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THE ZIKA SCAN
The 2016 Environmental Scan of Policies and Provisions for Public Health Surveillance of Zika and Emerging Infectious Diseases across Canada
ABOUT THE ZIKA SCAN
In August, 2016 NCCID was requested by Canadian public health officials to conduct an environmental scan of jurisdiction-specific legislation, regulations and authorities for public health surveillance of Zika and emerging infectious diseases.
This web page presents the results of this scan. The contents represent the information shared with NCCID, from August to December, 2016.
SUMMARY AND ANALYSIS
Lesley Dyck, an experienced public health consultant, has prepared an insightful, high-level summary and analysis of the data collected from Canadian jurisdictions on policies and provisions related to public health surveillance of the Zika virus.
Information sharing, data quality, international and national legal and regulatory frameworks including data privacy legislation, as well as ongoing refinements of systems and support structures are among the many topics she explores.
OUR OBJECTIVES
1. FACILITATE COMPARISON
To facilitate comparison of public health policies and authorities related to surveillance of Zika and emerging infectious diseases across jurisdictions.
2. ALIGNMENT & VARIATION
To display areas of alignment and variation in policy and provisions across jurisdictions.
3. INFORMED DECISION-MAKING
To help inform public health decision-making for surveillance and privacy during international outbreaks and epidemics.
OUR APPROACH
1. DATA COLLECTION
Information was collected iteratively and formatively with expert contacts designated by the Chief Medical Officers of Health in jurisdictions across Canada (11 provinces and territories, 1 federal).
2. REVIEWS & CONSULTATIONS
Consultations were conducted in parallel with reviews of jurisdiction-specific legislation and policies related to public health surveillance.
3. ITERATIVE VERIFICATION
Verification was collaborative and iterative prior to the publication and dissemination of this product.
CONTACT US
For more information please contact Shivoan Balakumar, Project Manager, NCCID : Email Shivoan about the Zika Scan
RESULTS OF THE ZIKA SCAN
1. Use the QUICKMENU below to explore the Zika scan results or,
2. Download the Zika scan results in Excel format.
Alberta
Zika is not on the legislated list of notifiable communicable diseases, but is currently managed as a reportable disease in Alberta.
Zika was added to the Notifiable Disease management Guidelines under the Rare or Emerging Communicable Disease guideline.
www.health.alberta.ca/documents/Guidelines-Rare-Emerging-Communicable-Disease-2014.pdf
The Guidelines are supplemental to the Public Health Act and the CD Regulation and Schedule 4 ‘Epidemics and diseases in rare or unusual form (any communicable disease)’ in particular. Unlike Schedules 1 and 3, Schedule 4 has provisions for additional public health measures beyond surveillance.
Link to CD Regulation: http://www.qp.alberta.ca/documents/Regs/1985_238.pdf
Link to Public Health Act: http://www.qp.alberta.ca/documents/Acts/P37.pdf
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?Ad-hoc outbreak response committee struck - developed surveillance policies and clinical guidance.
Alberta participated on a national working group for WNV and other mosquito-borne diseases - the current case definition is based on the recommendations of this group. A new case definition is currently being developed that takes a slightly different direction. No futher information can be given at this time until case definition is approved by Office of the Chief Medical Officer of Health.
Case definition: http://www.health.alberta.ca/documents/Guidelines-Zika-Virus-2016.pdf
The reporting elements for Zika are the same as the elements for all other notifiable diseases. Alberta uses a generic reporting form.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Question 2
The Chief Medical Officer of Health (CMOH) can write a directive to put new or emerging infectious diseases under surveillance. This directive may ask a Medical Officer of Health, physician or laboratory director to provide the CMOH any information about the disease. The powers for this come from Section 15(1) of the Public Health Act.
This method relies on Section 27(2) of the Health Information Act (HIA) for the use of the information, and Section 47(1) of the HIA to disclose identifying information to other custodians for the purposes of public health surveillance.
