Surveillance Working Group

1. Surveillance Working Group Anne-Luise Winter OAML Pandemic Planning Educational Day Toronto June 16, 2005

2. OHPIP Development Structure

3. Assumptions of Pandemic Planning • Epidemiology of the Pandemic strain will be similar to current circulating strains • Individuals who recover from the Pandemic strain will be immune from further infection from that strain • Laboratory testing is required for definitive diagnosis, testing is limited in capacity and will be done during initial phases only • Health care and public health resources are limited and often overwhelmed even in the inter-pandemic phase

4. Objectives of Pandemic surveillance • To detect early the entry of the Pandemic strain in Ontario • To track the occurrence, severity, and progression of influenza outbreaks, based on WHO/Canadian pandemic phases • To detect unusual events (new strains including epizoonotic strains, antigenic drift/shift, unusual outcomes or syndromes, unusual severity, unusual distribution) • To compare new strains with vaccine composition and recommendations • To estimate the impact of ILI in terms of attack rate, outpatient visits, hospitalizations, and case fatality rate • To describe affected population/s in order to identify high risk groups, modes of transmission, and risk and protective factors

5. Interpandemic/pandemic alert (seasonal) surveillance components PHAC: • Laboratory surveillance • Sentinel physician ILI Surveillance Ontario • Influenza activity reporting • Reports of laboratory-confirmed sporadic cases of influenza through RDIS/iPHIS • Respiratory infection outbreaks in institutions

6. Pandemic surveillance components • Laboratory • Disease/epidemiological • Animal health • Vaccine and antiviral uptake • Adverse events • Communication • Data collection system/s

7. Interpandemic Period • No new influenza virus subtypes detected in humans  A circulating animal influenza virus subtype poses a substantial risk of human disease Surveillance: • Routine influenza surveillance with layered progression of activities • Communication of phase progression

8. Pandemic alert • Human infection/s with a new subtype. Rare  limited  larger cluster/s of human to human spread Surveillance • Detection of the novel strain (e.g. FRI/SRI surveillance) • Ongoing review of case definition • Continue with heightened surveillance until no longer sustainable

9. Pandemic • Increased and sustained transmission in general population Surveillance: • Utilization of pandemic reporting tools • Monitor uptake, efficacy, adverse events associated with vaccines and antivirals • Ongoing evaluation of epidemiology, to direct priorities to high-risk groups

10. Postpandemic Period • Recovery/Resolution Surveillance: • Estimate burden of disease • Evaluate surveillance systems • Eventual resumption of interpandemic activities

11. Next steps for SWG • Working on identifying specific data elements to be collected for different settings (institutional and community) • How best to track vaccine and antiviral uptake • Need to address gaps in current system

12. Conclusions • Maximize efficiency of surveillance system/s to avoid undue burden on data collectors • Surveillance data provides the “trigger for action”, hence accurate and timely data needs