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PHO in Action is Public Health Ontario’s blog. Here we tell stories of the work we do day in and day out, with our partners, to keep Ontarians safe and create a healthier tomorrow.
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September 20
What you need to know: Emerging Multidrug Resistant Bacteria

​09/20/2017

PHO expert, Dr. Jennie Johnstone, recently appeared in the Canadian Medical Association Journal’s podcast to talk about emerging multidrug resistant bacteria. These bacteria, including Carbapenemase producing Enterobacteriacaeae, or CPE, are resistant to most or all antibiotics. They are common in hospitals and nursing homes and are difficult to treat, making them extremely deadly. 

Tune in below to hear Dr. Johnstone talk about why CPE is so dangerous, how we can detect and treat it, and what public health and healthcare providers can do to help prevent the spread. 

Dr. Johnstone also recent published an article with Dr. Samir Patel in CMAJ, Five Things to know about an Emerging Multidrug Resistant Bacteria

Want to learn more? See our infographic on Antibiotic overuse in Ontario’s long-term care homes, or the Ontario Health Profile on Antimicrobial Resistance. To find more about Dr. Johnstone’s work, see her scientist video profile

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September 13
Save the Date! PHO Talks: Big ideas, short talks

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​9/13/2017

New ideas and creative minds help drive innovation in public health. Hear some of the brightest minds at Public Health Ontario share their ideas in this unique event on October 26th. 

This brand new series of short, compelling talks by our diverse experts are appropriate for all audiences. In one hour, you’ll hear three short talks from experts Dr. Natasha Crowcroft, Rhonda Pollard and Stacie Carey. These talks will help you re-think how we can work together to address health issues and challenges, and ultimately move knowledge to action. 

Register now for the live stream and save the date!

We’ll be revealing more information about the speakers and events over the coming weeks. Stay tuned to our blog or follow us on Twitter (@PublicHealthON)!

July 26
Vector-borne diseases in Ontario — annual update

07/26/2017​

What are vector-borne diseases? 

Vector-borne diseases are infections that are transmitted by a vector such as a mosquito, tick or flea. The most common types of vector-borne diseases in Ontario are:

  • West Nile virus: a virus transmitted through the bite of an infected mosquito. It was first detected in Ontario in birds in 2001, with the first human cases following in 2002. 
  • Lyme disease: an infection transmitted through the bite of an infected tick. In Ontario, the majority of these human cases have occurred in areas associated with the blacklegged tick populations.
  • Eastern equine encephalitis virus​ (EEEV): a virus that circulates between birds and mosquitoes, with bridge vectors (mosquitos) transmitting the virus to humans and horses. EEEV has been reported in Ontario’s horse population since the 1930s; however, the virus has been detected sporadically in the Ontario mosquito population since 2009.

Annual trends in vector-borne diseases

VBD-Square.jpgIt’s important to monitor the trends in vector-borne diseases across the province. That’s why every year, with support and routine surveillance from the local public health units in Ontario, we publish our annual report on vector-borne diseases. We are happy to announce the release of the Vector-Borne Diseases: 2016 Summary Report​, which provides an overview of the 2016 data on the vectors that transmit West Nile virus, EEEV and Lyme disease in Ontario.

Interesting findings from the report:

  • ​There was an increase in West Nile virus positive mosquito pools over the last two years – with 211 positive pools identified in 2016.
  • While human data are not included in this report, it was noted that Ontario had the first ever human case of EEEV reported in Canada.
  • There was an increase in the number of blacklegged ticks submitted to PHO from 1,903 in 2015 to 2,041 in 2016.

Please note that human data are not included in this report. However this information is still available on our website through the Infectious Diseases Query tool and Reportable Disease Trends in Ontario.

Additional resources 

We offer a number of great resources and tools on vector-borne diseases. Check out our interactive West Nile virus surveillance page (updated weekly) or our Lyme disease page for more information.