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Alberta's CD Regulations will be revised in regards to reporting of emerging infectious diseases. Schedules 1 and 3 may be refined to include Zika virus, and an item for emerging diseases not included in the Schedules.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
Based on the PHEIC declaration, IHR requirements, and data sharing provisions of the MLISA agreement, Provinces and Territories have agreed to report all cases of laboratory confirmed Zika virus to the Public Health Agency of Canada. This may be revised as the outbreak evolves.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
First case of Zika in Alberta detected in 2014 (isolated incident prior to current outbreak) - protocols for Zika reporting were developed following this case.
See Question 5
Serotype (Zika Virus)
Diagnosis Status Description (Confirmed or Probable)
CDOM number (internal ID used to identify case in system)
Age at diagnosis
Zone reporting (Alberta has 5 zones: North, Edmonton, Central, Calgary, South)
Diagnosis date
Gender (Male, Female, Unknown)
Pregnant (Yes or No)
Travel Country Description (Country name)
Travel Location Description (City name)
Travel Arrived Date
Travel Left Date
Onset Date
Report Comments (list of all symptoms)
Specimen Collected Date
Specimen Comments (Lab accession number, and Zika test results (RT PCR, IgM, IgG, PRNT))
British Columbia
Zika is not on the legislated list of reportable communicable diseases, but is considered reportable under legislated provisions.
Zika is reportable, pursuant to the Public Health Act Communicable Disease Regulation Section 2 (b) and definitions as follows:
Interpretation
1. In this regulation:
"communicable disease" means an illness, due to a specific infectious agent or its toxic products, which arises through the transmission of that agent or its product
(a) directly from an infected person or animal, or
(b) indirectly through the agency of an intermediate host vector or the inanimate environment;
"epidemic" means an occurrence of a disease within a community or region in excess of normal expectancy;
"infectious agent" means an organism capable of producing an infection or infectious disease;
"reportable communicable disease" means a disease
(a) listed in Schedule A or B, or
(b) which becomes epidemic or shows unusual features;
Reportable disease
2. (2) Where a physician knows or suspects that an animal or another person is suffering from or has died from a communicable disease, he shall, without delay and in accordance with section 4, make a report to the medical health officer if the disease
(a) is listed in Schedule A, or
(b) becomes epidemic or shows unusual features.
Link to CD Regulation: http://www.bclaws.ca/civix/document/id/loo84/loo84/12_4_83
Link to Public Health Act: http://www.bclaws.ca/civix/document/id/complete/statreg/08028_01
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
Ad-hoc outbreak response committee struck - developed surveillance policies and clinical guidance.
Have aligned BC case definition and report form with PHAC Zika surveillance request and guidance.
Link to case report form: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Forms/Epid/Vector-bourne/Zika%20CaseReportForm_with%20Panorama%20instructions.pdf
Link to case definition: http://www.bccdc.ca/resource-gallery/Documents/Guidelines%20and%20Forms/Forms/Epid/Vector-bourne/Zika_Case_definiton.pdf
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Question 2
Other provisions in the Public Health Act allow for an Order in Council to add/change regulations in a Cabinet meeting - Minister and Premier sign off (this was performed following the SARS epidemic).
PHA Section 113 - Regulations respecting reporting of disease, health hazards and other matters
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Current plans for changes to public health regulations specific to disease reporting. Future reportable disease list will include vector-borne diseases with WNV, SLE, Zika etc as examples.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
BC authorities are aware of their responsibility under the IHR to report on these issues.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
The process to make emerging infectious diseases notifiable in BC can be rapid - depends solely on CMOH decision (no other review/approval process required).
See case report link from Q10. Only non identifiable data to be shared as per agreement.
