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The Canadian Pandemic Influenza Plan for the Health Sector

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Glossary of Terms and List of Acronyms

A | B | C | D | E | F | G | H | I | J | K | L | M | N | O | P | Q | R | S | T | U | V | W | X | Y | Z

A

ACD Acute and communicable disease prevention
Acute Short term, intense symptomatology or pathology, as distinct from chronic. Many diseases have an acute phase and a chronic phase. This distinction is sometimes used in treatments.
Acute care Services provided by physicians and other health professionals and staff in the community and in hospitals. These include emergency, general medical and surgical, psychiatric, obstetric and diagnostic services.
AEFI Adverse Event Following Immunization*
Alternate level of care See also Acute care, InterQual criteria Alternative care that, had it been available, would have been more appropriate for a person in an acute care hospital who does not meet the criteria for acute care.
Amantadine An antiviral agent indicated in adults and children >1 year for the treatment of illness due to influenza and for prophylaxis following exposure to influenza type A viruses. It has no effect against the influenza type B virus.
Antigen Any molecule that is recognized by the immune system and that triggers an immune response, such as release of antibodies.
Antigenic drift A gradual change of the hemagglutinin or neuraminidase proteins on the surface of a particular strain of influenza virus occurring in response to host antibodies in humans who have been exposed to it. It occurs on an ongoing basis in both type A and type B influenza strains and necessitates ongoing changes in influenza vaccines.
Antigenic shift The movement of a type A influenza virus strain from other species into humans. The novel strain emerges by reassortment with circulating human influenza strains or by infecting humans directly. Because they flourish in the face of global susceptibility, viruses that have undergone antigenic shift usually create pandemics.
Antibody Protein molecules that are produced and secreted by certain types of white cells in response to stimulation by an antigen.

B

Bed (Institutional Bed) In any institution a “bed” includes infrastructure support, including staffing, that is required to care for the patient in that bed. Therefore the requirements for a bed in an intensive care unit, for example, include all the support required for a patient to be cared for at that level.

C

Case weight A measure representing the relative resources consumed by different types of hospital cases, distinguishing simple from complex cases.
CCMOH Council of Chief Medical Officers of Health*
Cross-resistance The development of strains of a pathogen that not only withstands the effects of a given antimicrobial agent, but other chemically related agents as well.
CDC United States Centers for Disease Control and Prevention, a federal agency of the United States Department of Health and Human Services
CDPE Center for Disease Prevention and Epidemiology
CEPR Centre for Emergency Preparedness and Response (Public Health Agency of Canada)*
CIDPC Centre for Infectious Disease Prevention and Control (Public Health Agency of Canada)*
CLSN Canadian Laboratory Surveillance Network
CPHLN Canadian Public Health Laboratory Network

D

DFA Direct fluorescent antibody

E

EHS Emergency Health Services*
EIA Enzyme immunoassay
ESS Emergency Social Services*
Epidemic An outbreak of infection that spreads rapidly and affects many individuals in a given area or population at the same time.
Epidemiology The study of the distribution and determinants of health-related states or events in specified populations, and the application of this study to control of health problems.1

F

Flu Another name for influenza infection, although it is often mistakenly used in reference to gastrointestinal and other types of clinical illness.
F/P/T Federal, Provincial and Territorial governments (noun)* or Federal, Provincial and Territorial (adjective)

G

Goblet cell A mucous gland in the epithelial lining of specific mucus-secreting passages of the respiratory tract. Mucigen droplets swell the upper portion of the cell, giving it a goblet-like shape.

H

H3N2 A strain of influenza type A virus that caused the pandemic infection of 1968-1969. Of the three influenza viruses that currently circulate in humans, this type causes the greatest morbidity and mortality.
H5N1 A strain of influenza type A virus that moved in 1997 from poultry to humans. While the outbreak of this virus was rapidly contained, it produced significant morbidity and mortality in persons who became infected, probably from direct contact with infected poultry. In 2003 a slightly different strain of H5N1 started circulating in avian species in Asia. As of 2005 this strain has become virtually endemic in the avian population, has infected other species such as swine and felines and has resulted in several fatal human cases.
Hemagglutinin (H) An agglutinating protein antigen spiking from the surface of the influenza virus. Differences in the amino acid sequencing of the HA antibody give rise to the different subtypes of type A virus (e.g. H1, H2, H3).
Health Care Worker (HCW) with close patient contact

Persons who work in settings where essential health care is provided and who during the pandemic would be working within 1 meter of any patients/residents with or without personal protective equipment.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of the antiviral and vaccine strategies. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

Health Care Worker (HCW) without close patient contact

Persons who work in settings where essential health care is provided and who during the pandemic would not be expected to work within 1 meter of any patients/residents.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of the antiviral and vaccine strategies. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

Health status The state of health of an individual or a population, as in community health status.
HECN Health Emergency Communications Network
High-risk groups Those groups in which epidemiological evidence indicates there is an increased risk of contracting a disease.

