Facebook: If you find a tick on you it’s important to remove it right away. As close to the skin as possible carefully grab the tick’s head with tweezers and gently pull straight out. Once removed, disinfect with rubbing alcohol and see your health care provider. Visit www.myhealthunit.ca/Lyme for more information. Twitter: If you find a tick on you it’s important to remove it right away. As close to the skin as possible carefully grab the tick’s head with tweezers and gently pull straight out. Once removed, disinfect with rubbing alcohol and see your health care provider. Visit www.myhealthunit.ca/Lyme for more information.

Photo of a tick being removed with tweezers

General Public may not be aware of the correct method to remove a tick

July 25 Facebook: When hiking in tick habitat, like talk grass and shady woodland, protect yourself by wearing long pants tucked into socks, closed toed shoes and long sleeved shirts. DEET insect repellant works too. Learn more about ticks and Lyme disease at www.myhealthunit.ca/Lyme Twitter: When hiking in tick habitat, like talk grass and shady woodland, protect yourself by wearing long pants tucked into socks, closed toed shoes and long sleeved shirts. DEET insect repellant works too. Learn more about ticks and Lyme disease at www.myhealthunit.ca/Lyme

Photo of person demonstrating a personal protective measure

General

Remind the public to practice personal protective measures

August 15 Facebook: Do a tick check after walking in the woods. Check all over your body including groin, armpits and head. Throw your clothes in the dryer for an hour to kill any ticks you might have missed. If you are in our area and find a tick on your body, let us know! Visit www.myhealthunit.ca/Lyme for more information Twitter: Do a tick check after walking in the woods. Check all over your body including groin, armpits and head. Throw your clothes in the dryer for an hour to kill any ticks you might have missed. If you are in our area and

Tick photo General

Public may unaware of common tick attachment sites and how thorough one need to inspect their bodies


https://www.cdc.gov/lyme/prev/in_the_yard.html



https://www.cdc.gov/lyme/prev/in_the_yard.html







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find a tick on your body, let us know! Visit www.myhealthunit.ca/Lyme for more information

September 5

Facebook: If you are travelling this weekend, be tick aware. The Lyme disease risk is greater in areas of the province where the blacklegged tick population is highest. Visit our website for more information www.myhealthunit.ca/Lyme Twitter:

If you are travelling this weekend, be tick aware. The

Lyme disease risk is greater in areas of the province where the blacklegged tick population is highest. Visit our website for more information www.myhealthunit.ca/Lyme

Public Health Ontario estimated risk area map 2019

Seniors / cottage owners Boosted post targeting age demographics

To show areas of high tick activity and remind public to take precautions when they are away from home





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6.6 APPENDIX 6 - Glossary of Terms

Adulticide A type of pesticide used to kill adult mosquitoes.

Amplification vector An arthropod (in this case, a specific species of mosquito) that is involved in the main transmission of West Nile virus between bird species.

Bacillus thuringiensis israelensis (BTI)

A bacterium; type of biological pesticide used to eradicate mosquito larvae in water (mosquito larvae die after ingesting this bacteria).

Bridge vector An arthropod (in this case, a specific species of mosquito) that serves as a main transmission of virus between the reservoir (birds) and a dead end host (humans).

Catch basins Grates seen at street corners and in other properties for water run-off.

Culex pipiens Species of mosquito, the primary known vector for West Nile virus, commonly found in urban areas; breeds in fresh but stagnant water such as backyard containers and storm drains.

Debris Accumulation of loose materials capable of holding water eg. leaves.

DEET DEET (chemical name, N, N-diethyl-meta-toluamide) is the active ingredient in many insect repellent products.

Depression Any natural or man-made condition on property that is capable of holding water but does not include a municipally-owned storm water management facility.

Diapause A period of suspended development or growth, characterized by inactivity and decreased metabolism.

Encephalitis Inflammation of the brain, which can be caused by numerous viruses, including West Nile virus.

Enhanced passive surveillance Not actively participating in surveillance activities however, actively tracking all cases reported.

GIS (Geographic Information Systems)

Computer based systems for the integration and analysis of geographic data.

GPS (Global Positioning Systems) A navigation system that uses a series of 24 satellites of known position in space to determine a position on the earth’s surface.

Icaridin Is an insect repellent. It has broad efficacy against various insects and is almost colorless and odorless.

Integrated Pest Management Is an effective and environmentally sensitive approach to pest management that relies on a combination of common-sense practices. IPM programs use current, comprehensive


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information on the life cycles of pests and their interaction with the environment. This information, in combination with available pest control methods, is used to manage pest damage by the most economical means, and with the least possible hazard to people, property, and the environment

Larvae Immature mosquitoes; stage which hatches from the egg, prior to adult stage.

Larvicide A type of pesticide used to eradicate immature mosquitoes (larvae).

Methoprene A type of larvicide; chemical that is used to prevent mosquito larvae from emerging and developing into adult mosquitoes.

Mosquito Development Site Previously known as a “Mosquito breeding Site”, a location where mosquitoes lay eggs, usually in stagnant water with organic material and where the larvae hatch and develop to the adult stage. Changed due to the technicality that mosquitoes do not ‘breed’ in these areas.

