The H1N1 Pandemic in Canada Presented to the Canadian Institute of Actuaries Dr. Danielle Grondin

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 year’s 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 <2) • People with underlying chronic medical conditions – diabetes, asthma, lung disease, kidney disease, neuromuscular disorders and immunosuppressed (HIV/AIDS) • Severe obesity (BMI > 35) • Living in remote and isolated areas or being of Aboriginal descent

8. Descriptive characteristics of laboratory-confirmed 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 • Vaccineis 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 Canada’s 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/home

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 (FAQ’s) 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/disease/swineflu/en/index.html

21. QUESTIONS?