[Table of Contents]

Volume: 23S1 - January 1997

Canadian Contingency Plan for Viral Hemorrhagic Fevers and Other Related Diseases

LINES OF COMMUNICATION FOR SUSPECTED OR CONFIRMED CASES

The management of the presentation and the consequences of serious communicable diseases associated with travel requires the coordination of multiple jurisdictional responsibilities.

Local, provincial/territorial, national, and international action or measures may be indicated. Additionally, the rare nature of many of these diseases and the complexity of some of the diagnostic investigations limits the number of facilities available to deal appropriately with some of the threats posed by these infections.

Expedient, efficient, and coordinated communication is an essential component of this and any contingency plan.

Site of Case Identification

1. Ports of Entry

Imported unusual or emerging communicable diseases may be identified or suspected at Canadian Ports of Entry. An unusual or emerging communicable disease presenting on an aircraft or at a Port of Entry may be associated with considerable logistic and operational problems.

Imported diseases may present in one of two manners at Ports of Entry.

a. Advance warning from arriving aircraft

The presence of serious illness in aircraft passengers during flight is communicated to the airport of destination or diversion. Ground staff then transmit the information to appropriate destinations according to airport medical contingency plans.

This manner of identification is often sufficient to allow for advance notification of public health, transport, and hospital receiving personnel. Officials at the Port of Entry should immediately contact the Federal and Provincial/Territorial Response Coordinators.

b. Identification of ill persons during primary inspection

Arriving passengers are subject to inspection at Ports of Entry by either Canada Customs or Immigration officers. Persons who are noted to be ill may be referred for medical assistance and/or further medical evaluation. Both the Quarantine Act and the Immigration Act provide the authority for the medical examination and evaluation of individuals identified at Ports of Entry who are seriously ill.

In these situations prior notification of appropriate individuals and facilities is not possible. Contingency plans for the medical evaluation, isolation, contact notification and close liaison with local public health and hospital authorities were recently evaluated during the plague surveillance system and are currently functioning well.

Periodic testing and evaluation of the contingency plans in place to deal with arrivals with serious communicable disease is required to maintain an efficient system.

National quarantine services are provided at Ports of Entry by Health Canada. The official in charge should immediately notify the Federal and Provincial/Territorial Response Coordinators. Provincial/territorial and local public health staff should be responsible for follow-up of fellow travellers under surveillance. The Federal Response Coordinator will ensure that appropriate destination lists are obtained.

Quarantine health issues can be directed to the 24-hr LCDC Reference Line:
1-800-545-7661

2. Presentation Within the Local Health Care System

Suspected or identified cases who present at medical offices, clinics or hospitals will activate the provincial/ territorial public health notification system as defined below.

To ensure a prompt and coordinated response to deal with the management of an unusual or emerging communicable disease, the following Response Coordinators have been designated:

• Provincial Response Coordinators are listed in the Appendix.
• The Federal Response Coordinator is the Director, Quarantine Health Services, Office of Special Health Initiatives, Laboratory Centre for Disease Control (LCDC), Health Protection Branch, Health Canada, Ottawa. Telephone, day: 613-957-8739; night: 1-800-545-7661. Fax: 613-952-8286.

If the patient's illness is compatible with or confirmed as an unusual or emerging communicable disease, it is incumbent upon the attending physician to discuss the situation immediately with the local Medical Officer of Health/Chef du département de santé communautaire who should, in turn, contact the Provincial/Territorial Response Coordinator (see the Appendix).

If the attending physician is unable to contact the Medical Officer of Health/Chef du département de santé communautaire, the Provincial/Territorial Response Coordinator should be notified immediately. The Provincial/Territorial Response Coordinator should then notify the Federal Response Coordinator. If the Provincial/Territorial Response Coordinator and the Federal Response Coordinator agree that a reasonable or strong suspicion of VHF or a disease requiring similar control measures exists, then the procedures described in the rest of this document should be followed.

Cases arising at, or en route to, Canadian ports of entry should be reported by the Federal Quarantine Officer directly to the Federal Coordinator; this person, in turn, should immediately notify the appropriate Provincial/ Territorial Coordinator. Following the evaluation of the situation, the Provincial/Territorial Coordinator will notify the appropriate Medical Officer of Health/Chef du département de santé communautaire.

In the rare instance of a medical evacuation to Canada from overseas of a patient with a suspected or proven unusual or emerging communicable disease, the Federal Response Coordinator should be contacted prior to the evacuation. The Federal Response Coordinator will notify the appropriate Provincial/Territorial Response Coordinator and the laboratory where diagnostic tests will be done.

If a VHF is first suspected by a physician at a hospital without an appropriate isolation room, or in the physician's office, or in a residential setting, etc., the Provincial/ Territorial Response Coordinator and the local Medical Officer of Health/Chef du département de santé should arrange with the nearest appropriate hospital to have the patient transported there. Internal protocols within the hospital setting may need to be developed to address these situations in order to care safely for the patient and deal with the laboratory specimens. Assistance will be given to the hospital and the laboratory in establishing these protocols.

In hospitalized individuals where the diagnosis is suspected or in cases where a suspect case is being moved to a hospital, it is essential that the Infection Control Unit of that institution be immediately notified. Infection control officials will be instrumental in establishing and monitoring isolation practices and, in some centres, will notify appropriate public health personnel. In clinical situations, on-site advice and assistance may be obtained from experts in infectious diseases, infection control or tropical medicine. Due to the nature of the situation, the hospital administrators should be informed as well.

There should be ongoing and close communication between the attending physician(s), the local Medical Officer of Health/Chef du département de santé, the Provincial/Territorial Response Coordinator, the Federal Response Coordinator and the designated laboratory where diagnostic tests for VHF will be done.

The Provincial/Territorial Response Coordinator will be responsible to ensure that appropriate arrangements have been made by the local Medical Officer of Health/Chef du département de santé for transportation and isolation of suspect cases, that all appropriate staff have been notified, and that the ongoing communication referred to above occurs. The Coordinator should also notify other local public health staff who will be responsible for contact follow-up.

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