Important Health Notice
Important Health Notice
April 23, 2009
Information for Healthcare Professionals
Volume 6, Issue 1
Page 1 of 2
Clusters of Severe Respiratory Illness in
Mexico
The Ministry of Health and Long Term Care and the
Advice to healthcare providers
Ontario Agency for Health Protection and Promotion
were contacted on April 20th by the Public Health Agency
Severe Respiratory Illness (SRI) and Febrile
of Canada (PHAC) regarding a number of individuals
Respiratory Illness (FRI) screening in Emergency
with severe respiratory illness (SRI) occurring in various
Departments:
locations of south and central Mexico.
Emergency Departments are to use the existing
Epidemiology Update from PHAC:
Sample Case Finding/Surveillance Form in the
Two clusters have been identified, one in Mexico City
PIDAC FRI document (attached and available at
http://www.health.gov.on.ca/english/providers/program/infectious/
and one San Luis Potosi. As of yesterday, 23 hospitals
diseases/best_prac/bp_fri_080406.pdf) with the following
in Mexico City have reported 120 SRI cases including 13
modifications:
deaths. San Luis Potosi (central Mexico) has reported 14
1) In (iii), the relevant travel history question is:
SRI cases including 4 deaths. Most cases have occurred
“Have you traveled within the last 10 days to
in previously healthy young adults aged 25-44 years old.
Mexico?” It is important that a travel history
In addition, 1 death has been reported in Oaxaca
be obtained in all patients with FRI and SRI.
(southern Mexico) and 2 deaths reported in Baja
2) Cases who meet the definition of SRI who
California Norte (bordering California, USA). Five
have a travel history from Mexico in the past
healthcare workers have been identified in the clusters.
10 days should be treated in droplet/contact
precautions in a single room. In addition,
The clinical symptoms include high fever, headache,
healthcare providers should wear properly fit
ocular pain, shortness of breath and extreme fatigue.
tested N-95 respirators for direct care of
Rapid progression of symptoms to severe respiratory
these patients. This change has been made
distress occurred in about 5 days. High proportion
because a pathogen has not yet been
requiring mechanical ventilation reported (exact
identified and because of the high mortality
percentage unknown). Case-fatality rate has ranged
rate being reported at this early stage.
from 11 to 29% based on Mexico City and San Luis
These precautions only apply to this
Potosi data.
situation; all other healthcare providers not
providing direct care to these patients only
The same pathogen has not been identified in all cases.
need to follow Routine Practices. As new
To date influenza A/H1N1 and B, and one parainfluenza
information becomes available, this
strain have been detected. For many cases, no
recommendation will be reviewed.
pathogen has yet been identified. The National
Microbiology Laboratory has received 51 clinical
Patients with FRI who do not meet the definition of
samples from Mexico on April 22, and will be testing
SRI but have a Mexico travel history and who do not
them for a range of pathogens. The results of the lab
require admission, may be sent home. There is no
testing is expected shortly.
requirement for isolation at this time. There is no
requirement to quarantine contacts of cases at this
time.
Laboratory Testing:
Case reporting to local public health
Cases which fit the above SRI definition should have the
The MOHLTC case definition for SRI (dated April 23,
following specimens collected for testing at PHL-
2009) is provided. Patients fitting this case definition
Toronto:
are to be reported to the local health unit.
Nasopharyngeal swab in viral transport medium
(viral culture)
(original signed by)
Bronchoalveolar lavage specimen if available
Dr. David Williams
(sterile container for viral culture)
Acting Chief Medical Officer of Health
Throat swab in MultitransTM transport media
(Mycoplasma/Chlamydophila pneumoniae pcr)
Blood in EDTA (purple top)
(original signed by)
Blood in clotted tube (red top)
Phil Graham
Urine
for
Legionella antigen
Interim Director, Emergency Management Unit
Other investigations such as blood cultures
should be done locally
Please write “SRI-High Priority: Attention Dr.
Gubbay” on the requisition form.
Submit the Public Health Agency of Canada
(PHAC) SRI report form, available at:
http://www.phac-aspc.gc.ca/eri-ire/pdf/03-SRI-
Report-Form_e.pdf
Specimens should be transported to the laboratory
at 4ºC. Please contact the medical microbiologist on-
call prior to sending specimens to discuss whether
other specimens should be collected and method of
transportation. Phone:
1-800 640-7221, or after hours 416-605-3113 (Duty
Officer).
Laboratory testing is not currently recommended for
persons who have recently returned from Mexico with
upper respiratory tract symptoms/FRI but do not have
SRI.
Treatment of SRI cases:
There are no specific treatment recommendations for
FRI or SRI cases with a Mexico travel history. In cases
where influenza has been diagnosed, it is recommended
clinicians follow the influenza treatment guidelines
issued by the BC Centre for Disease Control (attached)
