Role of Health Unit Rolling out Vaccines and Anti-Virals

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Role of Health UnitRolling out Vaccines and
Anti-Virals

• Kathy Jovanovic (Peel Health)
• Claudine DSouza (Toronto Public Health)
• OAML Pandemic Planning Education Day
• Toronto
• June 16, 2005

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Pandemic Influenza Planning

• Public Health has a leading/
• supporting role in the pandemic planning process
  for the City of Toronto Region of Peel
• Key stakeholder model
• Linkages with hospitals and the health care
  sector
• Linkages with business, volunteer sectors, etc.
• Adhering to Federal and Provincial plans

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Routine Public Health Measures

• Disease surveillance and reporting
• Case investigation and management
• Identification and follow-up of close contacts
• Health risk assessment and communications
• Liaison with hospitals and other agencies
• Community-based disease control strategies
• Vaccine (e.g. UIIP, Hep. B, Men.C.) distribution
  and administration

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Routine Disease Surveillance and Reporting

• Communicable disease reporting
• Dissemination of institutional outbreak list
• Daily monitoring of CD activity
• Weekly flu bulletin
• Monitor Federal and global CD activity

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Ongoing Influenza Surveillance

• Sentinel physician system
• Monitoring outbreaks in hospitals and
• long-term care facilities
• Network with local labs
• Enhanced surveillance program and
• syndromic surveillance (FRI)
• iPHIS roll-out (2005)

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PH Surveillance/Management During a Pandemic

• Data collection and reporting for Mass
  Prophylaxis of priority groups for
  vaccine/antiviral agents
• Efficacy of vaccine/antiviral for priority groups
• Track unusual or adverse events related to
  prophylaxis treatment
• Liaise and report to MOHLTC
• Initially Aggressive individual investigation
• Move to broader community messaging re self-care

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Case Investigation and Management

• FRI/SRI investigations will continue into the WHO
  Pandemic Alert Phases
• Management will change throughout the pandemic
  waves
• Isolation of all cases at home or in hospital
• Antiviral treatment to be considered

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Close Contacts Identification and Follow-up

• Contact tracing and quarantine/active
  surveillance will be used early in the pandemic
  alert phases
• With widespread community transmission
• Quarantine/active surveillance no longer
  effective --gt broad-based community messaging

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Workplace Preparedness

• Employers should
• Identify essential services that must be
  maintained as part of good Business Continuity
  Plan
• plan to have sufficient supplies for at least one
  month (stockpile as required)
• Identify alternate supply sources/chains
• Expect high rates of staff absenteeism
• Consider cross training of employees to maintain
  essential services
• Employers will participate in enumerative process
  for vaccine/antiviral roll-out with local health
  units
• Consider role for education by Occupational
  Health services re Influenza Pandemic and UIIP

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Expect These Types of Absenteeism

• Absenteeism Related to pandemic
• Absenteeism Normal
• Absenteeism Related to sick family members
• Absenteeism Scared, worried well

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What Health Care Employers Can Do to Enhance
Surveillance

• Absenteeism
• Monitor general rates
• Establish baseline each season, prepandemic
• During Pandemic Alert
• Enhance surveillance and request reporting of
  respiratory symptoms
• Review work place policies-stay home if you are
  sick and report respiratory illness

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Infection Prevention Controlfor Workplaces

• General Hygienic Practices
• Hand hygiene (soap water or alcohol-based
  rinse)
• Respiratory etiquette (cover your cough sneeze)
• Healthy workplace (stay home when ill)
• Health Care Measures
• Consistent use of Routine Practices in all work
  settings
• Additional Precautions (droplet and contact) for
  management of patients with respiratory illnesses

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Infection Prevention Controlfor Workplaces

• Droplet Precautions
• Surgical mask, eye protection for all activities
  that may generate coughing or when within one
  metre of the patient
• Contact Precautions
• Gown and gloves for activities that may result in
  soiling of uniform with blood, body fluids

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Hand Hygiene Essential Items

• Handwashing
• Sink with hot and cold running water
• Taps Electronic or manual?
• Soap dispenser amount dispensed?
• Paper towel or air dryer?
• Waterless hand rinses
• Pump style and location?
• Amount Quarter size, sufficient to cover all
  surfaces)
• Procedure Squirt, swirl, switch, swirl, scrub

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Vaccine/Antiviral Distribution

• Assumptions
• Vaccine not be available for 4-6 months after the
  identification of a novel strain
• Anti-viral distribution for priority groups
• Vaccine and anti-viral rolled out over time
  period
• Cross-jurisdictional planning between public
  health units
• Enumeration of priority groups
• Maintain Federal and Provincial priority groups
  at local level

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Vaccine/Antiviral Distribution and Administration

• Public Health to
• Adopt the Federal and Provincial priority groups
• Play role in the distribution of vaccine and
  antiviral medication to priority groups
  (co-ordination between provincial and local
  levels)
• Conduct mass vaccination/anti-viral clinics

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Planning for Vaccine/Anti-viral Administration

• Enumerate Health care/essential service workers
  according to priority groups
• Clinic set-up and administration consideration
  On and off sites (depending on the size of a
  facility)
• Authentication For each person in priority
  group (e.g. Pay stub, photo/employee ID)
• Reporting to MOHLTC doses provided, efficacy,
  A/E

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Our Enumeration Process

• Use of newly developed planning tool for
• Obtaining staff numbers to be vaccinated/ receive
  anti-virals
• Clinic planning Who? What? How? Where?
• Determining total staff numbers for reporting to
  MOHLTC

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Considerations for OAML

• Staff identification e.g. photo ID, pay stub
• Communication What is your process?
• Alpha list Need to identify staff and provide
  list at time of clinic
• Screening On arrival to clinic (i.e. ill/well)
• Informed consent issue Verbal/written
• Security Consider for on-site

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Next Steps

• Is there a centralized role for the OAML in the
  enumeration process?
• Is there a centralized role for the OAML for
  co-ordinating clinics with local HUs?
• Do you have occupational health support? If so,
  are they able to assist in these processes? If
  not, then who?
• What are options for implementing planning tool
  with labs?

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Influenza Pandemic Planning

• ANTICIPATE
• PLAN
• PROTECT

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For More Information

• Health Line Peel
• (905) 799- 7700
• www.region.peel.on.ca
• Toronto Public Health
• (416) 338- 7600
• www.toronto.ca