Board of Health Meeting Documents

PREPARED BY

Planning and Strategic Initiatives Department

DATE

May 19, 2022

SUBJECT

2022 Board Self-Assessment Survey

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 and outcomes that is completed at least every other year. Completion includes an analysis of the results, board of health discussion, and implementation of feasible recommendations for improvement, if any”. 

In order to meet this requirement, the WECHU developed a competency based self-evaluation survey for Board of Health (BOH) members. The survey includes twelve competency areas used to identify the strengths of the BOH, as well as opportunities to provide additional training and support for the BOH.

DISCUSSION

The survey will be sent to current BOH members via email in May 2022. A report will be presented to BOH members in early summer 2022. Upon request, Board members will receive individual reports, which compare their competency scores to the overall group scores, and will identify strengths and areas for potential improvement.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Rino Bortolin, Fabio Costante, Gary Kaschak, Judy Lund, Robert Maich, Mark Ferrari

Board Member Regrets:

Ed Sleiman, Aldo DiCarlo

A SHORT-TERM VISION FOR LOCAL PUBLIC HEALTH PRIORITIES AND PLANNING IN WINDSOR-ESSEX

The COVID-19 pandemic has dramatically influenced the focus of local public health efforts and resources. COVID-19 has disrupted public health programing, created a backlog of public health services, and impacted established partnerships. As well, the pandemic has furthered existing health inequities and depleted health care capacity, expanding the health disparity gap for those most in need of support. Immediate plans and services will ensure a focus on those disproportionately affected by the pandemic. 

While public health must continue to remain vigilant in response to the pandemic, it is necessary for local public health efforts to shift toward other pressing public health concerns. The WECHU will proceed cautiously, balancing the continued COVID-19 emergency response with incremental and strategic steps forward. This will include ongoing assessment of health needs and public health capacity. Longer-term renewal and transformation efforts will require internal capacity building, ongoing assessment and surveillance to ensure that resources align with the needs of residents. This will include addressing organizational readiness and capacity building to achieve community-based goals. This short-term focused set of priorities will direct our planning and actions in specific areas, providing the most value to the community.

The Windsor-Essex County Health Unit (WECHU) will work towards re-establishing and catching up on mandated program areas where the WECHU is the sole or a primary service provider. These programs include services such as health inspections, dental services (for qualifying children and adults), new parent supports (for qualifying parents), required school-aged immunizations, and infection prevention and control supports for the community. Beyond these core programs and services, the WECHU has identified mental health, substance use, and healthy growth and development as priorities for immediate response. These priorities will set the direction for the Windsor-Essex County Health Unit for the 2022 year.

Goal

Renew public health services to address immediate local public health needs and address service backlogs as the COVID-19 pandemic stabilizes. Development of a foundation for sustained long-term support for public health transformation based on local priorities.

Short-Term Priorities

Health Assessment and Surveillance

• Assessing the impact of COVID-19 on local population health outcomes to inform long-term priorities.
• Assessing partner resources and direction to support local public health priorities while the COVID-19 pandemic stabilizes.
• Providing data and support to the community based on assessments to support long-term planning for program renewal and transformation.

Addressing Backlog of Services

• Restart dental health screenings in schools with increased supports for high and moderate risk schools.
• Increasing support for qualifying dental service groups (i.e., children and seniors).
• Routine support for school-age vaccinations.
• Completing all infectious disease investigations in a timely manner.
• Completing all outstanding inspections across the community in a timely manner.
• Enrolling and engaging all qualifying parents in the Healthy Babies, Healthy Children program.
• Providing community support for infection prevention and control practices.

Mental Health and Substance Use

• Development of long-term plans/supports based on the assessment of local needs, partner service plans, and evidence-based interventions.
• Mental health and substance supports for school-aged children and youth, families, and workplaces.
• Enhanced support for existing mental health programs/services provided by the Windsor-Essex County Health Unit.
• Enhanced support for existing substance use programs/services provided by the Windsor-Essex County Health Unit.

Healthy Growth and Development

• Increased support for positive parenting.
• Support for maternal mental health through new or existing programs and services.
• Breastfeeding support for new mothers.

Capacity Building

• Staff re-orientation, training, and preparation for response to long-term local public health priorities.
• Assessing and providing internal support for burnout and mental health considerations because of the COVID-19 pandemic response.

Recommendation/Resolution Report
2022/23 Budget for Programs Funded by the Ministry of Children, Community and Social Services

MAY 19, 2022

ISSUE/PURPOSE

The Windsor-Essex County Health Unit (WECHU) administers the Healthy Babies Healthy Children Program and the Pre-natal and Post-natal Nurse Practitioner Program (collectively referred to as the Programs).  These Programs are funded entirely by the Ministry of Children, Community and Social Services (MCCSS).  The operating budget for the fiscal year April 1, 2022 to March 31, 2023, requires approval by the Board of Health prior to submission to the MCCSS.

