The Canadian Pandemic Influenza Plan for the Health Sector

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INFORMATION NOTICE The Canadian Pandemic Influenza Plan for the Health Sector (the Plan) was developed through a collaborative consultative process including representatives of Federal, Provincial, Territorial, local and regional governments, experts in the respective fields and non-government stakeholders. Development of the Plan was originally coordinated by Health Canada with direction from the Pandemic Influenza Committee, a Federal, Provincial and Territorial technical advisory committee. The 2006 edition was coordinated by the Public Health Agency of Canada. The Plan is provided for information purposes to support consistent and comprehensive planning for the health sector response to pandemic influenza across Canada by governments and other stakeholders within their respective roles and responsibilities. DISCLAIMER The views and recommendations expressed in the Plan and technical annexes were developed through a collaborative consultative process including representatives of Federal, Provincial, Territorial, local and regional governments, experts in the respective fields and non-government stakeholders. Users should seek their own independent legal and technical advice on how they will put to their own use and purpose the views, and recommendations contained in the Plan. COPYRIGHT AND PERMISSION The Plan may be used and reproduced by the User for information and educational purposes and for the User’s own pandemic influenza planning purposes. The User shall not otherwise reproduce the Plan or distribute the Plan to any third party, in whole or in part, for commercial or for any other purposes by any means, without the prior written permission of the Public Health Agency of Canada. Requests for permission may be made to the Public Health Agency of Canada. The copyright of the Plan rests with the federal Crown/federal government. Position of contact: Director, Immunization and Respiratory Infections Division Centre for Infectious Diseases Prevention and Control (CIDPC) Public Health Agency of Canada Address of contact: 100 Eglantine Driveway A.L. 0602B, Building #6, Health Canada Ottawa ON K1A 0K9 Fax: (613) 998-6413 © Her Majesty the Queen in Right of Canada (2006) Cat. N° HP40-10/2006E-PDF ISBN 0-662-44409-4
The Canadian Pandemic Influenza Plan for the Health Sector
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 and 14: Past Surveillance Working Group Mem
Page 15 and 16: With special thanks to the : • Ad
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
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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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ii The Canadian Pandemic Influenza
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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
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Table of Contents Annexes
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Annex A Planning Checklists Date of
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Consider how special studies, ident
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Purchase in bulk and stockpile extr
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Develop a list of essential communi
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B Pandemic Influenza Planning Consi
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Clear protocols for on-reserve FNs
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2. FNIHB Regions 2.1 Develop FNIHB
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5. Centre for Emergency Preparednes
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C Pandemic Influenza Laboratory Pre
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The Pandemic Influenza Laboratory P
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The NML currently performs testing
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and manipulation of viral cultures.
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3. Communication Information such a
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as appropriate, and the provision o
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3. Communication As in Phases 1.0 t
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8. Allow the swab to sit in place f
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Disease Surveillance Liaison Jeanne
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Annex D Recommendations for the Pri
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D Recommendations for the Prioritiz
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1. Priorities for Vaccination Prior
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Group 3: Persons at High Risk of Se
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Annex E Planning Recommendations fo
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3.0 Classes of Antiviral (Anti-Infl
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3.2 M2 Ion Channel Inhibitors (Cycl
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There are ethical obligations to pr
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) Neuraminidase inhibitors can be u
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At a national Influenza Research Pr
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F Infection Control and Occupationa
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helpful when transmission has enter
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Glossary of Terms Antiseptic hand r
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Infectious waste Influenza Intermed
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Statement.......
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Part C: Pandemic Influenza in Non-T
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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
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3. Waste vi. All caregivers and lau
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Appendix I. Guideline Rating System
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Phase 4: Second or later waves of t
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B. Decontaminating Hands with an Al
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Appendix V. Tables Table A. Cleanin
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Reference List 1. Boyce JM, Pittet
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32. Duchini A, Hendry RM, Redfield
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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
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Annex G Health Services: Clinical C
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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
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influenza viruses supplant all othe
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maternal age 189 . Only four of the
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developed severe infections, one ch
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1.2.3 Cardiovascular Sudden death o
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High-risk conditions: (Co-morbidity
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Chapter 2. Patient Management I 2.1
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Legend: 1) Triage centres may be lo
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Initial influenza illness assessmen
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Microbiologic Diagnostic tests Micr
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2.2 Pediatric Triage This algorithm
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Initial influenza illness assessmen
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Secondary assessment (15% Platelets
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Clinical assessment for evidence of
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Appendix 2.I. Caring For Your Self
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B. Protect Yourself Against Influen
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C. Plan Ahead Spend a little time t
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Read the label to be sure that the
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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
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C) Self-care Algorithms, Adults Sta
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Does Your Infant or Young Child (Bi
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Does Your Older Child (Age Six Year
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Appendix 2.II. Assessment Forms 1.
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Clinical features on history YES NO
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) Children ≤ 18 years: Identifica
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Symptoms (children 18 years) Date a
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Provisional Diagnosis Please Tick a
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Provisional Diagnosis Please Tick a
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Investigations Complementary labora
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If not admitted: Sent to: Home car
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measurements and minimize false ala
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2. Trans cutaneous PO2 monitoring
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3.2. Assessment and management of l
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3.2.2.1 Symptoms consistent with fl
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c) Specific therapy: Specific thera
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Appendix 3.I. Influenza-Like Illnes
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Chapter 5. Patient Management IV Ho
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5.3.3 General management Fluid the
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Appendix 5.I. Admission form 171 Id
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Symptoms Date and time of onset of
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Investigations (Not all tests will
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Provisional Diagnosis Please tick a
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Appendix 5.II. Rapid Virologic Diag
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Appendix 5.III. Antiviral Drugs for
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susceptible Staphylococcus aureus.
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Table 5.7. Antimicrobials for the t
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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
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) General management: Specific aspe
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15. Barrett MJ, Hurwitz ES, Schonbe
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50. Duchini A, Viernes ME, Nyberg L
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85. Govaert TM, Dinant GJ, Aretz K,
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119. Kim HW, Brandt CD, Arrobio JO,
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152. NACI August 1, 2001, posting d
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182. Ruff RL, and Secrist D. 1982.
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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 . . . . . . . . . . . . . . . .
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2.0 . . . . . . . . . . . . . . . .
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Various options to increase bed cap
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addition, provinces and territories
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3.2 Human Resource Management Durin
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technicians (laboratory, radiograph
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Clerical skills in terms of patient
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3.2.5 Immunization of Health Care W
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workers, as well as the public will
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Appendix A Evaluation of Bed Capaci
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Inventory of Beds (Work Sheet) Type
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Emergency Ventilatory Capacity Cons
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Annex I Guidelines for the Manageme
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Steps Requirements Limiting Factors
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In order to deal with the increase
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1.6 Capacity of and Access to Vault
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As a result of these special requir
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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.
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timely distribution. The NESS shoul
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most likely the local medical offic
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1.6.4 Assess Locations for Potentia
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Security and Safety The safety of b
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intravenous equipment (e.g., needle
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1.7.4 Coordinate Procurement of Sup
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2.2.1 Appoint a Human Resource Mana
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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
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Based on the Checklist of Functions
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Malpractice/Liability Insurance of
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c. Volunteer screening Volunteers i
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Annex K Canadian Pandemic Influenza
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Interpandemic Phase - National Comm
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Health Canada Primary Communication
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Primary Communications Roles Primar
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Pandemic Alert Phase - National Goa
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Health Canada Primary Communication
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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:
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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
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In March 2004, WHO hosted an intern
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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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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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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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