Severe Respiratory Ilness in Mexico

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

• MOHLTC flu site with links to various useful guidance documents: http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro/
• New MOHLTC guidance document for Home Care settings: http://www.health.gov.on.ca/en/ccom/
  

  flu/h1n1/pro/docs/homecare_guidance.pdf

• New MOHLTC guidance document for Shelters: http://www.health.gov.on.ca/en/ccom/flu/
  

  h1n1/pro/docs/shelters_guidance.pdf

• New MOHLTC guidance document for First Nation Communities: http://www.health.gov.on.ca/en/ccom/flu/h
  

  1n1/pro/docs/firstnation_guidance.pdf

• New MOHLTC guidance document for Provincial Correctional Institutions:

• New MOHLTC guidance document for Ontario Youth Justice Centres

• New U.S. Department of Labor: Guidance on Preparing Workplaces for an Influenza Pandemic: http://www.osha.gov/Publications/
  

  OSHA3327pandemic.pdf

• Ontario Health Plan for Influenza Pandemic (OHPIP) Chapter 7 gives occupational health and safety/infection control advice for the health care sector: http://www.health.gov.on.ca/english/
  

  providers/program/emu/pan_flu/ohpip2/ch_07.pdf

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps

H1N1 Flu Watch

H1N1 Influenza Update

H1N1 influenza is now circulating everywhere throughout the province and is affecting many OPSEU members where they work, at home and in the community. Many members are turning to their union for information and assistance to address work-related concerns about influenza. Following are some of the most commonly raised concerns and some useful sources of additional information:

I work in a Correctional or Youth Justice facility where H1N1 influenza vaccine is being offered to inmates or youth but not to staff. Is that the right approach?

OPSEU says this is the wrong approach. Correctional Officers, Youth Service Officers and other staff work in the same environment where inmates and youth live, and their duties often require them to be in close proximity to inmates or youth. Many inmates and youth are at high risk of contracting influenza and other infectious illnesses because their underlying health status is poor, hygiene conditions in the facilities are often not optimal, and their living environments are often very crowded. These same conditions also put staff at risk. It is OPSEU’s position that Correctional facilities and Youth Justice facilities should be offering H1N1 influenza vaccine to staff at the same time as vaccine is being offered to inmates or youth.

OPSEU members, through their Joint Health and Safety Committees, should strongly encourage their employers to request the Ministry of Health and Public Health Units to release vaccine that can be offered to employees at risk.

I work in a Correction or Youth Justice facility where we have a local pandemic influenza plan, but there is a lot of confusion about how to implement it. What should I do?

OPSEU members in these facilities should request that their Joint Health and Safety Committee have an urgent meeting to review their pandemic flu plan in light of the current influenza situation in the province and their facility. Local Infection Prevention and Control Committees should also be involved in this discussion. Areas to be considered are: screening of new admissions for Influenza-Like Illness (ILI); screening of other inmates/youth for ILI if an inmate/youth develops flu symptoms; staff self-screening for flu symptoms; encouraging staff to stay home when ill with no reprisals from employers; where inmates/youth will be housed while awaiting medical assessment and when they are diagnosed with flu; issues around personal protective equipment such as availability, accessibility, respirator fit-testing and training; and, communication to staff about health and safety measures and changes to measures.

The Ministry of Health and Long Term Care (MOHLTC) has released two new guidance documents for Corrections and Youth Justice Centres which provide useful information. Links to these documents are below.

I work in a Developmental Services home where two of our residents have been diagnosed with influenza. Although one has been transferred to hospital, we are caring for the other resident in the home. What should staff do?

OPSEU members in Developmental Services workplaces should be requesting that their JHSC or Health and Safety Representative have an urgent meeting to discuss measures and procedures to protect staff from influenza in the workplace. If employers refuse to meet or say that pandemic planning is not a health and safety issue, remind them that their obligations under Sections 8 and 9 of the Regulation for Health Care and Residential Facilities require employers to consult with the JHSC or Health and Safety rep when developing measures and procedures to protect staff from infectious illnesses.

