Preparing for Pandemic Influenza in Manitoba - Public Health - A Guide for the Public from the Office of the Chief Medical Officer of Health

 
Public        Health
                                 Emergency Preparedness and Response

Preparing for Pandemic
Influenza in Manitoba
A Guide for the Public from the Office
of the Chief Medical Officer of Health
March 2006
Manitoba’s Public Health Pandemic Influenza Plan

This is a living document that will be reviewed and updated on a regular basis by the
Office of the Chief Medical Officer of Health. The document will be a reflection of its time,
as new scientific information becomes available and as a result of our ongoing planning
process.

There is currently not an influenza pandemic in Canada or the world. It is important,
however, to be prepared and ready to respond in the event that one does occur.

This is a summary document that highlights key facts about pandemic influenza, public
health preparedness activities in Manitoba and how a public health response to pandemic
influenza will be handled in Manitoba. The goal of this document is to provide information
to the public about pandemic influenza, how public health is preparing, and how
individuals and families can prepare themselves.

Manitoba’s public health plan for pandemic influenza is based on the Canadian Pandemic
Influenza Plan. The Canadian Pandemic Influenza Plan can be accessed at the following
website: www.phac-aspc.gc.ca/cpip-pclcpi/

                                                                      Preparing for Pandemic Influenza   1
Table of Contents
             Introductory Comments from Manitoba’s Chief Medical Officer of Health     3

                 1. Understanding Influenza
                     “Ordinary” Influenza and Pandemic Influenza                        5
                     History of Influenza Pandemics                                   14

                 2. How will Pandemic Influenza affect Manitoba and What Can I Do?
                     The Potential Impact of Pandemic Influenza in Manitoba           15
                     What Can I do to Prepare Myself and My Family                   16

                 3. Responding to Pandemic Influenza in Manitoba
                     Threat Levels for Pandemic Influenza                             18
                     Assumptions used in Planning for a Pandemic Response            18
                     Pandemic Influenza Response Goals                                20
                     Public Health Pandemic Influenza Strategy in Manitoba            20
                     Specific Components of Public Health Pandemic Preparedness
                     Efforts in Manitoba                                             21

             List of Figures and Tables

             Table 1.1       The Differences Between Ordinary Flu and Pandemic Flu   12
             Table 2.1       History of Pandemic Influenza                            14

2   Preparing for Pandemic Influenza
Pandemic Influenza and Other Respiratory Disease Threats

Introductory Comments from Manitoba’s Chief Medical Officer of Health

Manitobans are familiar with influenza –        Avian (bird) influenza has been identified
“the flu” – which returns to Manitoba every     in poultry and birds for many years. The
winter. Although symptoms of the flu –          H5N1 strain was first discovered in a
fever, cough, tiredness and muscle aches –     small number of humans in Hong Kong in
are often severe, most people are back         1997. Avian flu is not a pandemic influenza
on their feet within a few days. Influenza      because it does not spread easily from
and other respiratory infections cause         human to human.
increased absenteeism from school and
work in the winter months. For some,           Manitobans, like others around the world,
serious complications and death can occur      may not know when the next pandemic
– especially the very young, the elderly       will be, but are preparing to respond
and those with chronic medical conditions.     when the next pandemic arrives. How
Although not always confirmed by                bad could it be? Perhaps, not as bad as
diagnostic tests, it is estimated that about   some are fearing. Nevertheless, we need
100 deaths are associated with influenza        to be prepared. An effective response
every year in Manitoba.                        to a pandemic, including appropriate
                                               use of vaccines, antivirals, other public
To fight these effects, Manitobans at high      health measures and treatment, should
risk, their caregivers and all health care     significantly reduce the rate of severe
workers are encouraged to get an annual        illness and death, as well as the levels of
flu shot. Getting a flu shot every year is       fear and social disruption. The health of
necessary because there are many different     Manitobans and the abilities of our health
influenza strains and each year they            system are much better now than they were
undergo mild changes (drifts). About three     during previous pandemics, so we have
times a century, a more dramatic change        good reasons to be optimistic about our
(shift) occurs in an influenza strain. When     ability to withstand the next pandemic.
that happens our immune systems have
no specific antibodies or immune cells to
fight the new strain. When a new strain
of influenza causes significant illness and
spreads from human to human around the
world, it is called a pandemic influenza.

We do not have a pandemic influenza in
Canada or anywhere in the world at
this time.

                                                                    Preparing for Pandemic Influenza   3
The public health plan described here      diseases such as diabetes, injuries
             is the result of the hard and good work    and mental health. If we can address
             of many – but there is more to do. Our     the underlying causes of our major
             goal is that every Manitoban – whether     health problems, especially for those
             a health care worker, essential service    populations and groups at greatest risk,
             provider or parent - will know what they   we will go a long way to reduce the
             need to do to care for themselves and      impact of any new public health threat,
             others. This will help reduce illness      not only a pandemic influenza.
             and keep our province and its towns
             and cities functioning well during a       While focusing on pandemic influenza,
             pandemic.                                  it is intended that these plans can be
                                                        used to address other new or emerging
             Like all public health issues, it is       public health problems.
             important to keep things in perspective.
             While it is necessary to prepare for the   As Manitoba’s planning evolves, this
             next pandemic, we must also continue       document will be updated to keep
             to address today’s public health           everyone informed of the progress.
             threats – infectious diseases such as
                                                        Dr. Joel Kettner
             tuberculosis and HIV/AIDS; chronic

4   Preparing for Pandemic Influenza
1.       Understanding Influenza

“Ordinary” Influenza and Pandemic Influenza: Key Facts
What is “ordinary” influenza (flu)?               Every year during the winter months,
Influenza, commonly called “the flu,” is          Manitoba experiences an epidemic of
caused by the influenza virus, which infects     influenza. There are three types of influenza
the respiratory tract (nose, throat, lungs).    - A, B and C - as well as subtypes, all of
Influenza is highly infectious and can           which can cause infection in humans.
spread easily from person to person.            Influenza A viruses are the most common
                                                cause of winter influenza epidemics.
What are the symptoms of the flu?                Influenza B viruses circulate at lower levels
                                                causing less severe outbreaks, particularly
Influenza affects people with different
                                                among young children in schools. Influenza
degrees of seriousness, ranging from minor
                                                C viruses are typically mild and usually
symptoms through to pneumonia and
                                                not considered a public health concern.
death. Influenza usually appears with a
                                                Influenza viruses undergo minor changes
sudden onset of symptoms that typically
                                                every year, causing the need for annual
feature fever and a cough, and may include
                                                influenza immunization to protect against
one or more other symptoms such as:
                                                circulating strains of flu viruses.
     •   aching muscles and joints
     •   headache                               Fortunately, this annual variation in
                                                influenza viruses is usually minor. This
     •   severe weakness and fatigue
                                                allows scientists to guide vaccine
     •   sore throat                            manufacturers in producing annual
     •   runny nose                             vaccines that are generally effective for
                                                circulating viruses. These vaccines protect
Children can have additional gastro-
                                                individuals at high risk of developing
intestinal symptoms, such as nausea,
                                                complications from influenza. Over the
vomiting and diarrhea, but these symptoms
                                                years, most people have acquired some
are uncommon in adults.
                                                resistance to circulating types of influenza.
Although the term "stomach flu" is               As a result, the effects of influenza from
sometimes used to describe vomiting,            year to year are greatest in people with
nausea or diarrhea, these illnesses are         lowered immunity, such as young children,
caused by other viruses, bacteria or            the elderly and those with chronic diseases.
possibly parasites, and are rarely related to   This is why these high-risk groups are
influenza.                                       targeted for immunization each year, along
                                                with those at risk of spreading influenza to
                                                them, such as health care workers.

