Board of Health Meeting Documents

PREPARED BY:

Communications Department

DATE:

September 21, 2023

SUBJECT:

May 15, 2023 – June 14, 2023, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request

Media Exposure Overview Graph

Notes: Between May 15 – June 14, we experienced one large peak, and four small peaks in media exposure:

Friday May 19 – At the Board of Health meeting the night before, three presentations were given, including a  SafePoint update, a new mental health training program, and water testing programs. A total of 26 news stories were released based off the information shared.

May 28 – 30 – We issued a news release announcing the official start of the beach water testing, following incorrect dates reported by the media. Additionally, Dr. Aloosh participated in five media interviews as an introduction to the position. A total of 15 stories were released in this date range on these topics.

Friday June 2 – The media were invited to an active tick dragging event to announce the start of the surveillance program. This resulted in 11 stories.

Thursday June 8 – Environment Canada issued a Special Air Quality Statement for our region due to smoke from wildfires, and we issued a media statement regarding the topic. Eight news stories featured this topic.

Wednesday June 14 – We issued the first set of beach water testing results, resulting in 8 stories.

Website Overview Graph

Notes: During the timeframe of May 14 – June 15, we saw similar website traffic as the previous period of April 14 – May 15. There was a small uptick on June 8, corresponding with the media statement regarding the wildfires and air quality (the statement and the webpage ranked second and third, respectively, in page views that day).

Social Media Overview Graph

Note: Overall, our social media followers / fans remained consistent over the month.

DISCUSSION

Communications Department worked closely with the Environmental Health Department to announce the start of the active tick surveillance program which will ast throughout the summer and early Fall months. Two members of the Communications team attended the event on Friday, June 2, 2023 to assist with the media, and capture photos and videos of the activity.

A media advisory was released inviting the media to an event at the Ojibway Nature Centre, of which three different media outlets attended. Additionally, a news release was issued, which included tips to help prevent tick bites. The email sent to our General Subscribers list had an open rate of 54%.

A social media post went out on Monday, June 5 which included a short video of a Public Health Inspector dragging for ticks. The video received 571 views on Facebook, 992 views on Twitter, and nearly 400 views on Instagram.

Prepared By:

Planning and Strategic Initiatives Department

Date:

September 21, 2023

Subject:

Q2 2023 Board of Health Feedback Survey Results

BACKGROUND/PURPOSE

The Ontario Public Health Standards (2021), under the Good Governance and Management Practices Domain, states: “the board of health shall have a self-evaluation process of its governance practices…”.

In addition to a yearly self-evaluation process, the WECHU has developed a quarterly self-assessment survey for Board of Health (BoH) members. The survey provides an opportunity for feedback on BoH operations and is used to inform quality improvement efforts.

DISCUSSION

Responses in the second quarter of 2023 related to BoH operations were generally positive. In most cases, 80% or more of the responses were Agree or Strongly agree regarding the aspects queried. The one exception was related to the item ‘All material notices of wrongdoing or irregularities were responded to in a timely manner’, where 78% of the responses were Agree or Strongly Agree. In terms of overall perceived BoH effectiveness, 78% of the responses were either a 9 or a 10 (on a 10-point scale), where all responses were greater than an 8.

Suggestions for improvement included providing a complete summary of the reports when they are given to the BoH, providing suggested actions by administration resulting from presentations to the BoH, increased frequency of BoH meetings, and additional information about marketing and communication information.
 

Prepared By:

Healthy Schools Department - Immunization

Date:

 September 21, 2023

Subject:

Immunization Coverage in 7, 12 and 17-year-olds in Windsor-Essex County

BACKGROUND/PURPOSE

The compliance rates of students in elementary and secondary schools were assessed as part of the Immunization of School’s Pupil Act (ISPA) enforcement during the 2022-2023 school year. Students born in 2008 were not included in this compliance review due to the timing of their transition from elementary to high school and the planned implementation process. This compliance data, apart from the rates of students born in 2008, was presented in the  April 2023 Board Report.

Local available temporal trends of immunization coverage rates among 7- and 17-year-olds is presented on the WECHU’s Healthy Schools Immunization dashboard. The dashboard also provides comparisons to provincial coverage rates and national coverage goals.

This report is in follow-up to the April 2023 commitment to the Board of Health and the community to provide updated and expanded immunization coverage rate data as an outcome of the completed process in the previous school year.

Immunization Coverage Rates

Immunization coverage rate describes the proportion of a population that is appropriately immunized against a vaccine preventable disease (VPD) at a point in time. Achieving and maintaining high immunization coverage is essential for effective prevention and control of VPDs.

Vaccine coverage rates for ISPA required vaccines and strongly recommended school ages vaccines are presented below.

Of interest is the HPV vaccine coverage rate among 17 year olds, which is higher than the provincial rate of 64.1% (as of August 31, 2022). While the WEC region surpasses the provincial coverage rate for HPV, WEC is below the  national coverage goal of 90% vaccination coverage by 17 years of age. Also interesting to note, is the vaccine coverage for Hepatitis B among 17 year olds, which is higher than the provincial rate of 74.9%, is also lower than the desired national goal of 90%. Both of these vaccines, in addition to Meningococcal disease vaccine, is provided to all students in grade 7 as a part of the WECHU’s school-based vaccine program.

Discussion

The coverage rates for 7-year-olds reflect families who have completed the immunization record review process, including notification of immunizations missed and catch-up vaccination clinics as part of the 2022-2023 ISPA enforcement process.