Some workplaces have pandemic influenza plans or emergency plans while others do not. Plans should address issues such as: screening of residents for ILI; screening of staff for ILI; encouraging staff to stay home when ill with no reprisals from employer; where sick residents will be housed; additional hygiene measures to reduce risk of exposure to influenza; issues around personal protective equipment such as availability, accessibility, respirator fit-testing and training; and, communication to staff about health and safety measures and changes to measures.

Although the MOHLTC has not developed guidance specifically for Developmental Services workplaces, it has released guidance for Long Term Care and for Home Care workers which will provide useful tips relevant to DSS workplaces. Links are below.

Additionally, the MOHLTC has adopted the following definition of health care worker from the Canadian Immunization Committee for the purposes of priority access to H1N1 vaccine: “Healthcare workers including hospital employees, other staff who work or study in hospitals (e.g. students in health care disciplines and contract workers), other health care personnel (e.g. those working in clinical laboratories, nursing homes, and home care agencies), and child care workers are at risk of exposure to communicable diseases because of their contact with patients or material from individuals with infections, both diagnosed and undiagnosed.” The definition includes “regulated and unregulated professionals” and those who “provide direct/indirect patient care.” Health care workers are considered to be a priority group to receive vaccine before the general public. OPSEU believes this definition should include DSS workers as well and encourages members in this sector to insist that they are offered the vaccine as a priority group.

I work in an office and one of my co-workers in the next cubicle went home sick today with influenza symptoms. What should I do?

Wherever you work, your employer should have developed a pandemic influenza or emergency management plan. JHSCs and Health and Safety reps should have had input into the measures and procedures in the plan to protect workers. JHSCs and Health and Safety reps should strongly encourage a meeting with employer representatives to either review the existing plan or to develop a plan with measures and procedures including an effective communication strategy to protect and inform workers.

It is believed that influenza is primarily spread through large droplets that directly contact a person’s nose, mouth or eyes. These droplets are produced when an infected person coughs, sneezes or talks sending infectious droplets into the air. Influenza may also be spread when a person touches an area contaminated with influenza viruses and then touches their nose, mouth or eyes. In a workplace where a worker has been working with H1N1, it would be advisable to wipe down commonly used areas with disinfectant wipes to reduce the risk of contact transmission. It is a good practice in general, even if no one is ill, to implement good cleaning practices to ensure that commonly touched items such as door handles, telephones, and counters are cleaned regularly. Workers should be encouraged to practice frequent hand hygiene using soap and water or alcohol-based hand cleanser.

In an office setting where a worker has contracted influenza, it would be advisable to alert staff to be vigilant about their own health since they may have been exposed to the virus. Staff who develop flu symptoms should be encouraged to stay home with no reprisals from the employer.

The MOHLTC has useful guidance on how to stay healthy and how to do a self-assessment for influenza symptoms. Additionally, the U.S. Department of Labour has published a valuable document to assist workplaces prepare for an influenza pandemic which contains guidance for office settings as well as other higher risk workplaces. See links below.

I am pregnant (or have a serious underlying health condition) and my doctor has advised me to try to avoid exposure to people with H1N1 until I can be vaccinated. What should I do?

If you have a medical reason supported by a doctor’s note to request a workplace accommodation you should follow the regular procedure used by OPSEU members in your workplace when they request an accommodation. Different OPSEU locals follow different processes when assisting members with accommodation issues. Some locals have an Accommodation Committee to assist members while in others, stewards, a member of the Local Executive or an OPSEU member of the JHSC may assist. Advise your supervisor that you will be requesting an accommodation and contact your Local steward, executive member or health and safety representative to discuss how a safe accommodation could be arranged and to schedule a meeting with your employer.

I’ve heard that doctors’ offices are too busy to book appointments for people who need a doctor’s note before returning to work after having the flu. Is that true and if so, what should I do when my employer demands that I provide a doctor’s note?

Some employers have decided to relax the requirement for workers to provide doctors’ notes during this time. In a recent press release, the Ontario Medical Association encouraged employers to reconsider asking their employees for a sick note from a physician because of an absence from work. “In order to help reduce the transmission of H1N1 and other illnesses, Ontario’s doctors believe it is wise for patients to stay home when they have flu-like symptoms,” said Dr. Suzanne Strasberg, President of the OMA. “Employers need to recognize that by requiring a sick note, they are encouraging those who are experiencing their worst symptoms and are most infectious to go out, when they should just be home in bed.”

