17
2013 Health Watch Issue # 81 October, 2013 Contents Summary ........................................ 1 Our Region ..................................... 2 Pregnancy Support ..................... 3 Communicable Diseases........... 4 Emergency Room Visits ............. 9 Boil Water Advisories.................. 10 Drinking Water Quality .............. 12 Food Service Closures................ 14 Air Quality ..................................... 15 Acknowledgements ................... 17 This month’s health promotion message: Healthy Mothers = Healthy Babies Summary Rates of enteric and respiratory illness are increasing at expected levels throughout Vancouver Coastal Health. Heroin overdoses during this period surpassed the historical ER visit average. Public Health at Vancouver Coastal Health is enhancing public health services for women during pregnancy. All data herein should only be used with reference to the “2013 Health Watch prepared by Vancouver Coastal Health, Public Health Surveillance Unit”.

2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

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Page 1: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

2013 Health Watch Issue # 81 October, 2013

Contents

Summary ........................................1

Our Region .....................................2

Pregnancy Support .....................3

Communicable Diseases...........4

Emergency Room Visits .............9

Boil Water Advisories ..................10

Drinking Water Quality ..............12

Food Service Closures ................14

Air Quality .....................................15

Acknowledgements ...................17

This month’s health promotion message:

Healthy Mothers = Healthy Babies

Summary Rates of enteric and respiratory illness are increasing at expected levels throughout Vancouver Coastal Health. Heroin overdoses during this period surpassed the historical ER visit average.

Public Health at Vancouver Coastal Health is enhancing public health services for women during pregnancy.

All data herein should only be used with reference to the “2013 Health Watch prepared by Vancouver Coastal Health, Public Health Surveillance Unit”.

Page 2: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

2013 Health Watch October, 2013 2

Our Region

The Vancouver Coastal Health Authority (VCH) is one of five geographically distinct health authorities in British Columbia (BC). The VCH region covers a large geographic area and includes both urban and rural communities. It is comprised of three health service delivery areas (HSDA): North Shore/Coast Garibaldi (i.e. Coastal Urban and Coastal Rural), Richmond, and Vancouver.

The Vancouver HSDA is further divided into six local health areas (LHA), and the North Shore/Coast Garibaldi HSDA further divided into seven (two LHAs in Coastal Urban and five in Coastal Rural). The estimated VCH population is 1.1 million, approximately 25% of BC’s population.

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October, 2013 3

“Some pregnant women don’t have the knowledge or experience of interacting with the health care system”, said Joanne Wooldridge, regional leader, early child development, who led the implementation of the new service. “By making the call to the Prenatal Line, expectant moms will be linked to the health services they need for a healthy pregnancy and a healthy baby.”

Healthy Mothers = Healthy Babies

2013 Health Watch

For a full list of services offered by VCH to support at risk women please visit www.vch.ca/pregnancy.

The service aims to engage pregnant women who have one of the following risk factors to offer them public health nursing services: o Young mother – 24-years or under o Low income (financial stress, inadequate housing, food security) o Mental heath issues o Lack of support/isolation o Substance use (tobacco, alcohol, other substances) o Pre-existing conditions that may impact their ability to parent

Women without a risk factor are encouraged to obtain a copy of Babies Best Chance and Pregnancy Passport from their maternity care provider or local health unit.

Vancouver Coastal Health is enhancing public health services to support healthy pregnancies for vulnerable women, giving new moms and babies their best chance at living healthy lives.

Public health nurses in VCH will be on call at 1.855.550.2229 as part of a service to provide information on maternal and infant nutrition, emotional health, healthy lifestyle promotion, safety, immunizations, and baby care. These nurses may also refer new mothers and pregnant women to prenatal classes and other community programs to better meet their wellness needs.

Image Source: http://www.gettyimages.ca/

Page 4: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

October, 2013 4

Routine Notifications

E. coli O157:H7: Gort’s Gouda Cheese Farm

On September 17, 2013 BC Centre for Disease Control issued a public advisory to avoid consuming select cheeses from Gort’s Gouda Cheese Farm in Salmon Arm, BC due to E. coli O157:H7 contamination.

