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Steven Sternthal
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Steven Sternthal
2014-06-03 8:53
Good morning.
Thank you, Mr. Chair and members of the committee, for the opportunity to contribute to your deliberations on Bill C-442.
I am pleased to be here today to address the work under way in the Public Health Agency of Canada to reduce Lyme disease across the country.
I'll begin by addressing the agency's role and how it applies to Lyme disease.
The agency aims to promote better overall health of Canadians by preventing and controlling infectious diseases. We undertake primary public health functions, such as health promotion, surveillance, and risk assessment. These inform evidence-based approaches to prevent and control the spread of infectious diseases.
As part of its public health leadership role, the agency coordinates the national surveillance on Lyme disease as one of the most rapidly emerging infectious diseases in North America. I know that was part of your deliberations late last week.
The spread of Lyme disease is driven, in part, by climate change, as the tick vector spreads northwards from endemic areas of the United States. Moving into Canada, it is impacting our most densely populated regions. Based on the lessons learned in the United States, we anticipate the disease will affect over 10,000 Canadians per year by the 2020s.
To date, we have seen cases increase from 128, in 2009, when Lyme disease became a nationally notifiable disease, to an estimate of over 500, in 2013. That's a fourfold increase in just over five years.
However, this national snapshot only reflects a portion of all cases in Canada. This is because some people do not seek treatment for milder symptoms. Others do seek medical help, but may be misdiagnosed because their doctors are not always aware of the range of symptoms, or even that Lyme disease is in Canada. Agency risk models estimate the true number of infections to be at least three times higher than what has been reported today.
To support physicians in diagnosing Lyme disease, laboratory diagnostic testing is available across Canada in various public health laboratories. Like the United States, we use a two-tier test that must be requisitioned by a physician: the ELISA, to screen; and the western blot, to confirm Lyme disease.
The following are just a few facts about the testing in Canada.
Last year, almost 40,000 ELISA tests were administered by provincial and national laboratories. Of this total, approximately 3,000 tested positive or inconclusive, and were sent on to have essentially the second part of the screening and testing, the western blot, for confirmation of Lyme disease, by either our National Microbiology Laboratory in Winnipeg, or by public health laboratories in Ontario and British Columbia.
Following a thorough review of this surveillance information, available domestic and international research, stakeholder views, and existing public health messaging on this important topic, the agency has put in place an action plan to prevent and control Lyme disease in Canada. The action plan identifies three pillars for concrete action: engagement, education, and awareness; surveillance, prevention, and control; and research and diagnosis.
The first pillar includes a comprehensive public awareness plan that focuses on educating health care professionals and the public about Lyme disease.
Raising awareness among health professionals is one of our main goals: informing them that Lyme disease is here, educating them on symptoms, and encouraging them to properly diagnose and report cases.
This year, we have already reached an estimated 200,000 health professionals with awareness posters published in medical journals beginning in March. We have also presented to clinicians at a variety of venues across Canada in recent months.
We are also using every means available to get the message out to the general public. From social media, to Google AdWords, to partnering with organizations like The Weather Network, we are telling Canadians that Lyme disease is here, how to recognize it, and how to protect themselves from it. These public messages will continue throughout the summer period, which really is the Lyme disease season in Canada.
The agency has also worked with provincial and territorial public health authorities, as part of the Pan-Canadian Public Health Network, to develop a coordinated, vector-borne disease communications strategy, and public awareness tools targeting Lyme disease.
We hope that by the end of this year's tick season Lyme disease will be a household term.
I would now like to address the second pillar, which focuses on innovative ways to conduct surveillance and encourage preventive behaviour.
Efforts made in Lyme disease surveillance are starting to show some results. This year the majority of provinces are providing detailed case information, which will help identify new areas where Lyme disease is endemic and assist provinces in tailoring their preventive strategies.
The information will also provide a clear picture of the signs and symptoms of Lyme disease, information that is key for clinicians to properly diagnose it.
The final pillar focuses on increasing lab capacity, testing new diagnostic methods and carrying out research to generate new insights into effective diagnosis and treatment.
Under this pillar the agency is increasing testing capacity and quality by using state-of-the-art laboratory equipment. We recognize the challenges with current testing, particularly around detecting early Lyme disease, as the human body takes some time to develop antibodies to the bacteria.
The agency is committed to improving diagnostic testing. New methods are being evaluated and any that outperform current methods, the two-step method, will of course be adopted.
In the meantime we continue to recommend doctors diagnose patients on the basis of a full, wholesome, clinical assessment.
We recognize that laboratory technologies have evolved and will continue to do so in the future. The agency's national microbiology laboratory, in collaboration with the Canadian Public Health Laboratory Network and other stakeholders, will be updating our laboratory diagnostic guidelines in the near future.
However in doing so the agency faces a challenge. We can update the guidelines to reflect the current available evidence, but new evidence is needed to inform new diagnostic and new treatment methods. Therefore the agency is committed to continuing to work with medical professionals, patient advocacy groups such as the Canadian Lyme Disease Foundation and the Canadian Institutes of Health Research, and my colleagues on the video conference today to identify and address research gaps.
In closing, I would like to restate that the goal of the agency is to mitigate the impact of Lyme disease on Canadians. Through our collective efforts, Canadians will become more aware of the disease, how to recognize its symptoms, and the benefits from early treatment.
Together, we can reduce the severity of Lyme disease in Canada.
Thank you for your attention.
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