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Environmental risk from Lyme disease in central and eastern Canada: A summary of recent surveillance information

Figure 1: The number of cases of Lyme disease reported in Canada from 1994 to 2012.

This is a bar graph showing the incidence of Lyme disease reported annually in Canada from 1994 to 2012. The y axis is the number of cases and ranges from 0 to 350. The x axis is year and ranges from 1994 to 2012. Numbers of cases before 2009, when Lyme disease became nationally notifiable in Canada, are estimates based on information provided by provincial and territorial public health organizations. The trend depicted shows the incidence of Lyme disease increasing markedly over time. The number of estimated cases in 1994 is 35. For every year after 1994 to 1999, the number of cases remains below 35, ranging from of 25 cases in 1997 to 30 cases in 1999. In 2000, there is an increase in cases to 55, following which the number of reported cases declines over the period covering 2001 and 2004, with numbers ranging from 35 in 2001 to 40 in 2004. Between 2005 and 2008 there is a steady increase in incidence rates, ranging from 70 to 150 cases. Following 2008, the next two years shows a drop in reported cases, with 120 in 2009 and 140 in 2010. In 2011 the incidence rate is 275 cases, while the 2012 figure is highest, with 315.

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Figure 2: The distribution of known (red triangles) and suspect (blue circles) Lyme disease-endemic areas in Canada.

This figure is a map showing where Lyme disease-endemic areas are currently known to occur in southeastern Canada (including southern Ontario, Quebec, New Brunswick, and Nova Scotia) and, by means of an inset map of Manitoba, central Canada. Known endemic areas are shown as red triangles, while areas that are suspected, but not confirmed as Lyme disease-endemic areas, are shown by blue triangles. The locations shown are:

  1. Four locations in Manitoba: A region of the western shore of the Lake of the Woods (known endemic), the Pembina Valley and escarpment areas (known endemic), the Vita/Arbakka population along the Roseau River (suspect area), the eastern Assiniboine population including Beaudry Provincial Park (suspect area), the St. Malo population comprising one area west of Steinbach and the other in the St. Malo/Roseau River area (suspect area), the Richer/Ste. Genevieve Population adjacent to the Agassiz and Sandilands provincial forests (suspect area).
  2. Seven locations in Ontario (all known endemic): Point Pelee National Park, Rondeau Provincial Park, Turkey Point Provincial Park, and Long Point Peninsula including Long Point Provincial Park and the National Wildlife area (all on the north shore of Lake Erie), Wainfleet bog region near Welland on the Niagara Peninsula, Prince Edward Point in Prince Edward County, and parts of the Thousand Islands National Park.
  3. Five known endemic locations in Montérégie in southern Quebec.
  4. Two known endemic locations in New Brunswick: Northern Saint John area and North Head, Grand Manan Island.
Six known endemic locations in areas of the following jurisdictions in Nova Scotia: Lunenburg County, Halifax Regional Municipality, Shelburne County, Yarmouth County, Pictou County, and Queens County.

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Figure 3: Results of field surveillance activities for blacklegged ticks in Canada from 2008 to 2012.

This figure is a map of Canada showing field surveillance activities for blacklegged ticks in Canada from 2008 to 2012. Four regions are identified on the map and described by means of inset maps. These regions cover five provinces: Manitoba, Ontario, Quebec, New Brunswick, and Nova Scotia. Sites where at least one I. scapularis tick was found are indicated by red circles. Sites where I. scapularis ticks were not found are indicated by black crosses.

The locations in the insets shown are:

  1. The region extending across Manitoba south of Winnipeg into northwestern Ontario. There are 29 sites in which at least one I. scapularis tick was found. There are 40 locations where I. scapularis ticks were not found.
  2. The region of Toronto as far west as Lake Huron covering the Golden Horseshoe and Bruce Peninsula area to Midland, as far south as the northwest shore of Lake Erie, and as far east as the southwest tip of Lake Ontario and the northwest tip of Lake Erie. In this region, there were four sites where I. scapularis ticks were found. The inset map shows 25 sites where I. scapularis ticks were not found.
  3. The region of southern Quebec and eastern Ontario, extending as far south and west as the northeastern edge of Lake Ontario in Ontario, and as far north and east as Shawinigan in Quebec. In southern Quebec and eastern Ontario, the proportion of I. scapularis-positive sites was considerably greater than in the sites in any of the other regions. There were 45 sites where I. scapularis were found. There were 27 sites where I. scapularis ticks were not found.
The region including New Brunswick and Nova Scotia. In this region, eight I. scapularis-positive sites were found in the province of Nova Scotia, and none in New Brunswick. There were 34 sites in the two provinces where I. scapularis were not found.

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Figure 4: The proportion of sites visited in field surveillance, in different regions of Canada, at which I. scapularis ticks were found.

