Public Health Agency of Canada Expert Panel on Avian Influenza A(H5Nx) in Canada: Meetings
Meetings are closed to the public, but a summary of discussion is provided below for each meeting.
Past meetings
July 2024
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
The PHAC Chief Public Health Officer (CPHO), Dr. Theresa Tam and Chief Science Officer (CSO), Dr. Sarah Viehbeck, provided opening remarks for the meeting. The objectives of this meeting were to 1) present information on the potential value of anti-neuraminidase immunoassays and 2) leverage the expertise of the panel to explore previously successful examples of behavioural sciences to inform effective risk communication and community engagement approaches that could be adapted to support preparedness and response efforts for avian influenza. |
Agenda overview and administrative updates For Information |
Participants were invited to raise additional declarations of affiliations and interest with respect to the meeting's agenda items. None were raised. |
Situational update on A(H5N1) For Information |
Dr. Kerry Robinson, acting on behalf of the PHAC Vice President, Infectious Diseases and Vaccination Programs Branch, provided an overview of the current situation of avian influenza. As of July 23rd, avian influenza A(H5Nx) has not been detected in Canadian cattle or ruminants, and there have been no human cases reported. Key developments since the last panel meeting included a fourth human case in the United States associated with exposure to infected cattle, and 6 confirmed human cases in Colorado associated with the depopulation of an infected poultry farm. All cases exhibited mild symptoms and have recovered. There remains no evidence of person-to-person transmission and the risk to the general population remains low. PHAC continues to partner with other Canadian science-based departments and agencies working collaboratively to monitor, respond and prepare for avian influenza A(H5Nx). |
May 22 Follow up: Highly pathogenic avian influenza (HPAI) H5N1 human risk assessment: Potential role of anti-neuraminidase immunity |
Dr. Danuta Skowronski, epidemiologist with the British Columbia Centres for Disease Control (BCCDC) presented on the potential role of neuraminidase (NA) antibodies in modulating age-related risk of emerging or pandemic influenza viruses, and implications for risk assessment, preparedness and response. In light of the potential protective role of anti-NA, Dr. Skowronski recommended that Canadian laboratories develop and validate anti-NA assays to support systematic, population-based sero-susceptibility monitoring and age-related H5N1 (and other emerging influenza) risk assessment. Such information is critical to both pre-pandemic and pandemic evaluation and response activities, including vaccine development and deployment. Recognizing she had additional analyses and information to share, Dr. Skowronski will be invited to complete her presentation at a follow-up meeting of this expert group. |
Key issue: Behavioural science and Indigenous community engagement For Discussion |
Dr. Tom Wong, Chief Medical Officer of Public Health, Indigenous Services Canada (ISC), provided an overview of ISC activities and a situational update on the development of an evergreen Operational Plan for supporting First Nations Communities. Dr. Sean Hillier, Associate Professor & York Research Chair in Indigenous Health Policy & One Health at York University presented on engaging with Indigenous communities and experts. Dr. Hillier reinforced the importance of engaging Indigenous communities early and often for effective communication and trust-building, and that information should be community-specific, addressing needs and concerns collaboratively. There is a need to ensure One Health approaches and surveillance activities incorporate and actively engage with Indigenous ways of knowing. |
Key issue: Behavioural science: Lessons learned in effective communication and perspectives for avian influenza communications For Discussion |
Dr. Michelle Driedger, Professor and Department Head, Max Rady College of Medicine, University of Manitoba, presented on lessons learned in risk communication from the 2009 influenza A(H1N1) pandemic and COVID-19 response that are applicable to the current situation with avian influenza A(H5N1). The presentation highlighted the challenges with communicating public health risks to the public in light of uncertainty, rapidly evolving science and misinformation, and recommended strategies for a layered approach to ensure the information needs and interests of diverse groups are met by accessible government communications and websites. |
Roundtable For Discussion |
Panel members and participants engaged in discussions on how social and behavioural sciences can inform risk communications, community engagement, and public health actions. Panelists spoke to the value of utilizing trusted community sources when engaging to facilitate trust and uptake, the importance of targeting communications to specific audiences, and the critical need for equitable interventions. There is also an opportunity for communications to leverage the rapidly evolving technologies to help ensure information is more accessible. |
