Infectious Diseases At A Glance in Durham Region

Transcription

1 Infectious Diseases At A Glance in Durham Region Last Updated: November 2017 Highlights The rates of all reported infectious diseases combined are highest among youth and young adults aged 15 to 29 and among older adults aged 90 and older. Chlamydia was the most commonly reported infectious disease in Durham Region males and females. The rate of enteric illness was higher in the northern municipalities of Durham Region (Brock, Scugog and Uxbridge combined) in most years and in Clarington since Rates of salmonellosis have been increasing in both Durham Region and Ontario since The rate of influenza was higher in the northern municipalities of Durham Region from 2013 to 2016 compared to Durham Region as a whole. Although chlamydia rates decreased between 2011 and 2013 among both Durham Region and Ontario females and levelled off among Durham Region males, rates increased again between 2014 and The rate of chlamydia is higher most years in Ajax, Pickering, and Oshawa than Durham Region as a whole, and lower in Whitby, Clarington, and the northern municipalities of Durham Region. Incidence rates of gonorrhea have been increasing since 2009 in both Durham Region and Ontario, especially among males. Incidence rates of syphilis have increased since 2013 in Ontario and 2014 in Durham Region. The rate of hepatitis C infection is consistently higher in Oshawa than in other Durham Region municipalities, and higher than in Durham Region as a whole. The rate of latent tuberculosis infection is consistently higher in Ajax than in Durham Region as a whole and the rate has increased since Rates for all reportable infectious diseases included in the report are either similar or lower in Durham Region compared to Ontario with the exception of legionellosis. There were more cases than expected in 2016 for adverse events following immunization, cyclosporiasis, gonorrhea, invasive group A streptococcal disease, hepatitis A, influenza, Lyme disease, salmonellosis, shigellosis, and infectious syphilis. There were fewer cases than expected for hepatitis C. Page 1 of 56

2 Introduction Ontario's Health Protection and Promotion Act (1) requires that physicians, nurses, other regulated health professionals, hospitals, and laboratories report a number of infectious diseases to the local Medical Officer of Health. The Durham Region Health Department investigates and manages identified cases and contacts of infectious diseases and enters them into the integrated Public Health Information System (iphis) as outlined in the Ministry of Health and Long-Term Care's Infectious Disease Protocol (2). The most common source of case finding is through notice of confirmed test results from a laboratory. There may be considerable under-reporting of cases because an infected person with mild or no symptoms may not seek medical care and/or medical professionals may not order laboratory testing. A list of reportable infectious diseases is available as Appendix 1. This report includes confirmed cases, unless otherwise noted, of reportable infectious diseases according to provincial case definitions provided in the Infectious Disease Protocol (3). We included probable cases along with confirmed cases for some diseases (noted in the comments below each graph where relevant) from 2009 onward. This enabled comparison to previous years because the case definitions changed in For all indicators, we analyzed data by the residence of the case at time of diagnosis. This report includes indicators with relevance to public health programming, referenced in the Ontario Public Health Standards (OPHS) (4). The Ontario Ministry of Health and Long- Term Care published the OPHS under the authority of Section 7 of the Health Protection and Promotion Act (1). This report includes charts and tables for the following indicators for Durham Region: All reportable infectious diseases: incidence rate; age-specific incidence rate Most common reportable diseases All enteric diseases: incidence rate; age-specific incidence rate; incidence rate by municipality Campylobacter enteritis: incidence rate; incidence rate by municipality Giardiasis: incidence rate Salmonellosis: incidence rate; incidence rate by municipality All vaccine preventable diseases: incidence rate Influenza: incidence rate; age-specific incidence rate; incidence rate by municipality Pertussis: incidence rate; age-specific incidence rate Invasive pneumococcal disease (IPD): incidence rate All sexually transmitted and blood-borne infections: incidence rate Chlamydia: incidence rate; age-specific incidence rate; incidence rate among youth aged 15 to 19, adults aged 20 to 24, and adults aged 25 to 29; incidence rate by municipality Gonorrhea: incidence rate; age-specific incidence rate; incidence rate by municipality Syphilis: incidence rate Hepatitis B, chronic: incidence rate Hepatitis C: incidence rate; incidence rate by municipality Latent tuberculosis infection: incidence rate; incidence rate by municipality Page 2 of 56

