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The Canadian Pandemic Influenza Plan for the Health Sector

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Response

Table of Contents

1.0 Introduction

In this Response Section of the Canadian Pandemic Influenza Plan (the Plan), activities corresponding to each component (i.e. surveillance, vaccine programs, the use of antivirals, health services, public health measures and communications) are organized in a table format by each Canadian pandemic phase. The tables include the key actions necessary to facilitate a comprehensive and consistent response to pandemic alerts and an influenza pandemic. However, it is recognized that additional details and modifications will need to be added as the pandemic unfolds. For example, it cannot be determined in advance of the appearance of a novel virus when an effective vaccine might be available; therefore, all activities listed under “Vaccine Programs” in the tables may occur at different phases than the ones that are currently listed (in the tables).

2.0 Use of Pandemic Phases

The pandemic phases declared by the World Health Organization (WHO) are based on the evaluation of pandemic risk situations, with the declared phase representing the highest global risk. Therefore if there is concurrent circulation of two or more novel influenza viruses, the phase will correspond to the situation presenting the highest risk of pandemic. In April 2005, WHO published new terminology for pandemic phases, which replaced the terminology published in 1999. The new terminology includes six phases spanning three pandemic periods: Interpandemic Period, Pandemic Alert Period and the Pandemic Period. A Post-Pandemic Period has also been identified but it is not linked to a numerical phase.

To succinctly summarize the global situation and the situation in Canada, the Pandemic Influenza Committee (PIC) developed Canadian pandemic phase terminology that combines the WHO phase and an indicator of the highest level of novel influenza activity in Canada. The Canadian pandemic phases are described in the Background Section of the Plan. In general, the nomenclature is the WHO phase followed by a decimal point and then 0, 1 or 2 to indicate absence of cases, single (unlinked) cases, or localized or widespread activity in Canada (e.g. 3.1). This Response Section has been updated since it was first published in February 2004 to include this terminology.

For responders at the time of a pandemic, the focus will be on more localized “triggers” that may or may not correspond to the Canadian pandemic phase because the phase is based on the highest level of novel influenza activity observed in Canada. It is expected that differences in influenza activity within Canada will be described on the basis of surveillance data that is reported similarly to that during the annual influenza season. Planners at all levels in the health and emergency service sectors, from municipal to federal, are encouraged to think about the “phase” under which their specific jurisdictions would fall based on influenza activity within the jurisdictions. This is so they can operationalize an appropriate response for the jurisdiction, recognizing that their plans will also be affected by the epidemiology of the pandemic nationally and globally.

Other unknown factors (e.g. age distribution, severity of the illness caused by the pandemic strain, efficiency of transmission from human to human) will also affect the response measures. The Plan assumes that progression to a pandemic will occur if novel influenza activity occurring during the Pandemic Alert Period is not halted. Therefore the response to novel virus activity during the Pandemic Alert Period may need to be significantly modified from what is outlined in this Plan if the epidemiology (e.g. of a domestic AI outbreak) does not suggest the need for aggressive measures.

3.0 Federal Emergency Response

Planning at the federal level has resulted in the development of a generic emergency management structure. This structure, which indicates roles and responsibilities of specific groups in response to an emergency, is included in Annex L, Federal Emergency Preparedness and Response System. The specific composition, roles and responsibilities of the Advance Planning Group still need to be determined; however, members that can provide technical advice specific to pandemic influenza will be essential.

Also included in Annex L is a flow diagram that aligns response activities with the phases. This tool provides a visual overview of the response from a federal perspective.

The Canadian Pandemic Influenza Plan is a disease-specific plan. It is an example of a specific, technical emergency plan that has been developed as part of much larger initiative to create plans to deal with all types of national emergencies. By creating a set of plans that are increasingly specific, i.e. range from generic emergency response issues to more specific threats (e.g. infectious diseases) and finally to detailed disease-specific threats, it is anticipated that a set of “nested” or linked documents will be available; these nested documents will be comprehensive and flexible enough to cover off any type of national emergency.

4.0 The Severe Acute Respiratory Syndrome Experience

Prior to March 2003, when the severe acute respiratory syndrome (SARS) arrived in Canada, the vast majority of health care professionals and certainly the general public had limited personal experience with large outbreaks of serious respiratory infections. The SARS outbreak caused an exponential increase in the knowledge of and experience with this type of health threat. Awareness of SARS, the severity of the illness, method of spread and the implementation of control measures penetrated Canadian society from coast to coast regardless of the actual case count in each province or territory.

Those involved in disease surveillance and pandemic planning saw SARS as a type of "dress-rehearsal" for pandemic influenza. They recognized that many of the response issues would be the same but on a much larger scale. Although the costs due to SARS were high in terms of morbidity and mortality and economic losses, the costs of pandemic influenza have the potential to be much greater. The response to pandemic influenza also would need to be sustained for a longer period of time and would likely include a mass immunization effort on top of the demands of acute care for patients.

The SARS experience reinforced the need for preparedness activities as cited in the Preparedness Section of the Plan. In particular, the need for resources and surge capacity within the health system to deal with public health emergencies is highlighted. Advanced preparation and removal of potential barriers in communication systems, data management technology, and the acquisition and mobilization of supplemental health care workers and settings are just a few of the other needs identified in the Plan and validated by the SARS experience.

It is with this experience behind us that those involved in drafting this Plan have identified the key action items listed in this Response Section.

5.0 Avian and Animal Influenza

Outbreaks caused by novel influenza viruses in avian or animal populations present opportunities for transmission to humans. Sporadic human infection with a number of avian (e.g. H5, H7, H9) and swine (e.g. H1N1) influenza subtypes have been documented. In addition, there may be opportunities for reassortment between animal and human influenza viruses when they simultaneously infect the same swine or human host. Such reassortment events may result in the development of a new influenza virus subtype with pandemic potential.