                                                                      Preparing for Pandemic Influenza   5
How is influenza spread?                        How do I know if I have influenza?
             Influenza is easily passed from person          Respiratory illnesses caused by
             to person by droplets and small                influenza are hard to distinguish
             particles released into the air when           from other respiratory illnesses by
             infected people cough or sneeze.               symptoms alone. Generally speaking,
             The virus can travel about one metre in        if you have a fever and a cough when
             the air and has been shown to survive          influenza viruses are known to be
             on hard, non-porous surfaces (ex:              circulating in the community, there
             telephones and doorknobs) for 24 to 48         is a good chance that you may have
             hours; on cloth, paper and tissue for          influenza. Swabs may be taken from
             eight to 12 hours and on hands for five         sick individuals by doctors and sent
             minutes. The virus survives better at          for laboratory testing. This helps to
             low humidity, like we experience during        determine when the flu has reached
             winter.                                        Manitoba and to monitor the types of
                                                            flu viruses circulating in the province.
             The influenza virus enters the body             This testing is performed by some
             through the nose or throat. This               physicians in Manitoba as part of the
             can happen when someone inhales                national FluWatch program.
             droplets produced by the coughing or
             sneezing of others; after hand-to-hand         During confirmed influenza outbreaks,
             contact with infected individuals; or,         many people seeking medical advice
             after handling objects contaminated by         for upper respiratory tract infections
             infected individuals, then touching their      could be infected by influenza. Testing
             mouth, eyes or nose. Once infected             of all affected individuals is neither
             with the influenza virus, it usually takes      necessary nor practical. Rapid
             from one to three days to develop              diagnostic tests that can be used
             symptoms. However, someone with                to detect influenza viruses within
             influenza can be contagious from the            30 minutes have recently become
             day before they develop symptoms               available. However, these tests are not
             up to seven days afterwards. Not               widely available and are reserved in
             everyone who is infected with influenza         Manitoba for specific circumstances,
             gets sick, but it is still possible for them   such as to confirm an outbreak in a
             to spread it to others. The disease            personal care home.
             spreads very quickly, especially in
             crowded situations. Because of this,
             and the fact that the virus can survive
             outside the body longer in cold and
             dry weather, seasonal epidemics
             in Manitoba (and the Northern
             Hemisphere) occur in the late fall and
             winter and are generally over by spring.

6   Preparing for Pandemic Influenza
How is flu activity monitored?                  The most recent Influenza A pandemics
Manitoba participates in the national          occurred in 1957 (Asian influenza) and
FluWatch program to monitor flu activity in     1968 (Hong Kong influenza). Each caused
Canada. Volunteer doctors take part in the     significant illness and death around the
FluWatch program in Manitoba and submit        world. The most infamous pandemic was
weekly reports to the Public Health Agency     the Spanish Flu, which is believed to have
of Canada (PHAC) on the number of people       killed at least 40 million people worldwide
they see with flu-like illnesses in a typical   in 1918 and 1919. During this pandemic,
day. Samples are submitted to the public       the death rate was highest among healthy
health laboratory for flu testing. The PHAC     young adults. This is directly opposite to
monitors and identifies circulating strains     annual influenza epidemics, which identify
of the influenza virus in Canada. The World     high-risk groups like the youngest and
Health Organization (WHO) analyzes data        oldest, and those with chronic illnesses.
from around the world and, early in the        This explains why a pandemic could pose
year, recommends strains to include in the     such an impact on everyday activities and
vaccine to make sure it is effective against   essential functions.
recently circulating strains.
                                               Based on historical patterns, public
What is pandemic influenza and how is it        health experts predict that a pandemic
different from ordinary flu?                    will occur. However, it is not known when
                                               this will happen, where it will emerge,
Influenza A is the type involved in all         or how severely people will be affected.
known influenza pandemics. This is              Theoretically, it is possible that a new
because these viruses can undergo major        influenza virus could emerge from a re-
changes or shifts in makeup, producing a       assortment of genetic material among
completely new strain. Most people have        different sources of influenza viruses,
not built up any immunity to a new strain      including human, avian (bird) and swine
of influenza. As a result, large numbers of     (pig) origin. This could happen if someone
people become infected as it spreads. An       were infected with a human influenza virus
epidemic like this that spreads throughout     and an avian or swine influenza virus at
the world is known as a pandemic. For a        the same time. This is why public health
pandemic to occur, it must be a new virus      officials are concerned about outbreaks
(to which the population has no immunity)      of avian or swine influenza where humans
and easily spread from person to person.       become infected.
There were at least three pandemics in the
last century.

                                                                     Preparing for Pandemic Influenza   7
What are the key characteristics of      It is obvious that the effects of a
             pandemic influenza?                       pandemic would be much wider than
             Experts look at a number of key          just the health sector. As a result,
             characteristics when deciding if         all parts of society and government
             a particular flu virus is a potential     must review their business continuity
             pandemic strain.                         planning as a priority, paying
                                                      particular attention to human resource
             For a new influenza virus to be           contingency planning. Given the
             capable of causing a pandemic,           potential effects of a pandemic and the
             it must be able to:                      broad scope of preparedness activities,
                                                      the Government of Manitoba has the
                 •   infect people (not just          responsibility to make sure that co-
                     mammals and birds)               ordinated preparedness and response
                 •   cause illness in a high          efforts are undertaken in our province.
                     proportion of those infected
                 •   spread easily from person to     Is this something Manitobans should
                     person                           be afraid of?
             All previous influenza pandemics          Pandemic influenza could affect much
             exhibited these characteristics.         more than the health sector. As people
                                                      avoid business or entertainment
             Why should we be prepared for a          activities, a pandemic could affect all
             pandemic?                                parts of society including the delivery of
                                                      critical services.
             In a typical flu season, up to 20 per
             cent of the population could get         In a pandemic, we expect there may
             sick. In a pandemic, this number         not be enough health care providers
             could be much higher, and cause          or resources to meet the increased
             more serious illness. When planning      demand for health services.
             for a pandemic, we must prepare for
             situations where many health care        Some Manitobans may find it scary
             workers and other essential workers      to think about the effects a pandemic
             could become ill when there is an        may have on rates of illness and death.
             increase in demand for their services.   However, we must put these fears into
                                                      perspective. There is no confirmed
                                                      evidence of any human-to-human
                                                      spread of a new influenza virus at
                                                      this time. In addition, Canadians are
                                                      generally healthier now than during
                                                      previous pandemics and our health
                                                      system is better than ever before.
                                                      Measures are being taken to increase
                                                      our capacity to respond to the threat of
                                                      a pandemic.