Primary Contact
Bonnie Henry
Deputy Provincial Health Officer
Office of the PHO
Ministry of Health
4th floor, 1515 Blanshard St
Mailing address: PO Box 9648, STN PROV GOVT
Victoria, BC
V8W 9P4
Bonnie.henry@gov.bc.ca
Phone: 250 952-1330
Manitoba
Zika is not on the legislated list of reportable diseases, but public health surveillance of Zika has been established under legislated provisions.
Note:
- For every confirmed case, the regional public health unit is notified and conducts an investigation. An investigation form is returned to the Surveillance Unit and information is validated/verified with data from the Provincial Lab.
- The Provincial Lab collects elementary data on cases and suspect cases, and a senior staff member provides regular updates to provincial authorities on Zika testing/cases.
- Zika is not being entered into any MB Surveillance Unit databases
Section 7 and 8 of the Reporting of Diseases and Conditions Regulation (under "Reporting of Other Diseases and Conditions") contains provisions for reporting on Zika and other emerging infections.
Section 7: "If a health professional becomes aware that a person has a disease or condition that is potentially serious but is not otherwise reportable under this regulation, the health professional must make a report respecting it if the disease or condition a) is occuring in a cluster or outbreak; or b) has presented itself with unusual clinical manifestations."
Section 8: "If a person in charge of a laboratory becomes aware of an unusual pattern of test results or test requests, relating to a potentially serious disease or condition that is not otherwise reportable under this regulation, the person must make a report respecting the disease or condition."
When compared to provisions for diseases in the reportable disease list, there are no additional restrictions in Section 7 to information collection and disclosure (information is collected on a ministerial approved form).
Link to CD Regulation:
http://web2.gov.mb.ca/laws/regs/current/_pdf-regs.php?reg=37/2009
Link to Public Health Act:
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)?
If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
Senior officials developed first case definiton and case report form in absence of a national definition/form (informed by PAHO's definition and case report forms in other countries). Case definition and data elements in case report form evolved as knowledge improved and epidemiology of Zika changed.
Current case definition aligned with national definition/guidance (Zika cases are reported with positive lab confirmation).
Created specific reporting form to share select information on Zika cases with PHAC.
Case Definition
Suspected case:
An individual who has met Manitoba’s criteria for conducting Zika testing
Confirmed case*:
Laboratory confirmation of Zika virus infection by one or more of the following laboratory criteria, with or without clinical evidence:
• Isolation of virus from, or detection of specific viral antigen or nucleic acid from an appropriate clinical specimen (e.g. blood, plasma, serum, CSF, urine)
OR
• Viral IgM antibodies against Zika virus in an appropriate clinical specimen and the identification of confirmatory virus-specific neutralizing antibodies in the same or a later specimen
OR
• A demonstrated seroconversion or diagnostic rise (4-fold or greater change) in virus-specific neutralizing antibody titers in paired sera
*Source: Proposal for reporting Zika virus and related disorders in Canada – February 22, 2016
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Question 2
Additional provisions are listed in the Public Health Act, Part 8 - Information Gathering and Sharing and Health Surveillance.
Link to Public Health Act:
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
No changes planned - current provisions are sufficient.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
Although not directly related, Canada is a signatory to the International Health Regulations, which helped to strengthen the decision in MB to collect data. Canada is bound by IHR to report local transmission of Zika.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
Internal group evaluating the situation
- will recommend Zika to be added to reportable disease list if deemed appropriate.
Thus far, there have been minimal opportunities for bi-directional discussion about Zika surveillance between federal public health authorities and provinces/territories.
MB_Zika Virus Case Report Form (PDF format)
The national minimum data elements (as determined by FPT consensus) are reported to PHAC.
Primary Contact
Nancy MacAngus BSc MSc MBA
Protocol Development Coordinator
Communicable Disease Control
Manitoba Health, Seniors and Active Living
4062-300 Carlton St.
