Pandemic Influenza

Submitted by jdorion on Sun, 07/26/2009 - 22:42

Pandemic Influenza

Current phase of alert in the W.H.O global pandemic

The current alert status issued in June 2009 is Phase 6 - Pandemic -“A new influenza virus subtype is causing disease in humans and is spreading efficiently and sustainably among humans.”

The pandemic influenza virus was first report in Mexico in March 2009. Since then, the World Health Organization (WHO) has been tracking the spread and severity of illness the virus is causing around the world. In June 2009, the WHO declared a global outbreak (pandemic). This means that all countries were advised to activate their pandemic plans. The Public Health Agency (PHAC), provincial, regional and local/communities pandemic plans should be in full operation at this time. See web sites for more information.

Current pandemic influenza strain

The current pandemic influenza virus has been identified as a “new” strain of H1N1. This virus has also been referred to as the “swine flu”, however this term is misleading. Normally the H1N1 virus is only seen in pigs and does not spread to humans.

The new H1N1 flu virus is a mixture of pig flu and human flu. When the pig virus mixed with a human flu virus a new, stronger virus was created (mutation). It is not unusual for viruses to change and grow stronger each year – that is why a new flu vaccine is manufactured each year. However, the pandemic virus has not been seen before and humans do not have immunity to this new virus.

The H1N1 flu virus currently circulation in humans is causing mild flu symptoms in most people. Unlike seasonal flu, this flu virus is causing illness and death in younger people between the age of 18 and 60 years. Regular seasonal flu tends to cause severe illness in those over the age of 60 and those with a chronic illness (asthma, diabetes etc).

Because this is a new flu virus that humans have not been exposed to before, scientists must develop and new vaccine to protect people. Developing a new vaccine can take several months.

Historical view: Pandemic Facts and trends

• Pandemics typically happen every 30 years or so
• The next pandemic (world wide spread of a new influenza virus) is overdue
• Historical pattern:
1918-1919…. 50 million deaths (20-40 million deaths < 1 year)
1957-1958… 1-2 million deaths
1968- 1969… 700,000 deaths
1977 …….. re-emergence no pandemic

*Significant note related to deaths - A higher proportion than usual in younger healthy adults in all past pandemics.

Expected pattern for a pandemic

• attack rate is high – 35% of the population will become ill
• up to 75% will become infected with the virus
• tends happen in ‘waves’ – each wave can be 6-8 weeks long with a 4-6 week decline in reported illnesses and then a resurgence of illnesses
• there could be 4 waves over a 12 -18 month period
• at the peak of each wave many people become ill, some severely ill with flu-like symptoms; some people develop a secondary infection such as a pneumonia

Current pandemic information released by Health Officials – the World Health Organization (WHO) and Public Health Agency of Canada (PHAC)

• the pandemic virus – H1N1 is spreading rapidly and easily among people
• tracking the number of cases is not as important as tracking the severity of illness
• the majority of people becoming sick with this virus have mild illness
• to date (July 23) approximately 700 people have died (around the world)
• the virus has been reported in most countries around the world; The United Kingdom is currently dealing with a major outbreak (100,000 cases reported over a 7 day period – July 23, 2009)
• antiviral medications (pills) i.e. Tamiflu will be available through the provincial and regional health facilities however these medications are only effective if taken within 24-48 hours of becoming ill with flu-like symptoms and they do not provide immunity to the virus
• a vaccine is currently being tested in Australia however this will not be ready for use in the general public for some time – health officials are hopeful that the vaccine may be ready by December of this year
• PHAC is expecting a second more severe wave of the pandemic virus to come in the fall when flu season begins (October-November) and expect a sharp rise in the number of H1N1 cases - just about the time that schools and universities resume classes
• The W.H.O is recommending that officials consider the possibility of school closures and alternative methods of teaching (televised, email, internet etc) to reduce the risk of spread, however it is up to PHAC and provincial health authorities and school boards to make this decision – parents should keep themselves informed and decide what is best for their children

General Influenza Information

Influenza is highly contagious and spreads quickly where large groups of people gather.