I

IFA Immunofluorescence assay
IHR International Health Regulations
IMPACT Immunization Monitoring Program, ACTive: a paediatric surveillance network
ILI Influenza-like illness
Inactivated vaccine A vaccine prepared from killed viruses that no longer retain their infective properties.
Influenza A highly contagious, febrile, acute respiratory infection of the nose, throat, bronchial tubes, and lungs caused by the influenza virus. It is responsible for severe and potentially fatal clinical illness of epidemic and pandemic proportions.
Influenza type A A category of influenza virus characterized by specific internal proteins and further subgrouped according to variations in their two surface proteins (hemagglutinin and neuraminidase). It infects animals as well as humans and has caused the pandemic influenza infections occurring in this century.
Influenza type B A category of influenza virus characterized by specific internal proteins. It infects only humans, causes less severe clinical illness than type A, and spreads in regional rather than pandemic outbreaks.
Influenza type C A category of influenza virus characterized by specific internal proteins. It does not cause significant clinical illness.
Interpandemic Period The interval between the last pandemic and the onset of the Pandemic Alert Period. During this period no new virus subtypes have been detected in humans although an influenza virus subtype that has caused human infection may be present in animals.
Isolate A pure specimen obtained by culture.
Isolation (as used in epidemiology) Separation, for the period of communicability, of infected persons or animals from others in such places and under such conditions as to prevent or limit the direct or indirect transmission or the infectious agent from those infected to those who are susceptible or who may spread the agent to others.1
Infection Condition in which virulent organisms are able to multiply within the body and cause a response from the host's immune defences. Infection may or may not lead to clinical disease.
Infectious Capable of being transmitted by infection, with or without actual contact.
Inpatient An individual who receives health care services while admitted in a health care facility overnight or longer.
InterQual criteria. See also Alternate level of care A set of measurable clinical indicators, as well as diagnostic and therapeutic services, reflecting the need for hospitalization. Rather than being based on diagnosis, they consider the level of illness of the patient and the services required; thus they serve as the criteria for all acute hospital care, regardless of location or size of the hospital. The criteria are grouped into 14 body systems, and there are three sets of criteria for each body system: Severity of Illness, Intensity of Service, and Discharge Screens.

K

Key health sector decision makers

Persons whose decision-making authority is necessary for implementing and maintaining the health sector response to pandemic influenza.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of specific public health interventions. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

Key social sector decision makers

Persons whose decision making authority will be necessary at the time of the pandemic to minimize societal disruption.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of specific public health interventions. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

L

LICO (Low income cutoff point) The proportion of people in low-income households to the total population in private households. LICOs are set where families spend 20 percent more of their pre-tax income than the Canadian average on food, shelter and clothing. The LICO takes into account changes in the Consumer Price Index of the area and gives various LICOs according to different family sizes.
LPN (Licensed practical nurse) A nursing school graduate who has been licensed by a provincial or territorial body; occasional synonym, licensed vocational nurse.

M

MD (Doctor of Medicine) An individual holding a doctoral degree in medicine.
MEDLARS Medical Literature Analysis Retrieval System. The computer on which “Medline” and “AIDSLINE®” reside at the National Library of Medicine.
Medline Medical Literature Analysis Retrieval System on Line. A computer searchable database of published medical literature.
Mean (statistical) Commonly referred to as the “average,” the mean of a set of quantities is the sum of the quantities, divided by the number of quantities summed.
Median (statistical) The value such that for a series of ranked quantities, half are above the median, and half are below.
Morbidity Departure from a state of well-being, either physiological or psychological; illness.
Morbidity rate The number of cases of an illness (morbidity) in a population divided by the total population considered at risk for that illness.
Mortality Death, as in expected mortality (the predicted occurrence of death in a defined population during a specific time interval).
Mortality rate The number of people who die during a specific time period divided by the total population.
Mutation A permanent, transmissible change in the genetic material of a cell.