Winnipeg, MB R3B 3M9
Phone: (204) 788-6372
Fax: (204) 948-2040
Email: Nancy.MacAngus@gov.mb.ca
New Brunswick
Zika is not on the legislated list of notifiable diseases, communicable diseases, and reportable events, but reporting has been established under legislated provisions
Reporting of Zika has been established under provisions in the Reporting and Diseases Regulation - Public Health Act:
Schedule A
Reportable Events
Unusual illness, defined as follows: patient presenting with symptoms that do not fit any recognizable clinical picture; known aetiology but not expected to occur in New Brunswick; known aetiology that does not behave as expected or clusters presenting with unknown aetiology.
Link to CD Regulation:
http://laws.gnb.ca/en/showdoc/cr/2009-136
Link to Public Health Act:
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
NB protocols developed by working group (formally involved with West Nile Virus surveillance protocol development).
PHAC guidance and West Nile surveillance tool used to inform Zika case definition and report form.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Q2
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
The provisions specific to reporting of unusual health events in the Reporting and Diseases Regulation - Public Health Act are being reviewed.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
For the purposes of collection of data there isnt any difference, however for the purposes of disclosure it would as NB authorities respect the agreement made with PHAC (MLISA) to share information/data on any disease considered a Public Health Emergency of International Concern under the International Health Regulations. This applies to Zika.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
No other comments
Minimum datasetes required by the National Surveillance and Reporting guidelines are captured by the Reportable Disease Surveillance System (RDSS).
Minimum datasets as per the National Surveillance and Reporting guidelines.
Shelley Landsburg BNRN MPH
Director/Directrice
Communicable Disease Control Branch /Direction du contrôle des maladies transmissibles Office of the Chief Medical Officer of Health/Bureau de médecin-hygiéniste en chef
Tel: (506) 444-2706
Fax: (506) 453-8702
E-mail/courriel: Shelley.landsburg@gnb.ca www.gnb.ca
Newfoundland and Labrador
Zika is not on the legislated list of notifiable communicable diseases, but is considered notifiable under legislated provisions.
Zika is reported under provisions in the Communicable Diseases Act:
Sections 2, and the Schedule (notifiable disease list)
Specifically:
"'Communicable disease' means and includes...
Viral hemorrhagic fevers"
Link to Communicable Disease Act:
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)?
If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?Team of senior officials developed surveillance protocols.
Zika reporting form and case definition based on guidance from PHAC.
Under usual laboratory practice, unexpected or unusual results are provided to the Medical Officer of Health by the Public Health Laboratory.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
Emerging infectious diseases can become notifiable under provisions in the Communicable Diseases Act:
Sections 2, and the Schedule (notifiable disease list)
Specifically:
"'Communicable disease' means and includes...
other diseases that may be declared by the minister by order to be a communicable disease"
Link to Communicable Disease Act:
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Current plans to revise public health and personal health information legislation in Newfoundland (including sections related to disease reporting).
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
NL authorities respect the agreement made with PHAC (MLISA) to share information/data on any disease considered a Public Health Emergency of International Concern under the International Health Regulations. This applies to Zika.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
No other comments
Prov ID
Name
Healthcare number(MCP)
Age
Sex
Pregnant (Y/N)
Travel-associated (Y/N)
Country of travel
Date of Departure
Date of Return
Travel dates other
Travel details
Symptomatic (Y/N)
Clinical symptoms
Date of onset of symptoms
Complications
Death (Y/N)
RT-PCR result
IgM Serology+ result
PRNT confirmed (Y/N)
PRNT result
Information shared with PHAC is non-nominal. Data is aggregated at the provincial level.
