Preventing Communicable Diseases: A-Z Index

Exposures may occur through:

• injuries such as needle stick, human bite or a cut that breaks the skin
• a splash onto your eye, nose, or mouth
• contact with non-intact skin (rash, cut or scrape)

First aid steps

• If your eyes, nose, or mucous membranes like your mouth have been exposed to bodily fluids, flush thoroughly with large amounts of cold water or saline. When flushing the mouth, ensure that the water or saline is spat out and not swallowed.

• Wash any wounds and injured areas including intact skin that was exposed thoroughly with soap and warm water. Alcohol Based Hand Rub (ABHR) may be used if soap and water are not available.
• Remove contaminated clothes as appropriate.
• After an injury, immediately allow the wound to bleed freely. Needle stick injuries should not be squeezed.
• Sharps must be disposed of safely in appropriate sharps container.

Seek medical attention

• You should seek medical attention to be assessed as soon as possible by a physician. Early intervention ensures that timely treatment and Post Exposure Prophylaxis (PEP) are started if appropriate.

• The Healthcare Practitioner will do an assessment to determine if treatment and/or PEP is recommended. PEP is available for HBV and HIV but not for HCV.
  • Canadian Immunization Guide- passive immunization (external link )
  • Hepatitis B Vaccine: Canadian Immunization Guide - Canada.ca (external link)
  • Pocket P.E.P. - Clinical management of non-occupational and occupational exposure to blood borne pathogens (simcoemuskokahealth.org) (external PDF)
  • Catie.ca post exposure prophylaxis (external link)
  • Post-Exposure Prophylaxis (PEP) | HIV Risk and Prevention | HIV/AIDS | CDC (external link)

• You may be recommended to have your blood tested for HBV, HCV, and HIV. This is referred to as baseline testing and will determine if you have been exposed to these infections before. These blood tests are usually repeated because it can take time for the infections to show up on a blood test and you may not show symptoms if infected. Your doctor will tell you when to have the blood tests repeated.
• You should see your doctor immediately if you develop symptoms such as nausea, vomiting, stomach pain or jaundice (yellowing of the whites of the eyes and skin) after an exposure.

Testing the source

• You may be able to approach the person to request he/she voluntarily be tested for blood borne infections (HIV, HBV and HCV), depending on where you work, such as in an institutional setting through your occupational health department.
• Emergency Service Workers, medical professionals, correctional workers, victims of crime and those who provide emergency first aid to an individual - can submit an application through the Mandatory Blood Testing Act (MBTA) (external link) to have the source provide a blood sample to be tested for HIV, HBV and HCV.

• The MBTA is provincial legislation that allows certain eligible individuals (“Applicants”) to apply to have the blood of another person (“Respondent”) tested for specific infectious diseases (Hepatitis B, Hepatitis C and Human Immunodeficiency Virus/Acquired Immunodeficiency Syndrome (HIV/AIDS)) if the Applicant has come into contact with or has been exposed to the Respondent’s bodily fluids.
• These eligible individuals should immediately contact a medical professional who can help assess the risk of infection and discuss care and treatment options. Eligible individuals include those who provide emergency services, emergency first aid, or correctional services, to name a few.
• For more information on the MBTA and to see if you are eligible to apply under the MBTA, please visit: Ontario.ca Mandatory Blood Testing (external link).
• For information on how to submit an MBTA application to Halton Region Public Health, please call 311.

• Public Health Ontario   Instructions for Hepatitis B Test information (external link)
• Public Health Ontario   Instructions for Hepatitis C Test information (external link)
• Public Health Ontario   Instructions for HIV Test information (external link)
• Communicable disease control (bccdc.ca) (external PDF)
• Canadian Immunization Guide: Tetanus wound management – see post-exposure prophylaxis (external link)
• Needlestick and Sharps Injuries: OSH Answers (ccohs.ca) (external link)

Chickenpox is a very common childhood infection that can also affect adults. It is caused by the varicella-zoster virus (VZV).

While chickenpox is usually a mild to moderate illness in the majority of children, it can be much more severe in teens and adults.

Chickenpox spreads easily from person to person through the air when someone who has the virus sneezes or coughs. It can also be spread through the saliva of a person who has chickenpox and by touching the fluid from the infected person’s chickenpox blisters.

The chickenpox rash can appear from 10 to 21 days after contact with someone who has chickenpox. Usually the symptoms appear in 14 to 16 days.

The first symptoms of chickenpox are similar to those of the common cold – mild fever, headache, aches and pains and a general feeling of being unwell. This may last for one to two days. People with chickenpox can spread the virus easily at this time.

One or two days later, a rash develops. Usually, itchy red spots appear first on the face and scalp, and then spread quickly down the body and to the arms and legs. The spots may be painful. Small blisters will appear, filled with clear fluid. The fluid in these blisters then becomes cloudy. The blisters break and a crust or scab forms while the skin heals. New spots continue to appear over a three to four-day period.

Some people will only have a few blisters while others will have many blisters over their entire body. The illness is usually mild, but may be accompanied by a high fever and severe rash.

Chickenpox is most contagious one to two days before the rash appears, until the lesions are crusted over, which is usually about five days after the rash appears.

Those who are most at risk of developing serious complications from chickenpox include:

• People who have not had chickenpox and are not vaccinated
• Newborn babies
• People with a weak immune system
• Pregnant women as they can pass the disease to their unborn baby (possibly causing birth defects)
• Teens and adults

Complications of chickenpox include:

• Skin infections - most are mild, but chickenpox has been linked to a life-threatening infection called flesh-eating disease (necrotizing fasciitis) 
• Infection of the lungs (pneumonia)
• Severe inflammation of the brain (encephalitis)
• Sudden loss of muscle co-ordination and difficulty walking (cerebellar ataxia)

Complications of chickenpox are much more frequent and severe in adults.

Chickenpox may cause harm to the unborn child if a pregnant woman becomes infected during the early part of the pregnancy. If the mother develops chickenpox around the time of delivery, the baby can develop very severe chickenpox, which can lead to problems in the brain, heart, and liver.

Prior to the introduction of the chickenpox vaccine, every year, more than 1,800 people were hospitalized for complications of chickenpox. Approximately 100-150 people died each year from chickenpox, with over 90 percent of these deaths occurring in previously healthy persons.

If you think you have chickenpox, call your healthcare provider’s office. Tell them about your symptoms.

Do not go to your healthcare provider without calling ahead. The office needs to take proper precautions when seeing you so that other people do not get sick.

The rash of chickenpox is very typical. Chickenpox can usually be diagnosed without laboratory tests, but your health care provider may order tests (i.e. blood test or swab of the blister).

Immunity (the ability to prevent the infection again) to chickenpox disease is generally life-long. However, the body does not get rid of the virus. Instead, the chickenpox virus lies dormant (asleep) in nerve cells in the body. Years later, the virus may become active again and cause a painful condition known as shingles.

There is no cure for chickenpox. However, there are medications that can make chickenpox illness less severe in people who are at higher risk. Ask your healthcare provider or your pharmacist about things you can do to help reduce the itching and to relieve fever.

If fever does occur, do not use products that contain salicylates, such as aspirin, ASA, or willow bark. Taking aspirin increases the risk of getting Reye's syndrome. This is a severe illness can damage the liver and brain, especially in children.

Contact a healthcare provider as soon as possible if the ill person:

• has a fever over 38.5°C that lasts more than two days or comes back
• develops redness, swelling, and severe pain around any of the spots
• has a severe headache, constant vomiting, sensitivity to bright light, or unusual sleepiness, or confusion

Encourage children with chickenpox to practice good hand-washing and keep their fingernails short. This is very important because germs on the hands and skin can infect the sores.

If you are pregnant and have never had chickenpox or chickenpox vaccine, immediately call your healthcare provider. Your healthcare provider may order a blood test for you to determine if you are immune to chickenpox. If the result shows that you are not immune, your healthcare provider may give you a special type of injection to help prevent you from getting a severe infection.

It is recommended that individuals who have chickenpox stay home until they are feeling well and it has been five days since the start of their rash or until the lesions have crusted over, whichever comes first.

It is also recommended to avoid people that are more at risk for chickenpox complications such as pregnant women and people with weak immune systems (such as cancer) until all lesions have crusted over.

Chickenpox is a reportable communicable disease. Please advise your daycare, preschool, or school if your child has chickenpox.

Get vaccinated! The chickenpox vaccine is safe and effective. Most people who get the vaccine do not get chickenpox. If they do, it is usually mild, with a minor rash. If given within three days of exposure, the vaccine can prevent chickenpox or reduce its severity.