During the 2016-17 school year, the Grade 7 HPV vaccination program was expanded to include provincially funded coverage for males. While these students have since graduated high school, it is likely that the HPV coverage rate among young males is impacted by societal norms, which may take some time to increase the rate of HPV coverage.

The coverage rates for diphtheria, tetanus and pertussis among 17-year-olds is lower than many immunizations listed below. This suggests many students missed receiving their adolescent tetanus-diphtheria-pertussis (Tdap) booster dose during the pandemic, typically administered between 14-16 years of age by primary care providers. The WECHU continues to work with local primary care providers to promote adherence to Ontario’s Routine Immunization Schedule.

Also of note, effective September 2014, the ISPA was amended to require children born on or after 2010 to be vaccinated against Varicella-zoster – a herpes virus that causes chickenpox. The publicly funded immunization schedule outlines this dose of Varicella vaccine should be administered when the child is 15 months old. Students who are 17 years old in 2023, reflected in much lower rates upon review, were born in 2006, before the ISPA requirement was instituted.

1. National goal to achieve 95% vaccination coverage by 7 years of age, highlighted in green above.

2. National goal to achieve 90% vaccination coverage by 17 years of age, highlighted in green above.

3. Vaccination with Meningococcal C conjugatevaccine.

4. Vaccination with Quadrivalent meningococcal conjugate vaccine.

Note: Cells in orange above, highlight the coverage rates for vaccine-preventable diseases that are below the national goal.

Improved coverage rates can be attributed to several WECHU interventions that were implemented during the ISPA enforcement activities of the 2022-2023 school year. An improved level of human resources was dedicated to the school aged vaccine administration and the ISPA enforcement process compared to what was previously available. This enabled increased capacity to accomplish:

• comprehensive immunization records review and updating
• enhanced communication and support for families
• improved technologies to support parent/guardian consent process
• increased catch-up vaccinations administered via in-house clinics and in collaboration with health care providers.

Conclusion

There is a significant opportunity in Windsor and Essex County to improve the existing vaccine coverage rate for HPV among 12- and 17-year-olds. The HPV vaccine is safe and over 95% effective in protecting students against 9 types of HPV that can cause head and neck cancers, genital cancers, and warts. The best protection against these diseases is receiving the HPV vaccine before a person engages in sexual activity. The WECHU will be implementing future communication campaigns to raise uptake of the HPV vaccine in eligible populations (Grades 7-12 students) based  on current criteria for access to free vaccine (until the end of Grade 12) and explore advocacy efforts to expand current provincially funded eligibility requirements.

The WECHU continues to focus on parent/guardian communication strategies to increase awareness of their duty to report immunizations to the health unit and to help address vaccine hesitancy concerns. These interventions will focus on reporting prior to entry to school and using an online reporting tool that parents can use to update their child’s immunization from infancy. The WECHU is also planning to expand our efforts to work with families of pre- school age children, prior to their entry to school, to ensure protections are in place even sooner than the start of elementary aged attendance.

The WECHU implemented and completed ISPA assessment, enforcement (including the suspension processes) for elementary and secondary school students (except for those born in 2008) in the 2022-2023 school year. Any student who was overdue for their age-appropriate ISPA-vaccine (and did not have an exemption) by the deadline; was suspended from school for up to 20 days. Currently, any student born in 2008 (Grade 10 students for the 2023- 2024 school year) has received a notification letter informing them of any vaccines they’re overdue for; catch up clinics took place over the entire summer to provide students with an option to get those vaccinations prior to the new school year.

The WECHU will be implementing a robust maintenance strategy for all school aged children in the spring. Student immunization records, in all grades, will be assessed this fall and winter and the WECHU will implement the enforcement process for any student enrolled in WEC elementary and secondary schools that are overdue for required ISPA vaccines (based on age eligibility). Although highly resource intensive, this maintenance process will take place annually, and is the most effective and sustainable way to support ongoing protections and improved immunization coverage for our community.

To ensure ongoing protections for vaccine preventable illness, the WECHU remains committed to working with primary care providers helping them adhere to the publicly funded immunization schedule. Following the schedule will help ensure infants start on the right timetable for important childhood immunizations, and can help get students’ vaccination back on schedule, if there are gaps in coverage. The WECHU continues its work in ensuring access to publicly funded vaccines for students who currently do not have access to primary care providers.   
 

Prepared By:

Chronic Disease and Injury Prevention Department

Date:

September 21, 2023

Subject:

Windsor-Essex Community Opioid and Substance Use Strategy Update

BACKGROUND

The Windsor-Essex Community Opioid and Substance Strategy (WECOSS) was established in 2018 by the Windsor-Essex County Health Unit (WECHU) to bring together leadership representatives from across the region to address increasing rates of opioid use and overdose. The WECOSS is a four-pillar approach that leverages the knowledge and resources of more than 40 agencies and individuals with lived experience to address the harms of substance use at the community level through Prevention and Education, Harm Reduction, Treatment and Recovery, and Enforcement and Justice interventions.

Since the Strategy began, an Annual Report has been released as part of the WECOSS’ commitment to information sharing. The purpose of each Annual Report is to highlight the work being done to address substance use in the community through the collaborative efforts of our WECOSS partners. In 2021, an evaluation of the WECOSS was conducted by engaging members and the public to assess the level of awareness and early impact of the WECOSS in the community. The findings from this evaluation were used to form recommendations as presented in the WECOSS Modernization (2021) to guide the pathway forward for the WECOSS, including highlighting priority areas, and emphasizing a collective impact approach.

