Lyme disease in Canada : A Federal Framework

Telephone conference with Federal Government staff at Ottowa

Rukshanda Ahmad (Medical Advisor), Michel Deilgat (Medical Advisor), Julie Theriault (Nurse Consultant), Lindsay Colas (Manager of tick-borne diseases policy team), Annie-Claude Bourgeois (Manager of vector-borne team), Karyn LaCroix (Senior policy analyst in the tick-borne unit), Anne Magnan (Policy analyst) and Nick Ogden and I in St Hyacinth.

The team gave me an overview of the Framework and their roles to co-ordinate and report on the activities tasked in the framework, the team are 1 year into the implementation and have to report progress in year 5 (2022).

The full document is available at : https://www.canada.ca/en/public-health/services/publications/diseases-conditions/lyme-disease-canada-federal-framework.html

The document is centred around 3 pillars

* Surveillance

* Guidelines and best practice

* Education and Awareness (Public and Health Professionals)

Year 1 has been spent planning, engaging with stakeholders and looking for collaborators. There was a round table event in June 2018 which included Provincial representatives, public health authorities, health professionals, academics and patient advocates.

To support framework delivery –$4 million has been committed for a Pan-Canadian Research Network on Lyme Disease in order to generate knowledge to improve diagnosis and treatment, and an additional $1.25 million to increase Canada’s capacity to respond to the health impacts of Lyme disease. More information available at https://www.canada.ca/en/institutes-health-research/news/2018/10/government-of-canada-takes-action-to-address-lyme-disease.html


Enhanced Surveillance reporting

The framework is committed to collecting accurate data and as I discussed in another post Jules at PHAC in St Hyacinthe has been instrumental in the design of the surveillance system.

Reporting form- this is 1/2 of the first page

(3 pages in total) link below to the complete form

https://www.gov.mb.ca/health/publichealth/cdc/protocol/mhsu_8232.pdf

The surveillance data published to date is available for viewing online at :


Professionals guidance and best practice resources

Monitoring and review is performed of all guidance and practice documentation that includes review of NICE guidance published in the UK in June 2018.

Management protocol

Guidance is available to health professionals with diagnosis, testing and treatment.

Defines how to diagnose the different stages and the testing that is required

https://www.gov.mb.ca/health/publichealth/cdc/protocol/lyme.pdf

An online resource is available for staff in Quebec

Institute for Santa de

https://www.inspq.qc.ca/nouvelles/un-guide-d-identification-des-tiques-du-quebec-pour-les-professionnels-de-la-sante

Prophylaxis

At a couple of the meetings I attended this week reference has been made for the use of prophylaxis in patients with a tick bite, the tick bite has to have been received in an area identified in Canada as a highly endemic area. This is not encouraged in the UK or USA.

The current use of prophylaxis can be seen on this link: https://www.canada.ca/en/public-health/services/diseases/lyme-disease/health-professionals-lyme-disease.html

The research paper that provides the recommendation for use of prophylaxis is Nadelman et al (2001) Prophylaxis with single-dose Doxycycline for the prevention of Lyme disease after an Ixodes Scapularis. The New England Journal of Medicine, 345(2).


Health education and awareness

Government staff have participated in outreach activities at national conferences attended by primary care physicians.

Speak at family medicine forums, about clinical aspects, and treatment of all tick borne diseases.

This has led to the creation of a zoonotic/climate change group to find out physicians priorities and identify areas they want to increase knowledge

Toolkits are being developed for clinical guidelines for obstetricians due to the concerns that have been raised about maternal/foetus transmission.

The school of Nursing is also committed to adding some modules into the training programme.

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