Influenza symptoms are similar to the common flu but more severe and complications are more serious (pneumonia, dehydration, worsening of chronic health problems)

Rapid onset of flu-like-illness
• Fever > 38 degrees C 3-4 days
• Sore throat
• Cough dry
• Headache severe
• aches & pains severe
• weakness severe
• tiredness severe
• nausea & vomiting, diarrhea

*If ill, limit close contact with others as much as possible
*Contact health professionals for instructions/treatment.

Time frames Influenza Virus survives/lives outside the body and can be spread to others (Public Health Agency of Canada - Canadian Pandemic Influenza Plan)

• 5 minutes on a warm hand
• 8-12 hours on cloth, paper or tissue
• 24-48 hours on hard, nonporous surfaces (door knobs, tables etc)

Influenza Virus infections- Contact and risks for spread (time frames)
• contact time with no symptoms – 1-3 days
• contact time when person is infectious- 1 day before symptoms appear up to 7 days after symptoms appear
• consider infectious for approximately 10 days- maybe longer for children and elderly

Influenza is mainly spread by:
• small particle aerosols- inhalation person to person of respiratory secretions (accounts for most transmissions) - coughing, sneezing, etc.
• large droplet- rides on dust and other particles in the air, ventilation systems, fans etc.
• direct person-person contact - shaking hands, etc.
• contact with soiled articles/objects- tissues, tables, door knobs, toys, cribs, beds, mattresses, floors, carpets, toilets, walls etc.

How to reduce spread and becoming sick

• Recognize symptoms- contain infection and reduce contact with others
• Hand hygiene- wash hands often (soap & water or waterless hand wash) , wash/scrub hands vigorously for 20 seconds, use clean towel/disposable towels to dry each time
• Sneeze & cough etiquette- cover mouth/nose with tissue, clean hands each time
• avoid touching eyes, nose, or mouth after touching surfaces (doorknobs, desks, tables, etc)
• Do not go to work/school if you are sick- report symptoms to Health personnel (tracking and monitoring of infection spread patterns; treatment advise)
• reduce personal space (social space 3-5 feet)
• limit social contact if sickness is suspected, find alternate ways to do your job if possible
• Isolation of sick people in one room - use masks, gloves, protective disposable gowns/plastic aprons, face shields/goggles for splashing of body fluids etc, separate supplies for hygiene, eating, etc, avoid shaking linen
• contain contaminated secretions/objects- place tissues etc in a bag/container immediately, burn garbage if possible, keep environment clean
• Restrict visitors/traffic flow in room/home where there are sick people
• ensure adequate ventilation
• clean surfaces etc regularly (virus lives on these for 24-48 hours)
• keep at least 1 meter away (3 feet) from people who are sic
• Stay informed.
• Teach your children to wash hand frequently with soap and water, to cover their mouths when they cough or sneeze, and to stay away from others who are sick.

Stockpile supplies for an extended period at home – recommend a minimum 2 months supply (Suggested list from Center of Disease Control)

• bottled water and non-perishable food (protein bars, dry cereal/granolas, peanut butter/nuts, dried fruit, crackers, canned juices, pet food etc)
• soap, hand wash, thermometer, anti-diarrheal medication, vitamins, fluids/electrolytes, cleaning supplies, flashlights, batteries, portable radio, manual can opener, garbage bags, tissues/toilet paper etc
• prescribed medical supplies (diabetes, hypertension etc)
• non prescription medications to treat fevers and body aches

For more information on Pandemic planning and preparedness go to:

The World Health Organization (WHO)

• Health Canada – Public Health Agency of Canada (PHAC): , or .
The Canadian Pandemic Influenza Plan for the Health Care Sector PHAC (Public Health Agency of Canada) for influenza information for individuals and families
The First Nations and Inuit Health Branch (FNIHB)
Saskatchewan Health web site
• Local health care providers: Regional Health Authorities and Public and Community Health Nurses