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  • #16
    FluWatch report: January 4 to January 10, 2015 (Week 1)

    Posted 2015-01-16 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: January 4 to January 10, 2015 (Week 1) (PDF Version - 385 KB- 10 pages)

    ?? Help with PDF documents


    Overall Summary
    • In week 1, seven of the thirteen provinces and territories reported widespread activity within their jurisdictions- the highest levels reported to date.
    • Similar to the previous week, there were a large number of newly-reported laboratory-confirmed outbreaks of influenza: 195 outbreaks in 9 provinces, of which 152 were in long-term care facilities (LTCF). This is record number of LTCF outbreaks reported over the last five influenza seasons.
    • The percent positive for laboratory detections of influenza decreased in week 01 in Canada - suggesting that the seasonal influenza has peaked.
    • Overall in week 01, many indicators such as laboratory detections, prescriptions for antiviral medications, paediatric hospitalizations and ILI consultations rate have decreased.
    • To date, the NML has found that the majority of A(H3N2) influenza specimens are not optimally matched to the vaccine strain. This may result in reduced vaccine effectiveness against the A(H3N2) virus. However, the vaccine can still provide some protection against A(H3N2) influenza illness and can offer protection against other influenza strains such as A(H1N1) and B

    Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
    Influenza/ILI Activity (geographic spread)

    In week 01, 22 regions reported widespread activity: in BC(3), AB(5), SK, MB(2), ON(5), QC(3), NF(3). The same five regions in Alberta have reported widespread activity for the past 3 weeks. Thirteen regions reported localized activity: in SK, MB(3), ON, QC(3), NB(4) and PE and eight regions reported sporadic activity: in BC(2), SK, ON, NB(2), NF and NWT.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 1




    Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
    Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
    Influenza and Other Respiratory Virus Detections

    The number of positive tests decreased from 5,313 in week 53 to 4,579 in week 01. The percentage of positive influenza tests also decreased from 34.4% to 28.5% (Figure 2). This may be an indication that we have reached the peak in laboratory detections with the percent positive for influenza peaking in week 52 (35%) and the number of positive influenza tests peaking in week 53 (5,313). To date, 98% of influenza detections have been influenza A, and 99.8% of those subtyped have been A(H3) (Table 1). The timing of the season and predominant A(H3N2) subtype is similar to the pattern observed during the 2012-13 influenza season when percent positive for influenza peaked in week 52 (35%). To date, among the cases of influenza with reported age, the largest proportion was in adults ≥65 years of age (63%) (Table 2).
    Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
    Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
    In week 01, the number of positive RSV tests increased to 1,001 RSV detections up from 979 RSV detections in week 53. RSV remains the second most frequently detected virus after influenza. Detections of RSV since week 38 have been higher than in the previous season while detections of parainfluenza and adenovirus continue to follow their seasonal patterns of broad winter circulation (Figure 3).
    For more details, see the weekly Respiratory Virus Detections in Canada Report.
    Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15

    RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
    Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
    B Total
    1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
    2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
    807 0 264 543 12 1699 2 726 971 39
    394 0 257 137 32 3517 2 3279 236 152
    104 0 0 104 0 898 0 0 898 5
    267 0 41 226 7 617 0 186 431 12
    1216 0 305 911 11 4622 5 1906 2711 59
    1332 0 0 1332 66 8301 3 422 7876 245
    37 0 0 37 0 70 0 5 65 2
    25 0 12 13 2 72 0 29 43 9
    8 0 8 0 0 23 1 20 2 1
    130 0 0 130 0 342 0 53 289 2
    4320 0 887 3433 130 20161 13 6626 13522 526
    97.1% 0.0% 20.5% 79.5% 2.9% 97.5% 0.1% 32.9% 67.1% 2.5%
    Total Total
    1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
    2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
    3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
    126 0 17 109 10 1210 4 520 686 55 1265 6.8%
    81 0 13 68 8 1085 0 622 463 62 1147 6.1%
    256 0 35 221 15 2127 1 870 1256 77 2204 11.8%
    325 0 36 289 28 2229 1 759 1469 99 2328 12.5%
    1800 0 240 1560 43 11525 4 3561 7960 194 11719 62.7%
    3 0 1 2 1 30 0 18 12 1 31 0.2%
    2591 0 342 2249 105 18206 10 6350 11846 488 18694 100.0%
    96.1% 0.0% 13.2% 86.8% 3.9% 97.4% 0.1% 34.9% 65.1% 2.6%

    Antiviral Resistance

    During the 2014-2015 influenza season, NML has tested 235 influenza viruses for resistance to oseltamivir and 233influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 339 (99.7%) of influenza A viruses tested for amantadine resistance were resistant (Table 3).
    * NA - not applicable
    206 0 204 0 338 337 (99.7%)
    2 0 2 0 2 2 (100%)
    27 0 27 0 NA * NA *
    235 0 235 0 340 339
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 89 influenza viruses [55 A(H3N2), 2 A(H1N1) and 32 influenza B]. The majority of circulating influenza B and A(H1N1) viruses have been antigenically similar (good match) to the recommended strains for the 2014-15 seasonal influenza vaccine, while the majority of A(H3N2) viruses have shown evidence of an antigenic drift (sub-optimal match) from the vaccine strain.
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=55), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 49 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 250 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 249 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 32 influenza B viruses characterized, 29 viruses were antigenically similar to B/Massachusetts/2/2012, and three viruses showed reduced titers (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 89

    The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
    The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.



    Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
    Influenza-like Illness (ILI) Consultation Rate

    The national influenza-like-illness (ILI) consultation decreased in week 01 to 50.1 consultations per 1,000, which is above expected levels for week 01 (Figure 5). The rates were highest among the 0 to 4 years of age group (269.8 consultations per 1,000) and lowest among the adults ≥65 years of age (12.0 consultations per 1,000).
    Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
    Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
    Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
    Influenza Outbreak Surveillance

    In week 01, 195 new outbreaks of influenza were reported: 152 in long-term care facilities (LTCF), 12 in hospitals and 31 in institutional or community settings (Figure 6). Among the outbreaks in which the influenza subtype was known, two LTCF outbreaks and four institutional or community setting outbreaks were associated with A(H3N2). To date this season, 623 outbreaks in LTCFs have been reported. The number of outbreaks reported since week 47 is above those of previous seasons and is similar to the numbers reported during the 2012-13 influenza season when influenza A(H3N2) also predominated. The majority of the outbreaks with known subtypes are attributable to A(H3N2).
    Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
    1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
    Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
    Pharmacy Surveillance

    During week 01, the proportion of prescriptions for antivirals decreased to 918.5 antiviral prescriptions per 100,000 total prescriptions (down from 969.6 per 100,000 total prescriptions). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in age groups except children decreased in week 01. The antiviral prescription rate remains the highest amongst seniors at 1,552.8 per 100,000 total prescriptions.
    Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
    Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
    Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
    Sentinel Hospital Influenza Surveillance

    Paediatric Influenza Hospitalizations and Deaths (IMPACT)
    In week 01, 44 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 41 cases of influenza A and one case of influenza B(Figure 8a). Among the reported cases, 21 (48%) were <2 years of age, 19 (43%) were 2 to 9 years of age and 4 (9%) were 10-16 years of age. Four cases were admitted to the ICU. To date this season, 358 hospitalizations have been reported by the IMPACT network, 337 (94%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (127/129) were A(H3N2). Children <5 years of age represented 61% of cases (Table 4). To date, 38 cases were admitted to the ICU, of which 22 (58%) were 2 to 9 years of age (Figure 9a).
    Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
    Adult Influenza Hospitalizations and Deaths (PCIRN)
    In week 01, 106 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network, compared to 137 in week 53. Among cases in week 01, 96 cases (91%) were in adults over the age of 65 and 105 cases (99%) had influenza A (Figure 8b). To date this season, 672 cases have been reported; 664 (99%) with influenza A. The majority of cases (85%) were among adults ≥65 years of age (Table 5). Forty ICU admissions have been reported and the majority of cases (75%) were adults ≥65 years of age, most (69%) with known underlying conditions or comorbidities. Twenty-six deaths have been reported, all but three were adults >65 years of age (Figure 9b).
    Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
    Total # (%)
    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
    42 0 13 29 2 44 (12.3%)
    78 1 25 52 8 86 (24.0%)
    87 1 34 52 4 91 (25.4%)
    85 0 35 50 5 90 (25.1%)
    45 0 20 25 2 47 (13.1%)
    337 2 127 208 21 358
    94.1% 0.6% 37.7% 61.7% 5.9% 100.0%
    Total # (%)
    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
    3 0 0 3 0 3(%)
    38 0 10 28 0 38(6%)
    63 0 21 42 0 63(9%)
    560 2 131 427 8 568(85%)
    664 2 162 500 8 672
    99% 0% 24% 75% 1% 100%
    Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
    A) Paediatric hospitalizations (≤16 years of age, IMPACT)
    Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
    B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
    * See footnote above following the section related to PCIRN-SOS data.
    Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
    Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
    A) Paediatric hospitalizations (≤16 years of age, IMPACT)

    Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
    B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

    Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
    Provincial/Territorial Influenza Hospitalizations and Deaths

    In week 01, 566 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*; all but eight with influenza A, and 79% were patients ≥65 years of age. Since the start of the 2014-15 season, 2161 hospitalizations have been reported; 2121 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.6% (914/917) were A(H3N2). The majority of cases (69%) were ≥65 years of age (Table 6). Sixty two ICU admissions have been reported in adults ≥65 years of age with influenza A and 34 ICU admissions have been reported in adults 20-64 years. A total of 125 deaths have been reported since the start of the season: one child <5 years of age, one child 5-19 years, six adults 20-64 years, and 117 adults ≥65 years of age. Adults 65 years of age or older represent 94% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
    * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
    Total # (%)
    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
    175 1 74 100 3 178 (8%)
    115 0 67 48 2 117 (5%)
    117 1 56 60 5 122 (6%)
    226 1 109 116 5 231 (11%)
    1471 0 591 880 24 1495 (69%)
    17 0 17 0 1 18 (1%)
    2121 3 914 1204 40 2161
    97.4% 0.3% 70.3% 29.4% 2.6% 100.0%
    See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
    ...

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    • #17
      FluWatch report: January 11 to January 17, 2015 (Week 2)

      Posted 2015-01-23 For readers interested in the PDF version, the document is available for downloading or viewing:
      FluWatch report: January 11 to January 17, 2015 (Week 2) (PDF Version - 385KB - 10 pages)

      ?? Help with PDF documents

      Overall Summary
      • In week 2, influenza activity levels decreased slightly from the previous week with fewer regions reporting widespread activity. Many regions continue to report localized and sporadic influenza activity.
      • Several indicators (number of laboratory detections, outbreaks and hospitalizations, and the ILI consultation rate) declined from the previous week, indicating that peak of the influenza season in Canada may have passed.
      • RSV is the second most frequently detected virus after influenza and since week 38 detections of RSV have been higher than in the previous season.
      • A(H3N2) continues to be the most common type of influenza affecting Canadians. In both laboratory detections, hospitalizations and deaths, the majority of cases have been among seniors ≥65 years of age.
      • To date, the NML has found that the majority of A(H3N2) influenza specimens are not optimally matched to the vaccine strain. This may result in reduced vaccine effectiveness against the A(H3N2) virus. However, the vaccine can still provide some protection against A(H3N2) influenza illness and can offer protection against other influenza strains such as A(H1N1) and B. Data from the NML suggests that the circulating A(H1N1) and B strains are a good match for this year?s vaccine and will continue to provide protection for the rest of the flu season.

      Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
      Influenza/ILI Activity (geographic spread)

      In week 02, 17 regions reported widespread activity: in BC(3), AB(1), MB(2), ON(6), QC(3) and NF(2). Twenty four regions reported localized activity: in BC (1), AB (4) SK (2), MB(3), ON (1),QC(3), NB(6), and NS(4), seven regions reported sporadic activity: in YT (1), BC(1), SK(1), NB(1), PE(1) and NF(2). One province reported no activity in 5 regions (NS) and no data were received from NT and NU.
      Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 2



      Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
      Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
      Influenza and Other Respiratory Virus Detections

      The number of positive tests decreased from 4,579 in week 01 to 3,761 in week 02; however the percentage of positive influenza tests increased slightly from 26.4% to 29.5% (Figure 2). This may be an indication that we have reached the peak in laboratory detections with the percent positive for influenza peaking in week 52 (35.9%) and the number of positive influenza tests peaking in week 53. To date, 97% of influenza detections have been influenza A, and 99.8% of those subtyped have been A(H3) (Table 1). The timing of the season and predominant A(H3N2) subtype is similar to the pattern observed during the 2012-13 influenza season when percent positive for influenza peaked in week 52 (35%). To date, among the cases of influenza with reported age, the largest proportion was in adults ≥65 years of age (63%) (Table 2).
      Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
      Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
      In week 02, the number of positive RSV tests decreased to 875 RSV detections from 1047 RSV detections in week 01. RSV remains the second most frequently detected virus after influenza. Detections of RSV since week 38 have been higher than in the previous season while detections of parainfluenza and adenovirus continue to follow their seasonal patterns of broad winter circulation (Figure 3).
      For more details, see the weekly Respiratory Virus Detections in Canada Report.
      Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
      RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
      Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
      B Total
      1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
      2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
      961 0 720 241 7 1872 2 1446 424 46
      213 0 170 43 48 3211 1 3065 145 190
      89 0 0 89 4 987 0 0 987 9
      210 0 34 176 5 1105 0 326 779 24
      1,100 0 491 609 16 5722 5 2421 3296 75
      838 0 0 838 74 8626 3 422 8201 317
      62 0 0 62 1 132 0 5 127 3
      63 0 26 37 4 135 0 55 80 13
      14 0 14 0 0 37 1 34 2 1
      52 0 0 52 0 394 0 53 341 2
      3602 0 1455 2147 159 22221 12 7827 14382 680
      95.8% 0.0% 40.4% 59.6% 4.2% 97.0% 0.1% 35.2% 64.7% 3.0%

      Total Total
      1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
      2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
      3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
      124 0 16 108 6 1399 4 577 818 65 1464 6.7%
      85 0 12 73 13 1228 0 673 555 77 1305 6.0%
      178 0 31 147 19 2423 1 1033 1389 100 2523 11.6%
      204 0 33 171 36 2591 1 954 1636 141 2732 12.6%
      1223 0 233 990 59 13388 4 4550 8834 260 13648 62.8%
      3 0 1 2 1 44 0 31 13 2 46 0.2%
      1,817 0 326 1,491 134 21073 10 7818 13245 645 21718 100.0%
      99.9% 0.0% 17.9% 82.1% 6.9% 97.0% 0.0% 37.1% 62.9% 3.0%

      Antiviral Resistance

      During the 2014-2015 influenza season, NML has tested 280 influenza viruses for resistance to oseltamivir and 278 influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 512 (99.8%) of influenza A viruses tested for amantadine resistance were resistant (Table 3).
      * NA - not applicable
      237 0 235 0 511 510 (99.8%)
      2 0 2 0 2 2 (100%)
      41 0 41 0 NA * NA *
      280 0 278 0 513 512
      Influenza Strain Characterizations

      During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 106 influenza viruses [62 A(H3N2), 2 A(H1N1) and 42 influenza B]. The majority of circulating influenza B and A(H1N1) viruses have been antigenically similar (good match) to the recommended strains for the 2014-15 seasonal influenza vaccine, while the majority of A(H3N2) viruses have shown evidence of an antigenic drift (sub-optimal match) from the vaccine strain. Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=62), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 56 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 395 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 393 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 42 influenza B viruses characterized, 38 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers to B/Massachusetts/2/2012 and one was B/Brisbane/60/2008-like (Figure 4).
      Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 106

      The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
      The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.


      Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
      Influenza-like Illness (ILI) Consultation Rate

      The national influenza-like-illness (ILI) consultation rate decreased in week 02 to 37.7 ILI consultations per 1,000 patient visits, which is within expected levels for week 02 (Figure 5). The rates were highest among the 20 to 64 and <5 year age group (55.9 and 50.0 ILI consultations per 1,000).
      Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
      Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
      Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
      Influenza Outbreak Surveillance

      In week 02, 145 new outbreaks of influenza were reported (118 in long-term care facilities (LTCF), eight in hospitals and 19 in institutional or community settings) and is fewer than the number of outbreaks reported in week 01 (Figure 6). Among the outbreaks in which the influenza subtype was known, three LTCF outbreaks were associated with A(H3N2). To date this season, 741 outbreaks in LTCFs have been reported. The number of outbreaks reported since week 47 is above those of previous seasons and is similar to the numbers reported during the 2012-13 influenza season when influenza A(H3N2) also predominated.
      Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
      1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
      Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
      Pharmacy Surveillance

