Ontario gets new vaccine program
The Ontario Government has recently announced important changes in the publicly
funded vaccine programme in this province. There will be new vaccines for adults
and children, as well as a new schedule for their administration. The following
summary is intended to explain to both community members and healthcare professionals
in the Kingston, Frontenac and Lennox & Addington area how the programme will be
restructured.
First, a new vaccine for infants will be introduced to provide protection against
rotavirus, a common diarrhoeal illness. This virus normally causes only nuisance
illness, but can lead to dehydration requiring hospitalisation. Mercifully, there
are few deaths in Ontario owing to this illness, because of the excellent paediatric
care in this province. Nevertheless, this vaccine will eradicate infants’ risk of
contracting rotavirus in the first place, thereby reducing absences from child care
and lost time from work for parents. The schedule comprises two doses administered
to infants orally beginning at 6 weeks of age and with a minimum interval of four
weeks. The two doses must be given by 24 weeks of age. More details on the administration
of this vaccine will be provided by the Ministry of Health and Long-term Care during
the summer.
Second, Ontario will provide two doses of chickenpox vaccine to children instead
of one. The reason for this change is to ensure longer-term protection, and to prevent
outbreaks of the illness that have been observed when only one dose is given. The
first doses still will be given as separate injections of MMR and chickenpox vaccine.
The second dose of chickenpox vaccine will be combined in one injection with the
existing vaccine against measles, German measles, and mumps (MMR): this new combination
is called MMRV. The new MMRV vaccine will be administered at 4-6 years of age, thus
providing children with protection against these diseases that is hoped will extend
through adolescence into early adulthood and beyond. This longer-lasting immunity
will prevent outbreaks of measles and mumps in populations of young adults, in which
there have been several in recent years.
Finally, one dose of an existing vaccine that protects against tetanus, diphtheria
and whooping cough, and which is currently provided to adolescents, will also be
offered to all adults free of charge. It will replace one dose of the tetanus and
diphtheria vaccine that is given every ten years. This vaccine will provide a boost
in protection against whooping cough, preventing disruptive, exhausting, long- lasting
cough illness in adults. More importantly, however, the new vaccine will reduce
the circulation of whooping cough in people who have contact with young infants
who have not yet received full protection from the vaccine. Infants do not receive
all of their initial whooping cough vaccine until they are at least 6 months old,
and by that time, they have already passed the period during which the illness is
most dangerous to them. The goal is to prevent parents, family and caregivers from
passing on an illness that can be life-threatening for infants. In other words,
the new vaccine will provide a protective cocoon around young babies so that they
will not be exposed to this severe and life-threatening illness through the people
who look after them. We cannot fully protect infants from whooping cough with vaccine
before six months of age, but we can protect them by reducing the circulation of
this disease, and making sure that the people caring for them do not expose them.
I encourage every eligible person to take advantage of these new vaccines to improve
and protect their health, particularly adults, who are probably no longer protected
against whooping cough, because the protection that they received from older vaccine
has diminished over time. Vaccines are the safest, most effective and longest-lasting
way to protect ourselves from communicable diseases, and have reduced deaths and
disabilities over the decades. Please take advantage of these new free vaccines,
both for yourselves and for your children. For more information, contact the Immunisation
Team at KFL&A Public Health.
Seasonal Influenza
Influenza season is upon us again, but it will be very different this year than
it was last year when we were facing the H1N1 pandemic scare. Read on to get the
facts about this year’s strains of influenza, and about how to protect yourself
and your family from this illness.
First and foremost, the H1N1 pandemic is over. Mercifully, it turned out to be much
milder than anyone feared: there were fewer elderly people affected, and there were
fewer deaths from the virus than normally happen each year.
So what will happen now? The new H1N1 influenza has not disappeared, but it may
well be less prevalent this year. The primary reason for this likely decrease in
risk is that many people are already immune to the virus, either because they became
ill with it last year, or because they had the vaccine last year to protect themselves
against infection. As a result, it is reasonable to guess that the virus will have
trouble circulating this year. This phenomenon has been observed in the southern
hemisphere, where the influenza season has just finished.
It is important to note that H1N1 influenza is a different strain of influenza virus
than the other, seasonal influenza viruses. In pandemics, it is often the case that
the new virus (in this case, H1N1) will eliminate the old strains (in this case,
the other, old influenza A strains). While it is reasonable to guess that H1N1 influenza
may knock out the other A strains that cause seasonal influenza, as happened in
most previous pandemics, we are not yet certain of whether that will actually happen.
We have seen, for example, a few isolated outbreaks of the old Hong Kong influenza
that was around before the H1N1 pandemic. The bottom line is: since a large percentage
of the population is immune to H1N1, and since there is a good chance that the old
influenza A viruses may be wiped out by it, we may be in for a mild influenza season.
