Health Canada Advisory Regarding H1N1 Flu Virus

Health Canada is advising Canadians not to purchase products claiming to fight or prevent H1N1 flu virus (human swine flu). While there are approved antiviral drugs that may help prevent or reduce the symptoms associated with the flu in general, there are currently no products authorized for sale in Canada that are indicated specifically for the treatment of H1N1 flu virus (human swine flu).

Antivirals such as Tamiflu (oseltamivir) or Relenza (zanamivir), which are authorized in Canada, can be effective in the prevention or early treatment of influenza. The Public Health Agency of Canada recommends limited use of antivirals to treat H1N1 flu virus (human swine flu) and only on the recommendation of the patient's doctor when the illness is moderate to severe and if the patient is at high risk of complications of influenza. If taken within 48 hours after getting sick, these drugs can help reduce symptoms, shorten the length of illness and potentially reduce serious complications. Antivirals should only be purchased with a prescription from a health care practitioner who has examined the patient.

Consumers should not purchase products claiming to be "generic" versions of drugs sold under the brand names Tamiflu or Relenza as Health Canada has not authorized generic versions of these drugs. They should also be extremely cautious if buying these drugs over the Internet. While there are legitimate Canadian Internet pharmacies, consumers should be aware of the risks associated with buying drugs online. For more information on the subject, Health Canada has developed an It's Your Health article on Buying Drugs over the Internet <http://www.hc-sc.gc.ca/hl-vs/iyh-vsv/med/internet-eng.php> .

Taking unapproved or counterfeit drugs could pose serious risks to health. These products may contain active ingredients not listed on the label or dangerous additives, and could cause serious side effects. Authorized health products will display either an eight-digit Drug Identification Number (DIN), a Natural Product Number (NPN), or a Homeopathic Medicine Number (DIN-HM) on the label. This authorization indicates that the products have been assessed by Health Canada for safety, effectiveness and quality.

H1N1 flu virus (human swine flu) is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu. Symptoms can be similar to seasonal flu and include headache, chills, cough followed by fever, loss of appetite, muscle aches and fatigue, runny nose, sneezing, watery eyes and throat irritation. Nausea, vomiting and diarrhea may also occur. In more severe cases, or in people with chronic conditions, complications such as pneumonia may develop.

There are simple measures you can take to protect yourself and your family against H1N1 flu virus (human swine flu). The Public Health Agency of Canada advises Canadians to wash hands thoroughly with soap and warm water, or use hand sanitizer, cough and sneeze into your arm or sleeve, stay home when sick, get your annual flu shot, and talk to a health professional if you experience flu-like symptoms.

Canadians are encouraged to stay informed on H1N1 flu virus (human swine flu) by visiting the Public Health Agency of Canada's website <http://www.fightflu.ca/index-eng.html> , or calling the toll-free public information line at 1-800-454-8302.

Canadians with questions or complaints about counterfeit drugs and / or drugs purchased over the Internet can call Health Canada's toll-free line at 1-800-267-9675.

Health Canada issued an advisory <http://www.hc-sc.gc.ca/ahc-asc/media/advisories-avis/_2005/2005_137-eng.php>  about the online purchase of Tamiflu in December 2005.

The WHO is reporting 985 cases globally

• Canada 101 - 3 in York Region all mild
• USA 226
• Mexico 506
• Costa Rica 1
• Columbia 1
• El Salvador 2
• UK 18
• Ireland 1
• France 4
• Spain 44
• Netherlands 1
• Denmark 1
• Germany 8
• Italy 2
• South Korea 1
• Hong Kong 2
• New Zealand 6

There has been person to person spread in 6 countries There have been media reports stating that the WHO is going to raise the pandemic level to 6. The WHO states that before they consider raising the pandemic level to 6 there would need to be a spread of the virus throughout Asia or Europe.

National: On 03 May, the Public Health Agency of Canada (PHAC) web site indicated that, as of 14:00 EDT, there were 101 confirmed cases of influenza H1N1 in Canada: 29 in British Columbia, eighteen in Alberta, 16 in Ontario, three in Quebec, one in New Brunswick, one in Manitoba and 33 in Nova Scotia. All Canadian cases to date have resulted in mild illness. WHO remains at global pandemic alert Phase Five.

Seasonal Mexican migrant workers are not a risk to the public. We have been assured by federal and Mexican authorities that precautions to prevent the spread of influenza have been implemented. All foreign workers who come to Ontario under the Seasonal Agricultural Workers program (SAWP) are covered by OHIP from the minute they arrive in Ontario. They will be treated like any other individuals who have a travel history to Mexico. If they have symptoms of respiratory illness, they should contact their health care provider, or phone Telehealth. If they are feeling well, they should go about their normal business. Other Government Departments Activities: (update) PHAC and PS are coordinating the integrated Government of Canada public communications response to the H1N1 flu virus.

