2015 Health Watch - Vancouver Coastal Health

2015 Health Watch
Issue # 88
Nov 2014 - Mar 2015
This bulletin is a surveillance update
for our region and includes public
health program highlights. This
issue covers the time period from
November 2014 - March 2015.
Contents
Summary............................. 1
Our Region.......................... 2
Transportation & Health..... 3
Program Highlights............. 6
Surveillance Updates.......... 7
Public Health Update.......... 12
Environmental Health......... 13
Summary
Well-planned and accessible transportation
systems positively influence our health.
Influenza season continues into spring.
Know Your Source: Deaths from overdoses
involving fentanyl are increasing.
This issue’s feature topic:
My Health My Community report on Transportation
and Health in Metro Vancouver.
Read more on page 3
All data herein should only be used with reference to the
“2014 Health Watch prepared by Vancouver Coastal Health, Public Health Surveillance Unit”.
For questions or comments please contact [email protected].
2015 Health Watch
Nov 2014 - Mar 2015
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Our Region
The Vancouver Coastal Health Authority (VCH) is one of five geographically distinct health authorities in British Columbia
(BC). The VCH region covers a large geographic area and includes both urban and rural communities. It is comprised of
three health service delivery areas (HSDA): North Shore/Coast Garibaldi (i.e. Coastal Urban and Coastal Rural), Richmond,
and Vancouver.
The Vancouver HSDA is further divided into six local health areas (LHA), and the North Shore/Coast Garibaldi HSDA
further divided into seven (two LHAs in Coastal Urban and five in Coastal Rural). The estimated VCH population is
1.2 million, approximately 25% of BC’s population.
2015 Health Watch
Nov 2014 - Mar 2015
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Transportation & Health: highlights from MHMC
The first My Health My Community report, on Transportation and Health in Metro Vancouver, was released in March 2015.
This timely release was intended to help inform discussion leading up the Metro Vancouver Transportation and Transit
Referendum. The report summarizes information on 22,000 of the 28,000 Metro Vancouver respondents who commute to
work and school and how the modes of transportation they use relate to health and lifestyle behaviour and health
outcomes.
55% of respondents indicated they commute to work or school by car (as a driver or a passenger) and 43% of respondents
indicated they commute by “active” modes of transportation (transit 29%, walking 10% and cycling 4%) (Figure 1).
Figure 1.
For more information on the Metro Vancouver Transportation and Transit Referendum please visit the following website:
http://mayorscouncil.ca/
2015 Health Watch
Nov 2014 - Mar 2015
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Transportation & Health: highlights from MHMC continued
The key findings related to mode of transportation were:
• Active transportation users are 33% less likely to be overweight or obese compared to those who commute by car
(Figure 2).
• Active transportation users are twice as likely to meet the recommendation of 30+ minutes of walking per day.
• Cyclists and walkers are more likely to meet the physical activity guidelines of 150+ minutes per week.
• Active Transportation users have more positive lifestyle* attributes.
• Car users with commute times of more than 50 minutes (one way) are 56% less likely to report a strong sense of
community belonging than those with commute times of less than 10 minutes.
• Transportation is an important social justice issue – transit use is highest among lower income households, visible
minorities and recent immigrants (Figure 3).
*Lifestyles characterised by eating 5+ servings of fruits and vegetables a day, 30+ minutes of walking a day, 150+ minutes of moderate
Figure 2.
Figure 3.
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Nov 2014 - Mar 2015
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Transportation & Health: highlights from MHMC continued
The map below shows the differences in car use across Metro Vancouver in relation to some of the existing and proposed
transit infrastructure under the Metro Vancouver Mayors’ Council Plan (Figure 4). Respondents living in the dark purple
areas (above average car use) are 33% more likely to be overweight or obese and 34% less likely to walk 30+ minutes a day
than those in the light purple (below average car use).
For full My Health My Community Transportation and Health report, please visit the following website:
https://www.myhealthmycommunity.org/Results.aspx
The My Health My Community results echo the findings of a new report, Health Benefits of Transit Investment: Policy Brief,
by UBC Professor Lawrence Frank, who reviewed over 30 studies on transit and health from North America and beyond.
The report found that when transit improvements are made, residents not only use the new infrastructure but also walk
more and are less likely to be obese and develop chronic disease.