BACKGROUND

For fiscal 2022/23, these Programs support twenty-five and three quarters (25.75) FTEs comprised of one (1.0) manager FTE, one-quarter (0.25) director FTE,  sixteen (16.0) public health nursing FTEs, one (1.0) nurse practitioner FTEs, four (4) family home visitor FTEs, one (1.0) social worker FTE, two and one-half (2.5) support staff FTEs.

The 2022/23 operating budget is detailed below:

Significant changes in the operating budget include the following:

• Increase in Salaries and Benefits $129,008 - The 2021/22 fiscal year contemplated a more fluid staffing complement to support the WECHU’s COVID-19 Pandemic response, including case and contact management and vaccinations.  For example, in Q1 and Q2 of 2021/22, the public health nursing FTE complement was 6 and 4 respectively, grading upward in Q3 and Q4.  Conversely, the social worker FTE complement in Q1 and Q2 of 2021/22, was 2 and 10 respectively, grading downward in Q3 and Q4.  The 2022/23 budget contemplates staffing to return to pre-pandemic levels. 
• Reduction in Mileage of $10,000 – The 2022/23 fiscal year contemplates staff re-orienting to the Programs.  In addition, it is anticipate that client visits will be a hybrid of in-person and virtual.
• Reduction in Professional development of $11,600 – The 2021/22 fiscal year contemplated substantially higher professional development costs due to the fluctuation in the staffing complement throughout the fiscal year.
• Reduction in Program Supplies of $101,608 – The fiscal 2021/22 budget contemplated expenditures being incurred on account of information technology hardware and software to address increased FTEs. 
• Reduction in Purchased Services of $5,800 – The fiscal 2021/22 budget contemplated the costs of the annual financial statement audit.  For 2022/23, it is anticipated that these costs will be borne by the Cost-Share Budget. 

PROPOSED MOTION

Whereas, The Windsor-Essex County Health Unit receives grants from the Ministry of Children, Community and Social Services to fund the Healthy Babies Healthy Children and Pre-natal and Post-natal Nurse Practitioner Programs,

Whereas, the total budgeted expenditures for the Programs for the period April 1, 2022 to March 31, 2023 is $2,894,941, and

Now therefore be it resolved that the Windsor-Essex County Board of Health approve the operating budget as presented by Administration for the period April 1, 2022 to March 31, 2023

Meeting held via video: https://youtu.be/3wmW8cdpJW4

SUBMITTED BY

Epidemiology and Evaluation Department

DATE

April 21, 2022

SUBJECT

COVID-19 Surveillance and Epidemiology – March, 2022

BACKGROUND

Overview

The Epidemiology & Evaluation department conducts on-going population health assessment and surveillance. The data and surveillance for COVID-19 plays an integral role in understanding and managing the pandemic locally. The evidence provides information on how the pandemic has and is evolving, assessing the risk and severity, and assists in the development of timely interventions to limit further spread in the community.

Due to the recent surge in Omicron cases and changes in eligibility for testing, testing capacity is limited and case, contact, and outbreak management has been modified to focus on high-risk settings. As a result, case counts in the report are an underestimate of the true number of individuals with COVID-19 in Windsor-Essex County and may impact data completeness. Please interpret these data accordingly. Due to these changes, data from before December 31, 2021 should not be compared to data after the testing changes.

Trends

In the month of March, the health unit reported 2,353 confirmed high-risk cases of COVID-19. As the weeks progressed in March, the weekly high-risk incidence rate increased from 124.0 cases per 100,000 population (Week 9) to 145.1 cases per 100,000 population (Week 13).  

In-Patient and ICU Admissions

In March, in-patient COVID-19 hospitalizations began to increase in Windsor-Essex County. A total of 155 new COVID-19 related patients were admitted to local hospitals.

Percent Positivity

Locally, Windsor-Essex County continued to experience a week-over-week increase in percent positivity in March after observing the opposite for February. As the month drew to a close, the local percent positivity rate for COVID-19 rose to approximately 19.3% in the last week of the month. It is also important to note that these were for high-risk individuals that were eligible for testing.

Wastewater Surveillance

For the month of March, viral signal for COVID-19 in wastewater intensified as the month drew to a close. Current levels are beginning to reach levels observed during the onset of the Omicron wave in December 2021.  

Outbreaks

In the month of March, 21 outbreaks were declared in high risk settings compared to the 24 outbreaks in February. This includes seven outbreaks in long-term care and retirement homes, four in hospital settings, and ten in other congregate settings. As of March 31st, there were 16 active outbreaks in the Windsor-Essex County region.

Deaths

For the month of March 2022, 16 deaths were reported that were attributed to COVID-19. This represents a 45% decline in comparison to the deaths reported in February.

DISCUSSION

With the changes in testing eligibility, and guidance with case, contact and outbreak management, the health unit has modified its public reporting to better understand the burden of illness locally. New indicators, such as wastewater data, have been included as a proxy indicator for COVID-19 case counts, which are underestimated. The health unit will continue to monitor and provide epidemiological expertise on COVID-19 to internal leadership, community partners, and residents to support evidence-informed decision-making. This includes daily epidemiological updates, weekly epidemiological presentations to the community and supporting policy decisions through data driven approaches.