Health Portfolio: A Special Advisory Committee (Deputy Ministers/Council of Chief Medical Officers of Health) has been formed to provide policy and technical advice to the Conference of Deputy Ministers of Health on public health matters related to the H1N1 Flu Virus outbreak. Department of Foreign Affairs and International Trade (DFAIT): The Canadian Embassy in Mexico remains in regular contact with Canadians registered in Mexico. Messages providing emergency numbers, web links to both Canadian and Mexican health departments, airline advisories, and a list of precautionary measures have been sent. Non-essential staff have been recommended to work from home until 6 May. The Embassy will continue to provide emergency consular and passport services. Consular staff are visiting major international airports that Canadians use frequently to provide airline representatives with consular emergency contact information in the event that any Canadian is denied boarding because of flu-like symptoms, and to monitor the situation on the ground. Alberta reported the identification of the H1N1 flu virus in a swine herd. It is probable that the pigs were exposed to the virus from a Canadian farm worker recently returned from Mexico, who had exhibited flulike symptoms and had contact with the pigs.

The WHO advises there is no indication of virus adaptation through transfer from human to pigs at this time. The WHO also advises there is no risk of infection from this virus from consumption of well-cooked pork and pork products. DFAIT/Transport Canada (TC): 03 May was the last day that any charter service from Canada is scheduled to fly in or out of Mexico; the only direct flights to Canada as of 04 May will be via Air Canada through Mexico City. In anticipation of this, airlines have been working to ensure the timely departure of all of their clients. Recognizing that complications may nonetheless arise, DFAIT consular officials are prepared to deal with any emerging issues related to the reduction in flights. TC has requested airlines with flights departing from Mexico to inform the department of flight schedule changes. This information will be provided to PHAC, so quarantine officers can be deployed to meet the aircraft.

Canada Border Services Agency (CBSA): CBSA is reporting reduced volumes of travelers being processed by its officers at Toronto’s Pearson International Airport, and Border Services officers at Ottawa’s Macdonald-Cartier International Airport are reporting that Aeromexico has cancelled all of its flights until at least 26 Jun.

Canadian Food Inspection Agency: (CFIA): Additional laboratory diagnostic testing is underway to further characterize the virus initially identified as Influenza A virus of an H1 type in one of two Alberta pig farms. The two farms remain under quarantine. Department of National Defence (DND): Eight Canadian Forces (CF) members returning from Mexico or Southern USA have been tested for potential H1N1 infection. One has been confirmed negative and others are pending. No was hospitalization was required. The CF Health Services Group (HSG) has started the release of antiviral stocks from their Central Medical Equipment Depot located in Petawawa and antiviral stocks have been shipped to Joint Task Force Afghanistan and DND / CF HSG are working on quantities and logistics for smaller missions and deployed Ships.

International Activities: U.S.: The U.S. is expected to spend $251 million to buy 13 million courses of antiviral treatments to replenish the Strategic National Stockpile. There is no restriction of regular travel or closure of borders. The Department of Education reports 433 schools in 17 states are closed due to confirmed and probable cases of H1N1. The closures impact 245,449 students and 15,544 teachers. Mexico: The Government of Mexico has declared that all non-essential activities for both government and the private sector cease in Mexico City, part of Mexico State and Cuernavaca City between 01 May and 05 May.

Issues: Government - Federal Employees: 1. Messaging for employees, TBS-lead. 2. Personal Protective Recommendations, Health Portfolio-lead. The Treasury Board Secretariat (TBS) and the Health Portfolio are working on an advisory about employees returning from Mexico. TBS will be working through the GOC to send a reporting template to the Heads of Human Resources to track confirmed cases of the virus and work refusal cases within the Public Service. On 01 May, the Government of Canada launched the initial stages of a major public information Citizen Readiness Campaign to make Canadians and their families more aware of simple measures they can take to reduce the likelihood of getting the flu – including the H1N1 flu virus. Print ads related to the campaign, which focus on how to prevent flu infection will appear across the country in major daily and weekly newspapers on 02 May and 04 May. In addition, print ads will appear in newspapers in Aboriginal communities starting on 05 May. The campaign aims to help people take precautionary measures to prevent the spread of influenza. It has a number of phases that can be activated as the situation evolves.

Forward Looking: The Government Operations Centre (GOC) is currently assessing the socio-economic impacts that may arise from this current health situation. Strategies are being developed to identify the specific issues and potential impacts, including impacts on the critical infrastructure that are non-health related. Based on this information, subject matter experts from impacted departments/agencies will be invited to form part of the GOC’s advance planning group.

