2016-2017 Influenza Season: Our Annual Epidemic Kieran Moore AMOH KFLA Piotr Oglaza PHPM Resident KFLA October 2016 Working together for better health
Acknowledgements Dr Bryna Warshawsky Public Health Ontario Public Health Ontario Laboratory
Objectives Overview of the season to date Prediction of strain and overview of influenza vaccine for 2016-2017 Discuss system preparedness and response
Chain of infection: infectious agent
Infectious agent: current influenza activity PHAC Flu Watch Public Health Ontario Ontario Influenza-like Illness (ILI) Mapper
Flu Watch - Canada Influenza activity level by provincial and territorial influenza surveillance regions Ontario, September 18 to 24, 2016 (week 38) No Activity Sporadic activity Localized activity Widespread activity
Flu Watch - Canada Influenza activity level by provincial and territorial influenza surveillance regions Ontario, September 18 to 24, 2016 (week 38)
PHO Respiratory Virus Surveillance Reports
PHO Respiratory Virus Surveillance: Laboratory-based surveillance reports New PHO Respiratory Viral Testing Algorithm Effective November 7, 2016 all specimens undergoing respiratory viral testing will be tested using the multiplex respiratory viral PCR (MRVP) method. The best testing possible when testing is indicated.
ILI Mapper ILI Season Week 39 Oct. 02, 2016 to Oct. 08, 2016
ILI Mapper ED respiratory visits curve for Ontario hospitals providing data to the ACES system along with previous year comparisons.
Current Influenza Activity Ontario PHO As of week 37-38 (September 11-24) Influenza A and influenza B are circulating at low levels. Increasing activity from previous 2 week period Influenza A H3N2 identified in two institutional outbreaks Rhinovirus is currently the dominant circulating respiratory virus. Source: PHO Respiratory Virus Surveillance Reports
Current Influenza Activity Ontario PHO Weeks 37-38 (September 11-24) 851 samples submitted 17 positive for influenza A 2 positive for influenza B 22 positive for parainfluenza 86 positive for entero/rhinovirus Source: PHO Respiratory Virus Surveillance Reports
Respiratory Outbreaks 2015/2016 Season Ontario PHO
Influenza Outbreaks, Hospitalizations and Deaths: Ontario, 2012-2016 Source: Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, extracted by Public Health Ontario [2016/09/07].
2016 SEASON IN THE SOUTHERN HEMISPHERE, PREDICTIONS FOR THE 2016-2017 SEASON FOR ONTARIO
Global detections of influenza September 5-18, 2016 Influenza A (82%) H1N1 (12%) H3N2 (88%) Influenza B (18%) Yamagata (25%) Victoria (75%) Source: http://www.who.int/influenza/surveillance_monitoring/updates/2016_10_03_influenza_update_273.jpg?ua=1
Influenza vaccines for 2016-2017
Influenza: chain of infection
Influenza rates by age group and type: Ontario, 2014-15 and 2015-16 seasons 2014-15 season 2015-2016 season Source: (Case data) Ontario Ministry of Health and Long-Term Care, integrated Public Health Information System (iphis) database, extracted by Public Health Ontario [2016/09/13]; (Population projections, 2015-16) Ontario Ministry of Health and Long-Term Care, Health Analytics Branch, Date Received: [2015/03/13].
Influenza vaccine Prevents influenza in healthy individuals Ameliorates the symptoms and duration of influenza in the elderly Prevents hospitalization for pneumonia and influenza among elderly persons living in the community Prevents hospitalization and death in elderly persons living in long-term care homes
Ontario Universal Influenza Immunization Program Types of vaccine Products Eligibility Quadrivalent inactivated FluLaval Tetra Fluzone Quadrivalent 6 months to < 18 years Live attenuated intranasal Trivalent inactivated Adjuvanted trivalent inactivated Flumist Agriflu Fluviral Influvac (only 18 years of age and older) Fluad 2 years to < 18 years 18 years of age and over 65 years of age and over in long term care homes
Health System Preparedness and Response
KFL&A PH Supporting Health Systems: LHIN-wide approach Five key principles 1. Ensure maximum preparedness for the annual influenza epidemic 2. Ensure that patient access across the health system continuum is maintained throughout the holiday season. 3. Ensure the system anticipates and is prepared for a surge in visits to the Emergency Departments and admissions to hospitals 4. Monitor the effectiveness of health system interventions in preparation and response and respond to gaps through a coordinated system response. 5. Communicate to health care partners and the public in a consistent, coordinated transparent fashion to enhance system preparation, response and recovery
Supporting Health System Preparedness KFL&A Public Health Influenza Action Plan Framework and surge plan for management of seasonal influenza. LTCH/RH Annual in-service with OB exercise Updated outbreak guide Acute Care Surge Preparedness SECHEF Working group
LTCH Preparedness Maximize immunization coverage Prepare for resident antiviral chemoprophylaxis Increase infection, prevention and control(ipac) strategies starting now.
LTCH Preparedness - continued Consider how you might support immunized staff to obtain anti-viral prophylaxis in the event of strain mismatch. Encourage covering NP/MDs to see patients to avoid unnecessary ED referrals Be familiar with MOHLTC guidelines for repatriation of residents
Admissions and Transfers during OB
Repatriation of non-line listed residents Consider: Status of OB Medical concerns -Hospital attending MD agrees to return/admission Protection of resident from pathogen -Antiviral use, IPAC Appropriate accommodations available? Resident/substitute decision informed
Public Health will provide: Guidance and support throughout flu season Surveillance & situational awareness Policy and plan development 24/7 OB Management Recovery Ongoing communications First case, outbreak, strain identification, surge issues - Weekly Influenza Update - Infectious Disease Advisory
Summary Overview of the season to date Prediction of strain and overview of influenza vaccine for 2016-2017 Discuss system preparedness and response
Thank you!