Avian Influenza, commonly known as “bird flu” is an infectious disease of birds caused by type A influenza viruses. Sometimes it doesn’t make the bird sick. However, the influenza A virus is highly contagious, and wild birds can spread the virus through contaminated saliva, nasal secretions and feces. There are two types of avian influenza:

• Low Pathogenic Avian Influenza (LPAI)
• Highly Pathogenic Avian Influenza (HPAI)

Most avian influenza viruses are low pathogenic. These typically cause little or no signs of illness in infected birds.

However, highly pathogenic viruses can cause severe illness and death in birds.

Avian influenza can also infect wild and domestic mammals, especially those who hunt, scavenge, or eat infected birds. Foxes, mink, bears and seals, as well as dogs and cats, are some mammals that have been infected with avian influenza.

Avian Influenza in Humans

What is the risk to humans?

The risk of transmission of HPAI to humans from wild birds and other wildlife is low. The risk is raised for people working with infected poultry, livestock, and other animals. Avian influenza is caused by different virus subtypes than seasonal influenza in humans. The current strains of Avian influenza A (H5N1) circulating in the world have only rarely led to human infection. Human-to-human transmission is even more rare.

Individuals having unprotected direct contact with infected poultry, livestock, and other animals or surfaces heavily contaminated with avian influenza virus should self-monitor for symptoms of avian influenza for 10 days after their last exposure to the infected poultry, livestock, and other animals or contaminated environmental surfaces.

Signs and symptoms

Symptoms of avian influenza are similar to those of seasonal influenza and may include:

• cough
• fever
• shortness of breath
• diarrhea
• headache
• body aches
• sore throat
• runny nose
• bleeding from the gums
• fatigue
• jaundice
• conjunctivitis (pink eye)

If symptoms develop and you have been exposed to an infected bird or poultry operation:

• Contact your health care provider for assessment and testing
• Isolate away from others

Prevention

Rarely, avian influenza spreads to humans. Most human cases have occurred after close contact with infected sick or dead poultry, or after exposure to heavily contaminated environments (e.g., poultry barns or live bird markets).

While the likelihood of becoming infected with avian influenza virus is low, individuals should still be cautious when handling infected wild birds or other wildlife, because avian influenza has the potential to cause severe disease in people.

If you find a dead bird on your property, report it to the Canadian Cooperative Wildlife Health Centre at 1-866-673-4781.

Take precautions:

• Avoid handling sick or dead wild birds or other wildlife, as they may be infected with diseases that can spread to humans.
  • Pets should also be kept away from sick or dead wildlife.
• If handling sick or dead wild birds or other wildlife is unavoidable, wear gloves or use a doubled plastic bag and avoid contact with blood, body fluids and feces.
  • Clean your hands after handling the sick or dead wildlife.
• Do not handle or eat birds or mammals that appear to be sick or that have died from unknown causes.
• When handling or cleaning wild game birds or other wildlife:
  • Always work in a well-ventilated environment
  • Avoid direct contact with blood, feces and respiratory secretions
  • Do not eat, drink or smoke and do not touch your eyes or face while handling wildlife
  • Wear nitrile or rubber gloves
  • Wash hands with soap and warm water immediately after you have finished
  • Keep children and pets away from materials and area that could be contaminated
  • After you are done, clean all work surfaces and tools with hot, soapy water and then use a household disinfectant (e.g., 5 teaspoons (25mL) of household bleach in 2L of water)
  • Remove and wash all clothing and footwear that may be contaminated with blood, feces or respiratory secretions, including gloves if they are re-usable
• If you own domestic birds or poultry, review Public Health Ontario’s Evidence Brief: Reducing Health Risks Associated with Backyard Chickens and follow the recommendations
• Do not eat unpasteurized dairy products
• Cook all food including eggs to at least 74°C (165°F)
• Keep raw meat, organs, and eggs separate from other food products to avoid cross contamination
• Wash your hands often, including before and after handling raw foods
• Thoroughly clean kitchen utensils and work surfaces with hot, soapy water and then using a household disinfectant (e.g., 5 teaspoons (25mL) of household bleach in 2L of water)