CURRENT INITIATIVES

Each of the four WECOSS pillars develops and implements at least one project per year, which are outlined in Annual Reports. In 2022, the development of these projects were guided by the six priority areas for focus and action. Future initiatives will continue to address and expand upon these priorities as the Strategy evolves.

The Addressing Substance Use in Corrections Reintegration Supports project was a key initiative undertaken in 2022 by the Enforcement and Justice Working Group. This involved collaborating with the South West Detention Centre, Windsor Probation and Parole, and the Canadian Mental Health Association Windsor-Essex County Branch. The goal of the project was to improve access to substance use and harm reduction supports and services for justice-involved individuals who had a history of problematic  substance use.

Through this project, 179 individuals were engaged, 138 of which were justice-involved individuals and 41 of which were justice system staff. This highlighted that justice-involved individuals released from custody required more knowledge and information in six (6) key areas:

• Housing support;
• Job skills or help getting a job;
• Community support groups;
• Help with obtaining identification;
• Referral to mental health and substance use services;
• Referral to withdrawal management or treatment for substance use

Additionally, justice-involved individuals expressed that their preferred methods for obtaining this information included one-on-one discussions with staff at intake, appointments, or during education sessions.

FUTURE PLANS

The findings from Addressing Substance Use in Corrections Reintegration Supports project resulted in the development of a wallet card resource containing information on more than 35 relevant supports and services. These will be distributed by various partners involved in the project and other relevant law enforcement partners to people involved with the justice system. There is also opportunity to work with partners to develop the necessary policies and procedures to facilitate discussions about relevant supports for successful reintegration. To support the educational needs of justice system staff, a hub of resources and educational materials was also compiled and will be made available through the WECOSS website.

Substance use supports and harm reduction approaches are critical for justice-involved individuals, especially during release from custody as this is when individuals are at an increased risk for drug-related deaths.¹ Additionally, addressing the basic needs of justice-involved individuals who use substances can aid in successful reintegration following incarceration.²

Subsequent work will focus on addressing barriers and building trust with people who use substances to enhance coordination between law enforcement and health services. To facilitate this, an online inventory of more than 200 local substance use, addictions, and mental health services will be designed through an ongoing WECOSS Treatment and Recovery Pillar Working Group project. The inventory will assist service providers in making referrals to relevant services for their clients.

References

1. Cooper, J. A., Onyeka, I., Cardwell, C., Paterson, E., Kirk, R., O’Reilly, D., & Donnelly, M. (2023). Record linkage studies of drug-related deaths among adults who were released from prison to the community: A scoping review. BMC Public Health, 23(1), 826. https://doi.org/10.1186/s12889-023-15673-0
2. McKiernan, A. (2017). Supporting reintegration in corrections by addressing problematic substance use: An environmental scan. Canadian Centre on Substance Use and Addiction. Retrieved from:   https://www.ccsa.ca/sites/default/files/2019-04/CCSA-Reintegration-Corr…- Environmental-Scan-2017-en.pdf
    

BACKGROUND

Overview

• SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m. daily.
• In order to ensure transparency related to SafePoint operations, the Board of Health will be provided with regular updates.

Application Status

• The WECHU’s application to operate SafePoint under a Supervised Consumption Services (SCS) exemption was approved by Health Canada on July 21st, 2023.
• The SCS exemption was shared with the Ministry of Health immediately following approval and in doing so, the Ministry confirmed that there are no outstanding elements in the WECHU’s application to operate a fully funded Consumption and Treatment Services (CTS) site at SafePoint.
• As it stands, the Ministry of Health application for CTS funding remains under review.

CURRENT INITIATIVES

Operational Data

It has been four months since SafePoint opened on April 26th, 2023. From opening to August 31st, there have been 418 client visits amongst 119 unique clients, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of August are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of August, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client #1

SafePoint staff connected with the Wellness Program for Extended Psychosis with the Transitional Stability Centre (TSC) on behalf of a SafePoint client. Staff walked with the client to the TSC so that they could be administered their medication that was overdue.

FUTURE PLANS

SafePoint has continued to expand the wraparound services available on-site. The Mobile Medical Support (MMS) Team and their Dental Hygienist will be on-site of SafePoint on Friday, September 8th, 2023 to provide clients with dental services. SafePoint has also developed a procedure with Family Services Windsor-Essex to dispatch Homelessness Outreach Workers to SafePoint as needed.

SafePoint is preparing to launch its business engagement strategy as part of the site’s ongoing commitment to community engagement. The business engagement strategy will involve regular outreach and resource distribution to the area businesses to learn about and address their concerns about the site.     
 

BACKGROUND

Overview

• SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m. daily.
• In order to ensure transparency related to SafePoint operations, the Board of Health will be provided with regular updates.

Application Status

• On July 21st, 2023, the WECHU received a letter from the federal government authorizing the requested Supervised Consumption Services (SCS) exemption.
• The SCS exemption granted by Health Canada has since been shared with the Ontario Ministry of Health, and in doing so, the WECHU confirmed with the provincial Ministry of Health that there are no elements outstanding in its application to operate a fully funded Consumption and Treatment Services (CTS) site.
• As it stands, the Ministry of Health application for CTS funding remains under review.

CURRENT INITIATIVES

Operational Data

It has been three months since SafePoint opened on April 26th and there have been 288 client visits amongst 93 unique client visits, with no overdoses reported on-site to date. Additional details about the services provided at SafePoint during the month of July are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of July, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following client experience narrative:

Anonymous Client #1

SafePoint security staff witnessed a person using a substance in the area surrounding SafePoint and encouraged them to access the site. The person was informed that if they entered the site that the nursing staff would monitor them to reduce their risk of harm. After staff educated the client about the services available on site, the client agreed to remain inside and be monitored. The client was able to be monitored under the supervision of medically trained staff and was provided the option to access wraparound services.