SUBMITTED BY

Communications Department

DATE

April 21, 2022

SUBJECT

February 15 – March 14, 2022 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

Website Overview Graph

Discussion

Current notable projects that the department is working on.

We promoted World TB Day on March 24 - Shining a Red Light for World TB Day through multiple media channels.

The First Case of Influenza A Confirmed in Windsor-Essex news release was issued on Tuesday, March 22.

The Communications department is maintaining marketing and communication efforts regarding COVID-19 vaccinations in the region with our partners. In particular, the COVID-19 pop up clinics in the community continue to be promoted and we are working on messages around the Devonshire Mall Vaccination Centre To Cease Operations Saturday, April 2nd.

We are providing support for the Catch-Up Immunization Clinics for Students in Grades 7 to 12 that will occur until August in multiple locations throughout Windsor and Essex County.

PREPARED BY

Records Coordinator & Privacy Officer

DATE

April 21, 2022

SUBJECT

2021 IPC Annual Statistical Reporting 

BACKGROUND

The WECHU is a “health information custodian (HIC)” in accordance with section 3 of the Personal Health Information Protection Act (PHIPA), and an “institution” in accordance with section 2 of the Municipal Freedom of Information and Protection of Privacy Act (MFIPPA). Under this legislation the WECHU has obligations to ensure the rights of individuals with respect to privacy, access and correction of records of personal information (PI) and personal health information (PHI), and access to general records that pertain to the WECHU operations and governance.

All institutions under MFIPPA, and HICs under PHIPA, are required to provide statistical reports to the Information and Privacy Commissioner of Ontario (IPC) on an annual basis with respect to:

• Confirmed privacy breaches under PHIPA (Appendix A)
• Access and correction requests under PHIPA (Appendix B)
• Access and correction requests under MFIPPA (Appendix C)

The WECHU submitted statistical reports for each category by the required deadline of March 1st for PHIPA reports and March 31st for MFIPPA.

DISCUSSION

Privacy breaches

In 2021, the WECHU had eight confirmed breaches, compared to thirteen in 2020. Privacy breaches in 2021 predominantly included incidents where PI and/or PHI was emailed or faxed to the wrong person and/or organization.

The WECHU is looking at various ways to prevent breaches of this manner through training and investigating additional email security options.

MFIPPA Access and correction to information requests

In 2021, the WECHU received thirty-eight formal MFIPPA access requests, compared to thirty-five in 2020, and zero correction requests during the reporting year. One of the requests was transferred to Statistics Canada. Thirty-one of the requests were completed within the reporting year and six of the requests carried over to the 2022 reporting year.

Of the thirty-eight access requests completed in 2021, the majority of requests came from an “individual by agent” or lawyer (48%). This was followed by “individual/public” (29%), “business” (13%), and “media”, “government” and “other” (3% each).

PHIPA Access and correction to information requests

In 2021, the WECHU received five formal PHIPA access requests and sixty-two formal correction requests during the reporting year. This was a significant increase from 2020 due to the WECHU’s involvement in supporting the proof of COVID-19 vaccination certificate program, as well as in the implementation of a COVax client access and correction process.

CONCLUSION

In summary, 81% of all MFIPPA requests and 100% of all PHIPA requests were completed within the statutory time limits, despite the operational impacts of the pandemic. Priorities for the coming year will include continued dedication of resources for the access to information and privacy program, including additional training, and class customization within the WECHU’s M-Files system. These actions will improve records and information management (RIM) within the program, and allow the WECHU to respond with increased efficiency to information requests.

PREPARED BY

Oral Health Department

DATE

April 21, 2022

SUBJECT

WECHU Oral Health Services and Oral Health Month

BACKGROUND

April is Oral Health Month. Oral health is a critical component of overall health and well-being. Oral Health month highlights the importance of good oral health practices and the role of dental professionals in improving community oral health.

In Ontario, one in every three people do not have access to dental insurance, requiring  them to pay out of pocket for ongoing and urgent oral health needs (StatsCan, 2018). We know in Windsor-Essex, to avoid the high cost of dental bills, many individuals forgo treatment impacting their overall quality of life (WECHU, 2018).  The Healthy Smiles Ontario (HSO) program, offered for qualifying children under the age of 18,  the Ontario Seniors Dental Care Program (OSDCP) for qualifying seniors 65 years and older, offer opportunities for routine, emergency and urgent dental services at no cost. The provincial Ministry of Health’s Oral Health Protocol (2021) provides direction to local public health units for the delivery of these oral health services, as well as oral health screening, and oral health promotion and education.

