Region 6 Quarterly Communicable Disease Report Fourth Quarter, 2008

Transcription

1 Region 6 ly Communicable Disease Report Fourth, 28 Generated for Ottawa County Health Department Contents: Outbreak Updates.. 3 CD Updates Region 6 Summaries of Reportable Diseases in MDSS Disease Group Summaries Disease Specific Summaries Administrative Statistics... 1 OCHD EDSSS Alerts Summaries Report Generated by Diana Brown Region 6 Epidemiologist MDCH 1/26/29

2 Region 6 Local Health Jurisdictions: Central Michigan District Health Department Clare County Isabella County Osceola County District Health Department 1 Lake County Mason County Mecosta County Newaygo County Oceana County Ionia County Health Department Kent County Health Department Mid-Michigan District Health Department Montcalm County Muskegon County Health Department Ottawa County Health Department n 2s 2

3 OUTBREAK SUMMARIES Shigella illness outbreak: Public Health Muskegon County (PHMC) continues to investigate an ongoing outbreak of Shigella illness. As of January 22 nd, PHMC reported 93 confirmed cases of Shigellosis associated with the outbreak, with most of the cases being in children under the age of 1 years old. As a means of stopping the spread of illness, daycare centers and elementary schools throughout Muskegon County are being educated on proper hygienic practices. PHMC has enlisted the aid of the American Red Cross, Access Health, and Volunteer Muskegon, through the Medical Reserve Corps, in addition to their own public health educators to help with the education efforts. Shigella Sept 28 Oct 28 Nov 28 Dec 28 Jan 28* Outbreak Total Confirmed * As of January 22, 29 (Source: ) Please note, given this current Shigellosis outbreak, the 28 fourth quarter Foodborne Illness counts for Region 6 are higher than in any fourth quarter in the previous five years (see graph in Region 6 Summaries of Reportable Diseases in MDSS section below). E. coli Outbreak: An investigation of an Escherichia coli 17:H7 outbreak at Michigan State University (MSU), which was later confirmed to be of the same genetic footprint to a concurrent outbreak at a Lenawee County jail, started with cases reported into MDSS in September 28. In the end, several other counties reported to Michigan Department of Community Health (MDCH) confirmed cases with the same genetic footprint, bringing the total to 38 Michigan cases with 21 hospitalizations, and one hemolytic uremic syndrome (HUS). Additionally, nine individuals in Illinois and three from the Province of Ontario were identified to be ill with the same genetic strain of E. coli 17. No deaths are known to be associated with this outbreak. Through collaborative efforts between local health jurisdictions, university officials, Michigan Department of Agriculture (MDA) and MDCH, the epidemiological investigation pointed towards iceberg lettuce as the source of the illness outbreak. Independent case control studies performed in Michigan and in Illinois both identified iceberg lettuce as the common source of illness. MDA product traceback investigation identified Fresh Pak/Aunt Mid s as the common processor of the lettuce supplied to the outbreak locations at MSU, Lenawee County Jail, and in Illinois as well as other foodservice locations identified by ill individuals. Product samples from the time of the outbreak were not available for testing, thus only samples from the time of testing were tested for E. coli. These samples along with environmental samples from Aunt Mid s processing plant tested negative for E. coli. MDA continues to work with food safety partners at 3

4 the California Department of Public Health Food & Drug Branch, who are investigating the origin and handling of the lettuce in that state. (Source: and MDCH epidemiologists) Norovirus activity for 28: Out of 138 Norovirus outbreaks reported to MDCH, 27 were in Region 6. Of these 27 outbreaks, 17 were healthcare related, 4 other, 3 restaurants and 3 schools/camps. Of the 27 outbreaks, 1 outbreaks were not tested, 11 were laboratory confirmed (1 GI, 1 GII) and 1 outbreak tested negative. Region 6 Outbreak Locations 28* Michigan Outbreak Locations 28* 63% Norovirus Outbreak Locations, 28 11% Restaurant Healthcare 1% Schools/Camps 11% Other N = 27 46% Norovirus Outbreak Locations, 28 18% Restaurant 17% Healthcare Schools/Camps Other 19% N = 138 * Data as of 1/8/29 * Data as of 1/8/ Outbreaks Reported to MDCH 22-28* Outbreaks Reported per Month 28* 1 2 Count *Data as of 1/8/ Jan Feb Mar Apr May Jun Jul Aug Sept Oct Nov Dec * Data as of 1/8/29 Outbreaks Per Region 28* Outbreaks Per Region, 28* Laboratory Testing Status N 2S N 2S Pending Negative Not Tested Confirmed * Data as of 1/8/29 (Source: MDCH epidemiologists) * Data as of 1/1/29 4