8   Preparing for Pandemic Influenza
Manitoba Health is working with Manitoba’s      What is being done to protect people
regional health authorities, other provinces    from pandemic influenza?
and territories and the Public Health Agency    Due to the widespread effects of pandemic
of Canada, to make sure an excellent            influenza, planning for a pandemic
public health surveillance system is in place   requires the involvement of the health
locally, provincially and nationally. The       sector, other government sectors, non-
system will detect new strains of influenza      government organizations and ultimately,
and other communicable diseases early so        the participation of all Manitobans.
we can respond quickly and effectively. In
turn, the Public Health Agency of Canada is     Manitoba Health is working within the
working with the World Health Organization      department and with the regional health
to make sure a strong global surveillance       authorities and other partners in health
system is in place.                             service delivery, to make sure that business
                                                continuity plans are in place for the health
Through global surveillance systems,            sector. These business continuity plans will
the avian influenza situation is being           help us respond to any emergency affecting
monitored closely. Measures are being           the health sector, whether a public health
taken internationally to reduce the chances     emergency (ex: pandemic) or another type
that human and avian influenza strains will      of emergency (ex: natural disaster).
mix, as this could create a new strain of
influenza to which people would not be           We do not know what strain of influenza will
immune.                                         cause the next pandemic. Some believe
                                                that it will be caused by an avian influenza
The collaborative efforts of all levels of      virus that mutates into a virus that is able
government to contain the avian influenza        to infect people and be transmitted from
outbreak in British Columbia in spring 2004     person to person. For this reason, public
demonstrated how well animal and human          health officials and scientists monitor avian
surveillance and health systems can work        influenza outbreaks and instances where
together. Manitoba Health has a close           people have become infected. International
working relationship with counterparts in       public health alerting mechanisms are in
the animal health field and is working to        place and Canada plays a key role in this
enhance links between animal and human          global public health surveillance network.
influenza surveillance.

                                                                      Preparing for Pandemic Influenza   9
An effective vaccine1 is the main                          •    Improve your overall health.
                 defence against an influenza pandemic.                           In general, healthier people are
                 But, until that vaccine is available,                           better at fighting off disease.
                 antivirals2 may be an important part of                         To stay healthy, you should eat
                                                                                 healthy foods, live an active
                 our response. This shows the need for
                                                                                 lifestyle, don’t smoke and avoid
                 a balanced and multi-faceted strategy,
                                                                                 heavy alcohol consumption.
                 including providing information to the                          Get enough sleep and try
                 public on self-care and care of others                          to maintain a positive and
                 at home, communicating when to stay                             balanced outlook.
                 home and when to go to work during
                 a pandemic, and where and how to                           •    Wash your hands often.
                 access health services.                                         Washing hands is the most
                                                                                 effective way of preventing the
                 The purpose of this document is to                              spread of disease. Get into the
                 give Manitobans information about                               habit of washing your hands
                 pandemic influenza and efforts to                                often with soap and warm
                 prepare for such a public health                                water, scrubbing your wrists,
                                                                                 palms, fingers and nails for 10
                 emergency. More information about
                                                                                 to 15 seconds. Rinse and dry
                 specific readiness and response
                                                                                 with a clean towel. This should
                 measures is outlined in the sections                            be done especially before
                 that follow.                                                    meals, after using the toilet,
                                                                                 and after you cough, sneeze
                 What can I do to prevent myself from                            or blow your nose. Teach your
                 getting infected with influenza during                           children to do the same.
                 a pandemic?
                                                                            •    Avoid visiting people who have
                 Public health officials expect that if                           the flu if you are able to do so.
                 a new type of influenza emerges and                              This will help prevent you from
                 causes a pandemic, this virus will                              becoming infected. This advice
                 spread like the influenza viruses that                           must be balanced with the
                 cause outbreaks each winter. Influenza                           need to provide support and
                 is highly contagious, so it spreads                             care to sick people. Caregivers
                 quickly in families and communities.                            to sick people should wear a
                 There are, however, some steps you                              mask when coming face to
                                                                                 face with a coughing individual
                 can take to reduce your risk
                                                                                 to reduce the risk of catching
                 of infection.
                                                                                 influenza.

1
 Vaccines are given by a needle in your arm. Vaccines cause         2
                                                                     Antivirals are drugs prescribed by your doctor and used for
the body to produce antibodies against the flu virus in the          the prevention and early treatment of influenza. Antiviral drugs
vaccine, providing immunity from the virus. The influenza            work by reducing the ability of the virus to reproduce; however,
vaccine contains inactive virus, so it cannot cause influenza.       they do not provide immunity from the virus. Some antiviral
In a pandemic, a vaccine specific to the pandemic influenza           drugs are available as capsules (pills) that must be swallowed
virus affecting people will need to be developed. This is           and some of these are available as a liquid; others are powders
considered to be the most effective tool to protect the public in   that must be inhaled.
a pandemic.

