MRSA in the Northwest Territories. Wanda White Manager of Health protection Unit Department of Health & Social Services March 23, 2012

Transcription

1 MRSA in the Northwest Territories Wanda White Manager of Health protection Unit Department of Health & Social Services March 23, 2012

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3 Outbreak setting Northwest Territories Large, sparsely populated ( in 2010) 33 communities, mostly small (< 1000 pop) Inuvialuit, Dene, Métis comprise ~ 50 % pop Population health status: higher rates of some communicable diseases (STIs and TB) Socioeconomic status: lower in smaller communities MRSA reportable to the Office of the Chief Public Health Officer (OCPHO) laboratory based surveillance with case investigation/follow up 2

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5 Context Known Number of MRSA cases has increased since 2007 marked increase in April 2009 in one community led to outbreak interventions (5 cases between up to 41 in 2009) Some regions more heavily burdened CMRSA 10 Some severe infections, non SSTI Unknown Specific descriptive epidemiology Clinical presentations and severity of infections Treatment patterns 4

6 Investigation objectives Summarize descriptive epidemiology of MRSA cases in the territory, looking back to 2009 Develop indicator for, and describe, severity of infections Describe antibiotic use Assess potential link between severity of infection and CMRSA strain type 5

7 Results 267 cases with 345 infections 208 (77.9 %) cases with one infection, 44 (16.5 %) with two, 11 with three (4.1 %), 4 (1.5 %) with four Age range 3 days to 88.1 years, median 30.9 years Age group 60+ over represented as cases (p<0.05) Significantly more male cases 152 (56.9 %) vs. 115 (43.1%) female (p<0.001) 195 (73.0 %) Dene; Aboriginal persons significantly overrepresented (p<0.001) 3 deaths (not necessarily attributable to MRSA) 6

8 MRSA case rate by age group, Northwest Territories, Jan Dec (n=232) 7

9 Cases and infections per 1000 population, by region, Northwest Territories, 2009 and 2010 Region Cases per 1000 population (# cases) Infections per 1000 population (# infections) Cases per 1000 population (# cases) Infections per 1000 population (# infections) Northwest Territories 2.33 (102*) 2.56 (115*) 2.97 (130**) 3.80 (179**) Beaufort Delta 1.00 (7) 1.00 (7) 1.15 (8) 1.29 (9) Dehcho 1.63 (5) 1.95 (6) 0.65 (2) 0.65 (2) Tlįcho (50) (59) (61) (89) Fort Smith 1.21 (3) 1.21 (3) 1.21(3) 2.01 (5) Sahtu 2.61 (7) 2.61 (7) 4.08 (11) 4.82 (16) Yellowknife 0.81 (17) 0.91 (19) 1.57 (33) 1.95 (42) Hay River 0.72 (3) 0.72 (3) 0.72 (3) 1.45 (6) * Ten cases with eleven infections for whom home region is unknown ** Nine cases with ten infections for whom home region is unknown 8

10 MRSA infections, Northwest Territories, Jan May (n=345) 9

11 Frequency of MRSA infections by infection type, Jan May (n=345) Infection type Number Percentage Skin and soft tissue Severe, invasive* Ear infection Eye infection Urinary tract infection Respiratory infections Bacteremia Musculoskeletal Other or unknown Total 345 * excluded from total 10

12 Treatment for MRSA Skin and Soft Tissue Infections, Northwest Territories, Jan May (n=281) 11

13 Results Antibiotic use: Trimethoprim sulfamethoxazole (Septra) prescribed most frequently (44.9 % of SSTI treated with antibiotics) Clindamycin second most frequent (22.2 % of SSTI treated with antibiotics) 28 (12.7 %) of all courses of antibiotics by IV route 12

14 MRSA epidemic types in Northwest Territories, Jan May (n=163) Epidemic type Number of cases Percentage ST ST USA 1100,SWP/Oceania Total 163 Two PFGE patterns (0473 and 1028) were found in 77.3 % of CMRSA10 cases All severe, invasive cases were caused by CMRSA-10 13

15 Discussion More males related to behaviour, sub optimal personal hygiene, delay in accessing treatment? No seasonality apparent from this data Region most heavily burdened is geographically closer to northern Alberta, where CMRSA 10 is the predominant strain of MRSA CMRSA 10 in NWT vs. CMRSA 7 in northern Saskatchewan and Manitoba and in Nunavut 14

16 Interventions Public & HCP Education Campaigns: Interagency meetings & presentations Presentation to Chief and Council Tlicho specific posters & handouts highlighting support from community & local champions Radio PSAs (nurse & CHRs) Targeted Education to high risk families (Home support workers) Educational checklist added to cleaning kits 15

17 Education & Intervention Home assessments carried out on all new positive cases: water, laundry, assistance required for at risk family members, etc. (Revised MRSA Investigation Form & Instituted HC Tracking System). Self care Checklist for parents/guardian or pts CDC available for MRSA Consultation 16

18 Water & Infrastructure Community Meeting to find solutions to water needs for residents with MRSA Assistance from MACA & Council to increase water supply to families in need & at risk (cover costs). New washers & dryers acquired for large atrisk families Requested the community plan for a Public Laundromat 17

19 Community based control measures, including nurse home visits, education, home cleaning kits and increased home water delivery have promise 18

20 Government of Northwest Territories, Department of Health and Social Services resources tions/pubresult.asp?id=291 19

21 Superbug Campaign Annually 20

22 Possible next steps Coordinated implementation and evaluation of communitybased control measures (tracking system implemented & costs). Refinements to case investigation form and data management systems Education of community health staff re: new territorial CDC guidelines Monitoring of antibiotic use, treatment and susceptibility patterns 21

23 Acknowledgements Government of Northwest Territories, Department of Health and Social Services, Office of the Chief Public Health Officer Marie Adele Bishop Health Centre staff Canadian Field Epidemiology Program (PHAC) National Microbiology Laboratory (PHAC) Centre for Communicable Diseases and Infection Control (PHAC) 22

24 Summary MRSA The number of cases of MRSA decreased in 2011, an increase noted already for 2012 in smaller communities Data from shows that there may be some seasonality in the cases with the peak occurring in the summer months The rate of MRSA is highest in the very young and the very old Since 2009 the majority of cases have been in the small communities. This trend was not seen prior to 2009.

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