COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT

NEW BRUNSWICK COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004

COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 2

The New Brunswick Communicable Diseases Epidemiologic Report is published by Public Health Services. To obtain additional copies, visit the web-link: http://www.gnb.ca/0051/0053/index-e.asp or contact: Communicable Diseases Epidemiology Services Public Health Services, P.O. Box 5100, 2nd Floor, Carleton Place, Fredericton, New Brunswick Canada E3B 5G8 Telephone: 506-453-2323 Fax: 506-453-8702 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 3

TABLE OF CONTENTS EXECUTIVE SUMMARY... 6 LIST OF TABLES... 14 SEXUALLY TRANSMITTED AND BLOODBRONE INFECTIONS... 16 GENITAL CHLAMYDIA... 18 GENITAL HERPES... 20 GONORRHEA... 21 INFECTIOUS SYPHILIS... 23 HEPATITIS B... 25 HEPATITIS C... 29 HIV... 32 AIDS... 34 ADVERSE BLOOD TRANSFUSION EVENTS... 36 ENTERIC, FOOD AND WATERBORNE DISEASES... 39 AMEBIASIS... 41 CAMPYLOBACTERIOSIS... 43 CRYPTOSPORIDIOSIS... 44 GIARDIASIS... 46 LISTERIOSIS... 47 NOROVIRUS... 49 SALMONELLOSIS... 50 SHIGELLOSIS... 53 TYPHOID FEVER... 54 VEROTOXIN-PRODUCING E. COLI (VTEC) INFECTION... 56 YERSINIOSIS... 57 BOTULISM... 59 CHOLERA... 59 CYCLOSPORIDIOSIS... 59 HEPATITIS A... 59 DISEASES PREVENTABLE BY ROUTINE VACCINATION... 60 INFLUENZA... 62 PERTUSSIS... 67 INVASIVE HAEMOPHILUS INFLUENZAE TYPE B (HIB)... 69 MEASLES... 69 MUMPS... 69 RUBELLA... 69 TETANUS... 69 DISEASES TRANSMITTED BY DIRECT CONTACT AND RESPIRATORY ROUTES... 70 CLASSICAL CREUTZFELDT-JAKOB DISEASE (CJD)... 72 CHICKENPOX... 73 LEGIONELLOSIS... 75 INVASIVE MENINGOCOCCAL DISEASE (IMD)... 77 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 4

INVASIVE PNEUMOCOCCAL DISEASE (IPD)... 79 INVASIVE GROUP A STREPTOCOCCUS (GAS)... 81 GROUP B STREPTOCOCCUS IN NEWBORN... 83 TUBERCULOSIS (TB)... 84 HANTAVIRUS PULMONARY SYNDROME (HPS)... 86 LEPROSY (HANSEN S DISEASE)... 86 VECTORBORNE AND OTHER ZOONOTIC DISEASES... 87 MALARIA... 89 Q FEVER... 91 LYME DISEASE... 91 RABIES... 91 WEST NILE... 91 REFERENCES... 92 CONTRIBUTORS... 93 APPENDIX... 95 REPORTABLE COMMUNICABLE DISEASES IN NEW BRUNSWICK... 95 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 5

Summar y EXECUTIVE SUMMARY This is the first epidemiologic report summarizing all reportable Communicable Disease activity in the province of New Brunswick during 2004. This report deals specifically with diseases that are reportable in New Brunswick and focuses on those cases reported for 2004. Most descriptive data were collected through the Provincial Reportable Diseases Surveillance System while other data were collected through enhanced surveillance systems. The report is intended to assist health care professionals in understanding how communicable diseases are distributed in the province and disease trends that may be evolving to better control and prevent further spread. In this report, disease summaries are grouped in a way that reflects their major mode of transmission. Sexually Transmitted and Bloodborne Infections The 2004 incidence rate of Chlamydia (181.1 per 100,000), the most commonly reported STI in New Brunswick, was slightly lower than the rate reported in 2003. Similarly, incidence rate of gonorrhea (2.0 per 100,000) has decreased compared to the previous 3 years where a steady rate increase was observed. The 2004 rate of genital herpes (42.1 per 100,000) has gradually increased since 1999. Peak rates for all STI s mentioned above were reported among women in the 20 to 24 year age group. Conversely, the 2004 rate of Infectious Syphilis (0.5 per 100,000) peaked among males in the 20 to 24 year age group. Following a gradual increase in rates of Infectious Syphilis since 1999, no change in rate was observed between 2003 and 2004. In 2004, the rate of Hepatitis B (4.0 per 100,000) was higher than the rate reported in 2003. Incidence rates of acute Hepatitis B in 2004 (2.8 per 100,000) were at their highest rate since 1999. Overall rates of Hepatitis B have remained above the Canadian rate since 1999. The 2004 rate of Hepatitis C (30.5 per 100,000) gradually increased to its highest rate since 1999. The 2004 infection rate of HIV (0.8 per 100,000) and AIDS (0.3 per 100,000) decreased between 2003 and 2004. The most common risk factor for acquiring HIV was men having sex with men. The annual number of deaths from AIDS has declined since 1994. Apart from Hepatitis B, all other rates of sexually transmitted infections in New Brunswick were below the Canadian incidence rates. New Brunswick has participated Transfusions Transmitted Injuries Surveillance System (TTISS) since April 2003. From 2003 to 2004, there were 103 adverse transfusion reactions and the majority of them were minor reactions.

Enteric Food and Waterborne Diseases In 2004, the infection rate of campylobacteriosis (19.4 per 100,000), the most commonly reported enteric pathogen in New Brunswick, and Giardiasis (10.5 per 100,000) both declined to their lowest level since 1999. Incidence rates of Amebiasis (0.3 per 100,000), Cryptosporidiosis (1.3 per 100,000), Listeriosis (0.5 per 100,000) and Typhoid fever (0.4 per 100,000) have remained low and fairly constant since 1999. Infection rate of Verotoxin-producing E. coli (2.3 per 100,000) was low in 2004 and little change in the rate was observed between 2003 and 2004. The 2004 rate of Yersiniosis (0.4 per 100,000) declined from the rate reported in 2003. No cases of Botulism, Cholera, Cyclosporidiasis or Hepatitis A were reported in 2004. Rates of Shigellosis (0.9 per 100,000) in 2004, which included 3 travel related cases, declined compared to the rate reported in 2003. Despite an outbreak of Norovirus (2.9 per 100,000) in 2004 involving 13 cases that attended a private catered dinner where no food or water source of infection was identified, the infection rate declined compared to the rate reported for 2003. The rate of Salmonellosis (18.2 per 100,000) infection was slightly higher in 2004 compared to the 2003 rate and can be explained by an outbreak of S. typhimurium involving 22 cases that were all linked to consuming food at a restaurant where contaminated eggs were supplied. In 2004, S. typhimurium replaced S. Heidelburg as the most commonly identified serotype in the province. Salmonella was the only enteric, food and waterborne pathogen that exceeded the Canadian rate of infection for 2004 with all other infection rates remaining below the Canadian rates. Diseases Preventable by Routine Vaccination Incidence of influenza (59.8 per 100,000) for the 2004/2005 season increased compared to the previous season and is explained by an enhanced surveillance system that has lead to reporting more cases of Influenza each season. Influenza activity for the 2004/2005 season was considered moderate with 449 laboratory confirmed cases. The greatest majority of these cases (419 cases) were influenza A. Reports of a new confirmed influenza A variant (A/California/07/04(H3N2)) emerged during February 2005. A total of 24 nursing homes reported laboratory confirmed outbreaks during the season. Infection rate of Pertussis (42.6 per 100,000) reached its highest level since 1999 and was due to 3 outbreaks that occurred during 2004. New Brunswick s infection rate in 2004 exceeded the national rate. Peak infection rates occurred in the 10 to 14 year age group. Since 1999, the age group with the highest rates shifted from 0 to 4 years of age to 10 to 14 years of age. This may be due to the introduction of the accellular vaccine in 1997 which may provide better prophylaxis for infants. No cases of Haemophilus influenza Type b, Measles, Mumps, Rubella or Tetanus were reported in the province during 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 7

With the exception of Influenza and Pertussis, incidence rates of all other diseases in this grouping were below the Canadian incidence rate. Diseases Transmitted by Direct Contact and Respiratory Routes Four cases of Classical Creutzfeldt-Jakob Disease (0.5 per 100,000) were confirmed by the Public Health Agency of Canada as definite sporadic cases in 2004. Among the 230 chickenpox cases reported in 2004, 30 were lab confirmed cases (4.0 per 100,000) and 200 were without lab confirmation. Infection rates were highest in adults age 80 to 84 followed closely by children age 5 to 9. Incidence of Invasive Meningococcal Disease (0.7 per 100,000) increased slightly in 2004 compared to the rate reported in 2003. The most commonly typed serogroup was Type B. One death occurred in an elderly patient and 4 cases occurred in individuals under 20 years of age. Since 1999, only 3 cases of serogroup C were reported in the province. In 2004, New Brunswick s infection rate increased slightly above the national rate. The 2004 rate of Invasive Pneumococcal Disease (IPD) (4.0 per 100,000) increased from the 2003 rate. Rates peaked in children under 4 years of age and in those over 80 years of age. The higher number of reported cases reflects the broadened Public Health Agency of Canada (PHAC) case definition for IPD which now includes reporting all other invasive manifestations in addition to meningitis. The infection rate of Invasive Group A Streptococcus (GAS) (1.2 per 100,000) in 2004 was slightly lower than the rate reported in 2003. Among the 9 reported cases for 2004, 3 cases reported necrotizing fasciitis, 2 cases reported toxic shock syndrome and 1 adult case was fatal. Rates were highest in children under 4 years of age. Rates of Tuberculosis (1.3 per 100,000) in New Brunswick have gradually been declining since 1999. All cases occurred in the 20 to 29 year age group as well as in those over 70 years of age and 90% of cases were reported in men. A single case of fatality was associated with this disease in a 90 year old patient. One case of drug resistance (Pyrazinamide) was reported. Only one case of Legionellosis (0.1 per 100,000) was reported in 2004 and since 1994, 9 cases have been reported. In 2004, 1 case of Group B Streptococcus (0.1 per 100,000) was reported in a 1 month old infant. Since 2000, when this disease was made reportable, this has been the only case reported in the province. No cases of Hantavirus Pulmonary syndrome or Leprosy were reported in the province. Incidence rates of all diseases transmitted by direct contact and respiratory routes in this grouping were below the Canadian incidence rate except for Invasive Meningococcal disease and Classical Creutzfeld Jakob Disease. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 8

Vectorborne and Other Zoonotic Diseases Two cases of Q fever (0.3 per 100,000), 1 travel related case of malaria (0.1 per 100,000), and no cases of either Lyme disease or West Nile were reported in New Brunswick in 2004. New Brunswick has only reported 1 case of Human West Nile in 2003 and it was acquired outside the province. Incidence rate of all vectorborne and zoonotic diseases were below the Canadian incidence rate. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 9

LIST OF FIGURES Figure 1-1: Genital Chlamydia cases and rates by gender and year, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------------------------------19 Figure 1-2: 2004 Genital Chlamydia rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------19 Figure 1-3: Genital Herpes cases and rates by gender and year, New Brunswick 1999-2004 ----------------------------------------------------------------------------------------------------------------------20 Figure 1-4: 2004 Genital Herpes rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------21 Figure 1-5: Gonorrhea cases and rates by gender and year, New Brunswick 1999-2004---22 Figure 1-6: 2004 Gonorrhea rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------23 Figure 1-7: Infectious Syphilis cases and rates by gender and year, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------------------------------24 Figure 1-8: 2004 Infectious Syphilis rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------25 Figure 1-9: Hepatitis B cases and rates by gender and year, New Brunswick 1999-2004 --27 Figure 1-10: Acute Hepatitis B cases and rates by gender and year, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------------------------------27 Figure 1-11: 2004 Hepatitis B rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------28 Figure 1-12: 2004 Acute Hepatitis B rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------28 Figure 1-13: Hepatitis C cases and rates by gender and year, New Brunswick 1999-2004-30 Figure 1-14: 2004 Hepatitis C rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------31 Figure 1-15: HIV cases and rates by gender and year, New Brunswick 1999-2004 -----------33 Figure 1-16: 2004 HIV rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 ----------------------------------------------------------33 Figure 1-17: AIDS cases and rates by gender and year, New Brunswick 1999-2004 ---------35 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 10