The OMA statement goes on to note that people with mild flu symptoms who do not need medical care may place others at risk if they come to the doctor’s office just to get a note. Additionally, the OMA states that during this time, doctors’ resources are better spent focusing on patients who need their care, rather than producing notes to satisfy employer policies.

Locals and individual OPSEU members should inquire whether their employers will relax current requirements to produce doctors’ notes while the pandemic is creating huge demands on our health care system.

H1N1 Resources

• MOHLTC flu site with links to various useful guidance documents: http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro/
• New MOHLTC guidance document for Home Care settings: http://www.health.gov.on.ca/en/ccom/
  

  flu/h1n1/pro/docs/homecare_guidance.pdf

• New MOHLTC guidance document for Shelters: http://www.health.gov.on.ca/en/ccom/flu/
  

  h1n1/pro/docs/shelters_guidance.pdf

• New MOHLTC guidance document for First Nation Communities: http://www.health.gov.on.ca/en/ccom/flu/h
  

  1n1/pro/docs/firstnation_guidance.pdf

• New MOHLTC guidance document for Provincial Correctional Institutions:

• New MOHLTC guidance document for Ontario Youth Justice Centres

• New U.S. Department of Labor: Guidance on Preparing Workplaces for an Influenza Pandemic: http://www.osha.gov/Publications/
  

  OSHA3327pandemic.pdf

• Ontario Health Plan for Influenza Pandemic (OHPIP) Chapter 7 gives occupational health and safety/infection control advice for the health care sector: http://www.health.gov.on.ca/english/
  

  providers/program/emu/pan_flu/ohpip2/ch_07.pdf

October 23, 2009 H1N1 Influenza Update

The Ministry of Health and Long-Term Care (MOHLTC) has released updated clinical guidelines for Long-Term Care Settings, Ambulatory Care and Emergency Departments.

In all three guidance documents, occupational health and safety and infection prevention and control advice continues to take a precautionary approach recommending ongoing screening for influenza like illnesses (ILI), good hand hygiene, and appropriate use of personal protective equipment, including N95 respirators where necessary. Section five of each document contains the updated Infection Prevention and Control/Occupational Health and Safety guidance.

Long-Term Care settings

Key health and safety/infection prevention and control measures recommended are:

• Passive screening (signage at the entrance) should continue; advising persons not to enter if they have ILI symptoms.
• Daily screening of residents for ILI.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers caring for or assessing patients/residents with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing residents should be instructed to wash their hands, cover mouth and nose with a surgical mask if possible and be placed in a separate room or stay 2 metres away from others while awaiting assessment.

Ambulatory Care settings

Key health and safety/infection prevention and control measures recommended are:

• Encourage patients to self-screen at home for ILI and screen patients by phone when making appointments.
• Screen patients for ILI at reception using either signage or by receptionist.
• Patients with ILI symptoms should be asked to wear a surgical mask and, if possible, stay at least 2 metres away from others or in a separate room while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns (if hazard of skin or clothing contamination), eye protection, and fit-tested N95 respirators.
• Coughing patients should be instructed to wash their hands and cover mouth and nose with a surgical mask

Emergency Departments

Key health and safety/infection prevention and control measures recommended are:

• Active screening (screening by a person) of patients for ILI symptoms using Febrile Respiratory Illness screening tool.
• Patients with fever or other ILI symptoms to be advised to wear a surgical mask and to be placed in separate room or remain at least 2 metres away from others while awaiting assessment.
• Healthcare providers should continue to self-screen for ILI and should not come to work if they are ill.
• All Emergency room staff within 2 meters of ILI patients should wear fit-tested N95 respirators and eye protection.
• Healthcare providers performing clinical assessments of patients with ILI should wear gloves, gowns, eye protection, and fit-tested N95 respirators.

