Pandemic Influenza Plan for Middlesex-London Version 1.0 January 2006 © Copyright 2006 Middlesex-London Health Unit 50 King Street London, Ontario N6A 5L7 www.healthunit.com Cite reference as: Middlesex-London Health Unit (2006). Pandemic Influenza Plan for Middlesex-London, Version 1.0. London, Ontario: Author. Authors: Bryna Warshawsky, MDCM, CCFP, FRCPC Cathy Egan CIC, MBA, CPHI(C) Alison Locker, MSc Graham L. Pollett, MD, MHSc, FRCPC Patricia Simone, BA Mary Anne Simpson, RN, BScN, MScN Laurie Young In collaboration with the Health Emergency Sub-Committee For more information, please contact: Laurie Young Middlesex-London Health Unit 50 King Street London, Ontario N6A 5L7 Phone: 519 -663-5317 ext. 2346 Fax: 663-8241 E-mail: [email protected] Pandemic Influenza Plan for Middlesex-London, January 2006 1 Acknowledgements The authors would like to acknowledge the important contributions made to this report and pandemic influenza planning in Middlesex-London by the following individuals: Mr. Brian Arnold – London Fire Department Mr. Mike Barrett – Ministry of Health and Long Term Care Mr. Mike Bessegato - St. Joseph's Health Care London Ms. Shawna Bourne – Ministry of Environment Detective Sergeant Tom Bradley – London Police Service Superintendent Rob Brown - London Police Service Dr. Abdul Chagla – London Public Health Laboratory Mr. Jim Christie – Thames EMS Mr. Dave Colvin - City of London Mr. Gerry Cook - London and District Pharmacy Association Mr. Steve Coulahan - London Health Sciences Centre Ms. Karen Dyer - St. Joseph's Health Care London Ms. Mary Anne Dzialoszynski - London and District Pharmacy Association Dr. Tom Freeman - Department of Family Medicine University of Western Ontario Ms. Julie Girard - Ministry of Health and Long-Term Care Ms. Katie Gibbs - St. Joseph's Health Care London Mr. Ron Heyboer – London Health Sciences Centre Mr. Michael Jaczko - London and District Pharmacy Association Dr. Michael John - London Health Sciences Centre Dr. Martin King - London Health Sciences Centre Deputy Chief David Kitterman - London Fire Service Ms. Donna Ladouceur - Community Care Access Centre Ms. Cheryl Marks - London Health Sciences Centre/St. Joseph's Health Care London Mr. Dan McMillan - Health Canada Mr. Kent McVittie – City of London Community Services Mr. Denis Merrall - Director Middlesex London EMS Mr. Dave O'Brien - City of London Pandemic Influenza Plan for Middlesex-London, January 2006 2 Superintendent Ian Peer - London Police Service Ms. Mary Raithby – Country Terrace Long Term Care Facility Ms. Yvonne Richardson – Middlesex Hospital Alliance Dr. P. C. Shah - Middlesex Hospital Alliance Mr. Brent Shea - London Police Service Ms. Lori Smith - London Health Sciences Centre Dr. Carina Starok - Family Physician Dr. Robert Stodilka – St. Joseph’s Health Care London Ms. Barb Watterworth - London Health Sciences Centre Ms. Bettina Weber - Middlesex County Emergency Planning Officer Mr. Russ Wheeler - St. Joseph's Health Care London Ms. Heather Whyte- London Health Sciences Centre Dr. Thomas Wilson - Office of the Chief Coroner Hospital pandemic influenza planning is key to a community pandemic influenza response plan. The Middlesex-London Health Unit wishes to acknowledge the excellent work of Ms. Cheryl Marks in developing the pandemic influenza plan for the London hospitals. The ongoing contributions of the Co-Chairs and members of the Working Groups in continuing to move the planning process forward are gratefully acknowledged. Pandemic Influenza Plan for Middlesex-London, January 2006 3 Table of Contents CHAPTER 1: Introduction and Overview.......................... 8 CHAPTER 2: Influenza and Pandemic Influenza............... 14 CHAPTER 3: Pandemic Influenza Planning ...................... 22 CHAPTER 4: Health and Social Infrastructures in Middlesex-London .................................. 32 CHAPTER 5: Surveillance ................................................ 44 CHAPTER 6: Public Health Measures ............................... 52 CHAPTER 7: Antiviral Drugs............................................ 62 CHAPTER 8: Vaccinations ............................................... 72 CHAPTER 9: Health Services ........................................... 84 CHAPTER 10: Human Resources ....................................... 92 CHAPTER 11: Business Continuity .................................... 96 CHAPTER 12: Communications ......................................... 100 CHAPTER 13: Mass Fatality Management.......................... 104 CHAPTER 14: Pandemic Influenza Outbreak Response ...... 108 CHAPTER 15: Conclusions ................................................ 116 REFERENCES: .................................................................. 