The My Health My Community Transportation and Health report, the Health Benefits of Transit Investment: Policy Brief
and a series of municipal specific “Speak up for Health” documents can be found on the BC Healthy Living Alliance
website: http://www.bchealthyliving.ca/lower-mainland-health-experts-urge-residents-to-vote-yes-for-health/
Figure 4.
2015 Health Watch
Nov 2014 - Mar 2015
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Program Highlights
Immunization coverage among VCH school-age children
Immunization antigens assessed by grade,
BC, 2013-2014
The VCH Immunization Program and Public Health Surveillance Unit are
preparing to release the 2013/2014 academic year VCH school-age children
immunization coverage results.
Each school year, VCH public health nurses work with schools to collect
student immunization records and update immunizations among
kindergarteners, 6th graders and 9th graders. These school grades align
with the current recommended BC immunization schedule. At the end of
the school year, immunization records are analyzed to determine
coverage levels by antigen for each group of children by school and
geography (Figure 5).
Highlights from 2013/2014 school year~
Kindergarteners
•Immunization coverage levels for all antigens increased from the 2012/2013
school year in both Coastal Urban and Coastal Rural.
Kindergarteners
•Diphtheria, Tetanus, acellular
Pertussis (DTaP) + Polio
•Measles
•Mumps
•Rubella
•Varicella
•Meningococal C
•Hepatitis B
6th graders
•Hepatitis B
•Meningococcal C
•Varicella
•Human papilloma virus (HPV)
9th graders
•TDaP: primary series + booster
•HPV
Note: Please see online annual report for full
description of valid vaccine doses by school grade.
6th graders
•Human papilloma virus (HPV) vaccine coverage among Richmond 6th grade females decreased from 72%, in the
2012/2013 school year, to 61% the following year.
•Immunization coverage levels for all other vaccine antigens increased or remained the same when compared to the
2012/2013 school year for all areas.
9th graders
•Coverage for HPV vaccine among Coastal Urban 9th grade females increased from 52% to 66% when compared to the
previous year.
•Immunization coverage levels for all vaccine antigens increased or remained the same when compared to the previous
school year for all areas.
Look for the 2013/2014 school-age children immunization coverage numbers to be posted on VCH’s website in late April.
Find them here: http://www.vch.ca/your-health/disease-surveillance/
Figure 5.
Measles vaccine coverage among kindergarteners by Community of Care
Vancouver Coastal Health, 2009/2010-2013/2014 academic year
2009/2010
2010/2011
100%
2011/2012
2012/2013
2013/2014
94.2%
89.3%
90%
88.4%
83.5%
83.2%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Vancouver
Richmond
Data source: VCH Primary Access Regional Information System
Prepared by: Public Health Surveillance Unit, VCH, March 2015
Coastal Urban
Coastal Rural
Vancouver Coastal Health
Measles coverage definition: Number of kindergarteners who had at least
two valid doses of measles containing vaccine.
2015 Health Watch
Nov 2014 - Mar 2015
7
Surveillance Updates
Investigations
Epidemic keratoconjunctivitis outbreak
In January, clinicians at a Vancouver eye clinic notified VCH of an increased number of patients presenting with severe
pink eye, or epidemic keratoconjunctivitis (EKC). EKC is a highly infectious, severe form of conjunctivitis. It is one of the
most common eye infections worldwide.
More than 70 patients have since presented to the Vancouver clinic with symptoms compatible with EKC. Approximately
30% of patients tested positive for adenovirus, the virus which causes EKC. More than half of the patients tested
negative for adenovirus. Among the adenovirus positive cases, 55% were female and the majority of cases were between
35-60 years old. Ten cases visited an eye care professional in the two weeks prior to symptom onset, suggesting possible
health-care-associated transmissions. Among the remaining cases, at least four were determined to have
community-acquired EKC. VCH will continue to work with the Vancouver clinic to identify additional cases.
Norovirus outbreak among Vancouver conference attendees
In late February, a conference coordinator reported cases of gastrointestinal illness among attendees of a Vancouver
conference. The event was located at a large Vancouver hotel and included over 700 BC participants. Sixteen attendees
reported experiencing vomiting and diarrhea over the course of the three day meeting. The illness was confirmed by
laboratory testing to be caused by norovirus.
VCH Environmental Health Inspectors conducted a site visit and worked with hotel and restaurant staff to review
outbreak protocols and cleaning/disinfection procedures. No hotel or restaurant staff reported illness.