In total, there have been 26 cases and one death reported in Canada that were linked to the Gort’s Cheese outbreak including 12 cases from British Columbia, 10 cases from Alberta, 2 cases from Saskatchewan, and one case each in Manitoba and Quebec. The cases ranged in age from 3 years to 82 years old and were 38% male.

A recall was put in place by the Canadian Food Inspection Agency for 14 cheeses sold from May 27 to September 14, 2013.

The cheese company has been permitted to resume operations as of October 21, 2013 following inspection by environmental health officers.

For further information regarding the Gort’s Gouda Cheese Farm Outbreak including the complete list of cheeses recalled please visit:

• http://www.inspection.gc.ca/about-the-cfia/newsroom/food-recalls-and-allergy-alerts/complete-listing/2013-09-17eng/1379466612985/1379466625512 • http://www.phac-aspc.gc.ca/fs-sa/phn-asp/2013/ecoli-0913-eng.php

Background

While most types of E. coli are harmless some strains including E. coli O157:H7 can cause illness.

E.coli O157:H7 is a food borne infection that can cause severe stomach cramps, diarrhea (may develop into bloody), nausea and vomiting with potentially serious complications that can include kidney failure. Symptoms usually begin 3 to 4 days after contact with the E. coli and generally people get better in about a week.

Prevention of E. coli O157:H7 is similar to most food borne infections and includes proper hygiene and food handling and preparation techniques. Actions include cooking beef to at least 71°C, washing hands often with hot soapy water especially after contact with raw meat, keeping surfaces and utensils in contact with raw food clean, use only pasteurized milk and juice products, and drink only treated or chlorinated water.

For further information about infections caused by some strains of E. coli including E. coli O157:H7, please visit:http://www.healthlinkbc.ca/kb/content/mini/hw133795.html

Communicable Disease Summary

2013 Health Watch

Page 5: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

October, 2013 5

Gastrointestinal Illness

Outbreaks due to gastrointestinal illness in facilities across VCH exceeded the historical average during this reporting period (weeks 37-41) (Figure 1). There were eight facility outbreaks with five occurring in child day care (4 Vancouver, 1 North Shore), one long term care facility in Vancouver and two in acute care (both Vancouver). Norovirus was identified as the cause of the outbreak in two facilities (1 child day care, 1 long term care).

Communicable Disease Summary

2013 Health Watch

0

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12

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51

JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Num

ber o

f rep

orte

d ou

tbre

aks

Epidemiological week

Health care facilities Child day care facilities

Previous 5-week average Historical 5-week average

Figure 1. Enteric outbreaks reported in facilities* by epidemiological week. Vancouver Coastal Health Authority, 2013 compared to previous 5-week average and historical 5-week average†

*Facilites include acute care, long-term care, rehabilitation settings and child day care. Includes data since 2006.Source: Vancouver Coastal Health, Public Health Surveillance Unit (Enteric and ILI Outbreak Reports Database). Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

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October, 2013 6

Communicable Disease Summary

2013 Health Watch

Gastrointestinal Illness

Throughout BC, facility outbreaks are at expected levels except in week 38 (Sep 15-21) where the number of outbreaks was significantly higher than the 5 year historical period (Figure 2). Two of the 15 outbreaks investigated identified Norovirus as the cause of the outbreak.

Figure 2. Number of gastrointestinal illness outbreaks investigated by agent.British Columbia, 2012/13 compared to previous five years

Source: BCCDC Public Health and Microbiology Reference Laboratory, Provincial Health Services Authority, October 22, 2013.

Page 7: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

October, 2013 7

Communicable Disease Summary

2013 Health Watch

Respiratory Illness

No respiratory facility outbreaks were reported in VCH during this reporting period (weeks 37-41).

During this reporting period, an increase in acute respiratory illness (ARI) visits was seen in VCH emergency rooms. While an increasing trend in ARI ER visits is expected this time of year based on historical visit averages, visit volumes related to ARI surpassed the historical maximum number of ER visits in weeks 38 and 39.

In BC, the number of respiratory outbreaks investigated was within expected levels. Influenza A or B was not identified in any outbreak during this reporting period with the majority of outbreaks due to Entero/Rhinovirus (Figure 3).