Resources

Government of Ontario:

• Animal health: Influenza
• Avian influenza in poultry
• Animal health updates and veterinary advisories
• Deadstock disposal options on-farm
• Biosecurity recommendations for commercial poultry flocks in Ontario

Government of Canada:

• Avian influenza (bird flu) – Canadian Food Inspection Agency
• Avian influenza in Canada 
• Latest bird flu situation – Canadian Food Inspection Agency
• Guidance on human health issues related to avian influenza in Canada
• Avian influenza A(H5N1): For health professionals
• Avian influenza A(H5N1): Symptoms and treatment 
• Wildlife and avian influenza – Handling guidelines to protect your health
• Avian influenza in wild birds
• Wildlife and avian influenza – Handling guidelines to protect your health

Other:

• Ontario Animal Health Network
• Reducing Health Risks Associated with Backyard Chickens
• Avian Influenza – World Organization for Animal Health

What is Group A Streptococcus?

Group A Streptococcus (GAS) is a bacterium found in the nose, throat, and on the skin of healthy people. When people have GAS but do not have any symptoms, they are referred to as carriers. GAS can cause a mild illness with symptoms such as a sore throat (commonly known as “strep throat”), scarlet fever, and impetigo or other skin infections, or a more serious illness due to invasive infections.

What is invasive GAS (iGAS)?

GAS infection is considered invasive when it is found in places in the body that are normally sterile, such as blood, the fluid surrounding the brain, or in the linings of the muscles or joints. It is also considered invasive if it causes the following severe infections:

• Necrotizing fasciitis, also known as “flesh-eating disease” (destruction of skin and fat tissue)
• Myositis (destruction of muscle tissue)
• Meningitis (inflammation of the membranes covering the brain)
• Streptococcal toxic shock syndrome (STSS), a life-threatening condition that causes low blood pressure and failure of multiple organs

Symptoms

• Early symptoms of necrotizing fasciitis and myositis include fever, severe localized pain, and in some cases, redness and swelling. Redness may spread quickly, up to 3 cm (1 inch) per hour.
• Early symptoms of meningitis include headache, stiff neck, sensitivity to bright lights, vomiting, and confusion.
• Early symptoms of streptococcal toxic shock syndrome include rapid onset of generalized or localized severe pain, dizziness, influenza-like symptoms, confusion, and sometimes, rash.

Treatment

All confirmed GAS infections are treated with antibiotics (Note: most sore throats are caused by viruses, not GAS, and do not require antibiotics). In cases of iGAS, early medical treatment is critical to reduce the risk of complications and death.

Prevention

To prevent the spread of GAS infection, it is recommended that you:

• Wash your hands well, especially after coughing and sneezing, before preparing food, before eating, and before and after cleaning or handling a cut or wound
• Keep all wounds clean and observe for signs of infection, such as increased redness, swelling, drainage, or pain at the wound site; see your health care provider immediately if the wound looks infected, especially if a fever develops
• Stay at home for at least 24 hours after the start of antibiotic treatment for strep throat or impetigo
• Keep up to date with vaccinations against viral illnesses, including chickenpox, Covid-19, and influenza, that would increase the risk of GAS infection

Additional Information

• Government of Canada: Group A Streptococcal diseases: Risks and prevention – Canada.ca
• Canadian Pediatric Society: Strep throat | Caring for kids (cps.ca)
• RCDHU: Immunization Clinics 

Ticks, especially the blacklegged tick (also called a deer tick), are small and hard to see. Ticks are most often found in wooded, shrubby, long-grassed, or leaf-littered areas providing shade and humidity and the strip immediately bordering such areas. Ticks are most active in spring and summer but can be found at any time of the year when the temperature is above freezing (0°C). Ticks do not fly but can crawl onto a person or animal when coming into contact with them.

