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The H1N1 Pandemic in Canada

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The H1N1 Pandemic in Canada Presented to the Canadian Institute of Actuaries Dr. Danielle Grondin November 20, 2009 – PowerPoint PPT presentation

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Title: The H1N1 Pandemic in Canada


1
The H1N1 Pandemic in Canada Presented to the
Canadian Institute of Actuaries Dr. Danielle
Grondin November 20, 2009
2
Seasonal vs. Pandemic Influenza
  • Every year influenza viruses mutate slightly
    called the antigenic drift, which is why a new
    seasonal flu vaccine is required every year
  • Three or four times a century the viruses undergo
    a major mutation called the antigenic shift. When
    shift occurs, virtually no one is immune
  • Seasonal Influenza
  • Occurs every year
  • November to April
  • 10 of population affected
  • Fatality rate of two in a 1000
  • Pandemic Influenza
  • Two or three times a century
  • Two or three waves lasting about two months
  • 35 of population affected
  • Fatality rate of four in a 1000 for this pandemic
    so far

3
THE PANDEMICS
  • 1918 H1N1 virus of avian origin
  • 1957 H2N2 virus
  • 1968 H3N2 virus
  • 2009 pH1N1 virus we have had to change the
    definition of pandemic because of this outbreak
    being H1N1, like in 1918
  • The Future The Public Health Agency through
    consultation with stakeholders is continuously
    refining its modeling techniques to better
    anticipate and prepare for the next pandemic

4
H1N1 VIRUS
  • Entered humans in 1918 from birds
  • Disappeared in 1957 when H2N2 arrived
  • Escaped from a lab in 1977 and reentered the
    human population
  • Continued circulating ever since
  • Last years major influenza virus was an H1N1
    strain Seasonal H1N1
  • PH1N1 virus has been circulating in Canada since
    the end of April 2009.
  • The WHO declared Pandemic Phase 6 (i.e.
    widespread influenza due to a new strain) on June
    11, 2009.

5
KEY INFORMATION ABOUTPH1N1
  • Spread largely by droplets from coughs/sneezes
  • Virus filled droplets can drop up - to 2 metres
    away from source
  • Virus can survive on hard surfaces up to 48 hours
  • Hands often pick up virus from contaminated
    surfaces (door knobs, phones, pens, chair arms,
    etc)
  • Virus can enter the body
  • through mouth, nose or rarely,
  • eyes (via hands, hand held food,
  • or direct from the cough of
  • another person).

6
TRANSMISSION
  • Incubation period of up to four days.
  • Infectious 24 hours before symptoms develop.
  • Remain infectious for about seven days after
    symptoms start.
  • Most infectious the first two days of symptoms.
  • Up to half of infected people do not develop
    symptoms still mildly infectious.

7
WHO IS AT GREATEST RISK?
  • Overall number of cases
  • As of November 7, 2009
  • A total of 3,764 hospitalized cases
  • 606 cases admitted to ICU
  • 295 cases required ventilation
  • 135 deaths
  • Vulnerable Groups
  • Pregnant women in second and third trimesters of
    pregnancy and new mothers 6 weeks postpartum
  • Children under five (especially those lt2)
  • People with underlying chronic medical conditions
    diabetes, asthma, lung disease, kidney disease,
    neuromuscular disorders and immunosuppressed
    (HIV/AIDS)
  • Severe obesity (BMI gt 35)
  • Living in remote and isolated areas or being of
    Aboriginal descent

8
Descriptive characteristics of laboratory-confirme
d Canadian pH1N1 2009 hospitalized cases,
ICU-admitted cases and deaths with core
information available, reported to PHAC as of
October 31, 2009
9
Current Pandemic Response
  • Surveillance
  • Surveillance for pandemic activity and
    epidemiological analysis of data are ongoing both
    within Canada and internationally.
  • Pharmovigilance strategy has been implemented to
    monitor vaccine safety and antiviral drug
    reactions
  • Vaccine Program
  • Since October 26, 2009 immunization campaigns
    using a vaccine sequencing strategy were
    initiated in the P/Ts. Aim is to provide enough
    vaccine for all Canadians by the end of 2009.
  • Antiviral Drugs and Clinical Care
  • The National Antiviral Stockpile (NAS) is
    increasing its capacity to 58M doses from 55.7M.
  • Requests to NESS for paediatric doses of
    oseltamivir are being received and addressed
    through the deployable resources group under the
    current IMS.

10
Current Pandemic Response
  • Public Health Measures
  • Guidance developed during first wave is in place
    need to update is being monitored.
  • Health Services Emergency Planning
  • Requests for surge capacity in P/Ts and within
    the HP response are being addressed.
  • Deployable resources including Personal
    Protective Equipment (PPE) and ventilators are
    being pre-positioned.
  • Guidance has been developed to facilitate best
    practices (e.g., ICU guidelines)
  • Communications
  • HP Communications is working with provincial
    counterparts to determine how to best support
    their activities and coordinate initiatives.

