Human Health Issues related to Avian Influenza in Canada

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3 Roles and Responsibilities

Due to the paucity of outbreaks of highly pathogenic avian influenza in Canada, the roles and responsibilities of various responders and stakeholders have not been previously compiled in one document for the purpose of national consensus. The current draft of the Respiratory Illness Outbreak Response Protocol (RIORP)⁽¹³⁾ includes roles and responsibilities for the various levels of government, general principles and operating procedures agreed to by federal, provincial and territorial agencies in order to help coordinate the investigation and control of severe respiratory illness outbreaks in Canada. Coordination with animal health authorities is not currently specifically addressed in RIORP; however federal departments and agencies are working on protocols for collaboration including a Zoonotic Illness Outbreak Response Protocol (ZIORP). ZIORP will include an agreed-upon roles and responsibilities framework.

The outbreak in British Columbia in 2004 highlighted the importance in having roles and responsibilities clearly defined in order to ensure appropriate and timely communication and optimal implementation of the outbreak response. As part of the response to the BC 2004 outbreak, lead agencies responsible for enhanced surveillance recommendations, public health recommendations and clinical occupational health responsibilities for each type of worker potentially involved in the response, were identified and agreed upon on a teleconference involving the participants from the lead agencies⁽¹⁴⁾. This detailed information, compiled in table format, is provided in Appendix D. It can be used as a starting point to clarify roles and responsibilities at the outset of any future avian outbreaks.

Provinces and Territories may have existing response frameworks that involve more organizations than those listed below (e.g. Ministry of Labour). The following list outlines key departments/organizations. This list is not necessarily all inclusive and may not reflect P/T variations.

Federal

Canadian Food Inspection Agency (CFIA): The Canadian Food Inspection Agency (CFIA) is responsible for the administration and enforcement of the federal Health of Animals Act and Regulations. Consequently, the CFIA is the lead authority for the monitoring, control and eradication of foreign animal diseases in Canada. This includes Avian influenza (AI), a reportable disease under the Health of Animals Act. CFIA AI activity focuses on five areas: import controls, surveillance of domestic poultry and wild birds, biosecurity, disease response strategies, and international cooperation, With respect to avian influenza this includes:

• • • animal health surveillance
    • lead for the animal outbreak response and the implementation of animal disease control measures
  • occupational health and safety for CFIA workers (including workers contracted by the CFIA)^[7]
  • scientific advice, risk assessment and research to contribute to AI prevention, preparedness and response measures
  • receiving and testing samples from animals and receiving reports re. Avian influenza from provincial/territorial laboratories (National Centre for Foreign Animal Diseases, CFIA).
• Environment Canada(EC): The identification of risks associated with outbreaks in wildlife and the overall health of wildlife is the collaborative responsibility of both federal and provincial/territorial departments and agencies as well as academia (such as EC, the Canadian Cooperative Wildlife Health Centre (CCWHC) and CFIA). The National Wildlife Disease Strategy (approved by the Canadian Council of Forest Ministers, Wildlife Ministers' Council of Canada, Canadian Endangered Species Conservation Council, Canadian Council of Fisheries and Aquaculture Ministers in 2005) identifies diseases such as avian influenza that have the potential to cause significant social, ecological or economic harm and potential management options in wildlife settings.
• Workplace Health and Public Safety Programme (WHPSP), Health Canada:
  • Provide advice and support on occupational health issues relating to federal employees involved in the outbreak response e.g. for CFIA workers if so requested.
• Centre for Infectious Disease Prevention and Control, Public Health Agency of Canada(PHAC):
  • international reporting of the Canadian situation and international consultation,
  • convening of expert committees to provide advice on risks to human health,
  • human resources to support outbreak response if necessary,
  • liaison with the involved P/T to ensure that technical advice provided to CFIA and WHPSP is consistent with recommendations being provided by the P/T and local public health authority.
• National Microbiology Laboratory, PHAC:
  • consultation with CIDPC and P/T public health authorities regarding recommendations for the collection, transportation and reporting of human laboratory specimens and tests,
  • consultation with P/T public health laboratories to facilitate appropriate and timely outbreak specimen management,
  • laboratory testing including virus isolation and characterization,
  • provision of reagents/diagnostic testing kits (PCR primers etc.)
• First Nations and Inuit Health Branch, HC:
  • role will likely be consistent with that identified below for the Provincial/Territorial Public Health Authorities with application to on reserve populations

Provincial/Territorial

• Provincial/Territorial Public Health Authority involved in outbreak:
  • tailoring of national recommendations to suit the local situation/epidemiology,
  • developing additional public health recommendations as needed based on the local situation/epidemiology,
  • liaison with The Public Health Agency of Canada, CFIA, EC and others (e.g. Ministry of Agriculture, Natural Resources) to ensure consistency of recommendations being provided to the workers and others involved in the outbreak,
  • reporting summary data on human health issues and prevention/control measures taken to The Public Health Agency of Canada,
  • provision of information to the public and health care providers (particularly those within the P/T that reside outside of the jurisdiction of the local public health authority(s) with the outbreak(s)).
• Provincial/Territorial Workplace Health / Occupational health departments
  • Working with public health authorities, address occupational health issues relating to populations under P/T jurisdiction
• Provincial/Territorial Veterinary Diagnostic Laboratories^[8]:
  • receiving and testing samples from animals
• Provincial/Territorial Public Health Authority NOT involved in outbreak:
  • monitoring of the outbreak and its potential impact on the population in their respective jurisdictions,
  • review and implementation as necessary of actions identified in the Canadian Pandemic Influenza Plan for the Canadian Pandemic Phase as determined by the epidemiology of the avian outbreak,
  • potential source of human health resources to support the outbreak response if requested by the affected P/T(s).

Local

• Local Public Health Authority:
  • implementation of enhanced surveillance and public health recommendations related to human health issues (e.g. surveillance of farm families, personal protection or occupational advice for farm families and local veterinarians, quarantining of contacts-if appropriate),
  • occupational health issues pertaining to any of local public health staff involved in the response,
  • provision of information to local health care providers and public as necessary,
  • reporting data on human health issues and prevention/control measures taken to P/T Public Health Authority.
• Local physicians or occupational health staff:
  • reporting of any individuals who may have avian influenza infection to local public health authority

While the reporting of human illness to public health authorities is usually a requirement under provincial/territorial legislation, the reporting of avian or animal illness that may impact human health is not as well defined. These processes are currently being examined at the national level. In the meantime, P/T public health authorities are encouraged to develop working relationships with their animal health counterparts (including occupational health authorities) within their respective jurisdictions in order to facilitate timely two-way communication and management of these types of events. This should include consensus on outbreak management structure, to facilitate an efficient outbreak response, and development of a coordinated P/T specific response plan(s).

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