Spatio-Temporal Clustering of Multi-Location Time Series to Model Seasonal Influenza Spread.

Although seasonal influenza disease spread is a spatio-temporal phenomenon, public surveillance systems aggregate data only spatially, and are rarely predictive. We develop a hierarchical clustering-based machine learning tool to anticipate flu spread patterns based on historical spatio-temporal flu activity, where we use historical influenza-related emergency department records as a proxy for flu prevalence. This analysis replaces conventional geographical hospital clustering with clusters based on both spatial and temporal distance between hospital flu peaks to generate a network illustrating whether flu spreads between pairs of clusters (direction) and how long that spread takes (magnitude).

Development and assessment of a hospital admissions-based syndromic surveillance system for COVID-19 in Ontario, Canada: ACES Pandemic Tracker.

Background: The COVID-19 pandemic has continued to pose a major global public health risk. The importance of public health surveillance systems to monitor the spread and impact of COVID-19 has been well demonstrated. The purpose of this study was to describe the development and effectiveness of a real-time public health syndromic surveillance system (ACES Pandemic Tracker) as an early warning system and to provide situational awareness in response to the COVID-19 pandemic in Ontario, Canada.

Prescription opioid characteristics at initiation for non-cancer pain and risk of treated opioid use disorder: A population-based study.

Background: Long-term prescription opioid use has been associated with adverse health outcomes, including opioid use disorder (OUD). We examined a population of opioid naïve individuals who initiated prescription opioids for non-cancer pain and investigated the associations between opioid prescription characteristics at initiation and time to treated OUD.

Methods: We conducted a retrospective population-based cohort study in Ontario, Canada among opioid naïve individuals aged 15 years and older dispensed an opioid for non-cancer pain between 2013 and 2016.

Committee Opinion No. 399: Management of Tick Bites and Lyme Disease During Pregnancy.

Objective: Lyme disease is an emerging infection in Canada caused by the bacterium belonging to the Borrelia burgdorferi sensu lato species complex, which is transmitted via the bite of an infected blacklegged tick. Populations of blacklegged ticks continue to expand and are now established in different regions in Canada. It usually takes more than 24 hours of tick attachment to transfer B.

A longitudinal analysis of temporal and spatial incidence of neonatal abstinence syndrome in Ontario: 2003-2016.

Objective: This study describes the incidence of neonatal abstinence syndrome (NAS) in Ontario, Canada by year and health region from 2003 to 2016.

Design: The incidence of NAS diagnoses per 1,000 live births was calculated for the 36 local public health agency regions in Ontario from 2003 to 2016 using retrospective hospital admissions data. Infants with a diagnosis of NAS were identified using ICD-10 code P961.

Recommendations for action: a community meeting in preparation for a mass-casualty opioid overdose event in Southeastern Ontario.

Given the steady rise of overdose morbidity and mortality in North America, and increasing frequency of sudden clusters of non-fatal and fatal overdoses in other jurisdictions, regional preparedness plans to respond effectively to clusters of overdoses may reduce the impact of such events on the population. On the 27th of February 2017 in Kingston, Ontario, KFL&A Public Health, in collaboration with public health partners, hosted a full-day workshop involving table-top exercises and discussions for service partners on how to prepare for, respond to, and manage a mass-casualty event secondary to opioid overdose in Southeastern Ontario. The workshop assisted in identifying the various challenges faced by service partners, provided an understanding of the roles and responsibilities of partner agencies, and helped to determine next steps in preparation to address a mass opioid overdose situation at the local level.

Risk Assessment During the Pan American and Parapan American Games, Toronto, 2015.

During the summer of 2015, the Pan American and Parapan American Games took place in the Greater Toronto area of Ontario, Canada, bringing together thousands of athletes and spectators from around the world. The Acute Care Enhanced Surveillance (ACES) system-a syndromic surveillance system that captures comprehensive hospital visit triage information from acute care hospitals across Ontario-monitored distinct syndromes throughout the games. We describe the creation and use of a risk assessment tool to evaluate alerts produced by ACES during this period.

Delayed parenthood on the rise: A call for upstream preconception health promotion in Canada.

The trend toward delayed parenthood is on the rise across Canada. Societal emphasis on attaining higher education, career advancement and financial security may be some reasons why individuals delay becoming a parent; whatever the reason, this trend is linked to significant health and economic impacts. Many Canadians are unaware of the impact this may have on their fertility and potential birth outcomes.

Death of a 29-Year-Old Male from Undifferentiated Sepsis.

Tumour necrosis factor alpha inhibitors, such as infliximab, and other biologic agents are associated with increased risk of opportunistic infection, including tuberculosis. Tuberculosis infections associated with infliximab tend to present atypically and can be difficult to diagnose, as they are more likely to manifest as extrapulmonary or disseminated disease. The authors report a case involving a 29-year-old male patient who died following 16 days of treatment for undifferentiated sepsis and who was found on autopsy to have widespread disseminated tuberculosis.

Association between socio-economic status and hemoglobin A1c levels in a Canadian primary care adult population without diabetes.

Background: Hgb A1c levels may be higher in persons without diabetes of lower socio-economic status (SES) but evidence about this association is limited; there is therefore uncertainty about the inclusion of SES in clinical decision support tools informing the provision and frequency of Hgb A1c tests to screen for diabetes. We studied the association between neighborhood-level SES and Hgb A1c in a primary care population without diabetes.

