Pandemic influenza

Pandemic Influenza logoAn influenza pandemic (worldwide flu) is declared when a new strain of influenza virus that has never been seen before emerges and begins to spread quickly around the world.
  • The pandemic phase level indicates the spread of the virus around the world, not how severe the virus is.
  • People have little or no natural immunity, so large numbers of people become ill.
  • Pandemics occur 3–4 times each century. The last one was in 2009 and called Pandemic (H1N1) 2009.

Alberta's Pandemic Plan

Alberta’s Pandemic Influenza Plan 2014 (APIP) was developed by Alberta Health, Alberta Emergency Management Agency (AEMA) and Alberta Health Services (AHS). The provincial plan will guide the response and recovery efforts during a pandemic with an emphasis on how these organizations work together. Pandemic influenza planning and preparedness activities are equally important and are incorporated into all-hazards planning as a continuing part of the emergency management cycle.

The 2014 APIP replaces and is significantly updated from Alberta’s Plan for Pandemic Influenza (2009). Changes were based on recommendations put forward by the Health Quality Council of Alberta (HQCA) on lessons learned from the 2009 pH1N1 influenza pandemic. The 2014 APIP also replaces the Alberta Pandemic Influenza Operations plan (2008) and the AHS Pandemic Influenza Plan (2010).

The APIP is reviewed and revised regularly to reflect current knowledge and leading practices. It aligns with the Public Health Agency of Canada’s Canadian Pandemic Influenza Plan (CPIP) and supports coordination between the Government of Alberta and AHS pandemic operational plans. It also serves as a reference for local authorities, business and industry and other stakeholder pandemic operational plans.

Ethical framework for responding to pandemic influenza

Alberta’s Ethical Framework for Responding to Pandemic Influenza is a resource to help planners and strategic policymakers consider the ethical implications of decisions they face in a pandemic.

Public health ethics focuses on the health and interests of a population and are distinct from clinical ethics which focus on the health and interests of the individual. This framework is not intended for use in making clinical ethical decisions. For more information on clinical ethics, go to Alberta Health Services’ Clinical Ethics Service.

Alberta’s Ethical Framework for Responding to Pandemic Influenza is based on the extensive work completed by Alberta, British Columbia and the United Kingdom. It is based on a consistent and well-recognized set of principles and outlines a transparent and clear process to assess potential choices.

As Alberta’s planning for pandemic influenza evolves, Alberta’s Ethical Framework for Responding to Pandemic Influenza will be reviewed and updated to reflect new learnings.

Pandemic influenza general information

1. Pandemic influenza is different from seasonal influenza

Seasonal influenza

  • Seasonal influenza virus strains constantly change and continually circulate in every part of the world, typically resulting in local outbreaks of influenza A and B.
  • In North America, seasonal influenza usually affects people in the fall and winter.
  • Even though the virus may change slightly from year to year, most people will continue to have some protection against slightly changed viruses, particularly if they are immunized yearly for seasonal influenza.

Pandemic influenza

  • Pandemic influenza is a global epidemic that can happen at any time of the year. It typically occurs 3–4 times each century when a completely new strain of influenza type A virus emerges.
  • People generally do not have any natural immunity, that is, protection against a pandemic virus.
  • If this new virus spreads easily from person to person, it could quickly travel around the world.
  • Pandemic influenza differs from seasonal influenza in that everyone is at risk of infection with the new strain and larger numbers of people catch it.
  •  Current vaccines for seasonal influenza will not offer protection against pandemic influenza and need to be developed to target the specific virus.
  • In the 20th century there were 3 pandemics: 1918–19, 1957–58 and 1968–69; and one in the 21st Century: 2009–2010.

2. Vaccine for protection against pandemic influenza

Vaccines are the first line of defense against a pandemic, but it could take at least six months to produce the vaccine for a new virus. This complex process cannot begin until the pandemic begins and the new virus has been identified.

Canada is one of the few countries in the world prepared to have a vaccine manufacturer develop and supply a pandemic influenza vaccine as soon as a new strain is identified. The manufacturer will be able to produce enough vaccine for all Canadians.