That said, we still have some advice about how to prepare for this year’s influenza
season. Influenza is not gone, and the vaccine is still the safest option for protection:
it is the longest-lasting and the most effective way to prevent this illness. It
is available at your family doctor’s office and at various clinics in the community
organized through KFL&A Public Health. People who are at high risk of severe
complications from influenza (elderly people, people with chronic illness), and
those who care for them (health workers, family members and volunteers) still need
to protect themselves and their loved ones. Moreover, B strains of the virus are
probably not affected by the pandemic, and they may still cause outbreaks of illness.
The approach that we should adopt for this year’s influenza season is: back to business
as usual. It is still important for you and your loved ones who may be at high risk
to get influenza vaccine, which will include protection against the pandemic strain
along with another A and a B strain that cause illness unpleasant illness for most
and serious illness for the high risk. Everyone can benefit from the influenza vaccine,
and should give it careful consideration.
Unpasteurized Milk
May 17, 2010
The sale of raw—also known as unpasteurized—milk through ‘cow-sharing’ programs
is becoming an issue in Ontario, and has started to occur even in our community.
Milk that has not been properly pasteurized can cause a number of serious infections.
Pasteurization is a proven and safe way to treat food by using heat to kill disease-causing
organisms. It is extremely effective and safe and does not use chemicals to kill
disease-causing organisms and does not harm the flavour or quality of the food.
It is essential for everyone to understand the implications of drinking raw, possibly
contaminated milk, before considering buying it or participating in these programs.
I want to tell you about these risks.
People rarely think twice about the safety of dairy products. Like water, many of
us assume that milk is always safe. In the Walkerton water crisis, however, failure
to maintain strict safety procedures led to serious, and in some cases, chronic,
illness and the death of seven people. Drinking unpasteurized milk is as risky,
and probably more so, as drinking untreated water.
The dangers of drinking unpasteurized milk were recognised decades ago. During the
1890s, the Women’s Institute began a crusade to make it mandatory for milk to be
pasteurized before it was sold, because of the high toll of child deaths caused
by consumption of raw milk. Finally, in the 1930s, after public health groups across
the province also joined the movement, a law was passed requiring that all dairy
products to be pasteurized. Since this landmark in public health, children have
been safe from the serious infections that can occur when milk is not pasteurized,
but ‘cow-sharing’ completely reverses this public health advance.
The following potentially serious infections can occur by drinking raw milk:
- Tuberculosis
- E. Coli O:157 H:7 (which can lead to kidney failure, and sometimes death, in children)
- Brucellosis
- Q fever
- Salmonella
Even when farms and barns are as clean as they can be, contamination can occur easily.
Without pasteurization, if bacteria are in the milk, they grow well and rapidly,
because milk is full of nutrients that feed them. Pasteurization is therefore imperative,
and is done for a very valid reason.
The people who have the greatest risk of contracting serious infections from raw
milk are children and the elderly. The same germ that caused children to develop
kidney failure in the Walkerton outbreak, E. Coli O:157 H:7, can contaminate milk,
because cows carry it in their intestines. Children do not have a choice of what
milk products are purchased for and provided to them. As a result, parents must
understand that raw milk can make the whole family, especially the young, very ill.
Selling raw milk is illegal in Ontario, but some people still get it through ‘cow-sharing’
programs, in which people pay a penny to ‘buy’ part of a cow, and pay ‘expenses’
every time they get milk to drink. While this is a way to get around the law prohibiting
the sale of raw milk, since it is not illegal to drink the raw milk from a cow that
one owns, it is dangerous.
Do not put your own health or your family’s health at risk by buying or drinking
raw milk. Milk purchased through ‘cow-sharing’ programs is just as unsafe to drink
as any other raw milk. Contrary to myth, unpasteurized milk is
not healthier; it
is riskier. Pasteurization does not reduce the nutrient content of milk
significantly, but rather, ensures that milk will not contain bacteria that can
be fatally harmful if ingested by children. Other safety measures simply do not
work. Pasteurization is the only sure way to ensure that milk is safe to drink.
We simply cannot wait until a child dies to stop this practice of selling raw milk
through ‘cow-sharing.’
An important message on pandemic H1N1 influenza
November 5, 2009
We have all felt the effects of pandemic H1N1 influenza. While many of you know
someone who has been sick lately with influenza-like symptoms, some of you have
been sick yourself. Perhaps you are one of the thousands who waited patiently in
line to get your pandemic H1N1 influenza vaccine or stayed back and waited while
your more vulnerable neighbours and family members got their vaccine. Because of
your patience and understanding, we’ve been able to provide over 45,000 doses of
the pandemic H1N1 influenza vaccine to KFL&A area residents—through our community
vaccine clinics, family doctors, healthcare teams, partners, and hospitals. To you
all, thank you for your patience.