Conclusions and next steps For Information |
PHAC's CPHO and CSO provided concluding remarks, acknowledging the benefits of communicating the avian influenza work being done by the Canadian government and partners to help improve awareness and build trust. |
June 2024
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
The Chief Science Officer (CSO) of PHAC, Dr. Sarah Viehbeck, provided opening remarks for the meeting. The objectives of this meeting were to provide a situational update and engage panelists in discussion about scientific considerations for potential pre-pandemic A(H5Nx) vaccination. It featured roundtable discussions among panel members and participants. |
Agenda overview and administrative updates For Information |
Participants were invited to raise additional declarations of affiliations and interest with respect to the meeting's agenda items. None were raised. |
Situational update on A(H5N1) For Information |
The Deputy Chief Veterinary Officer of the Canadian Food Inspection Agency (CFIA), and Director General of the PHAC Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, provided an overview of the current situation for avian influenza from the animal and human health perspectives, respectively. To date, Canada has not identified any confirmed cases of avian influenza A(H5N1) in dairy cattle, or any associated cases in humans. All 600 commercial dairy samples tested by the CFIA have been negative for fragments of highly pathogenic avian influenza to date. The CFIA continues to proactively monitor suspect cases in dairy cattle and is developing guidance and resources to help prevent the introduction of avian influenza A(H5Nx) into Canadian cattle. PHAC continues to take a proactive approach to scientific preparedness activities, including considering an extended federal network for wastewater testing for influenza, validating diagnostic assays, developing guidance, access, and readiness and exploration around candidate vaccine options. In addition, PHAC will continue to update the risk assessment and pandemic risk scenario analysis as new epidemiological and research evidence emerge. Following a brief situational overview from both human and animal health perspectives, panelists discussed concerns regarding cross-border movement of livestock and associated biosecurity risks, namely with agricultural and transport equipment, and the importance of better defining how risk assessments can inform trigger points for pre-pandemic interventions, including enhancing risk assessment communication for public health action. |
Key issue: Pre-pandemic vaccination considerations For Discussion |
Panel members and participants engaged in discussions on considerations related to pre-pandemic influenza vaccines. Roundtable discussions expressed support for considering the utilization of pre-pandemic influenza vaccines to protect individuals at high risk of influenza A(H5N1) exposure. Panelists highlighted considerations including the importance of taking a One Health approach to consider both animal and human vaccination, the role vaccination could play in preventing subsequent reassortment, concerns regarding implementation barriers such as fear and mistrust driving low vaccine uptake and acceptance, and best approaches for public health messaging that appropriately communicate risk levels, promote uptake, and foster cross-sectoral engagement. |
Conclusions and next steps For Information |
PHAC's CSO provided concluding remarks and invited panelists to share any outstanding reflections via written follow-up. Discussions on key topics, including appropriate risk communication and implementation strategies for public health measures will continue in future meetings. |
May 2024
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
The Chief Public Health Officer (CPHO) of PHAC, Dr. Theresa Tam, provided opening remarks for the meeting. Dr. Tam acknowledged the value of bringing together intra- and extra-mural One Health expertise on this priority public health topic and noted the importance of input from panelists in informing decision-making for the current A(H5N1) outbreak across the Health Portfolio. This meeting will focus on virological and phylogenetic evolution and how these fields can best inform risk assessments for Influenza A(H5N1). |
Agenda overview and administrative updates For Information |
Panelists were provided with a draft Summary of Discussion (SoD) from Meeting 3 (May 3, 2024) and invited to provide feedback via written follow up. Following panel members' review, the SoD will be considered approved and will be posted on Canada.ca. Participants were invited to raise additional declarations of affiliations and interest with respect to the meeting's agenda items. None were raised. |
Situational update on A(H5N1) For Information |