DISCUSSION

Oral Screening, Assessment and Surveillance

In 2021, COVID-19 impacted many public health programs and services, including the WECHU’s oral health program. While clinical services offered through HSO and OSDCP experienced some setbacks and delays through 2021, the WECHU was unable to complete school dental screening.   As part of the Oral Health Protocol (Ministry of Health, 2021), all public health units implement dental screening for all students in Junior Kindergarten (JK), Senior Kindergarten (SK), and Grade 2. Screenings are completed by registered dental hygienists and certified dental assistants during the school day. Oral health screening requires the collection of the total number of decayed, missing and filled teeth (DMFT). Data on DMFT is used to determine if additional grades are also to be screened. Following the Oral Health Protocol, schools that are identified as medium risk also receive screening for all Grade 7 students and for schools identified as high risk, Grades 4 and 7 are screened in addition to the standard grades for screening.

Despite dental screening not occurring in 2021, the WECHU Oral Health department sent out screening information to parents and families and offered virtual and on-site screening at one of our two oral health clinics. Parents who wanted their children screened were able to book an appointment and choose the option that best suited their needs.

Oral health screening is not only an important part of overall oral health surveillance for Windsor-Essex, it provides an opportunity to identify oral health concerns early and to provide parents with information about the Healthy Smiles Ontario program and options for a dental home. With schools reopening for additional visitors the Oral Health department at the WECHU has developed an ambitious and comprehensive plan to resume oral health screening over last three months of the 2021-2022 school year. The oral health team will focus on schools identified as high risk and medium risk from previous years to ensure that we are able to reach all students most in need of oral health screening, prevention and support. The oral health screening teams have already reached out to these schools and screening will commence in April, running through June of this year.  

WECHU Healthy Smiles Ontario (HSO) Program

Over the course of 2021,there were 1,572 children/youth screened at one of the WECHU’s dental clinics and referred into either the HSO-Emergency and Essential Services Stream (EESS), or the HSO-PSO (preventive services only) program. The EESS program is provided to child/youth identified with an emergency or essential dental condition such as infection, haemorrhage or pathology that requires immediate clinical treatment. The PSO stream is delivered through public health unit clinics only and identified through health unit screening activities. Treatments covered under the PSO stream include topical fluoride, pit and fissure sealants, scaling, and some interim stabilization therapies.

Ontario Seniors Dental Care Program (OSDCP)

In 2021, the WECHU oral health department supported 3,349 clinic visits across all clients enrolled in the OSDCP. This includes 398 new patient exams, for an average of 1.6 new patients added to our client roster every working day. New dentures have been provided to 117 clients at the WECHU, with 1,311 appointments with a dentist or denturist to be fitted for these new dentures. The oral health department supports the OSDCP at both clinic sites (Windsor and Leamington). Clinic hours of operation are Monday to Friday from week day from 8:30 a.m. to 8 p.m in Winsor and 8:30 a.m. to 4:30 p.m. in Leamington.

Oral Health Resources for Educators

The Ontario Public Health Standards outline the requirement for health units to support health related curriculum and health needs in schools. Oral health education programs can help to build skills of young children, in terms of their oral health knowledge and practices and are a key area of need for children and youth in Windsor-Essex. In 2021, oral health resources for educators were updated and posted to the WECHU website. These included lesson plans and resources intended to help teach students from Kindergarten to Grade 8 about oral health and how students can keep their teeth and mouth healthy. Presentations are also available to schools and community programs at request.

Baby Oral Health Program (BOHP)

The Canadian Dental Association and the Canadian Pediatric Society recommend children see a dentist by their first birthday, even before they have all of their teeth. The BOHP provides free screening for all children, aged 0 to 4, in Windsor-Essex County. A screening by a registered dental hygienist includes a check for signs of cavities, education on supporting a healthy mouth and teeth, and a fluoride treatment, if needed. These screenings are important as they offer an opportunity for early intervention. During a BOHP visit families are also encouraged to visit a dentist or make a follow-up appointment at the WECHU if they do not have a home dental office. Children who present with urgent dental needs are enrolled into the HSO program, if eligible, or receive outside referrals for dental treatment. In 2021, 138 infants and toddlers were screened through the BOHP.

Board Members Present:

Gary McNamara, Joe Bachetti, Tracey Bailey, Fabio Costante, Aldo DiCarlo, Gary Kaschak, Judy Lund, Robert Maich, Ed Sleiman

Board Member Regrets:

Rino Bortolin

Please contact us if you require this document in an alternate format.

Please contact us if you require this document in an alternate format.

Please contact us if you require this document in an alternate format.

1. Period covered by this report:  January 1, 2022 to March 31, 2022
2. For the period covered by this CEO Quarterly Compliance Report:
   
   1. The undersigned has personal knowledge of the matters herein reported or has made due inquiry with respect to the same.
   2. Except as reported in any previous CEO Quarterly Compliance Report, the undersigned reports as follows:
      
