Occupational Health Advice for Federal Employees Working or Traveling Outside of Canada During the H1N1 Flu Pandemic

November 13, 2009

This information has been prepared by the Public Service Health Program to provide federal departments and agencies of the core public administration with general and specific occupational health and safety advice and guidance to assist them in meeting their obligations, as outlined in the  Canada Labour Code, Part 2. This guidance document is being provided by Health Canada in response to the continued pandemic outbreak of H1N1 Flu Virus in Canada and around the world. This guidance has been developed to assist federal employees whose work or job duties may place them at higher risk of exposure to the H1N1 Flu Virus and to provide specific recommendations in this regard. This guidance is based on current available scientific evidence about this emerging disease and is subject to review as new information becomes available.

Introduction

The H1N1 Flu Virus is caused by a new virus with the ability to spread person-to-person. The H1N1 Flu Virus has been reported in Canada and worldwide, and thus is considered to be a pandemic. The Public Health Agency of Canada (PHAC) is working collaboratively with provinces and territories, other countries, and the World Health Organization, to monitor and respond to this pandemic on an ongoing basis.

Health Canada's Workplace Health and Public Safety Programme is providing federal departments and agencies of the core public administration with this health advisory to assist them in addressing questions and concerns about the H1N1 Flu Virus and to advise and support them in protecting their employees, particularly those who may be at higher risk of infection. The content of this document is largely based on the general recommendations included in the Canadian Pandemic Influenza Plan for the Health Sector.

Federal employees and their dependants living or traveling outside of Canada should also follow other guidance for travel and for H1N1 Flu Virus found on the  Public Health Agency of Canada Web site.

Assumptions

The following are assumptions, based on current available scientific evidence that were used to make recommendations in this document:

• Based on epidemiologic evidence, the high risk groups of complications resulting from the H1N1 virus include: children under five years of age (especially those less than two years old); women who are pregnant; and people with chronic conditions such as heart disease, liver disease, kidney disease, blood disorders, diabetes, severe obesity, asthma and chronic lung disease, immunosuppressed (people taking cancer drugs or people with HIV AIDS) and neurological disorders.

Symptoms of the flu virus (H1N1 and seasonal)

Almost always:

• Cough and fever
  
  

Common:

• Fatigue
• Muscle aches
• Sore throat
• Headache
• Decreased appetite
• Runny nose
  
  

Sometimes:

• Nausea
• Vomiting
• Diarrhea

• For more information consult the  Public Health Agency of Canada Web site Web site.
• Like seasonal influenza, H1N1 Flu Virus can vary in severity from mild to severe.
• Human-to-human transmission of H1N1 Flu Virus is occurring.
• Human-to-human transmission of the H1N1 Flu Virus occurs in the same way as seasonal influenza i.e. mainly through close contact with infected people who are coughing or sneezing and the virus enters the nose, eyes, or throat of another person. The virus can also rest on hard surfaces like counters and doorknobs, and can be picked up on hands and transmitted to the respiratory system when someone touches their mouth and/or nose.
• Although the seasonal influenza vaccine will not provide protection against the H1N1 Flu Virus it does provide some protection against other influenza strains (non-H1N1) likely to circulate this coming flu season. In Canada, the seasonal influenza vaccine will be offered according to provincial and territorial procedures and sequences. Arrangements are being made to offer the seasonal vaccine to those mission employees and Canadian-based staff (CBS) dependents located overseas.
• An H1N1 vaccine is currently in production and the first doses are being distributed. Canada has purchased sufficient vaccine for all Canadians who need and want to be vaccinated. However, due to timelines in producing sufficient quantities of the H1N1 vaccine, not everyone can be vaccinated at the same time. Those groups who will benefit most from immunization will be targeted first. Those groups were identified by a Federal, Provincial and Territorial expert group, taking into account various factors, including scientific evidence of the disease, vaccine strategies and logistics. Therefore, not all employees who wish to be vaccinated will be able to do so by mid-November. Arrangements are being made to offer the H1N1 vaccine to all mission employees and CBS dependents located overseas.
• More research is being done on how long a person can be infectious (able to spread the virus to others), but it is believed that this period is for one day before the onset of symptoms and continues for approximately seven days after symptoms have started. Transmission is also possible when not showing obvious symptoms, but it is more likely when symptoms such as coughing are present and viral shedding is high (i.e. early in the symptomatic period).

Recommendations

These specific recommendations are based on information as of November 13, 2009. You are advised to also follow local public health authorities' recommendations and those found on the PHAC Web Site. Since PHAC recommendations are targeted to Canadians living in Canada, the information may differ from that of local health authorities abroad. While working abroad, most federal employees are not at greater risk than the local public and should pay attention to local government and public health announcements regarding movement restrictions and prevention recommendations. Mission officials will provide advice when local recommendations conflict with those provided by Canadian health authorities.

Federal employees working abroad, including dependants and locally engaged staff (LES), are advised to follow the recommendations set out below. These recommendations are similar to those given to all individuals living abroad during seasonal influenza season, including those who must meet and deal with travellers or local inhabitants who present to the mission.

