The Canadian Pandemic Influenza Plan for the Health Sector

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Ms. Rolande D’Amour Public Health Agency of Canada Dr. Patty Daly Vancouver Richmond Health Board Dr. Bonnie Henry Toronto Public Health Ms. Judy Morrison Public Health Agency of Canada Ms. Laurie O’Neil Infection Control and Prevention Consultant Ms. Shirley Paton Public Health Agency of Canada Ms. Joan Rannie Canadian Red Cross Dr. Ross Upshur Sunnybrook and Women’s College Health Sciences Centre Dr. Thomas Wilson Regional Coroner, London, Ontario Dr. Alice Wong Royal University Hospital Saskatoon, Saskatchewan Laboratory Working Group Dr. Margaret Fearon - Chair Canadian Public Health Laboratory Network Dr. Michel Couillard Institut national de santé publique du Québec Dr. Francisco Diaz-Mitoma Children’s Hospital of Eastern Ontario Dr. Theodore Kuschak Public Health Agency of Canada Dr. Spencer Lee Nova Scotia Department of Health Dr. Yan Li Public Health Agency of Canada Dr. Jim Talbot Provincial Laboratory of Public Health, Alberta Non-traditional Sites and Workers Working Group Ms. Sandra Callery - Chair Canadian Hospital Infection Control Association Mr. Bill Alexander St. John Ambulance Mr. Mark Allen Department of Health and Wellness New Brunswick Ms. Lynn Cochrane Department of Health and Wellness, New Brunswick Mr. Ron Fenwick Family Services and Housing, Manitoba Ms. Mehrun Forth Health and Social Services, Nunavut M. Patrice Guyard Ministère de la Santé et des Services sociaux du Québec Mr. Kelly Hart Health Canada Mr. Garnet Matchett Saskatchewan Health Ms. Judy Morrison Public Health Agency of Canada Mr. Don Shropshire Canadian Red Cross Society Additional Public Health Agency of Canada Contributors Ms. Leonor Alvarado Ms. Estelle Arseneault Ms. Lisa Belzak Ms. Olivia Colasante Ms. Rolande D’Amour Ms. Nathalie Groleau Ms. Shelie Laforest Ms. Margie Lauzon Ms. Suzanne Mayotte Ms. Julie McGihon Ms. Sarah Poirier Mr. John Rainford Ms. Jennifer Rendall Ms. Carole Robinson-Oliver Mr. Andrew Swift Mr. John Spika Ms. Loretta Scott Ms. Heather Stacey Mr. Nicholas Trudel Dr. Tom Wong Ms. Susan Vent x Canadian Pandemic Influenza Plan for the Health Sector
With special thanks to the : • Advisory Committee for Public Health and Health Security • Council of Chief Medical Officers of Health • Pan-Canadian Public Health Network Council The Pandemic Influenza Committee would like to express its appreciation for the input received from numerous organizations, including the following: • Biologics and Genetic Therapies Directorate • Canadian Association of Clinical Microbiology and Infectious Diseases • Canadian Association of Chiefs of Police • Canadian Association of Fire Chiefs • Canadian College of Family Physicians • Canadian Geriatrics Society • Canadian Hospital Epidemiology Committee • Canadian Infectious Disease Society • Canadian Medical Association • Canadian Nurses Association • Canadian Nursing Coalition for Immunization • Canadian Occupational Health Nurses Association • Canadian Public Health Association • Canadian Public Health Laboratory Forum • Canadian Paediatric Society • Canadian Pharmacist Association • Canadian Police Association • College of Family Physicians • Community and Hospital infection Control Association • Department of National Defence • Fédération des médecins omnipracticiens du Québec • Funeral Service Association of Canada • National Advisory Committee on Immunization (NACI) • National Infection Control Steering Committee • Office of Critical Infrastructure Protection and Emergency Preparedness (OCIPEP) Pan American Health Association (PAHO) • Royal Canadian Mounted Police (RCMP) St. John Ambulance • Solicitor General Canada • The Salvation Army • The Adventist Development and Relief Agency Canada • The Mennonite Disaster Service • The Christian Reformed World Relief Committee of Canada • VON Nurses • World Health Organization The Pandemic Influenza Committee extends its gratitude to the staff of the Scientific Publication and Multimedia Services, Public Health Agency of Canada for their contribution to the publication of the Plan. Additional Acknowledgements For the provision of leadership in drafting and editing this document. Ms. Jill Sciberras Public Health Agency of Canada Dr. Theresa Tam Public Health Agency of Canada Dr. Arlene King Public Health Agency of Canada Table of Contents xi