3 Age-standardized incidence ratios for selected reportable diseases (males, females, & both sexes combined) Number of confirmed cases of selected reportable diseases in Durham Region among both sexes For more detailed, topic specific reports that include infectious disease data please go to the Health Statistics in Durham Region webpage found at durham.ca/healthstats. The Health Neighbourhoods project presents indicators, including infectious disease indicators, for 50 Health Neighbourhoods in Durham Region. Public Health Ontario has a variety of reports that include infectious disease data including the Reportable Burdensome Infectious Disease Incidence Snapshot, Monthly Infectious Disease Surveillance Reports, Reportable Diseases Trends in Ontario tool, West Nile Virus surveillance, and Vector-Borne Disease Surveillance Reports. For more information or if you require this information in an accessible format, please contact the Durham Health Connection Line at or Page 3 of 56

4 Definitions Definition: Age-standardized incidence ratio The ratio of the number of cases observed in the population of interest to the number of cases that would be expected if the population had the same age-specific incidence rates as a standard population. For this report, we used Ontario as the standard population. Since statistical estimates may be unstable when the number of events is small, we used confidence intervals to determine whether an age-standardized incidence ratio was statistically different from one. A ratio with confidence intervals greater than one indicates that the incidence rate is higher in Durham Region than Ontario, whereas a ratio with confidence intervals less than one indicates that incidence is lower in Durham Region. Definition: Incidence rate The total number of cases per 100,000 population. This rate depicts the "true" picture of disease in a community. Definition: Age-specific incidence rate The total number of cases in a specified age group per 100,000 population in that age group. The numerator and denominator refer to the same age group. For some indicators, the count of total cases displayed is more than the sum of male and female cases because of unspecified or other gender. Page 4 of 56

5 All reportable infectious diseases All reportable infectious diseases are included in these rates with the exception of adverse vaccine events; chickenpox (varicella); Clostridium difficile infection; gastroenteritis, institutional outbreaks; & respiratory infection outbreaks in institutions. Institutions include long-term care homes, hospitals, retirement homes, child care centres and schools. Page 5 of 56

6 Figure 1: All reportable infectious diseases incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases ,156 1,038 1,131 1,245 1,289 1,373 1,337 1,585 Durham Female Cases ,089 1,121 1,144 1,314 1,492 1,473 1,604 1,657 1,508 1,577 1,632 1,871 Durham Total Cases 1,328 1,318 1,267 1,062 1,421 1,138 1,103 1,259 1,459 1,755 1,689 1,952 2,051 2,081 2,308 2,649 2,512 2,739 2,902 2,797 2,950 2,970 3,455 Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Crude reportable infectious disease incidence rates increased steadily since 2001 in males and females and were higher among females in both Durham Region and Ontario. Trends in chlamydia have the strongest influence on trends in overall infectious disease rates. Chlamydia has accounted for over half of all reported infectious diseases since Page 6 of 56

7 Figure 2: All reportable infectious diseases age-specific incidence rates, Durham Region and Ontario, 2012 to 2016 combined Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases ,597 1, Durham Female Cases ,494 2,464 1, Durham Total Cases ,104 4,061 2,067 1, Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rates of all reported infectious diseases are highest among youth and young adults aged 15 to 29 and among older adults aged 90 and older. As with overall rates, the age distribution of chlamydia has the strongest influence on this distribution. Chlamydia accounted for over half of all reported infectious diseases between 2012 and Page 7 of 56