    10   Preparing for Pandemic Influenza
•   Avoid large crowds.                        including the influenza virus,
    Large crowds are ideal for the             although they will be effective
    spread of influenza, so at the time         against complications caused
    of a pandemic, public health may           by bacteria such as pneumonia.
    recommend that people avoid large          Avoid going to work or social
    gatherings. In general, the wearing        gatherings if you are sick. During
    of masks by well individuals               a pandemic, if you are sick with
    during daily activities is not a           symptoms of influenza and need to
    recommended preventive measure.            visit your doctor, you should wear
    At the time of a pandemic, specific         a face mask to prevent spreading
    recommendations will be made by            infection to others. At the time of
    public health officials as needed.          a pandemic, Manitoba Health will
                                               provide information on steps you
•   Don’t share eating utensils                can take to help care for yourself if
    or drinks.                                 you have influenza.
    If a family member is sick, keep
    their personal items (ex: towels and   •   What if my child is sick?
    toothbrushes) separate from those          Like adults, most children get
    of the rest of the family.                 better from influenza without any
                                               specific treatment. Sick children
•   Get a vaccine when available.              should be kept home from school
    Vaccination is the main way to             and daycare. At the time of a
    prevent influenza and reduce the            pandemic, Manitoba Health will
    effects of epidemics. Various types        provide information on steps you
    of influenza vaccines have been             can take to help care for your
    available and used for more than 60        children if they have influenza.
    years.
                                               During a pandemic, it will be
•   Take antivirals if recommended             important to:
    by your doctor.
    When taken before or immediately       •   follow directions given by
    after exposure to influenza virus,          public health officials.
    but before symptoms have                   These may change over time
    occurred, antivirals may help              as more information becomes
    prevent illness. If symptoms               available about the characteristics
    have already occurred, their early         of the particular virus causing the
    administration may reduce the              outbreak.
    duration and severity of symptoms.
                                           •   follow infection control
•   What if I think I have the flu?             procedures if caring for
    Most people with influenza recover          a person with influenza.
    without any serious problems.              Providing care to a person with
    The disease can last for four to           an influenza-like illness will be
    seven days and leave a cough               common during a pandemic.
    and tiredness for several weeks.           The likelihood of transmitting the
    In general, there is no specific            disease is reduced by following
    treatment for influenza. Antivirals         basic precautions. Watch the
    may occasionally be prescribed             Manitoba Health website for
    by your doctor. Antibiotics are            updates.
    not effective against any virus,

                                                            Preparing for Pandemic Influenza   11
Table 1.1: The differences between ordinary flu and pandemic flu:

                   Ordinary Flu                                Pandemic Flu

 When, Where       Every year during the winter months in      Occurs about three times a century and
                   Canada and the rest of the Northern         can take place in any season.
                   Hemisphere.                                 A pandemic is a global event.

 Who               Affects Manitobans every winter.            Affects more people than ordinary flu;
                                                               one-quarter or more of the world’s
                                                               population.

 How               •   Severe illness and deaths are           •   Pandemic flu is associated with
                       generally confined to people                 much higher rates of illness, and a
                       over age 65; people with existing           higher severity of illness and death.
                       medical conditions like lung
                       diseases, diabetes, cancer, kidney      •   The worst flu pandemic of the last
                       or heart problems; people with              century - the 1918 Spanish Flu
                       weak immune systems and the                 - caused about 30,000 to 50,000
                       very young.                                 deaths in Canada alone and at least
                                                                   20 to 40 million deaths worldwide.
                   •   Four thousand deaths in Canada              Some experts believe that these
                       and approximately 100 deaths in             estimates are low.
                       Manitoba are attributed to influenza
                       each year. These are cases where
                       flu is known or highly suspected
                       to have played a role in a person’s
                       death.

 Prevention        •   A slightly new vaccine is produced      •   A vaccine against a pandemic type
 —Vaccines             every year to ensure protection from        of influenza will not be available at
                       the types of influenza expected to           the start of a pandemic.
                       circulate in the community.
                                                               •   This is because the virus type
                   •   This is required every year due to          will be completely new. It will
                       small changes in influenza viruses           be different from the viruses that
                       from one year to the next year.             circulated the previous winter, and
                                                                   not predictable in the same way.
                   •   The vaccine is effective because
                       scientists are able to predict fairly   •   Once a pandemic is detected,
                       reliably which types of influenza            scientists need to identify the
                       virus will circulate during the             virus. A specific vaccine is then
                       annual flu season in the Northern            manufactured based on the
                       Hemisphere, based on flu activity in         scientific findings.
                       other parts of the world.
                                                               •   It is anticipated that a specific
                                                                   vaccine will become available for
                                                                   use on a prioritized basis within four
                                                                   months.

12   Preparing for Pandemic Influenza
Ordinary Flu                                Pandemic Flu

Prevention and   •   Antiviral drugs can be used to          •   Antiviral drugs are expected to be
Treatment—           both treat and prevent influenza             in limited supply.
Antivirals           infections.
                                                             •   Countries, including Canada,
                 •   Currently, antiviral drugs are used         are stockpiling the antiviral drug
                     to manage outbreaks of influenza             oseltamivir (Tamiflu ).
                                                                                     ®

                     in long-term care facilities and to a
                     lesser extent, to protect and provide   •   Manitoba has participated in
                     early treatment for people at risk of       national purchasing initiatives
                     becoming seriously ill due                  to stockpile Tamiflu for use in a
                                                                                     ®

                     to influenza.                                pandemic. The use of antivirals
                                                                 during a pandemic will depend on
                                                                 the nature and characteristics of the
                                                                 outbreak.

                                                                  Preparing for Pandemic Influenza     13
History of Influenza Pandemics

             Historical Background                            differences. These differences are not only
             Despite predictions that an influenza             between pandemics, but even within a
             pandemic will occur at some point in             single pandemic in different geographical
             the future, there is much that we can’t          areas. The following is a brief overview of
             predict. The influenza pandemics that             the major influenza pandemics in the last
             took place in the last century share some        century.
             similarities; however, there have also been

             Table 2.1

              Pandemic                 “Spanish Flu”           “Asian Flu”           “Hong Kong Flu”

              Strain                   A(H1N1)                 A(H2N2)               A(H3N2)

              Year                     1918-1919               1957-1958             1968-1969

              Likely origin            Not known (first         China                 China
                                       cases identified
                                       in Europe and the
                                       U.S.)

              Estimated Deaths:

              Global                   At least 20 to 40       1-2 million           1-4 million
                                       million – some
                                       experts believe this
                                       is a low estimate

              Canada                   30,000-50,000           not known             not known

              Age Group Most           Healthy young           Very young and        Very old and those
              Affected                 adults (20 to 50        very old              with underlying
                                       years)                                        medical conditions

14   Preparing for Pandemic Influenza
2.      How Will Pandemic Influenza Affect Manitoba and
        What Can I Do?

It is not possible to predict when a         The potential effects of
pandemic will occur. However, it will        pandemic influenza in Manitoba
likely start elsewhere in the world, then
                                             We will not know how big the effects
spread across the globe. Therefore,
                                             of an influenza pandemic in Manitoba
once a pandemic starts, it will only
                                             will be until it happens. A pandemic
be a matter of time before it reaches
                                             may affect the population like ordinary
Canada and Manitoba. It is also
                                             influenza, where the youngest
not possible to predict who will be
                                             and oldest and those with chronic
most affected by the pandemic or
                                             conditions are most severely affected.
how severely they will be affected.
                                             Or, a different age group or section
There is much uncertainty associated
                                             of the population might be affected.
with estimating the scale of illness,
                                             A model for estimating the potential
hospitalization rates and death rates.
                                             impact of an influenza pandemic has
We are still learning about pandemics
                                             been used to calculate estimates for
that occurred in the 20 century. What
                        th