Since 2003, an unprecedented number of avian outbreaks of influenza have been detected worldwide. Human cases, ranging in severity from conjunctivitis to fatal cases, have resulted from these various outbreaks. The WHO global phases now include the occurrence of avian and animal influenza outbreaks and the role of these outbreaks as potential precursors to a pandemic.

As a result of the avian outbreak of H7N3 in British Columbia in 2004, a guideline document was developed by PHAC to provide recommendations for public health authorities and other stakeholders involved in the management of actual and potential human health issues related to domestic avian influenza outbreaks. This document has recently been updated and expanded to include guidance on the management of all AI events with potential human health implications (see Human Health Issues Related to Avian Influenza in Canada, on the PHAC website). Because the actions in the guideline document pertain to the new Canadian Phases 1.1, 2.1 and 3.1, the human health issues document is referenced in the tables in section 6 below. Although the control of animal influenza outbreaks is a key part of preventing the emergence of a human influenza pandemic—and there are critical animal and human health linkages—the responses to the actual animal outbreaks are best addressed in animal health guidelines and plans. The Canadian Food Inspection Agency (CFIA) is the lead agency for AI outbreak response and animal health and food safety issues.

6.0 Key Response Actions by Pandemic Phase

The key response actions listed in the following tables are organized by the component of the response to which they relate (Component) and by the phase during which each action should take place (Phase). High-level activities for emergency management and coordination have also been added to the tables. It is assumed that each jurisdiction will refer to the phase that is consistent with their respective levels of novel influenza activity. For example, if the southern part of one province is experiencing localized pandemic activity, the Canadian Phase would be 6.2 (the Canadian Phase always reflects the highest level of activity in the country) and the geographic areas or region with the activity would follow the actions under Phase 6.2. However if no other pandemic activity was occurring in Canada at that time, then the areas with no known cases would take the actions consistent with Phase 6.0 until they started to experience pandemic activity.

As previously discussed, flexibility in the response is needed because the availability of resources (e.g. vaccine, antiviral drugs) may require deviation from the proposed sequence of response actions. It is expected that many of the response actions under each phase will need to occur simultaneously. The action items have not been prioritized within each phase. More detailed actions are provided in many of the technical annexes.

Response actions and messages are organized by pandemic period rather than by Canadian phase in Annex K, Communications; therefore, readers are referred to this annex in each of the phase-specific tables below.

The tables also include Response Level designations (see legend below) that are provided for guidance only. It is likely that many response actions, especially those for which national consistency is desirable, will be led by PIC or collaborative federal, provincial, territorial processes. Other non-governmental responders (e.g. Salvation Army, Red Cross) will be likely involved in the response but have not been specifically identified in the Plan because it is anticipated that their respective roles and activities would be developed in conjunction with public health authorities at the P/T, regional and local level.

Legend for the Canadian Pandemic Phase Tables

Acronyms for organizations

  • CATMAT = Committee to Advise on Tropical Medicine and Travel
  • CEPR = Centre for Emergency Preparedness and Response
  • CIHR = Canadian Institutes for Health Research
  • CPHLN = Canadian Public Health Laboratory Network
  • HPFB = Health Products and Food Branch
  • NACI = National Advisory Committee on Immunization
  • NML = National Microbiology Laboratory
  • PHAC = Public Health Agency of Canada
  • PWGSC = Public Works and Government Services Canada

Abbreviations for response levels

  • F = Federal
  • L = Local
  • P/T = Province/Territory

Note: The term "animal" in the tables below is intended to cover both avian and animal species.

6.1 Interpandemic Period

6.1 Interpandemic Period - Canadian Phase 1.0
Canadian
Phase 1.0
No new virus subtypes in humans, animals outside Canada may be infected with a new subtype that is considered low risk for humans
Component Focus Actions Response Level
Surveillance Pandemic
Preparedness activities
  • As per Preparedness Section
    • Ensure links to veterinary counterparts are in place as part of general pandemic preparedness
    • Routine human influenza surveillance
F,P/T, L
Information sharing
  • Disseminate available surveillance information from countries experiencing animal cases and/or outbreaks to public health stakeholders
F (Lead: PHAC)
  • Provide updates on ongoing risk assessment for pandemic influenza potential
F (Lead: PHAC)
Public Health Measures Public education
  • If animal outbreaks are occurring:
    • Provide general travel health information pertaining to safe food handling, respiratory etiquette
F (Lead : PHAC)
All other components Pandemic Preparedness activities  
Emergency Management and Coordination  
  • Develop/maintain response plans
F,P/T, L
  • Explore need to stockpile (e.g. syringes, other medical supplies)
F,P/T, L
  • Identify how essential services will be maintained during a pandemic
F,P/T, L
  • Practice emergency plans
F,P/T, L
  • Train staff that may be re-assigned during a pandemic
F,P/T, L


6.1 Interpandemic Period - Canadian Phase 1.1
Canadian Phase 1.1 No new virus subtypes in humans, animal(s) inside Canada infected with a new subtype that is considered low risk for humans
Component Focus Actions Response Level
Surveillance, Vaccine Programs, Antivirals, Health Services, Public Health Measures, Communications Veterinary Outbreak Control
  • As per Human Health Issues Related to Avian Influenza in Canada document; Rapid sharing of information among animal and human health professionals
F,P/T, L
Prevention of Human Infection
  • Provide updates on ongoing risk assessment for pandemic influenza potential and make recommendations for increased vigilance for surveillance and public health action
F,P/T, L
Emergency Management and Coordination
  • Continue as per Phase 1.0 actions and;
 
