Acute Respiratory Infections in Travelers Returning from MERS-CoV–Affected Areas

We examined which respiratory pathogens were identified during screening for Middle East respiratory syndrome coronavirus in 177 symptomatic travelers returning to Ontario, Canada, from regions affected by the virus. Influenza A and B viruses (23.1%) and rhinovirus (19.8%) were the most common pathogens identified among these travelers

Epidemiology of Enterovirus D68 in Ontario.

In August 2014, children's hospitals in Kansas City, Missouri and Chicago, Illinois notified the Centers for Disease Control and Prevention (CDC) about increased numbers of pediatric patients hospitalized with severe respiratory illness (SRI). In response to CDC reports, Public Health Ontario Laboratories (PHOL) launched an investigation of patients being tested for enterovirus D-68 (EV-D68) in Ontario, Canada. The purpose of this investigation was to enhance our understanding of EV-D68 epidemiology and clinical features. Data for this study included specimens submitted for EV-D68 testing at PHOL from September 1, 2014 to October 31, 2014. Comparisons were made between patients who tested positive for the virus (cases) and those testing negative (controls). EV-D68 was identified in 153/907 (16.8%) of patients tested. In the logistic regression model adjusting for age, sex, setting and time to specimen collection, individuals younger than 20 years of age were more likely to be diagnosed with EV-D68 compared to those 20 and over, with peak positivity at ages 5-9 years. Cases were not more likely to be hospitalized than controls. Cases were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). Routine viral culture and multiplex PCR were inadequate methods to identify EV-D68 due to poor sensitivity and inability to differentiate EV-D68 from other enterovirus serotypes or rhinovirus. Testing for EV-D68 in Ontario from July to December, 2014 detected the presence of EV-D68 virus among young children during September-October, 2014, with most cases detected in September. There was no difference in hospitalization status between cases and controls. In order to better understand the epidemiology of this virus, surveillance for EV-D68 should include testing of symptomatic individuals from all treatment settings and patient age groups, with collection and analysis of comprehensive clinical and epidemiological data

Laboratory testing and phylogenetic analysis during a mumps outbreak in Ontario, Canada

In September 2009, a mumps outbreak originated in New York and spread to Northeastern USA and Canada. This study compares the performance of different diagnostic testing methods used in Ontario and describes molecular characteristics of the outbreak strain

The direct healthcare costs attributable to West Nile virus illness in Ontario, Canada: a population-based cohort study using laboratory and health administrative data

Abstract Background West Nile virus (WNV) is a mosquito-borne flavivirus, first detected in the Western Hemisphere in 1999 and spread across North America over the next decade. Though endemic in the most populous areas of North America, few studies have estimated the healthcare costs associated with WNV. The objective of this study was to determine direct healthcare costs attributable to WNV illness in Ontario, Canada. Methods We conducted a cost-of-illness study on incident laboratory confirmed and probable WNV infected subjects identified from the provincial laboratory database from Jan 1, 2002 through Dec 31, 2012. Infected subjects were linked to health administrative data and matched to uninfected subjects. We used phase-of-care methods to calculate costs for 3 phases of illness: acute infection, continuing care, and final care prior to death. Mean 10-day attributable costs were reported in 2014 Canadian dollars, per capita. Sensitivity analysis was conducted to test the impact of WNV neurologic syndromes on healthcare costs. Results One thousand five hundred fifty-one laboratory confirmed and probable WNV infected subjects were ascertained; 1540 (99.3%) were matched to uninfected subjects. Mean age of WNV infected subjects was 49.1 ± 18.4 years, 50.5% were female. Mean costs attributable to WNV were $1177 (95$1001, $1352) for acute infection,$180 (95% CI: $122,$238) for continuing care, $11,614 (95$5916, $17,313) for final care - acute death, and$3199 (95% CI: $1770,$4627) for final care - late death. Expected 1-year costs were $13,648, adjusted for survival. Three hundred seventeen infected subjects were diagnosed with at least one neurologic syndrome and greatest healthcare costs in acute infection were associated with encephalitis ($4710, 95% CI: $3770,$5650). Conclusions WNV is associated with increased healthcare resource utilization across all phases of care. High-quality studies are needed to understand the health system impact of vector-borne diseases and evaluate the cost effectiveness of novel WNV interventions

Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks <i>Ixodes scapularis</i> and the Lyme Disease Agent <i>Borrelia burgdorferi</i> in Ontario, Canada

<div><p>We identified ticks submitted by the public from 2008 through 2012 in Ontario, Canada, and tested blacklegged ticks <i>Ixodes scapularis</i> for <i>Borrelia burgdorferi</i> and <i>Anaplasma phagocytophilum</i>. Among the 18 species of ticks identified, <i>I</i>. <i>scapularis</i>, <i>Dermacentor variabilis</i>, <i>Ixodes cookei</i> and <i>Amblyomma americanum</i> represented 98.1% of the 14,369 ticks submitted. Rates of blacklegged tick submission per 100,000 population were highest in Ontario's Eastern region; <i>D</i>. <i>variabilis</i> in Central West and Eastern regions; <i>I. cookei</i> in Eastern and South West regions; and <i>A</i>. <i>americanum</i> had a scattered distribution. Rates of blacklegged tick submission per 100,000 population were highest from children (0–9 years old) and older adults (55–74 years old). In two health units in the Eastern region (i.e., Leeds, Grenville & Lanark District and Kingston-Frontenac and Lennox & Addington), the rate of submission for engorged and <i>B</i>. <i>burgdorferi</i>-positive blacklegged ticks was 47× higher than the rest of Ontario. Rate of spread for blacklegged ticks was relatively faster and across a larger geographic area along the northern shore of Lake Ontario/St. Lawrence River, compared with slower spread from isolated populations along the northern shore of Lake Erie. The infection prevalence of <i>B</i>. <i>burgdorferi</i> in blacklegged ticks increased in Ontario over the study period from 8.4% in 2008 to 19.1% in 2012. The prevalence of <i>B</i>. <i>burgdorferi</i>-positive blacklegged ticks increased yearly during the surveillance period and, while increases were not uniform across all regions, increases were greatest in the Central West region, followed by Eastern and South West regions. The overall infection prevalence of <i>A</i>. <i>phagocytophilum</i> in blacklegged ticks was 0.3%. This study provides essential information on ticks of medical importance in Ontario, and identifies demographic and geographic areas for focused public education on the prevention of tick bites and tick-borne diseases.</p></div

Rate of spread of <i>Ixodes scapularis</i>, measured in cumulative number towns with blacklegged ticks submissions along the northern shores of Lake Ontario/St. Lawrence River and Lake Erie, Ontario, Canada (2008–2012).

<p>* *Includes <i>I</i>. <i>scapularis</i> submitted from: human (n = 6,147), dog (1,961), cat (206), environment (24), white-tailed deer (6), horse (3) and other animals not specified or unknown (51).</p

Summary of age and sex of persons submitting selected tick species in Ontario, Canada (2008–2012).

<p>*Means for age of submitters followed by different letters are significantly different at a familywise error rate of p<0.05 (F_3,9462 = 60.2; p<0.0001).</p>†<p>Chi-square analyses performed to test null hypothesis that there is no significant difference between the expected and observed numbers of men and women submitting a tick species.</p><p>Summary of age and sex of persons submitting selected tick species in Ontario, Canada (2008–2012).</p