Surveillance

Canadian Paediatric Surveillance Program
Public Health Impact

• Canadian Paediatric Society confirms rickets still a major health issue – News Release June 2004
• Public health impact of the Canadian Paediatric Surveillance Program (CPSP). Grenier D, Doherty, J, Medaglia A. Presented at the 81st Annual Meeting of the Canadian Paediatric Society, Montreal, June16 to 20, 2004. 
• What does the CPSP have to do with public health? Paediatr Child Health 2004;9(3):155
• Canadian Paediatric Surveillance Program – A developmental check-up. Scott J. Paediatr Child Health 2004;9(1):13-14
• CPSP 2002 Results: What have we learned? Paediatr Child Health 2003;8(7):447
• The Canadian Paediatric Surveillance Program: A new opportunity to help shape public health policy. Paediatr Child Health 2001;6(5):237-8

In 2003, the Canadian Paediatric Surveillance Program was able to provide national data on three emerging paediatric concerns, namely nutritional vitamin D deficiency rickets, varicella-complicated necrotizing fasciitis and baby walker injuries. In all of these, front-line health care providers felt that there were increasing numbers of missed opportunities for prevention.  

For example, in a country where vitamin D was added to milk in the 1950s, there was a false presumption that nutritional rickets had all but disappeared, yet study results confirmed that not only does it still occur in the general paediatric population but most specifically in darker-skinned, exclusively breast-fed infants not supplemented with vitamin D. After 18 months of surveillance, a total of 69 cases were confirmed with significant morbidity present at diagnosis including limb deformity, seizures, failure to thrive, fractures and delayed developmental milestones. 

In Canada, varicella vaccine is approved but only universally provided in three out of ten provinces and in two out of the three territories and must be purchased in the remaining areas. Effective February 2004, Health Canada’s National Advisory Committee on Immunization recommended universal varicella vaccination. The necrotizing fasciitis study supported this recommendation having documented that a high percentage of group A ß-streptococcal complicated cases of NF (16/26) were preceded by varicella within four weeks. 

Even though a voluntary ban on the sale of baby walkers had been in effect since 1989, the CPSP January 2002 survey confirmed a minimum of 132 injuries in the previous year. This was followed by an April 2004 announcement from Health Canada of a total ban on baby walker sales, advertisements and importations. 

The CPSP is most encouraged by these important public health outcomes stemming from recent study results.