Mosquito Pools A group of mosquitoes collected in one area and combined at the laboratory for testing for the presence of West Nile and related viruses.

Natural Body of Water A creek, stream, bog, marsh, river, pond or lake created or maintained by the forces of nature, which contains water and include spring fed man-made ponds.

Objects Container of any kind capable of holding water eg. tires, cars, boats, garden fixtures, bird baths.

Outbreak An unexpected increase in frequency or distribution of a disease.

Pesticide Substance used to kill pests such as insects, mice and rats; an insecticide is a form of pesticide.

Overwintering A period of rest or hibernation by which insects survive the winter.

Source Reduction The removal or reduction or larval mosquito habitats.

Standing Water Any water which is not continuously filtered and in movement by mechanical means that is found either on the ground or in any object or debris as defined above but does not include a natural body of water that exists on a permanent basis or is contained within a municipally owned drain or storm water management facility.

Vector An organism (an insect in most cases) capable of carrying and transmitting a disease-causing agent from one host to another.

Vector Control Mechanism instituted to control and reduce the vector population.


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SECTION 7.0 - REFERENCES:

Best Management Practices for Mosquito Control in New Jersey. Appendix to Brattsten, L.B. 2002. Insecticides recommended for mosquito control in New Jersey in 2002. Retrieved May 9, 2016. URL: http://entomology.rutgers.edu/

Crans, W.J. Products and Promotions That Have Limited Value for Mosquito Control. Retrieved May 9, 2016. URL: http://entomology.rutgers.edu/

Ellis, R. 2001. Municipal Mosquito Control Guidelines – prepared for Health Canada. Released May 21, 2001. Last accessed April 9, 2011. URL: http://ubcm.ca/assets/Funding~Programs/Documents/west-nile-virus-mosquito-control-quidelines.pdf

Glare, T.R. and O’Callaghan, M. 1998. Environmental and health impacts of Bacillus thuringeniensis israelensis. New Zealand Ministry of Health. URL: http://www.beyondpesticides.org/mosquito/documents/BacillusThuringiensisIsraelensisNZ.pdf Retrieved May 9, 2016.

Glare, T.R. and O’Callaghan, M. 1999. Environmental and health impacts of the insect juvenile hormone analogue, S-methoprene. 1999. New Zealand Ministry of Health. Retrieved April 9, 2011. Ministry of Health and Long-Term Care, Public Health Division (2011). Eastern Equine Encephalitis virus Surveillance and Management Guidelines. Released April, 2011.

Ministry of Health and Long-Term Care, Public Health Division (2011). Lyme Disease Surveillance and Management Guidelines. Released May, 2011.

Ministry of Health and Long-Term Care, Public Health Division (2010). West Nile virus preparedness and prevention plan. Released June 7, 2010.

North Bay Parry Sound District Health Unit (2015). 2014 Vector-Borne Diseases Surveillance Report. North Bay, ON: North Bay Parry Sound District Health Unit.

Ontario Agency for Health Protection and Promotion Public Health Ontario). Vector-borne diseases 2014 summary report. Toronto, ON: Queen’s Printer for Ontario; 2015.

Ontario Ministry of Health and Long-Term Care. Infectious diseases protocol, 2015. Toronto, ON: Queen’s Printer for Ontario; 2009. Retrieved April 9, 2011 URL: http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ ophs/progstds/protocols/id_protocol_09.pdf

Public Health Agency of Canada - Lyme Disease Fact Sheet URL: http://www.phac-aspc.gc.ca/id-mi/lyme-fs-eng.php Retrieved April 9, 2011.

Public Health Agency of Canada – 2010 West Nile virus Monitor URL: http://www.phac-aspc.gc.ca/wnv-vwn/index-eng.php Retrieved April 9, 2011. Ontario Agency for Health Protection and Promotion (Public Health Ontario). Technical report: Update on Lyme disease prevention and control. Second edition. Toronto, ON: Queen’s Printer for Ontario; 2016.

Westchester County Board of Health. 2002. Appendix 3. All: Larvicide component of the comprehensive plan. 3AII. LARVICIDE COMPONENT OF THE COMPREHENSIVE PLAN

http://entomology.rutgers.edu/

http://entomology.rutgers.edu/

http://ubcm.ca/assets/Funding~Programs/Documents/west-nile-virus-mosquito-control-quidelines.pdf

http://ubcm.ca/assets/Funding~Programs/Documents/west-nile-virus-mosquito-control-quidelines.pdf

http://www.beyondpesticides.org/mosquito/documents/BacillusThuringiensisIsraelensisNZ.pdf

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/protocols/id_protocol_09.pdf

http://www.health.gov.on.ca/english/providers/program/pubhealth/oph_standards/ophs/progstds/protocols/id_protocol_09.pdf

http://www.phac-aspc.gc.ca/id-mi/lyme-fs-eng.php

http://www.phac-aspc.gc.ca/wnv-vwn/index-eng.php

http://www.westchestergov.com/planning/environmental/StingEIS/DGEISfiles/AppendixFiles/Appendix%203.AII%20Larvicides.pdf

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