5 CD UPDATES Updated Norovirus Guidelines: The Norovirus Guidelines for Environmental Cleaning and Disinfection have been updated. Updates include: Norovirus-specific Food Code language, deletion of alternative disinfectants (gluts and iodine), addition of a bleach dilution table, deletion of contact time recommendation, addition of "pour or pump" bottles, corrected EPA language, and additional references. The updated Guidelines can be found on the web at: REGION 6 SUMMARIES OF REPORTABLE DISEASES IN MDSS Reportable Conditions* in MDSS Disease Groups: Foodborne Amebiasis Botulism Foodborne Campylobacter Cryptosporidiosis Escherichia coli O17:H7 Giardiasis Listeriosis Salmonellosis Shiga toxin, E. Coli, Non O17:H7 Shiga toxin, E. Coli, Unsp Shigellosis Typhoid Fever Yersinia enteritis VPD Chickenpox (Varicella) Diphtheria H. influenzae Disease Inv Measles Mumps Pertussis Polio Rubella Tetanus Meningitis Meningitis Aseptic Meningitis Bacterial Other Meningococcal Disease Streptococcus pneumoniae, Inv Vectorborne Dengue Fever Ehrlichiosis Ehrlichiosis, human granulocytic Erhlichiosis, human monocytic Erhlichiosis, human, other, unsp Encephalitis, California Encephalitis, Eastern Equine Encephalitis, Powassa Encephalitis, St. Louis Encephalitis, Western Equine Lyme Disease Malaria Plague Rocky Mountain Spotted Fever Tularemia Typhus West Nile Virus *NOTE: Not every condition listed has been reported in MDSS within the time periods analyzed in this report. Instead the lists represent conditions categorized within the MDSS disease groups summarized in this report.

6 Region 6 Reported Foodborne Illnesses in MDSS, Q1 24 Q4 28: Region 6 Reported Foodborne Illnesses by and Year, Region 6 Reported Foodborne Illnesses by Year and, Q1 Q2 Q3 Q Year 6

7 Region 6 Reported Meningitis Illnesses in MDSS, Q1 24 Q4 28: Region 6 Reported Meningitis Illnesses by and Year, Region 6 Reported Meningitis Illnesses by Year and, Q1 Q2 Q3 Q Year 7

8 Region 6 Reported Vectorborne Illnesses in MDSS, Q1 24 Q4 28: Region 6 Reported Vectorborne Illnesses by and Year, Region 6 Reported Vectorborne Illnesses by Year and, Q1 Q2 Q3 Q Year 8

9 Region 6 Reported Acute Viral Hepatitis Infections in MDSS, Q1 24 Q4 28: Region 6 Reported Acute Viral Hepatitis (A, B, C, D, E) Infections by and Year, Region 6 Reported Acute Viral Hepatitis (A, B, C, D, E) Infections by Year and, Q1 Q2 Q3 Q Year 9

10 Region 6 Reported Vaccine Preventable Diseases in MDSS, Q1 24 Q4 28: Region 6 Reported Vaccine Preventable Diseases by and Year, Region 6 Reported Vaccine Preventable Diseases by Year and, Q1 Q2 Q3 Q Year 1

11 Disease Specific Summaries: Region 6 Reported Campylobacter Illnesses by and Year, Region 6 Reported Campylobacter Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported E. coli O17:H7 Illnesses by and Year, Region 6 Reported E. coli O17:H7 Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Salmonellosis by and Year, Region 6 Reported Salmonellosis by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 11

12 Region 6 Reported Giardiasis by and Year, Region 6 Reported Giardiasis by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Shigellosis by and Year, Region 6 Reported Shigellosis by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Cryptosporidium Illnesses by and Year, Region 6 Reported Cryptosporidium Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 12

13 Region 6 Reported Flu Like Illnesses by and Year, Region 6 Reported Flu Like Illnesses by Month, 24-28, 2,, 4, 2, 4, 3, 3, 2, 2, 1, 1,, , 1,, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Histoplasmosis Illnesses by and Year, Region 6 Reported Histoplasmosis Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Chickenpox (Varicella) Illnesses by and Year, Region 6 Reported Chickenpox (Varicella) Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 13