Stay tuned to our PHO in Action blog for more vector-borne disease posts in the coming weeks.

Questions about the report?

Please feel free to contact us at ezvbd@oahpp.ca


July 25
For clinicians: Best Practices for pulmonary nontuberculous mycobacteria

​07/25/2017

NTM_Species.PNGNontuberculous mycobacteria (NTM) are organisms that can naturally be found in soil and water, including treated drinking water distribution systems and showerheads and faucets. Human NTM infections most often occur in the lungs (pulmonary) and typically cause slowly progressing respiratory and systemic symptoms. NTM infections are becoming increasingly common in Canada2, so it’s important to have updated information to understand the epidemiology and clinical management of NTM.

Best Practices for Pulmonary Nontuberculous Mycobacteria​ is a new resource that provides clinicians such as: chronic disease managers, family physicians, internal medicine and respirologists and infectious disease practitioners an overview of human NTM infections, including:

  • ​sample collection and microbiology
  • diagnostic and treatment criteria 
  • clinical presentations
  • treatment

The report also highlights the emerging evidence of potential human-to-human transmission involving cystic fibrosis patients and addresses the potential methods for reducing exposure to environmental pathogens for at-risk individuals.

This resource was developed by the Provincial Infectious Diseases Advisory Committee on Communicable Diseases (PIDAC-CD), Nontuberculous Mycobacteria Working Group, with support from Public Health Ontario.

For more information, please contact pidac@oahpp.ca.  

July 18
Public Health 101: Latent Period
July 17
Tobacco control: A spotlight on cessation

07/17/2017

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In early May, we launched the new Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) report, which provides a comprehensive assessment of 56 tobacco control interventions and highlights their impact on reducing tobacco use and associated burden in Ontario. The report is organized into four main chapters which align with the four pillars of tobacco control: industry, prevention, protection and cessation.

The Cessation chapter outlines 15 tobacco control interventions and their potential contribution for motivating and supporting people to quit smoking. The chapter was written by a working group made up of tobacco prevention scientists and experts and led by Dr. Brice Baskerville, Senior Scientist and Associate Research Professor with the Propel Centre for Population Health Impact at the University of Waterloo

“The Cessation chapter is extremely important,” says Dr. Baskerville. “It can help us make great advances toward having lowest prevalence of tobacco use in Canada.” 

The chapter introduces a number of cessation interventions which can be used at the local and provincial levels. It expands on previously implemented interventions and policies such as price and taxation and describes new evidence on technology-based interventions like text messaging.

“We need a comprehensive and integrative tobacco cessation strategy — a hub of services where smokers who want to quit can get the help whenever and wherever they need it,” emphasizes Dr. Baskerville.  “There will not be an *endgame for tobacco unless we have well developed cessation strategies in place.” 

Importance of the Cessation chapter

This chapter can be used to:

  • ​enhance knowledge about evidence on existing tobacco policies
  • learn about new technology-based interventions 
  • learn new cessation strategies for subpopulations such as Indigenous populations, LGBTQ+, individuals of low socioeconomic status, individuals with lower educational levels, and individuals dealing with mental health and addiction issues 

More information on the report

To read the full report or view a recording of the webcast showcasing highlights from the report, please visit the Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016)​ webpage. 

Did you miss any of our other spotlights? Check out our posts on industry​, prevention and protection​

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* A tobacco endgame frame defines strategies that address tobacco control at a system level (structural, political and social) in order to achieve and end to the tobacco epidemic.


July 10
Tobacco control: A spotlight on protection

07/10/2017

Family with baby

In early May, we launched the new Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) report, which provides a comprehensive assessment of 56 tobacco control interventions and highlights their impact on reducing tobacco use and associated burden in Ontario. The report is organized into four main chapters which align with the four pillars of tobacco control: industry, prevention, protection and cessation.