      1. that the Health Unit has been in material compliance with all laws, regulations, orders, judgments or decrees applicable to it.  Without limiting the generality of the foregoing the Health Unit is current in respect of all tax and related withholding and remittances required by law;
      2. the Health Unit has been in material compliance with its By-laws;
      3. the Health Unit has been in material compliance with all other Board resolutions;
      4. the Health Unit has been in material compliance with all contracts and commitments to which the Health Unit is a party including without limitation all funding and accountability agreements;
      5. the Health Unit is current with respect to the payment of all remuneration (including salary and benefits) to its employees;
      6. there are no material variances between what is contemplated by the Operational Plan and what in fact transpired or appears likely to transpire
      7. more specifically, no material changes are required in respect of financial resource allocation plans to address shifts in need and capacity
      8. no material adverse change has occurred in the operations of the Health Unit or its assets and liabilities taken as a whole
      9. there have been no material breaches of the Ethics Code of Conduct by anyone who is subject to it;
      10. there have been no unplanned terminations of any Health Unit employees;
      11. there have been no claims made pursuant to any insurance policies maintained by the Health unit; and,
      12. nothing has come to the attention of the undersigned which would materially adversely change any previous CEO Quarterly Compliance Report, except as detailed below:

Items (vi), (vii), and (viii) have been revised due to the COVID -19 pandemic as follows:

On March 17, 2020, the Province of Ontario enacted the Emergency Management and Civil Protection Act, R.S.O. 1990, c. E.9. (“the Act”), to support efforts to contain the spread of COVID-19 in our communities.  The Act supports public health units to, regardless of their collective bargaining agreements, suspend services, redeploy staff as deemed appropriate, modify hours of work, cancel and or defer vacations, utilize part-time/contract staff to perform the duties and responsibilities of bargaining unit staff and suspend the grievance process. 

The WECHU, in its response to COVID-19 within the communities of Windsor and Essex County has:

• Redeployed staff as considered appropriate to facilitate our response to the pandemic including transition of staff from case and contact management to support the vaccination efforts as directed by the province.
• Increased expenses related to vaccination to support resources required for implementing booster/third doses across the population.

Item (x) the CEO reports the following:

In January 2022, the WECHU had an unplanned termination of a single non-union staff person.

Date: March 31, 2022

Signature: Nicole Dupuis, Chief Executive Officer

Meeting held via video

SUBMITTED BY

Communications Department

DATE

March, 2022

SUBJECT

January 15 – February 15, 2022 - Communications Update

Metrics

Media Exposure Overview

Website Overview

Social Media Growth

Current Notable Projects

• Maintaining marketing and communication efforts regarding ongoing vaccine rollout in the region by public health and our partners. In particular, the numerous pop up clinics in the community and closures of mass vaccination sites at the Grovedale Arts and Culture Centre in Kingsville and Hôtel-Dieu Grace Healthcare
• Responding to media and public inquiries through multiple channels including emails, calls, and web form submissions. Social media direct messages are currently redirected to the wechu.org web form.
• Significant website updates to mirror provincial easing of public health restrictions.

Data Notes:

1. Media requests received is a compiled list of documented requests we captured for interviews, data clarification, or general request for information from the media. Given the volume of requests during COVID-19, many exchanges with the media through text messages or quick phone calls to answer questions may not be captured. In many instances, each request led to multiple interactions with reporters.
2. YouTube Live videos started on June 23, 2020. Prior Public Health Update videos on YouTube were exported videos recorded through Facebook Live. In July 2021, YouTube Live broadcasts were scaled down to Fridays only from a Monday, Wednesday, and Friday rotation. In September 2021, media briefings were increased to Monday, Wednesdays and Fridays and streamed live. On September 20, 2021, media briefings were recorded and then posted to YouTube.
3. Website analytics are provided by Siteimprove. The metric provided is for page views to wechu.org. Previously, we were reporting on the local-updates webpage only.
4. Email subscribers are those individuals who signed up to receive promotional emails from the Windsor-Essex County Health Unit. The analytics are provided through Mailchimp for last 30 days.
5. Social media metrics are provided through Hootsuite.
6. Media exposure information in this report were generated using Meltwater Media Monitoring Solution. News stories may be duplicates or missing as the platform is currently being optimized to better track Windsor-Essex County Health Unit mentions in the media landscape.

SUBMITTED BY:

Infectious Disease Prevention

DATE:

March, 2022

SUBJECT:

2021 Summary – Infectious Disease Prevention Department

BACKGROUND

The Health Protection and Promotion Act 1990 (HPPA), R.S.O., 1990, and Ontario Reg. 135/18, outlines the requirements for physicians, practitioners, and institutions to report any disease of public health significance (DOPHS) to the Medical Officer of Health (MOH). The Ontario Public Health Standards (OPHS) describe the mandatory programs and services that are to be delivered by the board of health, which includes infectious and communicable diseases prevention and control.

The Windsor-Essex County Health Unit (WECHU) Infectious Disease Prevention (IDP) department includes a multidisciplinary team of professionals including Public Health Nurses (PHNs), Health Promotion Specialist, Infection Control Practitioner (ICP) and clerical support. The IDP team delivers programs and services addressing sexually transmitted blood-borne infections (STBBI)/Sexual Health Clinic; tuberculosis (TB); and communicable diseases (CD).