11
PANDEMIC H1N1 PREPAREDNESS AND RESPONSE
  • Federal and Provincial Governments are preparing
    for a moderate second wave of pH1N1
  • Canadian Pandemic Influenza Plan (CPIP)
  • Special Advisory Committee (SAC)
  • Surveillance
  • Clinical and Infection Control Guidelines
  • Antivirals
  • Vaccine
  • Communications proactive information to the
    public and weekly updates with CPHO.

12
Prevention
  • Vaccine is the cornerstone of protection.
  • Hand hygiene
  • Wash your hands frequently and thoroughly.
  • Alcohol based hand-rubs.
  • Avoid touching your eyes, nose and mouth.
  • Social distancing
  • Stay at least two meters away from people with
    flu-like symptoms.
  • Avoid crowds.
  • Cough Etiquette
  • - Stay home when you are sick
  • - Cough or sneeze into your elbow or a
    tissue.
  • Keep common surfaces clean

13
WHAT SHOULD YOU DO?
  • If (Influenza-like Illness) ILI severity AVs
    and hospital
  • If ILI risk factor Antiviral medication and
    close follow up.
  • If ILI otherwise healthy Self
    isolate/supportive care until symptoms resolved.
  • One should return to work or school only 24 hours
    after the symptoms have resolved.

14
ANTIVIRALS
  • Safe for use in pregnant and breastfeeding women
    and for children and infants under one (Tamiflu)
  • Available by prescription and used as treatment
    when vaccine is unavailable, and should be taken
    within 48 of sympton onset.
  • MOST people with influenza have not needed them.
  • Used to decrease serious flu complications such a
    pneumonia.
  • Two drugs available
  • - Oseltamivir (Tamiflu)
  • - Zanamivir (Relenza)
  • 55 million doses in the National Antiviral
    Stockpile (NAS).
  • National Emergency Stockpile System (NESS) has
    additional doses.
  • Provinces and Territories have access to both.
  • If oseltamivir resistance develops, there will be
    guidelines on who should receive the remaining
    zanamivir.

15
H1N1 PANDEMIC VACCINE
  • Canada has secured enough
  • vaccine for those who need and
  • want it.
  • Two types of vaccine are available
  • - adjuvanted
  • - unadjuvanted
  • Guidelines for sequencing have been produced to
    ensure that those who need the vaccine the most,
    get it first, such as people over 65 with chronic
    illness, pregnant women, children between 6
    months and 5 years of age and so forth

16
PANDEMIC H1N1ROLES AND RESPONSIBILITIES
  • The Federal Government
  • Facilitates health system preparedness.
  • Provides national leadership and guidance.
  • Exercises regulatory function.
  • The Provinces/Territories (P/Ts)
  • Deliver health care services to the population
    during a pandemic.
  • Deliver vaccine through local health authorities.
  • Mechanisms for Coordination
  • F/P/T Special Advisory Committee (SAC) provides a
    forum for communication and decision making.
  • Canadian Pandemic Influenza Plan (CPIP) provides
    the framework for Canadas pandemic response.

17
PANDEMIC PREPAREDNESS BUSINESS COMMUNITY
  • Federal collaboration with private sector through
    the Private Sector Working Group
  • on Avian and Pandemic Influenza (PSWG)
  • over 90 organizations, representing the 10
    critical infrastructure sectors (transportation,
    manufacturing, safety, water, food, etc.)

www.fightflu.ca
18
Business Continuity Plan (BCP)
  • What is a Business Continuity Plan?
  • A proactive plan that ensures critical services
    or products are delivered during a disruption.
  • It includes arrangements and identification of
    resources to ensure continuous delivery of
    critical services and products.
  • For advice, visit http//www.businessfluplan.ca/ho
    me

19
BUSINESS CONTINUITY PLANNING
  • 6 steps for developing a Business Continuity
    Plan
  • STEP 1 - Assess the Impacts Changes in Demand,
    Employee Absenteeism, and Supply Chain
  • STEP 2 - How Will You Plan to Keep Your Business
    Operating?
  • STEP 3 - Will You Change Your Human Resource
    Policies?
  • STEP 4 - How Will You Help Protect Your
    Employees?
  • STEP 5 - How Will You Communicate?
  • STEP 6 - How Will You Recover?

20
ADDITIONAL RESOURCES
  • 1. Public Health Agency of Canada
  • - H1N1 information, Frequently asked questions
    (FAQs) and Guidelines
  • www.phac-aspc.gc.ca
  • 2. Fightflu
  • www.fightflu.ca
  • 3. Business Flu Plan
  • www.businessfluplan.ca/home
  • 4. World Health Organization www.who.int/csr/dise
    ase/swineflu/en/index.html

21
  • QUESTIONS?
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