Development and implementation of a Heat Alert and Response System in rural British Columbia.

SETTING: In 2018, a regional health authority in British Columbia (BC) initiated a multi-year project to support planning and response to extreme heat. Climate projections indicate that temperatures in the southern interior of BC will continue to increase, with concomitant negative impacts on human health. Successful climate change adaptation must include cross-sectoral action, inclusive of the health sector, to plan for and respond to climate-related events, including extreme heat. INTERVENTION: The objective of this project was to support the development and implementation of a Heat Alert and Response System (HARS) in a small, rural community. The health authority facilitated collaboration among provincial and local governments, community organizations, and First Nations partners to assess community assets, draft a plan for extreme heat, and prepare for a community-supported response during heat events. OUTCOMES: Stakeholders expressed the importance of utilizing existing partnerships and community resources, such as physical and procedural infrastructure, in which to embed the HARS. It was imperative that the plan be simple, concise, and considerate of the community's unique context. Educational materials and a tailored method of dissemination were important for collective and individual risk mitigation. IMPLICATIONS: A community-driven approach that utilized existing assets allowed for integration of HARS within municipal response plans and established infrastructure. The result is a sustainable public health intervention that has the potential to mitigate the negative health effects of extreme heat. Knowledge acquired through this initiative is informing similar HARS planning processes in other rural BC communities.

RéSUMé: Lieu En 2018, une régie régionale de la santé de la Colombie-Britannique a lancé un projet pluriannuel de soutien de la planification et des interventions face à la chaleur extrême. Selon les projections climatiques, les températures dans l'intérieur méridional de la province continueront d'augmenter, ce qui aura des effets nuisibles sur la santé humaine. Pour se préparer aux phénomènes climatiques comme la chaleur extrême et pour intervenir efficacement, les mesures d'adaptation doivent être intersectorielles et englober le secteur de la santé.Intervention Le projet visait à soutenir la création et la mise en œuvre d'un système d'alerte et d'intervention à la chaleur (SAIC) dans une petite communauté rurale. La régie de la santé a facilité la collaboration entre le gouvernement provincial, l'administration locale, les organismes associatifs et les partenaires des Premières Nations pour évaluer les actifs communautaires, dresser un plan en cas de chaleur extrême et se préparer à intervenir avec l'aide de la communauté durant les épisodes de chaleur.Résultats Les acteurs ont souligné l'importance d'utiliser les partenariats et les ressources communautaires existants, comme les infrastructures matérielles et administratives, et d'y intégrer le SAIC. Il fallait absolument que le plan soit simple et concis et qu'il tienne compte du contexte particulier de la communauté. Il a été jugé important d'avoir du matériel pédagogique et une méthode de diffusion créés sur mesure pour atténuer les risques individuels et collectifs.Conséquences Une approche communautaire utilisant les actifs existants a permis d'intégrer le SAIC dans les plans d'intervention municipaux et les infrastructures établies. Il en est résulté une intervention sanitaire durable qui peut potentiellement atténuer les effets néfastes de la chaleur extrême sur la santé. Les connaissances acquises grâce à cette initiative éclairent aujourd'hui des processus de planification de SAIC similaires dans d'autres communautés rurales de la Colombie-Britannique.

Declaring a tuberculosis outbreak over with genomic epidemiology.

We report an updated method for inferring the time at which an infectious disease was transmitted between persons from a time-labelled pathogen genome phylogeny. We applied the method to 48 Mycobacterium tuberculosis genomes as part of a real-time public health outbreak investigation, demonstrating that although active tuberculosis (TB) cases were diagnosed through 2013, no transmission events took place beyond mid-2012. Subsequent cases were the result of progression from latent TB infection to active disease, and not recent transmission. This evolutionary genomic approach was used to declare the outbreak over in January 2015.

Shifts in mortality during a hot weather event in Vancouver, British Columbia: rapid assessment with case-only analysis.

OBJECTIVES: We assessed shifts in patterns of mortality during a hot weather event in greater Vancouver, British Columbia. METHODS: We used a case-only analysis to compare characteristics of individuals who died during the hottest week of 2009 with those who died (1) during earlier summer weeks in 2009 and (2) during the same calendar weeks in the summers of 2001 through 2008. RESULTS: Compared with the 8 previous weeks of 2009, odds of mortality during the summer's hottest week were highest in the 65 to 74 years age category, compared with the 85 years and older category (odds ratio [OR] = 1.47; 95% confidence interval [CI] = 1.06, 2.03). The number of deaths at home increased over deaths in hospitals or institutions (OR = 1.43; 95% CI = 1.10, 1.86). Densely populated administrative health areas were more affected. CONCLUSIONS: A shift toward deaths at home suggests that in-home-based protective measures should be part of planning for hot weather events in greater Vancouver. Targeting should be considered for those aged 65 to 74 years. The case-only approach is quick and easy to apply and can provide useful information about localized, time-limited events.

Investigation of a pandemic H1N1 influenza outbreak in a remote First Nations community in northern Manitoba, 2009.

OBJECTIVES: First Nations communities in Manitoba were significantly affected by the pandemic H1N1 influenza virus (pH1N1) in 2009. Our objective was to conduct an epidemiologic investigation of a pH1N1 outbreak in one remote First Nations community (population 3,300) in northern Manitoba to inform a timely public health response and provide recommendations for preventing future outbreaks. METHODS: Chart reviews were conducted at the nursing station for patients meeting the influenza-like illness (ILI) case definition during the study period (April 20 to June 11, 2009). Descriptive analyses examined age, gender, clinical presentation, management, outcomes and risk factors. Comparisons were made for hospitalized versus non-hospitalized cases and laboratory-confirmed versus possible cases using Pearson's chi-square test for gender and symptoms and using a t-test for age. RESULTS: There were 180 ILI cases, including 23 laboratory-confirmed cases of pH1N1. Forty percent of children < 1 year old in the community and 9.4% of pregnant women presented to the nursing station with ILI. Most ILI cases were managed through the community nursing station, although 18.3% of cases (n = 33) were medically evacuated and 16.1% (n = 29) were hospitalized. There were no differences between hospitalized versus non-hospitalized or laboratory-confirmed versus possible cases. Risk factors identified in a subset of cases included exposure to an individual with ILI prior to illness onset, overcrowding and inadequate access to household water. CONCLUSIONS: Early arrival and rapid transmission of pH1N1 rendered usual non-pharmacological control measures largely ineffective. Recommendations for prevention of future outbreaks include an effective communications strategy and daily surveillance for disease detection and monitoring. Key determinants of health should be addressed in remote First Nations communities to prevent disease and protect the health of these populations.