      During week 02, the proportion of prescription sales for antivirals decreased to 799.8 antiviral prescriptions per 100,000 total prescriptions (down from 870.2 per 100,000 total prescriptions). The antiviral prescription rate increased in infants in week 2. The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The antiviral prescription rate remains the highest amongst seniors at 1,405.1 per 100,000 total prescriptions.
      Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
      Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
      Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
      Sentinel Hospital Influenza Surveillance

      Paediatric Influenza Hospitalizations and Deaths (IMPACT)
      In week 02, 42 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 40 cases of influenza A and two cases of influenza B (Figure 8a). Among the reported cases, 20 (48%) were <2 years of age, 13 (31%) were 2 to 9 years of age and 9 (21%) were 10-16 years of age. Four cases were admitted to the ICU. To date this season, 408 hospitalizations have been reported by the IMPACT network, 384 (94%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (132/134) were A(H3N2). Children <5 years of age represented 62% of cases (Table 4). To date, 46 cases were admitted to the ICU, of which 30 (65%) were 2 to 9 years of age (Figure 9a).
      Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
      Adult Influenza Hospitalizations and Deaths (PCIRN)
      In week 02, 121 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network, compared to 211 in week 01. Among the 121 cases in week 02, 102 (84%) were in adults over the age of 65 and all cases (100%) had influenza A (Figure 8b). To date this season, 884 cases have been reported; 875 (99%) with influenza A. The majority of cases (84%) were among adults ≥65 years of age (Table 5). To date, 118 ICU admissions have been reported and the majority of cases (79.7%) were adults ≥65 years of age, most (74%) with known underlying conditions or comorbidities. Seventy-three deaths have been reported, all but six were adults >65 years of age (Figure 9b).
      Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
      Total # (%)
      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
      60 0 13 47 2 62 (15.2%)
      81 1 26 54 10 91 (22.3%)
      94 1 34 59 4 98 (24.0%)
      94 0 36 58 5 99 (24.3%)
      55 0 23 32 3 58 (14.2%)
      384 2 132 250 24 408
      94.1% 0.5% 34.4% 65.1% 5.9% 100.0%
      Total # (%)
      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
      3 0 0 3 0 3(%)
      50 0 15 35 1 51(6%)
      85 0 29 56 2 87(10%)
      737 1 196 540 6 743(84%)
      875 1 240 634 9 884
      99% 0% 27% 72% 1% 100%
      Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
      A) Paediatric hospitalizations (≤16 years of age, IMPACT)
      Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
      B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
      * See footnote above following the section related to PCIRN-SOS data.
      Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
      Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
      A) Paediatric hospitalizations (≤16 years of age, IMPACT)
      Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
      B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
      Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
      Provincial/Territorial Influenza Hospitalizations and Deaths

      In week 02, 461 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*; all but five with influenza A, and 77% were reported in adults ≥65 years of age. Since the start of the 2014-15 season, 3127 hospitalizations have been reported; 3072 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.7% (1483/1487) were A(H3N2). The majority of hospitalizations (70%) were reported in adults ≥65 years of age (Table 6). A total of 168 ICU admissions have been reported to date, including 94 ICU admissions in adults ≥65 years of age. A total of 179 deaths have been reported since the start of the season: one child <5 years of age, two children 5-19 years, ten adults 20-64 years, and 166 adults ≥65 years of age. Adults 65 years of age or older represent 93% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
      * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
      Total # (%)
      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
      235 1 99 135 3 238 (8%)
      147 0 89 58 4 151 (5%)
      168 1 96 71 5 173 (6%)
      317 2 158 157 7 324 (10%)
      2164 0 1001 1163 33 2197 (70%)
      41 0 40 1 3 44 (1%)
      3072 4 1483 1585 55 3127
      98.2% 0.1% 48.3% 51.6% 1.8% 100.0%
      See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.


      .../
      http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

      "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
      -Nelson Mandela

      Comment


      • #18
        FluWatch report: January 18 to January 24, 2015 (Week 3)

        Posted 2015-01-30 For readers interested in the PDF version, the document is available for downloading or viewing:
        FluWatch report: January 18 to January 24, 2015 (Week 3) (PDF Version - 385KB - 10 pages)

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        Overall Summary
        • In week 3, all influenza indicators declined from the previous week, indicating that peak of the influenza season in Canada may have passed.
        • A(H3N2) continues to be the most common type of influenza affecting Canadians. In both laboratory detections, hospitalizations and deaths, the majority of cases have been among seniors ≥65 years of age.
        • On January 26, 2015, the first imported human case of avian influenza A (H7N9) from China was confirmed in Canada. A second case was confirmed on January 29, 2015. They are the first North Americans known to have been infected with this virus. The individuals were from British Columbia and travelled together to China. Neither required hospitalization and both have recovered. Close contacts are being monitored by appropriate public health authorities. The risk of Canadians getting sick with avian influenza A (H7N9) is very low.
        • A Canadian study has examined the mid-season data on the current flu vaccine?s effectiveness in Canada. The study observed little to no vaccine protection against the A(H3N2) virus, this season?s most common influenza virus. The results of this study are not unexpected. As flu viruses move through the population, they can change or drift. The time it takes from the start to the finish of a vaccine production, is sometimes sufficient time for the virus to change, which is what happened this year in particular with H3N2. Evidence from the NML, however, still suggests that the vaccine continues to provide protection against the circulating A(H1N1) and B strains.

        Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us atFluWatch@phac-aspc.gc.ca
        Influenza/ILI Activity (geographic spread)

        In week 03, 15 regions reported widespread activity: in BC(2), ON(5), QC(4), NF(3) and PEI. Twenty-five regions reported localized activity: in BC(3), AB(5), MB(5), ON(2), QC(2), NB(6), NS(6) and NL and seven regions reported sporadic activity: in NWT, YK, SK(3), NB and NF. NU did not report data for week 03.
        Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 3



        Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
        Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
        Influenza and Other Respiratory Virus Detections

        The number of positive tests decreased from 3,829 in week 02 to 2,928 in week 03. The percentage of positive influenza tests also decreased slightly from 28.3% to 27.4% (Figure 2). To date, 97% of influenza detections have been influenza A, and 99.8% of those subtyped have been A(H3N2)(Table 1). To date this season, detailed information on age and type/subtype has been received for 24,071 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (63%) this season compared to the 2013-14 season when only 15.4% of cases were in adults ≥65 years of age (Table 2).
        Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
        Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
        In week 03, the number of positive respiratory syncytial virus (RSV) tests decreased to 894 RSV detections and remains the second most frequently detected virus after influenza. Detections of RSV since week 38 have been higher than in the previous season. Detections of other respiratory viruses have been declining and have generally been lower this season compared to the previous season (Figure 3).
        For more details, see the weekly Respiratory Virus Detections in Canada Report.
        Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
        RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
        Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
        B Total
        1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
        2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
        UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
        514 3 369 142 12 2386 5 1815 566 58
        124 1 94 29 32 3340 2 3194 144 224
        41 0 0 41 0 1028 0 0 1028 9
        129 0 25 104 2 957 0 351 606 19
        1092 2 609 481 7 6814 8 3067 3739 82
        617 0 0 617 53 9243 3 422 8818 370
        145 0 20 125 5 277 0 25 252 8
        52 0 36 16 0 187 0 91 96 13
        10 0 10 0 0 47 1 44 2 1
        64 0 0 64 1 458 0 53 405 3
        2788 6 1163 1,619 112 24737 19 9062 15656 787
        96.1% 0.2% 41.7% 58.1% 3.9% 96.9% 0.1% 36.6% 63.3% 3.1%

        Total Total
        1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
        2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
        3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
        UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
        104 0 26 78 4 1560 5 634 921 71 1631 6.8%
        85 0 25 60 12 1379 0 756 623 92 1471 6.1%
        162 2 60 100 12 2652 4 1187 1461 117 2769 11.5%
        225 1 93 131 34 2891 4 1121 1766 179 3070 12.8%
        1155 0 497 658 35 14763 5 5367 9391 302 15065 62.6%
        18 0 16 2 0 63 0 49 14 2 65 0.3%
        1749 3 717 1029 97 23308 18 9114 14176 763 24071 100.0%
        94.7% 0.2% 41.0% 58.8% 5.3% 96.8% 0.1% 39.1% 60.8% 3.2%

        Antiviral Resistance

        During the 2014-2015 influenza season, the NML has tested 317 influenza viruses for resistance to oseltamivir and 313 influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 605 (99.8%) of influenza A viruses were resistant to amantadine (Table 3).
        * NA - not applicable
        274 0 270 0 604 603 (99.8%)
        2 0 2 0 2 2 (100%)
        41 0 41 0 NA * NA *
        317 0 313 0 606 605
        Influenza Strain Characterizations

        During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 132 influenza viruses [68 A(H3N2), 2 A(H1N1) and 62 influenza B]. The majority of circulating influenza B and A(H1N1) viruses have been antigenically similar (good match) to the recommended strains for the 2014-15 seasonal influenza vaccine, while the majority of A(H3N2) viruses have shown evidence of an antigenic drift (sub-optimal match) from the vaccine strain. Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=68), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 62 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 474 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 472 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.
        Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009.
        Influenza B: Of the 62 influenza B viruses characterized, 56 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and three were B/Brisbane/60/2008-like (Figure 4).

        Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 132

        The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
        The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.


        Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
        Influenza-like Illness (ILI) Consultation Rate

        The national influenza-like-illness (ILI) consultation increased in week 03 to 45.3 consultations per 1,000, which is slightly above expected levels (Figure 5).
        Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
        Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
        Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
        Influenza Outbreak Surveillance

        In week 03, 72 new outbreaks of influenza were reported, nearly half the number of outbreaks reported in the previous week. Fifty-four outbreaks were reported in long-term care facilities (LTCF), six in hospitals and 12 in institutional or community settings (Figure 6). Among the outbreaks in which the influenza subtype was known, seven LTCF outbreaks and one institutional or community setting outbreak were associated with A(H3N2), and four LTCF outbreaks associated with influenza B. To date this season, 795 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There has been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
        Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
        1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
        Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
        Pharmacy Surveillance

        During week 03, the proportion of prescriptions for antivirals decreased to 511.3 antiviral prescriptions per 100,000 total prescriptions (down from 806.1 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in age groups except in infants decreased in week 03. The antiviral prescription rate remains the highest amongst seniors at 859.9 per 100,000 total prescriptions.
        Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
        Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
        Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
        Sentinel Hospital Influenza Surveillance

        Paediatric Influenza Hospitalizations and Deaths (IMPACT)
        In week 03, 29 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 28 cases of influenza A and one case of influenza B (Figure 8a). Among the reported cases, 12 (41%) were <2 years of age, 15 (52%) were 2 to 9 years of age and two (7%) were 10-16 years of age. Three cases were admitted to the ICU. To date this season, 446 hospitalizations have been reported by the IMPACT network, 421 (94%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (137/139) were A(H3N2) (Table 4). To date, 50 cases were admitted to the ICU, of which 32 (64%) were 2 to 9 years of age (Figure 9a). Two deaths have been reported.
        Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
        Adult Influenza Hospitalizations and Deaths (PCIRN)
        In week 03, 98 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among cases in week 03, 81 cases (83%) were in adults over the age of 65 and 94 cases (96%) had influenza A (Figure 8b). To date this season, 1259 cases have been reported; 1244 (99%) with influenza A. The majority of cases (84%) were among adults ≥65 years of age (Table 5). Eighty-eight ICU admissions have been reported and the majority of cases (80%) were adults ≥65 years of age, most (83%) with known underlying conditions or comorbidities. Fifty-four deaths have been reported, all but three were adults >65 years of age (Figure 9b).
        Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
        Total # (%)
        1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
        UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
        68 0 13 55 2 70 (15.7%)
        92 1 28 63 10 102 (22.9%)
        101 1 35 65 4 105 (23.5%)
        105 0 38 67 6 111 (24.9%)
        55 0 23 32 3 58 (13.0%)
        421 2 137 282 25 446
        94.4% 0.5% 32.5% 67.0% 5.6% 100.0%
        Total # (%)
        1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
        UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
        3 0 0 3 0 3 (%)
        71 0 22 49 1 72 (6%)
        129 0 47 82 2 131 (10%)
        1041 2 318 721 12 1053 (84%)
        1244 2 387 855 15 1259
        99% 0% 31% 69% 1% 100%

        Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
        A) Paediatric hospitalizations (≤16 years of age, IMPACT)
        Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
        B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
        * See footnote above following the section related to PCIRN-SOS data.
        Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
        Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
        A) Paediatric hospitalizations (≤16 years of age, IMPACT)
        Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
        B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
        Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
        Provincial/Territorial Influenza Hospitalizations and Deaths

        In week 03, 357 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*; all but one with influenza A, and 74% were patients ≥65 years of age. Since the start of the 2014-15 season, 3,589 hospitalizations have been reported; 3,523 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.7% (1720/1725) were A(H3N2). The majority of cases (71%) were ≥65 years of age (Table 6). A total of 104 ICU admissions have been reported in adults ≥65 years of age with influenza A and 52 ICU admissions have been reported in adults 20-64 years. A total of 236 deaths have been reported since the start of the season: one child <5 years of age, two children 5-19 years, sixteen adults 20-64 years, and 217 adults ≥65 years of age. Adults 65 years of age or older represent 92% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
        * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
        Total # (%)
        1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
        UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
        258 2 103 153 3 261 (7%)
        171 0 95 76 5 176 (5%)
        186 1 104 81 6 192 (5%)
        366 2 182 182 8 374 (10%)
        2493 0 1189 1304 40 2533 (71%)
        49 0 47 2 4 53 (1%)
        3523 5 1720 1798 66 3589
        98.2% 0.1% 48.8% 51.0% 1.8% 100.0%
        See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
        Emerging Respiratory Pathogens

        Human Avian Influenza
        Influenza A(H7N9): On January 26, 2015, the first imported human case of avian influenza A (H7N9) from China was confirmed in Canada. A second case was confirmed on January 29, 2015. They traveled together to China and recently returned to Canada. All evidence regarding the Canadian cases indicates they were likely infected following exposure in China. They were not symptomatic during travel and only became ill after arrival in Canada. These are the first documented cases of H7N9 infection in humans in North America. The risk to Canadians of getting sick with H7N9 remains very low as evidence suggests that it does not transmit easily from person-to-person.

        Since the last FluWatch report, one new laboratory-confirmed case of human infection with avian influenza A(H7N9) virus was reported by the World Health Organization (not including the Canadian cases). The case was a 79 year-old male with a history of exposure to live poultry. The case has been in stable condition all along. Globally to January 30, 2015, the WHO reported a total of 486 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 185 deaths.
        Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
        PHAC - Avian influenza A(H7N9)
        WHO - Avian Influenza A(H7N9)

        Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to January 16, 2015, the WHO has been informed of a total of two cases of avian influenza A (H5N6) virus, including one death.
        Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
        Since the last FluWatch report, 6 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization from Saudi Arabia (5) and Oman (1). Globally, from September 2012 to January 30, 2015, the WHO has been informed of a total of 956 laboratory-confirmed cases of infection with MERS-CoV, including 351 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk).

        Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
        PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
        WHO - Coronavirus infections

        Avian Influenza A(H5)
        The Canadian Food Inspection Agency (CFIA) is continuing its investigation into an outbreak of highly pathogenic avian influenza H5N2 virus in British Columbia's Fraser Valley. No new sites have been identified since December 19, 2014. Further information on the outbreak is provided on the following CFIA website.

        CFIA - Notifiable Avian Influenza
        Enterovirus D68 (EV-D68)
        Information related to enterovirus D68, as well as guidance for health professionals and advice for the public is updated regularly on the following website:

        PHAC ? Non-polio enterovirus

        .../

        http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

        "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
        -Nelson Mandela

        Comment


        • #19
          FluWatch report: January 25 to January 31, 2015 (Week 4)

          Posted 2015-02-06 For readers interested in the PDF version, the document is available for downloading or viewing:
          FluWatch report: January 25 to January 31, 2015 (Week 4) (PDF Version - 385KB - 10 pages)

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          Overall Summary
          • In week 4, all influenza indicators continue to decline indicating that peak of the influenza season in Canada has passed.
          • A(H3N2) continues to be the most common type of influenza affecting Canadians. In both laboratory detections, hospitalizations and deaths and the majority of cases have been among seniors ≥65 years of age.
          • Detections of respiratory syncytial virus (RSV) continue to be the second most frequently detected virus after influenza. Since week 38, detections of RSV have been higher than in the previous season.
          • On February 5, 2015, a Canadian interim vaccine effectiveness (VE) study by the PCIRN-SOS Network was published in Eurosurveillance. This study which examined VE for those seriously ill and in hospital found the overall VE for those under 65 years of age to be 11% and minus 25% for those over 65 years of age. Almost all (99%) cases were laboratory confirmed with H3N2. These poor VE estimates are not unexpected given the high degree of drift of the circulating virus from the vaccine strain observed in Canada this season.
          • Evidence from the National Microbiology Laboratory does indicate that the other vaccine components will continue to provide protection against the circulating A(H1N1) and B strains.

          Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
          Influenza/ILI Activity (geographic spread)

          In week 04, 6 regions reported widespread activity: in ON(3), QC(2), NF. Twenty-seven regions reported localized activity: in BC(4), SK, MB, ON(4), QC(3), NB(6), NS(6), NL and PEI and fifteen regions reported sporadic activity: in NWT, YK, BC, SK(2), MB(4), QC, NB, NS(2) and NF(2). NU and AB did not report data for week 04.
          Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 4



          Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
          Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
          Influenza and Other Respiratory Virus Detections

          The number of positive tests decreased from 2,959 in week 03 to 2,388 in week 04. The percentage of positive influenza tests also decreased from 28.3% to 25.0% (Figure 2). To date, 97% of influenza detections have been influenza A, and 99.8% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 25,918 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (62%) this season (Table 2) compared to the 2013-14 season when only 15.5% of cases were in adults ≥65 years of age.
          Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
          Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
          In week 04, the number of positive respiratory syncytial virus (RSV) tests decreased to 936 RSV detections and remains the second most frequently detected virus after influenza. Detections of RSV since week 38 have been higher than in the previous season. During the past few weeks detections of other respiratory viruses have been relatively stable. Detections of other respiratory viruses have generally been lower this season compared to the previous season (Figure 3).
          For more details, see the weekly Respiratory Virus Detections in Canada Report.
          Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
          RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
          Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
          B Total
          1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
          2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
          UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
          314 3 252 59 13 2700 8 2067 625 71
          52 0 40 12 32 3410 2 3271 137 263
          30 0 0 34 2 1206 0 0 1206 13
          54 0 6 48 5 1011 0 357 654 24
          1,005 2 511 492 11 7819 10 3597 4212 93
          477 0 0 477 73 9720 3 422 9295 443
          149 0 41 108 9 426 0 66 360 17
          70 0 32 38 6 257 0 123 134 19
          13 0 13 0 0 60 1 57 2 1
          40 0 0 40 0 498 0 53 445 3
          2,204 5 895 1,308 151 27107 24 10013 17070 947
          93.6% 0.2% 40.6% 59.3% 6.4% 96.6% 0.1% 36.9% 63.0% 3.4%

          Total Total
          1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
          2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
          3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
          UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
          84 0 8 76 14 1695 5 663 1027 86 1781 6.9%
          73 1 14 58 19 1525 1 812 712 118 1643 6.3%
          110 0 24 86 17 2879 5 1309 1565 139 3018 11.6%
          139 0 31 108 27 3153 2 1247 1904 214 3367 13.0%
          552 1 119 432 35 15667 6 5838 9823 347 16014 61.8%
          15 0 13 2 0 93 0 78 15 2 95 0.4%
          973 2 209 762 112 25012 19 9947 15046 906 25918 100.0%
          89.7% 0.2% 21.5% 78.3% 10.3% 96.5% 0.1% 39.8% 60.2% 3.5%

          Antiviral Resistance

          During the 2014-2015 influenza season, the NML has tested 425 influenza viruses for resistance to oseltamivir and 424 influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 692 (99.8%) influenza viruses were resistant to amantadine (Table 3).
          * NA - not applicable
          352 0 351 0 691 690 (99.9%)
          2 0 2 0 2 2 (100%)
          71 0 71 0 NA * NA *
          425 0 424 0 693 692
          Influenza Strain Characterizations

          During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 151 influenza viruses [75 A(H3N2), 2 A(H1N1) and 74 influenza B]. Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=75), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 69 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 538 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 536 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 74 influenza B viruses characterized, 67 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).
          Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 151

          The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
          The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.


          Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
          Influenza-like Illness (ILI) Consultation Rate

          The national influenza-like-illness (ILI) consultation remained relatively the same as the previous week at 66.8 consultations per 1,000, which is above expected levels (Figure 5).
          Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
          Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
          Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
          Influenza Outbreak Surveillance

          In week 04, 93 new outbreaks of influenza were reported, up from the number of outbreaks reported in the previous week. Sixty-four outbreaks were reported in long-term care facilities (LTCF), 13 in hospitals and 16 in institutional or community settings (Figure 6). An additional 17 outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, eight LTCF outbreaks and one institutional or community setting outbreak were associated with A(H3N2). To date this season, 859 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There has been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
          Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
          1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
          Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
          Pharmacy Surveillance

          During week 04, the proportion of prescriptions for antivirals decreased to 395.7 antiviral prescriptions per 100,000 total prescriptions (down from 512.3 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups decreased in week 04. The antiviral prescription rate remains the highest amongst seniors at 650.0 per 100,000 total prescriptions.
          Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
          Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
          Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
          Sentinel Hospital Influenza Surveillance