                                             planning purposes. In Canada, it is
we do know, however, is that there
                                             thought that approximately 4.5 to
will likely be a significant impact on
                                             10.6 million people could become ill,
Manitobans and the health services
                                             resulting in 11,000 to 58,000 deaths.
they rely on for routine, emergency and
long-term care. Health care providers        The same model applied to Manitoba
and other service providers will be at       would lead to approximately 176,000
risk like the rest of the population, just   to 410,000 people becoming ill,
as the demand for their services will        resulting in 700 to 1,600 deaths.
rise greatly.                                To make sure the province is prepared,
                                             Manitoba is developing plans to
                                             prepare for 410,000 Manitobans
                                             becoming ill and between 4,100 to
                                             6,100 potential deaths. There is still
                                             much we do not know about previous
                                             pandemics, such as the precise effects
                                             on the population. However, we are
                                             a considerably healthier population
                                             now than in the past; and we have
                                             access to a wide range of interventions,
                                             such as antiviral drugs, vaccines and
                                             antibiotics, supported by a highly
                                             developed health care system. Careful
                                             and comprehensive planning will help
                                             reduce the illness and deaths that could
                                             possibly result from a pandemic.

                                                             Preparing for Pandemic Influenza   15
i.    Impact on Health Care                        closing schools to minimize
                       A pandemic will place great                  the spread within a community,
                       pressure on Manitoba’s health                particularly if school-age children
                       system. Higher-than-usual                    are among the groups most
                       numbers of people will seek                  affected by the virus. School
                       care for influenza and its                    and child care authorities will
                       complications. Health care and               collaborate with public health
                       other pandemic responders                    officials during a response to a
                       will also become ill. This will              pandemic.
                       decrease the health workforce
                       and increase demand for                  iv. Impact on Services
                       services, likely resulting in                The manufacture and
                       service delays. Some services                transportation of goods and all
                       may be unavailable. Health                   kinds of services are likely to be
                       human resource contingency                   affected by a pandemic influenza
                       planning takes into account the              due to the number of people
                       varying degrees of a pandemic’s              expected to get sick. Disruption
                       effects. Appropriate self-care               may also result from public
                       and care for family members                  health and other types of control
                       at home will be more important               measures that countries around
                       than usual.                                  the world may implement,
                                                                    such as restrictions on public
                 ii.   Impact on Business                           gatherings and other activities.
                       A pandemic will also affect
                       businesses, with staff getting sick   What Can I do to Prepare Myself
                       and staying home. Customers           and My Family?
                       may decrease in numbers due
                       to illness or because people are         •   Plan ahead. We don’t know
                       staying at home. This could have             if the next emergency facing
                       a negative economic impact                   Manitoba will be pandemic
                       on business and therefore, on                influenza or a natural disaster.
                       Manitoba. Business continuity                Therefore, you should make
                       plans should identify core                   general family emergency
                       services and address how                     preparedness plans, such as
                       services will be maintained in               making sure your family has
                       the event of an increase in staff            enough food, drinks and basic
                       absenteeism rates.                           household items to last for
                                                                    at least one week. For more
                  iii. Impact on Schools                            information on general family
                       Influenza spreads rapidly in                  preparedness, please refer to the
                       schools each winter. During                  Manitoba Emergency Measures
                       a pandemic, this spread is                   Organization’s family emergency
                       expected to occur even more                  preparedness checklist:
                       quickly. Higher than normal                  www.gov.mb.ca/emo/
                       student and staff absenteeism                handbook/checklist.html
                       rates are expected during a
                       pandemic. Schools may also
                       be affected by disruptions to
                       transportation services. Public
                       health officials may consider

16   Preparing for Pandemic Influenza
•       Plan with your neighbours                   Have a plan to check on sick
           and community to support                    people living alone. Remember
           each other in times of                      that schools and child care
           emergency. Make sure you                    centre may be closed. Have
           have someone you could call                 a backup plan to care for your
           for help if you were to become              children.
           seriously sick.

Some key points to remember:

 Ordinary Influenza—what you can do now

       •    During influenza season, you should wash your hands regularly, cover your
            mouth when you cough, cover your nose and mouth when you sneeze, and
            teach these basic hygiene practices to children. Stay home when you are sick
            to avoid spreading it to others.

       •    High-risk individuals and health care providers should be vaccinated annually
            against influenza.

       •    For more information on Manitoba Health’s eligibility criteria for influenza vaccine,
            visit www.gov.mb.ca/health/flu/

 Pandemic Influenza—what you should know

       •    We can’t prevent a pandemic from happening and we don’t know when one
            might take place.

       •    Should a pandemic occur, specific advice to the public will be communicated
            through regular channels, such as the media, Health Links-Info Santé, websites
            and health care providers.

       •    Direction and advice to the public, health care providers and others will be
            based on the immediate situation and will include actions people can take to
            help themselves, their families, their neighbours and their communities.

       •    Watch the Manitoba Health website (www.gov.mb.ca/pandemic/)
            for information on pandemic influenza and listen to your local news
            for important updates on preparedness and current events.

                                                                          Preparing for Pandemic Influenza   17
3.      Responding to Pandemic Influenza

             Threat Levels for Pandemic                   Assumptions Used in Planning
             Influenza                                     for a Pandemic Response
             Globally, we are currently in a              Since we do not know the precise
             pandemic alert period. There are             characteristics of a future pandemic,
             several levels indicating the threat of a    planning is based on several
             pandemic. Determining the level of risk      assumptions. We know that rapid
             is based on knowing if a new influenza        virus identification and analysis will
             virus has been detected, how people          be important to allow our plans to
             are being affected, whether the new          adapt quickly as events unfold. These
             virus is able to spread from person to       assumptions include:
             person, and if so, how easily it can be
             spread. Each alert level requires a set of   Characteristics of a Pandemic Virus:
             specific public health activities. These         •   The virus causing the next
             activities prepare the health system to             infuenza pandemic will be a
             detect, report, respond to and analyze              new strain of influenza A virus
             any cases of human illness caused                   to which the population may
             by the new virus, and to manage the                 have little or no immunity.
             demands on the health sector should an
                                                             •   The incubation period, or the
             outbreak or pandemic occur.
                                                                 length of time from exposure to
                                                                 symtom onset, is expected to
             Key actions during the pandemic
                                                                 be that of a typical influenza A
             alert period include enhancing normal
                                                                 virus – one to three days.
             operating systems and making sure
             contingency plans are in place for              •   The time frame when the virus
             managing a surge or increased demand                can spread from one infected
             on regular systems. The specific                     person to others will be from
             type and intensity of these activities              24 hours before onset of
             depends on how many people have                     symptoms up to seven days
             been affected by the new virus, the                 afterwards. This time frame
             location of the outbreak, and whether               may be longer in children and
                                                                 people with decreased immune
             the virus has shown it is able to spread
                                                                 systems.
             from person to person.
                                                             •   Many people will be infected
                                                                 but show no symptoms or mild
                                                                 symptoms. These people could
                                                                 still spread the virus to others.