Some tick-borne diseases are spread to humans from the bite of an infected black-legged tick (deer tick). While the most common tick-borne disease is Lyme disease, other less common diseases can include anaplasmosis, babesiosis and Powassan virus. It is important to be aware of ticks and the diseases they may carry.

Prevention

You can prevent tick bites when outdoors by:

• Wearing light-coloured clothing
• Wearing closed footwear and socks, with long sleeve shirts tucked into your pants, and your pants tucked into your socks
• Using an insect repellant with DEET or icaridin according to label directions
• When possible, stay on the trails during hiking in the woods or walking in long grass.
• Doing tick checks on yourself and your children after being outside
• Shower after outdoor activity and perform a “full body” check on self, children, and pets if applicable for ticks. Ticks often attach in areas such as between toes, behind knees, in the bellybutton, in the groin, armpits and scalp.
• Kill any ticks that might be on your clothing by putting your clothes in a dryer on high heat for at least 10 minutes before washing them.
• Maintain your property by keeping grass short and trim branches and bushes, removing leaf litter.
• Move children’s swing sets, playground equipment and sandboxes away from wooded areas.

To learn more about ticks and how to avoid tick bites check out the Government of Ontario website.

Tick Submission (passive surveillance)

If you find a tick on your body, bring it to Renfrew County and District Health Unit as we will send it off for tick identification at the Public Health Ontario Laboratory. Please note, RCDHU does not accept ticks found on animals.

You can also use these other services for tick identification:

Geneticks Statistics Center – Tick testing service, interactive tick maps and statistics
eTick – A public platform for image based identification and population monitoring of ticks in Canada

Tick Dragging (active surveillance)

Renfrew County and District Health Unit staff regularly conduct tick dragging to monitor tick populations and to test for Lyme disease. Tick dragging occurs in the spring (May) and will continue in the fall (October) if ticks are found during the spring drag. Risk areas in Renfrew County and District are determined using this surveillance method.

The current Ontario Blacklegged Tick Established Risk Area map can be found on Public Health Ontario’s website.

Tick-borne Diseases

Signs and symptoms in humans usually appear between 3 and 30 days after a bite from an infected blacklegged tick. Signs and symptoms can vary from person to person after being bitten by a tick.

The most common symptoms can include:

• rash (Lyme Disease can cause a “bulls-eye” rash at the site of the tick bite)
• chills
• fever
• headache
• joint and muscle pain
• spasms
• facial paralysis
• fatigue
• numbness or tingling

Disease Treatment

Your health care provider may diagnose you with a tick-borne disease depending on your signs, symptoms and risk factors. Laboratory testing is not always required to diagnose and treat tick-borne disease infection. Most cases can be treated successfully with antibiotics.

Pharmacists are now able to provide prescriptions for Lyme disease treatment.

More information on specific tick-borne diseases can be found here.

Resources

Lyme Disease & Other Tick-borne Diseases (anaplasmosis, babesiosis, Powassan virus ): 

• Government of Ontario – Tick-borne Diseases
• Public Health Ontario – Lyme Disease
• Public Health Ontario – Ontario Blacklegged Tick Established Risk Area
• Health Canada – Lyme disease: Symptoms and treatment

Tick Checks and Tick Removal:

• Health Canada Video – How to properly remove a tick 
• Health Canada – How to remove and identify a tick
• Health Canada – How to check for ticks (including alternative formats for Indigenous communities)
• Health Canada – Top 10 tick hiding spots on your body (including alternative formats for Indigenous communities)

Tick Prevention: 

• Health Canada – Lyme disease: Prevention and risks
• Health Canada – Poster: Enjoy the outdoors without a tick (including alternative formats for Indigenous communities)
• Health Canada – Pamphlet: Enjoy the outdoors without a tick (including alternative formats for Indigenous communities)
• Health Canada – Protect your pets from ticks and Lyme disease (including alternative formats for Indigenous communities)

What is measles?

Measles, also called red measles, is a very contagious infection that is caused by the measles virus. It is usually more severe in infants and adults than in children.