Chickenpox vaccine is routinely offered to toddlers at 15 months of age and to children entering school for the first time, at 4-6 years of age. The vaccine is publicly funded for children born on or after January 1, 2000 as well as for people with medical conditions that put them at increased risk for complications from chickenpox. Children born after January 1, 2010 need to show proof of immunization against chickenpox to attend school unless they provide a valid exemption.

Older children, teens and adults can also receive the chickenpox vaccine. It is not publicly-funded for people in these age groups.

More information about the chickenpox vaccine can be found on our website at Halton - Varicella (chicken pox) Vaccine.

Coronaviruses are a large family of viruses that usually cause mild to moderate respiratory symptoms in humans. There are many types of human coronaviruses and are typically associated with mild illnesses, similar to the common cold. Two novel coronaviruses in the recent past, Severe Acute Respiratory Syndrome (SARS-CoV) and Middle East Respiratory Syndrome (MERS-CoV), have been known to frequently cause severe illness. Viruses of this family also cause a number of animal diseases.

The best way to prevent the spread of respiratory viruses is similar to flu-like precautionary measures, including:

• Staying home if ill
• Covering coughs and sneezes with tissue or sleeve
• Washing hands with soap and water or with alcohol-based hand rub
• Cleaning and disinfecting objects and surfaces

Visit our main COVID-19 Vaccines webpage to learn more about COVID-19 vaccines.

Meningococcal disease is a very serious illness caused by meningococcal bacteria. The bacteria enter the body through the nose and throat. The bacteria can infect the lining of the brain and spinal cord or the blood.

Meningococcal bacteria are commonly found in throats of people who have no symptoms and never become ill.

It is spread by direct contact with nose and throat secretions of an infected person through coughing, sneezing and kissing, or sharing saliva. This type of bacteria does not survive very long outside the body.

The symptoms may develop rapidly, sometimes in a matter of hours, and if left untreated can lead to death. However, the symptoms may appear any time between two to 10 days after exposure, but usually within three to four days.

Symptoms vary depending on the area of the body the bacteria infects. Common symptoms include:

• Sudden onset of fever
• Drowsiness
• Irritability, agitation, and fussiness
• Severe headache
• Nausea and vomiting
• A rash that does not fade under pressure
• Rapid breathing
• Pain in muscles, joints, and abdomen

If the bacteria enters the lining of the brain or spinal cord, other symptoms that can occur include stiff neck and pain when moving neck.

Meningococcal disease can be contagious seven days before the start of symptoms up until 24 hours of receiving appropriate antibiotic treatment.

People living in the same household with the infected person are at risk of developing the disease, as well as people who come in direct contact with the infected person’s nose and throat secretions.

Most people who come in contact with meningococcal disease do not become sick. The disease primarily affects very young children, teenagers, and young adults.

Anyone who has had close contact with someone with meningococcal disease within 10 days and develops a fever with symptoms as listed here should see a health care provider (HCP) immediately. Your HCP may order tests to diagnosis meningococcal disease.

To avoiding infecting others, avoid sharing objects with others that may have come into contact with your saliva. Clean your hands often with soap and warm water or alcohol-based hand cleanser. Cover your mouth and nose with a tissue when you cough or sneeze, throw used tissues away immediately, and wash your hands.

Yes. Infection with one serogroup (strain) of the meningococcal bacteria does not give protection against other strains of the bacteria.

Meningococcal disease can be treated with antibiotics. Take the antibiotics as your HCP prescribes making sure to complete all of the medicine. If side effects from the medication are giving you problems, contact your HCP right away.

A person is no longer infectious after taking appropriate antibiotics for 24 hours.

Close contacts such as people who live in the same household or have had contact with the nose and throat secretions of the ill person should talk to a HCP about taking antibiotics. Close contacts should monitor for any signs and symptoms of disease and seek medical attention if symptoms develop.

Casual contacts such as classmates or co-workers may not need preventive antibiotics.

To prevent the spread of this type of bacteria, avoid sharing objects that have come in contact with another person’s mouth. Clean your hands often with soap and warm water or alcohol-based hand cleanser. Cover your mouth and nose with a tissue when you cough or sneeze, throw used tissues away immediately, and wash your hands.

There are three types of vaccine available to protect you against meningococcal disease: Men-C (protects against C strain), Bexsero (protects against B strain) and Menactra (protects against A, C, Y and W-135 strains).

Men-C and Menactra are given routinely as part of childhood/adolescent immunizations.

Bexsero is available, but currently not publicly-funded (free). Talk to your HCP for more information.

Publicly funded vaccine is also available for high risk groups, including people with:

• problems with their immune system (ex. HIV)
• no spleen or a spleen that does not work properly
• cochlear implants

Meningococcal vaccine or booster doses of vaccines may be recommended for travel. Please discuss with your physician or travel clinic for vaccination options.

No. Immunity from the vaccine gradually decreases over time. A booster dose of vaccine may be recommended for adults.

Fifth disease is also known as “slapped cheek syndrome” because of the rash it causes on the face. It is a very common viral infection of the respiratory system caused by parvovirus B19. Antibiotics will not help treat fifth disease.

Fifth disease is a very common infection in child care settings, schools and the general community.

Most children with fifth disease have very mild symptoms and sometimes no symptoms at all. Generally, it starts as a mild fever or cold followed by a very red rash on the cheeks, making the face look as if it has been slapped. This is followed one to four days later with a red, lace-like rash that spreads first on the torso and arms, and then on the rest of the body. The rash may last from one to three weeks and can vary with changes in temperature and exposure to sun. Usually, by the time the rash appears kids are feeling well and are back to their usual activities.

Adults typically get a more severe case, with fever and some joint pain. At least 50% of adults have had fifth disease in childhood and will not get it again.

The virus spreads the same way as a cold virus does. You can get the disease after coming in contact with secretions from the nose, mouth or throat of somebody who has it. The fluids can be found on objects, hands, or in the air.

There is no reason to isolate someone with fifth disease. It does not prevent the spread of the infection. Once the rash appears the person can no longer spread the infection.

Not usually, but some people may have complications:

• Severe anemia may occur in children with weakened immunity (such as leukemia) or with certain blood disorders (like sickle cell anemia).
• There is a very low risk for pregnant women that their unborn child may become infected and develop anemia before birth.

• Remind your child to wash their hands often with soap and water, cover their cough and sneezes, and not to share utensils or drinking cups.
• Your child may continue attending a childcare facility or school if feeling well enough to take part in the activities.

At least 50 % of pregnant women have had fifth disease in the past and are already immune, in which case they will not get it again or pass it to their unborn baby. If you are not immune and are exposed to fifth disease there is a small risk that your baby may be affected. Usually exposure to this virus does not result in serious harm to baby.

• If you are unsure of your immune status, and are either pregnant or planning a baby, you should discuss any concerns with your healthcare provider. A blood test may be considered to check your immunity.
• If you are pregnant and know you have been exposed to fifth disease, contact your health care provider.
• Frequent hand-washing and not sharing cups/utensils can help prevent infection.

Viral meningitis is a disease that causes the tissues that cover the brain and spinal cord to be inflamed. Many different viruses can cause viral meningitis. About 90% of cases are caused by a group of viruses known as enterovirus, such as coxsackievirus and echovirus.

While viral meningitis is a serious disease, it is rarely fatal. Most people recover fully with symptoms lasting 7 - 10 days.

Symptoms might not be the same for every person. More common symptoms include:

• Fever
• Severe headache
• Stiff neck
• Bright lights hurt the eyes
• Drowsiness or confusion
• Nausea and vomiting

For babies, the more common symptoms are:

• Fever
• Fretfulness or irritability
• Difficulty waking the baby
• Refusal to eat

There is no specific treatment for viral meningitis. Most patients recover fully on their own. Doctors will often recommend bed rest, plenty of fluids, and medicine to relieve fever and headache.

Enteroviruses, the most common cause of viral meningitis, are often spread through direct contact with an infected person's saliva, sputum, or nasal mucus. The spread usually happens by shaking hands with an infected person or touching something they have touched, and then rubbing your nose, mouth, or eyes.

The virus can also be in an infected person's stool. The virus spread through this route is mainly among small children who are not yet toilet trained. Adults can also spread the virus by changing an infected baby's diaper.

It usually takes 3 - 7 days from the time you are infected until symptoms develop. You can usually spread the virus to someone else beginning about 3 days after you are infected until about 10 days after you develop symptoms.