Figure 1-18: 2004 AIDS rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------35 Figure 1-19: Types of adverse transfusion reactions reported by year---------------------------37 Figure 1-20: Adverse transfusion reactions by gender and year -----------------------------------38 Figure 2-1: Incidence rate of Amebiasis infection by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------42 Figure 2-2: 2004 Amebiasis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------------42 Figure 2-3: Incidence rate of Campylobacter infections by month and year, New Brunswick 2000-2004---------------------------------------------------------------------------------------43 Figure 2-4: 2004 Campylobacteriosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------44 Figure 2-5: Incidence rate of Cryptosporidiosis infections by month and year, New Brunswick 2000-2004 ---------------------------------------------------------------------------------------45 Figure 2-6: 2004 Cryptosporidiosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------45 Figure 2-7: Incidence rate of Giardiosis infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------46 Figure 2-8: 2004 Giardiosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------------47 Figure 2-9: Incidence rate of Listeriosis infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------48 Figure 2-10: 2004 Listeriosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------------48 Figure 2-11: Incidence rate of Norovirus infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------49 Figure 2-12: Norovirus rates by age group, gender and overall rate, New Brunswick 200450 Figure 2-13: Incidence rate of Salmonellosis infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------51 Figure 2-14: 2004 Salmonellosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 ----------------------------------------------------------52 Figure 2-15: Incidence rate of the 5 most prevalent serotypes in New Brunswick, 2002-2004 ---------------------------------------------------------------------------------------------------------------52 Figure 2-16: Incidence rate of Shigellosis infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------53 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 11

Figure 2-17: 2004 Shigellosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------------54 Figure 2-18: Incidence rate of Typhoid Fever infections by month and year, New Brunswick 2000-2004 ---------------------------------------------------------------------------------------55 Figure 2-19: 2004 Typhoid Fever rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 ----------------------------------------------------------55 Figure 2-20: Incidence rate of Verotoxin-Producing E. coli (VTEC) infections by month and year, New Brunswick 2000-2004-------------------------------------------------------------------------56 Figure 2-21: 2004 Verotoxin-Producing E. coli (VTEC) infection rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-----------------57 Figure 2-22: Incidence rate of Yersiniosis infections by month and year, New Brunswick 2000-2004 -------------------------------------------------------------------------------------------------------58 Figure 2-23: 2004 Yersiniosis Infection rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003----------------------------------------58 Figure 3-1: Incidence rate of laboratory confirmed influenza by month and season, New Brunswick 2000/2001-2004/2005-------------------------------------------------------------------------64 Figure 3-2: Infection rate of 2004/2005 Influenza season by month, compared to seasonal average, New Brunswick 2000/2001-2003/2004-----------------------------------------------------65 Figure 3-3: Rates of laboratory confirmed influenza by age group, gender and overall rate, New Brunswick 2004/05 season compared to the 4 year seasonal average rate, 2000/01-2003/04 -----------------------------------------------------------------------------------------------65 Figure 3-4: Incidence rate of laboratory confirmed Influenza by type and season compared to the seasonal rate of infection, New Brunswick 2000/2001-2004/2005 -------------------66 Figure 3-5: Laboratory confirmed influenza cases by type and week reported compared to weekly Influenza-Like-Illness (ILI) consultations reported by FluWatch clinical sites for New Brunswick 2004-2005 season-----------------------------------------------------------------66 Figure 3-6: Incidence rates of Pertussis infection by month and year, New Brunswick 1999-2004 -------------------------------------------------------------------------------------------------------68 Figure 3-7: 2004 rates of Pertussis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-------------------------------------------------------------68 Figure 4-1: Cases and rates of Creutzfeldt - Jakob Disease by year and type, New Brunswick 1998-2004 ---------------------------------------------------------------------------------------73 Figure 4-2: Incidence rates of laboratory confirmed Chickenpox infections by month and year, New Brunswick 1999-2004-------------------------------------------------------------------------74 Figure 4-3: 2004 rates of laboratory confirmed Chickenpox by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-----------------------75 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 12

Figure 4-4: Incidence rates of Legionellosis infections by month and year, New Brunswick 1999-2004 -------------------------------------------------------------------------------------------------------76 Figure 4-5: 2004 rates of Legionellosis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 ----------------------------------------------------------76 Figure 4-6: Incidence rates of Invasive Meningococcal infections by month and year, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------78 Figure 4-7: 2004 Invasive Meningococcal disease rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 ---------------------------------78 Figure 4-8: Number of reported cases of invasive meningococcal disease by serogroup and year, New Brunswick 1999-2004-------------------------------------------------------------------79 Figure 4-9: Incidence rates of Invasive Pneumococcal infections by month and year, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------80 Figure 4-10: 2004 rates of Invasive Pneumococcal disease by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-----------------------81 Figure 4-11: Incidence rates of Invasive Group A Streptococcal infections by month and year, New Brunswick 2000-2004-------------------------------------------------------------------------82 Figure 4-12: 2004 rates of Invasive Group A Streptococcal disease by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003-----------------83 Figure 4-13: Incidence rates of Tuberculosis infections by month and year, New Brunswick 2000-2004 ---------------------------------------------------------------------------------------85 Figure 4-14: 2004 rates of Tuberculosis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003------------------------------------------------------85 Figure 5-1: Number of cases of Malaria by gender and overall incidence rate, New Brunswick 1999-2004 ---------------------------------------------------------------------------------------90 Figure 5-2: 2004 incidence rate of Malaria Infection by age group, gender and overall rate compared to 8 year average, New Brunswick 1996-2003----------------------------------------90 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 13

List of Tables LIST OF TABLES Table 1-1: Cases and rates* of selected STIs in New Brunswick by Regional Health Authority, 2004 ------------------------------------------------------------------------------------------------17 Table 1-2: Rates* of reported cases of selected STIs in New Brunswick and Canada, 1999-2004 ---------------------------------------------------------------------------------------------------------------18 Table 1-3: Risk factors for reported cases of acute and chronic Hepatitis B by gender, New Brunswick 2004 -----------------------------------------------------------------------------------------------29 Table 1-4: Distribution of risk factors* among reported cases of Hepatitis C by gender, New Brunswick 2004 ----------------------------------------------------------------------------------------31 Table 1-5: Distribution of risk factors* among reported cases of HIV by gender, New Brunswick, 1994-2004---------------------------------------------------------------------------------------34 Table 1-6: Number of AIDS cases by year of diagnosis and number of AIDS death reports by year of diagnosis and year of death, New Brunswick 1994-2004-------------------------36 Table 1-7: Adverse transfusion reactions by severity of outcome, New Brunswick 2003-2004 ---------------------------------------------------------------------------------------------------------------37 Table 2-1: Table 1: Cases and rates* of enteric food and waterborne diseases in New Brunswick by Regional Health Authority, 2004-----------------------------------------------------40 Table 2-2: Rates* of reported cases of enteric, food and waterborne diseases in New Brunswick and Canada, 1999-2004 ---------------------------------------------------------------------41 Table 3-1: Cases and rates* of vaccine preventable diseases reported in New Brunswick, by Regional Health Authority, 2004 --------------------------------------------------------------------61 Table 3-2: Rates* of reported cases of vaccine preventable diseases reported in New Brunswick and Canada, 1999-2004 ---------------------------------------------------------------------62 Table 3-3: Laboratory Confirmed Influenza cases and rates* by Regions, for New Brunswick, 2004/2005 surveillance season----------------------------------------------------------67 Table 4-1: Cases and rates* of diseases transmitted by direct contact or respiratory routes in New Brunswick, by Regional Health Authority 2004 ------------------------------------------71 Table 4-2: Rates* of reported cases of diseases transmitted by direct contact or respiratory routes in New Brunswick and Canada, 1999-2004 --------------------------------72 Table 4-3: Number of reported cases of Tuberculosis by anatomic site and country of origin, New Brunswick 2004 ------------------------------------------------------------------------------86 Table 5-1: Cases and rates* of vectorborne and zoonotic diseases reported in New Brunswick, by Regional Health Authority 2004-----------------------------------------------------88 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 14

Table 5-2: Rates* of reported cases of vectorborne and zoonotic diseases reported in New Brunswick and Canada, 1999-2004 ---------------------------------------------------------------------89 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 15

SEXUALLY TRANSMITTED AND BLOODBORNE INFECTIONS Chlamydia 69.3% Gonorrhea 0.8% Hepatitis C 11.7% Hepatitis B 1.5% AIDS 0.1% HIV 0.3% Herpes 16.1% Syphilis 0.2% COMMUNICABLE DISSEASSESS EPIDEMIOLOGI IC REPORTT 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 16

SEXUALLY TRANSMITTED AND BLOODBORNE INFECTIONS This section focuses on diseases that are transmitted by body fluids including blood, semen, vaginal secretions, saliva and breast milk. 1 This section also includes data on adverse blood transfusion events collected through the Transfusion Transmitted Injuries Surveillance System. Sexually transmitted infections (STIs) are caused by a variety of pathogens including bacteria, viruses, protozoa and ectoparasites. Transmission occurs from person to person through direct sexual contact or through other methods of direct entry into the bloodstream such as needle use, blood transfusions or perinatally from mother to infant. 2 Most data in this report were collected through the Provincial Reportable Diseases Surveillance System while data on Hepatitis B, Hepatitis C, HIV (Human Immunodeficiency Virus) and AIDS (Acquired Immune Deficiency Syndrome) were collected through enhanced surveillance systems. Incidence rates were calculated using the 2004 population estimates from Statistics Canada. 3 Incidence rates for each of the diseases in this grouping were reported for New Brunswick and Canada in the following 2 tables. 4 Table 1-1: Cases and rates* of selected STIs in New Brunswick by Regional Health Authority, 2004 * Rates calculated per 100,000 The table above outlines the distribution of the disease among the Regional Health Authorities in New Brunswick COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 17

Table 1-2: Rates* of reported cases of selected STIs in New Brunswick and Canada, 1999-2004 * Rates calculated per 100,000 ** Cases not reported nationally With the exception of Hepatitis B, the 2004 New Brunswick rate of infection for all the diseases in this group were below the Canadian infection rate The infection rate of Hepatitis B in New Brunswick has exceeded the Canadian rate of infection since 1999 Genital Chlamydia Chlamydia continues to be the most commonly reported STI in New Brunswick accounting for 63.9% of all STI reports. Cases and Rates by Gender (1999-2004) (Figure 1-1) There were 1361 cases reported (181.1 per 100,000) Number of female cases continued to exceed number of male cases and accounted for 71% (961 cases) of all reported infections The gap seen in the incidence rate between the genders is gradually narrowing as a much less painful urine test to diagnose the disease in males becomes more available In 2004, the overall incidence of infection decreased slightly representing a difference of 19 cases from the 2003 total of 1380 cases Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-2) Infection rates peaked in the 20 to 24 year age group (1188.9 per 100,000) Rates seen in each age group for 2004 closely mirrored the 5 year average rate COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 18

1000 275 900 250 800 225 # of Cases 700 600 500 400 300 200 175 150 125 100 75 200 50 100 25 0 1999 2000 2001 2002 2003 2004 Male Cases 319 320 312 369 407 400 Female Cases 811 912 890 944 973 961 Male Rates 85.9 86.2 84.2 99.6 109.8 107.9 Female Rates 214.0 240.5 234.7 248.6 255.9 252.5 0 Figure 1-1: Genital Chlamydia cases and rates by gender and year, New Brunswick 1999-2004 1800.0 1600.0 1400.0 1200.0 1000.0 800.0 600.0 400.0 200.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 280.3 753.7 345.9 118.8 46.4 6.3 9.6 0.0 0.0 5.5 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 71 197 83 30 13 2 3 0 0 1 0 0 0 0 0 0 Female Rate 0.0 5.0 21.9 1531.2 1653.3 496.0 164.6 54.4 6.3 6.4 6.9 8.0 5.4 0.0 0.0 0.0 0.0 0.0 0.0 Female Cases 0 1 5 364 405 120 42 15 2 2 2 2 1 0 0 0 0 0 0 2004 Rate 0.0 2.4 10.6 885.8 1,188.9 421.3 141.8 50.4 6.3 8.0 3.5 4.0 5.4 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.0 0.0 16.1 808.6 1115.7 342.6 100.2 35.9 19.9 5.0 4.8 1.3 1.9 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-2: 2004 Genital Chlamydia rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 19

