Provincial implementation supports for socio-demographic data collection during COVID-19 in Ontario's public health system.

SETTING: The Ontario government implemented a regulatory change to mandate the collection of socio-demographic (SD) data for individuals who tested positive for COVID-19. This change was informed by evidence of COVID-19's disproportionate impact on marginalized communities and calls for broader collection of SD data. Given the scarcity of similar efforts, there is a significant knowledge gap around implementing standardized SD data collection in public health settings. INTERVENTION: Public Health Ontario provided collaborative support for the implementation of SD data collection, grounded in health equity principles, evidence, and best practices. We supported the addition of SD fields in Ontario's COVID-19 data collection systems, issued data entry guidance, hosted webinars for training and learning exchange, and published a resource to support the data collection process. The current focus is on building sustainability and quality improvement through continued engagement of public health units. OUTCOMES: By November 28, 2020, almost 80% of COVID-19 cases had information recorded for at least one SD question (individual questions, range 46.8-67.0%). We hosted three webinars for the field, and the data collection resource was viewed almost 650 times. Practitioners continue to express needs for support on applying equity principles to data analysis and interpretation, and community engagement on data collection and use. IMPLICATIONS: Sharing knowledge on responsive implementation supports in collaboration with the field and using current evidence and guidance will strengthen public health practice for SD data collection. Laying this groundwork will also improve the likelihood of success and sustainability of these equity-focused efforts.

RéSUMé: LIEU: Le gouvernement de l'Ontario a appliqué une modification réglementaire exigeant la collecte de données sociodémographiques (SD) sur les personnes testées positives pour la COVID-19. Cette modification découle des preuves de l'impact disproportionné de la COVID-19 dans les populations marginalisées et appelle à une collecte élargie des données SD. Comme les démarches similaires sont rares, il y a de grandes lacunes au sujet de la mise en œuvre de la collecte de données SD standardisées dans les milieux de la santé publique. INTERVENTION: Santé publique Ontario a collaboré à la mise en œuvre d'une collecte de données SD ancrée dans les principes, les données probantes et les pratiques exemplaires de l'équité en santé. Nous avons appuyé l'ajout de champs SD dans les systèmes ontariens de collecte de données sur la COVID-19, fourni des orientations sur la saisie des données, organisé des webinaires de formation et d'échange de connaissances et publié un document à l'appui du processus de collecte de données. La priorité est actuellement accordée au renforcement de la durabilité et à l'amélioration de la qualité grâce à la participation continue des bureaux de santé publique. RéSULTATS: Au 28 novembre 2020, pour près de 80 % des cas de COVID-19, il existait des informations sur au moins une question SD (questions individuelles, intervalle de 46,8 à 67,0 %). Nous avions organisé trois webinaires pour le personnel de terrain, et notre document sur la collecte de données avait été consulté près de 650 fois. Les praticiens continuent à nous demander de l'aide pour appliquer les principes d'équité à l'analyse et à l'interprétation des données et pour faire participer les communautés à la collecte et à l'utilisation des données. CONSéQUENCES: Le partage des connaissances sur les supports de mise en œuvre adaptés, en collaboration avec le terrain et en faisant appel aux connaissances et aux orientations actuelles, renforcera la collecte de données SD dans la pratique en santé publique. En posant ces bases, nous améliorons aussi les chances de réussite et la durabilité de ces démarches axées sur l'équité.

Clinical manifestations of reported Lyme disease cases in Ontario, Canada: 2005-2014.

Lyme disease (LD) is the most common vector-borne disease in Ontario, Canada. We describe the epidemiology and clinical manifestations of LD in Ontario and examine trends in the incidence of non-disseminated and disseminated LD. LD surveillance data from the integrated Public Health Information System (iPHIS) from 2005-2014 were mapped to symptoms according to syndrome groups (erythema migrans (EM), flu-like, cardiac, neurologic or arthritic) and disease stages (early localized, early disseminated or late disseminated). During the study period, 1,230 cases due to Borrelia burgdoferi were reported in Ontario with annual incidence rates ranging from 0.32 (2006) to 2.16 (2013) cases per 100,000 population. Seventy percent of cases had EM and the proportion of cases with EM increased over time. Other clinical manifestations included flu-like (75%), arthritic (42%), neurologic (41%) and cardiac (6%) symptoms. Early localized disease (n = 415) manifested with EM (87%) and flu-like (57%) symptoms; early disseminated disease (n = 216) manifested with neurologic (94%), cardiac (10%) and EM (63%) symptoms; and late disseminated disease (n = 475) manifested with EM (62%), neurologic (55%), cardiac (9%), and arthritic symptoms (i.e., arthralgia (93%) and arthritis (7%)). Early localized and early disseminated cases (88% each) occurred primarily from May through September, compared to late disseminated cases (81%). The proportion of cases reported to public health within 30 days of illness onset increased during the study period, while the proportion of cases reported within 1-3 months and >3 months decreased. Geographical variations characterized by higher incidence of early localized disease and earlier public health notification (within 30 days of illness onset) occurred in regions with established or recently established LD risk areas, while later public health notification (>3 months after illness onset) was reported more frequently in regions with recently established or no identified risk areas. This is the first study to describe the clinical manifestations of LD in Ontario, Canada. The observed geographical variations in the epidemiology of LD in Ontario reinforce the need for regionally focused public health strategies aimed at increasing awareness, promoting earlier recognition and reporting, and encouraging greater uptake of preventive measures.