N

NPS Nasopharyngeal swab
Neuraminidase (N) A hydrolytic protein antigen spiking from the surface of the influenza virus. It dissolves the protective viscosity of cellular mucous lining, allowing release of new viruses into the respiratory tract. The different proteins are identified using a numerical system (e.g., N1, N2, N3) and when combined with the haemagglutinin type are used to identify various influenza virus subtypes (e.g. H1N1, H3N2)
Neuraminidase inhibitors A new class of antiviral agents that selectively inhibit neuraminidase activity in both influenza type A and type B viruses, while having no effect on human neuraminidase.
Non-traditional site The following is a definition of a Non-Traditional Site for the purposes of Pandemic Influenza planning: A Non-Traditional Site is a site offering care for influenza patients. These sites are currently not an established health care site, or are established sites which usually offer a different type or level of care. The functions of an non-traditional site will vary depending on the needs of the community but will focus on monitoring, care and support of influenza patients.

O

Opportunistic infections An infection in an immune compromised person caused by an organism that does not usually cause disease in healthy people. Many of these organisms are carried in a latent state by virtually everyone, and only cause disease when given the opportunity of a damaged immune system.
Outpatient An individual who receives health care services without being admitted to a health care facility.

P

PAHO Pan American Health Organization.
Palliative A treatment that provides symptomatic relief, but not a cure.
p value The probability of obtaining a given outcome due to chance alone. For example, a study result with a significance level of p < 0.05 implies that five times out of 100 the result could have occurred by chance.
PCR (Polymerase chain reaction) A highly sensitive test that can detect and/or DNA fragments of viruses or other organisms in blood or tissue. PCR works by repeatedly copying genetic material using heat cycling, and enzymes similar to those used by cells.
Pandemic Referring to an epidemic disease of widespread prevalence around the globe.
Pandemic Alert Period The interval following the Interpandemic Period. Characterized by the occurrence of human infection(s) with a new subtype of influenza virus in the absence of efficient human to human transmission of this new virus
Pandemic Period The interval characterized by increased and sustained transmission in the general population of a new influenza virus subtype which is spreading efficiently between humans.
Pandemic societal responders

Persons who are trained or primarily involved in the provision of an essential service that if not sustained at a minimal level would threaten public health, safety or security.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of specific public health interventions. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

Parenteral Not through the mouth. Intravenous, intramuscular, and intradermal administration are all parenteral.
Pathogen Any disease-producing microorganism or material.
Pathogenesis The natural evolution of a disease process in the body without intervention (i.e., without treatment). Description of the development of a particular disease, especially the events, reactions and mechanisms involved at the cellular level.
Pediatric Relating to the medical specialty concerned with the development, care and treatment of children from birth through adolescence.
PHAC Public Health Agency of Canada
PHEIC Public health emergency of international concern
PHL Provincial health laboratory
PIC Pandemic Influenza Committee
the Plan Canadian Pandemic Influenza Plan for the Health Sector
Pneumocyte An alveolar epithelial cell in the lungs.
PYLL (Potential years of life lost) The PYLL rate per 1000 population is the ratio of the total years of life lost between ages 0 and 75 due to a specific cause to the total population. The cause of death selected is the underlying cause of death, which is the cause that initiated the sequence of events leading to death.
Preventive care A comprehensive type of care emphasizing priorities for prevention, early detection and early treatment of conditions, generally including routine physical examinations, immunization, and well-person care.
Preventive medicine Taking measures for anticipation, prevention, detection, and early treatment of disease.
Primary care Primary care is the first level of care, and usually the first point of contact, that people have with the health care system. Primary care involves the provision of integrated, accessible health care services by clinicians who are accountable for addressing a large majority of personal health care needs, developing a sustained partnership with patients, and practicing in the context of family and community. It includes advice on health promotion and disease prevention, assessments of one's health, diagnosis and treatment of episodic and chronic conditions, and supportive and rehabilitative care.
PSEPC Public Safety and Emergency Preparedness Canada
P/T Provincial and Territorial governments (noun) and Provincial and Territorial (adjective).
Public health The art and science of protecting and improving community health by means of preventive medicine, health education, communicable disease control, and the application of social and sanitary sciences.
Public Health Responders

Persons who are essential to the implementation and maintenance of the public health response to pandemic influenza and who would not be expected to come within 1 meter of a known influenza case in their work setting.

Note: This definition was developed to facilitate pandemic planning regarding the identification of specific groups that may be targeted as part of specific public health interventions. It has been endorsed by the Pandemic Influenza Committee for this purpose but may not be well recognized outside of this group.

Q

Qualitative Of, relating to, or expressed in relative or subjective terms. Impossible to quantify precisely.
Quantitative Of, relating to, or expressed in terms of quantity.