Figure 3. Number of respiratory outbreaks investigated by agent.British Columbia, 2012/2013 compared to previous five years

Source: BCCDC Public Health and Microbiology Reference Laboratory (PHMRL), Provincial Health Services Authority, October, 2013.Note: The data available are from outbreaks in which the PHMRL has been notified. Some acute care microbiology laboratories are also testing for influenza in the province.

Page 8: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

Injury

The overdose surveillance system noted ER visits related to heroin overdoses surpassed the historical average during this reporting period in week 39 (Sep 22-28) with the highest number of overdoses observed this year to date. Heroinoverdoses at Insite were also above the historical average during this reporting period (Figure 4).

During this time period of higher than historical heroin overdoses, a public warning was issued by the Vancouver Police Department pertaining to bad heroin (September 16, 2013).

View the public warning issued by the Vancouver Police Department online at: http://mediareleases.vpd.ca/2013/09/16/police-warn-public-following-deadly-heroin-overdoses/

October, 2013 8

Communicable Disease Summary

2013 Health Watch

-40

-20

0

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40

0

10

20

30

40

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52JAN FEB MAR APR MAY JUN JUL AUG SEP OCT NOV DEC

Her

oin

over

dose

s at

ER

Her

oin

over

dose

s at

Insi

te

Epidemiological week

Insite visits Insite previous 3-week average Insite historical average (2004-2012)Week with cheque issued ER visits ER previous 3-week averageER historical average (2008-2012)

Figure 4. Number of ER and Vancouver Insite* visits related to heroin overdose† by epidemiological week.Vancouver Coastal Health Authority, 2013

*Supervised injection site. †Heroin misuse related visits are monitored through ICD-9 codes 304.0, 304.7, 305.5, 965.01, E850.0, E935.0, and ICD-10 codes F119B and T401 and a keyword search where the term "heroin" is indicated in presenting complaint, discharge diagnosis, nature of injury and mechanism of injury.Data sources: 1. Emergency room visits: Vancouver Coastal Health, CareCast System (Richmond Hospital, UBC Hospital, Vancouver General Hospital), Eclipsys System (Mount Saint Joseph Hospital, St. Paul's Hospital) and McKesson System (Lions Gate Hospital, Pemberton Health Centre, Squamish General Hospital, Whistler Health Care Centre). 2. Insite visits: Insite, Vancouver Coastal Health, HIV/AIDS & Harm Reduction Programs.Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

Page 9: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

Emergency room visit volume is monitored for nine of 13 acute care hospitals in the region. During weeks 37 to 41, visits to ERs were around expected levels for the majority of VCH hospitals.

ER visit volume exceeded the historical 95% confidence interval at the hospitals noted below in Table 1.

October, 2013 9

Emergency Room Visit Volume

2013 Health Watch

37 38 39 40 41

Hospital 08Sep-14Sep 15Sep-21Sep 22Sep-27Sep 29Sep-05Oct 06Oct-12Oct

Vancouver General Hospital x

UBC Hospital

Mount St. Joseph Hospital x x

St. Paul's Hospital x

Richmond Hospital x x

Lions Gate Hospital

Pemberton Health Centre

Squamish General Hospital

Whistler Health Care Centre

Table 1. Hospitals where the number of weekly ER visits exceed the historical 95% confidence limits*.

2013 epidemiological week

*Includes data since 2008. x = 2013 weekly visits exceed historical 95% limits.Source: Emergency Department Visits extracted from CareCast System (Richmond Hospital, UBC Hospital, Vancouver General Hospital), Eclipsys System (Mount Saint Joseph Hospital, St. Paul's Hospital) and McKesson System (Lions Gate Hospital, Pemberton Health Centre, Squamish General Hospital, Whistler Health Care Centre).Prepared by: Vancouver Coastal Health, Public Health Surveillance Unit.

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October, 2013 10

Environmental Health

New notices (September 8 to October 12, 2013)

Boil Water Notices

As of October 12th, 2013 there are 50 boil water notices in place for the VCH region (all in the Coastal area).

Date of BWN Location Reason for notice

October 6, 2013 Cedar Grove Estates, Pemberton UV system in need of repairs.

October 2, 2013 Emmonds Water System, Powell River Positive E. coli water sample.