While our surveillance shows us that the infection rates are starting to go down,
we are still very much in a race against the pandemic H1N1 influenza virus.
For reasons beyond the control of any local public health agency, we have temporarily
run out of pandemic H1N1 influenza vaccine. Until we get more, we will have to suspend
our community immunization clinics. We don’t expect that wait to be long—perhaps
only a matter of days. At KFL&A Public Health we have redeployed our staff and
made every resource available to get the vaccine into arms. Once we have more vaccine
we will work continually to provide pandemic H1N1 influenza vaccine to every resident
who wants it.
Keep listening to local radio stations, check your daily or weekly newspapers, or
visit our website, www.kflapublichealth.ca, for information on more clinic dates
when the vaccine is once again available.
Thank you.
PH1N1 Influenza A
October 27, 2009
The new variant of PH1N1 influenza A is already circulating widely in Kingston,
Frontenac and Lennox & Addington. It is essential for all members of our community
to learn the risks of this illness, and how to minimize them.
Our observations from the spring of 2009, and from the influenza season in the southern
hemisphere that has just ended, have helped us to understand how PH1N1 will affect
our population. First, there is potential for a lot of illness; we expect the disease
to be widespread, because a large number of people are susceptible. The infection
spreads quickly, and as it continues to do so, there will be a high chance of being
exposed.
Like most new strains of influenza, PH1N1 influenza A will mostly affect younger
people. The preponderance of cases is in school-aged children, adolescents, and
young to middle-aged adults in their 20s-50s. There is no reason to think that this
epidemiology will change during the influenza season in the northern hemisphere.
The illness tends to be no worse than regular influenza, but it is still a highly
unpleasant disease. Most people will feel very ill for a week, and fatigued for
several more. Although the number of particularly severe cases seems to be fewer
than with regular influenza, such severe cases will still occur. In fact, because
we expect lots of cases, there will be a small number of deaths amongst otherwise
healthy people, and it is impossible to predict who these people will be. Although
the absolute risk is small, as it is with regular influenza, people who already
have chronic medical conditions and pregnant women are at a higher risk for complications
than the general population.
There are a number of things that people can do to stem the spread of PH1N1 influenza
A and keep themselves from becoming ill:
- Always follow the rules of good hygiene: wash hands or use hand sanitizer regularly,
especially after touching objects in public places (buttons on elevators, shopping
carts at the market, etc.);
- Follow good cough etiquette: never cough into the hands, but rather into the sleeve;
- If you do become ill, you should stay home to prevent spreading the infection to
others.
That said, the best way to avoid becoming ill with PH1N1 is to get the vaccine that
protects against this illness. Although everyone will be offered the vaccine, those
who are at higher risk will be offered it first. The vaccine is now licensed and
is deemed safe by Health Canada; early trials show extremely good responses in healthy
adults and young children. It is certainly the most effective and long-lasting way
to prevent influenza.
Chlamydia
October 13, 2009
Chlamydia is epidemic among older adolescents and young adults. As the new school
year is underway in universities, high schools and colleges, it is important that
they understand the risks associated with this infection, and how to protect themselves.
Chlamydia is the most common reportable sexually transmitted infection (STI). Most
cases in women and some in men are asymptomatic (i.e. there are no symptoms indicating
that infection has occurred). Moreover, the risk of infection is directly proportional
to the number of sexual partners that a person has. That fact is compounded further
because there are now many more people in the highest risk ages: older adolescents
and young adults. For all of these reasons, the incidence of this infection has
risen to epidemic levels.
If a case of asymptomatic Chlamydia goes undiagnosed and untreated, it may have
serious consequences, especially for women. Moreover, women are at greater risk
of contracting the infection than men, because the transmission rate to women is
higher. It is thus essential for women to know what kind of complications Chlamydia
can cause, and to learn how to prevent that from happening.
If untreated in women, Chlamydia can lead to Pelvic Inflammatory Disease (PID),
an infection of the ovaries and fallopian tubes. PID can cause tubal pregnancies,
as well as infertility. Chlamydia poses a major risk to health and future reproduction
in women, but knowing about prevention can greatly reduce that risk.
There are several actions that young people can take to decrease the risk of infection,
such as consistent use of condoms, and limiting one’s number of sexual partners.
If these preventive measures don’t work, testing is available to detect both symptomatic
and asymptomatic infections. If an infection is detected before it spreads, it can
be treated with a course of antibiotics, and the complications of Chlamydia can
be prevented. All sexually active women who have more than one partner, or whose
partner does, should be tested for Chlamydia regularly: at least once per year,
or more often if the number of partners is higher. Men who have symptoms should
be checked and treated before they have any further sexual contact.