Genital Herpes There were 316 cases reported (42.1 per 100,000) which accounted for 16.1% of all STI reports Cases and Rates by Gender (1999-2004) (Figure 1-3) The frequency of female cases continued to exceed the frequency of male cases and represented 77% of all reported infections The overall rate among both genders has gradually increased over the last 5 years In 2004, the incidence rate was almost 1.2 fold higher than the reported rate in 2003 (36.4 per 100,000) representing an increase of 43 cases from the 2003 total of 273 cases Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-4) Infection rates continued to peaked in the 20-24 year age group (150.1 per 100,000) Rates seen in each age group for 2004 closely mirrored the 5 year average rate 250 70.0 60.0 200 50.0 150 40.0 # of Cases 100 30.0 20.0 50 10.0 0 1999 2000 2001 2002 2003 2004 0.0 Male Cases 37 41 55 66 54 73 Female Cases 146 197 164 210 219 243 Male Rates 10.0 11.0 14.8 17.8 14.6 19.7 Female Rates 38.5 51.9 43.2 55.3 57.6 63.9 Figure 1-3: Genital Herpes cases and rates by gender and year, New Brunswick 1999-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 20

275.0 250.0 225.0 200.0 175.0 150.0 125.0 100.0 75.0 50.0 25.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 4.8 0.0 27.6 57.4 41.7 23.8 50.0 15.7 19.2 10.7 0.0 21.9 7.2 0.0 0.0 0.0 35.7 0.0 Male Cases 0 1 0 7 15 10 6 14 5 6 3 0 4 1 0 0 0 1 0 Female Rate 5.7 0.0 8.8 231.4 249.0 161.2 105.8 47.2 40.9 22.4 17.3 35.9 21.6 13.4 7.4 8.3 20.7 17.5 0.0 Female Cases 1 0 2 55 61 39 27 13 13 7 5 9 4 2 1 1 2 1 0 2004 Rate 2.8 2.4 4.2 126.3 150.1 101.7 65.0 48.6 28.3 20.8 14.1 18.0 21.7 10.4 4.0 4.8 12.9 23.5 0.0 5 Year Average 0.0 0.5 3.3 81.7 122.6 79.2 55.9 32.7 22.5 14.1 16.5 8.8 9.1 5.8 2.4 5.8 4.0 0.0 15.0 Figure 1-4: 2004 Genital Herpes rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Gonorrhea There were 15 reported cases (2.0 per 100,000) which accounted for 0.8% of all STI cases Cases and Rates by Gender (1999-2004) (Figure 1-5) There was very little difference in the reports of gonorrhea between the genders with a slightly higher number of reports (53%) from men (2.0 per 100,000) Overall rates from 2004 decreased compared to the previous 3 years where a steady rate increase was observed. Infection rate in 2004 was 2.4 fold lower than the rate reported in 2003 (4.7 per 100,000) representing a difference of 20 cases from the 2003 total of 35 cases. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 21

Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-6) Among females, 57% of reports were in the 20 to 24 year age group and accounted for overall rates peaking in this age group Infection rates for males were higher than females for all age groups except 15 to 19 and 20 to 24 year olds. 20 6.0 18 16 5.0 14 4.0 12 # of Cases 10 3.0 8 6 2.0 4 2 1.0 0 1999 2000 2001 2002 2003 2004 0.0 Male Cases 6 10 7 13 16 8 Female Cases 5 1 5 17 19 7 Male Rates 1.6 2.7 1.9 3.5 4.3 2.2 Female Rates 1.3 0.3 1.3 4.5 5.0 1.8 Figure 1-5: Gonorrhea cases and rates by gender and year, New Brunswick 1999-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 22

18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 3.9 0.0 8.3 7.9 3.6 3.1 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 1 0 2 2 1 1 1 0 0 0 0 0 0 0 0 0 Female Rates 0.0 0.0 0.0 8.4 16.3 0.0 0.0 3.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Cases 0 0 0 2 4 0 0 1 0 0 0 0 0 0 0 0 0 0 0 2004 Rates 0.0 0.0 0.0 6.1 7.9 4.2 3.9 3.6 1.6 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.0 0.0 0.0 5.9 14.7 8.1 4.2 1.0 2.2 1.0 0.4 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-6: 2004 Gonorrhea rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Infectious Syphilis Infectious Syphilis is defined as infections less than 1 year old and this includes primary, secondary and early latent infections. 5 There were 4 cases reported (0.5 per 100,000) accounting for 0.2% of all STI reports Cases and Rates by Gender (1999-2004) (Figure 1-7) A higher frequency of infection was reported in males accounting for 75% (3 cases) of all reported cases Distribution of cases between the genders was the same for 2003 as it was for 2004 Following a gradual increase in Infectious Syphilis rates since 1999, little change in rate was observed between 2003 (0.5 per 100,000) and 2004 when 4 cases were reported in both years COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 23

Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-8) Among males, the highest rates were seen in the 20 to 24 year age group (7.7/100,000) representing 66% of all male cases The age group with the highest incidence rates shifted to a younger age group (20 to 24 year olds) in 2004 compared to 2003 when 30 to 34 (2.0 per 100,000) year olds experienced the highest infection rates The 2004 infection rate peaked above the 5 year average rate for the 20 to 24, 45 to 49 and 75 to79 year age groups 4 1.0 0.9 0.8 3 0.7 0.6 # of Cases 2 0.5 0.4 1 0.3 0.2 0.1 0 1999 2000 2001 2002 2003 2004 Male Cases 0 0 0 1 3 3 Female Cases 0 0 0 1 1 1 Male Rates 0.0 0.0 0.0 0.3 0.8 0.8 Female Rates 0.0 0.0 0.0 0.3 0.3 0.3 Figure 1-7: Infectious Syphilis cases and rates by gender and year, New Brunswick 1999-2004 0.0 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 24

9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 0.0 7.7 0.0 0.0 0.0 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 0 2 0 0 0 0 1 0 0 0 0 0 0 0 0 0 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 8.3 0.0 0.0 0.0 Female Cases 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 2004 Rate 0.0 0.0 0.0 0.0 3.9 0.0 0.0 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 4.8 0.0 0.0 0.0 5 Year Average 0.0 0.0 0.0 0.0 0.4 0.4 0.4 0.3 0.3 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-8: 2004 Infectious Syphilis rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Hepatitis B There were 30 new cases of Hepatitis B reported (4.0 per 100,000) accounting for 1.5% of all STI reports Among these cases, 7 were diagnosed with acute Hepatitis B and 23 were diagnosed as Hepatitis B carriers Overall, Hepatitis B cases were more frequently reported among men who accounted for 86% of the acute Hepatitis B reports and 57% of the Hepatitis B carrier cases Infection rate for acute Hepatitis B (2.8 per 100,000) peaked in Region 2 representing 5 male cases. Four of these 5 cases, had known risk factors. All 4 cases reported having sex with multiple male partners. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 25

Hepatitis B Cases and Rates by Gender (1999-2004) (Figure 1-9) Overall incidence rates of Hepatitis B continued to decline to 2003 when the lowest rates were reported In 2004, the overall rate of Hepatitis B was almost 1.6 fold higher than the rate reported in 2003 (2.5 per 100,000) representing an increase of 11 cases from the 2003 total of 19 cases Acute Hepatitis B Cases and Rates by Gender (1999-2004) (Figure 1-10) Incidence rates of acute Hepatitis B remained fairly constant from 1999 and reached their lowest level in 2003 when no cases were reported. Rates of acute Hepatitis B are now at their highest level in the last 5 years Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-11) Rates peaked in the 25 to 29 year age group (14.5 per 100,000) and 2 male children in the 5 to 9 year age group (9.5 per 100,000) were reported as Hepatitis B carriers Acute Hepatitis B Rates by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-12) Infection rates for acute Hepatitis cases peaked in the age group 20-34 Risk Factors for Reported Cases of Acute and Chronic Hepatitis B Cases by Gender (2004) (Table 1-3) The most commonly reported risk factor for acquiring acute Hepatitis B among the 6 male cases with a known risk factor was dental surgery. Among the 13 carrier cases with known risk factors, being born in an endemic country was most commonly reported COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 26

45 12.0 40 10.0 35 30 8.0 25 # of Cases 6.0 20 15 4.0 10 2.0 5 0 1999 2000 2001 2002 2003 2004 0.0 Male Cases 43 25 21 13 12 19 Female Cases 16 17 6 17 7 11 Male Rates 11.6 6.7 5.7 3.5 3.2 5.1 Female Rates 4.2 4.5 1.6 4.5 1.8 2.9 Figure 1-9: Hepatitis B cases and rates by gender and year, New Brunswick 1999-2004 8 2.0 6 1.5 # of Cases 4 1.0 2 0.5 0 1999 2000 2001 2002 2003 2004 Male Cases 5 4 5 5 0 6 Female Cases 3 3 2 5 0 1 Male Rates 1.3 1.1 1.3 1.3 0.0 1.6 Female Rates 0.8 0.8 0.5 1.3 0.0 0.3 Figure 1-10: Acute Hepatitis B cases and rates by gender and year, New Brunswick 1999-2004 0.0 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 27

18.0 16.0 14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 9.5 0.0 0.0 7.7 16.7 7.9 0.0 0.0 16.0 3.6 4.0 0.0 7.2 0.0 0.0 17.1 0.0 0.0 Male Cases 0 2 0 0 2 4 2 0 0 5 1 1 0 1 0 0 1 0 0 Female Rate 0.0 0.0 0.0 0.0 4.1 12.4 7.8 3.6 3.1 0.0 0.0 4.0 0.0 6.7 0.0 8.3 0.0 0.0 0.0 Female Cases 0 0 0 0 1 3 2 1 1 0 0 1 0 1 0 1 0 0 0 2004 Rate 0.0 4.9 0.0 0.0 5.9 14.5 7.9 1.8 1.6 8.0 1.8 4.0 0.0 6.9 0.0 4.8 6.4 0.0 0.0 5 Year Average 0.5 0.0 0.8 1.9 9.9 11.4 7.5 5.8 6.3 6.5 7.9 1.0 3.2 3.6 0.8 1.9 1.4 2.4 0.0 Figure 1-11: 2004 Hepatitis B rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 0.0 7.7 8.3 7.9 0.0 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 0 2 2 2 0 0 1 0 0 0 0 0 0 0 0 0 Female Rate 0.0 0.0 0.0 0.0 4.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Cases 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2004 Rate 0.0 0.0 0.0 0.0 3.9 4.2 3.9 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.5 0.0 0.0 0.0 2.0 2.7 1.5 1.0 1.6 1.0 0.7 0.0 1.3 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-12: 2004 Acute Hepatitis B rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 28

Table 1-3: Risk factors for reported cases of acute and chronic Hepatitis B by gender, New Brunswick 2004 * All risk factors are recorded; one person may have more than one risk factor identified. Hepatitis C There were 229 newly diagnosed cases (30.5 per 100,000) which accounted for 11.7% of all STI reports Case numbers in Region 7 increased in 2004 due to the opening of a methadone clinic where routine testing of Hepatitis C occurred prior to treatment. Since the opening of this clinic, others have been opened in New Brunswick and infection rates are expected to increase over the next few years Cases and Rates by Gender (1999-2004) (Figure 1-13) The overall incidence rate of Hepatitis C over the last 5 years gradually increased Numbers of male cases continued to exceed female cases and accounted for 62% (141 cases) of all reported cases The gap seen in the incidence rate between the genders is narrowing as female infection rate increases The incidence rate reported in 2004 was slightly higher than the rate reported in 2003 (28.4 per 100,000) representing an increase of 16 cases from the 2003 total of 213 cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 29

Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-14) In 2004, incidence rates in males exceed those in females in all age groups except in the 15 to 19 and 20 to 24 year age groups as well as individuals over 85 years of age In 2004, the age group with the highest overall incidence rate was 25 to 29 year olds The age group with the highest incidence rate shifted to a younger age group in 2004 compared to the 5 year average where infection rates were highest in the 35 to 39 year age group Risk Factors for Reported Cases by Gender (2004) (Table 1-4) In 2004, the most commonly reported risk factors for acquiring Hepatitis C, among the male cases with a known risk factor was injection drug use (86%) Among the female cases with a known risk factor, the most commonly reported risk factor was heterosexual activity (83%) 160 45.0 140 40.0 120 35.0 100 30.0 # of Cases 80 25.0 20.0 60 15.0 40 10.0 20 5.0 0 1999 2000 2001 2002 2003 2004 0.0 Male Cases 125 147 140 122 134 141 Female Cases 45 66 39 48 79 88 Male Rates 33.6 39.6 37.8 32.9 36.1 38.0 Female Rates 11.9 17.4 10.3 12.6 20.8 23.1 Figure 1-13: Hepatitis C cases and rates by gender and year, New Brunswick 1999-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 30

