The Canadian Pandemic Influenza Plan for the Health Sector

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Annex E Planning Recommendations for the Use of Anti-Influenza (Antiviral) Drugs in Canada During a Pandemic Date of Latest Version: October 2006 Summary of Significant Changes: Reflects the establishment of the National Antiviral Stockpile and provides information on the size, use and composition of the stockpile; Specific references to “priority groups” have been removed since they no longer are consistent with the decisions made to date regarding the use of the stockpile; Contains updated scientific data, regulatory information, policy decisions and knowledge based on experience, acquired since last version (2004); Uses new Pandemic Phase terminology.
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INFORMATION NOTICE The Canadian Pan
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Organization of Contents Preface Se
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Foreword and Acknowledgements The C
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Alternate Dr. Ross Findlater Chief
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Dr. Anne Roberts Department of Heal
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Past Surveillance Working Group Mem
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With special thanks to the : • Ad
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Preface Influenza A viruses periodi
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Section One INTRODUCTION
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ii The Canadian Pandemic Influenza
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Given that an influenza pandemic is
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The federal government, through Pub
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Table of Contents 1.0 Epidemiology
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Background 1.0 Epidemiology of Pand
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Based on past pandemics, when the p
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historical relationship between sic
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The Pandemic Influenza Committee wi
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4.0 Terminology On April 8, 2005, t
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4.1.2 Pandemic Alert Period Phase D
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4.1.5 Post-Pandemic Period A recove
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public of the risk from a pandemic,
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Section Three PREPAREDNESS
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2.6 Communications . . . . . . . .
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The changes are now resulting in em
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2.1.1 Current Status The national F
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2.2.1 Current Status The annual inf
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At the time of a pandemic, it is as
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The objectives of the antivirals in
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amantadine, which is not currently
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2.4.2 Planning Principles and Assum
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census, high intensive-care unit ce
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2.5.2 Planning Principles and Assum
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iii) Federal Federal communications
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Section Four RESPONSE
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Other unknown factors (e.g. age dis
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However if no other pandemic activi
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Canadian Phase 1.1 No new virus sub
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6.2 Pandemic Alert Period Canadian
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Canadian Phase 3.1 Sporadic human i
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Canadian Phase 3.1 Sporadic human i
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Canadian Phases 4.0 and 5.0 Cluster
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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
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6.3 Pandemic Period Canadian Phase
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Canadian Phase 6.0 Outside Canada,
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Canadian Phases 6.1 and 6.2 Pandemi
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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: ii The Canadian Pandemic Influenza
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
Page 154 and 155: 1. Priorities for Vaccination Prior
Page 156 and 157: Group 3: Persons at High Risk of Se
Page 160 and 161: E Planning Recommendations for the
Page 162 and 163: 1.0 Introduction The purpose of thi
Page 164 and 165: Antiviral (Anti-Influenza) Drugs Cu
Page 166 and 167: At a joint meeting of the Council o
Page 168 and 169: Containment The role and impact of
Page 170 and 171: 6.0 Outstanding Issues There are a
Page 172: Annex F Infection Control and Occup
Page 175 and 176: Executive Summary The Infection Con
Page 177 and 178: Interim Infection Control Guideline
Page 179 and 180: Decontaminate hands Decontamination
Page 181 and 182: Non traditional health care setting
Page 183 and 184: Part B: Pandemic Influenza in Tradi
Page 185 and 186: Part A. Overview of Pandemic Influe
Page 187 and 188: 2.3 Airborne Transmission Refers to
Page 189 and 190: Discard them into an appropriate re
Page 191 and 192: 3.1.1 Recommendations 1. All organi
Page 193 and 194: 3.2.4 Immunity to Influenza During
Page 195 and 196: 4.0 Pandemic Influenza Education 4.