The most effective way of preventing the spread of the virus is to wash your hands thoroughly and often:

• Before and after handling food
• After using the washroom
• After sneezing or wiping your nose

Wash objects and surfaces with a diluted bleach solution (mix 1 capful of chlorine-containing household bleach with 1 gallon of water).

Viral meningitis is caused by a viral infection (virus) and is rarely fatal. Bacterial meningitis can be very serious and result in disability or death if not treated promptly.

The symptoms for viral and bacterial meningitis are often the same. If you think that you or your child has meningitis, then see your doctor right away.

E. coli infection is a type of diarrheal illness caused by bacteria called Escherichia coli. It affects the digestive tract and, in serious cases, the kidneys. There are many strains of E. coli, and most are harmless.

E. coli are also used as indicators of water and food quality, and the bacteria can tell us if there is fecal contamination in the water or food.

The strain of E. coli that most often makes people sick is E. coli O157:H7. For ease, we will refer to E. coli O157:H7 as E. coli.

Symptoms of E.coli infection include:

• watery diarrhea, which in serious cases may become bloody;
• vomiting;
• stomach cramps; and,
• mild fever.

The symptoms can start 2 to 10 days after contact with or consuming something contaminated with E.coli, but usually start within 3 to 4 days. Symptoms can last for 5 to 10 days.

In a few cases, E. coli can cause a serious and sometimes fatal illness called hemolytic uremic syndrome (HUS) which can result in kidney failure, anemia and internal bleeding. HUS can be especially harmful for young children, the elderly, people with weakened immune systems, and pregnant women.

E. coli can be found in the stomachs and feces of many healthy animals including cattle, goats, sheep, deer, and elk.

During the butchering process, E.coli sometimes gets onto the surface of the meat. Whole cuts of meat such as steaks or roasts usually only have E. coli on the surface, which makes the E.coli easier to kill by cooking.

When the meat is ground or mechanically tenderized, E. coli on the surface can be transferred to the inside of the meat. This is why ground meat and mechanically tenderized meat are more likely to cause illness than whole cuts of meat. E. coli can be killed if the meat is cooked thoroughly. Infection can happen when people eat undercooked hamburgers or ground meat.

E. coli are also sometimes found in other foods including fruits and vegetables, as well as in unpasteurized milk, juice, cider, and untreated water.

Contaminated drinking water and swimming in recreational water that has been contaminated with water that has drained from areas with considerable animal activity, (e.g. pastures), can also cause infections.

To reduce the risk of E. coli infection:

• Refrigerate or freeze meat as soon as possible after buying it.
• Always thaw meat thoroughly in the refrigerator before you start to cook it. Ensure it is wrapped well and kept away from other foods. Do not try cooking frozen or partially frozen meat.
• Wash your hands thoroughly before preparing food, after handling raw meat, and after using the toilet as E.coli can be spread to others through infected feces.
• Always wash and then sanitize all utensils, cutting boards and counters that have touched raw meat to prevent E. coli from contaminating other foods. You can use a 200 ppm no rinse sanitizing solution.
  How to make a 200 ppm no rinse sanitizing solution:
  • Mix 15 mL (1 tablespoon) of household bleach into 4 litres (1 gallon) of water; or mix 5 mL (1 teaspoon) of household bleach into 1 litre (4 cups) of water.
  • Allow the sanitizer to contact the surface or utensil for at least 1 minute before wiping off with a clean paper towel or allowing to air dry.
  Use Public Health Ontario’s chlorine dilution calculator tool to make up the proper sanitizer strength based on the concentration of your bleach product.
• Cook whole or mechanically tenderized cuts of beef to a minimum internal temperature of 63°C (145°F). If cooking steaks, turn at least twice during cooking.
• Cook ground meat, such as hamburger patties, meat loaf and rolled roasts (beef roulade) until the middle reaches a temperature of 74°C (164°F) or hotter and remains there for at least 15 seconds. Measure the internal temperature of the meat with a good probe thermometer.
• Never put cooked meat back on the same unwashed surface that held the raw meat. The juices from the raw meat can be contaminated with E. coli, which can then contaminate the cooked meat.
• Do not use marinade as a sauce on cooked meat.
• Serve cooked meats right away or keep them hot. They should be at least 60°C (140°F) or hotter, until you are ready to serve them.
• Wash any fruits and vegetables with cold running water before eating them raw, even if they will be peeled or cut. Use a scrub brush on fruits and vegetables with rough skin, such as a cantaloupe.
• Avoid drinking unpasteurized milk, juice and cider.
• Do not drink or use untreated surface water from a spring, stream, river, lake, pond or shallow well. Assume it is contaminated with animal feces.
• Avoid swimming in water that may drain pastureland.

Anyone who has diarrhea for more than a few days and/or bloody diarrhea should see a health care provider.

Drinking lots of fluids is important to replace lost fluids and prevent dehydration. Do not take antidiarrhea medicine unless recommended by your health care provider.

Serious cases may require hospitalization, blood transfusion, and dialysis.

They are Gram-negative bacteria that produce an enzyme, beta-lactamaze that can break down commonly used antibiotics, such as penicillin and cephalosporins, making infections with ESBL producing bacteria more difficult to treat. Enterobacteriaceae E.coli and Klebsiella pneumoniae are common producers of ESBL, and they usually cause urinary tract infections and bacteraemia.

People who carry ESBL producing bacteria without any sign or symptom of infection are “colonized”.

• Extensive treatment with antibiotics
• Prolonged stay in a health care institution, particularly in an ICU
• Severity of illness: neutropaenia, organ transplant, haemodialysis or tube feeding
• Indwelling catheters
• Communal living setting

The main reservoir is the lower bowel of colonized or infected persons. Common ways of transmission is through unwashed hands.

ESBL producing bacteria can survive on environmental surfaces without a major role in transmission, if good hand washing and infection control measures are practiced.

Routine screening of residents in a LTCH is based on the burden of ESBL and the policy of the home, as directed by Infection Prevention and Control.

Routine screening of staff for ESBL is not recommended.

In an outbreak with ESBL producing bacteria screening should follow a protocol to actively identify new cases.

ESBL decolonization is not effective and not recommended

The preferred specimen for ESBL screening is a rectal swab or stool. Stool specimens have a higher yield. A urine culture may also be sent in certain circumstances such as the presence of catheters.

In general, use routine practices and contact precautions (gloves and gown) when providing direct resident care.

• Accommodation in single room with own toileting.
• Good Hand Washing and 4 Moments of Hand Hygiene:
  1. Before resident or resident environment contact
  2. Before performing aseptic procedure
  3. After care involving body fluids
  4. After resident or resident environment contact
• Provide help to residents with their hand hygiene practices
• Routine environmental cleaning
• Use dedicated personal care equipment whenever possible and thoroughly clean and disinfect shared equipment.
• PPE
  Use gloves and long sleeve gown while providing direct resident care and cleaning resident’s environment.
• Routine cleaning of the environment, laundry and dishwashing

Educate all visitors, including family members to practice good hand hygiene before and after leaving the resident’s room. Family members providing direct personal care wear the same PPE-gloves and gowns. Feeding and pushing a wheelchair is not direct care, but hand hygiene is necessary.

Review with the Infection Control at least three negative laboratory test results from all colonized or infected body sites, with specimens collected at least one week apart, in the absence of antibiotic therapy

Group A streptococci (group A strep or GAS) are bacteria that are commonly found in the nose, throat and on the skin of healthy people.

These bacteria are spread by direct contact with secretions from the nose or throat secretions, or from contact with an infected wound or sore on the skin of an infected person. Open mouth kissing, sharing drinks, mouth-to-mouth resuscitation, sexual intercourse, and sharing needles can also pass on the infection. Those who are ill with GAS are the most likely to spread it to others.

Most illnesses from the bacteria cause minor to moderate infections such as a sore (strep) throat, tonsillitis, or skin infections such as impetigo. Ear infections and scarlet fever can also occur.

Rarely, the bacteria can enter the lungs, blood or tissues. GAS found in these places is called “invasive disease” and can result in severe, life threatening infections known as “invasive” group A streptococcal (iGAS) disease.

If you think you have symptoms of GAS see your doctor right away for an assessment and treatment.

GAS is treated with antibiotics. Early treatment may prevent severe illness (iGAS). iGAS disease is rare. Those with serious infections may need hospitalization. People with flesh-eating disease (necrotizing fasciitis) may need surgery to remove damaged tissue.

A person with iGAS can become seriously ill within 12-24 hours.

If the bacteria enters the blood (septicemia), symptoms may include fever, chills, headache, generally not feeling well, pale skin, lack of energy, rapid breathing and increased heart rate.