14 Region 6 Reported Pertussis Illnesses by and Year, Region 6 Reported Pertussis Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Region 6 Reported Hepatitis A Illnesses by and Year, Region 6 Reported Hepatitis A Illnesses by Month, Jan-4 Apr-4 Jul-4 Oct-4 Jan- Apr- Jul- Oct- Jan-6 Apr-6 Jul-6 Month-Year Oct-6 Jan-7 Apr-7 Jul-7 Oct-7 Jan-8 Apr-8 Jul-8 Oct-8 Notes to Consider: Only cases with case status classified as Confirmed or Probable and with investigation status classified as New, Active or Completed were included in the summaries. In the Summaries of Reportable Diseases in MDSS, timelines were determined by onset date or referral date if onset date was missing. s are designated as follows: o Q1 January 1 st March 31 st o Q2 April 1 st June 3 th o Q3 July 1 st September 3 th o Q4 October 1 st December 31 st 14

15 MDSS ADMINISTRATIVE STATISTICS REGIONALLY AND STATEWIDE Foodborne Illnesses Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum N N S S Statewide Statewide Meningitis Illnesses Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum N N S S Statewide Statewide Vectorborne Illnesses Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum N N S S Statewide Statewide

16 Acute Viral Hepatitis (A, B, C, D, E) Infections Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum N N S S Statewide Statewide Vaccine Preventable Diseases Time from Onset to Referral (Days) Total time Referral to Completion (Days) Location N Average Median Maximum Location N Average Median Maximum N N S S Statewide Statewide MDSS Administrative Statistics Interpretation Guide: Dates: Onset Date = the first day the case experienced symptoms. This date is a user-generated value and may not be available for all cases. Referral Date = theoretically the date the case was referred to the Health Department and therefore entered into the MDSS. This date is automatically generated by the system as the date the case was entered into the MDSS but can be changed manually if desired, but must be no more than 9 before the system generated date. This value is available for all cases. Completion Date = the date the case was marked as completed. This date is a system-generated value, is only available for cases marked as completed in the investigation status field, but can be changed if the case is re-opened and then re-closed (see below). 16

17 Please consider: To be included in the analysis, a case must have an onset date during the specified time period (if onset date is missing, then referral date is used). If a case is not completed, the number of days from referral to completion is not available and it will not be included in the Referral to Completion analysis. If the onset date is missing, the number of days from onset to referral is not available for that case and will not be included in the Onset to Referral analysis. If a case is re-opened and the investigation status is marked as completed a second time, the case completion date will be changed to the most recent date. For example, if a case is completed on Jan 1 st, 2 and then re-opened and completed again on March 1 st, the completion date used in the calculation will be March 1 st. Theoretically, referral date is the date that the case is received by the local health department and therefore entered into the MDSS, however, this is not always the case and the referral date is changeable by the LHD. Statistics: N = number of cases used to determine the Average and Maximum values Average = the average (also called the mean) number of days between the Onset Date the Referral Date (or between the Referral Date and the Completion Date). Additionally, the mean can be influenced by outlying values. Median = the middle number in a given sequence of numbers Maximum = the largest number of days between Onset and Referral (or Referral and Completion) Additional points to consider when interpreting this report: It is important to keep in mind that administrative report results can vary widely. Factors affecting the administrative report results include: 1) The date on which the report is run. The specific cases included in the analysis can change as cases are entered, investigated and closed. 2) The number of cases / characteristics of cases included in the analysis. Small sample sizes (N) are subject to outlying data. For example, if your jurisdiction only has a couple of VPDs during a certain time frame and it takes an unusually long time to investigate one of them or a lab report was delayed, the time between Onset and Referral and Referral and Completion may be artificially elevated. Additionally, remember that the mean is more likely to be influenced by outlying values than the median. 17

18 EMERGENCY DEPARTMENT SYNDROMIC SURVEILLANCE SYSTEM ALERT SUMMARIES: Syndromic Surveillance Categories: Category Gastrointestinal Constitutional Respiratory Rash Hemorrhagic Botulinic Neurological Other Example Complaint Abdominal pain or cramping, nausea, vomiting, diarrhea Fever, chills, body ache, flu symptoms, weakness, fatigue, anorexia, malaise Nose, throat or lung problems, sinusitis, cold symptoms, bronchitis, cough, asthma, COPD, sore throat Any rash Bleeding from any site Ocular abnormalities, difficulty speaking or swallowing Non-psychiatric complaints. Headache, facial pain, numbness, seizure, tremor, convulsion, dizziness Pain or process in a system not being monitored. Lacerations, contusions, muscle aches, non-respiratory chest pain. All complaints that could not otherwise be Default classified, i.e. no word in the complaint matched any searchable keywords. NOTE: This list of example complaints is not comprehensive. 18

