Letter from Chief Medical Officer of Health to Ontario poultry industry stakeholders (Nov. 3, 2016)

November 3, 2016

Ministry of Health and Long-Term Care
Chief Medical Officer of Health

November 3, 2016

Dear Poultry Industry Stakeholder:

I am writing to recommend that you and your family get vaccinated against influenza this year.

Flu vaccination recommendations for all Ontarians:
Flu vaccines are offered free to all Ontarians over the age of six months who live, work or attend
school in Ontario, and are recommended for the general population.

Vaccination helps to prevent the spread of these flu viruses through the community and protects
individuals who may be at greater risk of serious complications from the flu, such as pregnant
women and those with chronic illnesses.

Flu vaccination recommendations for poultry workers:
While we encourage everyone in Ontario to get vaccinated, we are also recommending that those
in the poultry industry, in particular, get vaccinated because of the recent evidence that human flu
viruses can infect and cause disease in birds and other animals, as well as people. Most recently,
in the first half of 2016, an Ontario commercial poultry flock tested positive for the pH1N1 influenza
virus, which causes human respiratory illness and can be transmitted to poultry.

The flu strains covered by the vaccine are primarily human community-based infections, meaning
that you are most likely to get this flu from coming into contact with infected individuals in your
community. However, preventing the movement of influenza viruses between the human and
animal/bird populations is an important public health measure aimed at trying to prevent the
reassortment or mixing of different flu strains to produce new influenza viruses, which could cause
significant disease in both people and animals/birds. We are sending a similar letter to swine
industry workers.

Poultry workers who get the flu vaccine will help reduce the potential for an avian flu virus mixing
with these human influenza viruses, and help to keep the human viruses out of Ontario’s flocks.
With the initial arrival of highly pathogenic H5N2 avian influenza viruses in Ontario in 2015, and
another avian influenza outbreak occurring this past spring as well, this is becoming increasingly

Although it is unusual for individuals to get influenza infections directly from birds, personal
protective equipment – masks, eye protection and gloves – should be worn when working with sick
poultry to prevent infection, as occasional human infections have been reported. Individuals co-
infected with two or more different influenza viruses can also serve as mixing vessels for these
viruses, leading to the emergence of novel viruses.

Poultry workers who develop influenza-like illness:

Individuals with influenza-like symptoms (fever, cough, sore throat, muscle aches and, in some
cases, eye infections and pneumonia) should, if possible, be kept out of poultry barns and away
from bird flocks until seven days after their symptoms have resolved. The Ministry of Health and
Long-Term Care (MOHLTC) has developed a poster which producers can print out and use at entry
points to barns to reinforce this idea and help screen individuals/employees who may be infected
with influenza before they enter poultry barns. Electronic versions of this poster, in two size
formats, are available as attachments to this letter.

Individuals who develop influenza-like symptoms after working with poultry showing signs of
respiratory illness should seek medical attention and advise their health care provider of their
exposure to ill poultry.

Practise Good Personal Hygiene:
To protect against the flu, the Ministry of Health and Long-Term Care also recommends that
everyone, not just poultry workers, incorporate these simple steps into daily routines:
- wash hands frequently and thoroughly with soap and warm running water after handling
birds and before eating or drinking
- cover your mouth and nose with a tissue when you sneeze, dispose of the tissue
immediately, and then wash your hands
- if you don’t have a tissue, cough or sneeze into your upper sleeve – not into your hands
- avoid sharing food, eating utensils, towels or handkerchiefs
- keep an alcohol-based hand sanitizer (gel or wipes) handy at work, home and in your

MOHLTC is working closely with the Ontario Ministry of Agriculture, Food and Rural Affairs
(OMAFRA) to reduce the risk of influenza transmission between humans, poultry flocks and

If you have any human health questions, please contact your physician or your local public health
unit. If you have concerns about your flock, please contact OMAFRA and your veterinarian.

We appreciate your assistance in helping to protect everyone in Ontario from influenza.

For more information on getting the flu vaccine, speak to your doctor, nurse practitioner, public
health unit or pharmacist. To find a flu vaccination clinic near you, please contact your local public
health unit (a list of local public health units can be found at


Original signed by

David C. Williams, MD, MHSc, FRCPC
Chief Medical Officer of Health