Page 2 and 3: INFORMATION NOTICE The Canadian Pan
Page 5 and 6: Organization of Contents Preface Se
Page 7 and 8: Foreword and Acknowledgements The C
Page 9 and 10: Alternate Dr. Ross Findlater Chief
Page 11 and 12: Dr. Anne Roberts Department of Heal
Page 13: Past Surveillance Working Group Mem
Page 18 and 19: Preface Influenza A viruses periodi
Page 20: Section One INTRODUCTION
Page 23 and 24: ii The Canadian Pandemic Influenza
Page 25 and 26: Given that an influenza pandemic is
Page 27 and 28: The federal government, through Pub
Page 30 and 31: Table of Contents 1.0 Epidemiology
Page 32 and 33: Background 1.0 Epidemiology of Pand
Page 34 and 35: Based on past pandemics, when the p
Page 36 and 37: historical relationship between sic
Page 38 and 39: The Pandemic Influenza Committee wi
Page 40 and 41: 4.0 Terminology On April 8, 2005, t
Page 42 and 43: 4.1.2 Pandemic Alert Period Phase D
Page 44 and 45: 4.1.5 Post-Pandemic Period A recove
Page 46 and 47: public of the risk from a pandemic,
Page 48: Section Three PREPAREDNESS
Page 51 and 52: 2.6 Communications . . . . . . . .
Page 53 and 54: The changes are now resulting in em
Page 55 and 56: 2.1.1 Current Status The national F
Page 57 and 58: 2.2.1 Current Status The annual inf
Page 59 and 60: At the time of a pandemic, it is as
Page 61 and 62: The objectives of the antivirals in
Page 63 and 64: amantadine, which is not currently
Page 65 and 66:
2.4.2 Planning Principles and Assum
Page 67 and 68:
census, high intensive-care unit ce
Page 69 and 70:
2.5.2 Planning Principles and Assum
Page 71 and 72:
iii) Federal Federal communications
Page 73:
Section Four RESPONSE
Page 76 and 77:
ii The Canadian Pandemic Influenza
Page 78 and 79:
Other unknown factors (e.g. age dis
Page 80 and 81:
However if no other pandemic activi
Page 82 and 83:
Canadian Phase 1.1 No new virus sub
Page 84 and 85:
6.2 Pandemic Alert Period Canadian
Page 86 and 87:
Canadian Phase 3.1 Sporadic human i
Page 88 and 89:
Canadian Phase 3.1 Sporadic human i
Page 90 and 91:
Canadian Phases 4.0 and 5.0 Cluster
Page 92 and 93:
Canadian Phases 4.0 and 5.0 Cluster
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Canadian Phases 4.1 and 5.1 Sporadi
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Canadian Phases 4.2 and 5.2 Localiz
Page 98 and 99:
6.3 Pandemic Period Canadian Phase
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Canadian Phase 6.0 Outside Canada,
Page 102 and 103:
Canadian Phases 6.1 and 6.2 Pandemi
Page 104 and 105:
Canadian Phases 6.1 and 6.2 Pandemi
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Component Focus Actions Response Le
Page 108:
Table of Contents Annexes
Page 111:
Annex A Planning Checklists Date of
Page 114 and 115:
Page 116 and 117:
Consider how special studies, ident
Page 118 and 119:
Purchase in bulk and stockpile extr
Page 120 and 121:
Develop a list of essential communi
Page 123 and 124:
B Pandemic Influenza Planning Consi
Page 125 and 126:
Clear protocols for on-reserve FNs
Page 127 and 128:
2. FNIHB Regions 2.1 Develop FNIHB
Page 129 and 130:
5. Centre for Emergency Preparednes
Page 132 and 133:
C Pandemic Influenza Laboratory Pre
Page 134 and 135:
The Pandemic Influenza Laboratory P
Page 136 and 137:
The NML currently performs testing
Page 138 and 139:
and manipulation of viral cultures.