Complications of a measles infection are rare but can be dangerous. Ear infections are a common complication, 1 in 10 cases will develop pneumonia, 1 in 1,000 cases develop swelling in the brain, and one death occurs for every 3000 cases. Pneumonia accounts for 60% of the deaths due to measles, mostly in infants.

Symptoms

Symptoms of measles may develop 7 to 21 days after exposure to an infected person. Symptoms include:

• High fever
• Runny nose
• Cough
• Drowsiness
• Irritability
• Red eyes
• Small white spots may appear in the mouth and throat
• A red blotchy rash begins to appear on the face 3 to 7 days after the start of symptoms, then spreads down the body to the arms and legs. This rash usually lasts 4 to 7 days.

Symptoms generally last from 1 to 2 weeks.

If you develop symptoms of measles:

If you develop symptoms of measles, you should be assessed by a physician, and notify the health care facility that you plan to visit so that they are aware of your symptoms prior to your arrival. You should also wear a medical grade mask to the appointment. In the meantime, stay at home to avoid potentially exposing other people (“home isolation”).

Measles is diagnosed by a blood test, a urine sample and a nasopharyngeal swab.

If you are having a medical emergency, call 911 or visit the nearest emergency department. Advise them of your symptoms, if you were exposed to measles, and if possible wear a medical grade mask.

If you were exposed to someone with measles

Depending on the situation, your vaccination history, and other risk factors, a public health official may advise you of the need to stay home from work or school, get tested, get preventive treatment or get vaccinated.

Treatment

There is no specific treatment for measles. However, individuals may require treatment or hospitalization if they develop serious complications from this infection.

Prevention

The best way you can protect yourself and others against measles is by getting the measles vaccine. This vaccine is combined with the vaccine for mumps and rubella and is known as the MMR vaccine. The MMR vaccine can also be combined with the varicella vaccine (MMR-V) for some individuals. MMR and MMR-V are very safe vaccines and very effective against measles. Two doses of measles vaccination is 99% effective at preventing infection.

Immunization for Children and Youth:

In Ontario, as a part of routine immunizations, children receive two doses of a measles containing vaccine before the age of 7.
Children receive one dose of the MMR vaccine (measles, mumps & rubella) at 12 months of age.

Children receive a second dose of measles containing vaccine, MMRV (measles, mumps, rubella & varicella), vaccine, between 4 and 6 years of age.

Infants 6-11 months of age: One dose of MMR vaccine may be given if infant is travelling outside of Canada. (Note: Two additional doses of measles-containing vaccine must be administered after the child is 12 months old to ensure long lasting immunity to measles).

Immunization for Adults:

The best way you can protect yourself and others against measles is by getting the measles vaccine. This vaccine is combined with the vaccine for mumps and rubella and is known as the MMR vaccine. MMR vaccine is very safe and very effective against measles.

Adults born in or after 1970 can receive two doses of a Measles-Mumps-Rubella vaccine (MMR). In this age group, it is strongly recommended that travelers who are traveling outside of Canada and students in post-secondary educational settings receive two doses.

All adults born before 1970 are generally presumed to have natural immunity to measles. A one time dose of Measles-Mumps-Rubella (MMR) vaccine is publicly funded (no cost) for this age group. Individuals in this age group may be eligible to receive a second dose if traveling to destinations outside of Canada or as per healthcare providers judgement.

Immunization Records:

It is important to have an up-to-date copy of your immunization records. If you have missing or incomplete records, use these tips for locating your immunization records.

For more information on viewing or updating your immunization records, please visit RCDHU’s Immunization page.

Additional Information

• RCDHU: Immunization Clinics 
• Government of Canada: Measles: Symptoms and treatment 
• Canadian Pediatric Society: Measles 

Rabies is a disease caused by a virus that affects the brain. It is spread between warm-blooded animals and could be spread to humans from an infected animal through a bite or other contact with the animal’s saliva. Rabies is a very serious disease; if an infected person is not treated, rabies is almost always fatal.