8 Figure 3: Ten most common reportable infectious diseases in Durham Region, 2012 to 2016 combined Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July * We included probable cases along with confirmed cases for these diseases to be consistent with other reporting. Chlamydia was the most commonly reported infectious disease in Durham Region males and females for 2012 to Chlamydia accounted for a much larger proportion of all reportable diseases among females (62 percent) than among males (47 percent). Page 8 of 56

9 Table 1: Twenty most common reportable infectious diseases in Durham Region, 2012 to 2016 combined Reportable Disease Total Percent Total Rank Male Percent Male Rank Female Percent Chlamydia 55.1% % % 1 Influenza 10.7% % % 2 Latent tuberculosis infection 8.3% 3 5.8% % 3 Gonorrhea 6.9% 4 8.1% 3 5.9% 4 Campylobacter enteritis * 5.6% 5 7.0% 5 4.5% 6 Hepatitis C 5.5% 6 7.6% 4 3.8% 7 Salmonellosis * 5.1% 7 5.4% 7 4.9% 5 Giardiasis * 1.7% 8 2.3% 8 1.2% 9 Invasive pneumococcal disease * 1.6% 9 1.9% 9 1.3% 8 Hepatitis B carriers 1.2% % % 10 Non-infectious syphilis 0.8% % % 12 Invasive group A streptococcal disease 0.7% % % 11 Amebiasis * 0.7% % % 15 Infectious syphilis 0.7% % % 27 HIV/AIDS 0.5% % % 26 Lyme disease * 0.5% % % 14 Legionellosis * 0.5% % % 21 Pertussis (whooping cough) * 0.4% % % 13 Active tuberculosis 0.4% % % 16 Viral meningitis 0.4% % % 19 Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Female Rank * We included probable cases along with confirmed cases for these diseases to be consistent with other reporting. Influenza was the second most commonly reported infectious disease among Durham Region males and females accounting for close to 11 percent of all reportable diseases between 2012 and Among Durham Region females, latent tuberculosis infection was the third most commonly reported infectious disease at just over 10 percent. Among males, gonorrhea was the third most commonly reported infectious disease accounting for eight percent of all reportable diseases. Page 9 of 56

10 Enteric diseases Enteric diseases are diseases that affect the stomach and intestines and commonly cause symptoms such as diarrhea, nausea, vomiting, stomach pain, and fever. They can be spread by drinking contaminated water, eating contaminated food, or contact with sick people or animals or surfaces that they have touched. People can protect themselves from enteric diseases by washing their hands thoroughly and frequently, using safe food handling practices, and through safe use of drinking and recreational water. Reportable enteric diseases in Ontario include: amebiasis; botulism; brucellosis; Campylobacter enteritis; cholera; cryptosporidiosis; cyclosporiasis; food poisoning, all causes; giardiasis; hepatitis A; listeriosis; paralytic shellfish poisoning; paratyphoid fever; salmonellosis; shigellosis; trichinosis; typhoid fever; verotoxin-producing Escherichia coli (VTEC) infection; and yersiniosis. We included probable cases along with confirmed cases for all enteric diseases with the exception of listeriosis, paratyphoid fever and typhoid from 2009 onward. This enabled comparison to previous years because the case definitions changed in Page 10 of 56

11 Figure 4: All enteric diseases incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Rates of enteric diseases decreased between 1994 and 1999 in both Durham Region and Ontario, then remained relatively stable since Rates were higher in males than females in most years. Page 11 of 56

12 Figure 5: All enteric diseases age-specific incidence rates, Durham Region and Ontario, 2012 to 2016 combined Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Many enteric illnesses occur more frequently in infants and young children compared to adults. Rates were higher among males than females in most age groups. Durham Region rates were lower than Ontario rates in most age groups but were higher in Durham Region males aged 70 and older than among Ontario males in this age group. Page 12 of 56

13 Figure 6: All enteric diseases incidence rates, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rate of enteric illness was higher in North Durham (Brock, Scugog and Uxbridge combined) in most years and in Clarington since All other municipalities have rates similar to Durham Region as a whole. Page 13 of 56