118 Pandemic Influenza Plan for Middlesex-London, January 2006 4 Detailed Table of Contents CHAPTER 1: Introduction and Overview ..................................... 8 CHAPTER 2: Influenza and Pandemic Influenza .......................... 14 Regular influenza seasons.............................................................15 The influenza virus........................................................................16 Measures to prevent and treat influenza........................................16 Pandemic influenza .......................................................................18 Recent outbreaks of avian influenza ..............................................19 Table 2.1: Recommended Pediatric Dosage of Oseltamivir for Treatment Based on Weight ..........................................................................18 CHAPTER 3: Pandemic Influenza Planning.................................. 22 Pandemic planning documents......................................................23 Pandemic phases ..........................................................................23 Planning structure and framework ................................................24 Planning uncertainties ..................................................................24 Planning parameters .....................................................................25 Table 3.1: World Health Organization Phases of Pandemic Influenza ............23 Table 3.2: Estimated Impact of Pandemic Influenza for Middlesex-London.....26 Appendix 3-A: Terms of Reference - Health Emergency Sub-Committee ..............28 Appendix 3-B: Health Emergency Sub-Committee - Planning Framework.............31 CHAPTER 4: Health and Social Infrastructures in Middlesex-London ................................................. 32 Health Care Organizations ............................................................34 Essential Services .........................................................................36 Educational and Child Care Institutions .......................................37 Other ............................................................................................38 Table 4.1: Population Estimates for Middlesex-London by Age (2004) ............39 Table 4.2: Overview of Acute Care Facilities in Middlesex-London..................40 Table 4.3: Overview of Chronic Care and Psychiatric Facilities in Middlesex-London .........................................................................41 Table 4.4: Overview of Long Term Care Facilities in Middlesex-London ..........42 Table 4.5: Overview of Teaching Family Medicine Units in Middlesex-London .........................................................................43 Table 4.6: Overview of Contract Nursing Agencies in Middlesex-London ........43 Table 4.7: Overview of Elgin-Middlesex Detention Centre...............................43 CHAPTER 5: Surveillance ................................................................... 44 Monitoring the national and international influenza situation .......45 Surveillance during regular influenza seasons...............................47 Enhanced surveillance to detect the arrival of pandemic influenza .......................................................................................48 Enhanced surveillance once pandemic influenza has arrived in Middlesex-London .........................................................................49 Surveillance for use and adverse effects of antiviral drugs and vaccines ........................................................................................50 Surveillance tools ..........................................................................50 Next step.......................................................................................50 Pandemic Influenza Plan for Middlesex-London, January 2006 5 CHAPTER 6: Public Health Measures .......................................... 52 Early recognition and containment measures for isolated cases ....53 Infection control strategies for all times .........................................54 Enhanced infection control during an influenza pandemic ............56 Limiting social interactions ...........................................................56 Travel restrictions .........................................................................57 Avian influenza in local poultry flocks ...........................................57 Next steps .....................................................................................58 Appendix 6-A: Infection Control Strategies For All Times......................................59 CHAPTER 7: Antiviral Drugs ....................................................... 62 Allocation plans ............................................................................63 Distribution