Influenza Presentation for Health Care Workers Part 1 of 3 We are glad you can join us for a presentation on influenza geared toward health care workers working in facility settings. This presentation has been updated for the 2017-2018 season. 2017-2018 Season

Learning Objectives To gain a better understanding of: Influenza Virus and the Disease: Transmission, symptoms, diagnosis, and treatment Influenza Vaccine Components, types available, effectiveness, benefits and side effects Influenza Outbreak Control Measures Hand hygiene, outbreak signage, PPE use, room placement, patient/resident care equipment, cleaning and disinfection of resident areas The objectives of this presentation are to gain a better understanding of influenza the disease, influenza the vaccine and influenza control measures.

Disease Facts Influenza, commonly known as ‘the flu’ A respiratory illness caused by influenza A or B viruses that can be mild or serious Symptoms usually last 7-10 days, sometimes longer in the elderly Cough and fatigue can last weeks Influenza is very contagious, you can spread the disease 24 hours before you become symptomatic and for about 5 days after symptom onset Common symptoms: high fever, cough, muscle aches Children: may transmit the virus for longer than 7 days [CDC (2013). How flu spreads. Retrieved from http://www.cdc.gov/flu/about/disease/spread.htm] Seasonal: Occurs annually in Canada in late fall and winter months Global Attack Rate: 5-10% in adults and 20-30% in children Incubation Period: Average 2 days (ranges from 1-4 days) for seasonal influenza Period of Communicability: In adults, viral shedding is greatest in the first 3-5 days of illness. In young children, virus shedding can occur for longer, 7-10 days, and may be even longer in severely compromised persons. Heymann, D. (ed.) (2008). Control of Communicable Diseases Manual, 19th edition. Washington, American Public Health Association, pp. 315-322

Who is most vulnerable to the flu? Those at greatest risk of influenza-related complications: Adults and children with underlying health conditions Residents of LTCHs and other chronic care facilities People > 65 years of age Children < 60 months of age Pregnant women Indigenous peoples Each year in Canada, influenza is estimated to be responsible for: 12,200 hospitalizations 3,500 deaths Incidence of influenza is often underreported since the illness may be confused with other viral illnesses and many people with influenza-like illness do not seek medical care or have viral diagnostic testing done. Indigenous populations are at increased risk for several reasons. Obesity and chronic health conditions such as diabetes, kidney disease, chronic lung disease and other illnesses are more frequently found among First Nations people, and they all increase the risk of flu infection. Beyond the biological risk factors, social determinants of health such as inadequate access to health care, food insecurity, unsafe drinking water, poor housing, poverty and overcrowding — all issues for First Nations communities — contribute to risk. NACI Statement 2017-2018, pg 25

Modes of Transmission Respiratory Droplet Transmission Droplets are generated when a sick person coughs or sneezes droplets can travel up to two meters in distance Droplets need to be inhaled by nearby individuals or land on their mouth, eyes or nose to transmit the virus Contact Transmission Respiratory droplets can also contaminate surfaces or objects the flu virus can survive up to 48 hours on hard, non-porous surfaces such as stainless steel If an individual touches a surface or object contaminated with the flu virus and then touches their mouth, nose or eyes the virus can be transmitted (CDC, 2013; Public Health Agency of Canada, 2011; WHO, 2010) According to CDC (2013), Public Health Agency of Canada (2011), and WHO (2010), the influenza virus’s primary mode of transmission is through respiratory droplets. The droplets are generated when the sick person is coughing or sneezing and can travel up to 2 meters in the air. In a closed or crowded environment, the droplets can be inhaled or land on people’s noses or mouths (CDC, 2013). With reference to Public Health Agency of Canada (2011), the virus remains viable for up to 48 hours on hard, non-porous surfaces and up to 12 hours on cloth, paper, and tissues. An individual can be infected by touching the contaminated surface or object and then touching his/her own mouth or nose (CDC, 2013). References: CDC (2013). How flu spreads. Retrieved from http://www.cdc.gov/flu/about/disease/spread.htm Public Health Agency of Canada (2011). Influenza virus type A. Retrieved from http://www.phac-aspc.gc.ca/lab-bio/res/psds-ftss/influenza-a-eng.php WHO (2010). Limiting spread: Limiting the spread of pandemic, zoonotic, and seasonal epidemic influenza. Retrieved from http://www.who.int/influenza/resources/research/research_agenda_influenza_stream_2_limiting_spread.pdf NACI Statement 2017-18, pg. 8

Classical Sneeze Video

Tiredness and weakness Gastrointestinal Symptoms Influenza Symptoms Symptoms Flu Cold Fever Usually high, sudden onset, lasts 3-4 days *May not be prominent in adults > 65 years Rare Chills Common Sore throat Coughing Common – can be severe Sometimes - mild to moderate Muscle aches and pains Common – often severe Sometimes, - mild Headache Tiredness and weakness Common – severe, (may last 2-3 weeks) Sometimes - mild Runny, stuffy nose Sneezing Sometimes Gastrointestinal Symptoms Unusual In children, gastrointestinal symptoms (nausea, vomiting, diarrhea) may be present. Gastrointestinal symptoms are uncommon in adults. References: Heymann, D. (ed.) (2008). Control of Communicable Diseases Manual, 19th edition. Washington, American Public Health Association, pp. 315-322 MOHLTC (2015). Flu facts. Retrieved from http://www.ontario.ca/page/flu-facts (Ministry of Health and Long-Term Care, 2015)

Confirming Diagnosis Nasopharyngeal (NP) Swab Should be obtained from the most severe and most recently ill residents (i.e. during the first 4 days of their illness) Rapid test is takes a few hours; PCR up to 3-4 days and culture up to 10 days. Serology may be done but not very common. This test would need to be done as an acute and convalescent serology taken 10-14 days apart. Reference: Infectious Disease Protocols (2014). Appendix A: Disease Specific Chapters

Treatment Antiviral treatment for influenza must be started within 48 hours (or less) of onset of symptoms for maximum effectiveness Oseltamivir (Tamiflu) effective against influenza A and B recommended drug of choice for both prophylaxis and treatment in an influenza outbreak Zanimivir (Relenza) used when predominant circulating strain is resistant to Tamiflu Reference: Ministry of Health and Long Term Care. (2016). A Guide to the Control of Respiratory Infection Outbreaks in Long-Term Care Homes, pg.59.

Sick with the Flu? Stay home and get plenty of rest Seek medical attention as appropriate Limit your contact with others Wash your hands frequently with soap and water or with alcohol-based hand sanitizer, particularly after coughing or sneezing Ensure you practice respiratory etiquette (cough/sneeze into your sleeve or into a tissue, then wash your hands or use hand sanitizer) (Ministry of Health and Long-Term Care, 2015) Reference: Ministry of Health and Long-Term Care (2015). Flu facts. Retrieved from http://www.ontario.ca/page/flu-facts

Video - The flu: don't pass it on!

Vaccination is the most effective way to prevent influenza and its complications. Reference: NACI Statement 2017-18, pg. 7 (NACI Statement 2017-18, pg.7)