Potential Impacts: Impact A: Several countries have banned imports of live pigs, fresh pork and pork products from Canada. Some countries extended suspension measures to meat and meat products from any animal species. Exports have been a cornerstone for the domestic hog industry. Canada is one of the top three farm animal exporters in the world and it ships about 60 per cent of farm animals outside the country to about 100 countries. The declining export and domestic demand will affect revenues and employment figures within the industry and connecting industries (feed producers, packing companies).

Impact B: A school in British Columbia has been closed as a precautionary measure after one student presented mild symptoms. This decision will result in a number of impacts on the community and workforce. For example, both students and educators will be impacted by the loss of school days. Parents who are forced to seek alternative child care arrangements may remain at home to look after children, which will contribute to work-force absenteeism.

Impact C: Flight cancellations to Mexico will significantly impact Canadian travel industry, its revenues and employment. It will result in diminishing services of travel agencies, flights and cruise lines carriers as well as airport services. The decrease in travel demand is expected to result in lay-offs within the travel industry and diminishing revenues.

Use common sense infection control practices and seek medical attention if you are ill.

The Regional Municipality of York continues to work with provincial, federal and international authorities, in addition to health units across the GTA and the local health care community, to monitor, investigate and respond to the H1N1 flu virus (human swine flu) situation.

“With approximately 60,000 Canadians travelling to Mexico each month, we are not surprised we have local cases in York Region,” said Dr. Karim Kurji, York Region’s Medical Officer of Health.  “What is important for residents to know is that the two individuals from York Region were not hospitalized, and this illness is not widespread in our community.”
York Region and other jurisdictions have been planning and preparing for the potential of an influenza pandemic for several years.  York Region has a well-developed plan that the public health branch of the Community and Health Services Department is using as a guide to assist the work in responding to the current situation. 

The York Region Pandemic Influenza:  Prepared for Action Plan is available online at www.york.ca

The pandemic plan outlines actions carried out by public health in order to prepare for, respond to and recover from an influenza pandemic in York Region, should one occur.  The plan also provides information on partnerships with local area municipalities, health care facilities and key agencies for response coordination. 

As a response to Ontario’s preliminary activation of its emergency operations centre, York Region has initiated partial activation of the Health Emergency Operations Centre (HEOC).

“If an influenza pandemic should occur, we are prepared and our plan is in place,” added Dr. Kurji.  “Partial activation of the HEOC demonstrates that York Region public health is committed to ensuring consistent and coordinated responses to our stakeholders and community partners.”

Partial activation follows the protocols identified in the plan.  When the World Health Organization (WHO) pandemic alert reaches phase 4 or 5, the York Region Health Emergency Operations Centre (HEOC) can be partially activated. 
The WHO is the directing and coordinating authority for health within the United Nations system.  Among its many other responsibilities, it provides leadership on global health matters. 

The WHO provides a six-phase global pandemic alert system.  Currently, the WHO alert is at phase 5.
According to the WHO, phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region.  While most countries will not be affected at this stage, the declaration of phase 5 is a strong signal that the organization, communication and implementation of the planned mitigation measures must be finalized.
York Region’s response strategies may be impacted by the on-going evolution of the situation as it unfolds around the world, in addition to directives from the Provincial Ministry of Health and Long-Term Care, the Ontario Agency for Health Protection and Promotion and the Public Health Agency of Canada.

H1N1 flu virus (human swine flu) is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu.  The symptoms include fever, fatigue, lack of appetite, coughing and sore throat.  Some people with H1N1 flu virus (human swine flu) have also reported vomiting and diarrhea.

Influenza and other (severe) respiratory infections are transmitted from person-to-person via the respiratory route.  Coughs and sneezes release the germs into the air where they can be breathed in by others.  Germs can also rest on hard surfaces such as counters and doorknobs.
 
Residents are advised to take the usual measures to reduce the risk of transmission of respiratory illness. These measures include:

• Washing your hands well and often with soap and warm water;  if soap and water are unavailable, use an alcohol-based hand sanitizer 
• Covering your mouth and nose when you cough or sneeze; sneezing or coughing into your sleeve or arm
• Contacting your family doctor and staying at home if you are ill
• Practicing social distancing (minimizing contact with family members, not going out in public) while symptomatic
• Not going to work until 24 hours after symptoms are resolved or up to seven days from when you became ill (onset of symptoms), whichever is longer.