The Deputy Chief Veterinary Officer of the Canadian Food Inspection Agency (CFIA), and Director General of the PHAC Centre for Foodborne, Environmental and Zoonotic Infectious Diseases, provided an overview of the current situation for avian influenza from animal and human health perspectives, respectively. Canada continues to monitor the outbreak of avian influenza in US dairy cattle which is now associated with two human cases. To date there have been no human or bovine cases of influenza A (H5N1) reported in Canada, and recent CFIA testing has not detected any viral fragments in sampled retail milk products. PHAC continues to take a proactive approach to preparedness - planning for enhanced human surveillance activities, extending integrated surveillance efforts beyond the seasonal influenza season, updating guidance and public communications, and engaging with the Canadian Centre for Occupational Health and Safety regarding the development of guidance and risk communications for workplaces with animal and animal product exposures. |
Key issue: H5N1 High pathogenicity avian influenza: The journey from birds to mammals For Discussion |
A US expert in highly pathogenic avian influenza, Dr. David Swayne, delivered a presentation on the viral evolution and recent emergence of avian influenza clade 2.3.4.4b in the Americas followed by detection of transmission among US dairy herds. Discussions highlighted the value of genomic tools for characterizing the virus and understanding the evolving routes of transmission, as well as the need for vigilance and active monitoring of animal populations to ensure early identification of potential infection and inform response efforts. |
Key issue: Spillover and emergence of H5N1 in US dairy cattle For Discussion |
Virologist and researcher from the Vaccine and Infectious Disease Organization (VIDO) at the University of Saskatchewan, Dr. Angela Rasmussen, delivered a presentation on the spillover and emergence of influenza A (H5N1) in US dairy cattle, highlighting recent phylogenetic studies and genomic computational epidemiology. Findings suggest that the transmission of influenza A(H5N1) in US cattle is the result of a single spillover event with subsequent transmission, but studies have been unable to determine as of yet the functional impacts of virological mutations on mammalian adaptation. The presenter noted that important gaps remain in the available sequence data, and that there is a need for increased availability and accessibility of sequences together with accurate metadata from influenza A(H5N1) testing to better understand the scale and scope of the current animal outbreak. |
Collaborative Science Spotlight: Risk assessment virological studies with influenza A(H5N1) viruses detected in various species in Canada For Discussion |
A researcher with the PHAC National Microbiology Laboratory presented on recent research conducted in collaboration with the CFIA National Centre for Foreign Animal Diseases that aimed to explore the transmission routes and adaptation of avian influenza to mammals. In vivo studies assessed avian influenza viruses circulating in Canada for virulence and transmission in mice and ferret models. Findings were previously released in a 2023 preprint, and highlighted the varied ability of these viruses to productively replicate in mammalian cells and to cause disease in mammalian animal species. Additional research is required to better understand the impacts of evolving viruses in diverse animal populations, and in hopes of identifying genetic mutations that increase the risk of transmissibility and severity. Resulting discussion flagged that more information is needed to understand the respective roles of innate and adaptive immune responses. Expert panel members suggested there is a need for the development of anti-N1 assays so as not to overlook the potential effects of neuraminidase given high homology between the humanized N1 antigens and those of the currently circulating H5N1 strains. |
Roundtable discussion: For Discussion |
Panel members and participants engaged in discussions on the implications of virological evolution, and the ability of the circulating strain to spillover to unique animal populations, via various routes of transmission, and resulting in diverse presentations of symptoms/disease. Surveillance and genomic analyses provide valuable and necessary tools to help monitor the spread, inform risk scenarios and preparedness activities, and mitigate the impacts of disease on wildlife, agricultural animals, and humans. |
Conclusions and next steps For Information |
PHAC's CSO and CPHO provided concluding remarks, acknowledging the evolution of enhanced surveillance and purposeful interplay of animal/human surveillance activities, the outstanding knowledge gaps, and the need for strategic coordination and focusing of available resources where they will be most impactful. |
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