FUTURE PLANS

As part of SafePoint’s continued commitment to community engagement, the WECHU will work closely with the SafePoint Advisory Committee members, including the Downtown Windsor Business Improvement Association (DWBIA), to expand efforts in offering support to surrounding businesses and address concerns related to the site's operations. A “SafePoint Toolkit” will be distributed as part of active outreach to area businesses, which contains resources that outline services offered at SafePoint, who to contact if a business-related concern is identified, and other supports made available to businesses as the site operates.

Since opening, SafePoint staff have attended 6 community events where resources and information about SafePoint have been shared. This has led to connections with various community partners for client referrals.

SafePoint has continued in its efforts to expand the wraparound services available on-site. The Recovery Education for Addictions and Complex Trauma (RE/ACT) team will now be on-site every Wednesday from 4:00          
p.m. – 5:00 p.m. to support clients through their holistic substance use recovery program. The program focuses on the numerous ways in which trauma shapes people’s lives, thought patterns, behaviours, and health. To view the full wraparound service schedule for the site, please visit the WECOSS webpage: Consumption and  Treatment Services Site.          
 

PREPARED BY:

Communications Department

DATE:

September 21, 2023

SUBJECT:

June 15, 2023 – July 14, 2023, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request

Media Exposure Overview Graph

Notes: Between June 15 – July 14, we experienced one large peak, and three smaller peaks in media exposure:

June 15 & 21 – Beach water results were shared via email and social media posts on these two dates, resulting in 11 and 5 stories, respectively.

June 28 – An air quality statement for our region was issued due to the forest fires in Northern Ontario and Quebec, as well as beach water testing results. Combined, this resulted in 21 news stories.

July 5 – We issued beach water testing results, a heat alert, and an opioid overdose alert, which resulted in 17 stories (total).

July 12 – Beach water testing results were issued, resulting in 8 stories.

Website Overview Graph

Notes: During the timeframe of June 14 – July 15, we saw similar website traffic as the previous period. There was a small uptick on July 5, corresponding with the release of the weekly beach water testing results.

Social Media Overview Graph

Note: Overall, our social media followers / fans remained consistent over the month.

DISCUSSION

The Communications Department worked closely with the Infectious Disease Prevention Department on a campaign to raise awareness of, and educate people about, MPox. The campaign was multi-faceted, including components such as paid social media posts and a full-page ad in Windsor Life magazine.

There were three paid posts on Facebook which resulted in 702 total link clicks, which took viewers to https://www.wechu.org/mpox. This achieved the goal of boosting web traffic.

Windsor Life magazine has a reach of 60,922 via the printed edition.

Prepared By:

Healthy Schools Department - Immunization

Date:

September 21, 2023

Subject:

Seasonal Influenza and COVID-19 Season 2023/2024

BACKGROUND

Influenza (flu) Vaccine

The Windsor-Essex County Health Unit (WECHU) plays a key role in the implementation of the Ministry of Health’s Universal Influenza Immunization Program (UIIP) which offers influenza vaccine free of charge each year to all individuals six months of age and older who live, work, or attend school in Ontario.

Under the UIIP, the provincial supply of influenza vaccine doses is received from the Ontario Government Pharmacy (OGP) in predetermined increments dependent on vaccine availability. The WECHU receives influenza vaccine shipments from OGP and is responsible for the distribution to health care providers and facilities in the community. Allocation to providers is based on total community allocation, number of clients to be served, past usage by the provider, available fridge space, and the proportion of high-risk clients the provider is responsible for. Community Immunization Providers (e.g., primary care providers, hospitals, long-term care homes (LTCH) and retirement homes (RH)) order influenza vaccine from the WECHU, starting in September.

COVID-19 Vaccine

In July 2023, the Ontario Ministry of Health, recommended that Ontarians aged 5 years and older delay getting a COVID-19 booster until the fall. Receiving a booster dose in the fall, as respiratory season commences, will maximize protection against COVID-19 outcomes when peak circulation of the virus is likely to occur with other seasonal respiratory viruses.

Currently, the WECHU is administering primary doses of COVID-19 vaccines at their in-house clinics at the Windsor and Leamington offices. The Healthy Schools Immunization Team is supporting families of school aged children this summer by offering COVID-19 education and immunizations to individuals who want to be vaccinated at upcoming School Readiness Events.

In addition, any pharmacy that is participating in the annual UIIP is encouraged to also participate in the COVID-19 vaccine administration program. Pharmacies who have been approved to administer COVID- 19 vaccine are required to have a cold chain inspection on the vaccine refrigerator(s) that will be storing publicly funded influenza vaccines.

CURRENT INITIATIVES

Throughout the year, the WECHU has completed 366 vaccine fridge inspections throughout Windsor and Essex County (WEC) for health care providers, pharmacies, agencies, long-term care and retirement homes planning to administer influenza and COVID-19 vaccines this fall.

Eighty-four out of 120 local pharmacies that applied to manage and administer fall vaccines were approved by the Ontario Ministry of Health to provide both influenza and COVID-19 vaccine. Thirty-six pharmacies that were approved to provide influenza did not apply to administer COVID-19 vaccine.
Participating pharmacists may only administer publicly funded influenza vaccine to individuals 2 years of age and older. While pharmacists can administer COVID-19 vaccine for individuals 6 months and older, they generally administer COVID-19 vaccine to individuals 2 years and older.