Symptoms of flesh-eating disease include:

• severe pain and swelling, often rapidly getting worse
• fever
• redness around a wound

Symptoms of streptococcal toxic shock syndrome (STSS) include:

• fever
• sudden severe pain, often in an arm or leg
• dizziness
• confusion
• flu-like symptoms
• flat red rash on the body

When treatment is not received, cases can pass on the bacteria for 10 to 21 days. When someone is untreated and also develops pus, it can take weeks or months before they are no longer infectious. A sick person will no longer pass on the bacteria after 24 hours of antibiotic treatment.

Every year in Ontario, thousands of people experience various GAS infections such as strep throat or impetigo.

Healthy people are at low risk for getting iGAS disease. Risk factors for iGAS include individuals with:

• cancer
• diabetes
• heart disease
• kidney dialysis patients
• HIV/AIDs
• lung disease
• scarring (cirrhosis) of the liver
• alcohol abuse
• injection drug use
• use of steroid medication
• close Contacts of someone with iGAS

A break in your skin, such as a cut or wound, or open sores from chickenpox can also increase the risk of bacteria entering the body.

Complications of iGAS include:

• loss or removal of a body part (amputation)
• sepsis, which can lead to organ failure
• death

Close Contacts may be offered antibiotics to prevent getting sick and should monitor for any signs and symptoms for 30 days from their last contact with the sick person or until the sick person has taken antibiotics for at least 24 hours.

• Always practice good hand hygiene: 15 seconds of washing with soap and water or using alcohol based hand rub until hands are dry (70-90% alcohol concentration recommended)
• Maintain good personal hygiene
• Cough or sneeze into your sleeve or use a tissue and then throw it away
• Wounds and cuts should be cleaned and covered
• Avoid sharing items that have come into contact with saliva such as cutlery, drinking bottles, and lipstick
• Avoid spending time in hot tubs, swimming pools and natural bodies of water (e.g., lakes, rivers, oceans) when you have an open wound or skin infection
• Report any sudden, unusual, or severe signs of infection, sore throat, or fever to your doctor
• If you are diagnosed with iGAS do not go to work, school, or daycare until you have finished 24 hours of antibiotic treatment
• Finish all your antibiotics even if you are starting to feel better
• Keep yourself as healthy as possible. Eat right, stay active, and see your health care provider regularly!

For more information about GAS or iGAS talk to your health care provider, or call the Halton Region Public Health by dialing 311 to speak to a nurse.

• Thorough hand washing is the best prevention. Wash hands after using the toilet, changing diapers and before handling or eating food.
• Do not eat raw shellfish and avoid eating raw fish.
• If traveling outside Canada, be sure the water you drink is bottled or properly treated. Remember that ice cubes could be contaminated.
• Avoid sex that involves anal-oral contact.
• Consider the Hep A immunization if your personal and or professional life puts you at risk for Hep A. The Hep A vaccine consists of 1 dose with a booster, 6 – 12 months after the first dose. Protection is expected to last 10 years after the second dose.
• If traveling to an area where Hep A is common, immunization is strongly recommended.

Hepatitis B is a viral infection that can cause liver disease. Hepatitis B virus (HBV) can be acute or chronic. Acute hepatitis B happens during initial infection. Most adults who are exposed to hepatitis B don’t experience symptoms and can recover on their own. Less than 5% of adults who get acute hepatitis B develop chronic hepatitis, which can lead to liver cirrhosis (liver scarring) and/or liver cancer later in life.

Chronic hepatitis B is a “silent” disease because symptoms often do not appear until the liver is very damaged. Chronic carriers can spread the virus to others for the rest of their life. Infants and children infected with hepatitis B are more likely to develop a chronic infection.

Hepatitis B is common worldwide.

The HBV is spread through contact with an infected person’s blood, bodily fluids, or through sexual contact. The virus can also be spread by sharing needles, by piercings, or by tattooing.

An infected mother can also pass the virus to their baby during birth. HBV is not spread by water, food, or by casual contact and is rarely spread by a bite from an infected person.

Most people who are infected with the HBV do not have any symptoms. Symptoms of hepatitis B may include some or all of the following:

• Fatigue
• Loss of appetite
• Fever
• Abdominal pain
• Nausea and vomiting
• Diarrhea
• Pale/grey colored stools
• Dark urine
• Jaundice (yellow skin and eyes)

Those at risk include:

• Unvaccinated people
• Babies born to a HBV infected mother
• Sexual partners of those who have HBV
• People who engage in high-risk sexual activities (e.g., multiple sex partners or unprotected sex)
• Sexually active homosexual or bisexual males
• Children and household members of someone with HBV
• People who use injection drugs and share drug equipment
• Certain occupations where there is a risk of needle-stick injuries (i.e. health care workers, firefighters, etc.)
• People who were born/lived in or travelled to a country where HBV is common
• People who receive a tattoo, body piercing or acupuncture with unsterile equipment or techniques used

Complications of HBV can include liver cirrhosis (scarring of the liver), liver failure, possibly liver cancer and premature death. However, not all people infected with hepatitis B will develop these complications.

If you have been infected and have recovered from the virus, generally, immunity is life-long.

Treatment options are available. Treatment does not provide a cure but controls the virus from preventing further liver damage. Speak to your health care provider (HCP) for more information about possible treatment options.

If you suspect you have come into contact with someone with HBV, please speak to your HCP. Blood tests can be ordered to confirm if you have been infected or if you are already immune.

Get immunized! Immunization generally provides long-lasting protection against HBV for most people.

In addition to immunization, HBV can also be prevented by:

• Practicing safe sex
• Screening pregnant women and administering HBIg and the first dose of HBV vaccine at birth to newborn babies. Second dose should be given to the newborn at one month of age and the third dose should be given at six months of age. Premature babies or babies born weighing less than 2000 grams at birth should also receive a fourth dose of HBV vaccine. This provides the newborn a 95% chance of not being infected with hepatitis B.

• If you are getting a piercing, tattoo, or having acupuncture, ensure that the service is regulated or inspected, uses single-use needles, and that other equipment is sterilized
• Wear protective gloves if you are likely to come in contact with blood
• Do not share razors, toothbrushes, or other personal care items such as nail clippers
• Let anyone who may come into contact with your blood and bodily fluids know that you have HBV
• Mothers who have HBV and are breastfeeding should take good care of their nipples to prevent cracking and bleeding; however, breastfeeding is safe if the baby has received HBIg and first dose of hepatitis B vaccine within the first 12 hours of life.

Contact the Canadian Liver Foundation (external link) for support and information by visiting www.liver.ca or calling toll free 1-800-563-5483. You can also call Halton Region Public Health by dialing 311 for more information.

Hepatitis B. BC Centre for Disease Control. (n.d.). Retrieved September 28, 2021, from http://www.bccdc.ca/health-info/diseases-conditions/hepatitis-b (external link)

Hepatitis B. Canadian Liver Foundation. (n.d.). Retrieved September 28, 2021, from https://www.liver.ca/patients-caregivers/liver-diseases/hepatitis-b/ (external link)

Public Health Agency of Canada. (2021, July 27). Hepatitis B. Canada.ca. Retrieved September 28, 2021, from https://www.canada.ca/en/public-health/services/diseases/hepatitis-b.html (external link)

The hepatitis C virus (HCV) is one of several viruses that can cause hepatitis, a disease that attacks your liver. Of those infected with hepatitis C, only about 20 percent will clear the virus from their body. Most people infected with hepatitis C become chronic carriers. Chronic carriers have the virus in their blood for the rest of their life and can spread it to others.

You can get hepatitis C from any exposure to blood from a person infected with the virus. The virus enters the body through a break in the skin or through mucous membranes such as the mouth or nose

Symptoms can start to appear anytime from two weeks up to six months after exposure. Usually, symptoms begin to appear six to nine weeks after exposure. Often people have no symptoms.

Symptoms can include:

• fatigue
• jaundice (yellowing of the eyes and skin)
• dark urine
• lack of appetite
• itchy skin
• nausea, vomiting
• abdominal pain
• joint and muscle aches

Most carriers are symptom free for years. However, some people will get sick because of ongoing damage to their liver. Chronic hepatitis C can lead to liver cirrhosis (scarring of liver) and cancer.