The Chief Public Health Officer (CPHO) of PHAC, Dr. Theresa Tam, provided opening remarks and reflections on the evolving context of avian influenza A(H5Nx) in Canada and globally. Dr. Tam acknowledged the interdisciplinary scientific expertise within the panel, which included representation across animal and human health, specifically noting the importance of the panel in helping to identify research priorities and build improved pandemic preparedness approaches using a One Health approach. Research priorities informed through previous engagement are to be published on Canada.ca in Spring 2024. |
Agenda overview and administrative updates For Information |
Participants were reminded that panel discussions operate under Chatham house rules. The summary of discussion from meeting #2 was distributed secretarially following the previous meeting. Panelists were invited to raise additional declarations of affiliations and interest with respect to the meetings' agenda items. No additional declarations were raised. |
Situational update on A(H5N1) For Information |
Spillover and transmission of avian influenza A(H5N1) clade 2.2.4.4b in lactating dairy cattle in the United States of America was reported in March 2024. PHAC Vice President of the Infectious Disease and Vaccination Programs Branch, and the Canadian Food Inspection Agency (CFIA) Chief Veterinary Officer provided an overview of the current situation for avian influenza A(H5Nx) from a human public health and animal health perspective, respectively. PHAC is taking a proactive approach to preparedness through updated risk assessment, monitoring and surveillance, updating guidance and leveraging existing vaccine and therapeutic plans and measures. CFIA has implemented additional importation measures, expanded animal testing for H5N1, and promotion of enhanced biosecurity on farms. |
Key issue: Surveillance in poultry for avian influenza For Discussion |
A senior veterinary epidemiologist from the CFIA delivered a presentation on surveillance of avian influenza in poultry in Canada. The presentation offered an overview of how various surveillance components, including passive, active, and primary control zone (PCZ)-specific post-outbreak surveillance in poultry operate during peace time, and in support of outbreak response. Panelists identified approaches to help implement the use of a One Health approach. Ensuring data from routine surveillance and targeted enhanced surveillance and knowledge syntheses are integrated and interpreted across surveillance systems in Canada for a well-informed public health response. |
Key issue: UKHSA Avian influenza enhanced surveillance study For Discussion |
The lead principal investigator for the United Kingdom Health Security Agency's (UKHSA) Asymptomatic Avian Influenza Surveillance Study (AAISS) pilot attended as a guest speaker providing an overview and reflections of the study design, implementation, and study results. Considerations for conducting a similar study in Canada were discussed, including for protocol design to encompass multi-animal zoonotic influenza, considerations for the socially complex contexts, and community engagement in the study design and implementation. |
Opportunities for enhanced surveillance in Canada For Discussion |
Following the presentations, panel members engaged in discussions identifying opportunities and considerations for active, or enhanced surveillance study approaches for avian influenza in Canada integrating surveillance at animal-human interface. Discussions noted the importance of taking a One Health approach; complementing routine and enhanced surveillance with integrated reporting and interpretation across animal and health dimensions; exploring use of multiple methods for avian influenza A(H5Nx) surveillance and research (e.g., genomics, PCR testing, modelling, wastewater, serology); and the need for a framework for preparedness scenarios and triggers for action which bring together animal and human health dimensions with a focus on prevention interventions over response activities. Equity considerations and community engagement were also raised as critical dimensions to consider. |
Conclusions and next steps For Information |
Panelists were thanked for their continued contributions to discussions on this priority public health topic and invited to provide suggestions for forward agenda items for planning of future meetings. |
January 2024
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
PHAC's Chief Science Officer (CSO) welcomed participants and provided opening remarks on behalf of the Chief Public Health Officer of Canada, Dr. Theresa Tam. PHAC's Vice President of the Infectious Disease and Vaccines Programs Branch provided an overview of the current situation for avian influenza A(H5Nx) in Canada and globally. |
Agenda overview and administrative updates For Information |