                                                             •   The virus will be spread by
                                                                 droplets from coughing and
                                                                 sneezing, and by touching
                                                                 objects that have been
                                                                 contaminated with droplets
                                                                 from infected people.

18   Preparing for Pandemic Influenza
Onset of a Pandemic:                     Impact of a Pandemic:
   •   A new flu virus could arise in        •   In general, most people will
       any country. However, it is              not have specific immunity
       most likely to occur in Asia,            to a new strain of influenza
       where the close proximity of             virus and will be susceptible
       dense populations to domestic            in a pandemic. How well our
       animals may allow for mixing             immune systems will be able
       of influenza genes.                       to fend off disease during a
                                                pandemic will, in part, depend
   •   The emergence of a new                   on our overall health.
       influenza virus does not
       necessarily mean the onset           •   The intensity of a new flu virus
       of a pandemic. For this to               and the age groups it targets
       happen, three factors are                will have a major influence on
       thought to be important: little          its effects.
       or no human immunity to the
       new virus, the ability of the        •   The improved health of
       virus to cause serious illness           people today, antivirals,
       in people, and the ability of            vaccines and modern health
       the virus to spread efficiently           services will have positive
       from person to person. False             effects on mortality rates,
       alarms are also possible.                compared to previous
                                                pandemics. However,
Spread of a Pandemic:                           much will depend on the
                                                characteristics of the new flu
   •   The first peak of illness in              virus.
       Canada may occur within two
       to four months after the virus    For more background information on
       arrives in Canada. The first       pandemic influenza, please refer to the
       peak in deaths is expected        Canadian Pandemic Influenza Plan:
       about one month after the         www.phac-aspc.gc.ca/cpip-pclcpi/
       peak in illness.

   •   Historically, pandemics tend to
       spread in two or more waves,
       either in the same year or in
       successive influenza seasons.
       A second wave may occur
       within three to nine months of
       the initial outbreak wave and
       may cause more serious illness
       and deaths than the first.

   •   In any place, including
       Manitoba, the length of each
       wave of illness is likely to be
       six to eight weeks.

                                                        Preparing for Pandemic Influenza   19
Pandemic Influenza Response Goals                  •   developing public health
                                                                   measures to prevent or delay the
             Manitoba’s goals are the same as those                spread of infection
             of the Canadian Pandemic Influenza Plan,
             namely:                                           •   developing effective and accurate
                                                                   methods of diagnosis and
                 •   to minimize serious illness                   treatment, including supportive
                     and deaths                                    care and antibiotics for bacterial
                                                                   complications
                 •   to minimize societal disruption
                                                            Strategy Principles:
                                                            Manitoba’s response to public health
             Public Health Pandemic Influenza                emergencies, including pandemic
             Strategy in Manitoba                           influenza, is based on the following
                                                            principles:
             Manitoba Health has done considerable
             work to prepare for public health                 •   Strengthening existing systems
             emergencies, specifically pandemic                     and processes
             influenza. This work is part of our daily              Pandemic planning is being
             efforts to provide quality public health              included, as much as possible, in
             policy direction and program support to               regular operations. For example,
             the regional health authorities, who provide          expanded immunization programs
             public health programs and services to                strengthen the capacity of related
             Manitobans. This work is ongoing, and we              systems and infrastructure.
             work hard to make improvements as new
                                                               •   Building generic systems
             information becomes available                         and processes
                                                                   Manitoba needs to prepare
             While we are confident in our health system,
                                                                   for many possible health
             we know there is more work ahead. Both                emergencies, including an
             within and beyond public health, we need              influenza pandemic or any other
             to prepare for a public health emergency on           respiratory disease outbreak.
             the scale that an influenza pandemic could             Since we cannot predict
             create. We can’t prevent a pandemic from              emergencies before they happen,
             occurring and it is unlikely that the global          we must have a system that can
             spread of a pandemic flu virus could be                readily adapt to meet the needs
             prevented once it emerges. The emphasis               of any emergency response. It
             in pandemic flu response, therefore, is on             is more efficient to build a core
             reducing the effects. There are several ways          response system and adapt it to
                                                                   meet the needs of a single event
             the health system can do this, including:
                                                                   than to build individual response
                                                                   systems for each possible event.
                 •   providing vaccines (once they
                     become available)

                 •   using antiviral drugs

20   Preparing for Pandemic Influenza
•   Collaborating with and                      i.   Surveillance
       being consistent with other                      Surveillance is critical to the work
       jurisdictions                                    of public health and is required
       Due to the far-reaching effects of               to detect and assess an outbreak
       a significant respiratory disease                 and to identify the cause. Canada
       outbreak, such as a pandemic, it is              participates in global surveillance
       essential for Manitoba’s plan to be              efforts for influenza and other
       as consistent as possible with the               diseases, and within Canada, the
       nationally agreed-upon approaches,               provinces and territories participate
       and for our actions to be                        in national surveillance efforts.
       co-ordinated. This co-ordination                 The national system is in place for
       occurs with many organizations                   the rapid detection of respiratory
       including regional health authorities,           illnesses causing unusually severe
       the Public Health Agency of                      illness and/or death. This system
       Canada, First Nations and Inuit                  allows public health to provide
       Health Branch of Health Canada                   early warning and assessment of
       and other provinces and territories.             potential new cases of emerging
                                                        respiratory infections, such as with
                                                        a pandemic strain of influenza.
Specific Components of Public                    Established Systems and Processes for
Health Pandemic Preparedness                    Influenza and Other Respiratory Disease
Efforts in Manitoba                             Surveillance in Manitoba

                                                Manitoba Health receives information on
Manitoba already has existing systems
                                                influenza activity through the following
and resources to deal with respiratory
                                                routine surveillance initiatives:
disease outbreaks. We are also working
to make improvements as needed and
                                                   •    Outbreak detection, reporting and
ensure these systems have the capacity to
                                                        management: Regional medical
deal with a public health emergency such                officers of health, healthcare
as a pandemic. In keeping with nationally               practitioners and regional health
agreed-upon approaches, the components                  authorities report significant
of Manitoba’s plan that address a                       influenza developments to Manitoba
respiratory disease outbreak complement                 Health, such as outbreaks of
corresponding national plans.                           influenza in hospitals, nursing
                                                        homes and schools.