The Protection chapter outlines 10 tobacco control interventions and their role in protecting people from physical and social exposures. The chapter was written by a working group made up of tobacco prevention scientists and experts and led by Dr. Pamela Kaufman, Scientist with the Ontario Tobacco Research Unit, and Assistant Professor at the Dalla Lana School of Public Health​, University of Toronto

“We know from the scientific literature that tobacco smoke is harmful to our health,” says Dr. Kaufman. “Yet Ontarians are still exposed to secondhand and thirdhand smoke in their homes and vehicles, in some outdoor public places and workplace settings, and on post-secondary campuses.”

The Prevention chapter examines how creating tobacco-free and clean air environments protect people from the harms of tobacco smoke. Smoke-free laws and related policies, such as the Smoke-Free Ontario Act (2016) are integral to comprehensive tobacco control.

“In addition to protecting people from exposure to tobacco smoke, there is evidence that smoke-free policies support people who are trying to quit or have recently quit by reducing physical and social cues for smoking,” explains Dr. Kaufman. “They also help to prevent youth from starting to smoke by reducing social exposure to smoking and changing social norms about smoking.”   

Importance of the Protection chapter

This chapter can be used to:

  • ​highlight policy gaps and opportunities where Ontarians are still exposed (e.g., multi-unit housing, entrances to buildings, post-secondary campuses)
  • support a comprehensive approach to tobacco control by encouraging and sustaining attempts at quitting and changing social norms which influence tobacco use among young people
  • understand the integration of other products such as waterpipes and e-cigarettes into smoke-free policies

More information on the report

To read the full report or view a recording of the webcast showcasing highlights from the report, please visit the Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) webpage. 

Check out our posts on industry and prevention and stay tuned to our PHO in Action​ blog for more chapter spotlights.


June 30
Tobacco control: A spotlight on prevention

06/30/2017

Man smoking a cigarette

In early May, we launched the new Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) report, which provides a comprehensive assessment of 56 tobacco control interventions and highlights their impact on reducing tobacco use and associated burden in Ontario. The report is organized into four main chapters which align with the four pillars of tobacco control: industry, prevention, protection and cessation.

The Prevention chapter outlines 14 tobacco control interventions and their potential contribution for preventing people from starting to smoke. The chapter was written by a working group made up of tobacco prevention scientists and experts and led by Dr. Kelli-an Lawrance, an Associate Professor at Brock University, Health Sciences Department, and co-Director and Principal Investigator of Leave the Pack Behind

“The Prevention Chapter is unique because it goes beyond our conventional thinking about preventing tobacco use,” explains Dr. Lawrance. “I hope this chapter reinforces the message that we can move to a tobacco-free Ontario.”

Prevention is an important part of tobacco control. Adolescents and young adults are particularly vulnerable because:

  • ​the transition period to young adulthood increases risk of starting to smoke 
  • once individuals start smoking, they are at greater risk of progressing to increased tobacco use 
  • new products (e.g., e-cigarettes) may increase tobacco use among youth and young adults

The Prevention chapter addresses both primary and secondary prevention and broadens the scope of the tobacco prevention dialogue. “The chapter not only focuses on children to include youth and young adults,” says Dr. Lawrance, “it also looks at the individual, their families, social networks, school or workplaces as well as the social structures in which they live.” 

Importance of the Prevention chapter

This chapter can be used to:

  • ​learn about factors that contribute to smoking uptake 
  • help prevent tobacco use by understanding why youth and young adults start to smoke 
  • extend conventional smoking prevention initiatives into different age groups 
  • understand how to use mass media campaigns in even more compelling ways 

More information on the report

To read the full report or view a recording of the webcast showcasing highlights from the report, please visit the Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) webpage. 

Check out our post on industry and stay tuned to our PHO in Action blog for more chapter spotlights.


June 22
Tobacco control: A spotlight on industry

06/22/2017

Image of cigarettes
In early May, we launched the new Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016)​ report, which provides a comprehensive assessment of 56 tobacco control interventions and highlights their impact on reducing tobacco use and associated burden in Ontario. The report is organized into four main chapters which align with the four pillars of tobacco control: industry, prevention, protection and cessation.