Page 140 and 141:
3. Communication Information such a
Page 142 and 143:
as appropriate, and the provision o
Page 144 and 145:
3. Communication As in Phases 1.0 t
Page 146 and 147:
8. Allow the swab to sit in place f
Page 148 and 149:
Disease Surveillance Liaison Jeanne
Page 150 and 151:
Annex D Recommendations for the Pri
Page 152 and 153:
D Recommendations for the Prioritiz
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1. Priorities for Vaccination Prior
Page 156 and 157:
Group 3: Persons at High Risk of Se
Page 158:
Annex E Planning Recommendations fo
Page 161 and 162:
Page 163 and 164:
3.0 Classes of Antiviral (Anti-Infl
Page 165 and 166:
3.2 M2 Ion Channel Inhibitors (Cycl
Page 167 and 168:
There are ethical obligations to pr
Page 169 and 170:
) Neuraminidase inhibitors can be u
Page 171 and 172:
At a national Influenza Research Pr
Page 174 and 175:
F Infection Control and Occupationa
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helpful when transmission has enter
Page 178 and 179:
Glossary of Terms Antiseptic hand r
Page 180 and 181:
Infectious waste Influenza Intermed
Page 182 and 183:
Statement.......
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Part C: Pandemic Influenza in Non-T
Page 186 and 187:
1.1 World Health Organization Phase
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practices are the infection prevent
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3.0 Occupational Health and Infecti
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health care workers (see glossary f
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(b) (c) (ii) they have been immuniz
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(l) the importance of being immuniz
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5. Inform the public to avoid publi
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Part B. Management of Pandemic Infl
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(d) 3. Masks and eye protection, or
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Note: *Immune are those recovered f
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C. Infection Control Practices 1. U
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(e) Sterilization in Health Care 3
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3.0 Management of Pandemic Influenz
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(d) or using tissues; and the impor
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B. Management of Staff 1. Provide e
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to generate splashes or sprays of b
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(b) (c) washing. Antiseptic hand ri
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(f) Patient Care Equipment (Cleanin
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procedures is imperative to minimiz
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(b) Control of Pandemic Influenza 1
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3. Workers and their household memb
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Planning for Pandemic Influenza 1.
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Part C. Infection Control and Occup
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supplies and soap and towel dispens
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c. Gowns vii. Single-use disposable
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d. Laundry (linen) i. When reusable
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C. Infection Control Practices To p
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3. Environmental Control (Housekeep
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3.2 Control of Pandemic Influenza A
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v. before preparing, handling, serv
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c. Gowns i. Gowns are not required
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3. Disinfection a. Reuseable items
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(equipped with exhaust filter) rath
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. Collection and handling i. There
Page 254 and 255:
3. Waste vi. All caregivers and lau
Page 256 and 257:
Appendix I. Guideline Rating System
Page 258 and 259:
Phase 4: Second or later waves of t
Page 260 and 261:
B. Decontaminating Hands with an Al
Page 262 and 263:
Appendix V. Tables Table A. Cleanin
Page 264 and 265:
Reference List 1. Boyce JM, Pittet
Page 266 and 267:
32. Duchini A, Hendry RM, Redfield
Page 268 and 269:
67. Wade JJ, Desai N, Casewell MW.
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100. Orth B, Frei R, Itin PH, Rinal
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133. Korniewicz DM. Barrier protect
Page 274:
Annex G Health Services: Clinical C
Page 277 and 278:
Chapter 2. Patient Management I 2.1
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Chapter 6. Special circumstances 6.