14 Figure 7: Campylobacter enteritis incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Campylobacter enteritis is one of the leading causes of enteric disease in Ontario and occurs primarily in the summer months (5). We included probable cases of Campylobacter enteritis along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definition changed in Rates of Campylobacter enteritis decreased between 1994 and 2005 in both Durham Region and Ontario then increased between 2009 and 2012 but have decreased again in recent years. Page 14 of 56

15 Figure 8: Campylobacter enteritis incidence rates, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July We included probable cases of Campylobacter enteritis along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definition changed in Rates of Campylobacter enteritis were higher in the northern Durham Region municipalities (Brock, Scugog and Uxbridge combined) in most years, while all other municipalities have rates similar to Durham Region as a whole. Page 15 of 56

16 Figure 9: Giardiasis incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Rate Ontario Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Giardiasis is common in Ontario, especially in institutions and child care centres where children are not yet toilet trained (5). We included probable cases of giardiasis along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definition changed in Due to small numbers, we combined male and female cases to create more stable rates. Rates of giardiasis decreased between 1994 and 2011 in Ontario but have remained relatively stable since then. In Durham Region, rates decreased between 1994 and 2001 but have remained relatively stable since then. Page 16 of 56

17 Figure 10: Salmonellosis incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Salmonellosis is the second most common enteric infection in Ontario but experts estimate that only one percent of all infections are ever clinically recognized (5). We included probable cases of salmonellosis are included along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definition changed in Rates of salmonellosis decreased between 1994 and 2003 in both Durham Region and Ontario but have been increasing since then. Page 17 of 56

18 Figure 11: Salmonellosis incidence rates, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July We included probable cases of salmonellosis along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definition changed in In most years, the rate of salmonellosis is similar in the Durham Region municipalities to Durham Region as a whole. Page 18 of 56

19 Vaccine preventable diseases Vaccine preventable diseases (VPDs) are infectious diseases that can be prevented by routine vaccinations, mostly given during childhood. Reportable VPDs include: diphtheria; Haemophilus influenzae B disease, invasive; hepatitis A; hepatitis B; measles; meningococcal disease, invasive; mumps; pertussis; poliomyelitis, acute; rabies (human); rubella; rubella, congenital syndrome; Streptococcus pneumoniae, invasive (invasive pneumococcal disease); and tetanus. For this report, we included probable cases of invasive pneumococcal disease, measles, mumps, pertussis and rubella along with confirmed cases from 2009 onward. This enabled comparison to previous years because the case definitions changed in Page 19 of 56

20 Figure 12: All vaccine preventable diseases incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Rate Ontario Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The grouping of all vaccine preventable diseases excludes influenza, due to the sporadic nature of cases, and chickenpox (varicella) due to underreporting issues. Due to small numbers, we combined male and female cases to create more stable rates. A large measles outbreak occurred in Ontario from 1994 to 1995, which explains the peak in these years. Page 20 of 56

21 Figure 13: Influenza incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Rate Ontario Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Influenza is an acute respiratory illness. In Canada, the influenza season usually runs from November to April. Due to small numbers, we combined male and female cases to create more stable rates. The large number of cases for Ontario and Durham Region in 2009 was due to the H1N1 Pandemic. In addition, recent influenza seasons have also had large numbers of influenza cases. Influenza rates fluctuate from year to year but in general follow the same pattern in Durham Region and Ontario. We provide a summary of influenza activity for each influenza season on the Flu Surveillance page at durham.ca. Page 21 of 56

22 Figure 14: Influenza age-specific incidence rates, Durham Region and Ontario, 2012 to 2016 combined Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July In general, young children and the elderly have higher incidence rates of influenza. Page 22 of 56