  • Ensure that response network is ready to respond
F,P/T, L
  • Provide technical information liaison
F,P/T, L
  • Report situation to PSEPC (daily report)
F (Lead : PHAC)
  • Share PHAC/HC info with regional officers
F (Lead : PHAC)
  • Facilitate sharing of information between animal and human health authorities
F (Lead : PHAC)


6.1 Interpandemic Period - Canadian Phase 2.0
Canadian Phase 2.0 No new virus subtypes in humans, animals outside Canada infected with a new subtype that has a substantial risk for humans
Component Focus Actions Response Level
Surveillance, Vaccine Programs, Antivirals, Health Services, Public Health Measures, Communications Pandemic preparedness, Information sharing, Public education
  • As per Phase 1.0 with messages reflecting the increased risk to human health
F,P/T, L
  • Design and seek agreement on a common strategy for the communication of epidemiological data (nationally and with WHO internationally)
F,P/T, L
Emergency Management and Coordination
  • As per Phase 1.1 with increased communications/liaison with other government departments
F,P/T, L


6.1 Interpandemic Period - Canadian Phase 2.1
Canadian Phase 2.1 No new virus subtypes in humans, animals inside Canada infected with a new subtype that has a substantial risk for humans
Component Focus Actions Response Level
Surveillance, Vaccine Programs, Antivirals, Health Services, Public Health Measures, Communications Veterinary Outbreak Control
  • As per Human Health Issues Related to Avian Influenza in Canada document
F,P/T, L
Prevention of Human Infection
  • All measures would reflect the increased risk associated with this novel virus
F,P/T, L
Emergency Management and Coordination
  • As per Phase 2.0
F,P/T, L

6.2 Pandemic Alert Period

6.2 Pandemic Alert Period - Canadian Phase 3.0
Canadian Phase 3.0 Human infection(s) with a new virus subtype occurring outside Canada - no or at most rare instances of human to human transmission.
Component Focus Actions Response Level
Surveillance Establish and/or heighten existing surveillance systems
  • Verify epidemiological data and current risk assessment from official sources (WHO, Ministries of Health)
  • Review and confirm that all inter-pandemic surveillance activities (via FluWatch) are operating optimally
F (Lead: PHAC)
Information sharing
  • Convey current international risk assessment in Canadian context
  • Provide information and national recommendations to F/P/T stakeholders
F, P/T, L (Lead: PHAC)
Vaccine Programs Mitigation of potential complications of influenza through use of current vaccine resources
  • Promote use of annual influenza vaccine
  • Promote pneumococcal vaccination to "high-risk" and age-specific target groups to reduce the incidence and severity of secondary bacterial pneumonia
P/T, L
  • Collaborate on international vaccine development initiatives, including the development and testing of prototype vaccine strains as needed.
F (Lead: PHAC)
  • Review pandemic vaccine infrastructure readiness with domestic manufacturer
F (Lead: PHAC)
Antivirals Review of preparedness status and updating of strategy
  • Assess and/or re-assess availability of antiviral medications
F,P/T,L
  • Review recommended priority groups and plans for antiviral use based on available epidemiological data
    - Consider adequacy of stockpiled quantities in light of estimated sizes of the respective priority groups in your jurisdiction
F,P/T


F,P/T
  • Review and modify if necessary, contingency plans for storage, distribution and administration of antiviral drugs through public health and other providers to nationally defined priority groups
F,P/T,L
Communication and education
  • Communicate antivirals strategy as part of pandemic educational materials (including which priority groups will likely be covered, current supply and any shortfalls)
F,P/T,L
  • Ensure staff are trained and infrastructure is in place to track who is receiving the drugs for the purpose of treatment and prophylaxis
F,P/T,L
Health Services Evaluation of laboratory capacity
Information gathering
  • Ensuring at least one laboratory within the P/T has the capability to isolate and subtype influenza virus, and if not establish anticipatory "back-up" process
P/T (Lead: CPHLN)
  • Ensure that estimates of health care personnel capacity are current (i.e., estimated number of health care workers (HCWs) by type (physician, nurses, respiratory therapists, radiology technicians, etc), and by work setting (hospital, community, LTCF, para
    • Identify if possible HCWs by type of work that they usually do
F,P/T,L
Public Health Measures Information preparation
  • As per Annex M (Public Health Measures)
  • Review and update educational materials on all aspects of influenza for health care professionals, travellers, other special audiences and the general public
F,P/T,L
Communications    
Emergency Management and Coordination
  • Provide case count to PSEPC
F (Lead: PHAC)
  • Notify P/T's emergency service managers (ESS+CHEMD)
F (Lead: PHAC)
  • Coordinate international consultations (WHO/CDC)
F (Lead: PHAC)
  • Alert P/T's
F (Lead: PHAC)
  • Inform CMOH
F (Lead: PHAC)


6.2 Pandemic Alert Period - Canadian Phase 3.1
Canadian Phase 3.1 Sporadic human infection(s) with a new virus subtype occurring inside Canada - no or at most rare instances of human to human transmission.
Component Focus Actions Response Level
Surveillance Monitoring of evolving situation
  • Investigation of sporadic cases, including collection of detailed epidemiologic data, contact tracing, and public health monitoring
  • Ensure that enhanced surveillance is in place across Canada for rapid detection of potential spread
F (Lead : PHAC),
P/T
Dissemination of data
  • Review/Revise standard reports for dissemination of epidemiological data within Canada
  • Establish and convey current risk assessment to national and international surveillance partners
  • Dissemination of epidemiological data, as needed
  • If occurring in conjunction with an animal outbreak in Canada – refer to Human Health Issues Related to Avian Influenza in Canada document for more details
F (Lead: PHAC)