In Ontario, rabies is most commonly found in bats, raccoons, foxes, coyotes and skunks. Domestic animals, including dogs, cats, ferrets and rabbits can also carry the virus so pet vaccination is important.

Symptoms

Symptoms usually appear three to eight weeks after the bite, but they can appear as soon as nine days afterwards. Rabies is usually fatal unless treatment starts before symptoms appear. Symptoms usually begin with:

• Fever
• Cough
• Sore throat
• Headache
• General weakness or discomfort

As rabies progresses, more symptoms appear and may include:

• Insomnia – trouble sleeping
• Anxiety
• Confusion
• Partial paralysis
• Excitation and hallucinations
• Agitation
• Hypersalivation – increase in saliva
• Trouble swallowing
• Hydrophobia – fear of water or unable to drink

Death usually occurs within days of the start of these symptoms.

Prevention

Protect yourself, children and pets from animal bites:

There are dozens of preventable animal bites each year in Renfrew County and District. Always use caution around animals:

• Do not approach a dog with a Yellow Ribbon or collar – give them space
• Do not pet wild animals, stray cats and dogs
• Always keep your dogs on a leash while outdoors unless in designated dog parks
• Know the local by-laws on animal control and licensing
• It is a legal requirement in Ontario to vaccinate your pets (cats/dogs/ferrets) with rabies vaccine
• If there is a bat in your home:
  • Do not attempt to touch the bat as there is risk of a bite or scratch
  • Keep the door closed with an open window and the room lights ON to let the bat escape to the outside
  • If the bat does not leave, contact your local municipal animal control or a pest management company to capture and release the bat
  • If you or someone else wakes up to find a bat in the room (dead or alive), immediately call your health care provider or RCDHU to speak with a public health inspector for an assessment.
• Rabies is a 100% fatal disease when not treated early enough

If you are bitten or scratched by an animal:

If you are a victim of an animal bite, follow the below steps:

• Clean your wound immediately with soap and running water for 15 minutes
• Gather the pet owner’s contact information, if possible
• Try and remember what the animal looks like
• Visit your local hospital or speak to a health care provider to discuss treatment
• Inform RCDHU of the incident and follow the instructions given to you by a Public Health Inspector

Animal bite incidents must be reported to RCDHU immediately using the Contact with Suspected Rabid Animal Reporting Form.

If you are the owner of an animal involved in a biting or scratching incident:

• Provide your name, address and phone number to the person who was bitten or scratched. Your information will help Public Health Inspectors investigate the animal scratch/bite when it is reported to RCDHU. This will also help to avoid unnecessary rabies treatment for the person who was scratched/bitten.
• Follow RCDHU’s instructions on 10-day animal confinement. Animal confinement can take place at home or a kennel.
• Public Health Inspectors will release the dog after 10 days if the animal is alive and appears healthy.
• Release of the animal from confinement indicates that the animal was NOT infected with rabies at the time of the incident.
• Keep your dogs, cats, ferrets and livestock up-to-date with rabies vaccine.

Preventing Human Cases of Rabies

RCDHU works to prevent human cases of rabies through the following activities:

• Public Health Inspectors investigate animal bites and scratches that are reported to RCDHU. The owner has to put the suspect animal into quarantine. This is necessary to ensure that the rabies virus was not present in the saliva of the animal when the person was bitten or scratched. The animal is checked at the end of the quarantine period to make sure it is free of rabies symptoms.
• Monitoring the type, number and location of animals that have tested positive for rabies in Renfrew County and District and surrounding areas
• Having a Rabies Contingency Plan and keeping it up to date
• Investigating when people are exposed to animals suspected of having rabies
• Having a supply of rabies vaccine
• Consulting with doctors in deciding when there is a need to give the vaccine to a person who has been exposed to an animal suspected of having rabies

If you have questions or are looking for additional information regarding rabies, please contact RCDHU’s Healthy Environments department by phone: 613-732-3629 ext. 505 or by email: environmentalhealth@rcdhu.com.