Page 197 and 198: (b) information regarding Self Care
Page 199 and 200: It is thought that management of ex
Page 201 and 202: C. Infection Control Practices 1. R
Page 203 and 204: (e) Sterilization in Health Care 3
Page 205 and 206: 3. Visitors should be informed when
Page 207 and 208: (d) 3. Masks and eye protection, or
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F. Cohorting 1. Cohorting resident
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B. Physical Setting 1. If possible,
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iii. Gowns 1. Gowns are not require
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(c) Personal Protective Equipment i
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Recommendations A. Pandemic Plannin
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(d) (e) membranes to reduce the pot
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All patients’ blood and body secr
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(c) Masks 1. Wearing masks, when fa
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ii. Do not send students who have b
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Control of Pandemic Influenza A. Im
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Masks 1. Wearing masks when face-to
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2. When planning for the location o
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3. Personal Protective Equipment a.
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iv. Reuse of single use items is st
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2.0 Infection Prevention and Contro
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iii. Individuals should avoid touch
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4. Care of the Deceased Attention t
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. Hands should be washed or hand an
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. Gloves i. Gloves are not required
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Recommendations 1. Process a. Repro
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G. Environmental Control (Housekeep
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always removed before leaving the l
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iii. Separate carts should be used
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immediately in designated puncture-
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Appendix II. World Health Organizat
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Appendix III. Hand Hygiene Procedur
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Appendix IV. An Influenza-like Illn
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Table B. Directions for Preparing a
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16. Garner JS, HICPAC. Guideline fo
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50. Smith PW, Rusnak PG. Infection
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83. Drinka PJ, Krause P, Schilling
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117. Alfa MJ, Olson N, DeGagne P, H
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148. Reinhardt PA, Gordon JG, Alvar
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G Health Services: Clinical Care Gu
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Chapter 3. Patient Management II: M
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Chapter 1. Clinical Presentations o
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The severity of clinical disease du
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Chlamydia pneumoniae and Mycoplasma
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People of any age who are residents
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Although pre-existing cardiovascula
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predominantly mononuclear, and capi
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1.2.5 Muscular system Acute rhabdom
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Table 1.3. Comparative features of
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Triage of adults ( 18 years) 1 Tria
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Symptoms consistent with flu like i
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Secondary influenza illness assessm
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Co-morbidity: in addition to above
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Child with acute respiratory illnes
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Stiff neck, photophobia When these
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c) Values of WBC for young children
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Children at risk for influenza-asso
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What are the Symptoms of Influenza
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What Reactions do People have to th
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II. If You Are Unwell A. Is It The
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C. When To Seek Medical Attention I
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TAKE YOUR CHILD TO THE HOSPITAL EME
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Clean the thermometer with cool soa
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Make sure that you/the person whose
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What you can do for yourself (uncom
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If your child has symptoms/behavior
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What You Can Do For Your Child All
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Details of vaccination Yes No N/A B
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Provisional Diagnosis Please Tick A
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Examination Findings (children 18 y
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Investigations in Adults ( 18 years
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If not admitted: Sent to: Home car
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Provisional Diagnosis Please Tick a
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Appendix 2.III. Pulse Oximetry and
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Normal values (Fig. 2.1) Normal val
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Chapter 3. Patient Management II Ma
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3.2.2 Diagnosis and management of r
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cultures should be considered in in
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3.3 Timely diagnosis and management
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Chapter 4. Patient Management III M
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5.3 Ward management Standard ward m
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5.4 Intensive Care Unit (ICU) Manag
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Examination Findings Date _____/___
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Other investigations Investigation
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Disposition Admitted ICU General
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Procedure Table 5.1. Diagnostic tes
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Appendix 5.IV. Antibiotics Antimicr
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Table 5.6. Suggested empiric antimi
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Table 5.8. Suggested empiric antimi
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First Nations’ communities in the
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6.1.2 Triage of patients in small c
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6.1.3 Initial assessment The initia
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6.1.6 Discharge Criteria Once the p
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6.2.3 Triage of patients in correct
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6.2.3.2. Secondary assessment (Chap
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References 1. ACIP April 20, 2001,
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32. CDC. 2002. Update: Influenza ac
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67. FluWatch 2001, posting date. De
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102. Horman JT, Stetler HC, Israel
