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Lyme disease Emergence in Québec 2004: 2 cases 2013: near 140 cases

A multi-criteria decision analysis as an innovative approach to managing Lyme disease May 29 th , 2014. Cécile Aenishaenslin, Valérie Hongoh, Hassane Djibrilla Cissé , Anne Gatewood Hoen, Karim Samoura, Pascal Michel, Jean-Philippe Waaub, Denise Bélanger. Background.

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Lyme disease Emergence in Québec 2004: 2 cases 2013: near 140 cases

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  1. A multi-criteria decision analysis as an innovative approach to managing Lyme diseaseMay 29th, 2014 Cécile Aenishaenslin, Valérie Hongoh, Hassane DjibrillaCissé, Anne Gatewood Hoen, Karim Samoura, Pascal Michel, Jean-Philippe Waaub, Denise Bélanger

  2. Background Complexecology What public health actions are the mostappropriate in Quebec? LymediseaseEmergence in Québec 2004: 2 cases 2013: near 140 cases Environmental Social Economic 2 2

  3. Research objectives Plan 1. To prioritize potential Lyme disease management actions using a multicriteria decision analysis (MCDA) 2. To evaluate the opportunities and challenges associated with the use of MCDA for public health planning 3 3

  4. Methods Plan • Rank alternatives • Multiple decisioncriteria • Complexity • . • MCDA • Participatoryapproach • Quantitative & qualitative 4 4

  5. Methods Plan 1. Define the problem • . 2. Identifystakeholders 3. Identify important issues Problemstructuring 4. Definecriteria and indicators 5. Identify alternatives 6. Evaluate performance of alternatives 7. Weightcriteria 8. Conductdecisionanalysis Decisionanalysis 9. Performsensitivityanalysis 10. Interpret the results 5 5

  6. Results Plan What public health actions shouldbeprioritizedin a context of LD emergence in the province of Quebec? • Québec National Institute of Public Health • National Public HealthLaboratory • Ministry of Agriculture, Fisheries and Food • Ministry of Natural Resources and Wildlife • Montérégie RegionalBoard of Health and Social Services • Academic Expert 1- What surveillance actions are the mostappropriate? 2- What control actions are the mostappropriate? 6 6

  7. Plan (1) days; (2) weeks; (3) months; (4) years 7 7

  8. Results Plan • Inclusion of control actions orientedtoward: • Environment • Vectorhosts • Human populations CONT0 Basic risk communications CONT1a Small scale acaricide application CONT1b Large scale acaricide application CONT2 Application of insecticidal soap CONT3a Small scale Landscaping CONT3b Large scale Landscaping CONT4 Topical acaricide to deer (4-poster) CONT5 Feed-administered ivermectin to deer CONT6a Deer hunting CONT6b Deer culling CONT7 Exclusion of deer by fencing CONT8 Topical acaricide to rodents (Damminix) CONT9 Topical acaricide to rodents (Bait boxes) CONT10 Excluding people from high-risk public areas CONT11 Human vaccination CONT12 Making available special Lyme disease clinics Performance matrix 8 8

  9. Results Plan Individualweighting of eachcriteria Stakeholdersweights for eachcategory of criteria Public health Animal and environmental Social impacts Strategic & operationnal

  10. Results Plan Performance matrix Stakeholdersweights Action profiles Group ranking

  11. Results Plan Group ranking of actions

  12. Results Plan Actions profiles Human vaccination Small scalelandscaping Public health Animal and environmental Social impacts Strategic & operationnal Aenishaenslin et al.,2013. Multi-criteria decision analysis as an innovative approach to managing zoonoses: results from a study on Lyme disease in Canada. BMC Public Health, 13:897.

  13. MCDA strengths Plan • OneHealth • Multiple decisioncriteria • Knowledge gaps • Rank alternatives • MCDA • Institutionalempowerment • Quantitative & qualitative • Complexity • Participatoryapproach

  14. Key messages Plan • MCDA is an interestingtool to support ‘Evidence-based public health’ for complex public health issues • Each MCDA stepproduces a valuableresult • The model couldbegeneralized for other VB/zoonosicdisease

  15. Merci! Thankyou! Plan Thanks to all stakeholders and experts and the Lyme-MCDA Consortium: Nathalie Côté Annie Doucet Cécile Ferrouillet Anne Fortin Francis Girard Pierre Gosselin François Milord Louise Trudel Nick Ogden Patrick Leighton Jules Koffi Catherine Bouchard Anne-Laure Bouvier The realization of this project was made possible by financial contribution of the Public Health Agency of Canada (PHAC). The sights expressed here do not reflect the official position of the PHAC.

  16. Results Plan

  17. Additional slide Plan Lymedisease cases in Canada, 1994-2012 Lymedisease cases in Québec, 2004-2013 Ogden et al., 2014 Direction de la santé publique de la Montérégie, 2013 17 17

  18. Additional slide Plan

  19. Additional slide Plan GAIA decisionmapunder the emergence scenario

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