2015 Health Watch
Nov 2014 - Mar 2015
Surveillance Updates
Respiratory Illness
The 2014/2015 influenza season peaked during this time period. All influenza surveillance systems noted an increase in
influenza-like illness above seasonal levels in mid-December. The seasonal peak occurred in the last week of December
and first week of January. Levels of respiratory illness, including influenza, decreased in the following months but
continued to be at or above seasonal levels (Figure 6).
Figure 6. Proportion of patient visits due to influenza-like illness (ILI) by epidemiological week.
Sentinel Physicians, British Columbia, 2014-2015 compared to historical average*
*Historical average based on 2002-03 to 2013-14 seasons, excluding 2008-09 and 2009-10 due to atypical seasonality. CI=confidence interval.
Source: BC Centre for Disease Control, BC Influenza Surveillance Bulletin – 2014-15: Number 6, Week 44
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2015 Health Watch
Nov 2014 - Mar 2015
9
Surveillance Updates
Respiratory Illness
The majority of specimens positive for influenza at the BC Public Health Microbiology & Reference Laboratory were
positive for influenza A (95%). Among those, 98% were determined to be influenza A(H3N2), <1% influenza A(H1N1)
pdm09 and <1% influenza A(H7N9). Five percent of influenza positive specimens were determined to be influenza B.
BC-wide there was a two-fold increase compared to last season in the number of laboratory-confirmed influenza
outbreaks in licensed care facilities during this year’s influenza season (Figure 7). There was a record number of
outbreaks reported between September and the end of February (n=164). The majority, 95%, were reported from long
term care facilities and caused by influenza A virus. Six outbreaks were due to influenza B virus. VCH reported 48
influenza-like illness facility outbreaks during this time period (September – end of February). The majority of these were
reported from long term care facilities (81%) and confirmed to be caused by influenza A (68%) (Figure 8).
Illness caused by influenza B increased in February and March in VCH. Three facility-based outbreaks caused by influenza
B were reported in those months. Influenza B activity historically increases toward the end of the influenza season.
Figure 7. Influenza and other virus detections and proportion of respiratory specimens submitted to
BC Provincial Laboratory diagnosed positive for a virus by epidemiological week. British Columbia, 2014-2015
ddd
Source: BC Centre for Disease Control, BC Influenza Surveillance Bulletin - 2014-2015: Number 19, Weeks 9-10.
Figure 8. Influenza-like illness (ILI) outbreaks reported in facilities* by epidemiological week.
Vancouver Coastal Health Authority, 2014/2015 compared to previous 3-week average and historical 3-week average†
12
Unknown
Other Virus
10
Number of reported outbreaks
Influenza B and Other Virus
Influenza A and Other Virus
8
Influenza A & B
Influenza B
6
Influenza A
Previous 3-week average
4
Historical 3-week average
2
0
36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53
SEP
OCT
NOV
2014
DEC
1
2
JAN
Epidemiological week
*Facilites include acute care, long-term care and rehabilitation settings. †Includes data since 2008.
Source: Vancouver Coastal Health, Public Health Surveillance Unit (Enteric and ILI Outbreak Reports Database).
Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.
3
4
5
6
7
8
FEB
9
10 11 12 13 14 15 16
MAR
2015
APR
2015 Health Watch
Nov 2014 - Mar 2015
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Surveillance Updates
Gastrointestinal Illness
Gastrointestinal disease activity was below expected levels in this reporting period, as monitored through various
surveillance systems both within VCH and provincially. A small increase in facility outbreaks above seasonal levels was
reported in late December and early January. Thirteen VCH-licensed child care facilities and ten health care facilities
reported gastrointestinal illness outbreaks between November and February. Seven health care outbreaks were
laboratory confirmed norovirus outbreaks (Figure 9).
Gastrointestinal illness outbreaks in both childcare and healthcare facilities continued to be reported through the month
of March.
Number of Positive Agents Identified
Figure 9. GI Outbreak Investigations at the BC Public Health Microbiology & Reference Laboratory,
PHSA
No samples received
Unknown etiology
Clostridium difficile
Adenovirus
Sapovirus
Clostridium perfringens
Clostridium botulinum
Salmonella
Norovirus
Average outbreaks (previous 5 years)
+1 STDEV
-1 STDEV
20
15
10
5
0
363738394041424344454647484950515253 1 2 3 4 5 6 7 8 9 10111213141516171819202122232425262728293031323334
SEP
OCT
NOV
2014
DEC
JAN
FEB
Week
MAR
APR
MAY
2015
Source: BC Public Health Microbiology & Reference Laboratory, PHSA Laboratories
JUN
JUL
AUG
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Nov 2014 - Mar 2015
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Surveillance Updates
Overdose surveillance
Both VCH emergency departments and Insite experienced periodic increases in heroin overdoses in this period. The
increases occurred the same week as income assistance cheque distribution (Figure 10).