In preparation for, and over the course of the respiratory virus season, the WECHU maintains ongoing communication with all health care providers and pharmacies and relays information about the timelines for vaccine availability. Tailored information packages including vaccine product information, ordering information, and promotional materials are also compiled and distributed to providers by the WECHU each influenza season.

Community immunization providers are encouraged to help increase access and uptake of influenza and COVID-19 vaccines by offering co-administration of COVID-19 and influenza vaccine. To support widespread availability of both the influenza and COVID-19 vaccine in our community, the WECHU is working collaboratively with many community partners, including hospitals, operators of congregate living facilities, and primary care, to identify service gaps and opportunities to increase vaccine uptake. The WECHU will be supporting COVID-19 vaccine clinics, with a focus on prioritized populations and high-risk individuals; individuals attending these clinics will also have an opportunity to receive influenza vaccine at the same time.

The Ontario Ministry of Health has indicated that the timeline for the influenza and COVID-19 vaccine rollout will be aligned in the coming months. Initial inventory shipments are expected by the end of September/early October. The first allocation would target vaccine administration in hospitals, long-term care, and retirement homes. The second allocation would target high-risk groups for influenza and COVID- 19 related complications or hospitalization. The third allocation targets the entire population and is expected in November.

The WECHU will be running a communication campaign from October to December to raise awareness of the risks of contracting seasonal respiratory illnesses (e.g., influenza and COVID-19), and the importance of getting vaccinated, especially for individuals who are part of a high-risk group. Targeted, organic social media ads and print materials, and articles will be developed to communicate key messages.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Michael Horrobin, Judy Lund, Angelo Marignani, Michael Prue, Rob Shepley

Board Member Regrets:

Hilda MacDonald, Robert Maich

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Lee Anne Damphouse

WECHU Guests:

Joanne Hegazi, Manager, Healthy Schools   
Marc Frey, Manager Planning & Strategic Initiatives

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH – November 20, 2023

ISSUE/PURPOSE

Human Papillomavirus (HPV) is a very common virus that can cause many types of cancers. HPV can infect both males and females. Without immunization, approximately 3 out of 4 people will have at least one HPV infection in their lifetime 2. The Ontario government covers the cost of the HPV vaccination series for students in Grade 7-12 through the school-based immunization program.  The WECHU offers this vaccine to all grade 7 students in Windsor and Essex County schools each year. In Ontario, this vaccine is also available for free to men who have sex with men, individuals who identify as gay or bisexual, and some people who identify as transgender, up to the age of 26. For individuals not meeting these criteria, the vaccine can be purchased privately with a prescription. The HPV-9 vaccine currently used in the province is approximately $645 for a complete series ($215/dose)[i]. This cost may be covered through some private insurance plans, but would be considered prohibitive for many individuals considering vaccination.

Each year 3,800 new cancer cases in Canada are attributed to HPV; by 2042, this number will increase to 6,600[ii]. HPV infection increases the risk of developing six different types of cancer. Cervical cancer is almost exclusively caused by HPV and is the leading cause of most oropharyngeal cancers. It usually takes years after being infected with HPV for oropharyngeal cancer to develop, and not all oropharyngeal cancers are caused by HPV. While population-level Ontario data on the incidence of oropharyngeal cancers caused by HPV has only just begun to be collected, research has shown that the incidence of oropharyngeal cancers caused by HPV has increased in Canada since 2000. [iii] [iv]

As a part of an equity-based initiative, all strategies to reduce cervical and other cancers must consider health disparities and minimize existing barriers, such as cost, to be effective. The 2019–2029 Canadian Strategy for Cancer Control and the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 address the health inequities and barriers in accessing preventative care such as HPV vaccination that are experienced by rural and remote communities, people with low income, recent immigrants, First Nations, Inuit and Métis and other populations, such as LGBTQ2S+ individuals. 

The HPV vaccine product currently used in Ontario as a part of the publicly funded vaccine program, is authorized for use by the manufacturer in males and females aged 9 to 45 years old. The National Advisory Committee on Immunization (NACI) recommends this vaccine for all individuals between the ages of 9 to  26. According to Health Canada, HPV vaccination is recommended for females aged 9 to 45 and for males aged 9 to 26. For best protection from the vaccine, it should be administered before an individual becomes sexually active.

The current provincially funded vaccination schedule provides limited access to this free of charge important vaccine,  and creates a missed opportunity for an important preventative, protective, and evidence based public health strategy. 

BACKGROUND

HPV infection does not often show symptoms and can be spread easily by intimate skin to skin contact. In some cases, symptomatic HPV infections may even clear up on their own without treatment over time. Some infections cease to disappear and can lead to cancer. Certain high-risk HPV strains (i.e., types) can cause cervical cancer and are often associated with cancers of the penis, anus, vulva, vagina, mouth, and throat. Certain low-risk strains can cause warts. The virus can be passed from an infected mother to baby before and during birth. Newborns with HPV are at risk of developing respiratory papillomatosis. 

