January 2004

Update: Health Canada activities with respect to SARS

Health Canada has taken action in the following areas to strengthen its capacity to respond to future infectious disease outbreaks, including a possible re-emergence of SARS. Some of these areas include:

Epidemiology
In September 2003, Health Canada was involved in two SARS-related meetings. The first took place in Banff, Alberta, where Health Canada experts participated in an international workshop on mathematical modelling. The workshop brought together international leaders and active researchers working in the areas related to the modelling, simulations and analysis of the transmission dynamics of SARS and other infectious diseases, to link mathematical, statistical, epidemiologic sciences and operations research, in order to speed up the process of finding effective tests and prevention and control measures. Health Canada is also working on several research projects on the epidemiology of SARS that were initiated during the outbreak and is updating infection control guidelines.

In December 2003, Health Canada's National Microbiology Laboratory hosted a Current Science of SARS Symposium, in conjunction with the Canadian Institutes of Health Research, to review SARS research, surveillance and public health issues. It included participants from the Government of Canada, provincial partners (eg., Canadian Public Health Lab Network representatives, Chief Medical Officers of Health from each province), key stakeholders in public health, and international partners (eg., the U.S. Centers for Disease Control and Prevention, World Health Organization).

Surveillance
In mid-September, Health Canada's Centre for Infectious Disease Prevention and Control hosted an international workshop to discuss severe/emerging respiratory infections (SARS) case definitions and surveillance. One of the key outcomes of the meeting was to provide guidance on the detection, investigation and response to any respiratory illness outbreak, including laboratory testing guidelines. This type of generic approach is applicable to any emerging and re-emerging respiratory infections.

In collaboration with the provinces and territories, Health Canada has developed a series of public health tools to ensure that Canada is ready to identify severe or emerging respiratory infections and quickly implement prevention and control measures. These include:

• National Case Definitions for Severe Acute Respiratory Syndrome (SARS)
• Surveillance for Severe or Emerging Respiratory Infections in the SARS Post-Outbreak Period
• Public Health Management of cases and Clusters of Severe Respiratory Illness (SRI) in the Post-Outbreak Period
• SARS-CoV Laboratory Investigation Protocol for the SARS Post-Outbreak Period

In addition, the first phase of a national web-based alert system for respiratory infections has been launched, and the next phase is underway.

Influenza and SARS
On August 15, the National Advisory Committee on Immunization (NACI) released its statement on influenza vaccination. NACI states the importance of vaccination for persons at high risk of influenza-related complications and those who care for them. This will help minimize diagnostic confusion when trying to determine if SARS is present. Recommended recipients include, but are not limited to, residents of nursing homes and other chronic care facilities, persons over 65 years of age, persons, including children, with chronic cardiac or pulmonary disorders and health care workers and household contacts who have significant contact with persons in these high-risk groups.

Vaccines and immunotherapy products
In August 2003, Health Canada hosted an international workshop to examine regulatory issues associated with the development and licensing of SARS vaccines and immunotherapy products. The workshop facilitated the necessary regulatory process by identifying critical issues early on in product development and developing a scientific basis for making regulatory decisions concerning the clinical testing and licensing of SARS vaccines and immunotherapy products.

Lessons Learned
The report of the National Advisory Committee on SARS and Public Health was released on October 7, 2003. The committee's recommendations, together with findings from a number of other sources, will provide the Government of Canada with the necessary direction to build a better public health system for the 21st century.

The Canadian Public Health Laboratory Network During SARS

The Canadian Public Health Laboratory Network (CPHLN) is a partnership of federal, provincial, and territorial public health laboratories committed to providing leadership in protecting the health of Canadians. During the SARS outbreak in Canada, the CPHLN was responsible for defining the list of patient specimens required for comprehensive SARS testing, for creating bio-safety guidelines with Health Canada to protect front-line healthcare and laboratory workers, and for their constant dedication and support of their colleagues in Toronto, mostly by their clear thinking and daily sharing of ideas. The CPHLN secretariat together with key National Microbiology Laboratory (NML) personnel were responsible for operationalizing specimen processing, for building the NML SARS database, and for facilitating productive national dialogue and creating an atmosphere of cross-jurisdictional cooperation to deal with SARS.

SARS Screening

Health Canada continues to maintain vigilance at Canada's airports:

• Quarantine Officers are available at the Toronto, Vancouver, Montreal, Edmonton, Calgary and Ottawa international airports, and we are expanding the service to Halifax international airport. Health Canada continues to provide up to date information to Quarantine Officers and Canadian Customs officials about any suspected or confirmed cases of SARS worldwide.
• Travellers are asked to continue to monitor their health and report signs of illness.
• The yellow and cherry Health Alert Notices have been replaced with an infectious disease brochure that is available at major Canadian international airports, and at train stations and ferry stations that handle international travel. It is also available through travel medicine clinics and the Health Canada travel medicine web sites.
• If a significant infectious disease outbreak occurs, screening measures will be reinstated at Canada's airports within 24 to 96 hours.

These screening measures are in keeping with the recommendations in the Naylor Committee Report, and are consistent with the recommendation of the World Health Organization to remain vigilant.