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Public Health Response to Avian Influenza

Public Health Response to Avian Influenza. Dr. Michelle Murti Medical Health Officer Fraser Health BC Zoonoses Day November 10 2015. Outline. AI in the Fraser Valley PH Surveillance Activities Roles of Public Health Lessons learned. AI in the Fraser Valley.

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Public Health Response to Avian Influenza

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  1. Public Health Response to Avian Influenza Dr. Michelle Murti Medical Health Officer Fraser Health BC Zoonoses Day November 10 2015

  2. Outline • AI in the Fraser Valley • PH Surveillance Activities • Roles of Public Health • Lessons learned

  3. AI in the Fraser Valley

  4. Public Health notification • December 2, 2014 • Initial notification • 2 farms affected • Abbotsford and Chilliwack • AI detected – H5 • Highly pathogenic to birds

  5. AI Fraser Valley- 2004 (H7N3) http://www.iicacan.org/Publications%20and%20Documents/Avian%20Influenza%202006.pdf

  6. Additional AI in Fraser Valley • 2005 – H5 detections • 2009 – H5 on turkey farm

  7. Progression of AI, 2014 • Between December 1-19, 2014 • 11 commercial premises • 1 non-commercial premise • Broiler-breeder (7) • Turkey (3) • Egg-layer (1) • Backyard flocks (1) • >245,000 birds

  8. Virus Detections • HPAI H5N2 • A/turkey/BC/FAV10/2014 (H5N2) • First report of a Eurasian H5 lineage in North America • Novel reassortment • Eurasian H5N8 HPAI • North American N2 LPAI of wild bird origin

  9. Additional Detection • February 6, 2015 • Non-commercial egg layer flock farm • HPAI H5N1 • A/Chicken/BC/FAV2/2015 H5N1 • Identical to H5N1 strains identified in wild bird flocks in Washington state • H5N1, H5N2, H5N8 detections through US northwest

  10. Public Health Surveillance • HPAI to birds, not humans • Potential risk to those exposed to birds • New H5 to North America – potential for pathogenic introduction from novel reassortments • Contact tracing, monitoring, follow-up

  11. Contact follow-up • 50 contacts on the 13 premises • 35 (70%) male • Median age 42 years (12-75 yo) • Small farming families • Few additional workers • Deliveries/pick-ups

  12. Contact Education • Timing of exposures • Ongoing exposures • Bird management until decontamination • During decontamination • Education on signs and symptoms of ILI • Reporting if development of symptoms

  13. Active Surveillance • Daily active monitoring • During exposure • For 7 days from last exposure • Follow-up phone call day 17 • Ensure no new exposures • Ensure still asymptomatic

  14. Chemoprophylaxis • Offered influenza immunization • 26 (52%) immunized • Antiviral (oseltamivir) chemoprophylaxis if ongoing exposure • Daily dosing while exposed and 7 days post • Recommended to 26 contacts • Accepted by 11 (42%)

  15. Symptom Follow-up • 4 contact developed symptoms during monitoring • Cough and/or runny nose • No fever • NP swabs • 3 negative for Influenza A/B/RSV • 1 positive for Influenza B • 2/4 initiated treatment dose of oseltamivir pre-swab

  16. Communications • Notification to local area GPs and acute care • Public messaging via poultry and swine industry association liaisons • Awareness of public health risks • Recommendation for influenza vaccination • Routine use of personal protective equipment • Media and public messaging • Food safety questions

  17. Roles of local Public Health • Lead Coordinating Committee calls • BCCDC, JEOC, CFIA, WH contractor, WorksafeBC • Consultation to CFIA Occupational Health • Consultation to WorksafeBC • Collaboration with BCCDC re human exposure risk assessment

  18. Roles of local Public Health • Reporting to province and PHAC • Daily surveillance updates • Communications • Key messages • Collaboration with BCCDC • Risk Assessment • Surveillance and research • Virus identification

  19. Roles of Public Health • Presence at CFIA JEOC • Situational Updates • New farm identification • New issue identification • Linking to other affected jurisdictions • Water surveillance • Industry association

  20. History repeating • Documentation from 2004 experience • Able to share updated materials with Ontario • New processes • PH Observatory support for surveillance • Tools for surveillance • Lessons learned from EVD monitoring

  21. PH Nursing • Familiar with 2004 • Centralization of PHNs involved • Weekend coverage • Familiarity with community • Access to tamiflu

  22. Fraser Valley (the epicenter…) • Local connections with GPs, hospital • Facilitate testing • Immunization attitudes • CFIA contract with Workplace Health Cost Solutions • Collaboration (and confusion) around Occupational Health for workers

  23. Awareness of role of PH • Focus on poultry industry • Recognition of potential risk to those exposed • Need for surveillance on reassortment • Capacity to manage mental health effects

  24. Future actions • Collaboration with BCCDC on revision of provincial manual • Research readiness for future evaluations • Awareness of poultry (and swine) farming • Including backyard farming

  25. Acknowledgements • FH staff (Dr. Marcus Lem, Dr. Mark Bigham, Dr. Victoria Lee, Sherry Baidwan, Karen Dickenson-Smith, Susan Loadman, Christina Fung, Salman Klar, Dr. Andrew Larder), and the Chilliwack PHU team • BCCDC • PHO

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