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136. Loukides S, and Polyzogopoulos
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167. Nolte KB, Alakija P, Oty G, Sh
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200. Spillet D. 2001. Caring for yo
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233. Wright PF, Thompson J, McKee K
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H Resource Management Guidelines Fo
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Introduction During influenza epide
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f) A pandemic vaccine may be unavai
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2.1.2 Identify Triggers for Impleme
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availability of resources, stage of
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cohorting infectious and non-infect
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demands on the health care faciliti
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insurance, both site insurance, wor
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3.2.4 Consider Insurance and Licens
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3.3 Human Resource Management Durin
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3.3.6 Support Health Care Workers R
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3. What is the total number of vent
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Types of ventilators Intensive care
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Appendix B: Example Supply Manageme
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I Guidelines for the Management of
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Introduction During a pandemic, loc
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Steps Requirements Limiting Factors
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Any changes to regular practices pe
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Visitations could be a concern in t
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Appendix 1: List of Current Supplie
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J Guidelines for Non-Traditional Si
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Introduction In influenza pandemics
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1.3 Administrative Options for Non-
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obtain an Emergency Hospital or oth
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Designation of NT sites as triage c
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space for reception, waiting, patie
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Transportation and Supply Logistics
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1.7.2 Appoint Site Administrators/M
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Section 2: Human Resources Issues 2
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Health Care Workers (HCWs) Within f
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FUNCTIONS SKILL SETS/PERSONNEL B Pa
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safety and protection of workers, (
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a. Communicate with volunteer agenc
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ii) iii) iv) training programs will
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2.2.8 Establish Immunization Recomm
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2.3 Human Resource Planning During
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Due Diligence: The volunteer recrui
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K Canadian Pandemic Influenza Plan
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Primary Communications Roles Primar
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Provinces/Territories Primary Commu
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Pandemic Phase - National Communica
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Provinces/Territories Primary Commu
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Annex L Federal Emergency Preparedn
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The National Security Policy recogn
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National Emergency Response System
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3. The Centre for Emergency Prepare
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Public Health Agency of Canada and
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Annex M Public Health Measures Date
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7.0 Community Based Disease Control
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2.0 Principles and Assumptions The
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Review and update educational mater
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4.0 Avian Outbreaks in Canada durin
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Medical management of these individ
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which they are expected to be commu
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Scrupulous hand and respiratory hyg
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6.0 Management of Contacts of Cases
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Activity Restriction Antiviral Use
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Antiviral Use Consider the use of
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6.3 Rationale If outbreaks occur in
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7.0 Community-Based Disease Control
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7.2 Close Schools and Daycare Centr
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7.4 Use of masks by well individual
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7.6 Increase frequency of cleaning
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9.0 Travel and Border-Related Measu
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International Origin: Canadian Pand
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Domestic Origin: Canadian Pandemic
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Pandemic Period: Canadian Pandemic
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Appendix A: Summary of Recommendati
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Annex N Pandemic Influenza Surveill
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Preamble Since 2004, Canadian publi
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detection and characterization of u
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Interpandemic Period Table 1: Inter
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Table 1.1: National Surveillance Da
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Table 2: Pandemic Alert Period Cana
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Canadian Pandemic Phase 4.0 Outside
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Surveillance Objectives/Roles and R
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Canadian Pandemic Phase 4.0 Outside
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Pandemic Period Table 3: Pandemic P
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Canadian Pandemic Phase 6.2 Localiz
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Appendix 1: Generic Serosurvey Prot
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Laboratory methods As the antibody
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Annex 1 Sample Questionnaire for Av
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During the exposure period (to defi
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If exposed to infected poultry Plea
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If “yes” indicate what type of
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Appendix 3: National SRI Investigat
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Glossary of Terms and List of Acron
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Epidemiology Flu F/P/T Goblet cell
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Interpandemic Period Isolate Isolat
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NPS Neuraminidase (N) Neuraminidase
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Preventive care Preventive medicine
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Standard deviation (statistical) St
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