Role of Health Unit Rolling out Vaccines and Anti-Virals

1. Role of Health UnitRolling out Vaccines and Anti-Virals Kathy Jovanovic (Peel Health) Claudine D’Souza (Toronto Public Health) OAML Pandemic Planning Education Day Toronto June 16, 2005

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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 --> broad-based community messaging

9. 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

10. Expect These Types of Absenteeism • Absenteeism= Related to pandemic • Absenteeism= Normal • Absenteeism= Related to sick family members • Absenteeism= Scared, worried well

11. 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

12. 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

13. 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

14. 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”

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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 HU’s? • 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?

21. Influenza Pandemic Planning ANTICIPATE PLAN PROTECT

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