Residents are also reminded that if they have recently travelled to an area affected by H1N1 flu virus (human swine flu) and are experiencing respiratory illness, or in contact with a confirmed case within seven days of onset of symptoms, contact your health care provider or call Telehealth Ontario at 1-866-797-0000.  Make sure you mention your recent travel history when you are making the appointment.  People should only go to Emergency Rooms if they have severe symptoms.

For more information on this or any other public health-related program, please contact York Region
Health Connection at 1-800-361-5653. 

Outside of regular business hours, general information about H1N1 flu virus (human swine flu) is available by calling the ServiceOntario INFOline at 1-800-476-9708 from 8 a.m. to 8 p.m., seven days a week.

Updated information is also available on The Regional Municipality of York website at www.york.ca


Facts about H1N1 flu virus (human swine flu)

NEWMARKET – The Regional Municipality of York continues to work with provincial, federal and international authorities, in addition to health units across the GTA and the local health care community, to monitor, investigate and respond to the H1N1 flu virus (human swine flu) situation.   

What is swine influenza?
Swine influenza is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs.

What is H1N1 flu virus (human swine flu)?
Swine flu viruses do not normally infect humans.  However, sporadic human infections with swine flu have occurred.  Most commonly, these cases occur in persons with direct exposure to pigs.  There have been documented cases of one person spreading swine flu to others.

How is it spread?
Sometimes, humans and animals can pass strains of flu back and forth to one another through direct close contact.  When a swine influenza virus does affect a human, there is also a risk that the animal influenza can mutate and then spread directly between humans. 

More investigation is needed on how easily the virus spreads between people, but it is believed that it is spread the same way as regular seasonal influenza.  Influenza and other respiratory infections are transmitted from person to person, usually through coughing or sneezing, or when people touch surfaces contaminated by respiratory droplets.

What are the symptoms?
Symptoms are like the regular human seasonal flu.  They include fever, fatigue, lack of appetite, coughing, muscle and joint pain, sore throat and lack of appetite.  Some people with H1N1 flu virus (human swine flu) have also reported vomiting and diarrhea.

How can I protect myself?
To stay healthy generally and prevent the spread of influenza and other infections, it is always good practice to:
• Wash your hands well and often with soap and warm water; if soap and water are unavailable, use an alcohol-based hand sanitizer 
• Cover your mouth and nose when you cough or sneeze;  sneeze or cough into your sleeve or arm
• Contact your family doctor and stay at home if you are ill
• Practice social distancing (minimizing contact with family members, not going out in public) while symptomatic
• Stay home from work until 24 hours after symptoms are resolved or up to seven days from when you became ill (onset of symptoms), whichever is longer

What if I have recently travelled to Mexico or feel ill?
• If you have travelled to Mexico recently and are feeling well, monitor yourself for flu-like symptoms. In the meantime, go about your normal routine.  There is no need to stay away from work or school. If you are feeling well, do not go to the emergency department or your family doctor.

• If you have travelled to Mexico and are experiencing symptoms of respiratory illness, or in contact with a confirmed case within seven days of onset of symptoms, contact your health care provider or call Telehealth Ontario at 1-866-797-0000.  Make sure you mention your travel history.  People should only go to Emergency Rooms if they have severe symptoms, such as feeling short of breath.

Will the flu shot protect me?
It is unlikely that the seasonal flu shot will provide protection against H1N1 flu virus (human swine flu).  The flu shot will protect against the seasonal flu, which is still circulating.

What is a pandemic?
Pandemic influenza is defined as a new influenza virus that spreads easily between humans and affects a wide geographic area.   More information is needed to determine how easily this virus spreads.

What are the World Health Organization (WHO) pandemic alert phases?
According to the World Health Organization, the world is better prepared for an influenza pandemic than at any time in history.  They have developed a six-phase approach to pandemic preparedness.  It is based on the geographic spread of disease, not the severity:
• In phases 1 to 3, the virus circulates continuously among animals, especially birds, with few human infections
• In phase 4, there is verified human-to-human transmission of the virus to cause community-level outbreaks. Phase 4 indicates a significant increase in risk of a pandemic but does not mean it is a forgone conclusion
• In phase 5, there is human-to-human spread of the virus into at least two countries in one WHO region. The declaration of Phase 5 is a strong signal to organizations to finalize their planned mitigation measures
• Phase 6 indicates community-level outbreaks in at least one country in a different WHO region than phase 5. 

Is there a vaccine?
No.  Canada has a plan for a vaccine to be produced domestically if a pandemic occurs.  This will take about six months once the virus is identified.  Enough pandemic vaccine will be produced to cover all Canadians.

