an assessment of the evidence - Council of Canadian Academies

More documents

Recommendations

Info

Influenza Transmission and the Role of PPRE: An Assessment of the EvidenceSUMMARY ..............................................................................................................2CHAPTER 1 – INTRODUCTION .................................................................................9Terms of Reference..............................................................................................10Approach to the Assessment ................................................................................11Terminology.........................................................................................................12CHAPTER 2 – MODES OF INFLUENZA TRANSMISSION ..........................................16Generation of Infectious Material .......................................................................17Effect of Particle Size.......................................................................................18Effect of Evaporation ......................................................................................19Effect of Humidity...........................................................................................19Effect of Distance ............................................................................................20Exposure to Infectious Material...........................................................................21Inhalation.........................................................................................................21Contact Transmission ......................................................................................27The Role of Setting in Transmission ...................................................................28Seasonal vs. Pandemic Influenza .........................................................................30Conclusions on Modes of Influenza Transmission..............................................31CHAPTER 3 – PROTECTIVE MEASURES AGAINST INFLUENZA TRANSMISSION ......32The Hierarchy of Control ...................................................................................32Engineering Controls.......................................................................................33Administrative Controls...................................................................................34Personal Protective Equipment........................................................................35Personal Protective Respiratory Equipment ....................................................35Respirators ...........................................................................................................35Classification of Protection Level ....................................................................36Properties and Roles of Respirators ................................................................37Particle Release by Filters ................................................................................38Respirator Doffing ...........................................................................................39Mitigating Factors ................................................................................................39Design and Quality of Respirators ..................................................................39Fit Testing/Checking.......................................................................................39User Adherence ...............................................................................................40Comfort and Performance...............................................................................40Surgical Masks .....................................................................................................41Seasonal vs. Pandemic Influenza .........................................................................42Conclusions on Protective Measures Against Influenza Transmission ................43REFERENCES..........................................................................................................44APPENDIX A – COMPREHENSIVE GLOSSARY.........................................................52APPENDIX B – REVIEWS CONSIDERED & RELEVANT LITERATURE ..........................55
2 Influenza Transmission and the Role of PPRE: An Assessment of the EvidenceS U M M A R YSeasonal influenza and its complications send, on average, about 20,000 Canadiansto hospital every year, and approximately 4,000 die. Pandemic influenza occurswhen a new strain of the human influenza virus emerges for which people havelittle or no pre-existing immunity and that can spread efficiently from person toperson and become geographically widespread. It is impossible to predict when thenext influenza pandemic might occur or how virulent the virus will be.Given the likelihood of another pandemic, governments and international bodieshave developed various plans to help minimize the health, social and economicconsequences of such an event. In the context of updating the Canadian PandemicInfluenza Plan for the Health Sector, the Public Health Agency of Canada askedthe Council of Canadian Academies to appoint an independent expert panel toassess the current science that is relevant to the following questions:a) How and where are seasonal influenza and pandemic influenza transmittedbased on existing reviews, or where needed, original literature generated fromseasonal influenza outbreaks and from previous pandemics?b) Based on the conclusions of this review, what is your assessment of thecontribution that N95 respirators or surgical masks will make to the preventionof transmission of seasonal and pandemic influenza?This report represents the consensus findings of the panel.Despite the seasonal occurrence of influenza and its clinical and economicconsequences, definitive evidence is lacking regarding the transmission of influenzaand the relative contribution of each of the possible modes of transmission. In theabsence of definitive evidence, the panel sought to agree, where possible, on whatwas most likely.MODES OF INFLUENZA TRANSMISSIONThere are two primary routes by which influenza virus exits the respiratory tract ofan infected person: (i) expulsion of the virus into the air through sneezing, coughing,speaking, breathing or through aerosol-generating medical procedures, or (ii) bydirect transfer of respiratory secretions to another person or surface. The newhost acquires the virus either by inhalation of the infectious particles from theair or by contact with infectious material directly or via self-inoculation through acontaminated hand.
Page 7: Influenza Transmission and the Role
Page 11 and 12: 4 Influenza Transmission and the Ro
Page 14 and 15: Influenza Transmission and the Role
Page 58 and 59:
Influenza Transmission and the Role
Page 60 and 61:
Page 62 and 63:
show all

an assessment of the evidence - Council of Canadian Academies

You also want an ePaper? Increase the reach of your titles

Delete template?

Save as template?