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Pathogenesis of influenza The major
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dysfunction and less than 80 pg/mL
Page 285 and 286:
influenza viruses supplant all othe
Page 287 and 288:
maternal age 189 . Only four of the
Page 289 and 290:
developed severe infections, one ch
Page 291 and 292:
1.2.3 Cardiovascular Sudden death o
Page 293 and 294:
High-risk conditions: (Co-morbidity
Page 295 and 296:
Chapter 2. Patient Management I 2.1
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Legend: 1) Triage centres may be lo
Page 299 and 300:
Initial influenza illness assessmen
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Microbiologic Diagnostic tests Micr
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2.2 Pediatric Triage This algorithm
Page 305 and 306:
Initial influenza illness assessmen
Page 307 and 308:
Secondary assessment (15% Platelets
Page 309 and 310:
Clinical assessment for evidence of
Page 311 and 312:
Appendix 2.I. Caring For Your Self
Page 313 and 314:
B. Protect Yourself Against Influen
Page 315 and 316:
C. Plan Ahead Spend a little time t
Page 317 and 318:
Read the label to be sure that the
Page 319 and 320:
D. When A Child Is Unwell Older chi
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Attachments A) How To Take A Child
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Squeeze and hold down the button fo
Page 325 and 326:
C) Self-care Algorithms, Adults Sta
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Does Your Infant or Young Child (Bi
Page 329 and 330:
Does Your Older Child (Age Six Year
Page 331 and 332:
Appendix 2.II. Assessment Forms 1.
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Clinical features on history YES NO
Page 335 and 336:
) Children ≤ 18 years: Identifica
Page 337 and 338:
Symptoms (children 18 years) Date a
Page 339 and 340:
Provisional Diagnosis Please Tick a
Page 341 and 342:
Provisional Diagnosis Please Tick a
Page 343 and 344:
Investigations Complementary labora
Page 345 and 346:
If not admitted: Sent to: Home car
Page 347 and 348:
measurements and minimize false ala
Page 349 and 350:
2. Trans cutaneous PO2 monitoring
Page 351 and 352:
3.2. Assessment and management of l
Page 353 and 354:
3.2.2.1 Symptoms consistent with fl
Page 355 and 356:
c) Specific therapy: Specific thera
Page 357 and 358:
Appendix 3.I. Influenza-Like Illnes
Page 359 and 360:
Chapter 5. Patient Management IV Ho
Page 361 and 362:
5.3.3 General management Fluid the
Page 363 and 364:
Appendix 5.I. Admission form 171 Id
Page 365 and 366:
Symptoms Date and time of onset of
Page 367 and 368:
Investigations (Not all tests will
Page 369 and 370:
Provisional Diagnosis Please tick a
Page 371 and 372:
Appendix 5.II. Rapid Virologic Diag
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Appendix 5.III. Antiviral Drugs for
Page 375 and 376:
susceptible Staphylococcus aureus.
Page 377 and 378:
Table 5.7. Antimicrobials for the t
Page 379 and 380:
Chapter 6. Special circumstances 6.
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3. Education of all medical and non
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Legend for Table 6.1.2 1) This algo
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6.1.5 Management of influenza patie
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6.2 Correctional and penal institut
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Legend for Table 6.2.3 1. A special
Page 391 and 392:
) General management: Specific aspe
Page 393 and 394:
15. Barrett MJ, Hurwitz ES, Schonbe
Page 395 and 396:
50. Duchini A, Viernes ME, Nyberg L
Page 397 and 398:
85. Govaert TM, Dinant GJ, Aretz K,
Page 399 and 400:
119. Kim HW, Brandt CD, Arrobio JO,
Page 401 and 402:
152. NACI August 1, 2001, posting d
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182. Ruff RL, and Secrist D. 1982.
Page 405 and 406:
217. Van Caeseele, Macaulay A, Orr
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Annex H Resource Management Guideli
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3.2.4 Consider Insurance and Licens
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1.0 . . . . . . . . . . . . . . . .
Page 414 and 415:
2.0 . . . . . . . . . . . . . . . .