This is a combined error bar and symbol graph showing the proportion of sites visited in field surveillance in regions of Canada where I. scapularis ticks were found. The y axis shows the proportion of sites with ticks, indicated with numbers ranging from 0 to 1. The x axis shows the regions in Canada where field surveillance was conducted. The regions are Manitoba south of Winnipeg and northwestern Ontario (S MB and NW ON), Manitoba north of Winnipeg (N MB), Golden Horseshoe and Bruce Peninsula regions of Ontario (ON GH and B), eastern Ontario (E ON), southern Quebec (S QC), and New Brunswick and Nova Scotia (NB and NS). The error bars show exact binomial 95% confidence intervals for the proportion.

The proportion of sites at which I. scapularis are described as follows:

  1. For S MB and NW ON, the error bar is located between 0.22 and 0.39 on the y axis, with the symbol indicating the proportion of I. scapularis ticks found at 0.3.
  2. For N and MB, the error bar is located between 0.02 and 0.25 on the y axis, with the symbol indicating the proportion of I. scapularis ticks found at 0.12 and at 0.25.
  3. For ON GH and B, the error bar is located between 0 and 0.31 on the y axis, with the symbol indicating the proportion of I. scapularis ticks found at 0.05.
  4. For E ON, the error bar is located between 0.36 and 0.75 on the y axis, with the symbol indicating the proportion of I. scapularis ticks found at 0.55.
  5. For S QC, the error bar is located between 0.65 and 0.85 on the y axis, with the symbol indicating the proportion of I. scapularis ticks found at 0.78.
  6. For NB and NS, the error bar is located 0.05 and 0.25, with the symbol indicating the proportion of I. scapularis ticks found at 0.15

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Figure 5: The probable locations where I. scapularis ticks submitted from 2004 to 2012 in passive surveillance (acquired via domestic animal and human patients of participating veterinary and medical clinics).

This figure is a map of Canada showing probable locations where I. scapularis ticks submitted from 2004 to 2012 in passive surveillance; namely, acquired via domestic and human patients of participating veterinary and medical clinics.

Four regions are identified on the map and described by means of inset maps. The regions identified are Manitoba south of Winnipeg and northwestern Ontario, Manitoba north of Winnipeg, the Golden Horseshoe and Bruce Peninsula regions of Ontario, eastern Ontario, southern Quebec, and New Brunswick and Nova Scotia.

On the map of Canada and in the insets, probable locations of I. scapularis ticks are indicated with black circles for the years between 2004 and 2012. There are black circles to indicate 25 738 individual submissions, comprising 28 388 individual ticks, from medical and veterinary clinics in nine provinces. Broken down by province, the numbers are as follows:

  1. Alberta: 221
  2. Saskatchewan: 10
  3. Manitoba: 1 063
  4. Ontario: 9 905
  5. Quebec: 9 371
  6. New Brunswick: 1 631
  7. Prince Edward Island: 829
  8. Nova Scotia: 2 553
  9. Newfoundland: 155

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Summary of Canada's Action Plan on Lyme disease

Figure 1:  Diagram illustrating the three pillars of the Action Plan on Lyme Disease and their alignment with priority areas, key federal objectives, goals, and vision.

This is a flow chart describing the three pillars of the Action Plan on Lyme Disease and their alignment with priority areas, key federal objectives, goals, and vision.

The first priority area listed is Engagement, Education and Information. This priority area includes the following information:

  1. Knowledge transfer and exchange of surveillance/control tools for provincial/territorial public health
  2. Public awareness campaign: public and clinicians; risk communications developed; stakeholder engagement.

This priority area meets the following key federal objectives:

  1. Environmental risk is reduced by control of ticks and environmental management
  2. Canadians at risk adopt preventive behaviours due to targeted risk communications.

The key federal objectives of this priority area help to meet the goal of preventing cases of Lyme disease. Meeting this goal supports achieving the vision of minimizing the economic and health burdens of Lyme disease.

The second priority area is Surveillance, Prevention and Control. This priority area includes the following information:

  1. Risk perception and intervention assessment produced; systematic review of current information
  2. Tick control methods and programs designed
  3. Enhanced surveillance implemented; increase provincial/territorial surveillance capacity.

This priority area meets the following key federal objectives:

  1. Surveillance identifies the population at risk by identifying emerging endemic areas
  2. Canadians at risk adopt preventive behaviours due to targeted risk communications.
  3. Environmental risk is reduced by control of ticks and environmental management

The key federal objectives of this priority area help to meet the goals of preventing and treating early cases of Lyme disease. Meeting this goal supports achieving the vision of minimizing the economic and health burdens of Lyme disease.

The third priority area is Research and Diagnosis. This includes the following information:

  1. Enhance laboratory diagnostic methods; enhance suite of pathogens tested; identify range of Borrelia species and strains
  2. Tools to assist diagnosis/treatment by medical practitioners developed.

The priority area of research and diagnosis meets the following key federal objective:

  1. Medical practitioners are armed with up to date information to help diagnose Lyme disease properly.
The key federal objective of this priority area helps to meet the goal of treating cases early in the course of the disease. Meeting this goal supports achieving the vision of minimizing the economic and health burdens of Lyme disease.

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