Prov ID
Province
Age
Sex
Pregnant (Y/N)
Travel-associated (Y/N)
Country of travel
Date of Departure
Date of Return
Travel dates other
Travel details
Symptomatic (Y/N)
Clinical symptoms
Date of onset of symptoms
Complications
Death (Y/N)
RT-PCR result
IgM Serology+ result
PRNT confirmed (Y/N)
PRNT result
Primary Contact
David Allison, MD, FRCPC
Chief Medical Officer of Health
Population Health Branch
PO Box 8700
St. John’s, NL
A1B 4J6
DavidAllison@gov.nl.ca
Telephone 709-729-3433
Brenda Earles RN BN CIC
Provincial Infection Control Nurse Specialist
Health and Community Services , Population Health Branch
1st Floor Confederation Building, West Block
St. John’s NL Canada A1B 4J6
P O Box 8700
brendaearles@gov.nl.ca
709-729-3427 (T)
Northwest Territory
Zika is not on the list of reportable diseases, but Zika case reporting can be conducted under legislated provisions.
Zika reporting can occur under provisions in the Disease Surveillance Regulations of the Public Health Act:
Schedule 3 (Reportable Diseases)
- Epidemic forms of any disease
- Unusual clinical manifestations of a disease
- Hemorrhagic fevers
Link to CD Regulation:
https://www.justice.gov.nt.ca/en/files/legislation/public-health/public-health.r9.pdf
Link to Public Health Act:
https://www.justice.gov.nt.ca/en/files/legislation/public-health/public-health.a.pdf
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)?
If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
No Response
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Question 2
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Current plans for changes to public health legislation and regulations, including changes to the reportable disease list.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
No Response
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
No comments
No response
Reportable disease data (including Zika cases) shared with PHAC bi-weekly
Colin J. Eddie
Manager, Communicable Disease Control Unit
Population Health Division, Department of Health & Social Services
P.O. Box 1320, 5015 49th St. 5th Floor.
Yellowknife, NT X1A 2L9
(867) 767-9066 Ext-49275 / Mobile: (867) 444-0059 / Secure Fax: (867) 873-0442
Nova Scotia
Zika is not on the legislated list of Notifiable Diseases and Conditions, but is considered reportable under legislated provisions.
Zika reporting has been established under Section 31 (4) of the Health Protection Act:
"A physician, registered nurse licensed pursuant to the Registered Nurses Act or an administrator of an institution who believes that an illness is serious and is occuring at a higher rate than normal, shall fortwith report that belief to a medical officer."
where, under Section 2 (4) of the Reporting of Notifiable Diseases and Conditions Regulations,
“an illness is serious and is occurring at a higher rate than is normal” refers to any of the following:
(a) a disease occurring more frequently than would normally be expected or in a rare or unusual form;
(b) an unusual disease cluster;
(c) a disease outbreak;
(d) an unusual disease occurrence. "
Link to CD Regulation:
https://www.novascotia.ca/just/regulations/regs/hpanotfi.htm
Link to Health Protection Act:
http://nslegislature.ca/legc/statutes/health%20protection.pdf
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Not Applicable
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
The case definition and guidance developed by PHAC is what is used in Nova Scotia.
Reporting is primarily conducted through the central lab (Zika cases are reported with positive lab confirmation).
The lab form is NS specific but was informed by conversations with CPHLN. Any public health follow-up would follow the same procedure as follow-up for any other disease.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Question 2
If needed, the regulations can be opened up to add Zika or other emerging diseases to the notifiable disease list.
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
A notifiable disease working group conducts formal reviews of the list, and updated the list in 2015. No immediate plans to update the Regulations or the Act.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
A declaration would support the collection and disclosure of information to PHAC but is not necessary. NS is a signatory of MLISA which covers sharing of information with PHAC.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
As the notifiable disease list had been recently updated, it was decided that opening up the regulations again was not warranted and that Zika reporting could be established under Section 31 of the Health Protection Act.
Age, sex, pregnant (Y/N), Travel details, Symptomatic (Y/N), Clinical symptoms, symptom date of onset, Death(Y/N), lab results
Age, sex, pregnant (Y/N), Travel details, Symptomatic (Y/N), Clinical symptoms, symptom date of onset, Death(Y/N), lab results
Sarah Fleming
Senior Epidemiologist
Nova Scotia Department of Health and Wellness
Barrington Tower, 3rd floor
1894 Barrington Street, PO Box 488
Halifax, NS B3J 2R8
Ph. (902) 722-1494
Sarah.Fleming@novascotia.ca
Nunavut
Zika is not specifically reportable in Nunavut. However, the list of communicable diseases includes "Epidemic forms of other disease". Broadly interpreted, this could include Zika.