F, P/T
Vaccine Programs Reduce potential for genetic re-assortment
  • Immunize close contacts of cases with annual influenza vaccine if available as per Annex M (Public Health Measures)
F, P/T, L
Inventory and resource assessment
  • Conduct initial availability assessment of supplies (e.g. syringes, adrenalin, sharps disposal units), equipment and locations potentially required for a vaccine-based response (i.e., mass clinics)
Preparation (Legal, Educational etc.)
  • Develop list of currently qualified vaccinators and sources of potential vaccinators
F, P/T, L
  • Review educational materials re. Administration of vaccines and adapt/update as needed
F, P/T, L
  • Ensure that any legal issues that may impede rollout of a mass immunization program are addressed
P/T, L
  • Ensure domestic vaccine manufactures are alerted and participating in international efforts
F (Lead: PHAC)
Antivirals Antiviral strategy
  • Use neuraminidase inhibitors for treatment of cases as per Annex M (Public Health Measures)
  • Perform an inventory assessment (drugs, formulations, and expiry dates)
  • Test stockpiled antivirals for potency if necessary (i.e., if past expiry date)
F,P/T (Lead: PHAC)
Health Services Rapid case confirmation
  • Laboratory testing as per Annex C (Laboratory Procedures)
P/T (Lead: CPHLN)
Guideline review and/or revision
  • Review protocols and guidelines for prioritization of laboratory services during times of high service demand and staff and supply shortages
P/T (Lead: CPHLN)
Preparation (Legal, Educational etc.)
  • Ensure that any legal and insurance issues that may impede recruitment and use of active and retired health care workers and volunteers have been addressed with P/T licensing bodies
P/T
  • Prepare and/or update communications defining the extent of care that health care workers and volunteers can perform according to P/T laws and union agreements
P/T
Case and Contact management
  • Manage cases and contacts as per recommendations in Annex M (Public Health Measures)
    • Isolation of cases
    • Surveillance of contacts
F, P/T, L
Public Health Measures Resource assessment and preparation
  • Review staffing requirements for implementation of a pandemic response including mass immunization clinics, control measures, and public education
 
  • Consider delaying introduction of public health programs that may not be adequately resourced if situation evolves into a pandemic or other alternatives such as contracting out
P/T, L
  • Preparation of educational material for public
F, P/T, L
Communications    
Emergency Management and Coordination
  • As per Phase 3.0 and;
 
  • Report to International Health Regulations as required
F (Lead : PHAC)
  • Assess risk and disseminate information to and with stakeholders
F,P/T, L
  • Review NESS availability
F (Lead : PHAC)
  • Review medical personnel availability
F,P/T, L
  • Review federal legislative authorities
F,P/T, L
  • Aquire (when available) and disseminate any laboratory testing materials (i.e., reagents)
F (Lead: NML/CPHLN)


6.2 Pandemic Alert Period - Canadian Phase 4.0 and 5.0
Canadian Phases 4.0 and 5.0 Clusters with limited human-to-human transmission occurring outside of Canada, spread is localized, no cases in Canada
Component Focus Actions Response Level
Surveillance Establish and/or Heighten enhanced surveillance systems
  • Verify epidemiological data and current risk assessment from official sources
F (Lead : PHAC)
  • Enhance current surveillance activities based on circumstances
F, P/T, L
  • Review and/or revise case definitions, minimum data sets, and data collection forms
F, P/T (Lead: PIC)
Border issues
  • Implement border-based surveillance (depending on origin of cases) coordinated by CEPR, as per Annex M (Public Health Measures)
    • Include notifications to ill and well travellers
F, P/T (Lead: PHAC)
Plan for streamlined data collection
  • Initiate ramped up surveillance activities to detect and monitor increased morbidity and mortality
P/T, L
Dissemination of data
  • Review and/or revise standard reports for dissemination of epidemiological data within Canada
F, P/T, L
Vaccine Programs Planning for vaccine distribution
  • Ongoing involvement in vaccine development initiatives
F (Lead: PHAC with vaccine manufacturers)
Mass campaign infrastructure
  • Review and modify if necessary, contingency plans for storage, distribution and administration of influenza vaccine through public health and other providers to nationally defined high-priority target groups (See Annex J for use of non-traditional sites and workers)
F,P/T (Lead: PIC)
  • Ensure staff are trained and infrastructure is in place to record immunizations, including requirements for a two-dose immunization program (i.e. re-call and record-keeping procedures)
P/T, L
  • Review estimates of the number of people within the P/T who fall within each of the priority groups for vaccination (i.e., high risk groups, health care workers, responders, specific age groups) and access strategies
F, P/T, L
  • Ongoing promotion of current annual influenza vaccine for NACI recommended groups and for travellers (as per CATMAT recommendations)
F, P/T (Lead: PIC/NACI )
Antivirals Supply of antiviral drugs
  • Perform an inventory assesment of available supplies
F,P/T (Lead: PHAC)
Planning for antiviral drug distribution and tracking
  • Review recommended priority groups and plans for antiviral use based on available epidemiological data
F,P/T (Lead: PIC)
  • Review and modify if necessary, contingency plans for storage, distribution and administration of antiviral drugs through public health and other providers to nationally defined high-priority target groups
F,P/T,L
  • Review estimates of the number of people within the P/T who fall within each of the priority groups for receipt of antiviral drugs (i.e., high risk groups, health care workers, responders, specific age groups) and access strategies
F,P/T,L
  • Ensure staff are trained and infrastructure is in place to track who is receiving the drugs for the purpose of treatment and prophylaxis
P/T,L
Health Services Prepare for management of suspect cases detected through enhanced surveillance
  • Implement/Review infection control precautions for case management
F, P/T, L (Lead: PHAC)
  • Review national recommendations for clinical management of cases and modify if necessary
F, P/T (Lead: PIC)
  • Anticipate and plan to mobilize human and financial resources
F, P/T, L
Preparation for increased demand on acute care sites
  • Review and update local and P/T data on the number & type of health care facilities, and capacity: hospital beds, ICU beds, swing beds, LTC beds with enhanced level of care, emergency department, ventilatory capacity, oxygen supply, antibiotic supply
P/T, L
  • Conduct availability assessment of medications, supplies and equipment potentially needed for the response
P/T, L
  • Review, modify, and distribute P/T guidelines (or national guidelines) for prioritizing health care needs and service delivery, accessing resources and implementing infection control measures during a pandemic
F, P/T, L
  • Disseminate information on medical supply stockpiles and potential need for, and sources of, additional supplies
F, P/T (Lead: PHAC)
  • Review, modify, and distribute detailed regional and facility-level plans for providing health services during a pandemic, including the type of care to be delivered at non-traditional health care settings and the triage across sites; human resource, mate
P/T, L
  • Disseminate strategy for collecting and monitoring data on health care service use and demands
P/T, L
Public Health Measures Preparation of educational materials and public health resources
  • Review national recommendations as per Annex M (Public Health Measures) for public health management of cases and other control measures and modify if necessary
F, P/T (Lead: PIC)
  • Ensure adequate resources are available to implement recommended public health measures including isolation of cases
P/T, L
  • Prepare and revise (if necessary) educational and guidance materials for public health partners (specifically provincial/territorial and local health departments who will be on the front lines with respect to prevention and control measures), the general
F, P/T, L
Communications    
Emergency Management and Coordination
  • For Phase 4.0 -actions as per Phase 3.1 and;
 