The Industry chapter outlines 17 tobacco control interventions and their potential contribution to counter the tobacco industry’s efforts to promote and sell their product. The chapter was written by a working group made up of tobacco prevention scientists and experts and led by Dr. Robert Schwartz, Executive Director of the Ontario Tobacco Reduction Unit.

The Industry chapter is important because it looks at ways to decrease and eventually eliminate the use of use of tobacco by focusing on interventions aimed at the tobacco industry and products.

“For the first time this chapter takes a tobacco endgame frame,” states Dr. Schwartz. “It is really delightful to say that the federal government has adopted a tobacco endgame goal of reaching less than five per cent of the population using tobacco by the year 2035.”

A tobacco endgame frame defines strategies that address tobacco control at a system level (structural, political and social) in order to achieve and end to the tobacco epidemic. Tobacco endgame strategies are largely focused on the tobacco industry as part of a comprehensive tobacco control policy using approaches to address:

  • patterns of use
  • new products and users
  • changing populations of users
  • industry efforts to expand the market

Importance of the Industry chapter

This chapter can be used to:

  • ​learn about emerging and innovative approaches to addressing the tobacco industry
  • identify strategies for reducing the number of new and current tobacco users and achieving an end of the tobacco epidemic
  • understand the tobacco industry’s role in producing, marketing and delivering tobacco products to consumers 

More information on the report

To read the full report or view a recording of the webcast showcasing highlights from the report, please visit the Evidence to Guide Action: Comprehensive Tobacco Control in Ontario (2016) webpage

Stay tuned to our PHO in Action blog for more chapter spotlights over the next month.


June 16
Celebrating a milestone

​06/16/2017

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Last week marked a major milestone for public health in Ontario: the ten year anniversary of the passing of the Ontario Agency for Health Protection and Promotion Act and the creation of Public Health Ontario.

The Act was the first of its kind in Ontario with the purpose “to enhance the protection and promotion of the health of Ontarians and to contribute to efforts to reduce health inequities through the establishment of an agency to provide scientific and technical advice and support to those working across sectors to protect and improve the health of Ontarians…”1 

Renewing public health systems in Ontario

The early 2000s saw a series of major public health events in Ontario including the 2000 E. coli waterborne outbreak in Walkerton and the 2003 Severe Acute Respiratory Syndrome (SARS) outbreak. In response to these events, a number of reports were commissioned on the state of public health in Ontario and called for the renewal of local, provincial and national public health systems.

Operation Health Protection

Following these reports, Operation Health Protection was born and outlined a plan for “identifying strategic priorities to enhance capacity in public health for leadership, health emergency preparedness and response, infectious disease prevention and control and health human resources.”2

In January 2005, the Agency Implementation Task Force was established and provided a key recommendation for the need to create an organization in Ontario dedicated to providing scientific and technical advice on health protection and promotion. The final report From Vision to Action: A Plan for the Ontario Agency for Health Protection and Promotion (March 2006), provided a blueprint for the Agency’s design and implementation.

Realizing a vision: Ontario Agency for Health Protection and Promotion

On June 4, 2007 the Ontario Agency for Health Protection and Promotion Act was passed with overwhelming support from all political parties. A few months later, the founding Board of Directors was established and held its first meeting in September 2007.

A year after the Act was passed, PHO officially began operations in July 2008.

We came into operations as Ontario faced some of its most difficult public health challenges. Although operations officially began in 2008, the date of June 4, 2007 and the passing of the Ontario Agency for Health Protection and Promotion Act will forever be a major milestone in the history of public health in Ontario. 

