Pertussis survey tool

At the Provincial and Territorial level, pertussis is monitored routinely with many more details. The system within Provinces and Territories has allowed the detection of outbreaks. Routine monitoring varies from jurisdiction to jurisdiction not only in terms of timelines but also in terms of data collected.

If additional information is required at a national level, it is possible to request data from Provinces and Territories. Methods to strengthen our current system include more detailed and timely reporting to the national level and an improved ability to capture immunization history for individual cases as well as the population at large. The ability to thoroughly investigate an outbreak does not exist within the national surveillance program.

Thorough investigation does occur at the Provincial, Territorial and local level throughout Canada. Assistance with outbreak investigation can be sought from national programs such as the Canadian Field Epidemiology Program. The ability to disseminate findings from outbreaks is limited by resources.

A number of jurisdictions have written up and widely disseminated their outbreak experiences but not all jurisdictions have this capacity. This poses challenges to learning from our collective experiences.

Although Canada has a national immunization survey that occurs every two years, it typically does not have the sample size to determine jurisdictional variation, or investigate specific groups who may be under or unimmunized.

Many jurisdictions are moving towards immunization registries and have or will have the ability to analyze immunization coverage and to generate reminders for those who are not up to date.

The challenges of immunization coverage include ensuring all Provinces and Territories in Canada have this capability and ensuring that estimates are comparable in terms of the methods used to derive immunization estimates. PAHO has also recommended that all health care workers be immunized against pertussis, as well as pregnant women in the case of an outbreak.

NACI also supports immunization of pregnant women in outbreak situations 5. Based on the PAHO recommendations and the obligation that Canada bears as a member of the international community, there are important practice implications from this survey. For a frontline provider, ongoing vigilance, appropriate testing and reporting of individuals with illnesses compatible with pertussis remains of utmost importance.

These case notifications are the basis of accurate surveillance and enable identification of outbreaks that require the type of detailed investigations that can improve our understanding of the disease.

Since each level of government plays a role in surveillance, immunization coverage and protecting vulnerable groups, this survey also highlights opportunities for improvement from a broader public health perspective. In addition, further discussion and evaluation of changes in surveillance and public health measures various jurisdictions have made can provide evidence based determination of best practices in the control of pertussis in Canada.

Canada routinely monitors pertussis and is able to provide a national perspective on disease incidence and more detailed epidemiologic picture via Provincial and Territorial surveillance data when necessary. Canada maintains national immunization targets in-line with the PAHO recommendations, routinely assesses general immunization coverage via population-based surveys, and has national recommendations for the immunization of health care workers and pregnant women in outbreak situations.

Current gaps in Canadian surveillance and immunization practices include the availability of detailed information on pertussis activity at the national level. In addition, the absence of readily available immunization data on cases and the population in general limits our understanding of the impact of immunization on disease burden and prevents a meaningful evaluation of immunization programs in Canada.

These issues have previously been identified and are currently being discussed in the context of data sharing agreements with their Provincial and Territorial partners, and the renewal of the National Immunization Strategy. The authors would like to gratefully acknowledge members of the Chief Medical Officers of Health and their Provincial and Territorial teams in completing this survey, as well as the Province of Ontario for their assistance with development of the survey tool.

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