Canadian Immunization Research Network Education Series Case 3: No Rash Decisions


  1. To understand the role of surveillance in control of vaccine preventable diseases.
  2. To be aware of appropriate use of data collected for public health purposes and used secondarily for research.

Instructions for trainees: Please read the case, questions and resources prior to the seminar.


Following her pediatric residency, Amy is uncertain of her ultimate career path, but decides a good next step would be a locum at a remote hospital in northern Manitoba. Part of her role includes serving as acting medical officer of health for her region. A  nursing student, Adele Moreau, arrives at the hospital as a volunteer. She is also taking time from her nursing studies to train in Northern Manitoba for the Iditarod Trail Sled Dog Race, an annual 1,200 mile race in Alaska when weather permits. Amy and Adele soon become good friends.

Amy has been collecting data on reportable infectious diseases in a folder on her desk as the reports are submitted. She requests permission from her employer to enter the paper-based health-information on reportable infectious diseases into an electronic database, so that she can more easily keep track of trends and identify outbreaks. This is a perfect job for Adele who needs the money to pay expenses. During the day, Adele trains for the race, and in the evening she enters data from 15 years of paper records on her laptop. Adele finishes the task by the time she leaves in late winter.

One day, a nine-year-old girl from a First Nations community presents with a rash on her arms and legs. The child soon becomes desperately ill and Amy realizes she has meningococcemia, a severe infection caused by Neisseria meningitidis, serotype B. After being stabilized the child is evacuated by air to Winnipeg for critical care. Amy telephones the communicable disease nurse (CDC) to begin control measures for close contacts and notifies the provincial public health office.

Two weeks later, a 13-year-old boy from a different community presents with meningococcal meningitis, of a different serotype. In conversations with a nurse practitioner, Amy learns that there have been several such infections in these two communities in past two years. She reviews the electronic database and finds eight cases of meningococcal infection in these two communities over 5 years and only one case in the other five communities. Amy alerts provincial medical officer of health of her analysis and a task force is created to review the data and determine if a mass vaccination program is necessary.

Amy thinks these findings may be of interest to her colleagues outside the region, and prepares an abstract for an upcoming public health conference. In recognition of Adele’s data entry work and her CDC nurses, she adds them as authors to the abstract and submits it one hour prior to the deadline.

Questions for discussion:

  1. How would you define surveillance?
  2. What is the purpose of surveillance?
  3. What is the national definition for invasive meningococcal disease?
  4. The primary purpose that Amy collected infectious disease data was for public health purposes. How would you describe the use of this data for research purposes? What guidelines would govern its use?


Readings and Resources:

  1. Public Health Agency of Canada – Surveillance programs at <>
  2. Nationally notifiable Infectious Diseases and Definitions at <> .
  3. Notifiable disease surveillance system at
  4. Consent and use of identifiable information for research purposes. Chapter 5, TriCouncil Policy Statement: Ethical Conduct for Research Involving Humans (TCPS-2), 2014. Available at
  5. SockettPN_idmm_1995_06165

Further discussion:

  1. What is Amy’s research question?
  2. What research designs might be used to address Amy’s questions?
  3. Should Adele be an author on publications about the research?

Developed 2011 by: Dr. Robert Bortolussi, Dalhousie University

Revised: 25 March 2015, J M Langley MD