19 Ottawa County Date Range: 1/1/8-12/31/8 Syndrome Date County Observed Threshold Comments Constitutional 12/29/28 Ottawa /179 visits. Female: 7.9%. Average age: 29.6yo; median age: 18yo; age range: 1yo-84yo; predominant age group: yo-1yo (42.1%). Predominant complaints: fever (68.4%); weakness (31.6%). This is the second constitutional alert in two days. Fluctuations are still within 3 month historical range. Total visits for all registrations are elevated coming out of the holiday. Nothing remarkable in MDSS. OTC sales for "anti-fever pediatric" are slightly elevated over the holiday. Will continue to monitor. DB Fluctuations returned to pre-alert levels one day after alert. DB Constitutional 12/28/28 Ottawa /168 visits. Female: 43.8%. Average age: 27.8yo; median age: 13yo; age range: yo-73yo; predominant age group: less than 6yo (%). Predominant complaints: fever (68.8%). Despite a spike in normalized value- absolute value is within 3 month historical range. Nothing remarkable in MDSS or OTC sales. DB Neurological 12/24/28 Ottawa /146 visits. Within 3m hx limits. CCs diverse with no unusual clustering. Age range 19-96yrs. Headache/migraine in younger cases; tia/cva/syncope/seizure in older cases. Unremarkable. SS Gastrointestinal 12/17/28 Ottawa /144 visits. Female: 7%. Average age: 24.4yo; median age: 21.yo; age range: 1yo-9yo; predominant age group: 18yo-44yo (3.3%). Despite a spike in normalized value- absolute value is within 3 month historical range. Total registrations for all visits are slightly below moving average. There are two Salmonellosis cases reported in MDSS in previous 2 weeks. Nothing remarkable in OTC sales or by geography. DB Hemorrhagic 12/17/28 Ottawa /11 visits. Female: 8.7%. Average age: 4.7yo; median age: 31yo; age range: 2yo-9yo. Predominant complaints: GI bleed (4/7); vag bleeding (2/7). Fluctuations are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB Rash 12/16/28 Ottawa /19 visits. Female: %. Average age: 28.2yo; median age: 24.yo; age range: 1yo-67yo. Predominant complaints: Rash (7/12); scabies (4/12). Despite a spike compared to recent valuesvalues are within 3 month historical range. Nothing remarkable in MDSS- OTC sales or by geography. DB Gastrointestinal 12/1/28 Ottawa /18 visits. Female: 68.2%. Average age: 36.1yo; median age: 29yo; age range: yo-89yo; predominant age group: 18yo-44yo (4.9%). Predominant complaints: abd pain (9.1%); vomiting (31.8%); diarrhea (22.7%). Fluctuations are within 3 month historical range. Total registrations for all visits for one particular facility (HH) are below moving average (~2%). Nothing remarkable in MDSS- OTC sales or by geography. DB 19

20 Syndrome Date County Observed Threshold Comments Hemorrhagic 12/2/28 Ottawa /16 visits. Female: 81.8%. Average age: 43.4yo; median age: 46yo; age range: yo-77yo. Predominant complaints: rectal bleeding (/11); nose bleed (2/11). Despite a spike in values- values are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB Gastrointestinal 12/1/28 Ottawa /114 visits. Female: 72.2%. Average age: 36.4yo; median age: 34yo; age range: 1yo-83yo. Predominant complaints: abd pain (9/18); nasea/vomiting (4/18). Despite a slight spike in normalized value- both values are within recent historical range. Alert was generated when total GI visits (absolute value) was below moving average due to a decrease in total registrations for all visits ~% below moving average. Will follow-up regarding this decrease (likely due to delays data submission). DB Total registrations for all visits have since returned to norm one day after generation of alert. DB Respiratory 11/3/28 Ottawa /164 visits. Female: 62.2%. Average age: 33.6yo; median age: 3yo; age range: yo-91yo. Predominant complaints (alone or with other complaints): cough (42.2%); sore throat (17.8%); sob (1.6%). Both normalized and absolute values are 3 month historical range. Nothing remarkable in MDSS- OTC sales or by geography. Will continue to monitor. DB Values dropped to pre-alert values one day after alert. DB Gastrointestinal 11/21/28 Ottawa /13 visits. Female: 76.2%. Average age: 31.2yo; median age: 28yo; age range: 2yo-7yo. Predominant complaints (alone or with other complaints): abd pain (1/21); vomiting (8/21); diarrhea (4/21). Despite a spike in normalized value- absolute value is slightly above moving average. Total registrations for all visits are below moving average due to delays is data submissions from a particular facility (HH). One orovirus outbreak has been confirmed within the two weeks prior to the generation of the alert. The alert was likely generated from a spike in normalized value above threshold due to delays in data submission from a reporting facility. Nothing remarkable by geography or by OTC sales. DB Constitutional 11/19/28 Ottawa /1 visits. Female: 41.7%. Average age: 32yo; median age: 2.yo; age range: yo-93yo. Predominant complaints: fever (7/12); dizzy (4/7). Despite a slight spike in normalized valueabsolute value is slightly below moving average. Total registrations for all visits are ~3% below moving average likely contributing to the generation of the alert. Nothing remarkable in MDSS or by geography. DB Rash 11/6/28 Ottawa /17 visits. Female: 7%. Average age: 23yo; median age: 18yo; age range: yo-6yo. Predominant complaints: rash (11/12); hives (1/12). Despite a spike in normalized and absolute values- values are within 3 month historical range. Nothing remarkable in MDSS or by geography. DB 2