Until a pandemic vaccine is available, the best way to prevent getting influenza is by:

  • Cleaning your hands frequently with soap and water or an alcohol-based hand santizer;
  • Keeping your hands away from your eyes, nose and mouth; and
  • Avoiding close contact (within two meters) with people who have influenza-like symptoms.

Once the vaccine is available, Alberta Health Services will implement the immunization program according to policy set by Alberta Health and work in collaboration with municipal authorities to identify sites to provide pandemic influenza immunization to Albertans.

3. Antiviral drugs

Antiviral drugs are medications used for early treatment of severe cases of influenza. It is not typically recommended for treatment of mild influenza unless individuals are part of a group identified at higher risk of severe infection. If taken shortly after getting sick (within 48 hours), they can reduce influenza symptoms, shorten the length of illness, reduce the serious complications of influenza and minimize the spread of disease.

  • Antiviral drugs work by reducing the ability of the virus to reproduce but do not provide immunity against the virus. Antiviral drugs include oseltamivir (Tamilflu®>) and zanamivir (Relenza®).

Each province and territory, maintains their own portion of the national antiviral stockpile, established in 2004, to ensure equitable access across Canada to a secure supply of antivirals for pandemic influenza. At the time of an outbreak, the delivery and administration of these antivirals will be considered based on a risk assessment of the specific virus, the situation and the emerging epidemiology or other data, such as antiviral resistance or optimal treatment course.

4. How pandemic influenza will affect Alberta

The impact of pandemic influenza depends on the influenza strain, how easily it spreads, which groups of people are the most affected and how effectively we respond.

In the Alberta’s Pandemic Influenza Plan 2014 (APIP), multiple planning scenarios are used to identify probable implications associated with varying pandemic influenza impact levels on the population and on the health system. Alberta uses the same 4 pandemic planning impact scenarios used in the Canadian Pandemic Influenza Plan (CPIP) to reflect varying transmissibility and virulence characteristics.

Planning scenarios are not predictions and will be replaced with evidence when a pandemic occurs. The basic scenarios cannot incorporate all potential factors that can affect the impact of a pandemic. Some factors are population-wide and could affect all scenarios, such as seasonality, pre-existing immunity or antiviral resistance, whereas others may be setting-specific, such as the effects on a remote community.

5. Alberta is ready for a pandemic

The Government of Alberta has been preparing the health system and the province for an influenza pandemic since 1999. APIP is a provincial strategic plan developed jointly by Alberta Health, Alberta Health Services and the Alberta Emergency Management Agency and involves a range of partners.

The goal of Alberta’s plan is to control the spread of influenza disease, reduce illness and death due to influenza, minimize disruptions to the daily life of Albertans, minimize economic impacts of influenza and support an efficient and effective use of resources during response and recovery.

6. What to do during a pandemic

Be alert to information on radio, television, in newspapers, or the Internet and elsewhere. Information will be posted on the Alberta Government, Alberta Health, Alberta Heath Services and Alberta Emergency Management Agency websites.

Alberta Health and Alberta Health Services will advise you about the steps you can take to avoid disease, availability of vaccine and antiviral drugs, and any changes that may be made in health-care services to deal with the pandemic.

  • Read more about influenza self-care for things you can do to control the spread of influenza and take care of yourself and your family.

7. How to prepare for a pandemic

Staying informed and understanding the potential challenges you may face in your community in the event of an influenza pandemic can help you to prepare for a variety of scenarios. Albertans can prepare for a pandemic influenza just like they would for other emergencies by preparing a basic emergency kit to be self-sufficient for 72 hours.

8. How businesses can prepare for a pandemic

A pandemic may also affect businesses. Staff may be sick or may need to stay home to care for family members who are ill. Depending on the nature of services or products offered by the business, the demands for services and goods may increase dramatically placing additional pressure on businesses already coping with increased absenteeism due to the pandemic.

Alternatively, a business could suffer a negative economic impact due to the reduced number of customers. Businesses need to consider the impact of a pandemic on their staff and customers and make appropriate plans.

Compare pandemic and seasonal influenza

Pandemic influenza is similar in a number of ways to seasonal influenza, but at the same time, there are some key differences between the two.