  • Prepare to respond to GOARN request for participation
F (Lead: PHAC)
  • Anticipate and plan to mobilize human and financial resources
F,P/T, L
  • Disseminate information on medical supply stockpiles and potential need for sources of additional supplies
F,P/T, L
  • Alert voluntary organisations
F,P/T, L
  • For Phase 5.0 -actions as per Phase 4.2
F,P/T, L


6.2 Pandemic Alert Period - Canadian Phase 4.1 and 5.1
Canadian Phases 4.1 and 5.1 Sporadic infection(s) with virus that has demonstrated limited human-to-human transmission detected in Canada. No clusters identified in Canada but clusters have occurred outside of Canada
Component Focus Actions Response Level
Surveillance Prompt identification of any secondary cases Collect,compile and distribute epidemiological data for cases reported in Canada
  • Collection and dissemination of epidemiological and clinical data for cases occurring in Canada
  • Review and if necessary, revise case definitions, minimum data sets, and data collection forms
F,P/T, L
  • Review protocols for special studies and prepare dedicated teams as necessary to ensure prompt activation of the studies when appropriate
F. P/T, L (Lead: CIHR or other NGO)
Vaccine Programs Vaccine development
  • Ongoing involvement in vaccine development, testing and production initiatives
F (Lead: PHAC HPFB, manufacturers)
Preparation for mass immunization clinics
  • Review and modify if necessary, plans for vaccine security (i.e., during, transport, storage and clinic administration)
P/T, L
Implementation of targeted immunization clinics
  • If a potentially effective vaccine is available:
 
  • Follow national recommendations for use of the available vaccine
P/T, L
  • Implement streamlined VAAE surveillance, in collaboration with PHAC
F, P/T, L (Lead: PHAC)
  • Arrange for direct shipping of vaccine to health districts
F (Lead: PWGSC)
Antivirals Localized use of antivirals (treatment and prophylaxis of contacts) for containment purposes
  • Treat cases and provide prophylaxis for contacts of cases, based on local epidemiology and available supplies as per Annex M (Public Health Measures)
P/T, L
  • Ensure prompt mobilization of antivirals supplies allocated for early containment
F, P/T (Lead: PHAC)
  • Ensure that stakeholders are aware of how to report adverse drug reactions if antivirals are being used
F, P/T, L
Health Services Use of optimal infection control practices to prevent spread
  • As per Phase 3.1 and;
 
  • Evaluate infection control and occupational health recommendations and practices and revise as necessary
F, P/T (Lead: PHAC)
Public Health Measures Resource and risk assessment
  • Ensure adequate resources are available to implement recommended public health measures including isolation of cases
P/T,L
  • Establish current level of risk to guide public health actions (e.g. transmission characteristics associated with secondary cases)
P/T,L
Case and Contact management
  • Manage cases and contacts as per recommendations in Annex M (Public Health Measures)
    • Isolate cases
    • Quarantine or activity restriction of contacts
    • Update educational material (with Communications staff)
P/T,L
Advance planning
  • Review staffing requirements for implementation of a pandemic response including mass immunization clinics, control measures, and public education
P/T,L
  • Consider delaying introduction of public health programs that may not be adequately resourced if situation evolves into a pandemic or other alternatives such as contracting out
P/T,L
Communications    
Emergency Management and Coordination
  • For Phase 4.1 -actions as per Phase 4.0
F,P/T,L
  • For Phase 5.1 -as per Phase 4.2 and;
    • Prepare dedicated team as necessary
F,P/T,L