Yellow Ribbon Campaign – Animal Bite Awareness

Yellow is the colour of caution on traffic lights, and is now a warning sign to give space to dogs and other animals that need it.

RCDHU is encouraging the use of a yellow ribbon (or bandana, bow, or similar marker) tied to a dog’s leash or collar to remind people to give the animal space. This is part of RCDHU’s rabies awareness campaign to reduce the number of reported animal bites in the region.

Yellow = CAUTION. If you see yellow on a pet, give the animal space!

For more information, please visit Yellow Ribbon Campaign – Animal Bite Awareness.

What is Tuberculosis?

Tuberculosis (TB) is an infectious disease caused by bacteria that are spread from person to person through the air. It usually affects the lungs, but can also affect other parts of the body, such as the brain, kidneys, or spine. Tuberculosis is preventable and curable.

When a person with TB disease in his/her lungs coughs or sneezes, the TB bacteria are released into the air. Another person can then breathe the TB bacteria into his/her lungs. A person who breathes in the TB bacteria can become infected. This is called latent tuberculosis infection (LTBI). When a person has LTBI infection, the TB bacteria have entered the body, but they are not growing and are dormant (latent). With LTBI infection, a person does not feel sick and cannot give the TB bacteria to other people. A person with LTBI infection may develop active TB disease in the future.

Symptoms

A person with TB may have the following symptoms:

• cough
• fatigue
• night sweats
• fever
• loss of appetite
• weight loss

Only a health care provider can tell if you have TB disease. A chest x-ray, sputum and IGRA blood test will help show if you have the disease in your lungs. Other tests may be necessary to find out if TB disease is in other parts of the body.

Treatment

TB disease can be treated with antibiotics and may be cured. The antibiotics must be taken as recommended to make sure that the person does not become even more sick and to prevent the TB bacteria from becoming stronger or resistant to the medication.

Prevention

The risk of being exposed to tuberculosis is very low. If you have been in contact with someone who has active tuberculosis or think you may have, consult your health care provider. If you plan to travel to countries with high rates of tuberculosis, visit a health care provider or travel health clinic 6 weeks before you leave. If you believe you are at risk of getting tuberculosis, ask about getting a skin test.

Additional Information

• RCDHU: Immunization Clinics 
• Government of Canada: Tuberculosis (TB): Prevention and risks 

West Nile virus is spread to humans by the bite of an infected mosquito. Mosquitoes become infected after biting infected birds.

Learn more at Government of Ontario’s: West Nile virus.

Symptoms

Most people who are bitten by an infected mosquito have no symptoms and do not get sick. Some people such as the elderly and those with a weakened immune system may have flu-like symptoms.

Some see symptoms 2-15 days after being bitten by an infected mosquito.

Common symptoms include:

• fever
• headache
• body ache
• nausea
• vomiting
• rash on chest, stomach or back

Approximately 1 in 150 people will have serious symptoms including:

• high fever
• severe headache
• muscle weakness
• stiff neck
• confusion
• tremors
• numbness
• sudden sensitivity to light

If you think you have contracted West Nile Virus, contact your healthcare provider.

Prevention

• Cover up when going outside between the hours of dusk and dawn (when most mosquitoes feed). Remember to wear:
  • a long-sleeved shirt or jacket, long pants and socks
  • light-coloured clothing
  • if you will be outside for a long time, wear special clothing that is designed to protect you from bugs
• Use insect repellant containing DEET or icaridin
• Once a week, get rid of standing water around your home (mosquitoes lay their eggs in stagnant water, even small amounts)
• Keep bushes and shrubs clear of overgrowth and debris (adult mosquitoes like to rest in dense shrubbery)
• Turn your compost pile often

Mosquito Testing

Since 2005, Renfrew County and District Health Unit has been trapping and testing mosquitoes during the summer months. This helps us to know if mosquitoes that carry the West Nile virus are living in Renfrew County and District. West Nile virus was found in mosquitoes in Renfrew County for the first time in the summer of 2017.