Activities that put you at risk are:

• Sharing needles or drug using equipment
• Piercing, tattooing, or acupuncture with unsterilized equipment
• Receiving blood transfusions or blood product before 1992
• Hemodialysis
• Sexual activity with an infected partner when there is blood to blood contact
• Being born to an infected mother (about 5 percent risk)
• Sharing personal care items (e.g., razors, toothbrush)
• Needle-stick injuries

Most people who get hepatitis C have mild disease. After 20 years, approximately 20 percent of people will develop liver cirrhosis (scarring of liver).

Consult with your Health Care Provider (HCP) if you suspect that you may have hepatitis C. They can order blood tests to see if you have the virus in your blood. You should discuss testing with your HCP if you have any risk factors or think you may have been exposed.

Yes. Please discuss possible treatment options with your HCP. Treatment costs may not be covered by OHIP.

There is no vaccine for hepatitis C. To protect yourself you need to avoid behaviours that put you at risk of coming in contact with the blood of someone infected with hepatitis C.

• Do not share needles or any drug-using equipment (including straws for snorting). If you use injection drugs, check with your local health department for a needle exchange program. For Halton Region call 905-330- 3305, or for North Halton call 905-702-4200.
• If you are getting a piercing, tattooing, or having acupuncture, ensure that the service is regulated or inspected, uses single-use needles, and that other equipment is sterilized
• Wear protective gloves if you are likely to come in contact with blood
• Practice safer sex by using a condom every time
• Do not share razors, toothbrushes, or other personal care items such as nail clippers

• Discuss the possibility of treatment with your HCP
• Talk with your doctor about hepatitis A, hepatitis B, and pneumococcal polysaccharide vaccine for free
• Avoid alcohol
• Live and maintain a healthy lifestyle
• It is safe to touch, hug, and kiss your family and friends!
• Clean up any blood spills at home right away
• Keep cuts and scrapes covered with bandages or gauze
• Avoid activities that put others at risk of coming in contact with your blood, such as needle sharing
• Inform HCPs who may come in contact with your blood (e.g., dentist) about your hepatitis C status
• Do not donate blood, tissue, organs, or semen
• Beware of over-the-counter medications and herbal remedies. Consult with your HCP to discuss if these are safe for your liver.
• During birth, there is a small chance hepatitis C can be transmitted to the infant. Have the infant checked for Hepatitis C antibodies at 18 months of age
• If breastfeeding, stop temporarily if the nipples/areola are bleeding or cracked

Contact the Canadian Liver Foundation for support and information at liver.ca (external link) or toll free 1-800-563-5483.

hMPV is a respiratory virus that causes both upper and lower respiratory tract infections in people of all ages. hMPV infections usually occur in late winter and early spring, and most often affect young infants, elderly and individuals with weakened immune systems.

The virus is spread through droplets in the air when an infected person coughs or sneezes. You can also become infected through direct contact with discharges from the nose or throat of an infected person.

The normally expected symptoms include:

• Fever
• Runny nose or nasal congestion
• Cough
• Wheezing
• Sore throat or hoarseness
• Myalgia

The complications of hMPV are:

• Pneumonia
• Bronchiolitis
• Otitis media
• Diarrhea

Human metapneumovirus can cause serious complications (problems) in:

• Children less than 1 year of age and the elderly
• People who have underlying medical conditions such as:
  • problems with their immune system
  • lung conditions (chronic lung disease and severe asthma)
  • organ transplant recipients

Although it is not entirely known, most people will be come sick between 3- 5 days after contact with the virus.

Steps that will decrease the spread of hMPV:

• Stay home if you are sick. Don’t spread germs.
• Cover your mouth and nose with a tissue when coughing or sneezing. Dispose of tissues.
• If you don’t have a tissue, cough into your sleeve.
• Wash your hands frequently and wash them well.
• Use alcohol-based hand sanitizers if soap and water are not available.
• Germs are often carried on your hands. Avoid touching your eyes, nose or mouth.
• Clean hard surfaces that are handled regularly such as doorknobs, toys and telephones.

In order to diagnose hMPV your doctor needs to swab the back of your nasal passages through your nose. However, hMPV is not routinely tested for except in outbreak situations.

Treatment is supportive.

Measles is a highly contagious viral infection that can affect people of any age who are not immune to the virus.

For up-to-date media releases related to cases of measles in Halton Region, please visit Halton Region’s Newsroom.

Measles can easily spread to others if they come into  contact with droplets from an infected person or through the air when an infected person has breathed, coughed, or sneezed. The particles from an infected person can stay in the air and on surfaces for up to two hours after that person has left a room. Measles is not common in Canada due to high vaccination rates. However, measles can occur in unvaccinated or under vaccinated persons, especially if those people have travelled to countries where measles is more common.

Symptoms usually appear 10 days after contact with an infected individual, but can appear from 7 to 21 days. The rash usually appears 10-14 days after exposure.

Measles symptoms appear in two stages:

• During the first stage, symptoms can include a cough, runny nose, red and watery eyes that may be sensitive to light, and a slight fever.
• The second stage of symptoms begins after three to seven days. At this time, the fever increases, usually becoming very high. Small, white spots appear on the inside of the mouth (Koplik spots). A red blotchy rash then develops, first on the face and then moving down the body, arms, and legs. These symptoms last approximately five days with the rash clearing on the face first, followed by rest of the body.

Most people with measles are sick for up to 10 days and then recover completely. Symptoms can be more severe for infants and adults.

People infected with measles can spread it to others four days before to four days after the rash appears.

Some people are at higher risk of developing severe complications from measles, including:

• People who are pregnant
• People with weakened immune systems
• Children who are less than 5 years of age

Infants under the age of 12 months are most at risk since routine vaccination for measles is not given until children are 12 months of age or older.

Anyone born in 1970 or later who is not vaccinated and who has never had measles disease can become infected.

People born before 1970 generally are considered protected from measles because measles was widely circulating in Canada at that time. However, some of these individuals can be at risk. Those who are unsure can review their vaccine and medical history with their health care provider (HCP).

Health care workers, military personnel, post-secondary students and travellers to areas where measles is circulating are at risk of exposure to people infected with measles.

Measles can lead to ear infections, lung infections (pneumonia), middle ear infections, seizures, swelling of the brain (encephalitis), or even death. In rare cases, a fatal brain disease called subacute sclerosing panencephalitis (SSPE) can be triggered years after being infected with measles.

While measles does not cause birth defects, pregnant women with measles can have premature delivery and miscarriages.

Call your health care provider before visiting his/her office. Notify him/her about your symptoms. You may be asked to visit the office when there are no other patients waiting and to wear a mask to prevent others from getting sick.

Measles can be diagnosed by assessing your symptoms along with laboratory tests that may include collecting a swab from inside your nose or throat, a urine specimen, and a blood sample. For more information, talk to your health care provider.

No. Once someone has had measles, they are generally protected for life.

There is no specific treatment for measles. Supportive care in hospital may be needed for severe infections, but most people can recover at home. If you think you have measles, it is important to speak to a doctor before visiting the doctor’s office, so that the infection is not passed to others.

Get vaccinated! If you were born in 1970 or later, getting vaccinated is the best way of preventing infection. People born before 1970 are generally considered protected from measles, but should follow up with their health care provider to assess their immunity to measles.

Anyone who has had contact with measles should watch for signs and symptoms and contact their doctor if symptoms develop.

In Ontario, all children routinely receive two measles - containing vaccinations. For full protection against measles, two doses of vaccine are required. The first is given at 12 months of age (MMR). The second is given before school entry between four and six years of age with the chickenpox vaccine (MMRV). Adults born after January 1, 1970 should have two doses of measles containing vaccine.

Regardless of age, health care workers, students in post-secondary school, military personnel, and travellers should ensure they are immune either by receiving two doses of measles -containing vaccine or through a laboratory blood test to show they are immune. In order to be effective, the second MMR vaccine should be given at least four weeks after the first dose.

If travelling to areas where measles is circulating, infants 6 to 12 months of age can receive one dose of MMR vaccine. Two additional doses would still be required after the first birthday.

MSSA or Methicillin sensitive staphylococcus aureus is the common type of Staphylococcus aureus that is often found on the skin and in the nose of healthy people. Infections caused by staphylococcus aureus are usually treated with penicillin type of antibiotics.

MRSA or Methicillin resistant staphylococcus aureus are strains of staphylococcus aureus bacteria that became difficult to treat with commonly used antibiotics (penicillin, methicillin, oxacilin, cloxacilin and other antibiotics). These resistant strains have been more often associated with health care settings, affecting people with chronic illnesses or those with weakened immune system.

MRSA infections still respond to certain antibiotics as prescribed by your health care provider.