STBBI/Sexual Health:

Results of the 2020 Syphilis Survey Report, released in 2021 via the Sexual Advisory Committee, identified a gap in both knowledge and awareness of syphilis amongst the general population and local healthcare practitioners (HCPs).  Case numbers for the human immunodeficiency virus (HIV) in WEC in the 1st quarter of 2021 increased from previous years. Nine cases of HIV were reported in WEC from January 1 to March 31, 2021 compared to an average of 4.6 cases in the first quarter of the previous 5 reporting years. The HIV rate in WEC leveled as 2021 progressed to a total of 17 HIV cases. A comparison of the previous 5 years showed a yearly average of 21.8 HIV cases per year in WEC.  While the HIV rate in WEC was lower in 2021 than previous years, the crude rate averaged 4.0 HIV cases per 100,000 residents in WEC whereas the provincial crude rate was 3.7.

In response to the increased incidences of HIV cases that were observed in the initial part of 2021, a HIV Alert was posted on the Canadian Network for Public Health Intelligence (CNPHI) website, operated by the Public Health Agency of Canada in April of 2021. A comprehensive social media campaign was consequently developed to improve sexual health and well-being within WEC. The communication campaign included the development of syphilis awareness posters, banners, billboards, and social media messaging. Syphilis awareness banners were adapted and published in the WE Pride magazine (2021/2022) and as part of the 2021 WEC Pride Fest. Additionally, billboards were also posted in three WEC locations that shed light on the spread of STIs and promoted the use of condoms.

In order to engage our community, social media platforms, Facebook, Grindr, and Instagram were also utilized to increase STI awareness. PHNs were also involved in Pozitive Pathways podcasts (two episodes: syphilis and gonorrhea) and as AM800 guest speakers (two events: oral sex and syphilis).

PHNs continue to support resources, capacity building efforts for HCPs and community partners to support the appropriate diagnosis, treatment, and knowledge dissemination as it pertains to STIs. As a result of the change to the WECHU service delivery model, updates were made to our syphilis reporting form, and WECHU website. WECHU’s STI Guide was also updated to align with provincial/national STI guidelines and provides information about ordering STI medications. HCPs are able to request Bicillin-LA and other STBBI medications from the WECHU (free of charge).

Tuberculosis:

In 2021, there was a total of 17 active TB cases, and 146 cases of Latent TB Infections (LTBI) in WEC, as well as a TB cluster investigation identified at a local farm, crossing two sites and 4 cases. Services for both active and latent TB cases were delivered at either the client’s home, in-person at the WECHU clinic, or virtually. To increase awareness of TB, and TB reporting requirements among community partners (e.g. Shoppers Drug Mart, Tecumseh Medical Clinic), an outreach campaign was undertaken in 2021. Communication outlining updated HIV testing recommendations for individuals with active TB and LTBI, and a revised TB reporting form was distributed to physicians and pharmacists in WEC. Reminder magnets were also included to compliment the letter (Appendix A). The reminder magnets highlighted the need to call the health unit before dispensing TB medication and informing the health unit if a positive TB skin test has been identified.

CD:

The WECHU reported zero cases of influenza in 2021. IDP PHNs noted an increase of uncommon diseases reported in 2021, including Creutzfeldt-Jakob Disease (CJD), Echninococcus, and Acute Flaccid Paralysis. In addition, the IDP PHNs worked with the ICP in a number of outbreak situations (gastroenteritis and respiratory) in institutions and hospitals.

Refer to Appendix B for the DOPHS [diseases of public health significance] 2021 case numbers that were retrieved from iPHIS.

Appendix A: TB Reminder Magnets

Appendix B: DOPHS 2021 Case Numbers

Note: The table below includes the number of confirmed cases (and probable cases, depending on the DOPHS) from 2021. The date of extraction from iPHIS was on February 16, 2022.

SUBMITTED BY:

Environmental Health

DATE:

March, 2022

SUBJECT:

Zoonotic and Vector-borne Diseases Report

BACKGROUND

The Environmental Health Department conducts annual monitoring and testing of tick and mosquito populations in Windsor and Essex County (WEC) as part of the Windsor- Essex County Health Unit’s (WECHU) Zoonotic and Vector-borne Diseases Program. The program is required under the Health Protection and Promotion Act and provides the community with an early warning system for disease transmission through ticks and mosquitoes known as vector-borne diseases. Due to our geography and local climate, the WEC region is more susceptible to vector-borne diseases, as the ecological conditions influence transmission and distribution.

Upon the completion each VBD program season, the WECHU prepares an annual report which highlights surveillance information related to Lyme disease and West Nile Virus (WNV) Illness in WEC. The 2021 Annual VBD report is available on our website Vector-Borne Diseases - WE - 2021 and a high level summary of these findings is included below.

Ticks and Lyme Disease

In the last three years, surveillance data indicated an increase in black-legged ticks (Ixodes scapularis) in WEC. The black-legged tick is the primary vector for Borrelia burgdorferi, the bacteria that causes Lyme Disease. Environmental Health staff conduct active field surveillance at public parks and trails frequently used by residents twice a year to identify areas in WEC that have populations of black-legged ticks.

