2003-11
April 25, 2003
6:00 pm

Advisory

Update #39 - Severe Acute Respiratory Syndrome

New in this update:

• Latest Canadian Numbers on SARS
• Health Canada Reaction to WHO Travel Advisory
• Government of Canada support for the SARS outbreak
• Travel
• Most Recent Travel Advisory Information

Latest Canadian Numbers on SARS

As of April 25, 2003, Health Canada has received reports of 341 probable or suspect cases of severe acute respiratory syndrome (SARS) in Canada. There have been 18 deaths in Canada. To date, transmission has been limited to specific transmission settings such as households, hospitals and specific community settings. The information contained in this update is based on the information available to Health Canada at this time.

The details of the cases to date are as follows:

• Ontario is reporting 138 probable and 127 suspect cases.
• British Columbia is reporting 4 probable and 60 suspect cases.
• New Brunswick is reporting 2 suspect cases.
• Saskatchewan is reporting 1 suspect case.
• Alberta is reporting 5 suspect cases.
• Prince Edward Island is reporting 4 suspect cases.

Total # of probables discharged: 75
Total # of probables recovering at home: 2
Total # of suspects discharged: 85
Total # of suspects recovering at home: 69

These numbers are accurate as of 1:00 pm. Eastern Daylight Saving Time, April 25, 2003. For specific information on the provincial numbers, please contact the appropriate provincial health department.

Health Canada Reaction to WHO Travel Advisory

On April 23, the World Health Organization (WHO) extended its recommendation to postpone non-essential travel to include Toronto.

Health Canada formally challenged the WHO's assertion that Toronto is an unsafe place to visit through a letter sent to the WHO. Senior Health Canada and Ontario Ministry of Health officials met with WHO officials by teleconference. They reiterated our position that the WHO decision is based on outdated data and asked that they rescind the Advisory immediately. Health Minister Anne McLellan also outlined our objections in a call today with Dr. Gro Harlem Brundtland, the Director General of the World Health Organization.

Health Canada does not support the WHO's position; it is safe to travel to Toronto. The Department reiterated this advice in a Domestic Health Travel Advice notice issued today.

We have a clear understanding of the specific settings in which this virus has been transmitted in Canada and confidence in the steps being taken to manage infection control.

A CDC travel alert provides a more accurate assessment of the situation in Canada. It states that: "Currently, all cases in Toronto are linked to Toronto's original index case and spread has been through person-to-person contact. SARS transmission in Toronto has been limited to a small number of hospitals, households, and specific community settings."

Government of Canada support for the SARS outbreak

Since the SARS outbreak began over a month ago, the Government of Canada has been actively working with provincial, territorial and international partners to deal with this disease. Much of our effort has been focussed on six areas – investigation, laboratory diagnosis, infection control, treatment, travel and emergency response.

Investigation:
Health Canada has sent 14 epidemiologists and infectious disease experts to Toronto to assist with the analytical work as well as some of the initial, on the ground, investigation of SARS cases. Additionally, an outbreak investigation and response team has been in constant contact with counterparts in Toronto.

Laboratory diagnosis:
In terms of research and science, a number of efforts are underway and ongoing. Our National Microbiology Laboratory in Winnipeg has received many specimens from SARS affected individuals and is actively seeking the cause of the virus. This laboratory, and numerous others in Canada, continue to search for an effective diagnostic test, while, at the same time, considering the potential development of a vaccine. Additionally, the Canadian Institutes of Health Research has begun a process for receiving requests for proposals from those who could undertake additional SARS research.

Infection control:
Well before this outbreak, and indeed since it began, Health Canada has provided detailed clinical guidelines for infection control and recommendations on actions for public health settings.

Health Canada has also directed blood operators to temporarily defer from donating blood (for a period of 10 days) from people who have:

• travelled within the previous 10 days to a SARS affected area outside Canada
• been a patient, worked in or visited a facility that is under quarantine for SARS.