Page 416 and 417:
Various options to increase bed cap
Page 418 and 419:
addition, provinces and territories
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3.2 Human Resource Management Durin
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technicians (laboratory, radiograph
Page 424 and 425:
Clerical skills in terms of patient
Page 426 and 427:
3.2.5 Immunization of Health Care W
Page 428 and 429:
workers, as well as the public will
Page 430 and 431:
Appendix A Evaluation of Bed Capaci
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Inventory of Beds (Work Sheet) Type
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Emergency Ventilatory Capacity Cons
Page 436:
Annex I Guidelines for the Manageme
Page 439 and 440:
Page 441 and 442:
Steps Requirements Limiting Factors
Page 443 and 444:
In order to deal with the increase
Page 445 and 446:
1.6 Capacity of and Access to Vault
Page 447 and 448:
As a result of these special requir
Page 449:
Annex J Guidelines for Non-Traditio
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Section 2: Human Resource Issues 2.
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Section 1: Non-Traditional Sites 1.
Page 456 and 457:
timely distribution. The NESS shoul
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most likely the local medical offic
Page 460 and 461:
1.6.4 Assess Locations for Potentia
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Security and Safety The safety of b
Page 464 and 465:
intravenous equipment (e.g., needle
Page 466 and 467:
1.7.4 Coordinate Procurement of Sup
Page 468 and 469:
2.2.1 Appoint a Human Resource Mana
Page 470 and 471:
For each site the essential functio
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FUNCTIONS SKILL SETS/PERSONNEL F Mo
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2.2.5 Plan for Salaries or Payments
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c. Develop job descriptions and ski
Page 478 and 479:
Based on the Checklist of Functions
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Malpractice/Liability Insurance of
Page 482 and 483:
c. Volunteer screening Volunteers i
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Annex K Canadian Pandemic Influenza
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Interpandemic Phase - National Comm
Page 488 and 489:
Health Canada Primary Communication
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Primary Communications Roles Primar
Page 492 and 493:
Pandemic Alert Phase - National Goa
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Health Canada Primary Communication
Page 496 and 497:
Page 498 and 499:
Page 500 and 501:
Page 503 and 504:
L Federal Emergency Preparedness an
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1. The Federal System Traditionally
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National Response Structure Nationa
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2. Public Health Agency of Canada a
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Public Health Agency of Canada, Hea
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Technical Response Group Structure:
Page 516 and 517:
M Public Health Measures Table of C
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1.0 Introduction As an influenza pa
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Individuals who recover from illnes
Page 522 and 523:
In March 2004, WHO hosted an intern
Page 524 and 525:
5.1 Recommendations Encourage all
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As previously noted, antiviral trea
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Except when visiting a health care
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aseline data on these indicators sh
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Recommendations for Management of C
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Page 536 and 537:
Page 538 and 539:
The availability of antiviral drugs
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7.1 Strengthen recommendations to s
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7.3 Restrict indoor public gatherin
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7.5 Implement hand-sanitizing stati
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7.7 Other Measures NOT Recommended
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Increase awareness of the “travel
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initially at Customs, and within 4
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Contact management logistics Althou
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References 1. Department of Communi
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A.2 Community-Based Disease Control
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N Pandemic Influenza Surveillance G
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Introduction The overall goals of i
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Special Studies Protocols for speci
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Surveillance Objectives/Roles and R
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Pandemic Alert Period Table 2, belo
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Surveillance Objectives/Roles and R
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Canadian Pandemic Phase 4.1 Single
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Page 581 and 582:
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Table 4: Post-Pandemic Period Canad
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Study design Two types of surveys c
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Table 2 Sample size of each group (
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Household data How many total indiv
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Poultry and Other Animal Exposures
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Collected environmental swabs from
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Appendix 2: National FluWatch Influ
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Glossary of Terms and List of Acron
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Bed (Institutional Bed) Case weight
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Health Care Worker (HCW) without cl
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LICO (Low income cutoff point) LPN
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Pandemic Pandemic Alert Period Pand
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R Raw data Measurements and observa
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Vaccination Vaccine Virology Virus
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