Women (and men) can stay sexually healthy by being smart: use condoms, limit the
number of sexual partners that you have, know your partners’ sexual histories, and
have regular testing.
Lyme Disease
August 31, 2009
The incidence of Lyme disease, an infection carried by ticks, is on the rise in
eastern Ontario. Read on to learn about how it is transmitted and what its symptoms
are, so that you can protect yourself and your family.
In 1975 there were 50 cases of what appeared to be arthritis in children in the
town of Lyme, Connecticut, prompting an initial diagnosis of “Lyme Arthritis.” It
later became clear that this joint pain was in fact only one symptom of Lyme disease,
caused by bacteria that can be transmitted to a person when he or she is bitten
by an infected tick.
Lyme disease has become established in eastern Ontario, but at this point, it is
still a very small risk. Although infected ticks are now found more commonly, there
have still been only a handful of infections in humans. When infection occurs, however,
it can be serious. An important part of prevention is to avoid ticks in the first
place. Ticks cling to plants and grass in wooded areas, particularly in cottage
or camping country, and can attach themselves to the skin or clothes of humans.
After the tick begins to bite, it takes 18 hours or longer to transmit the bacteria
that cause Lyme disease. Although it is not possible for pets to spread Lyme disease,
they can bring infected ticks into your home. Knowing this information, it is easy
to minimize one’s risk of contracting the disease by taking a few simple protective
measures while enjoying the outdoors:
- Wear protective, light-coloured clothing so that ticks can be easily seen and kept
off the skin (long sleeved shirts, long pants, and socks).
- Wear insect repellent. Insect repellents containing DEET should not be used on children
under 6 months of age, and should be used only sparingly on children younger than
2.
- After spending time outside, check for ticks on any exposed areas: thighs, arms,
underarms and legs; check your pets too.
- Learn to recognize a feeding tick. They are very small and can appear like a freckle.
If you find one, use tweezers to pull it straight out, put it in a clean container
and contact KFL&A Public Health during business hours.
Most people who have been bitten by an infected tick will develop a rash at the
site of the bite that looks like a bull’s eye. The rash may grow bigger and then
disappear, after which other symptoms may develop, including fever, headache, stiff
neck, sore aching muscles and joints, fatigue, and sore throat. If detected at this
early stage, it can be easily cured with antibiotics. If Lyme disease goes undiagnosed
and untreated, however, it may cause potentially serious and rare complications
for the heart and nervous system. Early recognition of symptoms and avoiding ticks
in the first place, therefore, are essential.
H1N1 influenza A (new variant)
June 16, 2009
Over the past eight weeks, the media have focused significant attention on the new
variant of influenza A, elsewhere referred to as H1N1 or swine flu, presenting the
public with conflicting messages. Read on to learn the facts about this illness.
Many people wonder why the new variant of influenza A is causing more public concern
than seasonal influenza, the virus commonly called 'the flu.' The difference
between these two viruses is that many people will have little protection against
this new variant of influenza, having neither been immunized against it nor exposed
to it in the past. Because this is the first time that many people have been
exposed to the new variant of influenza A, it has the potential to cause a lot of
illness. In fact, the World Health Organization (W.H.O.) has announced that
this virus has reached a level 6 pandemic, meaning simply that it is now active
in many parts of the world. We also know that when there is a lot of influenza
around, even seasonal influenza, elderly and chronically sick people may die from
it. That said, it remains to be seen just how many people will get sick; there
is some early evidence that people who are over 50 years old may have been exposed
to a similar virus years ago, and may therefore have some immunity.
To date, H1N1 influenza A (new variant) has NOT caused a great number of deaths,
and seems to be NO MORE SERIOUS than seasonal influenza. In fact, the W.H.O.
designation of a level 6 pandemic DOES NOT imply that the infection is severe, only
that it is widespread. Because influenza is such an unpredictable virus, however,
anything is possible. Although it is NOT expected that this new variant will
turn nasty, public health agencies need to be prepared for any scenario, even the
unlikely one that the virus will cause severe disease in the autumn. Therefore,
we are monitoring its severity and spread to see how it behaves, preparing ourselves
for the unexpected. The system is gearing up to provide vaccine for those
people who need it, should it be available in the autumn. Doing so involves
production of the vaccine, testing it for safety and effectiveness, and co-ordinating
the logistics of a mass immunization program.
Finally, since the emergence of this new strain, the public health system has had
a chance to test out its pandemic response plan. We can now refine it for
use if a severe pandemic should occur—that is, if a particularly virulent
strain of influenza should become widespread throughout the world.