Methods: This is a retrospective study using data routinely collected in the electronic medical records (EMRs) of forty six community-based family physicians in Toronto, Ontario.

Influenza assessment centres: a case study of pandemic preparedness to alleviate excess emergency department volume.

Objectives: Influenza assessment centres (IACs) were deployed to reduce emergency department (ED) volumes during the pH1N1 influenza outbreak in the Kingston, Frontenac, Lennox and Addington (KFL&A) public health region of Ontario, Canada, in the fall of 2009. We present a case study for the deployment of IACs to reduce ED visit volume during both periods of pandemic and seasonal communicable disease outbreak.

Methods: An emergency department syndromic surveillance system was used to trigger the deployment of eight geographically distributed IACs and to time their staggered closure 3 weeks later.

Management of tick bites and lyme disease during pregnancy.

Lyme disease results from the bite of a black-legged tick, populations of which have now become established in parts of Nova Scotia, southeastern Quebec, southern Ontario from the Thousand Islands through the geographic regions on the north shore of Lake Ontario and Lake Erie, southeastern Manitoba, and British Columbia's Lower Mainland, Fraser Valley, and Vancouver Island. It takes more than 24 hours of attachment to transfer the spirochete Borrelia burgdorferi to the bitten animal or human. The diagnosis of Lyme disease is primarily clinical, with early Lyme disease characterized by a skin lesion (erythema migrans, a bull's-eye rash), which expands out from the site of the tick bite, and is often accompanied by influenza-like symptoms, arthralgia, myalgia, and fever.

Integration of primary health care and public health during a public health emergency.

We have provided a detailed evaluation of how collaboration between an Ontario public health unit and its primary care providers facilitated an optimal response to the 2009 H1N1 influenza pandemic. Family health teams (integrated, interdisciplinary teams that provide a range of care options) provided flu assessment centers, with public health as a partner providing infection control advice, funding, coordination, antiviral medication, clinical care guidelines, supplemental nurse staffing, and arrangement of communication strategies with the public. The family health team structure offers a new capacity for timely, coordinated, and comprehensive response to public health emergencies, in partnership with public health, and provides a promising new direction for healthcare organization.

Who uses telehealth? Setting a usage baseline for the early identification of pandemic influenza activity.

Objective: To describe Ontario Telehealth usage for respiratory complaints during normal (i.e., interpandemic) circumstances.

Modeling and syndromic surveillance for estimating weather-induced heat-related illness.

This paper compares syndromic surveillance and predictive weather-based models for estimating emergency department (ED) visits for Heat-Related Illness (HRI). A retrospective time-series analysis of weather station observations and ICD-coded HRI ED visits to ten hospitals in south eastern Ontario, Canada, was performed from April 2003 to December 2008 using hospital data from the National Ambulatory Care Reporting System (NACRS) database, ED patient chief complaint data collected by a syndromic surveillance system, and weather data from Environment Canada. Poisson regression and Fast Orthogonal Search (FOS), a nonlinear time series modeling technique, were used to construct models for the expected number of HRI ED visits using weather predictor variables (temperature, humidity, and wind speed).

A comparison of methods for forecasting emergency department visits for respiratory illness using telehealth Ontario calls.

Objectives: Anticipating increases in hospital emergency department (ED) visits for respiratory illness could help time interventions such as opening flu clinics to reduce surges in ED visits. Five different methods for estimating ED visits for respiratory illness from Telehealth Ontario calls are compared, including two non-linear modeling methods. Daily visit estimates up to 14 days in advance were made at the health unit level for all 36 Ontario health units.

Automated mortality surveillance in south-eastern Ontario for pandemic influenza preparedness.

Background: The recent Canadian experience with pandemic H1N1 (pH1N1) influenza in 2009 highlighted the need for enhanced surveillance at local and regional levels to support evidence-based decision making by physicians and public health. We describe the rationale, methodology, and provide preliminary findings from the implementation of an automated Mortality Surveillance System (MSS) in the Kingston, Frontenac and Lennox & Addington (KFL&A) health unit.

Methods: The MSS utilized an automated web-based framework with secure data transfer.

Telehealth Ontario detection of gastrointestinal illness outbreaks.

Objective: Prompt detection of infectious disease outbreaks and rapid introduction of mitigation strategies is a primary concern for public health, emergency and security management organizations. Traditional surveillance methods rely on astute clinical detection and reporting of disease or laboratory confirmation. Although effective, these methods are slow, dependent on physician compliance and delay timely, effective intervention.

Real-time surveillance for respiratory disease outbreaks, Ontario, Canada.

To validate the utility of a chief complaint-based emergency department surveillance system, we compared it with respiratory diagnostic data and calls to Telehealth Ontario about respiratory disease. This local syndromic surveillance system accurately monitored status of respiratory diseases in the community and contributed to early detection of respiratory disease outbreaks.

Visualization techniques and graphical user interfaces in syndromic surveillance systems. Summary from the Disease Surveillance Workshop, Sept. 11-12, 2007; Bangkok, Thailand.

Timeliness is a critical asset to the detection of public health threats when using syndromic surveillance systems. In order for epidemiologists to effectively distinguish which events are indicative of a true outbreak, the ability to utilize specific data streams from generalized data summaries is necessary. Taking advantage of graphical user interfaces and visualization capacities of current surveillance systems makes it easier for users to investigate detected anomalies by generating custom graphs, maps, plots, and temporal-spatial analysis of specific syndromes or data sources.