New October 14, 2009 Important Health Notice:

http://www.health.gov.on.ca/english/providers/

program/emu/health_notices/ihn_20091014.pdf

New Long Term Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ltc_guidance.pdf

New Ambulatory Care guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/

pro/docs/ambulatory_guidance.pdf

New Emergency Department guidelines:

http://www.health.gov.on.ca/en/ccom/flu/h1n1/pro

/docs/emergency_guidance.pdf

September 30, 2009 H1N1 Influenza Update

Overview

Flu season is fast-approaching and everyone is wondering how different it will be this year given that the H1N1 influenza is now the main type of flu circulating in our communities and workplaces. Researchers and scientists are looking to the Southern Hemisphere for answers, as countries they are just emerging from their winter flu season where H1N1 was the predominant flu virus.

The U.S. Centres for Disease Control and Prevention (CDC) reports that there were no changes to the epidemiology (the causes, transmission and control) of the H1N1 virus in the Southern Hemisphere during their winter. The virus behaved much as it did in Canada and the U.S. this spring. Also, researchers and scientists can see no significant changes to the virus itself, since its first appearance. In the temperate regions of the Southern Hemisphere, disease caused by H1N1 is declining, although it continues to infect substantial numbers in tropical regions. These observations are good news for us. This should mean that while the virus will probably continue to spread rapidly here because so few people have ever been exposed to a similar virus, in most cases it is not making people sicker than usual seasonal influenza. Overall, mortality rates from H1N1 are no higher than for seasonal influenza.

Those who appear to be at greatest risk of contracting H1N1 influenza are younger people. By the end of August, Ontario reported that more than half the cases of confirmed H1N1 influenza were under 20 years old. This is unlike seasonal influenza. Those who appear to be at greatest risk of getting very ill and developing complications are pregnant women and those with other health conditions such as heart or lung disease, diabetes, cancer, immune suppression and morbid obesity. Pregnant women do not appear to be at any greater risk of contracting the illness, but they do appear to suffer more complications from it. People living in remote and isolated communities such as native reserves appear to be at higher risk of contracting influenza and developing complications. It appears that people born before 1957 have some immunity to the illness.

In the weeks ahead, we expect to see increasing numbers of people contract H1N1. This will affect workers, their families, and workplaces. There continue to be unanswered questions and confusion over issues such as vaccines, the use of antiviral drugs such as Tamiflu, how to determine whether a case of H1N1 influenza is work-related, and what precautions to take in which circumstances.

Following are some frequently asked questions and topics raised by OPSEU members:

What’s happening with flu vaccines this year, especially in health care workplaces?

Seasonal flu vaccine: For a number of years Ontario has been promoting seasonal flu vaccine by running free flu vaccine clinics in various settings. In health care workplaces, employers have strongly encouraged workers to be vaccinated, and in cases of flu outbreaks, Medical Officers of Health have at times ordered employers to send unvaccinated employees home to reduce transmission of influenza among vulnerable patient populations. This year it’s different. On September 24, the province announced that in October it will provide seasonal flu shots only to people aged 65 and over and to residents of long-term care homes. Seasonal flu vaccine will not be available to the rest of the population until December or January

The province explains that this decision is based on a potential association between seasonal flu vaccines given in previous years and an increased risk of getting infection with H1N1 virus. This potential association was observed in Ontario, BC and Quebec in recent months; however this experience has not been reported in countries that have just come through their flu season or anywhere else. Whether or not this preliminary research is accurate, it probably makes sense not to widely promote the seasonal flu vaccine at this time anyway, given that H1N1 will probably be the main circulating flu this winter and seasonal flu vaccine will have no effect on H1N1 transmission.

H1N1 influenza vaccine: The province expects to have H1N1 vaccine available for distribution by November. It is following recommendations published by the Public Health Agency of Canada and will first offer the new vaccine to the following groups of people presumed to be at greater risk of either contracting the illness or developing more serious complications:

• People with chronic medical conditions under age 65
• Pregnant women
• Healthy children from 6 months to 5 years old
• Persons living in remote and isolated settings or communities
• Health care workers involved in pandemic response or the delivery of essential health care services
• Household contacts and care providers of persons at high risk who cannot be immunized or may not respond to vaccine

There is no indication yet how health care employers will respond to these new directives. It may be that for workplaces that have a seasonal flu vaccine immunization policy and program, it will be applied to H1N1 vaccines. However, given the newness of the vaccine, ongoing discussion about whether one dose or two will confer immunity, the role that age may play in vaccine uptake and natural immunity, there are clearly more questions than answers surrounding the expected vaccination campaigns in workplaces. Local unions and their Joint Health and Safety Committee members should begin to investigate and initiate discussions with employers about these issues.