120.0 100.0 80.0 60.0 40.0 20.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 11.8 57.4 116.7 87.1 57.1 62.7 51.3 42.9 20.0 16.4 7.2 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 3 15 28 22 16 20 16 12 5 3 1 0 0 0 0 0 Female Rate 0.0 0.0 0.0 29.4 77.6 49.6 58.8 25.4 28.3 32.0 13.9 12.0 0.0 0.0 0.0 0.0 0.0 17.5 28.9 Female Cases 0 0 0 7 19 12 15 7 9 10 4 3 0 0 0 0 0 1 1 2004 Rate 0.0 0.0 0.0 20.4 67.1 83.0 72.9 41.4 45.6 41.7 28.2 16.0 8.2 3.5 0.0 0.0 0.0 11.7 21.5 5 Year Average 1.6 0.0 0.0 11.7 37.6 43.3 48.3 50.6 45.6 49.6 23.3 12.9 7.5 4.3 7.3 3.9 11.2 2.4 10.1 Figure 1-14: 2004 Hepatitis C rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Table 1-4: Distribution of risk factors* among reported cases of Hepatitis C by gender, New Brunswick 2004 * All risk factors are recorded; one person may have more than one risk factor identified. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 31

HIV There were 6 cases reported (0.8 per 100,000) which accounted for 0.3% of all STI reports Cases and Rates by Gender (1999-2004) (Figure 1-15) Males accounted for 67% (4 cases) of all HIV cases While incidence rates for females remained stable over the last 5 years, rates for males have decreased since 2000 Infection rate for 2004 was approximately 1.6 fold lower than the 2003 rate (1.3 per 100,000) representing a difference of 4 cases from the 2003 total of 10 cases Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-16) In 2004, the age group with the highest incidence rate was 20 to 24 year olds Overall incidence rates shifted to a younger age group in 2004 compared to the 5 year average where infection rates were highest in the 35 to 39 year age group Risk Factors for Reported Cases by Gender (1994-2004) (Table 1-5) The most commonly reported risk factor for acquiring HIV among the male cases with a known risk factor was having sex with other men (66%). Among the female cases with a known risk factor, the most commonly reported risk factor was having sex with men (93%) COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 32

14 3.5 12 3 10 2.5 8 2 # of Cases 6 1.5 4 1 2 0.5 0 1999 2000 2001 2002 2003 2004 Male Cases 5 12 8 8 7 4 Female Cases 0 2 3 1 3 2 Male Rates 1.3 3.2 2.2 2.2 1.9 1.1 Female Rates 0 0.5 0.8 0.3 0.8 0.5 Figure 1-15: HIV cases and rates by gender and year, New Brunswick 1999-2004 0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 0.0 3.8 0.0 4.0 3.6 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 0 1 0 1 1 0 1 0 0 0 0 0 0 0 0 0 Female Rate 0.0 0.0 0.0 0.0 4.1 4.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Cases 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 2004 Rate 0.0 0.0 0.0 0.0 3.9 2.1 2.0 1.8 0.0 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.5 0.0 0.0 0.0 2.4 2.4 2.7 4.2 3.2 0.3 1.1 1.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-16: 2004 HIV rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 33

Table 1-5: Distribution of risk factors* among reported cases of HIV by gender, New Brunswick, 1994-2004 * All risk factors for any one case are recorded; one person may have more than one risk factor identified. AIDS There were 2 cases reported (0.3 per 100,000) accounting for 0.1% of all STI reports Cases and Rates by Gender (1999-2004) (Figure 1-17) Overall infection rates of AIDS has declined over the last 5 years Since 2000, no cases have been reported in females The rate in 2004 was approximately 2.3 fold lower than the reported rate in 2003 (0.7 per 100, 000) representing a difference of 3 cases from the 2003 total of 5 cases Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 1-18) In 2004, both reported cases were males, in the 35 to 39 year age group Number of Yearly Death Reports (1994-2004) (Table 1-6) The annual number of deaths reported in AIDS cases has declined since 1994 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 34

8 2.0 1.8 1.6 6 1.4 1.2 # of Cases 4 1.0 0.8 2 0.6 0.4 0.2 0 1999 2000 2001 2002 2003 2004 0.0 Male Cases 7 3 3 2 6 2 Female Cases 1 1 0 0 0 0 Male Rates 1.9 0.8 0.8 0.5 1.6 0.5 Female Rates 0.3 0.3 0.0 0.0 0.0 0.0 Figure 1-17: AIDS cases and rates by gender and year, New Brunswick 1999-2004 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 7.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Male Cases 0 0 0 0 0 0 0 2 0 0 0 0 0 0 0 0 0 0 0 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Cases 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 2004 Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.5 0.0 0.0 0.0 0.4 0.0 0.7 1.3 2.2 1.7 0.4 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 1-18: 2004 AIDS rates and cases by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 35

Table 1-6: Number of AIDS cases by year of diagnosis and number of AIDS death reports by year of diagnosis and year of death, New Brunswick 1994-2004 Adverse Blood Transfusion Events Transfusions Transmitted Injuries Surveillance System (TTISS) collects data on adverse events, infectious and non-infectious, resulting from the therapeutic use of blood and blood products. The system is a nation-wide, hospital based surveillance system in which New Brunswick participate since April 2003. The TTISS is an evolving and developing surveillance system and it will take a few years of data collection before the incidence of adverse transfusion events can be properly estimated Adverse reactions are investigated and reported by hospitals in New Brunswick where adverse events occur. Reported adverse reactions are categorized as minor, moderate and severe. From 2003 to 2004, participating hospitals transfused 55,250 units of blood components of which red blood cell accounted for 68.1% (for the purpose of TTISS, blood components are classified as Red Blood Cells, Fresh Frozen Plasma, Fresh Frozen Plasma-Apheresed, Platelets, Platelets-Apheresed, Cryoprecipitate and Other) COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 36

Types of adverse transfusion reactions reported by year (Figure 1-19) The majority of adverse transfusion reactions were minor reactions 100 90 80 70 60 50 40 30 20 10 0 Minor Reactions Others 2004 50 2 2 4 1 2003 38 6 Hypotensive Transfusion Reaction Acute Hemolytic Transfusion Reaction Figure 1-19: Types of adverse transfusion reactions reported by year Unknown Table 1-7: Adverse transfusion reactions by severity of outcome, New Brunswick 2003-2004 Serious adverse transfusion reactions accounted for 5.8% of all reported cases. These included 4 acute hemolytic reactions and 2 hypotensive reactions COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 37

Adverse transfusions reactions by gender and year (Figure 1-20) There was no significant difference in the number of adverse transfusion reactions reported by gender. The number of adverse reactions among females exceeded the number of reactions among males for only 8 cases. 35 30 25 20 15 10 5 0 2003 2004 Male 21 26 Female 23 32 Unknown 0 1 Figure 1-20: Adverse transfusion reactions by gender and year COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 38

Chapter 2 ENTERIC,, FOOD AND WATERBORNE DISEASES Salmonellosis 31.9% Typhoid Fever 0.7% Shigellosis 1.6% Yersinia 0.7% Verotoxigenic E.coli 4.0% Amebiasis 0.5% Botulism 0.0% Campylobacteriosis 34.0% Cholera 0.0% Norovirus 5.1% Listeria 0.9% Hepatitis A 0.0% Giardiasis 18.4% Cyclosporiasis 0.0% Crytosporidiosis 2.3% COMMUNICABLE DISSEASSESS EPIDEMIOLOGI IC REPORTT 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 39

ENTERIC, FOOD AND WATERBORNE DISEASES This section focuses on diseases caused by infectious agents that are primarily shed in feces and can contaminate food or drinking water. They are transmitted through the consumption of infected food or water and in rare circumstances through direct or fecal-oral contact with an infected person. 6 The summarized data were collected through the Provincial Reportable Diseases Surveillance System. Incidence rates were calculated using the 2004 population estimates from Statistics Canada. 3 Incidence rates for each of the diseases in this grouping were reported for New Brunswick and Canada in the following 2 tables. 4 Table 2-1: Table 1: Cases and rates* of enteric food and waterborne diseases in New Brunswick by Regional Health Authority, 2004 * Rates calculated per 100,000 The table above outlines the distribution of the disease among the Regional Health Authorities in New Brunswick COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 40

Table 2-2: Rates* of reported cases of enteric, food and waterborne diseases in New Brunswick and Canada, 1999-2004 * Rates calculated per 100,000 ** Removed from National Surveillance *** Cases not reported in New Brunswick **** Cases not reported nationally With the exception of Salmonellosis, the 2004 New Brunswick rate of infection for all the diseases in this group were below the Canadian infection rate The New Brunswick infection rate of Salmonellosis also exceeded the Canadian rate in 2003. Amebiasis There were 2 cases reported (0.3 per 100,000) which accounted for 0.5% of all enteric pathogens reported Incidence Rate of Infection by Month (2000-2004) (Figure 2-1) Both cases were reported in September Rates of infection have remained fairly constant over since 2000 Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-2) A male case was reported in the 5 to 9 year age group and a female case was reported in the 30 to 34 year age group COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 41

0.35 0.30 0.25 0.20 0.15 0.10 0.05 2000 2001 2002 2003 0.00 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 2002 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2003 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 Figure 2-1: Incidence rate of Amebiasis infection by month and year, New Brunswick 2000-2004 5.0 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 4.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 3.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 0.0 2.4 0.0 0.0 0.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.5 0.9 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 2-2: 2004 Amebiasis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 42

Campylobacteriosis This disease was the most commonly reported among enteric diseases with 146 cases reported (19.4 per 100,000). It accounted for 34.0% of all enteric agents reported The 2004 rate was approximately 1.4 fold lower than the rate in 2003 (27.2 per 100,000) representing a difference of 58 cases from the 2003 total of 204 cases With the exception of 2004, Region 4 has had the highest infection rate compared to all other regions. This may be explained by the anecdotal evidence which suggests a strong correlation between the high rates in Region 4 and the presence of a heavy poultry industry in this region. Incidence Rate of Infection by Month (2000-2004) (Figure 2-3) As expected, the rates were higher in the summer months and lower in winter months Rates of infection have continued to decline to the lowest level since 2000 Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-2) Infection rates peaked in the 15 to19 year age group. Males accounted for 55% (80 cases) of all cases 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 1.9 1.9 1.5 1.9 1.2 2.1 2.4 5.6 3.3 2.7 3.9 1.6 2001 1.7 1.5 1.3 1.9 2.3 2.9 2.8 6.7 3.2 3.9 3.1 2.4 2002 2.4 1.9 2.4 1.7 1.6 2.1 2.0 1.5 3.2 3.5 2.7 2.7 2003 0.9 2.0 1.9 1.5 2.7 1.9 4.0 3.2 2.3 2.5 2.7 1.7 2004 1.6 1.1 1.1 2.0 0.9 1.9 2.5 2.3 2.7 1.1 0.0 1.3 Figure 2-3: Incidence rate of Campylobacter infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 43

50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 21.5 4.8 8.3 47.4 23.0 8.3 23.8 28.6 37.6 32.1 10.7 16.0 16.4 21.6 17.3 11.4 17.1 0.0 0.0 2004 Female Rate 11.4 15.0 4.4 25.2 28.6 28.9 15.7 18.1 12.6 19.2 10.4 8.0 37.7 13.4 7.4 16.6 20.7 17.5 28.9 2004 Rate 16.6 9.8 6.4 36.7 25.7 18.7 19.7 23.4 25.1 25.6 10.6 12.0 27.2 17.3 12.0 14.4 19.3 11.7 21.5 5 Year Avg 41.1 18.8 11.5 28.1 46.2 37.3 25.5 29.1 29.4 28.5 30.7 32.1 29.8 19.4 38.2 25.1 15.5 28.1 15.0 Figure 2-4: 2004 Campylobacteriosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Cryptosporidiosis There were 10 cases reported (1.3 per 100,000) which accounted for 2.3% of all enteric diseases reported The 2004 rate was approximately 1.5 fold lower than the rate in 2003 (2.0 per 100,000) representing a difference of 5 cases from the 2003 total of 15 cases Region 2 had the highest rates (4.0 per 100,000) compared to all other regions. This represented 7 reported cases that were determined to be sporadic clusters Incidence Rate of Infection by Month (2000-2004) (Figure 2-5) Overall infection rates peaked in summer months (July through to September) when 9 cases were identified representing 90% of all cases Annual reporting has remained fairly constant over the last 5 years Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-6) Reporting rate was highest in children under 10 years of age. Prior exposure to infection is thought to contribute some degree of immunity to older age groups Males accounted for 60% (6 cases) of all cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 44

