Reported cases of Lyme disease in Canada have increased more than 20-fold in a little over a decade, spurred in part by the warming effect of climate change that is expanding the favourable habitats for ticks.
Health
As Lyme disease spreads in Quebec, tick checks and repellent remain best safeguards
New mapping tool focuses on human behaviours to determine which parts of Eastern Townships are most at risk.
Quebec recorded 451 cases in 2021, but experts believe the true number is much higher, since the disease is difficult to diagnose. The vast majority of infections originated in the Eastern Townships and the Montérégie, where the disease has become endemic in part because of their large populations of white-tailed deer that serve as hosts to infected black-legged ticks. Since both regions are close to Montreal, the city has become identified as an emerging risk zone, particularly for those who hike or vacation on the forested fringes of the metropolis.
“We thought that perhaps we also need to focus on the humans, too,” said Dr. Catherine Bouchard, a veterinary epidemiologist with the Public Health Agency of Canada’s National Microbiology Laboratory in St. Hyacinthe. “We’re not only victims, we’re interacting with the environment. And I think we can do better.”
Research had shown risk of transmission can be significantly reduced, even in areas with high tick density, when preventive measures like doing tick checks and using insect repellent were followed regularly. But there was no way to measure whether residents were following the recommendations. Until recently.
“Once we had that we knew we had a great resource to measure human behaviour against ticks and tick-borne disease, and that we really wanted to integrate this into a risk map,” Bouchard said.
She led a team of researchers along with Dr. Cécile Aenishaenslin at the University de Montréal’s Faculty of Veterinary Medicine to create a map of the risk of getting Lyme disease in the Eastern Townships that cross-references tick-monitoring data going back to 2007 along with the adoption of three preventive behaviours: doing body checks, using repellents and bathing or showering after being in high-risk areas.
The study found that the regions served by the La Pommeraie and Haute-Yamaska health and social service networks, the areas in the Eastern Townships and Montérégie that are the closest to Montreal, were the most at risk because of their higher populations, greater tick density and “inconsistent adoption of the three preventive behaviours.”
As few as 35 per cent of the population said they regularly applied insect repellent or performed tick checks, “which raise concerns regarding the effectiveness of key public health messaging in the two highly endemic regions,” the study states.
There are a variety of reasons residents may not keep up preventive measures, Bouchard said. Chief among them is fatigue after years of doing daily or weekly checkups.
“We know there’s room for improvement, considering these people are being exposed not only while hiking, but also in their own backyards.”
The results to date suggest the ecological risks (a large tick density combined with high human population densities) remain the greatest driver of Lyme disease.
But the experiences of Bouchard’s team, who regularly scour forests and fields looking for ticks, and Bouchard, who has been bitten dozens of times, indicate preventive techniques are effective at warding off disease. Thanks to a “militaristic” regimen of using insect repellent, doing full-body tick checks after every outing, and showering, none of her team has contracted Lyme disease. Wearing clothing treated with the insecticide permethrin is also effective, as it kills ticks on contact.
Given the spread of ticks in Quebec, Bouchard counsels that everyone, including Montrealers who go into forested areas, do a tick check afterward. Those who find a tick should remove it with tweezers. As long as the tick has been found within 24 hours it’s unlikely it will have passed its infected blood on to its human host.
If a patient bitten by an infected tick is not treated with antibiotics quickly, the bacteria can spread in the blood, often causing a circular rash. Some will experience fatigue, fever and muscle aches. If it goes untreated, victims can also experience facial paralysis, numbness, severe headaches and other symptoms that can last for months or years.
The most effective way to safeguard against Lyme disease is to combine prevention techniques along with environmental safeguards like cutting long grass and removing leaf litter and overhanging branches along walking trails. A pilot program in Bromont where mice, which are typically the carriers of the Borrelia burgdorferi bacteria that causes Lyme disease, have received treatments to make them impervious to ticks has also proven effective, Bouchard noted.
As their inhabitable environment spreads, the trend is for the tick population to increase.
“So it would be good if tick prevention actions become sort of a routine,” Bouchard said, noting that there are multiple varieties of ticks that can carry several different pathogens. “Because there’s no way we can eradicate those ticks.”
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The Canadian government says it will donate up to 200,000 vaccine doses to fight the mpox outbreak in Congo and other African countries.
It says the donated doses of Imvamune will come from Canada’s existing supply and will not affect the country’s preparedness for mpox cases in this country.
Minister of Health Mark Holland says the donation “will help to protect those in the most affected regions of Africa and will help prevent further spread of the virus.”
Dr. Madhukar Pai, Canada research chair in epidemiology and global health, says although the donation is welcome, it is a very small portion of the estimated 10 million vaccine doses needed to control the outbreak.
Vaccine donations from wealthier countries have only recently started arriving in Africa, almost a month after the World Health Organization declared the mpox outbreak a public health emergency of international concern.
A few days after the declaration in August, Global Affairs Canada announced a contribution of $1 million for mpox surveillance, diagnostic tools, research and community awareness in Africa.