This would be reported under the Nunavut Communicable Disease Regulations of the Public Health Act.
Link to CD Regulations:
http://www.gov.nu.ca/communicable-diseases-regulations
Link to Public Health Act:
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Note that Nunavut has not had any cases of Zika to date.
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
For emerging communicable diseases, a protocol is developing using a standard format. The contents of the protocol come from PHAC, CDC Atlanta etc. The data collected would be based on PHAC suggestions. The protocol is reviewed by Public Health staff in Nunavut and signed off by the CMOH.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
Enhanced surveillance of emerging infections that are not included in the reportable disease list is possible under provisions in the Communicable Disease Regulations - Schedule A (Communicable Diseases):
- Epidemic forms of other disease
- Unusual clinical manifestations of disease
Link to CD Regulations:
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
A new Public Health Act was passed by the Legislative Assembly in early Nov 2016. New notifiable disease and communicable disease control regulations are currently being written. The Act will come into force once the regulations are complete.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
The IHR are taken into account in determining which diseases are included on the notifiable disease list. In addition diseases that pose emerging public health threats can be added to the list quickly through an Order in Council.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
No comments
As noted previously we have not had any cases of Zika in Nunavut. IF we got a case we would work with PHAC on what information to collect.
We would release only non identifiable case information or aggregated information depending on the number of cases.
Carolina Palacios
Communicable Disease Consultant
Department of Health
PO Box 1000, Station 1000
Iqaluit, Nunavut
X0A 1H0
Email cpalacios@gov.nu.ca
Phone: (867) 975-5734
Fax: (867) 975-5755
Ontario
Zika is not reportable in Ontario.
Not Applicable
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
Ontario does have a lab-based surveillance system that detects Zika - some enhancements to this system were made following the emergence of Zika in early 2016.
This information is being reported from Public Health Ontario Laboratories to the Ontario Ministry of Health and Long-Term Care through legislation outlined in the Health Protection and Promotion Act and under the Personal Health Information Protection Act.
Although Zika virus infection is not reportable in Ontario, minimal data is being shared with PHAC to support the response to this virus.
Link to Health Promotion and Protection Act:
https://www.ontario.ca/laws/statute/90h07
Link to Personal Health Information Protection Act:
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
In Ontario, confirmed cases of Zika virus infection are based on positive laboratory findings only. Data collection protocols have not been developed.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
There are no provisions in the Public Health Act or regulations to allow public health bodies to collect, use or disclose personal health information for diseases that are not specifically named in the reportable or communicable disease regulations.
Link to RD Regulation:
https://www.ontario.ca/laws/regulation/910559
Link to CD Regulation:
https://www.ontario.ca/laws/regulation/910558
Link to Health Promotion and Protection Act:
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Ontario legislation does not support the reporting of "emerging infectious disease" or "unusual health event" .
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
This would have to be assessed for each emerging disease/event that would be declared a PHEIC through the IHR. Although Zika virus infection is not reportable in Ontario, the province is sharing minimal data to support the response to this virus.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
Public health officials continually assess and review the evidence as it emerges to better understand the immediate impact to the health of Ontarians.
Since Zika is not reportable, no case follow-up by public health occurs. Information is collected from laboratory requisition forms only.
Lab ID, age group, sex, date reported, country of travel, symptomatic, pregnant
Melissa Helferty, MIPH
Manager, Infectious Disease Policy & Programs
Public Health Policy & Programs Branch
Population and Public Health Division | Ministry of Health and Long-Term Care
393 University Ave., 21st Floor, Toronto, ON M7A 2S1
Tel: 416-326-3107| Fax: 416-327-7438
Email: melissa.helferty@ontario.ca
Prince Edward Island (did not participate)
Quebec
In Québec, Zika virus is not a reportable disease. However, because Zika was considered a public health emergency of international concern by WHO (within the framework of International Health Regulations - IHR), Québec implemented enhanced surveillance of this infection.