6.2 Pandemic Alert Period - Canadian Phase 4.2 and 5.2
Canadian Phases 4.2 and 5.2 Localized cluster(s) with limited human-to-human transmission occurring in Canada but spread is localized, suggesting that the virus is not yet well adapted to humans or fully transmissible
Component Focus Actions Response Level
Surveillance Timely collection, compilation and dissemination of epidemiological and clinical data
  • Refer to actions from phase 4.1, 5.1
F (Lead: PIC)
  • Revise case definitions based on observed clinical presentation of cases
F, P/T, L
  • Implement any special studies identified for these phases
F, P/T, L (Lead: CIHR or other NGOs)
Vaccine Programs Vaccine development
  • Ongoing involvement in vaccine development, testing, and production initiatives
F (Lead: PHAC HPFB, manufacturers)
Preparation for mass immunization clinics
  • Review recommended priority groups for immunization based on available epidemiological data
F,P/T (Lead: PIC)
  • Review and modify if necessary, plans for vaccine security (i.e., during, transport, storage and clinic administration)
P/T, L
Implementation of targeted immunization clinics
  • As per Phases 4.1 and 5.1, if a potentially effective vaccine is available
 
  • Follow national recommendations for use of the available vaccine
P/T, L
  • Implement streamlined VAAE surveillance, in collaboration with PHAC
F, P/T, L (Lead: PHAC)
  • Arrange for direct shipping of vaccine to health districts
F (Lead: PWGSC)
Antivirals Localized use of antivirals (treatment and prophylaxis of contacts) for containment purposes
  • As per Phases 4.1 and 5.1
 
  • Treat cases and provide prophylaxis for contacts of cases, based on local epidemiology and available supplies as per Annex M (Public Health Measures)
P/T,L
  • Ensure prompt mobilization of antivirals supplies allocated for early containment
F, P/T (Lead: PHAC)
  • Ensure that stakeholders are aware of how to report adverse drug reactions if antivirals are being used
P/T, L
Health Services Use of optimal infection control practices Management of increased demand on health care system
  • Evaluate infection control and occupational health recommendations and practices and revise as necessary
F, P/T (Lead: PHAC)
  • Ensure protocols and guidelines for prioritization of laboratory services during times of high service demand and staff and supply shortages have been distributed
P/T, L
  • Review and implement mechanisms for coordinating patient transport and tracking/managing beds (e.g. central bed registries, call centre and centralized ambulance dispatch)
P/T, L
Public Health Measures Outbreak control and containment
  • Manage cases and contacts as per recommendations in Annex M (Public Health Measures)
    • Isolate cases
    • Quarantine or activity restriction of contacts
F, P/T, L
  • Evaluate interventions and revise recommendations as necessary
F, P/T
  • Integrate national recommendations for isolation into practice at the local level
P/T, L
  • Implement use of mandatory isolation orders if necessary
F, P/T
  • Review and, if necessary, update and disseminate national recommendations regarding containment strategies (i.e., cancellation of public gatherings, school closures) as per Annex M (Public Health Measures)
P/T, L
  • Monitor and track compliance with containment recommendations
L
  • Develop or update educational materials for the public and health care providers as the situation evolves
F, P/T, L
Communications    
Emergency Management and Coordination
  • For Phase 4.2 -actions as per Phase 4.0
 
  • Consider sending a Liaison Officer to CDC (and vice versa)
F (Lead : PHAC)
  • Implement use of mandatory isolation orders if necessary in federal jurisdictions
F (Lead: PHAC)
  • For Phase 5.2 -actions as per Phase 5.1
 

6.3 Pandemic Period

6.3 Pandemic Period - Canadian Phase 6.0
Canadian Phase 6.0 Outside Canada, increased and sustained transmission in the general population has been observed (i.e., pandemic activity). No cases have been identified in Canada
Component Focus Actions Response Level
Surveillance Timely collection, compilation and dissemination of epidemiological and clinical data
  • Verify international epidemiological data and current risk assessment from official sources
F (Lead: PHAC)
  • Revise case definitions based on international assessment of observed clinical presentation of cases
F (Lead: PHAC)
  • Distribute data collection forms and database transmission instructions and protocols if not done previously
F, P/T (Lead: PHAC)
  • Follow any new recommendations regarding a switch-over to aggregate reporting of data
F, P/T (Lead: PHAC)
  • Review protocols for special studies and prepare dedicated teams as necessary to ensure prompt activation of the studies when appropriate
F. P/T, L (Lead: CIHR or other NGO)
Vaccine Programs Vaccine development
  • Ongoing involvement in vaccine development, testing and production initiatives
F (Lead: PHAC HPFB, manufacturers)
Preparation/Implement ation of mass immunization clinics
  • Review and if necessary revise recommended priority groups for immunization based on available epidemiological data
F, P/T (Lead: PIC)
  • Review and if necessary revise recommended priority groups for immunization based on available epidemiological data
P/T, L
  • Modify or refine of nationally defined priority target groups depending on local circumstances
P/T, L
  • Modify or refine other aspect of the federal guidelines, as needed for P/T and local application
P/T, L
  • Review and modify if necessary, plans for vaccine security (i.e., during, transport, storage and clinic administration)
 