• MRSA was first reported a decade ago and caused infections that were related to the healthcare settings (HA-MRSA).
• Some MRSA strains developed the ability to cause infections in otherwise healthy people and to spread throughout the community settings (CA-MRSA).
• Health care professionals can differentiate between the hospital associated and the community associated strains.
• Many characteristics of MRSA are overlapping and some characteristics are common to all staphylococcus bacteria.

• Symptoms are related to the type of infection and the body site affected by the MRSA infection – from abscesses (boils) or open wounds to more serious infections affecting the lungs, bones, urinary tract, or the blood stream.
• CA-MRSA infections are often seen as skin and soft tissue infections, such as folliculitis and abscesses often thought to be “spider bites” that occur in otherwise healthy people.
• Bacteria can enter through skin cuts or scrapes into the blood stream and cause more serious illness.
• Serious MRSA pneumonia may develop as a complication during an influenza illness.
• You may have MRSA and not be affected; however you can still spread it to others who might become ill.

• Like other strains of staphylococcus aureus, MRSA is more often spread person to person by direct skin-to-skin contact with a person who already has MRSA.
• An injury in the skin may allow bacteria that live on the skin to enter inside the body and cause an infection.
• All strains of MRSA can also be transmitted indirectly, through unwashed hands or through sharing contaminated clothing, towels, linen, sport-equipment etc.
• Very rarely, a person with a respiratory infection with MRSA can spread it through the air.
• Pets may become infected with MRSA similar to humans, but they do not have a major role in MRSA infection transmission.

• Some individuals are at increased risk of acquiring MRSA infection in a health care setting because of their other medical condition (chronic skin conditions, obesity, diabetes, or weaker immune system).
• Persons with invasive medical devices, including tube feedings, are at increased risk for developing staphylococcal infections with health care associated MRSA.
• Other risk factors are associated with too often or inadequate use of antibiotics.

Risk factors for acquiring CA-MRSA are a little different from the risk factors for health care associated MRSA, although there are some overlaps.

Higher risk for getting CA-MRSA is related to practices that facilitate transmission of germs from one person to another such as:

• Close skin-to-skin contact with a person who has MRSA
• Crowded living conditions
• Poor hand hygiene
• Skipping showers before and after using public swimming pools or whirlpools
• Sharing personal items such as towels, linen, razors, or bar soap
• Improper wound care of skin cuts or open wounds that can allow harmful bacteria throughout the normal skin barrier
• Touching objects that are contaminated with MRSA such as used band aids.

• MRSA can survive on some surfaces for a long time from hours to days or months, depending on the contaminated surface condition.
• MRSA is not naturally occurring in the environment.
• If surfaces are soiled with organic material, they may allow MRSA to survive for a long period of time. Porous surfaces that can not be properly cleaned and disinfected will allow MRSA survival longer than a smooth easily cleanable surface.

• MRSA infections can be treated with antibiotics (other than penicillin type) that are still effective against MRSA.
• Treatment of skin and soft tissue infections include incision and drainage with or without antibiotics.

• On rare occasions a MRSA infection can result in life threatening illness or death from complications.
• Most cases are successfully treated. The effectiveness of treatment is greater if MRSA is detected early.

• In November 2008, Ontario reported an increase of MRSA cases over a three-year period. Some of these cases were ill with MRSA infections, and some were MRSA carriers – (they only carried the MRSA on their skin or in their nose, without showing symptoms).
• Health care professionals are working hard to fight all health care associated infections.
• Starting on December 31, 2008 hospitals are required to publicly report MRSA rates along with other patient safety indicators.

There is no effective vaccine against MRSA available at this time. It is important to practice good hygiene step by step:

1. Wash your hands
   • Use soap and water or use alcohol-based hand rub for at least 15 seconds.
   • Wash hands after touching any skin lesion, wound drainage either yours or others, or potentially contaminated environmental surface.
2. When do I need to wash my hands?
   • After using the washroom
   • After coughing or sneezing
   • Before and after preparing food
   • Before eating and drinking
   • Before and after caring for your wound
   • Whenever your hands become soiled or contaminated.
3. Treat and cover open wounds
   • Any cut, abrasion, or skin lesion may be a point of entry for bacteria, including MRSA.
   • Cleanse wounds, treat with an anti-infective solution or ointment, and cover with a band aid. Keep them clean and covered until they have healed.
4. Seek health care advice
   • Consult your health care provider for any redness or swollen active wound, and for suspicion of a skin infection. Early diagnosis helps you to receive effective treatment.
5. Shower after each sport activity
   • Shower with soap and water after sport events and close contact with athletic team to avoid the spread of CA-MRSA.
6. Never share personal items
   • Towels, sport uniform, razors, clothing etc, should not be shared with others.
   • Exclude athletes from joining your team where there is open wound or drainage that can not be contained with a water proof band aid.
7. Thoroughly clean gear and equipment
   • Commonly used surfaces – sport mats, shared equipment, benches must be washed before and after use.
   • Non-washable items such as head gear must be wiped after each use with a disinfectant.

• Seek medical advice and appropriate treatment for your infection.
• Keep your wounds clean and covered until they have healed completely.
• Discard your used band aid and used skin care materials properly, so no other person can accidentally touch them.
• If your doctor prescribed antibiotics, take it until you have finished the entire prescribed dose. Never share antibiotics with another person.
• Wash your hands frequently. Use alcohol based hand rub to disinfect your hands if hands are not visibly soiled.
• Do not share personal items such as used towels, razors, and clothing, bar soap, cosmetics, and lotions.
• If you have wounds that can not be covered with a waterproof band aid, or if the wound drainage can not be contained, do not go to swimming pools, public fitness clubs, saunas, and do not participate in team sports.

• For casual household contact and if you have good hygiene practices, to protect others, your family is not at great risk of getting MRSA.
• Maintain a clean environment, and focus cleaning on frequently touched surfaces.
• Disinfect surfaces after cleaning with a product that destroys microorganisms. (E.g. use one tablespoon of household bleach in a quart of water solution to disinfect washroom surfaces).
• Wash your dishes and do laundry just like the rest of your household members. You may want to use hot air cycle for drying.
• No special cleaning of furniture is needed.
• Use barriers between your skin and shared equipment – such as sitting on a clean towel if you are using a common benches or the same toilet seat.
• The best prevention that can stop the spread of infection is hand washing.
• A member of your family who helps with your personal care, similar to your health care provider, needs to perform good hand hygiene and follow precautions, such as wearing clean and disposable gloves and a long sleeved gown, especially if they can touch your open wound.

Mumps is a contagious disease that is caused by a virus. It can infect people of any age, however it is more common in school-aged children and young adults.

It primarily affects the salivary glands that produce saliva/spit and are located on either side of the cheeks, near the ear and mouth.

Mumps is spread easily through the air when someone who is infected coughs or sneezes. You can catch it by:

• Breathing the air where an infected person has coughed or sneezed
• Kissing an infected person
• Touching an infected surface and then touching your nose or mouth
• Sharing items such as food, drinks, cigarettes, and drinking bottles with a person who has mumps

A person with mumps can spread the infection from seven days before their salivary glands begin to swell until five days after the swelling begins.

The most common symptom of mumps is swelling and pain in the salivary glands which can make the cheek or neck appear puffy on one or both sides. Other signs and symptoms may include:

• Fever
• Headache or earache
• Pain while talking, chewing or swallowing
• Sore muscles
• Dry mouth
• Tiredness
• Loss of appetite

Some people who get mumps have very mild symptoms (like a cold), or no symptoms at all and may not know they have the disease. However, they can still spread the disease to other people.

Symptoms can appear from 12 to 25 days after being in contact with someone who is infected with mumps.

Most people born in Canada before 1970 are likely to be protected from mumps as they are considered to have natural immunity.

However, individual cases and outbreaks still happen in Canada. Some people born before 1970 are at increased risk of being exposed to mumps and should receive two doses of the vaccine regardless of their year of birth including:

• Health care workers,
• Any travelers who go to destinations outside of Canada,
• Military personnel
• Students’ attending secondary or post-secondary school

Others at risk include anyone born in Canada in 1970 or later who:

• Have not received two doses of mumps-containing vaccine, and
• Have never had mumps disease

Infants under the age of 12 months are most at risk because the vaccination is not given until children are 12 months of age or older. Immunization of older children and adults helps protect infants.

Most people who get mumps are sick for up to 10 days and then recover completely. Symptoms are more severe for infants and adults.