23 Figure 15: Influenza incidence rates, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rate of influenza was higher in Clarington in some years (2008, 2009, 2012, 2014 and 2016) and higher in the North Durham (Brock, Scugog and Uxbridge combined) from 2013 to All other municipalities have rates similar to Durham Region as a whole. Page 23 of 56

24 Figure 16: Pertussis incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Rate Ontario Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Pertussis, or whooping cough, is an acute bacterial infection. Violent coughing, which may include a high-pitched inspiratory whoop, is the most well-known symptom (5). The Tdap vaccine protects individuals against tetanus, diphtheria and pertussis. Due to small numbers, we combined male and female cases to create more stable rates. Rates of pertussis have fluctuated over time with Durham Region and Ontario, showing a similar pattern in most years. Page 24 of 56

25 Figure 17: Invasive pneumococcal disease incidence rates, Durham Region and Ontario, 2003 to 2016 Rates and Cases Durham Rate Ontario Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2003 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 2003 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2003 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The bacterium Streptococcus pneumoniae causes invasive pneumococcal disease (IPD). This disease can cause serious illnesses such as pneumonia, blood infection, and meningitis (5). Ontario added the pneumococcal conjugate vaccine to their routine immunization schedule in 2005 for children less than two and high-risk children less than five (6). Due to small numbers, we combined male and female cases to create more stable rates. We excluded data prior to 2003 due to inconsistent reporting. Rates in both Durham Region and Ontario increased slightly between 2005 and 2012, then decreased in 2013 and have remained stable since then. Page 25 of 56

26 Sexually transmitted and blood-borne infections Sexually transmitted infections and blood-borne infections are passed mainly from person-to-person through sexual contact, needle use, blood transfusion, and from mother to infant during pregnancy and delivery (7). Reportable sexually transmitted and blood-borne infections in Ontario include: chlamydial infections; gonorrhea; group B streptococcal disease, neonatal; hepatitis B; hepatitis C; human immunodeficiency virus (HIV) / acquired immunodeficiency syndrome (AIDS); ophthalmia neonatorum; and syphilis. HIV data is not available for Ontario prior to 2005 so only AIDS data is included in all sexually transmitted and blood-borne Infection totals for those years. Page 26 of 56

27 Figure 18: All sexually transmitted and blood-borne infections incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases ,026 Durham Female Cases ,012 1,013 1,190 1,307 1,273 1,122 1,065 1,245 1,284 Durham Total Cases ,089 1,163 1,297 1,461 1,425 1,672 1,664 1,958 2,121 2,099 1,971 1,917 2,198 2,310 Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rates of sexually transmitted and blood-borne infections have been increasing in Durham Region and Ontario since There was a decrease in rates between 2011 and 2013 in Durham Region and Ontario females; however, rates have begun to increase again since. Page 27 of 56

28 Figure 19: Chlamydia incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases ,020 1,138 1, ,056 1,098 Durham Total Cases ,024 1,019 1,218 1,278 1,556 1,714 1,712 1,577 1,485 1,732 1,797 Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Chlamydia infection is frequently asymptomatic (5). In Ontario, chlamydia is the most commonly reported sexually transmitted infection. The rate is higher among females and increased between 1997 and The rates decreased between 2011 and 2013 in both Durham Region and Ontario females and levelled off among Durham Region males; however, rates increased again between 2014 and Page 28 of 56

29 Figure 20: Chlamydia age-specific incidence rates, Durham Region and Ontario, 2012 to 2016 combined Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases , Durham Female Cases 13 1,284 2, Durham Total Cases 15 1,737 3,395 1,514 1, Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rate of chlamydia was higher among females in most age groups. Reported rates were highest among youth and young adults aged 15 to 29. In this report, we excluded rates among those aged less than 10 due to small counts. Page 29 of 56

30 Figure 21: Chlamydia incidence rates in youth ages 15 to 19, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The chlamydia rate is higher among females aged 15 to 19 than males and increased between 1995 and 2011 in Durham Region and Ontario. Rates decreased between 2011 and 2013 in both Durham Region and Ontario females in this age group and levelled off among males; however, since 2014, rates have begun to increase again in both Durham Region and Ontario males and females. Page 30 of 56