The current HPV vaccine used in Ontario can protect against nine strains of HPV infection. Vaccination works best when it is received prior to exposure to HPV and will not protect against existing HPV infections or HPV strains not included in the vaccine. Additional prevention activities for women include receiving regular Pap tests (the current recommendation in Ontario is a Pap test every 3 years[v]), even after receiving HPV vaccine. Since 2007, 99 countries and territories have developed comprehensive human papillomavirus vaccination programs. In 2019, a Canadian study demonstrated strong evidence that HPV vaccination prevents infections, genital and anal warts, and precancerous lesions at a population level. The impacts were seen in both females and males. [vi]

The best way to prevent HPV is getting the HPV vaccine. Not only is immunization the best preventative strategy, it’s also cost effective. In a recent study, it was found that the Return on Investment for HPV vaccination was consistently above 1 (range: 1.4–3.58), which means for every dollar spent on HPV vaccination up to 3.58 dollars are saved.[vii]

PROPOSED MOTION

Whereas, the NACI recommends HPV vaccination in all individuals ages 9 to 26, inclusively, and 

Whereas, the Government of Canada’s HPV vaccination rate coverage target of 90% is based on disease reduction targets, program impact, disease characteristics, achievability, and jurisdictional variation in vaccination programs, as well as quality and effectiveness of the vaccine, and

Whereas, HPV vaccination is an evidence informed, cost-effective strategy to reduce related cancer risks, and

Whereas, the HPV vaccine is a critical component of the Action Plan for the Elimination of Cervical Cancer in Canada, 2020-2030 which aims to eliminate cervical cancer by 2040, and

Whereas, the WECHU’s current HPV vaccination coverage rate for individuals 12-17 years old is 61.47%.

Therefore be it resolved that the Windsor-Essex County Board of Health recommends that the Province of Ontario extend the coverage for HPV vaccine through the publicly funded vaccine schedule to include all individuals up to the age of 26 (at minimum), and to eligible individuals from all high-risk populations (age limit based on product monograph). 

Further that the Windsor-Essex County Board of Health recommends local health care providers in Windsor and Essex County engage all clients under the age of 45 and parents/guardians of children in grades 6-12 to discuss: HPV vaccine status, review the benefits of HPV vaccination, and discuss options for those eligible and unvaccinated/undervaccinated.

PREPARED BY:

Environmental Health

DATE:

June 15, 2023

SUBJECT:

Food Handler Training

BACKGROUND/PURPOSE

The Ontario Food Premises Regulation 493/17 requires all operators of food premises to ensure that there is at least one food handler or supervisor onsite who has completed food handler training during every hour in which the premises is operating. Food handler training and certification must be obtained from an Ontario public health unit or another provider that is recognized by the Ontario Ministry of Health, and in accordance with the requirements outlined in the Food Safety Protocol, 2019  and the Operational Approaches for Food Safety Guideline, 2019.

The number of infractions in which a certified food handler was not onsite, in the most two years, during a public health inspection in Windsor and Essex County (WEC) is summarized in the table below.

The Environmental Health (EH) department offers a free online Food Handler course, in English, French, Spanish, Chinese and Arabic languages. There is also a Food Handler manual providing course material to help individuals prepare for the exam. The manual is available to in English and French that individuals can purchased for $10 and can be picked up at one of the Windsor-Essex County Health Unit offices.

In-person certification exams are made available throughout WEC, in multiple languages, for a $10 fee. Individuals must register online to book their exam. A certification card is issued when a grade of 70 percent or higher is achieved and is valid for five years. This year WECHU has offered 28 exam sessions to date. An emerging challenge that the WECHU has identified are individuals registering to attend for examination, fulfilling one of the open spots, and not attending (average actual attendance is 72% of the available space). Based on this recent trend, we have adjusted exam registration capacity to ensure the classes are full at all times. We are also exploring opportunities to utilize larger spaces to accommodate more individuals at a time, that can be efficiently proctored with an efficient writer to proctor ratio.

DISCUSSION

In the fall, Public Health Inspectors (PHIs) will begin issuing fines to food premises operators who are non-compliant with the O. Reg. 493/17 requirement to have at least one certified food handler onsite during every hour in which the premise is operating. In accordance with  (items 248 and 249) of the Provincial Offenses Act, charges will be issued for the total amount of $385 ($305 set fine, plus $75 victim fine surcharge and $5 fee) Schedule 41 Ontario Provincial Penalties  O. Reg. 161/00: VICTIM FINE SURCHARGES under Provincial Offences Act, R.S.O. 1990, c. P.33. In the months leading to this deadline, operators will be provided with education and appropriate notice of this upcoming enforcement action. The EH department will continue increase the number of exam dates available throughout WEC locations to satisfy any additional demand that arises. 

PREPARED BY:

Infectious Disease Prevention (IDP)

DATE:

June 15, 2023

SUBJECT:

Sexual Health Campaigns in IDP

BACKGROUND/PURPOSE

Syphilis is a sexually transmitted and blood-borne infection (STBBI) of public health significance. Although syphilis is largely preventable, data for these infections in Windsor and Essex County (WEC) is showing cause for concern. Syphilis cases are steadily increasing. Over the past 5 years, the WEC crude incidence rate of syphilis (infectious, latent, and other) increased from 13.52 cases/100,000 population in 2018 to 17.37 cases/100,000 population in 2022. This is an increase of 28.55%. In comparison to provincial rates, the crude incidence rate of syphilis (infectious, latent, and other) in Ontario increased from 20.02 cases/100,000 population in 2018 to 35.51 cases/100,000 population in 2022, which is an increase of 77.37%. Congenital syphilis, the transmission of syphilis to a baby during pregnancy or childbirth, has also become increasingly more prevalent in Canada in recent years. (Public Health Agency of Canada, 2021). Locally, three congenital syphilis cases have been reported in WEC.

Most syphilis cases have been found in men, although women are also at risk. Of the 396 cases of syphilis that occurred in WEC from 2018-2022:

• 80.30% were male, 19.19% were female, and 0.51% were transgender;
• Age ranged from 18 to 75 years, with a median age of 39 years; and
• 4.55% of syphilis cases were co-infected with HIV based on iPHIS risk factors.