References

  1. Ontario Agency for Health Protection and Promotion Act, 2007, SO 2007, c 10, Sched. K. Available from: https://www.ontario.ca/laws/statute/07o10 
  2. Goel. V. Building Public Health Ontario: Experience in developing a new public health agency. Can J Public Health [Internet]. 2012 Jun 05 [cited 2017 Jun 6]; 103(4):e267-9. Available from: http://journal.cpha.ca/index.php/cjph/article/view/3289 ​


June 15
President’s Message - June 2017

​Earlier this month we reached an important milestone. June 4, 2017 marked the ten year anniversary of the passage of the Ontario Agency of Health Protection and Promotion Act. In turn, the Act led to the establishment of Public Health Ontario (PHO) in 2008.

I took a moment to reflect on how Ontario’s health and public health systems has continued to grow stronger since the passage of the Act, thanks to the collective efforts of all of our partners. I look forward to what we will accomplish together in the next ten years as we continue to work to keep Ontario healthy and safe.

This month, I also wanted to highlight PHO’s client satisfaction survey, which is conducted every two years, as part of our ongoing commitment to measure and enhance our performance and hear from you – our clients and partners.

The survey assessed the level of general client satisfaction, awareness and understanding of PHO and our products and services. An independent market research firm conducted the survey and analyzed the findings on our behalf. I am pleased to share with you highlights of our 2016 survey results.

The survey was sent to clients who used PHO products and services in the last two years and subscribers who registered to receive communications from PHO. A total of 1,391 respondents completed the survey.

I’m delighted to report that overall, our ratings remain high, but of course we are committed to continuous improvement. In the survey, our clients and partners told us that they:ClientSatisSmall.jpg

  • Have a high overall satisfaction with PHO products and services;
  • Would recommend PHO’s products and services to colleagues;
  • Consider PHO’s work relevant to protecting and promoting the health of Ontarians; and
  • See the agency as a credible source of scientific and technical information and advice.

I invite you to read the highlights of our survey results here.

Your feedback is extremely valuable to us. Thank you to everybody who took the time to complete the survey. We are using the results to inform improvements to PHO’s products and services.

Wishing you and your families a happy and healthy summer.

Dr. Peter D. Donnelly, M.D.
President and CEO
Public Health Ontario

June 14
Why is it important to monitor Ontario’s mosquitoes?

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Female Culex mosquito​


You may find mosquitos a nuisance in the spring and summer months, but did you know that monitoring them is a vital public health task that helps us prevent mosquito-borne diseases like West Nile virus​ (WNV) and eastern equine encephalitis virus (EEEV)? Read on to learn more about mosquito surveillance in Ontario.

What is mosquito surveillance?

In Ontario, mosquito surveillance consists of collecting mosquitoes and testing them for WNV and EEEV.

From June through October, over 300 traps collect mosquitoes one night per week across Ontario. Mosquitoes that get caught by these traps are identified to species and counted. This way, we can collect data on the numbers of each species during each season at each trap location. Public health officials use these data to assess the risk of WNV or EEEV infection in the human population.

Since 2002, over 11 million mosquitoes have been collected in Ontario, with 5 million of these identified to species. The most commonly identified mosquitos are:

  • Aedes vexans (30% of all mosquitoes identified)
  • Coquillettidia perturbans (25%)
  • Culex pipiens/restuans (14%)
  • Ochlerotatus trivittatus (7%)
  • Ochlerotatus stimulans (6%)

Why is mosquito surveillance important?

Besides assessing the risk of mosquito-borne diseases, mosquito surveillance is integral to understanding how mosquito populations change over time. Climate change (rising temperatures in summer and milder winters), increased urbanization, and increased international travel and trade contribute to the increased chance of detecting new mosquito species in Ontario.

As the world has recently seen with the global spread of chikungunya and Zika viruses, mosquito-borne viruses can emerge rapidly, creating a need for a rapid response. Ontario’s mosquito surveillance program is one of the most robust in North America, and allows public health officials to prepare a rapid response to emerging pathogens from invading mosquitoes.