21 Syndrome Date County Observed Threshold Comments Respiratory 1/26/28 Ottawa /136 visits. Female: 9.%. Average age: 26.6yo; median age: 16yo; age range: yo-87yo; predominant age group: yo-17yo (33.3%). Predominant complaints: cough (1.3%); sob (2.6%); sore throat (12.8%). Despite a spike in normalized values- absolute values are only slightly above historical range. OTC sales data indicates a slight increase in cough/cold meds sales. Nothing remarkable in MDSS or by geography. DB Gastrointestinal 1/24/28 Ottawa /184 visits. Female: 77.7%. Average age: 37.yo; median age: 3.yo; age range: 3yo-78yo. Predominant complaints: abd pain (7.%); vomiting (26.7%). Fluctuations are within 3 month historical range. There is a one confirmed E. coli O17:H7 and one Shigellosis case reported in MDSS in the 2 weeks before alert. There is nothing remarkable in OTC sales data or by geography. DB Respiratory 1/23/28 Ottawa /137 visits. Female:.9%. Average age: 32.4yo; median age: 26yo; age range: yo-86yo; predominant age group: 18yo-39yo (3.3%). Predominant complaints: cough (47.1%); sore throat (26.%); sob (14.8%). Despite a spike in normalized value- absolute value is within recent historical range. Nothing remarkable in MDSS- OTC sales or by geography. DB Constitutional 1/2/28 Ottawa /41 visits. Nothing remarkable my demographics or complaints- except / females. Fluctuations are within recent historical range- in which absolute values are below moving average. Note: Total registrations for all visits (for all facilities) are below moving average (around 6%) - HH last submitted registration data on 1/17/8 (currently overdue) - likely contributing to generation of alert. DB Hemorrhagic 1/19/28 Ottawa Alert summary for 1/18/8 and 1/19/8 alerts. 1/18/8 alert: 11/16 visits; 1/19/8 alert: 2/37 visits; combined alerts: 13/22 visits. Combined analysis: Female: 38.%. Average age: 4.6yo; median age: 33yo; age range: yo-86yo. Predominant complaints: gi bleed/bloody stools (4/13); blood in urine (2/13). There is one confirmed E. coli 17:H7 case reported in MDSS in the 2 weeks before generation of alerts. Despite an increase in normalized values- absolute values are below moving average. Total registrations for all visits (for all facilities) are below moving average (around 6%). Registration data from HH last submitted on 1/17/8 (currently overdue) - likely contributing to generation of the alert. Will continue to monitor and inquire about overdue submission from HH. DB HH has resumed submitting data- normalized and absolute values are still below moving average. DB Hemorrhagic 1/18/28 Ottawa See 1/19/8 alert summary. 21

22 Syndrome Date County Observed Threshold Comments Rash 1/1/28 Ottawa /196 visits. Female: 7.1%. Average age: 9.1yo; median age: yo; age range: 1yo-2yo; predominant age group: 6yo or younger (64.3%). Predominant complaints: rash (13/14); scabies (1/14). Seven chickenpox cases have been reported in MDSS in the 2 weeks prior to alert. Though values are spiked- they are within recent historical range. Nothing remarkable in OTC sales or by geography. DB Gastrointestinal 1/1/28 Ottawa /27 visits. Female: 69.7%. Average age: 3.1yo; median age: 2yo; age range: 1yo-83yo; predominant age group: 18yo-39yo (48.%). Predominant complaints: abd pain (66.7%); vomiting (1.2%); diarrhea (1.2%). Despite a spike in both normalized and absolute values- only the normalized value is higher (slightly) than the 3 month historical range. Total registrations for All Visits are below moving average- likely contributing to a higher normalized value and the generation of the alert. One case of Giardia has been reported in MDSS within last 2 weeks. DB 22

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