Canada

We left Boston and flew to Montreal and onto Quebec, hired a car and drove to St Hyacinthe.

I am based for the week at the Public Health Agency for Canada in St Hyacinthe in Quebec.

Dr Nicholas Ogden is the Director of the Public Health Risk Sciences Division at the Public Health Agency of Canada/University of Montreal in St Hyacinthe. He started off as a Vet in the UK, and since his PhD he has continued to work in the research of ticks and tick borne disease.

Nick spoke about some of the research he has been involved and also the Department of Risk Sciences that he is the director off. The department is a division of the Public Health Agency of Canada(PHAC) and works closely with the University of Montreal.

The research group in the Epidemiology of Zoonoses and Public Health is a research group of the Faculty of Veterinary Medicine of the University of Montreal, and the result of a partnership between professors of the University of Montreal and researchers from the Public Health Agency of Canada.

The staff are all involved in research themselves and they are also tutors delivering courses in the University and the MSc and PhD Students under their supervision complete research projects that relate to ticks and Lyme disease. This structure allows for fluidity in the research and ensures it all ties together and progresses the knowledge in a structured way as opposed to students choosing random projects. Over the week I will spend time with the staff finding out about their research.

Canada has three levels of government Federal, Provincial and regional. Federal- seated in Ottawa, this level deals with the law and matters that affect the whole of Canada. The federal government published the Federal action plan for Lyme disease. Available at : https://www.canada.ca/en/public-health/services/publications/diseases-conditions/lyme-disease-canada-federal-framework.html

The framework acknowledges that Lyme disease is an emerging infectious disease in many parts of Canada, and the Government of Canada recognizes the impact that it has on Canadians and their families. Efforts to prevent and control Lyme disease are being made by a variety of stakeholders. The interim Chief Public Health Officer, expressed concern about the challenges associated with Lyme disease in Canada. The plan includes the establishment of a Lyme disease research network. As an emerging disease it is important that researchers come together with an evidence-based approach, and address knowledge gaps through further research. However Provincial governors (10 provinces 3 Territorials with responsibility for areas such as education, health care, natural resources and road regulations) and Municipal governors (city, town or district level with responsibility for libraries, parks, water systems, local police, roadways and parking) are left to prioritise what is done within their own localities, which means that there is no consistent structure to how areas mange ticks and Lyme disease.

The Public Health Risk Sciences division in collaboration with others are at the forefront of progressing research being undertaken. In response to the Federal framework a Canadian research network has been proposed, a multidisciplinary, patient-centered research program, from discovery to implementation, with the ultimate vision of reducing the impact of Lyme disease on the health of Canadians. The network will integrate researchers, patients, HCPs, public health & non-researcher stakeholders into the planning, advisory, and oversight capacities of all research activities to create short and long-term outcomes that are specific, measurable, accountable and transparent. Solutions and strategies will be developed by facilitating engagement across stakeholder groups. Patient engagement will be guided by provincial Strategy for Patient Oriented-Research (SPOR) units and patient/citizen engagement experts. Training and development of highly qualified personnel will be integrated across all research areas. We will accomplish our vision by creating foundational resources and spearheading new research initiatives.

It has been suggested that many critical knowledge gaps exist in Canada including: conflicting views on the natural history of disease, including the impact that LD strains have on the effectiveness of current diagnostic tests and on disease clinical presentation and patient outcomes, and lack of evidence on prevention/intervention strategies to reduce risk and long-term sequelae. Further, training and education of healthcare providers (HCP) is required to improve awareness and understanding of LD.

More information on the network can be seen on the website: https://www.clydrn.ca/

Dr Ogden has been involved in projects looking at the risk modelling for developing knowledge on Lyme disease. Many researchers have been involved in passive and active surveillance and there are many challenges associated with these methods, particularly when the territory under surveillance is very large and available resources are limited. The use of risk modelling has been able to predict the spread of Lyme disease and this has allowed for identification of high/low risk areas and could ensure surveillance activities were delivered in a targeted way.

The method is now being used to look at other vectors i.e Lone Star Tick movement into Canada and the progress of West Nile Virus.


Serge Olivier Kotchi

Serge is a Medical Geographer who is an expert in geomatics and earth observation. One of his recent projects was ‘Earth observations based risk maps for Lyme disease Infection in Eastern Canada’. Serge gave me permission to use his slides to explain his study.

The study used multi scale land cover variable estimations and vector habit mapping, The estimates were developed using MODIS images, MODIS is a sensor on board earth observation satellite, Landsat satellites and annual crop inventory maps from Agriculture and Agri-Food Canada

Microclimate indicators (temperature/humidity) using similar technologies.

The images developed show

And this information can now be used to compare Ixodes scapularis risk maps to active surveillance data.

Using Earth observation images will help to guide targeting of national research, surveillance and prevention and control activities in known or newly identified areas.


Catherine Bouchard

Is a veterinary epidemiologist and Professor Adjuvant at the Department of Epidemiology of the University of Montreal, she completed her PhD by looking at the variability of tick abundance across 30 micro sites.

Catherine teaches an online Epidemiology class and Conducts and co-ordinates Veterinary students undertaking PhD and MSc projects. She was very enthusiastic about the close links with the University as it ensures all studies are linked and allows for consistency in the studies and also offers future employment opportunities to the students as she acknowledges that is how she started working in PHAC.

Catherine is very interested in how the general public perceive Lyme risk and recognises the importance of sharing the knowledge of tick abundance with those in the areas affected, Catherine feels that how this is done needs to improve as many people are not aware of the risks. The data is available on websites but that is not always accessible to everyone, the difficulties with service delivery across the regions/municipalities does not help as small areas are free to decide for themselves what they do for their own community. A suggestion could be that at a Federal level communications departments and Scientists undertaking the research could collaborate more to look at innovate ways to inform people of study results.

Catherine has personal experience of field surveillance and supervising students who carry out surveillance, so is very knowledgable on the results of previous sentinel surveys and the importance on monitoring the expanding edge of areas that have previously been recorded as demonstrating high tick abundance. It is more beneficial to observe the situation in the areas out-with than to continually drag sites that are already recorded and known about. Testing also needs to expand further to check the abundance in public sites/parks and peri-domestic sites.

Catherine and I participated in a telephone conference to Sandie Briand who works at the Institute National de Santa Publique de Quebec. Sandie spoke about the work of the Lyme disease enhance surveillance working group.

Catherine and I with Sandie on the phone!!!! (First selfie on the blog)

Risk is based on data collected from human surveillance, passive tick surveillance and active tick surveillance, the map indicates the risk identified for each area, although it is in french you can still figure it out!

Sandie also spoke about some of the resources available online from INSPQ.

This link takes you to the page: https://www.inspq.qc.ca/guide-d-identification-des-tiques-du-quebec

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