  • When vaccine is available
 
  • National coordination on vaccine purchase
F,P/T (Lead: PWGSC)
  • Activate immunization clinic capability
P/T,L
  • Implement streamlined VAAE surveillance, in collaboration with PHAC
F, P/T, L (Lead: PHAC)
  • Arrange for direct shipping of vaccine to health districts
F (Lead: PWGSC)
  • Communicate with bordering jurisdictions (other P/Ts and the U.S.) to facilitate awareness of the vaccine distribution plan and coordination and collaboration on efforts as much as possible
F, P/T, L
Antivirals Strategic and controlled use of antivirals
  • Review and if necessary revise national recommendations on antiviral use based on available epidemiological data
F, P/T (Lead: PIC)
Health Services Use of optimal infection control practices
Preparation for increased demand on health care system
  • Evaluate infection control and occupational health recommendations and practices and revise as necessary
F, P/T (Lead: PHAC)
  • Review protocols and guidelines for prioritization of laboratory services during times of high service demand and staff and supply shortages
P/T, L
  • Review mechanisms for coordinating patient transport and tracking/managing beds e.g. central bed registries, call centre and centralized ambulance dispatch
P/T, L
  • Contact and prepare sources of additional HCWs and volunteers i.e., Emergency Measures Organizations and NGOs (Red Cross, St. John ambulance)
F, P/T, L (Lead: PHAC)
  • Acquire extra supplies needed to provide medical care in non-traditional sites
P/T, L
Public Health Measures Preparation of implementation of public health response
  • As per Phases 4.0 and 5.0
 
  • Review national recommendations as per Annex M (Public Health Measures) for public health management of cases and other control measures and modify if necessary
F, P/T, L
  • Ensure adequate resources are available to implement recommended public health measures including isolation of cases
P/T, L
  • Prepare and if necessary revise educational and guidance materials for public health partners (specifically, P/T and local health departments who will be on the front lines with respect to prevention and control measures), the general public; Some documents for the public should emphasize infection control in homes, schools, places of work
F, P/T, L
Communications    
Emergency Management and Coordination
  • As per Phase 5.1
    • Ensure NESS resources are ready to be deployed
    • Contact and prepare sources of additional HCWs and volunteers (NGO's)
 


6.3 Pandemic Period - Canadian Phase 6.1 and 6.2
Canadian Phases 6.1 and 6.2 Pandemic virus detected in Canada (Phase 6.1 – single case(s) occurring, Phase 6.2 – localized or widespread activity occurring)
Component Focus Actions Response Level
Surveillance Timely collection, compilation and dissemination of epidemiological and clinical data
  • 6.1: Confirm that clinical spectrum of disease (based on feedback from local level experts), is consistent with what is being observed internationally (revise case definitions if necessary)
F, P/T, L
  • 6.2: Scale back to streamlined surveillance
F, P/T (Lead: PHAC)
  • 6.2: Implement any special studies identified for these phases
F, P/T, L (Lead: possibly PHAC, PIC and/or CIHR)
Monitoring the progress of pandemic
  • 6.2: When indicators suggest activity appears to be decreasing (i.e., end of a pandemic wave)
 
  • Determine ongoing surveillance needs for both documentation of end of first wave and detection of any new cases or outbreaks
F, P/T, L (Lead: PIC)
Vaccine Programs Vaccine development
  • As per Phase 6.0 (i.e., if not completed prior to Phase 6.1 or 6.2)
    • Ongoing involvement in vaccine development,testing and production initiatives
F (Lead: PHAC HPFB, manufacturers)
Preparation/Implement ation of mass immunization clinics
  • Review and if necessary revise recommended priority groups for immunization based on available epidemiological data
F, P/T (Lead: PIC)
  • Modify or refine nationally defined priority target groups depending on local circumstances
P/T, L
  • Modify or refine other aspect of the federal guidelines, as needed for P/T and local application
P/T, L
  • Review and modify if necessary, plans for vaccine security (i.e., during, transport, storage and clinic administration)
P/T, L
  • As per Phase 6.0, when vaccine is available
 
  • National coordination on vaccine purchase
F,P/T (Lead: PHAC)
  • Activate immunization clinic capability
P/T,L
  • Implement streamlined AEFI surveillance, in collaboration with PHAC
F, P/T, L (Lead: PHAC)
  • Arrange for direct shipping of vaccine to health districts
F (Lead: PWGSC)
  • Communicate with bordering jurisdictions (other P/Ts and the U.S.) to facilitate awareness of the vaccine distribution plan and coordination and collaboration on efforts as much as possible
F, P/T, L
Antivirals Strategic and controlled use of antivirals
  • If not previously completed in Phase 6.0, review and if necessary revise national recommendations on antiviral use based on available epidemiological data
F, P/T (Lead: PIC)
  • Based on local epidemiology and available supplies, administer antiviral treatment and prophylaxis according to national priority groups
F, P/T, L
  • Communicate with bordering jurisdictions to facilitate awareness of any antiviral distribution plans
F, P/T, L
  • If antivirals are being used, ensure that stakeholders are aware of how to report adverse drug reactions
F, P/T (Lead: HPFB)
  • Monitor for drug resistance
F, P/T, L (Lead: NML)
Health Services Management of increased demand on health care system

Mostly Phase 6.2 actions:

 
  • Implement protocols and guidelines for prioritization of laboratory services during times of high service demand and staff and supply shortages
P/T, L
  • Implement mechanisms for coordinating patient transport and tracking/managing beds e.g. central bed registries, call centre and centralized ambulance dispatch
P/T, L
  • Access sources of additional HCWs and volunteers i.e., Emergency Measures Organizations and NGOs (Red Cross, St. John ambulance)
F, P/T, L (Lead: PHAC)
  • Acquire extra supplies needed to provide medical care in non-traditional sites and open non-traditional sites as needed
P/T, L
  • Coordinate clinical care and health services activities with bordering jurisdictions to avoid migration to centres of perceived enhanced services
P/T, L
  • Monitor capacity of mortuary and burial services as well as need for social and psychological services for families of victims; Implement and establish alternative sites for provision of services as necessary
P/T, L
  • Track national stocks of medications as well as necessary medical equipment and supplies, including ventilators, oxygen, etc. Consider strategies to mitigate shortfalls
When incidence appears to be decreasing (i.e., end of a pandemic wave)
P/T, L
  • Assess status of stocks, impact of first wave, reorder supplies and ensure circulation of staff to avoid burnout, across all health care services (including mortuary)
P/T, L
Public Health Measures Implementation of public health response
  • Case and contact management as per Annex M (Public Health Measures) for Phase 6.1 and 6.2
F, P/T, L
  • Discontinue quarantine strategy if previously implemented
F, P/T, L
  • Shift-focus to self-care and self-monitoring as case numbers increase, with concurrent increase in public education messaging
F, P/T, L
  • Implement national recommendations regarding control strategies (i.e., cancellation of public gatherings, school closures)
P/T, L
Communications    
Emergency Management and Coordination
  • For Phase 6.1 as per Phase 6.0 and;
 