October 4, 2013 Edgmont Marina Resort, Sunshine Coast Positive E. coli water sample.

Removed advisories (September 8 to October 12, 2013)Date of BWNremoval

Location Reason notice

October 10, 2013 Lillooet Lake Estates Water System, Sea to Sky Main water source experiencing significant seasonal flow reductions. Treatment system for back up surface water source not designed for elevated turbidity.

September 30, 2013 Shearwater Water System, Bellas Surface water with no disinfection.

2013 Health Watch

Page 11: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

October, 2013 11

Environmental Health

VCH Health Protection staff are responsible for conducting surveillance and monitoring of drinking water systems. Information on water quality is obtained from routine monitoring inspections and evaluations that are undertaken on all regulated drinking water systems.

Water suppliers are required to make water quality information available to the public. Water suppliers must provide notice when a drinking water supply system shows an increased risk to health during such conditions as: a temporary treatment failure, the presence of pathogens as demonstrated through water quality test results or when there is inadequate treatment infrastructure to address source water quality challenges such as a turbidity event.

A Boil Water Notice (BWN) is issued when there is a potential health risk associated with drinking water consumption (e.g. the potential for unacceptable levels of disease-causing bacteria, viruses or parasites in the water system). A BWN advises water users to boil their water before consuming it.

The treatment options for addressing BWNs are as follows:

• Boil water (full boil for at least 1 minute; at elevations over 2,000 meteres boil water for at least 2 minutes).• Add two drops of household bleach per 1 litre warm water (double dose for cold water), shake, and allow to stand

for 30 minutes before using.• Add chlorine or iodine tablets and follow manufacturer’s instructions.

For more information on boil water notices, visit the Vancouver Coastal Health website at: www.vch.ca/your_environment/water_quality/drinking_water/advisories/boil_water_advisories

For more information on disinfecting drinking water, visit the Vancouver Coastal Health website at: www.vch.ca/media/How%20to%20disinfect%20Drinking%20Water_HealthLinkBC.pdf

Source: Vancouver Coastal Health, Environmental Health.

Boil Water Notice

2013 Health Watch

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October, 2013 12

Environmental Health

Drinking Water

*Turbidity measures the degree to which water loses its transparency due to the presence of suspended particulates. Turbidity levels above 1 NTU (Nephelometric Turbidity Units) prompt increased disinfection levels as a safety precaution.

Watershed average daily turbidity* readings after primary treatment, Metro Vancouver, September 1 to 30, 2013

*Chlorine is used for primary and secondary disinfection of water. Maintaining a measurable level of chlorine residual throughout the distribution system helps ensure continuous water quality from source to tap.

Watershed average daily chlorine residual* readings after primary disinfection, Metro Vancouver, September 1 to 30, 2013

2013 Health Watch

0.0

0.5

1.0

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Capilano Seymour Coquitlam

Note: Capliano source is removed from service between October and April.Note: Capilano source is measured once per week on a grab sample and was not in service in September 2013.

0.0

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Ave

rage

dai

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hlor

ine

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dual

leve

l (m

g/L)

Capilano Seymour Coquitlam

Note: Capliano source is removed from service between October and April.Note: Capilano source is measured once per week on a grab sample and was not in service in September 2013.

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Environmental Health

Drinking Water

October, 2013 13

*pH measures the acidity or alkalinity level of the water. Maintaining pH between 6.5 and 8.5 ensures water taste and quality. Capilano watershed pH readings are measured once per week on a grab sample.

Notes: 1. Water from the Seymour system is filtered.2. People with compromised immune systems should always use drinking water that has been boiled or treated to the same level as boiling.

For more information on drinking water, visit: www.metrovancouver.org

Source: Metro Vancouver, Quality Control Division.

Watershed average daily pH level* readings, Metro Vancouver, September 1 to 30, 2013

2013 Health Watch

6.0

6.5

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8.0

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September

Ave

rage

dai

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H le

vel

Capilano Seymour Coquitlam

Note: Capilano source is measured once per week on a grab sample and was not in service in September 2013.

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No closures reported.

Environmental Health

Food Service Establishment Closures

The following table lists new food service establishment closures in the region since the report of September 2013 (updated as of October 17, 2013).