Heroin overdoses at Insite
Figure 10. Number of ER and Vancouver Insite* visits related to heroin overdose† by epidemiological week.
Vancouver Coastal Health Authority, 2014/2015
Insite visits
Insite previous 3-week average
Insite historical average (2004-2013)
ER previous 3-week average
ER historical average (2008-2013)
Week with cheque issued
ER visits
40
70
30
60
20
50
10
40
0
30
-10
20
-20
10
-30
0
36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53
SEP
OCT
NOV
DEC
1
2
JAN
2014
3
4
5
6
7
8
FEB
9
10 11 12 13 14 15 16
MAR
Heroin overdoses at ER
80
-40
APR
2015
Epidemiological week
*Supervised injection site. †Heroin misuse related visits are monitored through ICD-9 codes 304.0, 304.7, 305.5, 965.01, E850.0, E935.0, and ICD-10 codes F119B and T401 and a keyword search where the term "heroin" is indicated in
presenting complaint, discharge diagnosis, nature of injury and mechanism of injury.
Data sources: 1. Emergency room visits: Vancouver Coastal Health, CareCast System (Richmond Hospital, UBC Hospital, Vancouver General Hospital), Eclipsys System (Mount Saint Joseph Hospital, St. Paul's Hospital) and McKesson System
(Lions Gate Hospital, Pemberton Health Centre, Squamish General Hospital, Whistler Health Care Centre).
2. Insite visits: Insite, Vancouver Coastal Health, HIV/AIDS & Harm Reduction Programs.
Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.
2015 Health Watch
Nov 2014 - Mar 2015
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Public Health Update
Know Your Source campaign
Deaths from overdoses involving fentanyl are increasing,
particularly in the Vancouver area.
Fentanyl-laced marijuana, heroin, oxycodone and other ‘party
drugs’ have resulted in the deaths of many recreational drug
users. Given the spike in overdose deaths, police and health
authorities believe there is an increased amount of fentanyl in
circulation, and are warning those who use these drugs, even on
a recreational basis, of the increased danger, especially as they
may be unaware of what they are taking.
Fentanyl is a synthetic narcotic that is 50-100 times more toxic
than other opioids. The dose must be carefully monitored to
avoid accidental overdose. This makes it particularly high risk
for people who have never used opioids or for people who may
mistakenly use fentanyl thinking it is something else.
In the Vancouver Coastal Health region the majority of people
dying from using fentanyl are not from the Downtown
Eastside. They are mostly recreational drug users who are
snorting or smoking drugs. They may not know there is
fentanyl in the drugs they are using.
Insite, which provides supervised drug injection services in the
Downtown Eastside, has managed overdoses related to fentanyl.
VCH staff there have been able to treat the overdoses, resulting
in zero deaths in the facility.
Image Source: www.knowyoursource.ca
To help prevent further deaths, VCH is partnering with the Vancouver Police Department, RCMP, BC Ambulance Service,
Provincial Health Services Authority, Fraser Health, BC Centre for Disease Control and BC Coroners Service to provide
education on the dangers of fentanyl.
Visit the Know Your Source site for more info on fentanyl, posters, and resources:
www.knowyoursource.ca
2015 Health Watch
Nov 2014 - Mar 2015
Environmental Health
Health Protection
Below are internet resources for more information about VCH Health Protection
(http://www.vch.ca/your_environment/) and our environmental health.
Food Service Establishment Inspection Results & Closures
http://www.vch.ca/your_environment/food_safety/
Water Quality
Beach Water Quality Reports
http://www.vch.ca/your_environment/water_quality/recreational-water/beach-water-quality-report/beach_water_quality_report
Pool Water Quality Reports
http://www.vch.ca/your_environment/water_quality/recreational-water/pool_water_quality_report/pool-water-quality-reports
Air Quality
BC
http://www.bcairquality.ca/readings/index.html
Metro Vancouver
http://www.metrovancouver.org/services/air/currentairquality/Pages/default.aspx
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