Important Health Notice

Important Health Notice

August 18th, 2009
Information for Healthcare Professionals
Volume 6, Issue 17
Page 1 of 3
H1N1 UPDATE

Highlights:
This Important Health Notice (IHN) is based on
• While the rate of influenza-like illness (ILI) is still
current information received to date and provides the
above what is expected for this time of year, there has
following:
been a steady decrease in ILI activity since June.
• Status of the Pandemic (H1N1) 2009
• The ministry is requesting that Pandemic (H1N1) 2009
(pH1N1) virus
(pH1N1) testing be performed on all Severe Respiratory
• Clarification on laboratory testing
Illness (SRI) patients admitted to hospitals.
recommendations
• Pregnant women have been found to be more likely to
• Information on the impact of the pH1N1
suffer from complications due to pH1N1 infection.
virus on pregnant women
However, the likelihood of contracting the virus is no
different from that of the general public.
• Information on Ministry of Health and
Long-Term Care planning activities
• Health care providers are encouraged to plan for a
second wave of pH1N1 in addition to the annual

impacts of seasonal influenza.

Status Update:

There have been 4,035 lab-confirmed cases of pH1N1

in Ontario as of August 8, 2009. On August 5, 2009,
Laboratory Testing:
48 lab-confirmed cases were in hospital, of whom

38 had underlying medical conditions. 283 other
Testing carried out to date has confirmed that
lab-confirmed cases have been hospitalized and
the pH1N1 virus is currently the predominant
have since been discharged. 21 deaths have been
circulating strain of influenza in Ontario.
reported among the cases to date.
Therefore, the indications for laboratory testing

for purposes of clinical treatment are extremely
Of the 19 respiratory illness outbreaks reported to
limited.
the ministry in summer camps, 9 have been lab-

confirmed as being caused by the pH1N1 virus.
However, testing for surveillance of disease

severity and associated characteristics of
Overall, there has been a decrease in influenza-like
patients in order to identify risk groups, monitor
illness (ILI) activity in Ontario since late June.
for antiviral resistance and determine further
However, the rate of ILI cases is above what is
assessment and intervention modalities is a high
expected for this time of year, particularly among
priority.
those under the age of 20.

Currently testing is only recommended for persons
While most pregnant women have a typical
admitted to hospital and those ambulatory patients
course of uncomplicated influenza, illness can
at higher risk of complications (e.g., persons with
progress rapidly for others requiring
pre-existing medical conditions, pregnant, persons
management in an Intensive Care Unit (ICU).
under the age of 2 years and over 65 years of age)

with ILI.
In Ontario, as of August 11th, a total of 14

pregnant women have been hospitalized with
Persons seen in emergency departments and
pH
discharged home should not be tested.
1N1, all of whom have been discharged. Of
these, 2 had underlying medical conditions, 2

cases were reported to have viral pneumonia
The ministry is also requesting lab testing for all
and 2 cases were admitted to ICU with 1 placed
hospitalized patients with Severe Respiratory
on a ventilator.
Illness (SRI) including:

i.
those admitted with SRI;
The likelihood of pregnant women contracting
ii.
those who develop SRI after admission for
pH1N1 is no different from that of the general
another reason; and
public. As a high-risk group, early treatment
iii.
those who are in respiratory failure for
within 48 hours of symptom onset should be
another presumed cause, where influenza
strongly considered1 and will help to reduce the
may be a contributing feature.
risk of complications. Interim clinical guidance

for pregnant and breastfeeding women with ILI
Laboratory requisitions should be clearly labelled to
has been released by the Public Health Agency
identify the patient as "Hospitalized" or "High-
of Canada and is available at:
Risk" to allow appropriate triage of specimens for
http://www.phac-aspc.gc.ca/alert-alerte/swine-
testing.
porcine/guidance-orientation-07-09-eng.php

Pregnant Women and the pH1N1 Virus:

Planning Activities:
Pregnant women, especially those in the later stages

of pregnancy, are at higher risk of complications
The Ministry of Health and Long-Term Care
from seasonal influenza than non-pregnant women.
has been engaged in extensive planning work in
Recent articles published in the Canadian Medical
the anticipation of a potential second wave of
Association Journal1 and by the Centers for Disease
the pH1N1 virus in the autumn in addition to the
Control and Prevention (CDC)2,3 suggest that this is
annual impacts of seasonal influenza.
likely the case for the pH1N1 virus.

These planning activities seek to finalize and

operationalize the guidance in the Ontario
1 Tanaka T, Nakajima K, Murashima A et al. (2009). Safety of
Health Plan for an Influenza Pandemic (OHPIP)
neuraminidase inhibitors against novel influenza A (H1N1) in
(http://www.health.gov.on.ca/pandemic) and
pregnant and breastfeeding women. CMAJ. 181(1-2).
include such areas as:
Retrieved July 30, 2009, from :

http://www.cmaj.ca/cgi/reprint/181/1-2/55
• The development of a surveillance strategy
2 MMWR Dispatch. (2009). Novel Influenza A (H1N1) Virus
to continue monitoring the pH1N1 virus in
Infections in Three Pregnant Women – United States, April-
the autumn and winter
May 2009. MMWR, 58. Retrieved July 30, from
• The immunization of Ontarians with pH
www.cdc.gov/mmwr/pdf/wk/mm58d0512.pdf
1N1
3 Jamieson DJ, Honein MA, Rasmussen SA et. al. H1N1 2009
vaccine in addition to the seasonal influenza
influenza virus infection during pregnancy in the USA. Lancet
immunization program
2009; 374: 451-58.

• Planning for the acute care system (with focus
Health Care Provider Hotline:
on critical care) in order to implement a

system(s) to track capacity in real time and
If you are a health care worker and have any
augment critical care capacity.
questions or concerns on the Important Health
• The potential establishment of local “Flu
Notices and related guidance documents, please
Centres” to treat Ontarians in order to offset
call the Health Care Provider Hotline toll-free at
pressure, should it arise, on the primary and
1-866-212-2272*.
acute care sectors

Hours of Operation**:
• The identification of key public health

measures, or non-pharmaceutical interventions,
Monday-Friday
0900hrs to 1600hrs
as well as guidelines for implementation
Saturday-Sunday CLOSED**
• The establishment of triggers for the release of

ministry stockpiles of supplies and equipment
*This hotline is intended to provide guidance and support
and implementation of the necessary
to health care workers only and is not a service to provide
distribution systems to ensure timely access
general information to the public
**Hours of Operation are subject to change. Please monitor
• Identification and support of key research
future Important Health Notices for changes
priorities and the provision of expert advice to
**On-call services are available for urgent issues, and can
health care providers on key technical issues
be reached through the Health Care Provider Hotline
• The development of a communications strategy

and associated products to inform the public and

to engage health stakeholders

• Continued engagement of First Nations
communities, in collaboration with Health

Canada, on all aspects of pandemic planning,
(original signed by)
with particular consideration of remote and
isolated communities.
Dr. Arlene S. King
Chief Medical Officer of Health

The ministry will be communicating with key

professional associations and labour unions in the

coming weeks and will continue engaging the

health care sector in planning for the autumn.

Health care providers are encouraged to continue
(original signed by)
their planning activities to date and to liaise through

their respective associations for further planning
Phil Graham
guidance as it becomes available.
Interim Director
Emergency Management Branch

In addition, health care providers are encouraged to

keep their contact information for Important Health
Notices up-to-date and to monitor the ministry’s
website for updates and further guidance. Health
care providers can register for Important Health
Notices through email and/or fax at:
http://www.PublicHealthOntario.ca