                                                   •    School absenteeism: Schools
                                                        report absenteeism rates above
                                                        10 per cent to public health in
                                                        their region. When authorized by
                                                        a medical officer of health, public
                                                        health nurses will test a small
                                                        number of ill children for influenza
                                                        to find out if an outbreak of
                                                        influenza is occurring.

                                                                     Preparing for Pandemic Influenza   21
•   Influenza-like illness activity       •   National guidelines on
                     monitoring: A number of pre-             surveillance and reporting of
                     identified doctors report weekly          emerging respiratory diseases
                     on influenza-like illness activity        are in place and Manitoba
                     in their practices. They also            follows these guidelines.
                     contribute to influenza virus
                     surveillance by performing           •   When there is a situation
                     throat swabs on some patients.           of concern about severe
                                                              respiratory illness in Manitoba,
                 •   Influenza virus activity–                 key public health responders
                     laboratory monitoring and                at the regional and provincial
                     reporting: Cadham Provincial             levels are notified. When such
                     Laboratory reports all                   an alert is issued, efforts are co-
                     confirmed influenza results                ordinated to further investigate
                     by rapid antigen testing and             sick individual(s), their contacts
                     culture. In Manitoba, both the           and the possible source of
                     Cadham Provincial Laboratory             infection.
                     and the National Microbiology
                     Laboratory in Winnipeg perform       •   Any laboratory detection
                     testing to identify the specific          of a new respiratory virus
                     types of influenza virus causing          in Manitoba is reported to
                     illness in the province.                 Manitoba Health. The director
                                                              of the Cadham Provincial
             The following systems are currently              Laboratory participates in
             in place for emerging respiratory                the Canadian Public Health
             diseases, including a new strain of              Laboratory Network. This
             influenza. These systems will be used             network provides surveillance
             for pandemic influenza:                           recommendations and
                                                              standards for public health and
                 •   When a new or re-emerging                laboratories, especially during
                     respiratory disease is detected          evolving crises.
                     anywhere in the world, the
                                                          •   Other provinces, territories
                     World Health Organization
                                                              and the Public Health Agency
                     informs the Public Health
                                                              of Canada are notified of
                     Agency of Canada, which
                                                              situations of concern or known
                     notifies provincial and territorial
                                                              or suspected cases, through
                     public health officials. Through
                                                              a secure national electronic
                     a variety of national networks,
                                                              surveillance system.
                     the provinces, territories and
                     federal government discuss
                     and develop recommendations
                     for enhanced surveillance and
                     for any actions that are being
                     taken or should be taken.

22   Preparing for Pandemic Influenza
ii. Vaccine and Antiviral Strategy               Manitoba’s Vaccine Strategy for
General information is provided below on         Pandemic Influenza
vaccines and antiviral drugs, followed by        Pandemic preparedness for vaccines
details of Manitoba’s strategy for vaccine       includes making sure we have the capacity
and antiviral use during a pandemic.             to carry out mass immunization campaigns.
                                                 As vaccine becomes available, the goal
General information about vaccines and           is to immunize the entire population. It
antiviral drugs                                  may be neccessary to provide two doses
Vaccination is considered the most effective     of vaccine to each individual. However,
way to protect the public from pandemic          since the vaccine will be available in a
influenza. Influenza vaccine causes the            series of shipments, priority groups will
body to produce antibodies against the flu        be first to receive the vaccine. As soon
virus in the vaccine, providing immunity         as Health Canada approves the new
from the virus. The vaccine contains             vaccine, Manitoba Health, regional health
inactive virus, so it cannot cause influenza.     authorities and other health service delivery
                                                 organizations will work together to mount
Antivirals are drugs used for the prevention     a province-wide mass immunization
and early treatment of influenza. When            campaign. Planning for mass immunization
taken before or immediately after exposure       is underway.
to influenza virus, but before symptoms
have occurred, antivirals may help prevent       How will vaccine be distributed during a
illness. If taken very soon after getting sick   pandemic?
(within 48 hours), they can reduce influenza      Vaccination is the cornerstone of the
symptoms, shorten the length of the              Canadian and Manitoba pandemic influenza
illness and potentially reduce any serious       preparedness plans.
complications. Antivirals work by reducing
the ability of the virus to reproduce;           The goal of Canada’s pandemic vaccine
however, they do not provide immunity from       strategy is to produce enough vaccine
the virus.                                       to protect all Canadians as quickly as
                                                 possible. Manitoba shares this goal for its
Influenza is a viral infection and antibiotics    population. Once available, the goal is to
do not work against viruses; however,            immunize all Manitobans on a priority basis.
antibiotics may be prescribed to treat
secondary bacterial complications such as        We understand that during a pandemic,
pneumonia.                                       Manitobans will be eager to have
                                                 themselves and their families immunized.
Antiviral drugs may have an important,           However, when vaccine becomes available,
though limited, role to play in an outbreak      it will likely be available in batches. This is
of pandemic influenza. Since a vaccine            why priority groups have been identified to
specific to the strain of disease is not likely   receive the first doses of vaccine. These
to be available for at least several months      groups will likely include health care
after the virus is detected, antivirals may be   workers, paramedics and other essential
the only treatment available until a vaccine     workers who will be needed to care for
is developed.                                    the sick.

                                                                        Preparing for Pandemic Influenza   23
Priority groups for vaccines are required   Established System and Processes
             because the vaccine will be available       for Vaccine Programs in Manitoba
             in batches as it is produced. As with       Manitoba has a well-established annual
             vaccination programs for annual flu,         influenza immunization program. The
             individuals at highest risk of getting      annual influenza vaccine becomes
             infected and developing complications       available in the fall of each year and is
             should be immunized as soon as              distributed to regional health authorities
             possible. During a pandemic, it is          and doctors’ offices. Manitoba has the
             critical that essential responders          following systems and processes in
             are protected so they can provide           place:
             essential health care, emergency and
             social response services. Therefore,            •   vaccine acquisition, storage
             nationally agreed-upon priority groups              and distribution (also applies to
             will be used in Manitoba for influenza               antiviral drugs)
             vaccination during a pandemic.
                                                             •   storage and handling protocols
             It is important to note that priority               for vaccines
             groups may be adjusted, depending on
             the epidemiology of the pandemic (ex:           •   established ways for health
                                                                 care practitioners to get the
             age and high-risk groups affected). We
                                                                 vaccine
             won’t know who will be at greatest risk
             until the time of a pandemic.                   •   defined target populations
                                                                 for vaccination (identified by
             For more information on vaccine                     vaccine eligibility criteria)
             for an influenza pandemic,
             please visit our website at:                    •   contracts in place to ensure
             www.gov.mb.ca/pandemic                              central storage and co-
                                                                 ordinated distribution of all
                                                                 publicly-funded vaccines

                                                             •   electronic database for
                                                                 vaccination coverage and
                                                                 reporting system for vaccine-
                                                                 associated adverse events (a
                                                                 component of all immunization
                                                                 programs in Manitoba)
                                                         In preparation for pandemic influenza,
                                                         Manitoba’s existing systems are being
                                                         tested and enhanced. The province
                                                         has experience in mass immunization
                                                         campaigns and rapid implementation of
                                                         such campaigns (ex: meningitis).