1.0 0.8 0.6 0.4 0.2 2000 2001 2002 2003 0.0 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.8 0.0 0.1 0.1 0.1 0.5 0.9 0.3 0.0 0.1 0.0 0.1 2001 0.0 0.3 0.3 0.0 0.0 0.1 0.0 0.1 0.5 0.1 0.0 0.4 2002 0.0 0.1 0.0 0.3 0.1 0.0 0.0 0.1 0.0 0.4 0.1 0.1 2003 0.0 0.0 0.3 0.3 0.3 0.0 0.0 0.3 0.8 0.1 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.7 0.3 0.0 0.0 0.1 Figure 2-5: Incidence rate of Cryptosporidiosis infections by month and year, New Brunswick 2000-2004 25.0 20.0 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 21.5 4.8 0.0 3.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 5.7 5.0 0.0 0.0 0.0 4.1 0.0 0.0 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 13.8 4.9 0.0 2.0 0.0 2.1 0.0 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 4.6 6.3 2.5 2.7 3.6 4.0 1.5 1.7 0.6 0.0 1.9 0.0 0.6 0.0 0.0 1.0 0.0 0.0 0.0 Figure 2-6: 2004 Cryptosporidiosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 45

Giardiasis There were 79 cases reported (10.5 per 100,000) which accounted for 18.4% of all enteric pathogens reported Incidence rates in 2004 were slightly lower than rates reported in 2003 (11.1 per 100,000) representing a difference of 4 cases from the 2003 total of 83 cases Incidence Rate of Infection by Month (2000-2004) (Figure 2-7) Rates were highest in the summer and may extend into the autumn season The incidence rate in 2004 was at it s lowest level since 2000 Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-8) Rates were highest in children under 4 years of age (19.4 per 100,000) and in males in the 70 to 74 year age group (34.7 per 100,000). 58% (46 cases) of all cases occurred among men 2.2 2.0 1.8 1.6 1.4 1.2 Rates/100,000 1.0 0.8 0.6 0.4 0.2 0.0 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.3 1.1 1.2 0.5 0.5 1.9 0.7 0.7 1.5 1.6 0.8 0.9 2001 0.5 0.4 0.9 0.5 0.8 1.2 1.1 1.2 1.9 0.5 0.7 0.9 2002 0.7 0.7 0.8 0.7 1.3 0.8 1.3 1.3 0.8 1.3 1.1 1.3 2003 0.8 0.4 0.9 0.8 0.1 0.5 1.1 0.9 1.2 2.3 0.3 1.7 2004 1.1 0.9 0.5 0.8 0.5 0.7 1.3 0.8 0.7 1.1 0.9 1.2 Figure 2-7: Incidence rate of Giardiosis infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 46

35.0 30.0 25.0 20.0 Rate/ 100,000 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 21.5 9.5 8.3 3.9 3.8 8.3 7.9 14.3 18.8 19.2 10.7 12.0 0.0 28.8 34.7 0.0 34.2 0.0 0.0 2004 Female rate 17.1 15.0 13.1 0.0 16.3 12.4 3.9 7.3 3.1 3.2 3.5 15.9 16.2 0.0 7.4 8.3 10.3 17.5 0.0 2004 Rate 19.4 12.2 10.6 2.0 9.9 10.4 5.9 10.8 11.0 11.2 7.0 14.0 8.2 13.9 20.0 4.8 19.3 11.7 0.0 5 Year Average 30.5 12.6 2.5 4.7 16.5 14.4 14.9 12.5 10.8 15.1 12.8 12.9 6.0 10.8 8.1 12.6 8.2 9.7 0.0 Figure 2-8: 2004 Giardiosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Listeriosis There were 4 cases reported (0.5 per 100,000) which accounted for 0.9% of all enteric pathogens In 2004, 1 infected individual was pregnant and gave birth normally Among the 11 cases that have been reported since 2000, 8 cases were over 55 years of age and only 1 from 2004 was pregnant Incidence Rate of Infection by Month (2000-2004) (Figure 2-9) All cases were reported during May, August and September Annual reporting has remained fairly constant over the last 5 years Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-10) All cases were female. Three cases were over 55 years of age. One of these cases had listeriosis meningitis. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 47

0.30 0.25 0.20 0.15 0.10 0.05 2000 2001 2002 2003 0.00 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.3 0.0 0.0 2001 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 2002 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2003 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.3 0.1 0.0 0.0 0.0 Figure 2-9: Incidence rate of Listeriosis infections by month and year, New Brunswick 2000-2004 12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.6 0.0 0.0 0.0 4.0 10.8 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.8 0.0 0.0 0.0 2.0 5.4 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 1.0 0.6 0.0 0.0 0.0 1.3 0.0 5.3 Figure 2-10: 2004 Listeriosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 48

Norovirus New Brunswick began reporting cases of Norovirus in 2003. There were 22 cases of Norovirus reported (2.9 per 100,000) which accounted for 5.1% of all enteric pathogens reported Norovirus is deemed to be severely under reported due to the short duration of illness and difficulties in identifying it in the laboratory The rate in 2004 was approximately 1.6 fold lower than the rate reported in 2003 (4.7 per 100,000) representing a difference of 13 cases from the 2003 total of 35 cases Incidence Rate of Infection by Month (2000-2004) (Figure 2-11) Infection rate peaked in December (2.3 per 100,000) when 17 cases were identified. Among these cases, 13 of them attended a private, catered dinner in Region 1 and were involved in an outbreak. No food or water source of infection was identified Cases and Rate by Age Group (2004) (Figure 2-12) For 2004, rates were highest in the 0 to 4 year age group (22.1 per 100,000). In comparison, the age group with the highest incidence rate in 2003 was in individuals over 75 years of age 55% (12 cases) of all cases occurred among men 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2002 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2003 2.8 0.4 0.3 0.5 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.4 2004 0.0 0.1 0.4 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 2.3 Figure 2-11: Incidence rate of Norovirus infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 49

35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 32.2 0.0 0.0 0.0 0.0 0.0 0.0 3.6 3.1 3.2 0.0 0.0 0.0 0.0 8.7 11.4 17.1 0.0 0.0 2004 Female Rate 11.4 0.0 0.0 0.0 8.2 0.0 0.0 7.3 6.3 0.0 3.5 0.0 5.4 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 22.1 0.0 0.0 0.0 3.9 0.0 0.0 5.4 4.7 1.6 1.8 0.0 2.7 0.0 4.0 4.8 6.4 0.0 0.0 Figure 2-12: Norovirus rates by age group, gender and overall rate, New Brunswick 2004 Salmonellosis There were 137 cases reported (18.2 per 100,000) which accounted for 31.9% of all enteric pathogens reported The infection rate in 2004 was slightly higher than the rate reported in 2003 representing an increase of 10 cases from the 2003 total of 127 cases Incidence Rate of Infection by Month (2000-2004) (Figure 2-13) Overall rates of infection peaked in May (4.3 per 100,000) when 32 cases were identified. This spike in cases was explained by an outbreak of S. typhimurium that occurred in Region 2 during the end of April and throughout May. It involved 22 cases all with identical PFGE patterns that were linked to a restaurant in Region 2 where contaminated eggs were supplied Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-14) Reporting rates were highest in females in the 25 to 29 year age group Females accounted for 55% (76 cases) of all cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 50

Incidence Rate of Prevalent Serotypes (2002-2004) (Figure 2-15) In 2004, the most commonly identified serotypes were 45 cases (6.0 per 100,000) of S. typhimurium, 27 cases (3.6 per 100,000) of S. Heidelberg and 19 cases (2.5 per 100,000) of S. enteritidis In 2004, S. typhimurium replaced S. Heidelburg as the most commonly identified serotype in the province 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 2000 2001 2002 2003 0.5 0.0 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.4 0.7 1.9 1.6 0.8 0.8 1.5 1.1 1.7 1.2 1.2 0.9 2001 1.7 1.2 0.9 1.6 0.8 1.9 1.5 1.6 1.7 0.8 2.0 1.5 2002 1.9 0.4 1.6 1.3 0.8 0.9 2.3 1.2 1.1 1.3 1.1 1.3 2003 1.3 0.5 0.9 1.1 1.3 1.6 2.4 2.8 2.4 1.1 0.8 0.7 2004 0.5 0.5 1.3 1.2 4.3 0.9 1.2 2.1 2.0 1.3 1.3 1.5 Figure 2-13: Incidence rate of Salmonellosis infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 51

55.0 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male rate 21.5 14.3 16.5 7.9 15.3 29.2 19.8 21.4 25.1 9.6 10.7 4.0 32.9 7.2 17.3 11.4 0.0 0.0 0.0 Female Rate 22.8 10.0 4.4 42.1 28.6 49.6 35.3 14.5 3.1 19.2 34.7 8.0 10.8 13.4 7.4 0.0 20.7 17.5 0.0 2004 Rate 22.1 14.7 10.6 24.4 21.7 39.4 27.6 18.0 14.1 14.4 22.9 6.0 21.7 10.4 12.0 4.8 12.9 11.7 0.0 5 Year Average 33.0 18.9 12.0 15.2 27.6 21.4 14.6 15.2 14.3 20.0 16.3 18.6 20.0 13.6 16.2 14.5 12.6 25.6 36.4 Figure 2-14: 2004 Salmonellosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 8.0 7.0 6.0 5.0 Rate/ 100,000 4.0 3.0 2.0 1.0 0.0 Typhimurium Heidelberg Enteritidis Agona Newport 2004 6.0 3.6 2.5 1.7 0.7 2003 2.5 7.3 0.8 1.2 0.4 2002 2.5 2.8 2.9 0.5 0.9 Figure 2-15: Incidence rate of the 5 most prevalent serotypes in New Brunswick, 2002-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 52

Shigellosis There were 7 cases (0.9 per 100,000) reported which accounted for 1.6% of all enteric pathogens reported The 2004 rate was approximately 2.5 fold lower than the infection rate reported for 2003 (2.3 per 100,000) and represents a difference of 10 cases from the 2003 total of 17 cases. It is explained by an outbreak in 2003 of S. sonnei in Region 1 involving drinking water. Incidence Rate of Infection by Month (2000-2004) (Figure 2-16) Rates peaked in March (0.7 per 100,000) when 5 cases of S. flexerni were reported. Among these cases, a cluster of 3 residents of Region 2 were identified. Isolates from the 3 individuals had identical PFGE patterns and were related to travel within Asia. Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-17) Reporting rates were highest in females in the 45 to 49 year age group (9.6 per 100,000) Females accounted for 71% (5 cases) of all the cases 1.8 1.6 1.4 1.2 1.0 0.8 0.6 0.4 0.2 0.0 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.1 0.0 0.3 0.0 0.1 0.3 0.0 0.0 0.0 0.3 2001 0.1 0.1 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 2002 0.0 0.1 0.0 0.0 0.3 0.0 0.3 0.0 0.1 0.3 0.0 0.1 2003 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 1.6 0.3 0.0 0.1 2004 0.1 0.0 0.7 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 2-16: Incidence rate of Shigellosis infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 53

12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 4.0 3.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 0.0 0.0 0.0 0.0 0.0 4.1 0.0 0.0 3.1 9.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.0 2.1 2.0 1.8 1.6 4.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 year avg 2.6 1.4 2.5 0.4 1.6 2.0 1.1 2.0 0.6 1.3 0.0 0.5 1.9 2.2 0.0 0.0 0.0 0.0 0.0 Figure 2-17: 2004 Shigellosis rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Typhoid Fever There were 3 cases reported (0.4 per 100,000) which accounted for 0.7% of all enteric pathogens reported Incidence Rate of Infection by Month (2000-2004) (Figure 2-18) Cases were reported in summer Annual reporting of Typhoid Fever has remained relatively stable over the last 5 years Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-19) Reported cases occurred in the 30 to 39 and 50 to 54 year age groups Males accounted for 67% (2 cases) of all cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 54

0.15 0.10 0.05 0.00 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2002 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 2003 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.1 0.0 0.0 0.0 Figure 2-18: Incidence rate of Typhoid Fever infections by month and year, New Brunswick 2000-2004 4.5 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 3.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 0.0 0.0 0.0 0.0 0.0 0.0 2.0 1.8 0.0 0.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 1.5 0.4 0.0 0.0 0.8 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 2-19: 2004 Typhoid Fever rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 55