Description Pandemic Influenza Seasonal Influenza
Virus Most people have no immune protection. Influenza A or B strains same as previous years or minor variation only.
  • Many people may have some immune protection from exposure in previous years.
Occurrence Pandemic viruses happen only two or three times in a century. They can occur at any time of the year.
  • Pandemic influenza usually comes in 2–3 waves several months apart.
  • Each wave lasts about 2–3 months.
Usually happens every year between November and April in Canada.
Diagnosis / Testing A nose swab (nasopharyngeal swab) may be taken:
  • In cases of moderate to severe symptoms;
  • To confirm the diagnosis when clinically indicated.
A nose swab may be taken:
  • At the beginning of the influenza season;
  • In cases of moderate to severe symptoms;
  • If symptoms noted outside of influenza season.
Symptoms Same as seasonal influenza, but may include:
  • Nausea;
  • Vomiting;
  • Diarrhea.
Seasonal influenza symptoms:
  • Fever greater than 38 C; and
  • Cough; and
  • Fatigue; and
  • Muscle aches; or
  • Lack of appetite; or
  • Runny or stuffy nose.
Severity People with chronic illnesses are at greater risk of more serious illness, especially those with asthma. Symptoms can vary from mild to severe, even resulting in death. Seasonal influenza is hardest on people who don’t have a strong immune system: the very young, the very old, pregnant women and people with certain chronic illnesses.
Care of Symptoms
  • Practice self-care and stay home from work or school for 7 days after the start of your symptoms and until you are able to resume daily activities.
  • Rest and avoid close contact with others until your symptoms have gone away.
  • If symptoms are not improving or worsen, contact your health care provider.
Same.
Prevention
  • Clean your hands frequently, especially after coughing, sneezing or blowing your nose. Wash your hands with soap and water, or use an alcohol-based hand sanitizer.
  • Cough and sneeze into your arm, not your hand.
  • Keep your hands away from your eyes, nose and mouth.
  • Keep common surfaces clean and disinfected, if possible.
  • Avoid touching common surfaces with your hands, if possible, and ensure you clean your hands regularly.
  • Avoid close contact with people who are experiencing influenza like symptoms.
  • Get the pandemic influenza vaccine if available.
  • Other steps to keep yourself healthy include:
    • Healthy eating;
    • Maintaining an active lifestyle;
    • Getting enough rest and sleep; and
    • Don't smoke and avoid second hand smoke.
Same prevention, and
  • Get the seasonal influenza vaccine every year.
Anti-viral medication
  • May be prescribed under certain circumstances.
  • Not recommended for mild symptoms.
Same
Vaccine It can take up to 6 months to produce the vaccine for a new pandemic virus. Annual seasonal influenza vaccinations (flu shots) help protect people from influenza. Free to all Albertans 6 months of age and older.

Pandemic influenza history

Evidence suggests that pandemics occur 3–4 times per century. There have been 4 pandemics over the last 100 years:

2009: Pandemic (H1N1) 2009 Influenza

On June 11, 2009, in response to the global spread of a new strain of influenza, the World Health Organization (WHO) declared the outbreak to be an influenza pandemic, the first since 1968.

Officials believed the outbreak began in Mexico in March 2009, or earlier. It was first called “H1N1 swine flu” was first identified in California in late April 2009. Health officials quickly linked the new virus to the outbreak in Mexico.

In Alberta, the pandemic occurred in two waves. The first wave peaked in June 2009, the second in October 2009. Overall, younger people were more at risk to get the virus, but with less severe symptoms compared to the seasonal influenza virus strains seen each year. Illness among school-aged children (aged 5–18 years) was particularly high.

From April 2009 to April 2010, in Alberta there were 1,278 hospitalized cases of Pandemic (H1N1) and 71 Albertans died. One death was an out of country resident. The total number of deaths includes those who died from H1N1 and those who died from other causes and also tested positive for H1N1. The media age of deaths in Alberta was 50 and median age of hospitalized cases was 34 years old.

The WHO declared the H1N1 pandemic over on August 10, 2010. The H1N1 influenza virus is expected to circulate for years as a regular seasonal influenza strain.