In 2021, active surveillance was conducted at four sites that included,

1. Ojibway Prairie Nature Reserve,
2. Chrysler Greenway,
3. Gesstwood Camp and Education Centre and
4. Ruscome Shores Conservation Area

A total of 33 black-legged ticks were found through tick dragging, with nine of these carrying the infectious agent that causes Lyme disease.

In 2021, there were seven cases of Lyme Disease in WEC.  All laboratory-confirmed cases are interviewed to determine activities and locations where exposure may have occurred. This information drives targeted tick awareness initiatives from the health unit.

Mosquito Surveillance and Testing

The WECHU has one of Ontario’s most comprehensive mosquito surveillance programs, including the West Nile Virus Program and Enhanced Mosquito Surveillance initiatives. In 2021, mosquito surveillance began in May and ended in early October. Species-specific traps were deployed in various locations throughout WEC to capture mosquitoes for testing and identification to determine the presence of West Nile, Eastern Equine Encephalitis (EEE) Virus, and Zika Virus in our region. Invasive mosquito species Aedes aegypti (Yellow Fever Mosquito) and Aedes albopictus (Asian Tiger Mosquito) were also monitored. These species are known carriers of Zika, Dengue, and Chikungunya diseases. The health unit monitors mosquitoes at different stages in their life cycle to determine prevention and control initiatives for the program.

In 2021, the weekly mosquito surveillance data is available on the WECHU’s Mosquito Surveillance Dashboard. The data is updated weekly during the season and is open to the public. During last year’s season:

• Total number of traps deployed per week: 47
• Total number of mosquitoes trapped: 187,918
• Total number of pools tested: 2,291
• Number of positive pools for West Nile virus : 17
• Number of positive pools for Zika virus: 0
• Number of positive pools for EEE virus: 0

Positive pools for WNV were reported in the following municipalities: City of Windsor (11), Town of Essex (3), Municipality of Leamington (2), and the Town of Amhestburg (1).  

Over 118,000 treatments of larvicide were applied to roadside catch basins and standing water sites last year to control mosquito populations. All municipalities in WEC have standing water by-laws that municipalities enforce that are an important activity to reduce breeding habitats. Furthermore, property standards enforcement from municipalities continues to be a key factor in controlling invasive mosquito populations in our region, as these mosquitoes are container breeders (mosquitoes that lay eggs in containers).

The WECHU follows up on all reported human cases of WNV. Cases are investigated to assess if additional targeted mosquito control activities are required. In 2021, there were three confirmed cases of WNV in WEC. There have been no human cases of Zika Virus identified in our community to date.  

CURRENT INITIATIVES

As previously reported, the WECHU was the successful receipient of  the Public Health Agency of Canada’s grant (August 2019 – March 2022) to study the effects of climate change and mosquito populations in our local communities.  The final report  for the project will be released in March and will include information regarding the types of mosquito species (including invasive species) in the region, the impact of climate change on mosquito-borne diseases, and information regarding the populations in our community that are more vulnerable to these health impacts. The WECHU will begin surveillance and monitoring activities for ticks and mosquitoes in May 2022. In addition to these activities, the WECHU will be launching our annual Fight the Bite public awareness campaign. This campaign will focus on the prevention of mosquito breeding sites, information on tick removal, signs and symptoms of WNV and Lyme disease, and personal protection. Messages and promotional materials will be developed to reach priority populations and inform the public of hot spots identified through previous monitoring efforts.

SUBMITTED BY:

Healthy Schools Department

DATE:

March, 2022

SUBJECT:

Student Immunization Catch-Up Plan

BACKGROUND

In Ontario, the Immunization of Schools Pupils Act (ISPA) R.S.O.1990 requires children and adolescents attending primary or secondary school to be appropriately immunized against measles, mumps, rubella, diphtheria, tetanus, meningococcal, varicella and polio, or have a valid Medical, Conscience or Religious Belief exemption on file at the Health Unit. As outlined in the Ontario Public Health Standards (OPHS), local public health units collect and assess immunization records for every student attending school, and provide provincially funded immunization programs through school-based clinics.

Due to the ongoing COVID-19 pandemic and the impact on local resources, the Windsor-Essex County Health Unit (WECHU) was unable to implement immunization clinics at every school setting as in previous years. In order to support widespread availability of publicly-funded vaccines to protect children from Hepatitis B, Human Papilloma Virus (HPV), and Meningococcal Disease (Men-C-ACYW135), the WECHU has been working collaboratively with local healthcare providers to ensure students continue to have access to these vaccines.

As of January 27, 2022 there are 7,953 ISPA based vaccines overdue for administration in the birth cohort years of 2004, 2008, and 2009. The overdue vaccinations for those in the 2004 birth cohort year (1,910) are of particular significance for catch-up before June 2022 due to the pending graduation from the secondary school making follow-up after this school year more difficult.