On Thursday, the Africa Centres for Disease Control and Prevention said mpox is still on the rise and that testing rates are “insufficient” across the continent.
Jason Kindrachuk, Canada research chair in emerging viruses at the University of Manitoba, said donating vaccines, in addition to supporting surveillance and diagnostic tests, is “massively important.”
But Kindrachuk, who has worked on the ground in Congo during the epidemic, also said that the international response to the mpox outbreak is “better late than never (but) better never late.”
“It would have been fantastic for us globally to not be in this position by having provided doses a much, much longer time prior than when we are,” he said, noting that the outbreak of clade I mpox in Congo started in early 2023.
Clade II mpox, endemic in regions of West Africa, came to the world’s attention even earlier — in 2022 — as that strain of virus spread to other countries, including Canada.
Two doses are recommended for mpox vaccination, so the donation may only benefit 100,000 people, Pai said.
Pai questioned whether Canada is contributing enough, as the federal government hasn’t said what percentage of its mpox vaccine stockpile it is donating.
“Small donations are simply not going to help end this crisis. We need to show greater solidarity and support,” he said in an email.
“That is the biggest lesson from the COVID-19 pandemic — our collective safety is tied with that of other nations.”
This report by The Canadian Press was first published Sept. 13, 2024.
Canadian Press health coverage receives support through a partnership with the Canadian Medical Association. CP is solely responsible for this content.
The Canadian Press. All rights reserved.
HALIFAX – The Nova Scotia government says it could be months before it reveals how many people are on the wait-list for a family doctor.
The head of the province’s health authority told reporters Wednesday that the government won’t release updated data until the 160,000 people who were on the wait-list in June are contacted to verify whether they still need primary care.
Karen Oldfield said Nova Scotia Health is working on validating the primary care wait-list data before posting new numbers, and that work may take a matter of months. The most recent public wait-list figures are from June 1, when 160,234 people, or about 16 per cent of the population, were on it.
“It’s going to take time to make 160,000 calls,” Oldfield said. “We are not talking weeks, we are talking months.”
The interim CEO and president of Nova Scotia Health said people on the list are being asked where they live, whether they still need a family doctor, and to give an update on their health.
A spokesperson with the province’s Health Department says the government and its health authority are “working hard” to turn the wait-list registry into a useful tool, adding that the data will be shared once it is validated.
Nova Scotia’s NDP are calling on Premier Tim Houston to immediately release statistics on how many people are looking for a family doctor. On Tuesday, the NDP introduced a bill that would require the health minister to make the number public every month.
“It is unacceptable for the list to be more than three months out of date,” NDP Leader Claudia Chender said Tuesday.
Chender said releasing this data regularly is vital so Nova Scotians can track the government’s progress on its main 2021 campaign promise: fixing health care.
The number of people in need of a family doctor has more than doubled between the 2021 summer election campaign and June 2024. Since September 2021 about 300 doctors have been added to the provincial health system, the Health Department said.
“We’ll know if Tim Houston is keeping his 2021 election promise to fix health care when Nova Scotians are attached to primary care,” Chender said.
This report by The Canadian Press was first published Sept. 11, 2024.
The Canadian Press. All rights reserved.
ST. JOHN’S, N.L. – Newfoundland and Labrador‘s chief medical officer is monitoring the rise of whooping cough infections across the province as cases of the highly contagious disease continue to grow across Canada.
Dr. Janice Fitzgerald says that so far this year, the province has recorded 230 confirmed cases of the vaccine-preventable respiratory tract infection, also known as pertussis.
Late last month, Quebec reported more than 11,000 cases during the same time period, while Ontario counted 470 cases, well above the five-year average of 98. In Quebec, the majority of patients are between the ages of 10 and 14.
Meanwhile, New Brunswick has declared a whooping cough outbreak across the province. A total of 141 cases were reported by last month, exceeding the five-year average of 34.
The disease can lead to severe complications among vulnerable populations including infants, who are at the highest risk of suffering from complications like pneumonia and seizures. Symptoms may start with a runny nose, mild fever and cough, then progress to severe coughing accompanied by a distinctive “whooping” sound during inhalation.
“The public, especially pregnant people and those in close contact with infants, are encouraged to be aware of symptoms related to pertussis and to ensure vaccinations are up to date,” Newfoundland and Labrador’s Health Department said in a statement.
Whooping cough can be treated with antibiotics, but vaccination is the most effective way to control the spread of the disease. As a result, the province has expanded immunization efforts this school year. While booster doses are already offered in Grade 9, the vaccine is now being offered to Grade 8 students as well.
Public health officials say whooping cough is a cyclical disease that increases every two to five or six years.
Meanwhile, New Brunswick’s acting chief medical officer of health expects the current case count to get worse before tapering off.
A rise in whooping cough cases has also been reported in the United States and elsewhere. The Pan American Health Organization issued an alert in July encouraging countries to ramp up their surveillance and vaccination coverage.
This report by The Canadian Press was first published Sept. 10, 2024.
The Canadian Press. All rights reserved.
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