Memo : Severe Respiratory Illness (SRI) in Mexico

To: Ottawa area hospital Emergency Room and Infection Control staff
From: Dr. Vera Etches, Associate Medical Officer of Health
Date: April 23, 2009
Subject: Severe Respiratory Illness (SRI) in Mexico

The Ministry of Health and Long term Care (MOHLTC) and the Ontario Agency for Health Protection and Promotion (OAHPP) have notified Ottawa Public Health (OPH) about a number of cases of severe respiratory illness (SRI) that have occurred recently in various locations in south and central Mexico. Most cases involved previously healthy young adults between 25 and 44 years of age, who presented with influenza-like symptoms that progressed to severe respiratory distress in about five days. Many patients have required mechanical ventilation and some have died. Some health care workers have been affected.

It is not clear at this point if these cases represent isolated events or whether they are linked. Some specimens have tested positive for Influenza A and B viruses. There is no evidence at present to suggest infection with an unusual pathogen, including a novel strain of influenza.

Given the severity of the cases, OPH is recommending that health care providers in the city of Ottawa take the following actions:

• Actively look for cases of SRI, particularly in persons who have recently returned from Mexico (within two weeks) and report this information to OPH immediately
• Continue to identify and report unusual clusters of febrile respiratory illness (FRI) or SRI in the community or in their health care setting to OPH
• Test clients who are suspect cases of SRI for common bacterial respiratory pathogens, common respiratory viral pathogens such as Influenza A/B, RSV, adenovirus, and parainfluenza (please note that results of rapid point of care tests may be falsely negative), and atypical bacteria pathogens such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. For specimen collection guidelines, you can go to http://www.health.gov.on.ca/english/providers/pub/labs/specimen.html
• Refer specimens that are negative for the above pathogens to the Public Health Laboratory, at 1-800-640-7221 during regular business hours, or consult with the Microbiologist on-call at 1-416-605-3113 after hours, for possible further testing
• Contact the Microbiologist on-call for any influenza positive specimens, as additional testing can be done at the PHL
• Isolate patients who fit the above categories in a single room and use droplet precautions, as per PIDAC guidelines
• Ensure health care providers in your work area use appropriate personal protective equipment when dealing with clients who are suspect SRI cases

The Public Health Agency of Canada is currently in communication with the Mexican Government and it is anticipated that more information will be available shortly. OPH will provide you with further information as they receive it from the MOHLTC and the OAHPP. Please do not hesitate to contact the Ottawa Public Health Information Line at 613-580-6744 if you have questions or concerns. Alternatively, and after hours, please call 3-1-1 and ask for the Ottawa Public Health Manager on call.

Sincerely,

Vera Etches, MD, CCFP, MHSc, FRCPC

Associate Medical Officer of Health