Risk factors for syphilis include: unprotected sexual activity (especially in men who have sex with men), sexual contact with an identified case of syphilis, sexual contact with an individual from a jurisdiction with an elevated prevalence of syphilis, previously tested positive for syphilis, HIV, or other sexually transmitted bloodborne infections, born to an individual who tested positive for syphilis during pregnancy, and being classified as a member of a vulnerable population engaging in unprotected sex (vaginal, anal, and oral), men having sex with men, and having sex with anonymous and/or multiple partners (Public Health Agency of Canada, 2021). This increasing trend of engaging in anonymous sex with partners found on the internet has created challenges in being able to notify contacts of exposure.

CURRENT INITIATIVES

Public health campaigns play a strategic role in society by raising awareness of important health issues and encouraging groups and individuals to seek information and services. With increased prevalence of syphilis and other sexually transmitted infections, like MPox (previously known as Monkeypox), IDP is developing a sexual health strategy that include various initiatives and platforms to address the issue.

The strategy aims to reach the broader community with an emphasis on reducing stigma, prevention, increasing public knowledge about syphilis, encourage individuals to get tested and know that it can be treated with antibiotics. Recognizing that June is Pride Month, IDP will be kicking off a MPox advertisement (ad) in the Summer Issue for Windsor Life Magazine (see Appendix A). Social media posts on WECHU’s Facebook and Instagram platforms will also push out critical messages about virus transmission, symptoms, testing, and vaccine availability that align with Public Health Ontario’s initiatives, alongside the Gay Mens Sexual Health Alliance. These efforts directly contribute to getting community members vaccinated and helping people access reliable and trustworthy information. The MPox ad will also be published in the 2023 Come OUT & Play Guide to support our local Windsor-Essex Pride Fest, which IDP will partake in as a vendor in August 2023. MPox vaccines, along with sexual health education, will be available at the event.

Moreover, IDP has collaborated with the Healthy Schools department and Merck to organize a Healthcare Provider Breakfast event that will be held on June 15, 2023. Dr. Mehdi Aloosh and Dr. Shanker Nesathurai will be shedding light on the increasing syphilis numbers in WEC. Kim Kirkpatrick, a Nurse Practitioner from Sexual Health Windsor, will also be presenting about the recent syphilis trends and resources available in the community in relation to syphilis. One of the objectives of the event is to emphasize the importance of testing and treating syphilis in the community. Aligning with the Healthcare Provider Breakfast event, a syphilis ad is also underway that focuses on removing the stigma from sexual health and promoting STI testing in the community. The syphilis ad will be included in the July/August issue of the Biz X Magazine, and social media posts will parallel this initiative. The campaigns are carefully crafted to address the demographic changes in WEC in relation to sexual health.

References

Public Health Agency of Canada. (2021, 11). Infectious syphilis and congenital syphilis in Canada, 2020. 2021. Retrieved from https://www.canada.ca/en/public-health/services/publications/diseases-c…

Appendix A
MPox Advertisement

PREPARED BY:

Communications Department

DATE:

June 15, 2023

SUBJECT:

April 15, 2023 – May 14, 2023, Communications Update

BACKGROUND/PURPOSE:

Provide regular marketing and communication updates to the Board of Health.

Data Notes can be provided upon request

Media Exposure Overview Graph

Notes: During the time frame of April 15 – May 14, we experienced three peaks in media exposure:

Wednesday, April 19 – We issued a Media Advisory and hosted a media event at SafePoint, where the official launch date was announced. This resulted in a total of 29 news stories.

Friday, April 21 – We issued a news release announcing the hiring of the new Acting Medical Officer of Health, which resulted in 11 news stories.

Friday, April 28 – We issued a news release announcing COVID-19 policy updates for staff and clients (e.g., removal of masking requirements and active symptom screening). This resulted in a total of 13 news stories.

Website Overview Graph

Notes: During the time frame of April 15 – May 14, website visitor traffic remained consistent when compared to the previous March 18 to April 14 timeframe.

Social Media Overview Graph

Note: On April 20, 2023, Twitter removed the Blue Verification Checkmark from user profiles and introduced a tiered system which involved payment for various types of verification. This resulted in many users leaving the platform, which may account for the change in our followers. The WECHU applied for a grey checkmark which denotes a verified government agency, which is now displayed on our account.

DISCUSSION

The Communications Department worked closely with the Chronic Disease & Injury Prevention team to announce the opening of SafePoint, which included planning a media event and a series of public open houses.

A Media Advisory was issued on Tuesday April 18, inviting the media to an on-site event on Wednesday April 19. The media event was attended by representatives from all six of the major local news outlets, and yieled 29 news stories which highlighted the public open houses as well as the official first date of service. The WECHU also issued a News Release to the General Subscribers list in MailChimp to notify the public of the open house sessions.

To further communicate the public open houses, two social media posts were issued on the WECHU’s Facebook and Twitter platforms, using a poster designed by the Communications Department Graphic Designer.

PREPARED BY:

Healthy Schools Department

DATE:

June 15, 2023

SUBJECT:

Update on Healthy Eating/Food Literacy Activities in WEC Schools

BACKGROUND/PURPOSE

Directed by the Ontario Public Health Standard’s School Health Guideline (2018), the mandate of the WECHU Healthy Schools team is to improve the health and well-being of school-aged children and their families across Windsor and Essex County. The WECHU works with schools to support the implementation of the Health and Physical Education Curriculum and the adoption of programs, practices, and policies that enable students to practice making healthy choices. To ensure that programming meets the needs of school communities and builds on identified strengths, the WECHU consults and collaborates with students, parents, teachers, principals, school administrators, and school boards.