Complications of mumps include:

• Lung infection (pneumonia)
• Swelling/inflammation of the brain (encephalitis)
• Swelling/inflammation of the membrane around the brain and spinal cord (meningitis)
• Seizures and convulsions
• Middle ear infections
• Hearing loss (usually temporary)
• Inflammation of the pancreas (pancreatitis)
• Painful swelling of the testicles in teenage boys and men, which may cause sterility
• Painful swelling of the ovaries in women and girls, which may cause sterility

Mumps can cause serious complications in:

• Infants under one year of age
• Pregnant women during their first three months of pregnancy as it can increase their chance of miscarriage
• People who have problems with their immune system as they may have difficulty fighting off the infection

It is recommended that you monitor for signs and symptoms of mumps for 25 days from your last contact with the person that tested positive.

If you develop any symptoms during this timeframe, wear a mask when around others and call your health care provider’s office to tell them about your symptoms and that you may have been exposed to mumps. Do not go to a walk-in clinic, family doctor or hospital without calling ahead and notifying them that you have been exposed to mumps and are showing symptoms. The office needs to arrange appropriate measures for the time of your appointment so that the infection is not passed to others.

Someone who has mumps should stay home from daycare, pre-school, school, or work for five days after the neck or cheek swelling develops.

It is important to avoid kissing or sharing food, drinks, cigarettes, drinking bottles, or musical instruments where others may come into contact with your saliva. When coughing and sneezing, cover your mouth and nose with a tissue, or use your sleeve. Always wash your hands after coughing or sneezing.

Mumps can be diagnosed by a health care provider based on the common signs and symptoms. However, laboratory tests may include:

• A swab of the inside of your cheek
• A urine sample
• Blood samples

No. People who have had mumps are generally protected for life.

There is no specific treatment for mumps. Most people can recover at home. Medications can be taken to relieve some symptoms. Please speak with your health care provider.

If you come into contact with someone who has mumps, call your doctor and tell them that you may have been exposed to mumps disease.

If you have never received the mumps vaccine you may be excluded from school, daycare, work or group activities.

Getting the mumps vaccine after contact with an infected person will not prevent infection from the current exposure. However, if you don’t become infected, mumps vaccine is recommended after contact to provide protection against future exposures.

Most people born before 1970 in Canada are generally considered protected from mumps. However, health care workers, travelers to destinations outside of Canada, military personnel, and students attending secondary or post-secondary school born before 1970 should receive two doses of the vaccine regardless of their year of birth.

Everyone else should have at least one dose of the mumps vaccine, given after his or her first birthday. Two doses of vaccine are required for full protection. Children should have both doses of mumps vaccine by four to six years of age.

For more information on mumps or immunization against mumps talk to your health care provider or call Halton Region Public Health by dialing 311 to speak with a nurse.

Pertussis, also known as whooping cough or the “100-Day-Cough,” is a respiratory infection caused by a bacterium called Bordetella pertussis. It can spread very easily and infect people of any age.

The bacteria that cause pertussis are spread through droplets in the air when an infected person coughs or sneezes. You can also become infected through direct contact with secretions from the nose or throat of an infected person.

Pertussis symptoms appear in three stages. In the first two stages, the person is highly infectious.

In the first stage, which lasts for one to two weeks, the symptoms are similar to those of the common cold:

• runny nose or nasal congestion
• red and watery eyes
• gradually worsening irritating cough
• sneezing
• low grade fever

The second stage lasts one to six weeks or longer. The symptoms include:

• series of coughs with no breath in between (the ill person may even stop breathing temporarily)
• coughing fits end in a high-pitched whoop as the ill person takes a breath in
• coughing spells which often end in vomiting
• exhaustion from coughing so much
• shortness of breath

In adults, the symptoms of whooping cough may resemble those of bronchitis. Infants under six months of age, vaccinated children, and adults may not whoop loudly, or even at all.

The final stage may last for one to two months. The person is not considered infectious at this stage. During this time, the coughing episodes gradually occur less often, and become less severe.

Symptoms can appear from six to 20 days after contact with an infected individual with symptoms. The average person becomes ill within nine to ten days.

Without antibiotics, the person is infectious for three weeks from the start of symptoms. A person is no longer infectious after five days of effective antibiotic therapy.

Pertussis can cause serious complications in:

• infants under one year of age
• pregnant women in their late third trimester, as they may pass the infection on to their newborns
• people who have problems with their immune system
• people who have underlying medical conditions (i.e. chronic lung disease, severe asthma, respiratory insufficiency, cystic fibrosis, congenital heart disease)

Pertussis infection is worse in infants and young children. Infants are at the highest risk for the most serious complications. People infected with pertussis can develop pneumonia. It can also cause seizures, convulsions, brain damage, and death.

People with immune system problems may have difficulty fighting the infection. People with underlying medical conditions are especially prone to complications including weight loss due to vomiting, pneumonia, severe breathing problems, collapsed lung, rib fractures, and an increase in angina pain.

If you think you have pertussis, call your doctor’s office. Tell them about your symptoms and that you may have been exposed to pertussis disease. The office needs to arrange appropriate infection control measures for the time of your appointment so that the infection is not given to others.

Your doctor may swab the back of your nasal passages through your nose for testing.

Someone who has pertussis should stay home from daycare, preschool, school, or work until he or she has taken five full days of antibiotics prescribed by the doctor. Without antibiotics, persons infected with pertussis should stay home from daycare, preschool, school or work for 21 days from the onset of symptoms.

Yes. Infection with pertussis disease does not give lifelong immunity.

Pertussis can be treated with antibiotics. Take the antibiotic as your doctor prescribes making sure to finish all of the medicine. If side effects from the medication are giving you problems, contact your doctor right away.

The antibiotics will eliminate the bacteria, but will not lesson symptoms. Even after treatment to kill the bacteria, a person may continue to cough as the body repairs the damage to the lining of the breathing passages. The cough may be worse at night.

Consult with your physician. There are antibiotics that may be recommended to prevent infection if someone is considered at high risk for complications, unimmunized, or those that are likely to come into contact with high risk groups.

Monitor your health for symptoms of pertussis for the next three to four weeks. If symptoms develop, contact your family doctor. Explain that you have been exposed to pertussis and are now ill. If you are not fully immunized against pertussis, call your family doctor and arrange to have your immunizations updated.

Get vaccinated! Infants, teenagers and adults should be vaccinated against whooping cough.

For full protection against pertussis, infants and toddlers need four doses of pertussis vaccine starting at two months of age followed by a booster dose between 4-6 years of age, as well as 14-16 years of age.

Adults may not have received any protection from pertussis since they entered kindergarten. A single dose of ADACEL® or BOOSTRIX® is recommended once , as either an adolescent or adult booster, after a primary childhood series, to increase their immunity that has decreased over time.

This vaccine is publicly funded for infants, children, teenagers, and adults up to age 64.

Immunity from the vaccine gradually decreases over time. Protection against severe pertussis illness begins to lessen after about five years. A booster dose of the vaccine should be received every 10 years.

Pneumococcal disease is caused by bacteria called pneumococcus or streptococcus pneumoniae. It is the most common cause of bacterial infections in children and adults. Many people have pneumococcal bacteria in their mouth, nose, and throat without becoming ill.

However, the bacteria can enter the blood, lungs, or lining of the brain causing invasive pneumococcal disease. Pneumococcal bacteria can also cause milder forms of pneumonia, sinus infections, and middle ear infections (otitis media), particularly in children.

These bacteria can be spread from the nose and throat of one person to another by close, direct contact like kissing, coughing, or sneezing. Infections can also be spread through saliva when people share things (i.e. food, utensils, drinking bottles, etc.).

Symptoms can start in as short as one to three days after contact with an infected person and can vary depending on where the bacteria enter the body.

If the bacterium enters the lungs, it can cause pneumococcal pneumonia. Common symptoms include sudden onset of high fever, chills, chest pain, difficulty breathing, increased heart rate, and a cough. In infants and young children, symptoms may include fever, vomiting, and seizures.

If the bacterium enters the bloodstream, it can cause bacteremia. Common symptoms include high fever, muscle aches/pain, fatigue, and sleepiness.

If the bacterium enters the lining of the brain and spinal cord, it can cause meningitis. Common symptoms include headache, high fever, stiff neck, vomiting, confusion, and sensitivity to light. In small children, symptoms may include fever, irritability, poor appetite, and sleepiness.

The pneumococcal bacteria can be spread until the nose and mouth discharges of the infected person no longer have the bacteria or up until 24 hours of appropriate antibiotic treatment.