At Ontario's request, Health Canada has agreed to lead an investigation, with some very specific technical assistance from the U.S. Centers for Disease Control and Prevention (CDC) in Atlanta, into the recent outbreak amongst health care workers. Health Canada, with the assistance of the CDC staff, will be gathering information in order to compare the circumstances surrounding those who were infected to those not infected, and will provide a report outlining the probable cause of the transmission among health care workers and recommendations for additional measures that may be taken to prevent further spread.

Health Canada's Workplace Health and Public Safety Programme (WHPSP) is providing advice to federal employers in Canada and abroad on occupational health and safety matters. Teams of WHPSP physicians and nurses were on site at the Pearson, Vancouver and Dorval airports to provide information sessions on SARS to federal employees. They continue to provide information sessions to employers and employees at workplaces across the country, and answer daily enquiries from employers. WHPSP is providing ongoing occupational health advisories to federal government departments and agencies, including precautionary measures and what recommendations to protect the health and safety of employees.

Treatment:
Health Canada's Special Access Program (SAP) is currently providing access to intravenous and oral Ribavirin for use in SARS. SAP is working closely with health care professionals at each of the hospitals involved to gather information on the use of Ribavirin for SARS, and potential adverse effects.

Travel:

Incoming airline passengers:
The Government of Canada, again through Health Canada, has placed significant numbers of staff at various airports through the country - most notably in Toronto, Dorval and Vancouver - as Quarantine Officers. These staff have been instrumental in watching for SARS exposed individuals who may be entering Canada from SARS affected regions of the world.

In addition, Health Canada has placed Health Alert Notices with accompanying posters in all terminals for distribution to passengers from all other international flights (i.e., those flights that do not arrive directly from Hong Kong, Singapore and Beijing) who are not being met by a Quarantine Officer.

Several thousand Health Alert Notices and Health Canada posters have been set up in airports in Halifax, St. John's, Montreal (Mirabel), Toronto, Ottawa, Winnipeg, Edmonton, Calgary and Vancouver.

All airlines are distributing yellow Health Alert Notice forms and traveller Contact Information Cards on direct flights coming into Canada from Asia.

Outgoing airline passengers:
Health Canada is using Health Alert Notices (cherry cards) to inform all passengers departing from Pearson International and Toronto Island Airports about symptoms and contact with persons with SARS.

We are working with airlines to ensure that the check-in procedure includes confirmation that passengers have read the cherry coloured card.

A Health Canada SARS team of health professionals has been sent to Pearson to provide information to airline and airport staff. In very limited cases, this team will assist the individual traveller and, if necessary, arrange for the transportation of individuals to local medical facilities.

Other travel measures:
Health Canada has issued a number of travel advisories to keep Canadian travellers informed regarding travel to affected areas in southeast Asia.

Emergency response:
On March 15, Health Canada activated its Emergency Operations Centre. It is currently being staffed by approximately 30 employees and is operating at a Level 3, which means the Department has activated its Emergency Response Plan.

Health Canada forwarded a supply of 10,000 class N95 masks to Toronto health officials and facilitated the purchase of approximately 1.5 million more.

In addition to the health and safety measures outlined above, the Government of Canada has also made changes to Employment Insurance regulations to ensure that those in voluntary isolation can receive benefits without undue delay, thus reducing the financial hardship of individuals who have had to go into quarantine.

Most Recent Travel Advisory Information

For further information on Health Canada's travel advice, please see:

http://www.phac-aspc.gc.ca/tmp-pmv/2003/sars0423_e.html
and
http://www.phac-aspc.gc.ca/tmp-pmv/2003/sarsdomestic_e.html

Health Canada will continue to do everything it can to keep Canadians informed and will continue to work with the provinces and territories so that medical officers are fully informed and appropriate steps are taken to mitigate risk.

For additional information on SARS, please contact Health Canada's information line at: 1-800-454-8302.

For information on previous travel advisories to South East Asia issued by Health Canada and the World Health Organization, please see the following links:

World Health Organization issues emergency travel advisory (April 2, 2003)

Health Canada Travel Advisory (April 23, 2003)

Media Enquiries:
Emmanuel Chabot
Health Canada
(613) 957-1803