September 3, 2009 : Update on pandemic H1N1 (pH1N1) planning

Memo: H1N1 Influenza

To: Primary Care Providers
From: Isra Levy, Medical Officer of Health
Date: September 3, 2009

Over the summer, Ottawa Public Health has been working with primary care providers, including community health centres, some family health teams, college and university health services, the Academy of Medicine Ottawa and others, to establish a local plan in anticipation of a second wave of pandemic H1N1 influenza. This memo is to update you on activities that may affect your practice this fall.

Surveillance: Our analysis of the Ottawa experience in the first wave of the influenza pandemic (which peaked in June in our community) demonstrates a marked spike in patients who screened positive for flu-like symptoms at emergency rooms at CHEO and at the QCH during the first two weeks of June. These increases were not as apparent in other hospitals. Of note, half of the laboratory-confirmed cases overall and half of the hospitalized cases in Ottawa were under 20 years of age. Our fall surveillance will focus on early detection of renewed pH1N1 activity and real-time epidemiologic profiling to help appropriate resource allocation and communications.

Seasonal influenza vaccination: We are expecting our first shipment of the seasonal trivalent vaccine in the week of September 28 and will start distribution as soon as the vaccine is available. We are planning on holding our clinics from October 10 to November 15. Flu information packages will be mailed out shortly.

H1N1 vaccine planning: We expect pH1N1 vaccine to be available in mid to late November 2009 at the earliest. At this time, it appears that two doses administered one month apart will be required, and the vaccine will come in multidose (n=10) vials that require reconstitution. Once reconstituted, the vaccine must be used within 24 hours or else discarded. All persons who want and need the vaccine will have access to it in Canada. There may however be a need for the sequencing of groups who will receive it first. Monitoring of adverse reactions, wastage management and sequencing of priority groups will be key with this new vaccine. At this time, we are still exploring options regarding vaccination programs. Alternatives include models that replicate community physicians’ role in seasonal influenza vaccination, as well as models in which primary care does not undertake vaccination. Should you be involved in administering the vaccine to your patients, prequalification will likely be required. More information is expected imminently from the Ministry of Health.

Pneumococcal vaccine: In the meantime, as a mitigation measure for complications of influenza, we encourage you to vaccinate all your eligible patients with the pneumococcal vaccine. We have noticed an increase of orders for this vaccine in the past month and encourage further efforts in this area.

Flu assessment and treatment for non-hospitalized patients: Our local plan is based on maximizing the use of existing primary care providers. Additional planning is underway to provide clinical services to patients who do not have a primary care provider or cannot access their own provider in a timely way. Discussion on how primary care providers can prepare their own offices suggests you could:

• identify approaches that could be used to reduce the number of routine primary care visits during the
• 4 to 6 weeks of a pandemic wave (for example, defer preventive care, extend prescription renewal periods)
• consider setting up increased telephone support for your most vulnerable patients
• review and implement enhanced infection-control measures (signage and masks at the entry, having a separate area for patients presenting with influenza-like illness, telephone screening when appointments are booked). Note that a practitioner resource kit (through a collaboration of Ottawa Public Health and planning agencies) will be available in early fall.

Surge capacity: We are interested in assessing the level of surge capacity in the community. The Academy of Medicine Ottawa is developing an inventory of local physicians who may be able to contribute additional hours of practice. If you are in a position to provide additional hours of service (you are retired but still licensed, you work part time, you are currently in a non-practice role and could temporarily be re-deployed), and are willing to participate in other practice settings conforming to your scope of practice, please contact the Academy of Medicine Ottawa at academy.medicine@on.aibn.com by October 31, 2009. In addition to providing your name, telephone number and e-mail address, please indicate number of hours available per week, geographic preference, and clinical skills (such as specialty).

Identifying communication channels: Ottawa Public Health is committed to keeping you current with local health information. We currently use Ritefax to reach physicians and are aware this is an imperfect system. If you have feedback or recommendations on improving the channels we can use to reach you or your colleagues, please e-mail your comments to Kathy.Beauregard@ottawa.ca.

Fall calendar

October 8, 2009 – Champlain Regional Infection Control Network – Taking the panic out of pandemic (N95 fit testing available by appointment) To register, contact info@cicn-rcic.on.ca or 613-761-4833.

Mid-October – Academy of Medicine Ottawa – pH1N1 Town Hall. This will be a panel discussion with Ottawa Public Health on clinical activities. A Practitioner Resource Kit for pH1N1 Influenza will be available for attendees. Details to follow.

Ongoing collaboration – You are invited to participate in the various planning groups that are working on antiviral distribution, surge capacity and clinical guidelines. Of particular note, there is a new community-based primary care committee being struck that will report into the clinical arm of the local emergency response. Please contact Dawna Ramsay at the Academy of Medicine Ottawa (613-733-2604) to express your interest and availability for this group.

Resources and questions

If you have any questions or wish to request resources, please contact us via phone (613-580-6744) or e-mail healthsante@ottawa.ca. Our phone line has been modified to improve service to physicians: please dial 15414 for immediate attention. Materials are also available on our web site, including the spring/summer 2009 edition of Physicians’ Update which lists providers of fit testing for N95 masks in Ottawa. Follow “Novel H1N1 flu virus” for links to other resources such as the Ministry of Health and Long Term Care’s Important Health Notices (IHN) and the College of Physicians and Surgeons of Ontario’s Infection Control in the Physician’s Office.