Preparing for uncertainty during public health emergencies: What Canadian health leaders can do now to optimize future emergency response.

It is clear that the risk for epidemics with high health and socio-economic impacts remains but there will be many unknowns at the start of future responses to these events. This article highlights principles and practices to assist health leaders in preparing for uncertainty, including integrating scalability to ensure response activities can be more easily adapted to suit evolving needs; assessing risk and capabilities to inform planning for appropriate response measures; and considering overall flexibility and adaptability of plans, systems, and resources. Ultimately, being prepared for "Disease X" is about applying the approaches that we have learned from previous events, using evidence-based practices to develop and strengthen foundational capacities, so that we are able to respond to the unanticipated in proportionate and appropriate ways.

Intranasal influenza vaccine: Why does Canada have different recommendations from the USA on its use?

Canada and the USA differ in their recommendations for the use of live attenuated influenza vaccine (LAIV). The Canadian National Advisory Committee on Immunization (NACI) continues to recommend LAIV as one of the influenza vaccines available for use in children 2 to 17 years of age. The US Advisory Committee on Immunization Practices (ACIP) made an interim recommendation against the use of LAIV for the 2016 to 2017 influenza season in response to low LAIV effectiveness observed in the USA during the 2013 to 2014 to 2015 to 2016 seasons.

A composite epidemic curve for seasonal influenza in Canada with an international comparison.

Background: Empirical data on laboratory-confirmed seasonal influenza is limited by very low and possibly non-systematic case ascertainment as well as geographical variation.

Objective: To provide a visual representation of an influenza epidemic at the community and regional level using empirical data and to describe the epidemic characteristics.

Methods: Weekly influenza A confirmations were obtained from the Canadian FluWatch program and American FluView program for the 1997/1998-2006/2007 seasons; 1- year data were also available for Europe (FluNet, WHO).

Estimating sensitivity of laboratory testing for influenza in Canada through modelling.

Background: The weekly proportion of laboratory tests that are positive for influenza is used in public health surveillance systems to identify periods of influenza activity. We aimed to estimate the sensitivity of influenza testing in Canada based on results of a national respiratory virus surveillance system.

Methods And Findings: The weekly number of influenza-negative tests from 1999 to 2006 was modelled as a function of laboratory-confirmed positive tests for influenza, respiratory syncytial virus (RSV), adenovirus and parainfluenza viruses, seasonality, and trend using Poisson regression.

Co-morbidities associated with influenza-attributed mortality, 1994-2000, Canada.

The elderly and persons with specific chronic conditions are known to face elevated morbidity and mortality risks resulting from an influenza infection, and hence are routinely recommended for annual influenza vaccination. However, risk-specific mortality rates have not been established. We estimated age-specific influenza-attributable mortality rates stratified by the presence of chronic conditions and type of residence based on deaths of persons who were admitted to hospital with a respiratory complication captured in our national database.

Role of influenza and other respiratory viruses in admissions of adults to Canadian hospitals.

Objective: We sought to estimate age-specific hospitalization rates attributed to influenza and other virus for adults.

Methods: Admissions from Canada's national hospitalization database (Canadian Institute of Health Information), from 1994/95 to 1999/2000, were modeled as a function of proxy variables for influenza, respiratory syncytial virus (RSV) and other viral activity, seasonality and trend using a Poisson regression model and stratified by age group.

Results: The average annual influenza-attributed hospitalization rate for all adults, 20 years of age or older, over the study period, which included three severe seasons, was an estimated 65/100,000 population (95% CI 63-67).

Influenza-attributed hospitalization rates among pregnant women in Canada 1994-2000.

Background: Although it is recommended that pregnant women at risk for influenza complications receive influenza vaccine, it is not clear if healthy pregnant women are at increased risk for adverse outcomes. We aimed to estimate the rate of hospitalization attributable to influenza for healthy pregnant women and for those with known co-morbidities.

Methods: Hospital admission records of women admitted from 1994 to 2000 with a respiratory condition during pregnancy were extracted from the hospitalization database (Canadian Institute of Health Information).

Protective measures and human antibody response during an avian influenza H7N3 outbreak in poultry in British Columbia, Canada.

Background: In 2004 an outbreak of avian influenza of the H7N3 subtype occurred among poultry in British Columbia, Canada. We report compliance with recommended protective measures and associated human infections during this outbreak.

Methods: We sought voluntary participation by anyone (cullers, farmers and their families) involved in efforts to control the poultry outbreak.

Hospitalization attributable to influenza and other viral respiratory illnesses in Canadian children.

Background: We sought to estimate the incidence of hospitalization attributable to influenza virus infection in Canadian children while controlling for the impact of other respiratory viruses.

Methods: Hospital admissions for children and youth 0 to 19 years of age, 1994-2000, were modeled as a function of proxy variables for influenza, respiratory syncytial virus (RSV) and other respiratory viral activity, seasonality and trend, using a Poisson regression model with a linear link. These proxy variables were developed from influenza mortality and laboratory test results for influenza, RSV and other viruses.

Border screening for SARS.

With the rapid international spread of severe acute respiratory syndrome (SARS) from March through May 2003, Canada introduced various measures to screen airplane passengers at selected airports for symptoms and signs of SARS. The World Health Organization requested that all affected areas screen departing passengers for SARS symptoms. In spite of intensive screening, no SARS cases were detected.

The Canadian Pandemic Influenza Plan: an evolution to the approach for national communicable disease emergencies.

Advance planning for a large-scale and widespread health emergency is required to optimize health care delivery during an influenza pandemic. The Canadian Pandemic Influenza Plan (CPIP) is an example of a successful communicable disease emergency plan that ensures a national, coordinated approach to preparedness, response and recovery activities in the event of an influenza pandemic. The general concepts incorporated into the CPIP may be utilised in the contingency planning for a bioterrorism event or other communicable disease emergencies, including: a national, coordinated approach in planning; an emergency management structure to conduct the response; the use of common terminology to facilitate communication and response coordination, and the establishment of specific technical, communications and operational response groups and networks in advance.

Factors influencing childhood influenza immunization.

Following the launch of a publicly funded influenza immunization program for all residents of Ontario over the age of 6 months, we evaluated 203 parents of children who presented to our emergency department between January and March of the following year (2001). Overall, 54 (27%) of the children had been vaccinated. Parents of non-immunized children were more likely to believe that immunization resulted in a flu-like illness (42% v.