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Considering that on 2016-11-18, WHO declared that Zika was no longer a public health emergency of international concern, enhanced surveillance of Zika in Québec will be reassessed by our Directeur national de santé publique du Québec.
Not applicable
3. If Zika is not notifiable/reportable, is information: a) being collected on Zika cases, and b) being disclosed to federal authorities (PHAC, NML, HC)? If so, under what legislation or policy authorities?
We are asking the Laboratoire de santé publique du Québec (LSPQ) to reportZika cases to the Bureau de surveillance et de vigie (BSV) and to public health authorities in the region of residence of the case. This guideline falls within the framework of the Québec Public Health Act under "Reporting" a real or apprehended threat to the population and for which enhanced surveillance is required in the context of IHR.
We agree to send information we obtain to federal authorities within the framework of International Health Regulations (IHR), as WHO requested the collaboration of all countries to better document this public health emergency of international concern.
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Considering that on 2016-11-18, WHO declared Zika was no longer a public health emergency of international concern, the transfer of information to Public Health Agency of Canada (PHAC) pertaining to cases reported in Québec will be reassessed by our Directeur national de santé publique.
Link to Regulation:
http://legisquebec.gouv.qc.ca/en/ShowDoc/cr/S-2.2,%20r.%202
Link to Public Health Act:
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
After a case is reported, regional public health authorities communicate with infected persons to obtain the following primary information: the location (region, country) where they were infected; the method of transmission (mosquito bite, sexual transmission, etc.); the signs, symptoms and complications; if the infected person is a woman, we verify if she is pregnant. Once completed, the depersonalized questionnaire is sent to the Bureau de surveillance et de vigie (BSV) who then transfers the requested information to PHAC.
We use the definition received from PHAC to categorize cases:
• Infection contracted during travel: category of laboratory-confirmed cases for which the period of exposure to the virus was outside Canada. Laboratory-confirmed cases (EIA Igm confirmed positive by PRNT or RT-PCR in urine sample or Zika positive serum) of persons who travelled during a part of the exposure period are first identified as having been infected while travelling, and they are assessed on a case-by-case basis.
• Infection contracted by sexual transmission in the country: category of laboratory-confirmed cases (a Zika positive PRNT or a positive PCR) and for which the person was in Canada during the entire period of exposure to the virus.
The maternal fetal infection has not been precisely defined. It would be interesting to discuss this case definition at the F/T/P level. In Québec, we considered a maternal fetal transmission (EIA with PRNT positive) from a CSF sample of an infant whose mother tested PCR positive with an amniotic fluid sample during her pregnancy.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
Non applicable
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
We are in the process of reviewing the Minister’s Regulation under the Public Health Act in Québec and we foresee adding a few arboviruses, notably Zika, to the list of reportable diseases (MADO). Currently, only cases of arthropod-transmitted encephalitis are reportable.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
Yes, this justifies the exchange of information from provincial to federal.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
Québec also accepted to collaborate in the surveillance of possible infection-related complications in women who are pregnant and their unborn children (This includes also a follow-up of the infant of infected woman for a period of 2 years). As a centre of expertise, CHU Sainte-Justine agreed to participate in this surveillance in Québec. We are currently awaiting information about the terms of this Canadian surveillance.
Questionnaire used:
All data gathered are not necessarily shared with PHAC. Disclosed variables are as follows:
Data elements disclosed to federal authorities_PQ (Excel file)
Marlène Mercier,
Chef de service
Bureau de surveillance et de vigie, Direction de la protection de la santé publique, Ministère de la santé et des Services Sociaux.