24   Preparing for Pandemic Influenza
Manitoba’s Strategy for the Use of              About Antiviral Drugs
Antiviral Drugs during a Pandemic               There are only a small number of antiviral
Uses of Antiviral Drugs                         drugs licensed for use for influenza in
                                                Canada. These are:
In an influenza pandemic, Manitoba will use
antiviral drugs in a way that is consistent
                                                    •   Oseltamivir (Tamiflu ), a
                                                                            ®

with the national approach and based
                                                        neuraminidase inhibitor, licensed for
on the best evidence available. Once we
                                                        both prevention and treatment of
know how the new virus is affecting the                 influenza A and B
population, a public health assessment
of risk will be made to guide the use of            •   Amantadine, an M2 ion channel
antiviral drugs.                                        inhibitor, licensed in Canada for
                                                        both the prevention and treatment
Antiviral drugs can be used for either                  of influenza A infections
treatment or prophylaxis.
                                                    •   Zanamivir, a neuraminidase
Treatment:      Antiviral drugs can be                  inhibitor, licensed for treatment
                taken to treat illness from             of influenza A and B
                influenza, after symptoms        It is important to note that antiviral drugs
                have occurred. To be            are not a cure-all remedy. There are several
                effective, antivirals must be   issues surrounding the use of antiviral drugs
                taken within 48 hours of the    in an influenza pandemic. They include:
                onset of symptoms.
                                                    •   Effectiveness: It is not known
Prophylaxis:    Antiviral drugs can be
                                                        for sure how well any specific
                taken to prevent illness                antiviral drug will work against a
                from influenza, either                   new influenza virus. Oseltamivir
                before exposure occurs or               (Tamiflu ), currently recommended
                                                                ®

                immediately after exposure,             for the treatment and prevention
                but before symptoms occur.              of influenza, is the drug being
                                                        stockpiled by governments in
                                                        Canada (including Manitoba), and
                                                        around the world.

                                                    •   Resistance: It is possible that
                                                        the influenza virus causing the
                                                        pandemic could become resistant
                                                        to a particular antiviral drug. The
                                                        scientific and medical community
                                                        currently monitor for antiviral drug
                                                        resistance in influenza viruses. This
                                                        monitoring would continue during a
                                                        pandemic.

                                                                      Preparing for Pandemic Influenza   25
•   Safety: The most common                 •   Ethics: There are many
                     side-effect of oseltamivir                  ethical issues surrounding the
                     is nausea. Safety and                       potential use of antivirals in a
                     effectiveness of repeated                   pandemic. Because there will
                     treatment or prevention courses             likely be insufficient supply
                     of drugs like oseltamivir have              of drugs available, decisions
                     not been studied. However,                  will need to be made how
                     there is some evidence of its               best to use them. Much
                     safety for continuous use for up            discussion has taken place
                     to six weeks.                               on this topic and guidelines
                                                                 have been developed by the
                 •   Availability: There are a limited           Canadian Pandemic Influenza
                     number of manufacturers of                  Committee. These guidelines
                     antiviral medication. Manitoba,             will be reviewed on an ongoing
                     along with the other provinces              basis as our collective scientific
                     and territories, continues                  understanding evolves.
                     to work with the Public
                     Health Agency of Canada             For more information on antiviral drugs
                     to strengthen provincial            and their potential use in Manitoba
                     and national stockpiles of          during an influenza pandemic,
                     oseltamivir.                        please visit our website at:
                     It is widely recognized that        www.gov.mb.ca/pandemic
                     antiviral drugs are in relatively
                     scarce supply internationally.
                     Therefore, a national stockpile
                     is required to secure a supply
                     of antiviral drugs in preparation
                     for a pandemic. Furthermore,
                     even with a national stockpile,
                     the demand may exceed the
                     stockpiled supply, as available
                     supplies will be used up rapidly
                     at the start of a pandemic either
                     for early treatment of cases or
                     for preventative treatment
                     of contacts.

26   Preparing for Pandemic Influenza
Established Systems, Plans and             iii. Other Public Health Measures or
Processes for the use of Antiviral              “Societal” Measures
Drugs in Manitoba
                                           In Manitoba, The Public Health
   •   Manitoba Health has protocols       Act gives public health officials the
       in place for the use of antiviral   authority to deal with public health
       drugs in the management of
                                           emergencies, such as pandemic
       influenza outbreaks in facilities
                                           influenza. Through provincial-regional
       such as personal care homes.
       Manitoba Health maintains an        networks, Manitoba Health provides
       annual stock of the antiviral       doctors and regional health authorities
       drug oseltamivir (Tamiflu )®         with regularly updated information
       specifically for this purpose.       on how to detect, report and manage
                                           cases of severe respiratory illness.
   •   Manitoba acquired a                 Regional health authorities are
       stockpile of this drug through      updated on provincial and national
       participation in nationally         planning for public health threats,
       co-ordinated cost-shared
                                           such as pandemic influenza, and
       stockpile purchasing
                                           are consulted on adapting nationally
       initiatives, where provinces,
       territories and the federal         produced guidelines for use in
       government purchased                Manitoba.
       antiviral drugs based on
       population proportions.             During an outbreak or pandemic,
                                           Manitoba Health will provide doctors,
   •   Central storage and regional        regional health authorities and health
       distribution mechanisms             care facilities/agencies with direction
       for antivirals are in place.        on managing patients with the
       Planning is underway to make        disease, and those who have come
       sure this system can support        in contact with infected individuals.
       mass distribution that would        A rapid communication system is in
       be needed during an influenza
                                           place to transmit information to health
       pandemic.
                                           providers on a same-day basis.
                                           This direction will help protect the
                                           health of the public and that of health
                                           care workers.

                                                           Preparing for Pandemic Influenza   27
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