Overview of National Enteric Disease Surveillance

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• Overview of National Enteric Disease Surveillance

Foodborne, Waterborne Zoonotic Infections
Division, Public Health Agency of Canada
November 9, 2005
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Enteric Disease Surveillance

• The FWZID enteric disease surveillance program
  systematically compiles selected data from public
  health and laboratory sources, analyzes and
  interprets data, and communicates the resultant
  enteric disease intelligence to Canadian and
  international public health and food and water
  safety officials

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Surveillance Aims.

• Determine magnitude of public health problem
• Monitor trends and emerging issues
• Identify outbreaks and take action
• Identify high risk populations, foods,
  behaviours
• Evaluate health impact of food safety programs
• Provide and disseminate information for policy
  and other prevention strategies, targeted
  research, risk assessment and priority setting

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Surveillance Programs.

• Enhanced / Sentinel
• Surveillance
• Integrated
• NSAGI
• C-EnterNet
• CIPARS

NESP Lab-based Weekly, Quarterly, Annual reports
and ad hoc requests

• Outbreak Surveillance
• Alerts
• Summaries

• Syndromic Surveillance
• ASAP
• ER Data
• Telehealth

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Supporting Activities Standards Training Ev
aluation Communication Administration
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NATIONAL NOTIFIABLE DISEASE DATABASE
NATIONAL ENTERIC SURVEILLANCE PROGRAM
NATIONAL LABORATORY
PROVINCIAL MEDICAL OFFICER OF HEALTH
PROVINCIAL LABORATORY

HEALTH UNIT
NESP
NND
NSAGI
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National Enteric Surveillance Program (NESP)
Integrates national data on enteric pathogens for
outbreak detection and response
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Outbreak Detection
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NESP News Week 2004/19 ( May 8 - 14, 2004
) Topics of The Week Outbreaks and Case
Clusters Heads Up Unusual and Rare Supplementary
Information Changes Contacts
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Outbreak Surveillance

• Public Health Alerts
• Retrospective National Enteric Disease Outbreak
  Summary Database (1996-2003)
• National Outbreak Summary Report Project
• Need for a timely, comprehensive, accessible,
  ongoing and sustainable outbreak summary
  reporting system

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Canadian Network for Public Health Intelligence
(CNPHI)Canadian Integrated Outbreak
Surveillance Centre (CIOSC)
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Enteric Public Health Alerts

• Purpose
• To support early notification of real or
  suspected outbreaks currently under
  investigation.
• To enable early recognition of geographically
  dispersed outbreaks that are related by a common
  source, otherwise seen as isolated events.

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Enteric Outbreak Summary Reporting Tool

• Goal
• To provide the ability to summarize results of
  outbreak investigation data in order to identify
  trends and patterns, and disseminate information

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Syndromic Surveillance

• Community surveillance of gastroenteritis using
  over-the-counter sales of anti-diarrheal and
  anti-nausea meds

• To reduce impact of a severe and sudden
  introduction of an infectious agent in the
  community by facilitating rapid outbreak
  detection
• Applications to other disease syndromes,
  including respiratory, dermatological, etc

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ASAP Key Components

• Automated data download/exchange system
• Establish a relevant baseline of unit sales for
  each pharmacy
• Create an automatic analytic system to detect
  trends that deviate from this baseline

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Available electronically at http//www.phac-aspc.
gc.ca/publicat/ccdr-rmtc/03vol29/29s1/index.html
En français http//www.phac-aspc.gc.ca/publicat/
ccdr-rmtc/03vol29/29s1/index_f.html
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National Studies on Acute Gastrointestinal Illness
NSAGI

NND
INFORMATION TRANSFER
STOOL POSITIVE
CASE PRESENTS TO GP AND SUBMITS STOOL
CASE IN COMMUNITY
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C-EnterNet
OBJECTIVES 1. Detect changes in trends of human
enteric disease incidence and pathogen exposure
levels from food, animal and water sources 2.
Source Attribution
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C-EnterNet

• 3. Early warning information about problems in
  the agri-food chain
• 4. Enhancing analysis, interpretation and
  reporting of laboratory and epidemiologic data
  for public health and agri-food sectors at all
  levels

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Framework
Federal
C
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EnterNet central
C
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EnterNet Central
Provincial PH
Surveillance
Surveillance
activities

activities

Episodic
_________________
Continuous
Local Public Health
Sentinel Communities across Canada
Surveillance components
Surveillance components
Food
Agri Water culture


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Canadian Integrated Program for Antimicrobial
Resistance SurveillanceCIPARS
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Multi-Provincial/Territorial Enhanced
Surveillance for Salmonella Newport StudyApril
1, 2003 December 31, 2004
Foodborne, Waterborne and Zoonotic Infections
Division, Public Health Agency of Canada In
cooperation with provincial/territorial public
health ministries and laboratories
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Enhanced Surveillance for S. Newport

• Background United States and Canada
• S. Newport third most common serotype in United
  States
• In U.S., 1 in 1998 to 26 in 2001 were resistant
  to 9 or more antimicrobials (NARMS Annual
  Report,2001)
• In 2003, 13 of S.Newport isolates in Canada were
  resistant to 4 or more antimicrobials (CIPARS,
  2004)
• Two major concerns are
• Severity of symptoms (ie. bloody diarrhea) in MDR
  S. Newport infections OR4.7, 95 CI (1.4, 17.9)
  (Gupta et al, 2003)
• Resistance to extended-spectrum cephalosporins
  (e.g. ceftriaxone), commonly used to treat
  serious infections among children and pregnant
  women (Gupta et al, 2003)

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Enhanced Surveillance for S. Newport
Antimicrobial Resistance Among S. Newport
Isolates in Canada, 1998 to 2003
Number of antimicrobials in resistance pattern
S. Newport isolates tested for AMR
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60
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9
39
98
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Enhanced Surveillance for S. Newport

• Research Questions
• Epidemiology of MDR S. Newport (person, place,
  time)
• Risk factors for MDR S. Newport infections in
  Canada
• Contact with dairy cattle (occupational,
  residential or casual exposure)
• Ingested products derived from dairy cattle (eg.
  ground beef, veal, unpasteurized dairy products)
• International travel
• Antimicrobial drug use the week prior to illness
• Burden of illness

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Enhanced Surveillance for S. Newport

• Epidemiological Data from Case Interviews
• Person, place, time
• Risk factors
• Exposure to dairy cattle
• Consumption of bovine products
• Antimicrobial drug use prior to illness
• International travel
• Burden of illness

• Microbiological Data from CIPARS
• Demographic data to link
• Microbiology of isolate
• Phage type
• PFGE pattern
• AMR profile
• Specimen type

• Descriptive comparisons between susceptible
  antimicrobial resistant S. Newport cases
• Comparisons with relevant animal and retail data
  from LFZ CIPARS

• Guide further research
• Direct prevention and control activities

• Increase understanding of burden of illness of
  and risk factors contributing to MDR S. Newport
  infections in Canada

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Questions?

• For further information, please contact
• Kathryn Doré, Surveillance Section Mgr
• (kathryn_dore_at_phac-aspc.gc.ca)
• Nadia Ciampa, Epidemiologist, Surveillance
  Section
• (nadia_ciampa_at_phac-aspc.gc.ca)