There are 168 local schools supported by the Healthy Schools team. Using a health equity approach to target the most vulnerable children and families, our program uses a two-pronged approach to service delivery: targeted and universal. In our targeted program, schools identified as higher needs are assigned a nurse who they can connect with directly. In our universal program, lower-needs schools can contact the Healthy Schools Program by phone or email for support. All schools are provided with WECHU-developed resources throughout the school year, which are also accessible from our WECHU School Health webpage.

Schools that identify healthy eating or food access as a priority during our annual school needs assessment, work School Health staff to create a targeted School Health Action Plan for support. The Action Plans are developed using the principles of Ontario’s Foundations for a Healthy School. Food literacy was introduced into Ontario’s Science and Technology Curriculum in 2022. As a result, our programs are being reviewed and developed in support of the new curriculum elements.

CURRENT INITATIVES

Supporting the Ontario Student Nutrition Program in Windsor and Essex County Schools

The Ontario Student Nutrition Program- Southwest Region (OSNP-SW) is a meal and snack program designed to ensure children have access to healthy food and beverages throughout the school day. The program is housed within the Victoria Order of Nurses (CON) Windsor-Essex site. These programs are run locally by students, parents, and volunteers, and are funded through multiple sources including provincial funding, grants, and local community groups, organizations, and fundraising. In the 2022/23 school year, 93 schools in Windsor-Essex enrolled in the OSNP, reaching approximately 29,000 students. The WECHU supports the OSNP locally by advocating for and supporting new schools to enter the program.

“You’re the Chef” Food Skills Program Training

You’re the Chef (YTC) is a food skills program that educators or volunteers can provide to students after being trained by a WECHU Registered Dietitian. Two sessions of You’re the Chef (YTC) Training were offered in March 2023 following requests from three schools. Interested schools who are identified as higher need, but lack sufficient funds to run this program, are granted start-up funds from the WECHU after training to purchase food or supplies. Trained schools can borrow YTC kits from the WECHU that contain kitchen equipment, and all certified instructors are given access to the YTC online portal for continued support.

Food Neutral Toolkit

The WECHU is in the process of creating a Food Neutral Toolkit for administrators and educators to understand the food neutrality approach and to implement it in their schools and classrooms. This new approach will create a supportive, positive eating and learning environment. The toolkit will be piloted in selected higher needs schools this fall, and then revised and released to all schools in March 2024 for Nutrition Month.

PREPARED BY:

Chronic Disease & Injury Prevention

DATE:

June 15, 2023

SUBJECT:

May 2023 – Monthly SafePoint Site Operations Update

BACKGROUND/PURPOSE

Overview

• SafePoint officially opened on Wednesday, April 26th, 2023, serving clients 7 days per week between the hours of 10:00 a.m. – 6:00 p.m.
• As part of the Resolution passed at the City of Windsor Council meeting on February 3rd, 2023, the Board of Health committed to providing updates, at regular intervals, about the ongoing operations at SafePoint to the City of Windsor.

Application Status

• Currently, as of May 31st, the respective applications to Health Canada and the Ministry of Health for the Consumption and Treatment Services (CTS) site remain under review.

CURRENT INITIATIVES

Operational Data

Since SafePoint opened on April 26th, there have been 74 client visits amongst 32 unique clients, with no overdoses reported on-site to date. Additional details about the clients served and services provided at SafePoint during the month of May are presented in Tables 1-3.

Client Experience Narrative

Beyond the number of client visits recorded in the month of May, SafePoint continues to demonstrate that the services being offered are having a positive impact on clients, as highlighted through the following narrative:

Anonymous Client #1

A client initially visited SafePoint for the first time in May for issues related to substance use, which impacted the relationship with their family. They returned to visit the site a few times per week to express their gratitude for the support they received from the SafePoint staff. The client recently informed staff that they had not used substances for more than a week due to the care they received at SafePoint. They have since been able to reconnect with their child.

FUTURE PLANS

• Since opening at the end of April, public open house tours continue to be offered every Friday from 8:30 a.m. – 9:30 a.m. as part of the commitment to community engagement.
• In this time, there have been 4 facilitated tours, with a total of 21 visitors. This included some people from the general public as well as community agencies who have brought their clients to visit the facility and provide feedback.
• The WECHU and HDGH staff are continuing efforts to raise awareness about the services being offered at SafePoint as well as engaging with service providers to reach potential clients. SafePoint staff attended the SouthWest Detention Center’s Health Fair on June 1 to provide information to justice-involved individuals about the programs and services being available at SafePoint.

Board Members Present:

Renaldo Agostino, Joe Bachetti, Fabio Costante, Fred Francis, Judy Lund, Hilda MacDonald, Michael Prue, Rob Shepley

Board Member Regrets:

Robert Maich, Angelo Marignani

Administration Present:

Dr. Ken Blanchette, Dr. Mehdi Aloosh, Dr. Shanker Nesathurai (virtual), Lorie Gregg, Kristy McBeth, Eric Nadalin, Dan Sibley, Linda Watson, Lee Anne Damphouse

WECHU Guests:

Michael Janisse, Manager, Communications

RECORDING SECRETARY: L. Damphouse

SUBMITTED BY: K. Blanchette

APPROVED BY: WECHU BOH - September 21, 2023