2003-11
April 30, 2003

Advisory

Update #44 - Severe Acute Respiratory Syndrome

New in this update:

• Latest Canadian Numbers on SARS
• Health Minister Sends Letter to Air Transport Association of Canada
• Health Canada Rescinds Routine Access to Ribavirin
• Government of Canada support for the SARS outbreak
• Travel
• Most Recent Travel Advisory Information

Latest Canadian Numbers on SARS

As of April 30, 2003, Health Canada has received reports of 346 probable or suspect cases of severe acute respiratory syndrome (SARS) in Canada. There have been 21 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 143 probable and 119 suspect cases.
• British Columbia is reporting 4 probable and 67 suspect cases.
• New Brunswick is reporting 2 suspect cases.
• Saskatchewan is reporting 1 suspect case.
• Alberta is reporting 6 suspect cases.
• Prince Edward Island is reporting 4 suspect cases.

Total # of probables discharged or at home: 88
Total # of suspects discharged or at home: 167

These numbers are accurate as of 1:00 pm. Eastern Daylight Saving Time, April 30, 2003. For specific information on the provincial numbers, please contact the appropriate provincial health department.

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Health Minister Sends Letter to Air Transport Association of Canada

On April 30, Health Minister Anne McLellan sent a letter to the Air Transport Association of Canada seeking the cooperation of the association's member airlines in implementing enhanced procedures for screening departing international passengers for SARS at Pearson International Airport, and to seek continued cooperation in screening in-bound passengers at all international airports in Canada.

For more information about this letter, please see the following link:
http://www.hc-sc.gc.ca/english/media/minister/events.html

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Health Canada Rescinds Routine Access to Ribavirin

Health Canada, through its Special Access Programme, will no longer provide routine access to ribavirin for the treatment of SARS. This decision stems from a recommendation by a working group advising Health Canada, comprised of health experts and clinicians from across Canada and representatives from the Centers for Disease Control and Prevention in the United States. After reviewing the existing anecdotal clinical experience with ribavirin, negative results from in vitro testing with ribavirin against SARS related coronavirus, and knowledge of reports of serious and unexpected adverse drug reactions, the working group reached a consensus that there is no data to support the continued use of ribavirin outside of clinical trials at this time. On April 27, Health Canada notified physicians that the continued access to the drug is contingent upon the submission and review of data in the possession of physicians with respect to the use, safety and efficacy of ribavirin for the treatment of SARS. Physicians currently treating patients with ribavirin are also strongly advised to critically re-examine the risk/benefit for each patient before continuing treatment.

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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.

Health Canada is the first country to be invited by the World Health Organization (WHO) to send a team of officials to Hong Kong to help investigate risk factors involved in the possible environmental transmission of SARS in specified residential buildings in the Special Administrative Region of Hong Kong.

The investigation would be conducted in the context of assisting the Hong Kong authorities to determine whether building mechanical systems (e.g., plumbing, ventilation, etc) played a role in spreading SARS at the Amoy Gardens and Metropole Hotel.

Officials from Health Canada's Workplace Health and Public Safety Programme (WHPSP) and National Microbiology Laboratory will participate in the investigation.

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.

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Travel

Incoming airline passengers
The Government of Canada, again through Health Canada, has placed significant numbers of staff at the Toronto, Dorval and Vancouver airports as Quarantine Officers.

All airlines on direct flights coming into Canada from Asia are distributing yellow Health Alert Notice forms and Traveller Contact Information Forms (TCIF). Health Canada personnel are collecting the TCIF as soon as passengers disembark the aircraft.

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. non-Asian flights) who are not being met by Health Canada personnel. These include airports in Halifax, St. John's, Quebec City, Montreal (Dorval and Mirabel), Toronto, Ottawa, Winnipeg, Regina, Saskatoon, Edmonton, Calgary and Vancouver.

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 is in place at 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.

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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/sars0428_e.html
or
http://www.phac-aspc.gc.ca/tmp-pmv/2003/sarsdomestic0428_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