Investigation of a Pandemic H1N1 Influenza Outbreak in a Remote First Nations Community in Northern Manitoba, 2009

Abstract

uring the first wave of the 2009 pandemic H1N1 influenza virus (pH1N1) in the province of Manitoba, Canada, there were 892 laboratory-confirmed cases of pH1N1; 1 of these cases, 156 (17.5%) were in northern remote First Nations communities served by nursing stations (total population 45,000) (First Nations and Inuit Health Manitoba Region, Winnipeg, Manitoba Health Surveillance and Analysis, personal communication, 2009). First Nations ethnicity has been associated with increased severity of pH1N1. 2 Health staff in a remote First Nations community in Manitoba identified an outbreak of influenza-like illness (ILI) in late April 2009, with subsequent laboratory confirmation of pH1N1 circulation. A field investigation of this pH1N1 outbreak was undertaken in June 2009. The objectives were to contribute to the understanding of the epidemiology of pH1N1 in this community, to inform a timely public health response and to make recommendations for the subsequent response to pH1N1 in other communities. METHODSThis investigation was conducted in a remote First Nations community (population 3,300) in northern Manitoba. The community is served by daily flights, but lacks an all-weather road. Primary nursing care and public health services are provided at the community nursing station. Itinerant primary care and specialist physicians provide care to this community on a scheduled basis. The study period was April 20 to June 11, 2009. April 20 was chosen as the beginning of the study period based on observations by nursing staff of increasing ILI occurring in the community and on the start date of the first wave of pH1N1 as declared by the province of Manitoba. June 11 was the last day that the study team was in the community for the purpose of data collection. Study data were collected for all of the laboratory-confirmed cases of pH1N1 in this community.The ILI case group comprised both the pH1N1 laboratoryconfirmed and possible cases. Case definitions were agreed upon by the study team. The possible case definition was in accordance with the ILI case definition from Manitoba Health and Healthy Living, which stated that fever and/or cough may not be prominent in children <5 years of age. 1. Confirmed: Laboratory confirmation of novel influenza A (pH1N1) virus taken from a clinical specimen collected on or

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