31 Figure 22: Chlamydia incidence rates in young adults aged 20 to 24, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The chlamydia rate is higher among females aged 20 to 24 than males and increased between 1997 and 2011 in Durham Region and Ontario. Rates decreased between 2011 and 2013 in both Durham Region and Ontario females in this age group and levelled off among males; however, since 2014, rates have begun to increase again among both Durham Region and Ontario males and females. Page 31 of 56

32 Figure 23: Chlamydia incidence rates in young adults aged 25 to 29, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department August 2017; iphis, Ontario, 1994 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The chlamydia rate is higher among females aged 25 to 29 than males and increased between 1997 and 2011 in Durham Region and Ontario. Rates decreased between 2012 and 2014 in Durham Region females and between 2013 and 2014 in Durham Region males; however, rates have levelled off among Durham Region males and begun to increase again among Durham Region females in this age group. Rates have increased since 2013 in Ontario males and females. Page 32 of 56

33 Figure 24: Chlamydia incidence rates, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rate of chlamydia is higher most years in Pickering, Ajax, and Oshawa than Durham Region as a whole. The rate is lower in Whitby, Clarington, and the northern municipalities (Brock, Scugog and Uxbridge combined). Most municipalities showed a similar pattern as Durham Region, they increased to 2011 or 2012, decreased to 2014 then have increased since. Page 33 of 56

34 Figure 25: Chlamydia incidence rates in females aged 15 to 24, Durham Region by municipality, 2008 to 2016 Rates by Municipality Pickering Ajax Whitby Oshawa Clarington North Durham Durham Region Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2008 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (2008 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July The rate of chlamydia among females aged 15 to 24 is consistently higher in Oshawa than Durham Region as a whole. The rate is lower than Durham Region in Whitby, Clarington, and the northern municipalities (Brock, Scugog and Uxbridge combined) and similar in Ajax and Pickering. Oshawa, Whitby and Ajax showed a similar pattern as Durham Region, rates increased to 2011, decreased to 2014 then have increased since. This increase is greatest in Oshawa. Rates increased between 2014 and 2015 in North Durham, Pickering and Clarington but then decreased between 2015 and Page 34 of 56

35 Figure 26: Gonorrhea incidence rates, Durham Region and Ontario, 1994 to 2016 Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 1994 to 2016, extracted by Durham Region Health Department July 2017; and Ontario Population Estimates/Projections (1994 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Like chlamydia, gonorrhea infections are frequently asymptomatic (5). In Ontario, gonorrhea is a commonly reported sexually transmitted infection. In Ontario and Durham Region, rates of gonorrhea are higher among males compared to females. Rates of gonorrhea increased in both Durham Region and Ontario from 1997 to Rates remained relatively stable between 2006 and 2009 and began to increase again after 2009, especially among males. Page 35 of 56

36 Figure 27: Gonorrhea age-specific incidence rates, Durham Region and Ontario, 2012 to 2016 combined Rates and Cases Durham Male Rate Durham Female Rate Ontario Male Rate Ontario Female Rate Durham Male Cases Durham Female Cases Durham Total Cases Data Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, 2012 to 2016, extracted by Durham Region Health Department, August 2017; iphis, Ontario, 2012 to 2016, Public Health Ontario, Accessed August 2017; and Ontario Population Estimates/Projections (2012 to 2016), Ontario Ministry of Health and Long-Term Care, Accessed July Reported rates of gonorrhea are highest among young adults aged 20 to 24 and among females aged 15 to 19 in both Durham Region and Ontario and also among Ontario males aged 25 to 29. Rates are higher in Ontario males than Durham Region males for all age groups. Rates are similar in Ontario and Durham Region females for all age groups. For this report, we excluded rates among those aged 14 and younger due to small counts. Page 36 of 56