Canadian Pandemic Preparedness Meeting: H1N1 Outbreak Research Response
Toronto, Ontario
July 8, 2009
Background
In April 2009, the first deaths from a novel strain of H1N1 influenza A virus were reported in Mexico and the United States. The virus quickly spread to other countries including Canada. In June 2009, the World Health Organization (WHO) issued a phase 6 pandemic influenza alert indicating that an influenza pandemic is underway. As of July 2009, the WHO reported almost 100,000 confirmed cases of human infection worldwide and almost 500 deaths, including 25 in Canada. The actual infection rate, however, may be in the millions because only a relatively small number of individuals have been tested for the virus. The virus, known now as the pandemic H1N1/09, continues to spread in many countries throughout the world.
While most infected individuals experience mild symptoms, a proportion develop severe respiratory symptoms requiring prolonged stays in intensive care units and ventilator support. Intensive care units in countries in the Southern hemisphere, currently at the start of its flu season, are beginning to reach their capacity. There are concerns that increased numbers of cases will overwhelm resources during the upcoming flu season this fall and winter in the Northern hemisphere. By the numbers
Number of Participants: 185
Number of Organizations Represented: 75
Number of Presentations: 6 in plenary and 40 in workshops
Funds available for new pandemic H1N1/09 research: $1.2 million
Total funding for pandemic research: $40 million
Meeting overview
Health-care providers and policymakers are under significant pressure to make informed health-care and public health decisions based on scientific information. To facilitate this process, the Canadian Institutes of Health Research (CIHR), Rx&D Health Research Foundation and Canadian Food Inspection Agency (CFIA) sponsored a one-day research meeting of more than 180 influenza and pandemic experts from across Canada on July 8, 2009, in Toronto. The goals of the meeting were:
- to facilitate information sharing among researchers and other influenza experts;
- to network and develop collaborations in order to focus the Canadian research response to the pandemic; and
- to discuss gaps in research knowledge about the pandemic H1N1/09 virus.
The meeting consisted of three parts: a plenary session, two sessions of concurrent workshops and an open forum.
Meeting summary
Dr. Bhagirath Singh, Scientific Director of CIHR Institute of Infection and Immunity (CIHR-III) opened the meeting by giving an overview of the Pandemic Preparedness Strategic Research Initiative (PPSRI), which was established with funds from the Government of Canada and partners in 2006. The goal of the Initiative is to support and promote research in pandemic influenza preparedness. Although the main focus of PPSRI has been on avian H5N1 influenza - which remains a threat - the initiative has greatly increased research capacity and should enhance Canada's response to both the pandemic and seasonal influenza. To coordinate current efforts, CIHR-III expanded the PPSRI Task Group with additional H1N1 experts. The H1N1 Outbreak Task Group has been meeting regularly by teleconference and consulting with the research and public health community since April.
In the plenary session that followed, Dr. Frank Plummer, the Public Health Agency of Canada's (PHAC) Scientific Director General based at the National Microbiology Laboratory gave an overview of the epidemiology of the current outbreak and clinical features of human infection. The pandemic H1N1/09 virus is a unique combination of genetic sequences with similarity to influenza viruses found in pigs, humans and birds. Individuals over the age of 51 appear to have some protection against the virus, while a greater proportion of young adults and older children develop severe respiratory symptoms upon infection. Dr. Plummer summarized several gaps in knowledge concerning pandemic H1N1/09, including determining why a small number of individuals infected with the virus succumb to severe disease.
Dr. John Pasick of the National Centre for Foreign Animal Disease at the CFIA then gave an overview of swine influenza and the human/animal interface. Influenza in pigs, including disease caused by pandemic H1N1/09 virus, is generally mild. Dr. Pasick emphasized pig-to-human infections occur via the nasopharyngeal route and not via consumption of meat.
Dr. Ross Upshur, Director of the University of Toronto Joint Centre for Bioethics outlined several of the ethical challenges in pandemics including the research response. In this regard, guidance and innovative approaches are urgently needed to speed approval times for clinical trials, permit collaborative research and facilitate tissue and data sharing amongst researchers.
Dr. Scott Halperin, Director of the Canadian Center for Vaccinology gave an overview of the newly established PHAC/CIHR Influenza Research Network (PCIRN). The Network will develop and test methods to evaluate influenza vaccines. Specifically, it will address questions of vaccine safety and effectiveness as well as program implementation and evaluation. The Network includes investigators at 30 institutions across Canada. The original plan was to build capacity over a three-year period, but PCIRN is now accelerating its activities to be fully operational in the fall when a vaccine against pandemic H1N1/09 virus is expected.
Dr. Danuta Skowronski, Physician Epidemiologist at the UBC/BC Centre for Disease Control outlined several public health research questions that require attention to provide practical information for health-care and public health workers as they deal with the pandemic. To address these questions, we must go beyond surveillance and engage in focused, case-controlled clinical research. Dr. Skowronski stated that the single most important current research question is whether there is a way to determine who is most likely to become severely ill, and what level of risk they face relative to others. This knowledge would allow for efficient and timely targeting of intervention strategies and treatment.
In workshop sessions covering a series of focussed topic areas, participants engaged in pandemic H1N1/09 research presented current results and research plans. Workshop participants then discussed questions that required additional research attention and ways in which they can work together to focus their research on the current pandemic. The topics of the workshops were:
- Aboriginal Populations and H1N1;
- Biology of the Virus, Immune Response and Antivirals;
- Clinical Pathogenesis & Infection Prevention;
- Diagnostics;
- Epidemiological Characteristics of Spread, Public Health Interventions and Health Services;
- Mathematical Modelling;
- Research Ethics and Ethical Issues; and
- Vaccines and Host Adaptive Immune Response.
Key research strategies from each workshop were brought back to the plenary open forum for discussion facilitated by the meeting chair, Dr. Earl Brown from the University of Ottawa.
Dr. Singh closed the meeting by announcing a new CIHR funding opportunity to support networking and collaboration of pandemic H1N1/09 virus research teams. It is expected that this targeted investment will enable teams to gather data, validate methodology or tools and explore novel research ideas that will contribute to control and management of the pandemic H1N1/09 virus. This new funding will add to previous CIHR investments in pandemic preparedness. The deadline for applications to this funding opportunity entitled "Catalyst Grant: Pandemic Outbreak Research Response" is August 10, 2009.