Verotoxin-Producing E. coli (VTEC) Infection There were 17 cases reported (2.3 per 100,000) which accounted for 4.0% of all enteric pathogens reported There was very little change in the reporting rate from 2003 (2.4 per 100,000) and 2004. This represented a difference of only 1 case from the 2003 total of 18 cases Incidence Rate of Infection by Month (2000-2004) (Figure 2-20) Peak rates occurred, as expected, during the summer months with rates highest in August (0.9 per 100,000) representing 41% of all E. coli isolates Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-21) Reporting rates were highest among females age 25 to 29 (12.4 per 100,000). Overall rates were highest in the 25 to 29 year age group (6.2 per 100,000) followed closely by children under 4 years of age (5.5 per 100,000) 2.5 2.0 1.5 1.0 0.5 0.0 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.0 0.0 0.1 0.5 1.5 1.2 0.7 0.0 0.0 0.0 2001 0.1 0.0 0.1 0.0 0.0 0.3 0.3 2.3 0.7 0.0 0.1 1.1 2002 0.1 0.0 0.0 0.0 0.1 0.0 0.1 0.1 0.4 0.3 0.0 0.0 2003 0.1 0.0 0.3 0.1 0.0 0.1 0.0 1.1 0.5 0.1 0.0 0.0 2004 0.1 0.0 0.3 0.3 0.1 0.0 0.3 0.9 0.1 0.1 0.0 0.0 Figure 2-20: Incidence rate of Verotoxin-Producing E. coli (VTEC) infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 56

14.0 12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 5.4 4.8 4.1 0.0 3.8 0.0 0.0 0.0 0.0 0.0 0.0 4.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 5.7 0.0 4.4 8.4 4.1 12.4 3.9 7.3 3.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rates 5.5 2.4 4.2 4.1 3.9 6.2 2.0 3.6 1.6 0.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 8.8 3.1 3.3 5.0 3.9 2.0 1.5 2.3 4.7 1.7 2.2 1.0 7.4 1.4 6.5 3.9 1.5 2.4 0.0 Figure 2-21: 2004 Verotoxin-Producing E. coli (VTEC) infection rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Yersiniosis There were 3 cases reported (0.4 per 100,000) which accounted for 0.7% of all enteric pathogens reported All cases reported in 2004 were Yersinia enterocolitica The 2004 rate was approximately 3.8 fold lower than the infection rate reported for 2003 (1.5 per 100,000). This represents a difference of 8 cases from the 2003 total of 11 cases Incidence Rate of Infection by Month (2000-2004) (Figure 2-22) Rates peaked in March (0.3 per 100,000) when 2 cases were reported Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 2-23) All cases were female, with the highest rates in children under 4 years of age (2.8 per 100,000) COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 57

0.6 0.5 0.4 0.3 0.2 2000 2001 0.1 2002 0.0 Jan Mar May July Sept Nov 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.1 0.1 0.0 0.1 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.0 2002 0.0 0.1 0.1 0.0 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 2003 0.3 0.0 0.0 0.5 0.0 0.3 0.0 0.0 0.0 0.3 0.0 0.1 2004 0.0 0.0 0.3 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 2-22: Incidence rate of Yersiniosis infections by month and year, New Brunswick 2000-2004 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 5.7 0.0 0.0 4.2 0.0 0.0 0.0 0.0 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rate 2.8 0.0 0.0 2.0 0.0 0.0 0.0 0.0 0.0 1.6 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5 Year Average 5.8 0.9 0.0 0.4 0.4 0.8 0.8 1.0 0.3 0.3 0.4 0.0 1.8 0.0 0.8 1.0 0.0 0.0 0.0 Figure 2-23: 2004 Yersiniosis Infection rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 58

Botulism There have been no reports of Botulism in 2004 or in the last 5 years Cholera There have been no reports of Cholera in 2004 or in the last 5 years Cyclosporidiosis There have been no reports of Cyclosporidiosis in 2004 or in the last 5 years Hepatitis A There were no cases reported in 2004 Annual reporting has continued to decline to the lowest level in 5 years COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 59

Chapter 3 DISEASES PREVENTABLE BY ROUTINE VACCINATION Haemophilus Influenzae Type B 0.0% Mumps 0.0% Tetanus 0.0% Influenza 58.4% Pertussis 41.6% Reubella 0.0% Measles 0.0% COMMUNICABLE DISSEASSESS EPIDEMIOLOGI IC REPORTT 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 60

DISEASES PREVENTABLE BY ROUTINE VACCINATION This section summarizes data on diseases that are spread in a variety of ways but a vaccine is routinely used to help prevent them. Due to the efficacy of the vaccines used, these diseases are rare in New Brunswick. Data were collected through the Provincial Reportable Diseases Surveillance System and data on Influenza was collected though an enhanced surveillance system. Incidence rates were calculated using the 2004 population estimates from Statistics Canada. 3 Incidence rates for each of the diseases in this grouping were reported for New Brunswick and Canada in the following 2 tables. 4 Table 3-1: Cases and rates* of vaccine preventable diseases reported in New Brunswick, by Regional Health Authority, 2004 * Rates calculated by 100,000 The table above outlines the distribution of the disease among the Regional Health Authorities in New Brunswick COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 61

Table 3-2: Rates* of reported cases of vaccine preventable diseases reported in New Brunswick and Canada, 1999-2004 * Rates calculated per 100,000 ** Rate reported for the season *** Data unavailable **** Cases not reported in New Brunswick ***** Cases not reported nationally With the exception of Influenza and Pertussis, no cases of the other diseases in this category were reported in 2004 Both Influenza and Pertussis were above the Canadian rate of infection for 2004 Influenza Enhanced influenza surveillance in New Brunswick is conducted every year starting the first week of October through to the end of April the following year. Information on influenza activity is based on data from specimen samples sent to laboratories, school absenteeism records and Influenza-like-illness (ILI) reports from both nursing homes and sentinel physicians. During the seasons 2003/2004 and 2004/2005, virologic surveillance was expanded to summer months as well as to include emergency rooms as sentinel sites for specimen collection. New Brunswick regularly participates in the national influenza surveillance through the Fluwatch system There were 449 laboratory confirmed influenza cases (59.8 per 100,000) which accounted for 58.4% of all vaccine preventable diseases Overall, influenza activity for the 2004/2005 season was moderate Reports of a laboratory confirmed new influenza A variant (A/California/07/04(H3N2)) emerged during February 2005. COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 62

Incidence Rate of Laboratory Confirmed Influenza by month and season (2000/2001-2004/2005) (Figure 3-1) An improved surveillance system has lead to reporting more cases each season Influenza activity for 2004/2005 season increased during January and mid- February 2005. Infection Rate of 2004/2005 Influenza Season by Month, Compared to Seasonal Average (2000/2001-2003/2004) (Figure 3-2) Influenza season 2004/2005 started later compared to the average of the 4 previous seasons with the first reports of laboratory confirmed influenza A cases received during the week of December 19, 2004. Influenza occurs during winter months with a peak number of cases in February and March. Rates of Laboratory Confirmed Influenza by Age Group, Gender and Overall 2004/2005 Rate Compared to Seasonal Average (2000/2001-2003/2004 (Figure 3-3) Among the laboratory confirmed influenza cases, 6.7% (30 cases) were under 4 years of age, 5.6% (25 cases) were in the 5 to 9 year age group, 6% (27 cases) were in the 10 to 14 year age group and 38% (170 cases) were over the age of 60 Incidence Rate of Laboratory Confirmed Influenza by Type and Season (2000/2001-2004/2005) (Figure 3-4) Since the 2000/2001 season, reports have become predominantly Influenza A. Weekly Laboratory Confirmed Influenza Cases by Type Compared to Influenza-Like- Illness (ILI) Consultations Reported by FluWatch Clinical Sites Reported for the Week (Figure 3-5) The National FluWatch Program maintains a network of sentinel clinical sites across the country including New Brunswick. For one clinic day each week, these sites are asked to report the total number of patients seen for any reason and the total number of patients meeting the ILI case definition. During this season, 20 physicians from NB participated in this network with the majority of them from Region 1. An overview of ILI consultations in New Brunswick compared to influenza virus types is presented in Figure 3-5 Peak reports of ILI activity in nursing homes and absenteeism in schools occurred during January and February. In total, 24 nursing homes reported laboratory confirmed outbreaks during the season. The first outbreak in nursing homes was reported during the last week of December 2004. Outbreak reports increased during the week ending February 19, 2005 through to the week ending March 12, 2005. School absenteeism reports were received from the week ending January 8, 2005 until the week ending April 9, 2005. The highest number of schools COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 63

reporting greater than 10% absenteeism was recorded between the weeks ending January 22 and February 26, Toward the end of surveillance season the proportion of influenza B virus detected had increased resulting in it becoming the dominant virus in laboratory reports. Laboratory Confirmed Influenza Cases and Rates by Regions (2004/2005) (Table 3-3) Influenza A accounted for 93% (419 cases) of all influenza reports 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 Oct Nov Dec Jan Feb Mar 2003/04 2002/03 2001/02 2000/01 Apr 2004/05 Oct Nov Dec Jan Feb Mar Apr 2000/01 0.0 0.0 0.5 8.4 8.7 0.7 0.1 2001/02 0.0 0.0 0.1 2.4 7.2 10.7 2.4 2002/03 0.0 0.0 0.0 2.0 6.3 3.9 0.8 2003/04 0.0 0.0 8.1 20.8 2.8 0.1 0.4 2004/05 0.0 0.0 0.1 8.4 36.2 13.3 1.7 Figure 3-1: Incidence rate of laboratory confirmed influenza by month and season, New Brunswick 2000/2001-2004/2005 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 64

40 35 30 25 20 15 10 5 0 Oct Nov Dec Jan Feb Mar Apr 2004/05 0 0 0.1 8.4 36.2 13.3 1.7 4 Year Average 0.0 0.0 2.2 8.4 6.2 3.8 0.9 Figure 3-2: Infection rate of 2004/2005 Influenza season by month, compared to seasonal average, New Brunswick 2000/2001-2003/2004 900.0 800.0 700.0 600.0 500.0 400.0 300.0 200.0 100.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004/05 Male Rate 85.9 57.2 49.5 15.8 45.9 29.2 35.6 28.6 25.1 28.9 21.5 28.1 32.9 79.1 86.7 217.1 222.1 321.1 836.1 2004/05 Female Rate 79.9 65.1 65.7 50.5 65.3 70.3 23.5 18.1 37.8 51.2 62.5 31.9 37.7 33.5 81.9 116.3 320.5 385.4 433.7 2004/05 Rates 83.0 61.1 57.4 32.6 55.3 51.9 29.5 23.4 31.4 40.1 42.3 32.0 35.3 55.5 84.1 158.7 283.4 364.2 537.1 4 year Average 63.9 29.0 32.6 25.9 29.7 24.2 15.8 15.5 12.3 9.1 12.2 8.0 8.8 20.6 15.1 18.0 32.1 55.3 53.0 Figure 3-3: Rates of laboratory confirmed influenza by age group, gender and overall rate, New Brunswick 2004/05 season compared to the 4 year seasonal average rate, 2000/01-2003/04 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 65

65.0 60.0 55.0 50.0 45.0 40.0 35.0 30.0 25.0 20.0 15.0 10.0 5.0 0.0 2000/01 2001/02 2002/03 2003/04 2004/05 Influenza A 6.0 22.4 8.0 32.0 55.8 Influenza B 12.4 0.4 4.9 0.3 4.0 Seasonal Rate 18.4 22.8 12.9 32.2 59.8 Figure 3-4: Incidence rate of laboratory confirmed Influenza by type and season compared to the seasonal rate of infection, New Brunswick 2000/2001-2004/2005 85 80 75 70 65 60 55 50 # of Cases 45 40 35 30 25 20 15 10 5 0 51 52 53 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Influenza A 0 1 0 3 10 21 29 46 70 80 72 40 26 9 4 6 1 1 0 Influenza B 0 0 0 0 0 0 0 0 1 0 3 1 4 0 5 6 3 1 4 ILI Cases 0 1 0 3 5 1 1 15 1 10 4 11 1 5 3 2 2 5 2 Week Figure 3-5: Laboratory confirmed influenza cases by type and week reported compared to weekly Influenza-Like-Illness (ILI) consultations reported by FluWatch clinical sites for New Brunswick 2004-2005 season COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 66