CURRENT INITIATIVES

The WECHU began hosting catch-up immunization clinics for eligible students on Tuesday, March 8, 2022 to service families with children born between 2004 and 2009 that were not able to receive their immunizations at a school-based immunization clinic in the fall, or through their primary healthcare provider. Appointments for booking are available during the day, afternoons, evenings and weekends at Sears-Devonshire Mall (3100 Howard Avenue) or WECHUs Leamington office (33 Princess Street).

 As part of this strategy, the WECHU prepared tailored communications to update students, families, and school board administrators regarding options available to students who are overdue and eligible for vaccinations. The catch-up clinics in March are the first set of student immunization clinics that the WECHU has planned for the year.

In May 2022, the WECHU will be re-visiting high-risk schools that received the first round of vaccines in the fall. Furthermore, additional community-based and in-house catch-up clinics are being planned for the summer to give families the opportunity to have eligible students immunized before the beginning of the 2022/2023 school year.

As part of this work, the WECHU will also be assessing immunization records for every student in Windsor and Essex County in the beginning of the 2022/2023 school year. Under the ISPA, the Medical Officer of Health may issue suspension orders to students who fail to become immunized and are not exempt as well as those who do not have up to date immunizations. With the successful implementation of this catch up plan, the WECHU is looking forward to returning to schools in the fall of 2022 to complete a single cohort of school-based immunizations.

SUBMITTED BY

Chronic Disease and Injury Prevention

DATE

March, 2022

SUBJECT

Ontario Active School Travel Grant – Update and Final Activities

BACKGROUND

Supported by a grant from Green Communities Canada (GCC), the Windsor-Essex County Health Unit in partnership with school boards, transportation services, municipalities, and police services has been developing policies, enviromental supports, and programming to promote active school travel in Windsor and Essex County amidst staff and resource allocation during the pandemic response. The Ontario Active School Travel (OAST) grant was awarded to the health unit in the amount of $60,000 to be used between January 2021 and June 2022. In order to operationalize this grant funding, the health unit created an Active School Travel (AST) Regional Committee which oversees the implementation of activities and use of the OAST grant funds to promote active travel in schools across the City of Windsor and Essex County.

PREVIOUS AND CURRENT INITIATIVES:

To date, funding has supported the hiring of an Active Travel (AT) Planner to assist schools and boards in implementing plans and coordinating community education and outreach. The AT Planner has assisted in the creation of the AST Regional Committee, identification of the initial six pilot schools, and establishing “champions” at each school to liaise with project staff on the implementation of interventions. The AT Planner has created an orientation package for school representatives, conducted a baseline asssessment of active transportation behaviours amongst students in each school, and serves as the Chair for individual school planning meetings.

In addition to maintaining the collaborative functions mentioned above, the AT Planner has also conducted a review of best practices for implementing active school travel interventions and has determined areas of opportunity for policy enhancement through a review of AT policies at the school board and municipal levels. As this is the third round of funding for the OAST grant, the AT Planner reviewed previously developed resources which could be repurposed and distributed to local pilot schools and board representatives. This process also helped to identify gaps which could be addressed through locally developed education materials. These materials (e.g., web based toolkits and seasonal AT safety promotions) were subsequently developed and shared with school board representatives and shared with all local schools.

As part of the grant activities, Windsor Police Service led walk-ability and bike-ability assessments at each pilot school during the 2021 school year. Several members of the AST Regional Committee along with principals, teachers, and parents were present for these assessments. The assessments helped to identify safe and accessible routes to and from school considering the built environment, traffic, and different modes of transportation as contributing factors in promoting active school travel. At the time of writing this report, summaries which highlight the results of these assessments and include tangible suggestions for intervention are being developed to be shared with each of the pilot schools.

With sustainability of the interventions enabled by this funding as a primary priority of both the funding agencies and the health unit, one of the most impactful initiatives contained and actioned as part of this grant was the creation of a Active School Travel Charter (ASTC). The ASTC was developed to serve as a statement of principles to guide schools, school boards, municipalities, student transportation services, and other community partners in decision-making around the built environment. As the ASTC has already been endorsed by the Board of Health and the City of Windsor, the AST Regional Committee will also be seeking endorsement from the County of Essex in the coming weeks.

FUTURE INITIATIVES:

As the project approaches the end of its funding cycle, remaining project activities will be completed prior to June of this year. Project funding will be allocated toward the purchase of new bike racks and other forms of equipment storage so that students attending pilot schools can feel confident that their equipment will be safe during the school day. Pilot schools will be engaging students through a crosswalk painting event to highlight and enhance school crosswalks. Cycling safety and training sessions will be provided through partnership with Bike Windsor-Essex (a local cycling advocacy agency) to teach students proper biking skills and techniques, and a media launch event will also be held concurrently with these sessions in order to acknowledge the activities supported through the grant and implemented through engagement with the schools.

Once all project activities have been completed, the AST Regional Committee will develop the sustainability plan for AST within the community beyond what could be offerred through the one-time grant funding. Post-intervention assessments will also measure changes in attitudes and behaviour toward AT in the pilot schools relative to the baseline assessment as a way in which to detemined the effectiveness of these interventions.