What’s happening with Tamiflu? My employer says it will provide Tamiflu to workers to prevent influenza.

The provincial government has stockpiled enough antiviral drugs, a combination of Tamiflu and Relenza, to treat 25 percent of the population if they contract influenza. OPSEU is aware that some employers, particularly in the health sector have also stockpiled large quantities of Tamiflu, which they plan to distribute to employees in some circumstances.

The OPSEU Health and Safety Unit has received reports from some workplaces where employers are planning to either offer or request employees to take Tamiflu as a prevention measure even though they may not have been exposed to influenza. Currently, no provincial or federal government or public health institution is recommending the long-term use of antivirals such as Tamiflu for prevention (prophylactic) purposes. Canadian and U.S. health authorities, at this time recommend the use of antivirals for treating influenza, not preventing it. Very little is known about the effects of long-term use of Tamiflu or other antivirals. Additionally, there are concerns that overuse of Tamiflu may contribute to H1N1 becoming resistant to the drug.

If your employer is proposing a program to offer prophylactic use of Tamiflu, seek advice from your own physician and ensure that your Joint Health and Safety Committee has been consulted about the program. Your employer cannot force you to take Tamiflu or any other antiviral.

My employer says that since H1N1 influenza is not very severe, we don’t need to wear N95 respirators when caring for patients with H1N1 influenza. Is that correct?

Good scientific evidence continues to mount demonstrating that fit-tested N95 respirators protect wearers from exposure to influenza viruses. In September, a study of 2,000 hospital workers in Beijing was published which demonstrated that N95 respirators reduced the risk of respiratory illness by 60 percent and the risk of confirmed influenza by 75 percent. Surgical masks worn by workers were shown to have no effect in reducing illness. This study was published just after the U.S. Institute of Medicine released a report to the CDC which affirmed existing CDC guidance that health care workers caring for H1N1 influenza patients should wear fit-tested respirators, not surgical masks.

In Ontario, guidance from the Ministry of Labour, Important Health Notices from the MOHLTC and our provincial pandemic influenza plan, all call for workers in the health care sector caring for patients with H1N1 influenza or patients suspected of having H1N1 to wear fit-tested N95 respirators.

If you work in a health care or other workplace where a risk assessment demonstrates that workers are at risk of being exposed to airborne infectious illnesses such as pandemic influenza or Tuberculosis, your employer should have implemented a Respiratory Protection Program which includes fit-testing respirators, purchasing adequate supplies and worker training on the use and care of respirators. If you are expected to use an N95 respirator and your employer does not have a Respiratory Protection Program in place, advise your local union and your JHSC, and ask for assistance.

My employer says that since H1N1 influenza is being spread in the community, I shouldn’t file a WSIB claim even if I think I caught the illness at work. Is that correct?

No, that is not correct. While it is believed that H1N1 influenza will be the predominant circulating influenza this fall and winter, workers in some workplaces or those who perform some duties may be at greater risk of contracting influenza because of their work. For example, a worker in a long-term care home where there is an influenza outbreak among the patients, or an admitting clerk or a technologist in a hospital who is exposed to large volumes of potentially ill clients daily, will probably be at greater risk of contracting influenza at work than an office worker who has no public contact with ill people. Workers in day care centres and schools may also be at greater risk.

It is not possible to predict how the WSIB will adjudicate claims for work-related H1N1 influenza. As with any WSIB claim, whether for an illness or injury, the worker will be expected to demonstrate the link between her/his work and the illness. If you or one of your members believes that they have contracted H1N1 influenza because of a work-related exposure, then a WSIB claim should be made. If WSIB denies a claim for H1N1 influenza, consult with OPSEU for advice and possible assistance with an appeal of the decision.

Next Steps