Table 3-3: Laboratory Confirmed Influenza cases and rates* by Regions, for New Brunswick, 2004/2005 surveillance season * Rates calculated per 100,000 ** Region for 2 cases was unavailable Pertussis There were 320 cases reported (42.6 per 100,000) which accounted for 41.6% of all vaccine preventable diseases In 2004, Pertussis reached the highest number of cases reported since 1999 The 2004 infection rate was approximately 2.8 fold higher than the 2003 rate (15.3 per 100,000) representing an increase of 205 cases from the 2003 total of 115 cases Incidence Rate of Infection by Month (2000-2004) (Figure 3-6) The elevated rates, compared to previous years, were explained by 3 separate outbreaks that occurred in Regions 1, 2 and 7 The first outbreak began in Region 7 in November 2003 and continued until March 2004. Among the cases involved in the outbreak, 46% of them were in the 10 to 14 year age group The second outbreak occurred in Region 2 during July when 35 confirmed cases were reported and 16 were found to be epidemiologically linked. The third outbreak occurred in Region 1 from the end of July through August Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 3-7) In 2004, the highest rates occurred in the 10-14 year age group (231.6 per 100,000) Female rates exceeded male rates for all age groups except 45 to 49 and 60 to 64 A shift in the age group with the highest rates was observed from 0 to 4 in 1999 and 2000 to 5 to 9 in 2001 and 2002. Another shift was observed in 2003 and 2004 to 10 to 14 year olds. This trend may be due to the introduction of the accellular vaccine in 1997 which may provide better prophylaxis for infants COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 67

6.5 6.0 5.5 5.0 4.5 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 4.0 3.5 3.0 2.5 2.0 1.5 1.0 0.5 0.0 2004 2003 2002 2001 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 1.3 1.1 1.2 0.3 0.8 0.7 1.6 0.8 0.3 1.1 1.9 1.1 2001 1.2 0.5 0.3 0.7 0.7 0.3 0.4 0.4 0.3 0.1 0.7 0.8 2002 0.9 0.0 0.1 0.3 0.0 0.9 0.8 1.7 1.9 2.1 3.7 3.2 2003 2.8 1.3 0.1 0.0 0.8 0.5 0.4 0.4 1.2 0.0 1.7 6.0 2004 5.9 5.5 6.0 1.3 1.7 1.6 5.7 3.5 2.8 2.0 2.4 4.3 Figure 3-6: Incidence rates of Pertussis infection by month and year, New Brunswick 1999-2004 300.0 250.0 200.0 150.0 100.0 50.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 155.6 95.4 189.8 51.3 7.7 8.3 11.9 10.7 15.7 16.0 7.2 4.0 11.0 14.4 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 171.3 125.2 276.0 79.9 8.2 20.7 39.2 32.7 25.2 6.4 10.4 8.0 10.8 20.1 0.0 8.3 0.0 17.5 0.0 2004 Rates 163.2 109.9 231.6 65.2 7.9 14.5 25.6 21.6 20.4 11.2 8.8 6.0 10.9 17.3 0.0 4.8 0.0 11.7 0.0 5 year Average 59.8 60.4 66.0 11.7 3.6 2.9 2.3 2.9 4.8 2.3 2.2 3.8 1.3 2.1 0.0 1.0 4.3 0.0 0.0 Figure 3-7: 2004 rates of Pertussis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 68

Invasive Haemophilus influenzae type b (HIb) No cases of HIb were reported in New Brunswick during 2004 The last reported case in New Brunswick occurred in 2003 in a 5 year old male Measles In 2004, no cases were reported in New Brunswick. The last reported case occurred in 2001 involving an adult male Mumps In 2004, no cases were reported in New Brunswick The last reported cases were in 1999 when 3 individuals under the age of 20 were infected Rubella No cases were recorded in 2004 The last recorded case was reported in 2000 involving an adult female Tetanus No cases were reported in 2004 The last recorded case occurred in 2000 involving an adult male COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 69

Chapter 4 DISEASES TRANSMITTED BY DIRECT CONTACT AND RESPIRATORY ROUTES Classical Creutzfeld- Jacob Disease Hantavirus 4.4% Pulmonary Syndrome 0.0% Lab Confirmed Chickenpox 33.3% Leprosy 0.0% Invasive Meninaococcal Disease 5.6% Invasive Pneumococcal Disease 33.3% Legionella 1.1% Tuberculosis 11.1% Group B Streptococcal Disease of Newborn 1.1% Invasive Group A Streptococcal Disease 10.0% COMMUNICABLE DISSEASSESS EPIDEMIOLOGI IC REPORTT 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 70

DISEASES TRANSMITTED BY DIRECT CONTACT AND RESPIRATORY This section focuses on diseases that are caused by infectious pathogens transmitted through inhalation of aerosolized secretions from an infected individual or through inhalation of aerosolized contaminated water. 6 The most common route of entry is inhalation of airborne infectious particles into the respiratory system. The summarized data were collected through the Provincial Reportable Diseases Surveillance System while data on Classical Creutzfeldt-Jakob Disease and Tuberculosis were collected through enhanced surveillance systems. Incidence rates for New Brunswick were calculated using the 2004 population estimates from Statistics Canada. 3 Incidence rates for each of the diseases in this grouping were reported for New Brunswick and Canada in the following 2 tables. 4,7,8 Table 4-1: Cases and rates* of diseases transmitted by direct contact or respiratory routes in New Brunswick, by Regional Health Authority 2004 * Rates calculated per 100,000 ** Lab confirmed *** Data unavailable The table above outlines the distribution of the disease among the Regional Health Authorities in New Brunswick COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 71

Table 4-2: Rates* of reported cases of diseases transmitted by direct contact or respiratory routes in New Brunswick and Canada, 1999-2004 * Rates Calculated per 100,000 ** Lab confirmed *** Cases not reported in New Brunswick **** Cases not reported nationally Classical Creutzfeld-Jakob disease and Invasive Meningococcal Disease were above the Canadian infection rate in 2004 Classical Creutzfeldt-Jakob Disease (CJD) Suspected cases of CJD are reported to the CJD Surveillance Unit of Public Health Agency of Canada (PHAC), which assist in organizing testing necessary for confirming the diagnosis of CJD CJD surveillance in Canada began in 1998 although some work dates back to 1994 On average, about 30 cases of classical CJD are confirmed each year in Canada. 9 Only one variant CJD case has been confirmed in Canada. It was linked to the United Kingdom where the individual resided during the peak of their BSE epidemic. 9 No cases of vcjd have been linked to eating Canadian beef. 9 There were 4 cases reported (0.5 per 100,000) in New Brunswick which accounted for 4.4% of all diseases transmitted by direct contact or respiratory routes All cases were confirmed by PHAC as definite sporadic cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 72

Cases and Rates by Year and Type, (1998-2004) (Figure 4-1) Since 1998, 11 cases have been reported from New Brunswick Among these cases, 9 were sporadic (scjd), 1 was Gerstmann-Sträussler- Scheinker Disease (GSS) and 1 iatrogenic (icjd) Females accounted for 54% (6 cases) of all cases 5 0.6 4 0.5 0.4 # of Cases 3 0.3 2 0.2 1 0.1 0 1998 1999 2000 2001 2002 2003 2004 icjd 0 0 0 0 0 1 0 GSS 0 0 0 0 1 0 0 scjd 1 0 2 0 1 1 4 Overall Rate 0.1 0 0.3 0 0.3 0.3 0.5 Figure 4-1: Cases and rates of Creutzfeldt - Jakob Disease by year and type, New Brunswick 1998-2004. 0 Chickenpox There were 30 lab confirmed (4.0 per 100,000) Chickenpox cases reported and 200 cases without lab confirmation for a total of 230 cases (30.6 per 100,000) Laboratory confirmed cases of Chickenpox accounted for 33.3% of all diseases transmitted by direct contact or respiratory routes in New Brunswick Rates in 2004 were slightly higher than rates reported in 2003 (3.3 per 100,000) representing an increase of 5 cases from the 2003 total of 25 cases Incidence Rate of Infection by Month (2000-2004) (Figure 4-2) In 2004, infection rates peaked in August and September Infection rates of lab confirmed infections have continued to increase to their highest level since 2000 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 73

Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-3) Among the lab confirmed cases, children in the 5 to 9 (14.7 per 100,000) year age group and adults in the 80 to 84 (19.3 per 100,000) year age group exhibited the highest rates of infection. Compared to 2003, chickenpox rates increased in all age groups between 5 and 24 years of age but decreased in the 0 to 4 year age group 1.00 0.80 0.60 0.40 0.20 2000 2001 2002 2003 0.00 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.1 0.3 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.3 0.0 0.0 0.4 0.0 0.1 0.0 0.0 0.3 2002 0.4 0.0 0.5 0.0 0.1 0.3 0.0 0.3 0.4 0.4 0.1 0.3 2003 0.8 0.0 0.1 0.3 0.5 0.1 0.5 0.0 0.3 0.1 0.4 0.1 2004 0.1 0.0 0.3 0.0 0.5 0.3 0.5 0.8 0.7 0.3 0.0 0.5 Figure 4-2: Incidence rates of laboratory confirmed Chickenpox infections by month and year, New Brunswick 1999-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 74

25.0 20.0 15.0 10.0 5.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 5.4 9.5 4.1 0.0 7.7 0.0 4.0 0.0 3.1 0.0 0.0 0.0 0.0 21.6 0.0 11.4 17.1 0.0 0.0 2004 Female Rate 5.7 20.0 4.4 4.2 4.1 0.0 3.9 0.0 0.0 3.2 10.4 4.0 5.4 0.0 0.0 0.0 20.7 0.0 0.0 2004 Rates 5.5 14.7 4.2 2.0 5.9 0.0 3.9 0.0 1.6 1.6 5.3 2.0 2.7 10.4 0.0 4.8 19.3 0.0 0.0 5 year Average 2.2 3.7 0.8 0.8 1.6 1.2 1.2 0.7 2.2 0.3 1.8 0.0 0.6 2.2 2.4 1.9 8.2 7.2 4.5 Figure 4-3: 2004 rates of laboratory confirmed Chickenpox by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Legionellosis There was 1 case reported (0.1 per 100,000) which accounted for 1.1% of all direct contact and respiratory route infections 9 cases have been reported since 1994 making this disease rare in New Brunswick Incidence Rate of Infection by Month (2000-2004) (Figure 4-4) The 2004 case was reported in November Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-5) The case occurred in a female in the 60 to 64 year age group COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 75

0.15 0.10 0.05 0.00 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2001 0.1 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2002 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2003 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Figure 4-4: Incidence rates of Legionellosis infections by month and year, New Brunswick 1999-2004 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 5.4 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rates 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.7 0.0 0.0 0.0 0.0 0.0 0.0 5 year Average 0.5 0.0 0.0 0.0 0.0 0.0 0.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2.5 0.0 Figure 4-5: 2004 rates of Legionellosis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 76

Invasive Meningococcal Disease (IMD) Meningococcal disease, caused by the bacterium Neisseria meningitidis, is classified in multiple serogroups. Strains belonging to groups A, B, C, Y and W- 135 are the usual cause of systemic disease. 6 When the bacterium are cultured from blood, cerebral spinal fluid or other normally sterile sites, the disease is considered invasive There were 5 cases (0.7 per 100,000) which accounted for 5.6% of all direct contact and respiratory diseases Among 4 cases for which an outcome was recorded, 1 death was caused by IMD in a female in the 80 to 84 year age group The 2004 rate was slightly higher than the rate seen in 2003 (0.5 per 100,0000) representing an increase of 1 case from the 2003 total of 4 cases Incidence Rate of Infection by Month (2000-2004) (Figure 4-6) Cases occurred in July, November and December with no clear seasonal pattern Rates of IMD infection have remained relatively stable over the last 5 years Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-7) There were 4 cases reported in individuals under 20 years of age The disease is correlated with the very young and very old Females accounted for 80% (4 cases) of all cases Number of Reported Cases by Serogroup and Year (1999-2004) (Figure 4-8) The most commonly typed serogroup was Type B which was seen in 80% (4 cases) of the cases. The other serogroup reported was 29E Over the past 5 years, only 3 cases of serogroup C have been recorded COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 77

0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.3 0.0 0.1 0.1 0.0 0.1 0.0 0.1 0.0 0.0 0.0 0.0 2001 0.0 0.3 0.1 0.0 0.3 0.1 0.0 0.0 0.0 0.0 0.0 0.1 2002 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.1 2003 0.1 0.1 0.1 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 2004 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.3 0.1 Figure 4-6: Incidence rates of Invasive Meningococcal infections by month and year, New Brunswick 1999-2004 12.0 10.0 8.0 6.0 4.0 2.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 5.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Female Rate 5.7 0.0 0.0 8.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10.3 0.0 0.0 2004 Rates 5.5 0.0 0.0 4.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.4 0.0 0.0 5 year Average 6.2 0.0 0.8 3.1 0.4 0.0 0.0 0.0 0.6 0.3 0.4 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Figure 4-7: 2004 Invasive Meningococcal disease rates by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 78

