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Surveillance Working Group Anne-Luise Winter OAML Pandemic Planning Educational Day Toronto June 16, 2005 OHPIP Development Structure OHPIP Steering Committee Public Health Subcommittee Operations Subcommittee Communications Subcommittee Surveillance Working Group Laboratory Working Group Vaccines/Antivirals Working Group Supply/Equipment Working Group Public Health Measures Working Group Health Human Resources Advisory Working Group ‹#› Assumptions of Pandemic Planning • Epidemiology of the Pandemic strain will be similar to current circulating strains • Individuals who recover from the Pandemic strain will be immune from further infection from that strain • Laboratory testing is required for definitive diagnosis, testing is limited in capacity and will be done during initial phases only • Health care and public health resources are limited and often overwhelmed even in the inter-pandemic phase ‹#› Objectives of Pandemic surveillance • To detect early the entry of the Pandemic strain in Ontario • To track the occurrence, severity, and progression of influenza outbreaks, based on WHO/Canadian pandemic phases • To detect unusual events (new strains including epizoonotic strains, antigenic drift/shift, unusual outcomes or syndromes, unusual severity, unusual distribution) • To compare new strains with vaccine composition and recommendations • To estimate the impact of ILI in terms of attack rate, outpatient visits, hospitalizations, and case fatality rate • To describe affected population/s in order to identify high risk groups, modes of transmission, and risk and protective factors ‹#› Interpandemic/pandemic alert (seasonal) surveillance components PHAC: Laboratory surveillance Sentinel physician ILI Surveillance Ontario • Influenza activity reporting • Reports of laboratory-confirmed sporadic cases of influenza through RDIS/iPHIS • Respiratory infection outbreaks in institutions ‹#› Pandemic surveillance components • Laboratory • Disease/epidemiological • Animal health • Vaccine and antiviral uptake • Adverse events • Communication • Data collection system/s ‹#› Interpandemic Period • No new influenza virus subtypes detected in humans A circulating animal influenza virus subtype poses a substantial risk of human disease Surveillance: • Routine influenza surveillance with layered progression of activities • Communication of phase progression ‹#› Pandemic alert • Human infection/s with a new subtype. Rare limited larger cluster/s of human to human spread Surveillance • Detection of the novel strain (e.g. FRI/SRI surveillance) • Ongoing review of case definition • Continue with heightened surveillance until no longer sustainable ‹#› Pandemic • Increased and sustained transmission in general population Surveillance: • Utilization of pandemic reporting tools • Monitor uptake, efficacy, adverse events associated with vaccines and antivirals • Ongoing evaluation of epidemiology, to direct priorities to high-risk groups ‹#› Postpandemic Period • Recovery/Resolution Surveillance: • Estimate burden of disease • Evaluate surveillance systems • Eventual resumption of interpandemic activities ‹#› Next steps for SWG • Working on identifying specific data elements to be collected for different settings (institutional and community) • How best to track vaccine and antiviral uptake • Need to address gaps in current system ‹#› Conclusions • Maximize efficiency of surveillance system/s to avoid undue burden on data collectors • Surveillance data provides the “trigger for action”, hence accurate and timely data needs ‹#›