1. 1 Public Health Response to Avian Influenza Dr. Michelle Murti Medical Health Officer Fraser Health BC Zoonoses Day November 10 2015

2. 2 Outline  AI in the Fraser Valley  PH Surveillance Activities  Roles of Public Health  Lessons learned

3. 3 AI in the Fraser Valley

4. 4 Public Health notification  December 2, 2014  Initial notification  2 farms affected  Abbotsford and Chilliwack  AI detected – H5  Highly pathogenic to birds

5. 5 AI Fraser Valley- 2004 (H7N3) http://www.iicacan.org/Publications%20and%20Documents/Avian%20Influenza%202006.pdf

6. 6 Additional AI in Fraser Valley  2005 – H5 detections  2009 – H5 on turkey farm

7. 7 Progression of AI, 2014  Between December 1-19, 2014  11 commercial premises  1 non-commercial premise  Broiler-breeder (7)  Turkey (3)  Egg-layer (1)  Backyard flocks (1)  >245,000 birds

8. 8 Virus Detections  HPAI H5N2  A/turkey/BC/FAV10/2014 (H5N2)  First report of a Eurasian H5 lineage in North America  Novel reassortment  Eurasian H5N8 HPAI  North American N2 LPAI of wild bird origin

9. 9 Additional Detection  February 6, 2015  Non-commercial egg layer flock farm  HPAI H5N1  A/Chicken/BC/FAV2/2015 H5N1  Identical to H5N1 strains identified in wild bird flocks in Washington state  H5N1, H5N2, H5N8 detections through US northwest

10. 10 Public Health Surveillance  HPAI to birds, not humans  Potential risk to those exposed to birds  New H5 to North America – potential for pathogenic introduction from novel reassortments  Contact tracing, monitoring, follow-up

11. 11 Contact follow-up  50 contacts on the 13 premises  35 (70%) male  Median age 42 years (12-75 yo)  Small farming families  Few additional workers  Deliveries/pick-ups

12. 12 Contact Education  Timing of exposures  Ongoing exposures  Bird management until decontamination  During decontamination  Education on signs and symptoms of ILI  Reporting if development of symptoms

13. 13 Active Surveillance  Daily active monitoring  During exposure  For 7 days from last exposure  Follow-up phone call day 17  Ensure no new exposures  Ensure still asymptomatic

14. 14 Chemoprophylaxis  Offered influenza immunization  26 (52%) immunized  Antiviral (oseltamivir) chemoprophylaxis if ongoing exposure  Daily dosing while exposed and 7 days post  Recommended to 26 contacts  Accepted by 11 (42%)

15. 15 Symptom Follow-up  4 contact developed symptoms during monitoring  Cough and/or runny nose  No fever  NP swabs  3 negative for Influenza A/B/RSV  1 positive for Influenza B  2/4 initiated treatment dose of oseltamivir pre-swab

16. 16 Communications  Notification to local area GPs and acute care  Public messaging via poultry and swine industry association liaisons  Awareness of public health risks  Recommendation for influenza vaccination  Routine use of personal protective equipment  Media and public messaging  Food safety questions

17. 17 Roles of local Public Health  Lead Coordinating Committee calls  BCCDC, JEOC, CFIA, WH contractor, WorksafeBC  Consultation to CFIA Occupational Health  Consultation to WorksafeBC  Collaboration with BCCDC re human exposure risk assessment

18. 18 Roles of local Public Health  Reporting to province and PHAC  Daily surveillance updates  Communications  Key messages  Collaboration with BCCDC  Risk Assessment  Surveillance and research  Virus identification

19. 19 Roles of Public Health  Presence at CFIA JEOC  Situational Updates  New farm identification  New issue identification  Linking to other affected jurisdictions  Water surveillance  Industry association

20. 20 History repeating  Documentation from 2004 experience  Able to share updated materials with Ontario  New processes  PH Observatory support for surveillance  Tools for surveillance  Lessons learned from EVD monitoring

21. 21 PH Nursing  Familiar with 2004  Centralization of PHNs involved  Weekend coverage  Familiarity with community  Access to tamiflu

22. 22 Fraser Valley (the epicenter…)  Local connections with GPs, hospital  Facilitate testing  Immunization attitudes  CFIA contract with Workplace Health Cost Solutions  Collaboration (and confusion) around Occupational Health for workers

23. 23 Awareness of role of PH  Focus on poultry industry  Recognition of potential risk to those exposed  Need for surveillance on reassortment  Capacity to manage mental health effects

24. 24 Future actions  Collaboration with BCCDC on revision of provincial manual  Research readiness for future evaluations  Awareness of poultry (and swine) farming  Including backyard farming

25. 25 Acknowledgements  FH staff (Dr. Marcus Lem, Dr. Mark Bigham, Dr. Victoria Lee, Sherry Baidwan, Karen Dickenson-Smith, Susan Loadman, Christina Fung, Salman Klar, Dr. Andrew Larder), and the Chilliwack PHU team  BCCDC  PHO