1968: Hong Kong Influenza

In early 1968, the influenza pandemic was first detected in Hong Kong. The first cases in North America were detected in the United States in September of that year, but illness did not become widespread until December.

Deaths from this virus peaked in December 1968 and January 1969. Those over the age of 65 were most likely to die. The same virus returned in 1970 and 1972. This was the mildest pandemic in the 20th century.

There could be several reasons why fewer people died due to this virus –

  1. The Hong Kong influenza virus was similar in some ways to the Asian influenza virus that circulated between 1957 and 1968. Earlier infections by the Asian influenza virus might have provided some immunity against the Hong Kong influenza virus.
  2. The pandemic did not gain momentum until near the school holidays in December. Since children were at home and did not infect one another at school, the rate of influenza illness among schoolchildren and their families declined.
  3. Improved medical care and antibiotics that are more effective for secondary bacterial infections were available for those who became ill.

1957: Asian Influenza

In February 1957, an influenza strain was identified in Asia that people less than 65 years of age were not immune to, and a pandemic was predicted. In preparation, vaccine production began in late May 1957, and health officials increased surveillance for influenza outbreaks.

Unlike the virus that caused the 1918 pandemic, the 1957 pandemic virus was quickly identified due to advances in scientific technology.

In October 1957, infection rates were highest among school children, young adults, and pregnant women. Most influenza-and pneumonia-related deaths occurred between September 1957 and March 1958. The elderly had the highest rates of death. By December 1957, the worst seemed to be over.

However, during January and February 1958 in the United States, there was another wave of illness among the elderly. This is an example of the potential "second wave" of infections that can develop during a pandemic. The disease infects one group of people first, infections appear to decrease and then infections increase in a different part of the population.

1918: Spanish Influenza

archive image of women wearing masksThe Spanish influenza pandemic is the catastrophe against which all modern pandemics are measured. It was named the Spanish influenza because Spain was the first country to report a serious outbreak of the disease, with nearly 8 million killed by May 1918.

It is estimated that approximately 20–40 per cent of the worldwide population became ill and more than 20 million people died. Some people who felt well in the morning became sick by noon, and were dead by nightfall. Those who did not succumb to the disease within the first few days often died of complications from influenza (such as pneumonia) caused by bacteria.

One of the most unusual aspects of the Spanish influenza was its ability to kill young adults. The reasons for this remain uncertain. With the Spanish influenza, mortality rates were high among healthy adults as well as the usual high-risk groups. Mortality was highest among adults 20–40 years old. The severity of that virus has not been seen again.

Contacts and resources

Alberta Health Services

Health Link

  • Call 811

Alberta Health

  • 780-427-7164

Alberta Emergency Management Agency

Alberta information

Inner city resources

  • The Flu and You – Prepared by Edmonton’s Boyle Street Community Services and Streetworks. This booklet gives tips for inner city residents, their friends and families on how to stay healthy during the influenza (flu) season
  • Planning for Pandemic guide – Prepared by Boyle Street Community Services and Streetworks of Edmonton. This guide is for inner city non-profit organizations to help with their influenza pandemic planning initiatives

Government of Canada / Public Health Agency of Canada

  • Flu Watch – FluWatch is Canada's national surveillance system that monitors the spread of flu and flu-like illnesses on an on-going basis
  • Influenza – A list of Government of Canada resources on influenza, including the Canadian Plan for Influenza Pandemic (CPIP), influenza surveillance and information on other types of influenza
  • Avian Influenza – A list of Government of Canada resources on Avian Influenza
  • Fight Flu – A collection of information on influenza, including links to provincial and territorial information on the flu and vaccination programs
  • Canadian Pandemic Influenza Plan for the Health Sector – The full version of the Canadian Pandemic Influenza Plan

International

  • World Health Organization (WHO) Influenza information – The website for the World Health Organization’s Global Influenza Programme, including information on their Pandemic Influenza Preparedness Framework
  • CDC Pandemic Resources– Center for Disease Control and Prevention (CDC) resources for pandemic flu, including international surveillance, risk assessment and pandemic preparedness tools