Anyone can get invasive pneumococcal disease, but some groups are at higher risk. Infants, people 65 years of age and older, and those with chronic health condition such as:

• chronic heart, kidney, or lung disease (except asthma)
• no spleen or have a spleen that does not work properly
• sickle cell disease
• HIV infection
• diseases that weaken the immune system had an organ transplant
• taking medications that suppress the immune system
• cochlear implants (pre/post implant)
• liver cirrhosis
• diabetes
• chronic cerebrospinal fluid leak

Seek medical attention from your health care provider (HCP). Good hand washing is also important to prevent the spread of the bacteria to others. It is also important to practice cough etiquette by covering your mouth and nose with a tissue or your sleeve while you cough or sneeze. Avoid sharing items that have come in contact with saliva.

Yes. Infection with one serogroup (strain) of the pneumococcal bacteria does not given protection against other strains of the bacteria.

People with pneumococcal disease can be treated with antibiotics.

The best way to prevent pneumococcal disease is through vaccination. In Ontario, pneumococcal vaccination is part of the publicly funded schedule for children, the elderly, and certain high risk groups.

Polio, short for poliomyelitis, is a viral infection caused by poliovirus. It is most common in children under the age of 5, but anyone who is not immune or fully immunized can get polio.

Polio mostly spreads from person to person through the fecal-oral route. It is spread when people drink water or eat food with feces that has poliovirus in it.

Most people infected with polio disease do not have any symptoms. It commonly takes 7 to 14 days for symptoms to appear after contact with the virus. However, there have been reports that symptoms can appear as early as 3 days to as late as 35 days after contact with the virus. Those who get symptoms may experience:

• Fever
• Nausea
• Aching Muscles
• Tiredness
• Loss Appetite
• Stiff Neck or Back

In rare cases, polio disease can damage a person’s nervous system (the spinal cord). It can cause nerve damage and paralyze the muscles used for breathing, talking, eating and walking.

Someone with polio can spread the disease to others in the days before and after onset of symptoms for as long as:

• 1 to 2 weeks from the throat, and
• 3 to 6 weeks through stool

As long as polio infections continue to occur, there is a risk of getting polio.

Those at risk include:

• Anyone who is not immune to polio disease
• Under-immunized or unimmunized persons
• Travelling or receiving travelers from, areas where poliovirus is known or may be spreading

If you have symptoms of polio disease, you should see your health care provider immediately. Describe your symptoms over the phone before your appointment, so the health care provider can arrange to see you so that the germs are not passed to others.

In order to prevent the spread of the virus to others it is important to:

• Wash your hand often, especially after using the washroom
• Wear a mask and cover your mouth and nose with a tissue if you cough or sneeze and throw your used tissues away immediately
• Avoid sharing items that have come into contact with saliva including as food, drinks, cigarettes, drinking bottles, toothbrushes, mouth guards and musical instruments with a mouth piece.
• Have a family member prepare meals or order in meals to your home
• Avoid contact with others as much as possible

Yes, because there are three known types of poliovirus (Type 1, 2, or 3). If you are infected with one type of poliovirus, it does not protect you against the other two types.

There is no cure for polio. Symptoms of polio are treated (for example, with rest and fluids). A person with complications from polio may also receive physiotherapy to help with mobility, occupational therapy to help with activities of daily lives, or follow-up from a medical specialist for the nervous system (neurologist).

The best way to prevent polio disease is through vaccination. The vaccine is 95 to 100% effective when all doses have been given. It protects against three types of poliovirus.

In Ontario, polio vaccination is part of the publicly funded (free) schedule. Please talk to a health care provider about options available to you and your family.

For more information on polio disease or vaccines against polio disease talk to your health care provider or call the Halton Region Public Health by dialing 311 to speak to a nurse.

RSV is a virus that infects the lungs and breathing passages. While it frequently occurs in infants and young children, it is also a significant cause of respiratory illness in older adults. Most people have been infected with this virus within the first few years of life. Immunity however is not complete and reinfection is common.

The infection usually occurs in late fall and early spring.

• Given the decreased rate of RSV cases in Ontario since December 2023, the Ministry of Health is not offering the publicly-funded RSV vaccine during the spring and summer seasons.
• Recommendations, including eligibility, for the 2024-2025 season will be made closer to fall 2024.
• Adults 60 years of age and older who are not eligible for a publicly-funded dose during the upcoming 2024-2025 RSV season, may choose to purchase this vaccine through a pharmacy with a prescription from their family doctor or other primary care provider. Check with your pharmacy and primary care provider before you go to understand the clinic policies and related costs.

Currently, there are two RSV vaccines authorized for use in Canada: 

• Arexvy: Authorized for people 60 years of age and older to prevent RSV disease. NACI recommendations are expected later in 2024.
• Abrysvo: Authorized for people 60 years of age and older to prevent RSV disease and pregnant individuals from 32 through 36 weeks gestational age to prevent RSV in babies from birth through six months of age. NACI recommends that Abrysvo may be considered as an individual decision together with information from their pregnancy care provider, in advance of, or during, the RSV season, to prevent severe RSV disease in their infant. At this time, there is no publicly-funded program for pregnant people in Ontario.

Through the Fall 2023 high-risk older adult vaccine program, the Ministry of Health covered the full cost of the RSV vaccine (Arexvy) for adults aged 60 years and older who are:

• living in long-term care homes
• living in elder care lodges
• residents of retirement homes licensed to provide dementia care services
• patients in hospitals receiving alternate level of care (ALC)
• patients receiving hemodialysis or peritoneal dialysis
• recipients of solid organ or hematopoietic stem cell transplants
• individuals experiencing homelessness
• individuals who identify as First Nations, Inuit or Métis

Monoclonal Antibodies

Monoclonal antibodies are laboratory-made proteins that mimic the antibodies that our bodies naturally produce.

Palivizumab

• Infants under 24 months at high risk of severe disease from RSV may be eligible for the drug palivizumab (Synagis).
• NACI’s current recommendations for palivizumab (external link) are for a very specific population and typically the infant's care team would raise the issue of RSV vaccine with the parent/guardian. Learn more about the program in Ontario (external link).

Nirsevimab (Beyfortus)

• Authorized for newborns and infants during their first RSV season and children up to 24 months of age who remain at risk to severe RSV disease in their second RSV season.
• NACI recommends building towards a universal RSV immunization program using nirsevimab for all infant protection. NACI also recommends RSV immunization programs use nirsevimab to prevent severe RSV disease for the following two priority groups:
  1. Infants born before or during their first RSV season or entering their second RSV season who are at increased risk of severe RSV disease, or those whose access to treatment may be difficult.
  2. All infants under 8 months of age entering their first RSV season.
• At this time, there is no publicly-funded program for nirsevimab in Ontario. 

As a precaution, it is recommended that the RSV vaccine be administered at least 14 days before or after the administration of COVID-19 or influenza vaccines.

If your health care provider recommends it, you may consider getting the RSV vaccine (Arexvy):

• at the same time as the COVID-19 or influenza vaccine; or
• within 2 weeks of getting the COVID-19 or influenza vaccine.

Here are some reasons to consider getting the Arexvy vaccine at the same time or within 2 weeks of getting the COVID-19 vaccine or influenza vaccine:

• There is an outbreak of RSV, COVID-19 or influenza within your facility or other facilities in the same area.
• There are high or increasing rates of COVID-19, influenza and/or RSV in your community.
• There is a risk that you may not be able to receive the other recommended vaccine doses.

For more information about RSV, visit ontario.ca/RSV (external link) or call Halton Region Public Health by dialing 311, if you have any further questions.

According to the Health Protection and Promotion Act, R.S.O. 1990, c. H.7, physicians, healthcare providers, hospital administrators and superintendents of institutions, school principals, pharmacists and operators of a laboratory are required to report all positive TSTs, suspect and active tuberculosis (TB) cases to the Halton Region Health Department. This includes persons who have an abnormal chest x- ray and/or symptoms of TB.

Please note that a referral to a specialist or pending results, ie sputum results should not delay the reporting of a positive TST.

• The Reportable Disease and Outbreak Reporting Line at 905-825-6000, ext. 7341 or via fax at 905-825-8797
• The Tuberculosis Physician Reporting form can be obtained by calling 311

• Management of cases and suspect cases of tuberculosis in partnership with healthcare providers
• Monitoring compliance with anti-tuberculosis medication regimes, including direct observation of medications being taken by people with active tuberculosis
• Tracing of contacts from active cases of tuberculosis
• Provision of free anti-tuberculosis medication for LTBI and TB cases
• Case management for Immigration Medical Surveillance
• Providing consultation and information by calling 311
• Providing education to the public and other healthcare providers