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English: Dr. Curtis Russell
1. Ontario’s Lyme Disease Surveillance Program
Curtis Russell, PhD
Senior Program Specialist
Enteric, Zoonotic and Vector-Borne Diseases Unit (EZVBD)
Communicable Diseases, Emergency Preparedness and
Response (CDEPR)
Public Health Ontario
2. PublicHealthOntario.ca
Faculty/presenter Disclosure
• Presenter: Curtis Russell
• Relationships with commercial interests:
- Grants/Research Support: none
- Speakers Bureau/Honoraria: none
- Consulting Fees: none
- Other: employee of Public Health Ontario
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6. PublicHealthOntario.ca
Lyme Disease Program
PHO is working closely with the Ministry of Health and Long-
term Care to provide updated evidence, resources and
guidance on Lyme disease surveillance, prevention and
control.
PHO’s program consists of the following elements:
• Human surveillance
• Vector surveillance
• Public and Physician education
• Research
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8. PublicHealthOntario.ca
Roles of Public Health Units
• To conduct tick surveillance in an effort to assess the risk of
Lyme disease to humans
• To conduct local risk assessments based on surveillance data
and local ecological factors
• To conduct human case investigations
• Create local programs based on the results of local risk
assessments
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9. PublicHealthOntario.ca
The Role of Public Health Ontario
• Expert scientific and medical consultative services; including
interpretation of Lyme disease testing results
• Provide scientific and technical expertise to Ontario’s PHUs
• Expert consultation
• Documentation that outlines guidelines/best practices
• Lyme disease surveillance (provincial level)
• Support PHUs to effectively conduct local risk assessments
• PHO laboratory provides:
• Tick identification
• Testing for human Lyme disease cases (Ontario only)
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10. PublicHealthOntario.ca
PHO Research
• Human pathogens associated with the blacklegged tick Ixodes
scapularis: a systematic review. Parasites and Vectors. In Press
• Population-Based Passive Tick Surveillance and Detection of
Expanding Foci of Blacklegged Ticks Ixodes scapularis and the
Lyme Disease Agent Borrelia burgdorferi in Ontario, Canada.
Plos One, 2014
• Healthcare costs attributable to Lyme disease: A population-
based matched cohort study in Ontario, Ongoing study
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11. PublicHealthOntario.ca
Passive Lyme Disease Surveillance in
Ontario
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Physicians and
public submit
ticks to local
PHU
PHU forwards
to PHO for
identification
Blacklegged
ticks forwarded
to National
Microbiology
Laboratory for
Borrelia
burgdorferi
testing
Confirmed and
probable
human cases
(bitten by
infected tick)
Health units
enter cases in
Integrated
Public Health
Information
System (iPHIS)
14. PublicHealthOntario.ca
The location and number of blacklegged ticks submitted to
Public Health Ontario, based on the submitter’s community
of residence: Ontario, 2014
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15. PublicHealthOntario.ca
Percentage Borrelia burgdorferi-positivity and total Ixodes
scapularis by submitter town of exposure in Ontario, Canada
(2008–2012)
Nelder MP, Russell C, Lindsay LR, Dhar B, Patel SN, et al. (2014) Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks Ixodes
scapularis and the Lyme Disease Agent Borrelia burgdorferi in Ontario, Canada. PLoS ONE 9(8): e105358. doi:10.1371/journal.pone.0105358
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358
16. PublicHealthOntario.ca
Distribution of ticks submitted for identification in Ontario,
Canada (2008–2012) as rates of submission per 100,000
population (based on submitter CSD of residence).
Nelder MP, Russell C, Lindsay LR, Dhar B, Patel SN, et al. (2014) Population-Based Passive Tick Surveillance and Detection of Expanding Foci of Blacklegged Ticks Ixodes scapularis and the Lyme
Disease Agent Borrelia burgdorferi in Ontario, Canada. PLoS ONE 9(8): e105358. doi:10.1371/journal.pone.0105358
http://journals.plos.org/plosone/article?id=info:doi/10.1371/journal.pone.0105358
I. Scapularis
Blacklegged tick
D. variabilis
American dog tick
I. cookei
Woodchuck tick
A. americanum
Lone star tick
18. PublicHealthOntario.ca
Ontario Lyme Disease Case
Definition
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http://www.health.gov.on.ca/en/pro/programs/publichealth/oph_standards/docs/lyme_disease_cd.pdf
• New provincial case definition released in 2015
• Risk areas added to the terminology
• Erythema migrans can be clinically confirmed without laboratory
evidence
22. PublicHealthOntario.ca
Key Vector-Borne Disease Partners
• Ministry of Health and Long-Term Care
• Ministry of Agriculture, Food and Rural Affairs
• Ministry of Natural Resources and Forestry
• Ministry of the Environment and Climate Change
• Canadian Wildlife Health Cooperative/Ontario Veterinary
College
• Public Health Units
• Public Health Agency of Canada
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