8 7 6 Number of Reported Cases 5 4 3 2 1 0 1999 2000 2001 2002 2003 2004 Z 0 0 0 0 1 0 Y 2 1 1 2 1 0 C 0 0 1 1 1 0 B 4 5 5 2 1 4 4 (NT) 1 0 0 0 0 0 29E 0 0 0 0 0 1 Figure 4-8: Number of reported cases of invasive meningococcal disease by serogroup and year, New Brunswick 1999-2004 Invasive Pneumococcal Disease (IPD) This bacterium is commonly found in the throat and nose but is considered invasive when it is detected in the blood, cerebral spinal fluid or other sites normally considered sterile. 6 This disease is a major cause of morbidity and mortality in children under 5 years of age. 10 The invasive form of this disease has been reportable in New Brunswick since 2000 In 2004, there were 30 cases (4.0 per 100,000) reported which accounted 33.3% of all direct contact or respiratory diseases The incidence rate of infection in 2004 increased from the rate in 2003 (0.9 per 100,000) representing an increase of 23 cases from the 2003 total of 7 cases The increased number of reported cases reflects the broadened case definition for IPD which now includes all other invasive manifestations in addition to meningitis Incidence Rate of Infection by Month (2000-2004) (Figure 4-9) Infection rates peaked in April (0.9 per 100,000) and December (0.8 per 100,000) COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 79

Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-10) Infection rates peaked in children under 4 years of age (19.4 per 100,000) as well as in the 80 to 84 (32.2 per 100,000) and 85 to 89 (11.7 per 1000,000) year age groups Males accounted for 60% (18 cases) of all cases 1.00 0.80 0.60 0.40 0.20 2000 2001 2002 2003 0.00 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.1 0.0 0.0 0.0 0.3 0.1 0.1 0.0 0.0 0.0 0.5 0.0 2001 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.1 0.0 0.3 0.0 0.0 2002 0.0 0.3 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 2003 0.1 0.4 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.3 0.0 2004 0.4 0.0 0.5 0.9 0.3 0.4 0.0 0.0 0.1 0.5 0.0 0.8 Figure 4-9: Incidence rates of Invasive Pneumococcal infections by month and year, New Brunswick 1999-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 80

70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 21.5 0.0 0.0 3.9 0.0 0.0 0.0 7.1 3.1 0.0 0.0 0.0 5.5 14.4 8.7 11.4 68.4 35.7 0.0 2004 Female Rate 17.1 0.0 0.0 4.2 0.0 0.0 0.0 0.0 0.0 3.2 6.9 4.0 0.0 13.4 0.0 8.3 10.3 0.0 0.0 2004 Rates 19.4 0.0 0.0 4.1 0.0 0.0 0.0 3.6 1.6 1.6 3.5 2.0 2.7 13.9 4.0 9.6 32.2 11.7 0.0 4 year Average 5.3 0.5 1.0 0.0 0.0 0.5 0.5 0.0 0.8 0.4 0.5 0.5 1.5 0.0 1.0 2.4 1.8 0.0 6.6 Figure 4-10: 2004 rates of Invasive Pneumococcal disease by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Invasive Group A Streptococcus (GAS) Group A Streptococcus (Streptococcus pyogenes) is a bacterium commonly found in the throat or on the skin. Most GAS infections are relatively mild illnesses such as pharyngitis or impetigo. 6 Occasionally these bacteria can become invasive and be found in normally sterile sites including the blood, deep muscle and fat tissue, or the lungs. Two of the most severe and possibly life-threatening but least common forms of invasive GAS disease are necrotizing facitis and streptococcal toxic shock syndrome. Necrotizing fasciitis (sometimes referred to as "the flesh-eating disease") is a destructive infection of muscle and fat tissue. Streptococcal toxic shock syndrome is a rapidly progressing infection, which causes septic shock and injury to internal organs such as the kidneys, liver, and lungs. 11 There were 9 reported cases (1.2 per 100,000) which accounted for 10.0% of all direct contact and respiratory diseases Among these cases, necrotizing fasciitis was reported in 33% (3 cases) and toxic shock syndrome was reported in 22% (2 cases) Case fatality was 11% (1 case) The infection rate in 2004 was slightly lower than the reported rate in 2003 (1.3 per 100,000) representing a difference of 1 case from the 2003 total of 10 cases COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 81

Incidence Rate of Infection by Month (2000-2004) (Figure 4-2) A peak in infection rate was observed in April (0.5 per 100,000) Infection rates for this disease generally increased since 2000 Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-3) Rates were highest in children under 4 years of age (5.5 per 100,000) Rates were evenly distributed between the genders with males having slightly higher frequency of infection at 55% (5 cases) of all cases 0.50 0.40 0.30 0.20 0.10 2000 2001 2002 2003 0.00 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.0 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 2001 0.0 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 2002 0.0 0.4 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 2003 0.3 0.0 0.3 0.3 0.1 0.0 0.0 0.1 0.0 0.0 0.3 0.0 2004 0.1 0.0 0.0 0.5 0.0 0.3 0.0 0.3 0.0 0.0 0.0 0.0 Figure 4-11: Incidence rates of Invasive Group A Streptococcal infections by month and year, New Brunswick 2000-2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 82

10.0 9.0 8.0 7.0 6.0 5.0 4.0 3.0 2.0 1.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ 2004 Male Rate 5.4 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.3 0.0 0.0 0.0 5.5 0.0 8.7 0.0 0.0 0.0 0.0 2004 Female Rate 5.7 0.0 0.0 0.0 0.0 0.0 3.9 3.6 0.0 3.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 2004 Rates 5.5 0.0 0.0 0.0 0.0 0.0 2.0 1.8 3.1 1.6 0.0 0.0 2.7 0.0 4.0 0.0 0.0 0.0 0.0 5 year Average 1.1 0.9 1.2 0.0 0.4 0.8 0.0 0.3 0.9 0.7 0.4 0.0 0.0 0.0 1.6 0.0 1.4 0.0 9.4 Figure 4-12: 2004 rates of Invasive Group A Streptococcal disease by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 Group B Streptococcus in Newborn Group B streptococcus (GBS) Disease is a leading cause of morbidity and mortality among newborns. Two general types of group B streptococcal infection in infants are defined by the patient s age. Early onset infections occur within the first week of life, generally in the first 24 hours. Late onset infections occur in infants between 1 week and 3 months of age, with most cases occurring in babies approximately 1 month old. The most common manifestations of GBS disease are sepsis, pneumonia and meningitis. 11 This disease has been reportable in New Brunswick since 2000 and is defined as clinical illness with isolation of group B Streptococcus from a normally sterile site in infants less than 1 month of age 5 In New Brunswick, there was 1 case reported (0.1 per 100,000) which accounted for 1.1% of all direct contact and respiratory diseases The case occurred in a 1 month old female from Region 2 in October No cases were reported between 2000 and 2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 83

Tuberculosis (TB) There were 10 cases of active Tuberculosis (1.3 per 100,000) accounting for 11.1% of all direct contact and respiratory diseases In 2004, a slight decrease in rate was seen compared to 2003 (1.6 per 100,000) representing a difference of 2 cases from the 2003 total of 12 cases In 2004, Tuberculosis contributed to the death of 1 case who was over 90 years of age From 1999 to 2004, only 2 cases of drug resistance were detected. One case in 2004, where Pyrazinamide resistance was recorded and another in 2002 when Isoniazid resistance was detected. Drug resistance in TB reports is continuing to be monitored From 1999 to 2004, TB has contributed to 3 deaths and has caused 1 death Among the 68 active Tuberculosis cases reported between 1999 and 2004, 26% (18 cases) were foreign born (China, Kosovo, Philippines, Chad, India, Ethiopia, Spain, Nigeria and Guinea Bissau). Arrival dates were known for 15 of the 18 cases. Among these 15 cases, 10 were diagnosed within 3 years of their arrival in New Brunswick and 4 were diagnosed within 5 years of their arrival in New Brunswick Incidence Rate of Infection by Month (2000-2004) (Figure 4-13) Infection rates peaked in November (0.4 per 100,000), June (0.3 per 100,000) and July (0.3 per 100,000) Rates of Tuberculosis in New Brunswick have been declining Cases and Rate by Age Group for 2004 Compared with 5 Year Average Rate (1999-2003) (Figure 4-14) All cases occurred in the 20 to 29 year age group as well as in individuals over 70 years of age Cases were reported more frequently among males, 90% (9 cases) Incidence rate for 2004 was above the 5 year average rate for the 20 to 29 year age groups as well as for individuals over 80 year of age Number of Reported Cases by Anatomical Site and Country of Origin (2004) (Table 4-3) The most commonly reported anatomic site of TB was the lung at 50% (5 cases) COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 84

0.45 0.40 0.35 0.30 0.25 0.20 0.15 0.10 0.05 0.00 2000 2001 2002 2003 2004 Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec Jan Feb Mar Apr May Jun July Aug Sept Oct Nov Dec 2000 0.3 0.0 0.3 0.0 0.3 0.1 0.0 0.0 0.0 0.1 0.1 0.1 2001 0.0 0.0 0.1 0.4 0.3 0.0 0.1 0.0 0.1 0.1 0.0 0.1 2002 0.0 0.0 0.1 0.1 0.1 0.0 0.1 0.4 0.0 0.1 0.1 0.3 2003 0.0 0.3 0.4 0.0 0.0 0.1 0.3 0.0 0.3 0.3 0.0 0.0 2004 0.1 0.1 0.0 0.0 0.0 0.3 0.3 0.0 0.0 0.1 0.4 0.0 Figure 4-13: Incidence rates of Tuberculosis infections by month and year, New Brunswick 2000-2004 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 10.0 0.0 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80-84 85-89 90+ Male Rate 0.0 0.0 0.0 0.0 7.7 4.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 8.7 11.4 34.2 35.7 83.6 Female Rate 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 10.3 0.0 0.0 2004 Rates 0.0 0.0 0.0 0.0 3.9 2.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 4.0 4.8 19.3 11.7 21.5 5 year Average 0.4 0.0 0.0 0.4 1.6 0.8 1.2 0.6 0.0 1.7 0.4 1.4 3.7 4.3 5.7 7.7 8.5 7.7 0.0 Figure 4-14: 2004 rates of Tuberculosis by age group, gender and overall rate compared to 5 year average, New Brunswick 1999-2003 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 85

Table 4-3: Number of reported cases of Tuberculosis by anatomic site and country of origin, New Brunswick 2004 Hantavirus Pulmonary Syndrome (HPS) No cases have been reported in New Brunswick Although cases of HPS have been only reported from western Canada, the presence of infected mice in eastern Canada suggests that the potential for HPS exists across the country. Leprosy (Hansen s Disease) No cases have been reported in New Brunswick since 1990 Leprosy is rare in Canada COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 86

Chapter 5 VECTORBORNE AND OTHER ZOONOTIC DISEASES COMMUNICABLE DISSEASSESS EPIDEMIOLOGI IC REPORTT 2004 COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 87

VECTORBORNE AND OTHER ZOONOTIC DISEASES This section summarizes data on diseases that are caused by pathogens transmitted by animal contact or vectors. Transmission of infectious agents into the bloodstream occurs most often through the bite of an arthropod (mosquito or tick). These diseases are rare in New Brunswick. Data for the diseases in this grouping are collected through the Provincial Reportable Diseases Surveillance System. Incidence rates were calculated using the 2004 population estimates from Statistics Canada. 3 Incidence rates for each of the diseases in this grouping were reported for New Brunswick and Canada in the following 2 tables. 4 Table 5-1: Cases and rates* of vectorborne and zoonotic diseases reported in New Brunswick, by Regional Health Authority 2004 * Rates calculated per 100,000 ** Case not reported nationally *** Data unavailable The table above outlines the distribution of the disease among the Regional Health Authorities in New Brunswick COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 88

Table 5-2: Rates* of reported cases of vectorborne and zoonotic diseases reported in New Brunswick and Canada, 1999-2004 * Rates calculated per 100,000 ** Data not reported nationally *** Data not available Vectorborne diseases are rare in New Brunswick Malaria There was 1 case (0.1 per 100,000) of Malaria reported Travel information for the case was unknown Incidence Rate of Infection by Month (2000-2004) (Figure 5-1) Incidence rates in 2004 decreased from the 2003 rate (1.2 per 100,000) representing a difference of 8 cases from the 2003 total of 9 cases. Eight of the 9 cases reported in 2003 were in immigrants. Cases and Rate by Age Group for 2004 Compared with 8 Year Average Rate (1996-2003) (Figure 5-2) The case occurred in a male in the 40 to 44 year age group COMMUNICABLE DISEASES EPIDEMIOLOGIC REPORT 2004 89