R

Raw data Measurements and observations recorded on study data forms. 2. Unedited computer-generated listings of data from study data forms, prior to use of reduction and summary procedures needed for data analysis.
Record A paper or electronic document that contains or is designed to contain a set of facts related to some occurrence, transaction, or the like.
Resistance The development of strains of a pathogen that are able to withstand the effects of an antimicrobial agent.
Respiratory epithelium The pseudostratified coverup of internal body surfaces, which lines all but the finer divisions of the respiratory tract.
Respiratory tract Structures contained in the respiratory system, including the nasopharynx, oropharynx, laryngopharynx, larynx, trachea, bronchi, bronchioles, and lungs.
RN (Registered Nurse) One who has graduated from a college or university program of nursing education and has been licensed by the state.
Rimantadine An antiviral agent indicated in adults for the treatment of illness due to influenza and for prophylaxis following exposure to influenza type A viruses. It has no effect against the influenza type B virus.

S

SARS Severe acute respiratory syndrome
Secondary care Services given by a specialist, normally after a referral from a primary care physician, and often in an acute care hospital. It does not include the services of specialists whose services are only available in major urban centres; this level of service would normally be considered tertiary care.
STD Sexually transmitted disease
Strain A group of organisms within a species or type that share a common quality. For example, currently circulating strains of influenza include type A (H1N1), type A (H3N2), and type B (H3N2).
Subtype A classification of the influenza type A viruses based on the surface antigens hemagglutinin (H) and neuraminidase (N).
Significance (statistical) Infers that an observation was unlikely to have occurred by chance alone. Statistical significance is often based on a p value < 0.05. Below this level, the smaller the p value, the greater the statistical significance.
Standard deviation (statistical) A statistic that shows the spread or dispersion of scores in a distribution of scores (i.e. a measure of dispersion). The more widely the scores are spread out, the greater the standard deviation. Standard deviation = the square root of the variance.
Statistics, descriptive The intent of descriptive statistics is to summarize and present data, e.g. measures of central tendency (mean, mode, median) and measures of variability (standard deviation, variance, standard error of the mean).
Subacute care Comprehensive, cost-effective inpatient level of care for patients who: (a) have had an acute event resulting from injury, illness or exacerbation of a disease process, (b) have a determined course of treatment, and (c) although stable, require diagnostics or invasive procedures but not intensive procedures requiring an acute level of care. Typically short-term, subacute care is designed to return patients to the community or transition them to a lower level of care. Subacute care is offered in a variety of physical settings. The philosophy of subacute care is to ensure that patients are receiving the most appropriate services at the most appropriate phase of their illness while ensuring quality, cost-effective outcomes.
Symptoms Any perceptible, subjective change in the body or its functions that indicates disease or phases of disease, as reported by the patient.

T

TAG Technical Advisory Group
Type A classification of influenza viruses based on characteristic internal proteins.
Toxicity The extent, quality, or degree of being poisonous or harmful to the body.
Toxin A harmful or poisonous agent.
TCIF Traveller contact information form
Triage A system whereby a group of casualties or patients is sorted according to the seriousness of their illness or injuries, so that treatment priorities can be allocated between them. It is designed to maximize the number of survivors in emergency situations.

V

Vaccination The act of administering a vaccine.
Vaccine A substance that contains antigenic components from an infectious organism. By stimulating an immune response (but not disease), it protects against subsequent infection by that organism.
Virology The study of viruses and viral disease.
Virus A group of infectious agents characterized by their inability to reproduce outside of a living host cell. Viruses may subvert the host cells' normal functions causing the cells to behave in a manner determined by the virus.
Volunteers (Pandemic) A volunteer is a person registered with a government agency or government designated agency, who carries out unpaid activities, occasionally or regularly, to help support Canada prepare for and respond to a pandemic influenza outbreak. A volunteer is one who offers their service of their own free will, without promise of financial gain, and without economic or political pressure or coercion.

W

WHIMIS The Workplace Hazardous Materials Information System (WHMIS) is Canadian legislation covering the use of hazardous materials in the workplace. This includes assessment, signage, labelling, material safety data sheets and worker training. WHMIS closely parallels the U.S. OSHA Hazcom Standard. Most of the content of WHMIS is incorporated into Canada's Hazardous Products Act and the Hazardous Materials Information Review Act, which are administered by Health Canada. Certain provincial laws may also apply. WHMIS is enforced by the Labour Branch of Human Resources Development Canada or the provincial and territorial agencies and offices of occupational health and safety.
Wild type A naturally occurring strain of virus that exists in the population.
WHO World Health Organization, a special agency of the United Nations generally concerned with health and health care.

References

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1. Last, John, M. (Editor) A Dictionary of Epidemiology (2nd edition), 1988. Oxford University Press Inc., New York, New York.

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