  • Consider declaring Public Welfare Emergency (as per Emergencies Act)
F
  • Track National stocks. Consider strategies to mitigate shortfalls
F (Lead : PHAC)
  • Discontinue border strategies
F (Lead : PHAC)
  • Conduct prediction analysis
F (Lead : PHAC)
  • Define clinical spectrum of disease
F
  • Review mass facilities plan
F,P/T,L
  • Review distribution policy of resources allocation
F (Lead : PHAC)
  • Assign medical and other resources
F,P/T,L
  • Access sources of additional HCW`s and volunteers
F,P/T,L
  • For Phase 6.2 as per Phase 6.1 and;
 
  • Monitor and adjust
F,P/T,L
  • Advise and assist P/T's on establishment and operations of non-traditional health care sites and clinics
F (Lead : PHAC)
  • Deploy HERT strategically for maximum benefit
F (Lead : PHAC)
  • Continue consultation with health sector partners
F,P/T,L
  • Planning for illness in the response team
F,P/T,L
  • Plan for emergency financial resources
F,P/T,L
  • Promote optimal use of emergency resources
F,P/T,L
  • Assess increased demand on health care system
F,P/T,L

6.4 Post-Pandemic Period

The following actions that pertain to the Post-Pandemic Period have been retained in this section of the Plan pending completion of the Recovery Section (anticipated for next edition of the Plan).

6.4 Post-Pandemic Period
Component Focus Actions Response Level
Surveillance Review, evaluation and return to routine operations
  • Resume routine ongoing laboratory and disease surveillance
F, P/T, L
  • Estimate burden of disease during outbreak periods
F, P/T
  • Evaluate surveillance during the pandemic and make recommendations for improvements
F, P/T
Vaccine Programs Review, evaluation, resumption of routine programs
  • Provide recommendations for routine prevention and control including recommendations for vaccines

If vaccine was available and administered in earlier phase(s)

F, P/T (Lead: PIC / NACI )
  • Expand vaccine programs to cover population not yet immunized
P/T, L
  • Summarize and report coverage data (with one and/or two doses) and AEFI data
F, P/T, L
  • Examine vaccine efficacy
F, P/T (Lead: PIC / NACI )
  • Review and if necessary revise guidelines and/or protocols used during the mass campaigns
P/T, L
Antivirals Review and evaluation
  • Perform inventory assessment and ongoing monitoring of antiviral availability
F, P/T (Lead: PHAC)
  • Evaluate effectiveness of strategic antiviral use (in Canada and/or based on international reports)
F, P/T (Lead: PIC)
  • Summarize and report antiviral resistance data
F (Lead: NML)
  • Summarize and report adverse drug reaction data
F (Lead: HPFB)
  • Provide recommendations for the strategic use of antivirals during a pandemic based on lessons learned within Canada and internationally
F, P/T (Lead: PIC)
Health Services Review, evaluation, return to routine operations
  • Review and activate aftercare and recovery plans and guidelines
P/T, L
  • Review and revise (if necessary) clinical management guidelines
F, P/T (Lead: PIC)
  • Review and revise (if necessary) infection control guidelines
F, P/T (Lead: PIC)
  • Review and revise (if necessary) guidelines for management of mass fatalities (if applicable)
F, P/T (Lead: PIC)
  • Close or reduce use of "alternate care" and "over-flow sites"
P/T, L
  • Restock laboratory supplies and resume routine laboratory services
F, P/T, L
  • Develop projections for future laboratory requirements (i.e., human and physical resources including test kits, etc.)
F, P/T
  • Summarize, evaluate and report on the use of social and psychological services for families of victims
P/T, L
  • Track national stocks of medications as well as necessary medical equipment and supplies, including ventilators, oxygen, etc. Consider strategies to mitigate shortfalls in next wave or pandemic
F, P/T, L
Public Health Measures Review, evaluation, resumption of routine programs
  • Review and revise (if necessary) public health management guidelines
F, P/T (Lead: PIC)
  • Document and report lessons learned
F, P/T, L
  • Update educational materials
F, P/T, L
  • Resume routine public health activities and programs
F, P/T, L
  • Promote immunization for influenza and other secondary infections observed during the pandemic (if appropriate and applicable)
P/T, L
  • Disseminate all revised guidelines to appropriate stakeholders
F, P/T, L
  • Evaluate the effectiveness of public health measures (e.g., closure of schools or other institutions etc.)
F, P/T, L
  • Provide recommendations for routine prevention and control including recommendations for any control measures other than vaccines and antivirals
F, P/T (Lead: PIC)
  • Provide lessons learned for ourselves and the public and prepare for the next emerging infectious disease
F, P/T, L
Communications    
Emergency Management and Coordination
  • Assess lessons learned
F, P/T, L
  • Assess impact
F, P/T, L
  • Update plans
F, P/T, L
  • Restock supplies and equipment
F, P/T, L
  • Implement recovery measures as required
F, P/T, L
  • Update educational materials
F, P/T, L

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