The expert panel was informed that the webpage on Canada.ca was updated to include the members' affiliation and interest declarations, as well as the updated Terms of Reference reflecting additions from the inaugural meeting. Panelists were invited to raise additional declarations of interest with respect to the meetings' agenda items. Additional declarations were noted from one panelist and will be updated on the webpage. The Summary of Discussion (SoD) from Meeting 1 was considered approved and will be posted on Canada.ca. |
Key issue: PHAC A(H5Nx) Preparedness For Discussion |
The Director General of PHAC's Centre for Emerging and Respiratory Infections and Pandemic Preparedness delivered a presentation on the Agency's A(H5Nx) preparedness, including action scenarios and triggers for federal public health action. Panelists were invited to provide feedback on the preparedness framework, inflection points for increasing risk across scenarios, availability of data required to inform decisions, and the highest priority research gaps. Panelists expressed that the inflection points and scenarios made sense. Suggestions were made around visualization and science communications considerations. Panelists discussed where, from a One Health perspective and in the context of the preparedness framework, Canada could most effectively intervene to prevent spillover to humans. Panelists asked about the status of preparedness actions and implementation. |
Public Health Research Priorities for Avian Influenza A(H5Nx) For Discussion |
The CSO provided an overview of the latest emerging evidence and outlined recent updates to a draft synthesis of knowledge gaps and research needs for avian influenza A(H5Nx) being developed by PHAC's Office of the Chief Science Officer. A roundtable discussion solicited panelists' comments, recommendations and invited their identification of gaps considered to be of immediate importance in light of the current risk assessment posture in Canada. Key priorities raised related to proactive surveillance and early detection at the animal-human interface (including value of seroepidemiology studies), enablers of preparedness and response (e.g. sharing of data and control materials), public communications, uptake of interventions, as well as the importance of gathering and integrating Indigenous knowledges, particularly given reported changes in which species are being encountered in communities - perhaps due to changes in migration patterns. The Office of the Chief Science Officer will continue to engage internally and with the A(H5Nx) expert panel to further refine, validate, and prioritize the knowledge gaps, which will be made publicly available. |
Conclusions and next steps For Information |
Panelists were thanked for their continued contributions to discussions on this priority public health topic. The Secretariat will prepare and circulate a meeting summary for panelists' review and will continue to engage on forward agenda planning for future expert panel meetings. |
October 2023
| Agenda Item | Summary |
|---|---|
Opening remarks For Information |
The Chief Science Officer (CSO) of PHAC welcomed participants to the Inaugural virtual meeting. The Deputy Chief Public Health Officer of Canada provided opening remarks on behalf of the Chief Public Health Officer of Canada and delivered a brief overview of the current context for avian influenza in Canada and globally. |
Review of Terms of Reference, Affiliations/Interests, Confidentiality For Information |
The CSO reviewed the Terms of Reference and invited comments and additional declarations of interest with respect to the meetings' agenda items. Minor adjustments to the Terms of Reference were suggested by panelists and will be reflected in an updated version and re-circulated to the expert panel before publicly posting here. |
Public Health Research Priorities for Avian Influenza A(H5Nx) For Discussion |
Expert panel participants reviewed a draft synthesis of knowledge gaps and research needs for avian influenza being developed by the PHAC Office of the Chief Science Officer (OCSO). An overview of the inputs and the process for development of the preliminary list was provided by the CSO. Participants provided feedback on the document, including comprehensiveness, framing, and identifying additional research gaps not yet captured. The Secretariat will update the document to reflect participants' feedback and will re-circulate to the expert panel at the subsequent meeting for further input, validation, and prioritization. |
Key issue: Antivirals For Discussion |
PHAC's Vice President of Infectious Disease and Vaccines Programs Branch (IDVPB) delivered a presentation on antivirals for preparedness. Following the presentation, panelists engaged in discussion on the role of antivirals within Canada's strategy. |
Conclusions and next steps For Information |
The CSO expressed gratitude to the panelists for their attendance and participation in discussions on this important topic. The Secretariat will prepare a meeting summary and will continue engaging within forward agenda planning for the expert panel. |
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