Section 1 - Federal employees working and residing outside of Canada during the H1N1 Pandemic

A. Work involves no contact with public

1. Get the seasonal influenza vaccine and the H1N1 vaccine when available.
2. Handwashing is the best method of preventing the spread of infectious disease. All employees and dependants should regularly wash hands with soap and water or use an alcohol based hand sanitizer (60-90%)
3. Avoid contact with people who appear to have an acute respiratory illness.
4. Should you develop a mild "cold" or influenza-like symptoms, you should stay home, isolating yourself from the workplace and, as much as possible, from others. Should your symptoms worsen (high fever, chills, cough, moderate to severe body aches, significant fatigue, diarrhea or vomiting) you should contact a health professional without delay. You should then be assessed regarding the need to take antiviral medications, which must be taken within 48 hours of the onset of symptoms to be most effective, but which may also be prescribed after this period.
5. If, however, you have medical conditions or other factors which place you in a high risk group for complications from H1N1 flu virus (see assumptions), you should contact a health professional without delay, even if you have a mild "cold" or influenza like illness (see 'assumptions' above for symptoms). You should be assessed as to whether you should receive antiviral medications. If such medications are prescribed, you should contact mission administration to determine how to obtain the medication.

B. Work involves contact with general public

In addition to the information in Section A, if an ill individual presents to you for services at your workplace:

1. The best procedure is to ask the ill person to seek medical attention and come back when well or is no longer experiencing flu-like symptoms. If the person requires immediate mission assistance, maintain a distance of two metres from the person who is ill. Frequent handwashing is important, especially after handling documents from an ill person. Wash hands with soap and water. If running water is not easily available and hands are not visibly soiled, use a 60-90% alcohol-based hand sanitizer. You should avoid touching your face, mouth, nose and eyes with unwashed or gloved hands.
2. Have the ill person wear a surgical mask. If they are unable to do this, have them cover their mouth and nose and cough into a tissue or the inside of their elbow.
3. Place ill person in an area or room away from others.
4. Call appropriate medical personnel to assess. If needed, call ambulance or first responders.
5. If you are required to spend time in close contact (less than two metres away) with an ill person (e.g. in a separate room or because you are restraining the person), a risk assessment should be performed to determine infection prevention and control measures. Infection prevention and control measures including, if possible, engineering controls (e.g. a physical barrier) or the use of personal protective equipment (e.g. surgical masks and N-95 respirators) should be implemented based on the following information as provided by PHAC:
   •  Interim Guidance: Infection Prevention and Control Measures for Prehospital Care
   •  Point of Care Risk Assessment Tool for Pandemic (H1N1) 2009 Flu Virus

• If recommended, the employee should also wear gloves and eye protection (e.g. goggles or safety glasses that seal to the face). Gloves and respirators/masks must be properly disposed of after use and hands should be washed again. Goggles should be disinfected after use.
• At the end of the close contact with the ill person, after leaving the room, the N95 respirator or surgical mask should be removed by the straps, being careful not to touch the mask or respirator itself. The mask or respirator should be disposed of in a hands-free waste receptacle.

Section 2 - Federal employees travelling outside of Canada during the H1N1 Pandemic

A. Posting with or without dependants

1. You will be assessed in the Ottawa National Capital Region (NCR) Clinic, and you may receive travel medicine services in the NCR Clinic or, if living outside the NCR, you may be referred to another facility with expertise in travel medicine where information on affected areas will be provided.
2. Before your posting commences, get the seasonal influenza vaccine and the H1N1 vaccine if available.
3. Follow the additional advice in Section 1 above.

B. Short-term work-related travel

The most recent information on travel can be found at on the  Public Health Agency of Canada Web site Web site.

If you travel outside of Canada

1. Receive the seasonal influenza vaccine and any other immunizations and advice appropriate for travel to the particular area.
   • If you have medical conditions or other factors which place you in a high risk group for complications from the H1N1 Flu Virus (see assumptions) you should also seek specific advice from your own health professional and/or a health professional with expertise in travel medicine.
2. Wash\clean your hands as explained in Section 1 above. You should avoid touching your face, mouth, nose and eyes with unwashed hands.
3. Avoid contact with people who appear to have an acute respiratory illness.
4. Should you develop a mild "cold" or influenza-like symptoms, you should stay home, isolating yourself from the workplace and, as much as possible, from others. Should your symptoms worsen (high fever, chills, cough, moderate to severe body aches, significant fatigue, diarrhea or vomiting) you should contact a health professional without delay. You should then be assessed regarding the need to take antiviral medications, which must be taken within 48 hours of the onset of symptoms to be most effective, but which may also be prescribed after this period.
5. If, however, you have medical conditions or other factors which place you in a high risk group for complications from the H1N1 Flu Virus, you should contact a health professional without delay, even if you have a mild "cold" or influenza like illness (see 'assumptions' above for symptoms). You should be assessed as to whether you should receive antiviral medications. If such medications are prescribed, you should contact mission administration to determine how to obtain the medication.
6. If you have medical conditions or other factors which place you in a high risk group for complications from the H1N1 Flu Virus and you have not yet left Canada, before leaving, it is advisable to see a medical professional who may prescribe a treatment course to carry with you to be used if treatment is necessary while abroad.