Health Professionals Update - Vol. 18, No. 9

From:
Rebecca Shalansky, MD MPH CCFP FRCPC
Associate Medical Officer of Health

In this issue:

• Introducing Peel's new Medical Officer of Health
• Avian (H5N1) Influenza

Key messages:

• Dr. Hamidah Meghani is Peel’s new Medical Officer of Health.
• The overall risk of avian influenza to the Canadian human population remains low.
• Since 2022, numerous cases of avian influenza have been identified in birds in Peel region. No human cases have been reported in Peel or Ontario.
• If you suspect avian influenza (influenza A, subtype H5N1) based on influenza-like-illness symptoms in an individual with a known link to sick or dead animals, follow up with Peel Public Health for guidance.

Introducing Peel's New Medical Officer of Health

Peel Public Health is pleased to announce the appointment of Dr. Hamidah Meghani as Peel's Medical Officer of Health (MOH), effective February 18, 2025. Under her leadership, Peel Public Health will continue to work towards improving health and quality of life, decreasing death and disease and reducing health inequities among population groups.

Dr. Meghani holds a Doctor of Medicine from McMaster University, Master of Public Health from Columbia University and a Master of Management from McGill University. Previously, she served as Deputy Chief, Medical and Systems Support at Public Health Ontario, Commissioner and MOH for Halton Region and Associate MOH for Hamilton Public Health. Dr. Meghani is a faculty member at the University of Toronto and McMaster University.

Dr. Meghani is passionate about healthcare provider outreach and will continue to be present at healthcare provider engagement opportunities across Peel.

More information on Dr. Meghani here.

Avian (H5N1) Influenza

Background Information on H5N1

Avian influenza is caused by the Influenza A virus, subtype H5N1 (A/H5N1). Avian influenza primarily infects wild birds but can be transmitted to commercial poultry and mammals (including humans). Worldwide, outbreaks of avian influenza have been occurring in wild bird populations since 2020. Cattle have also been infected; However, to date in Canada, the virus has not been detected in dairy cattle, other livestock, or in raw milk.

Avian influenza may spread to people. The risk of bird-to-human transmission is low, and, to date, no human-to-human transmission has been documented.

Since 2022, Peel has reported confirmed cases of avian influenza in a domestic cat, a fox, and as well as multiple wild bird populations in all three municipalities.

There have been no human cases reported in Peel or Ontario. The only known human case acquired in Canada was a youth in British Columbia in November 2024. The exposure source was not found. This is the first reported human case of avian influenza acquired in Canada.

Clinical Management and Testing

The local public health units, including Peel Public Health, are responsible for the follow up of human cases and contacts of avian influenza. Contact Peel Public Health if you suspect avian influenza infection in a patient.

Avian Influenza in humans typically presents as an acute respiratory illness, however, it can also manifest with gastrointestinal or central nervous system symptoms. Avian influenza testing should be considered for individuals presenting with clinically compatible symptoms and a history of exposure to suspected or confirmed infected birds, poultry or other sick or dead animals in the past 10 days.

Testing for avian influenza requires both a nasopharyngeal swab and a throat swab. Specimen types other than respiratory (e.g. conjunctival swabs) require approval by a PHO microbiologist. Contact PHO laboratory customer service prior to specimen submission. The investigation number ONT-2022-00001 should be included on all requisitions for local exposures related to infected birds or other animals. For more information on testing please visit: Avian Influenza – Real-time PCR | Public Health Ontario.

IPAC Considerations

Avian influenza is transmitted through direct or indirect contact with, or inhalation of, infectious respiratory particles.

Use Routine Practices for all patient interactions (i.e. perform a point-of-care risk assessment, screen for symptoms, ensure hand hygiene supplies are readily available, conduct environmental cleaning).

When examining, caring for or testing suspected or confirmed cases of avian influenza, initiate Additional Precautions: Droplet, Contact, and Airborne Precautions including the use of an N95 fit-tested mask, gown, gloves, and eye protection, ideally in an Airborne Infection Isolation Room (AIIR). If an AIIR is not available, place the patient in a single room with the door closed. A HEPA filtration unit may be used to improve ventilation. Schedule symptomatic patients with suspected avian influenza at the end of the day and ask them to wear a medical mask.

Treatment

Antiviral medications are available to treat avian influenza and are most effective when taken within 48 hours of symptom onset. Public health and/or infectious disease specialists can support the decision to prescribe antiviral medication to suspect or confirmed cases. Patients with severe disease may require supportive care and hospitalization.

Prevention

To prevent avian influenza infection, advise patients to avoid contact with ill or deceased wild birds and animals. All poultry, beef and other meat, organs and eggs should be thoroughly cooked to kill all potential viruses, parasites and bacteria including avian influenza, and all milk and milk products should be pasteurized before consumption.

Seasonal influenza vaccines are not designed or intended to protect against the avian influenza

A(H5N1) virus but continue to be recommended for general influenza prevention.

For additional information on Avian Influenza.

• PHO: Prevention and Management of Avian Influenza in Health Care Settings
• PHAC: Avian influenza A(H5N1): For health professionals
• CCOHS: How to Protect Yourself from Avian Influenza A(H5N1) at Work (Updated)

Reporting Requirements

Diseases of public health significance, including suspect or confirmed cases of avian influenza, must be reported to Peel Public Health by phone at 905-799-7700, 1-888-919-7800 (toll-free) or send lab results by fax to 289-801-0257.

Contact us

The Health Professionals Update (HPU) is distributed to physician offices in Peel region via fax or email. Share this update with other health professionals in your clinic.

More information:

• Review past HPUs
• Subscribe to HPU emails

For questions about this update, email healthprofessionals@peelregion.ca