Occasionally, mosquito surveillance detects new mosquitoes in Ontario. While most will never establish here due to absence of appropriate habitat and climate,  if they are given the appropriate habitat and climate, new mosquito species may become established. One particular new species is Aedes japonicus (normally from Southeast Asia), was first detected in Ontario in 2001 and rapidly spread throughout southern Ontario by 2005.

In fall 2016, public health officials discovered Aedes aegypti for the first time in Canada, in the city of Windsor, along with the first evidence of a reproducing population of Aedes albopictus. These species of mosquitoes are aggressive human biters and potential vectors of dengue, chikungunya, yellow fever and Zika viruses in warmer regions of the world. While we do not expect that these Aedes mosquitoes will survive the Ontario winter, it is important to continue surveillance for these species to ensure that neither of these two species establish in southern Ontario.

We know that mosquitoes can be nuisance biters and can carry pathogens, but what are the benefits to having mosquitoes in the environment?

“Mosquitoes will not be missed by most of us, and for the most part, the world would not change if they were eradicated. However, aside from their beauty and what they teach us about evolution, they serve important ecological roles in many ecosystems, from pollinators, to predators and prey” - Dr. Mark P. Nelder, Senior Program Specialist and Medical Entomologist on the Enterics, Zoonotics and Vector-Borne Diseases Unit at Public Health Ontario​

June 08
Public Health 101: Environmental Carcinogens
May 25
​Recent flooding in Ontario sparks concerns over water contamination
Flood_kingston.jpg
Photo credit: Kevin McDermott, Research Technician, Public Health Ontario Laboratory, Kingston.

Flooding and a private drinking water system
Every year as snow melts, the run-off (often called spring run-off) results in contaminants entering groundwater. This year, in addition to spring runoff, Ontario and Quebec endured a record amount of rainfall, which resulted in flooding in many areas. Flooding combined with annual spring runoff has resulted in a higher-than-usual risk of contaminants, particularly in private well water.
 
It’s important to take flooding seriously, understand the risks and know what steps to take to protect you and your family.
 
What are the risks?
Flooding can affect water quality, and this is a particular concern for rural residents in Ontario on private drinking water systems. Be aware that flooding may cause contamination of private water sources, such as wells.
 
 "Private drinking water systems serve many Ontarians, particularly in rural and remote areas. These systems are vulnerable to contamination with fecal pathogens, particularly during flooding, and should be tested frequently." 
  
 - Dr. Anna Majury, Clinical and Environmental Microbiologist, PHO
  
What should I do?
  •  If you use a private well for your water supply, ensure that you reach out to your local public health unit or your local Public Health Ontario laboratory to have your water tested. Don’t drink, use the water in food preparation, or for brushing your teeth, until it has been determined that there are no indicators of bacterial contamination in the water source.
  • It is important to test frequently throughout the year. However, in times of flooding, heavy rainfall, snow melt or spring run-off, it is recommended that private well owners test more often (minimum of once per month).
Flooding and a private sewage system
If your property is at risk of a flood, or flooded, consider the effect on your private sewage system. A flooded sewage system will not function properly and can cause problems such as:
  • sewage backup in your home, and;
  • contamination of your water supply. 
In the event of a flood, contact your local public health unit for guidance regarding how to manage your private sewage system during the flood period.
 
Resources
If you have any questions, or would like to have your water tested, please reach out to your local public health unit.
May 24
​​Check out what you missed at TOPHC 2017!

05/24/2017

For three days in March, TOPHC 2017: Global challenges. Local solutions. transformed Toronto’s Beanfield Centre into a hub of public health discovery, innovation and research. PHO partners with the Ontario Public Health Association and the Association of Local Public Health Agencies to put on this event. Now in its seventh year, TOPHC saw its largest attendance to date and featured over 180 sessions, workshops and poster presentations.

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Most of the presentations and posters from this year’s event are now available at tophc.ca. Also, be sure to check out the TOPHC blog, which covers sessions, workshops, and highlights of social media activity.

Some notable highlights and videos: 

Plenary sessions: 

The Hot TOPHC panel sessions: 


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