Phone:514-873-1580
Fax: 514-864-2778
e-mail: marlene.mercier@msss.gouv.qc.ca
Professional in charge of the ehanced surveillance : Marie-Andrée Leblanc, BSC.
418-266-6723; fax 418-266-8489
Saskatchewan
Zika is not notifiable in Saskatchewan.
Zika is not included in the list of reportable diseases in Saskatchewan's Disease Control Regulations. As the mosquito asssociated with its transmission is not present in Saskatchewan, there are no other provisions under the Public Health Act, 1994 or the associated Disease Control Regulations for making this travel-related disease notifiable.
Not Applicable
There are no restrictions under Saskatchewan's Health Information Protection Act (HIPA) for the Ministry's provincial laboratory to disclose limited non-identifiable clinical information from the lab requisition to the Ministry's Population Health Branch. There are also no restrictions under HIPA to sharing non-identifiable information on Zika infections with PHAC.
If there is no history of travel it would be considered an outbreak. Sections 20 and 22 in the Disease Control Regulations would then apply. The Co-ordinator of Communicable Disease (Deputy Chief Medical Health Officer) would have the authority to request personal health information from the provincial laboratory and disclose that information to local Medical Health Officer (MHO). The MHO is obliged to conduct an outbreak investigation and provide a written report to the Co-ordinator.
Link to CD Regulation:
http://www.qp.gov.sk.ca/documents/english/Regulations/Regulations/p37-1r11.pdf
Link to Public Health Act:
http://www.qp.gov.sk.ca/documents/English/Statutes/Statutes/P37-1.pdf
4. Briefly describe how your data collection protocols were developed, approved and implemented (e.g., case definition, information collection and sharing tools, standard procedures)?
Numerous meetings reviewing relevant legislations occurred including consultations with Ministry lawyers. An information flow diagram was created and shared with stakeholders. Local public health was also kept informed.
A memo was provided to the provincial laboratory from the Deputy Chief Medical Health Officer indicating data flows on persons with positive test findings for Zika. The case definition developed by PHAC with P/Ts is used.
5. Describe the provisions in your legislative/policy authorities to make emerging infectious diseases or unusual health events reportable? (may include any additional provisions not covered in Question 2)
See Q3. Provisions are limited. If a Medical Health Officer believes there is an outbreak of a communicable disease, there is an obligation to investigate and provide a written report about the outbreak investigation.
6. Are your legislative/policy authorities under review or being refined with regard to reporting of emerging infectious diseases or unusual health events?
Not yet clear whether Zika should be made notifiable under the Disease Control Regulations. Further discussion needed to articulate interventions and public health actions and how Zika ranks in terms of priority.
The Disease Control Regulations may undergo changes to enable time-limited flexibility for reporting of newly emerging infectious diseases or unusual health events.
7. Does the declaration by WHO under the International Health Regulations (IHR) of a Public Health Emergency of International Concern (PHEIC) make any difference to your authorities to collect and disclose information to federal authorities?
No difference in authorities.
Suspected local transmission of Zika was reported to IHR as an unusual event and a narrative was provided.
8. Other comments about Zika surveillance or processes/mechanisms for collecting data and responding to emerging infectious diseases or unusual health events
No other comments
For travel acquired infections: Sex, Age category, Pregnancy status, PRNT results, RT-PCR/PCR results, IgM results, Travel status, if travel-country and dates, Other exposures, Symptom status and onset. No public health follow-up so only information available is from the laboratory requisition.
If local acquisition suspected, we facilitate disclosure of personal health information to local public health for outbreak investigation. We receive a written outbreak report from local public health without personal identifiers.
See Q9 travel-related variables
Val Mann, PhD
Government of Saskatchewan
Chief Population Health Epidemiologist
Population Health Branch, Ministry of Health
3475 Albert St.
Regina, Canada S4S 6X6
Bus: 306.787.4086
Fax: 306.787.3237