Is there any treatment for H1N1 flu virus (human swine flu)?
Antivirals are drugs used for the prevention and early treatment of influenza.  Two antivirals that appear to be effective in treating this illness are oseltamivir (Tamiflu) and zanamivir (Relenza).  The Public Health Agency of Canada is advising treatment for severe cases only.

For more information, please contact York Region Health Connection at 1-800-361-5653.

Outside of regular business hours, general information about H1N1 flu virus (human swine flu) is available by calling the ServiceOntario INFOline at 1-800-476-9708 from 8 a.m. to 8 p.m., seven days a week.

Updated information is also available on The Regional Municipality of York website at www.york.ca

This afternoon, The Regional Municipality of York Medical Officer of Health, Dr. Karim Kurji, confirmed that one case of human swine flu has been identified in York Region.  The Ministry of Health and Long-Term Care today confirmed four cases of swine flu in Ontario – one in York Region and three within Durham Region.

This first confirmed York Region case is a 27-year-old male from the Town of Georgina who recently travelled to Mexico.  Like other cases in Canada, this was a mild case.  He was never hospitalized and is recovering at home.  It is probable that he contracted the virus during his recent trip to Mexico.  Public Health is investigating this case and his contacts.

This occurrence is not a surprise given the number of individuals in York Region that travel to Mexico.  It was only was a matter of time before cases of swine flu appeared in Ontario.  This shows that our monitoring and surveillance system is working as it should.

CURRENT SITUATION IN CANADA
There are approximately one dozen confirmed cases in Canada – within British Columbia, Alberta, Ontario and Nova Scotia.

Today, the Public Health Agency of Canada issued a travel advisory against travel to Mexico.  The advisory states any non-essential travel to Mexico should be postponed until further notice.

No country outside of Mexico has seen severe disease neither caused by this virus nor reported deaths.  However, the United States government has declared a public health emergency for preparedness purposes.  This is a standard procedure.  The declaration allows them to pre-position equipment, resources and services that may be required to respond.

YORK REGION’S RESPONSE
York Region and other jurisdictions have been planning and preparing for the potential of an influenza pandemic for several years.  York Region Community and Health Services, Public Health Branch, is the Region’s lead in coordinating the response to any type of influenza outbreak, under direction from the Medical Officer of Health.

Public Health has increased surveillance for influenza linked to the cases in Mexico and distributed a Surveillance Alert to hospitals, emergency rooms, infection control practitioners and physicians to ensure they are aware of the situation, and to request that they report any confirmed cases.  Further Surveillance Alerts to the health care community will be distributed, as necessary.
 
York Region Community and Health Services will continue to participate with health units across the GTA, provincial and federal authorities in monitoring, investigating and responding to this situation.

Until further notice, people do not need to change their regular routines.

FREQUENTLY ASKED QUESTIONS

What is Swine Flu and what are the symptoms?
Swine flu is a respiratory illness that causes symptoms similar to those of the regular human seasonal flu. The symptoms may include fever, fatigue, a lack of appetite, coughing and sore throat.  Some people with swine flu have also reported vomiting and diarrhea.

Influenza and other (severe) respiratory infections are transmitted from person to person via the respiratory route.  Coughs and sneezes release droplets into the air and onto surfaces.  Individuals may become infected by breathing in the germs or touching contaminated surfaces and not washing their hands afterwards.
 
If you have recently travelled to an area affected by swine flu and/or are exhibiting flu-like symptoms of sufficient severity that you need to seek medical attention, contact your health care provider.  Make sure you mention your recent travel history.
 
What you can do to stay healthy?
Everyone is advised to take the usual measures to reduce the risk of transmission of respiratory illness. These measures include:

• Wash your hands frequently and thoroughly with soap and hot water or, if soap and water are unavailable, use an alcohol- hand sanitizer
• Cover your mouth and nose when you cough or sneeze; sneeze or cough into your sleeve or arm
• Contact your family doctor and stay home if you are ill
 
RESOURCES
For more information and updates, visit the following websites:

 The Regional Municipality of York
 www.york.ca

World Health Organization
http://www.who.int/csr/swine_flu/swine_flu_faq_26april.pdf
Public Health Agency of Canada
http://www.phac-aspc.gc.ca/index-eng.php
 
The Public Health Agency of Canada has set up a hotline where you can get more information: 1-800-454-8302
 
Ministry of Health and Long-Term Care
http://www.health.gov.on.ca/index.html

The Ministry of Health and Long-Term Care has also set up a public inquiry line for the public: 1-800-476-9708.  Hours of Operation are 8 a.m. to 8 p.m.

Please note that as information could change rapidly please refresh the above links to ensure you are reading the most current information.
 
I appreciate that this is an uncertain time and will continue to keep you informed as this situation develops.