October, 2013 14

Richmond

Coastal Rural

Coastal Urban

Date Closed Reopened Establishment Reason

September 24, 2013 September 25, 2013 KIRIRI JAPANESE CUISINE & SUSHI BAR190-8780 Blundell Rd

Lack of hot water.

2013 Health Watch

Vancouver

View food establishment closures online at: www.vch.ca/your_environment/food_safety/restaurant_closuresTo contact us with a compliment, complaint or query: [email protected]

Source: Vancouver Coastal Health, Environmental Health.

No closures reported.

Date Closed Reopened Establishment Reason

September 25, 2013 September 26, 2013 JAGALCHI RESTAURANT851 Denman St

Improper dishwashing/glass washing.Pest infestation.Unsanitary Conditions.

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2012 Health Watch

Environmental Health

Air Quality Health Index (AQHI) Daily Maximum Value

October, 2013 15

AQHI, Metro Vancouver NW, July 1 to September 30, 2013 AQHI, Metro Vancouver NE, July 1 to September 30, 2013

AQHI, Metro Vancouver SW, July 1 to September 30, 2013 AQHI, Metro Vancouver SE, July 1 to September 30, 2013

AQHI, Whistler Meadow AQ Park Station, July 1 to September 30, 2013

AQHI Value Health Risk

1 to 3 Low

4 to 6 Moderate

7 to 10 High

10+ Very high

AQHI Health Risk Categories

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Note: Data for Whistler station were not available October 18, 20 and 21, 2012 due to technical issues.

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ly A

QH

I

Note: Data were not available January 13-16, 2012 due to technical issues.

0.0

2.0

4.0

6.0

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10.0

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axim

um d

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HI

Note: Data were not available January 13-16, 2012 due to technical issues.

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Note: Data were not available January 13-16, 2012 due to technical issues.

0.0

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Note: Data were not available January 13-16, 2012 due to technical issues.

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October, 2013 16

Notes:1. The Air Quality Health Index reports a number from 1 to 10+ indicating the air quality. The higher the number, the greater the health risk associated with the air quality. Index readings from 1 - 3 indicate a low health risk from air pollution. Readings from 4 - 6 indicate a moderate risk to health, especially for those with pre-existing health conditions. Readings between 6 and 10 indicate a high risk to health. When the amount of air pollution is very high, the number will be reported as 10+.

2. AQHI for Metro Vancouver areas reflect readings taken at a number of stations throughout each area. The reading for Whistler is taken at a single station.

For more information on the AQHI, visit: www.airhealthbc.ca and www.bcairquality.ca

Source: BC Ministry of Environment.

2012 Health Watch

Environmental Health

Page 17: 2013 Health Watch - Osteoarthritisoasis.vch.ca/media/Monthly_Health_Watch_October_2013.pdf · E. coli O157:H7: Gort’s Gouda Cheese Farm On September 17, 2013 BC Centre for Disease

The Health Watch appears monthly and is available online at:www.vch.ca/your_health/disease_surveillance/health_watch

To be added to the email distribution list or for questions/comments, please contact theVCH Public Health Surveillance Unit at: [email protected]

Acknowledgements

British Columbia Centre for Disease Control, Epidemiology Services British Columbia Centre for Disease Control, Public Health Microbiology and Reference LabBritish Columbia Ministry of EnvironmentBritish Columbia Ministry of HealthHealthLink BC, British Columbia Ministry of HealthLower Mainland Health Emergency ManagementMetro VancouverVancouver Coastal Health and Providence Health Care emergency rooms

• Lions Gate Hospital• Mount St Joseph Hospital• Pemberton Health Centre• Richmond Hospital• St Paul’s Hospital• Squamish General Hospital• UBC Hospital• Vancouver General Hospital• Whistler Health Care Centre

Vancouver Coastal Health • Communicable Disease offices • Environmental Health• Medical Health Officers• Mental Health and Addiction Services• Employee Health and Wellness

Vancouver Coastal Health, Providence Health Care and Provincial Health Services Authority Integrated Management Information Systems

October, 2013 17

The Health Watch began during the 2010 Olympic and Paralympic Games to provide Games organizers, public health partners and the public with a report on the health of the region.

2013 Health Watch