          Paediatric Influenza Hospitalizations and Deaths (IMPACT)
          In week 04, 23 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 22 cases of influenza A and one case of influenza B (Figure 8a). Among the reported cases, 5 (22%) were <2 years of age, 13 (56%) were 2 to 9 years of age and five (22%) were 10-16 years of age. Two cases were admitted to the ICU. To date this season, 467 hospitalizations have been reported by the IMPACT network, 441 (94%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (139/141) were A(H3N2) (Table 4). To date, 53 cases were admitted to the ICU, of which 33 (60%) were 2 to 9 years of age (Figure 9a). Three deaths have been reported.
          Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
          Adult Influenza Hospitalizations and Deaths (PCIRN)
          In week 04, 78 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 04, 63 cases (81%) were in adults over the age of 65 and 74 cases (95%) had influenza A (Figure 8b). To date this season, 1,411 cases have been reported; 1,392 (99%) with influenza A. The majority of cases (83%) were among adults ≥65 years of age (Table 5). One hundred ICU admissions have been reported and 76 cases were adults ≥65 years of age. A total of 79 ICU cases reported to have at least one underlying condition or comorbidity. Of the 74 ICU cases with known immunization status, 24 (32%) reported not having been vaccinated this season. Sixty-four deaths have been reported, 57 (89%) of the deaths were adults >65 years of age (Figure 9b).
          Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
          Total # (%)
          1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
          UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
          68 0 14 54 2 70 (15.0%)
          96 1 30 65 11 107 (22.9%)
          106 1 35 70 4 110 (23.6%)
          113 0 39 74 6 119 (25.5%)
          58 0 21 37 3 61 (13.1%)
          441 2 139 300 26 467
          94.4% 0.5% 31.5% 68.0% 5.6% 100.0%
          Total # (%)
          1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
          UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
          3 0 0 3 0 3(%)
          80 1 27 52 1 81(6%)
          150 0 63 87 2 152(11%)
          1159 2 380 777 16 1175(83%)
          1392 3 470 919 19 1411
          99% 0% 34% 66% 1% 100%
          Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
          A) Paediatric hospitalizations (≤16 years of age, IMPACT)
          Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
          B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
          * See footnote above following the section related to PCIRN-SOS data.
          Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
          Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
          A) Paediatric hospitalizations (≤16 years of age, IMPACT)
          Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
          B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
          Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
          Provincial/Territorial Influenza Hospitalizations and Deaths

          In week 04, 345 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*; all but six with influenza A, and 75% were patients ≥65 years of age. Since the start of the 2014-15 season, 4,079 hospitalizations have been reported; 4,001 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.7% (1930/1935) were A(H3N2). The majority of cases (71%) were ≥65 years of age (Table 6). A total of 120 ICU admissions have been reported in adults ≥65 years of age with influenza A and 63 ICU admissions have been reported in adults 20-64 years. A total of 275 deaths have been reported since the start of the season: three children <5 years of age, two children 5-19 years, 19 adults 20-64 years, and 251 adults ≥65 years of age. Adults 65 years of age or older represent 91% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
          * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
          Total # (%)
          1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
          UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
          285 2 110 173 4 289 (7%)
          190 0 98 92 5 195 (5%)
          200 1 109 90 7 207 (5%)
          419 2 209 208 13 432 (11%)
          2855 0 1354 1501 45 2900 (71%)
          52 0 50 2 4 56 (1%)
          4001 5 1930 2066 78 4079
          98.1% 0.1% 48.2% 51.6% 1.9% 100.0%
          See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
          Emerging Respiratory Pathogens

          Human Avian Influenza
          Influenza A(H7N9): On January 26, 2015, the first imported human case of avian influenza A (H7N9) from China was confirmed in Canada. A second case was confirmed on January 29, 2015. They traveled together to China and recently returned to Canada. All evidence regarding the Canadian cases indicates they were likely infected following exposure in China. They were not symptomatic during travel and only became ill after arrival in Canada. These are the first documented cases of H7N9 infection in humans in North America. The risk to Canadians of getting sick with H7N9 remains very low as evidence suggests that it does not transmit easily from person-to-person.

          Since the last FluWatch report, one new laboratory-confirmed case of human infection with avian influenza A(H7N9) virus was reported by the World Health Organization. Globally to February, 3 2015, the WHO reported a total of 486 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 185 deaths.
          Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
          PHAC - Avian influenza A(H7N9)
          WHO - Avian Influenza A(H7N9)

          Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to February 3, 2015, the WHO has been informed of a total of two cases of avian influenza A (H5N6) virus, including one death.

          .../
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          Comment


          • #20
            FluWatch report: February 1 to February 7, 2015 (Week 5)

            Posted 2015-02-13 For readers interested in the PDF version, the document is available for downloading or viewing:
            FluWatch report: February 1 to February 7, 2015 (Week 5) (PDF Version - 385 KB- 10 pages)

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            Overall Summary
            • In week 5, all influenza indicators with the exception of ILI and influenza activity continued to decline.
            • There is ongoing influenza activity in the Western, Central and the Atlantic provinces, predominantly due to influenza A. Influenza B detections have been increasing steadily, particularly in the Prairies and in Quebec.
            • A(H3N2) continues to be the most common type of influenza affecting Canadians. In both laboratory detections, hospitalizations and deaths and the majority of cases have been among seniors ≥65 years of age.
            • Detections of respiratory syncytial virus (RSV) continue to be the second most frequently detected virus after influenza. In the Prairies and Quebec, the percent positive for RSV detections surpassed the percent positive for influenza detections in week 05.
            • A record number of long term care facility (LTCF) outbreaks have been reported this season to date (n=910) and has surpassed the number of LTCF outbreaks reported in each of the past four seasons.
            • Evidence from the National Microbiology Laboratory (NML) does indicate that this year's vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

            Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
            Influenza/ILI Activity (geographic spread)

            In week 05, 11 regions reported widespread activity: in BC(2), ON(6), QC, NF and PEI. Eighteen regions reported localized activity: in BC, AB(2), MB, ON, QC(3), NB(4), NS(5), and NL. Twenty-four regions reported sporadic activity: in YK, NU, BC(2), AB(3), SK(3), MB(4), QC(2), NB(2), NS(4), and NF(2). Compared to the previous week, the number of regions reporting widespread activity in week 05 increased. However the overall number of regions reporting elevated activity (widespread and localized) in week 05 declined from the previous week.
            Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 5



            Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
            Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
            Influenza and Other Respiratory Virus Detections

            The number of positive influenza tests decreased from 2,409 in week 04 to 1,729 in week 05. The percentage of positive influenza A tests decreased from 23.1% to 19.5%. The percentage of positive influenza B tests have been increasing for the past few weeks to 2.2% in week 05, the highest this season thus far (Figure 2). The proportion of influenza B detections were highest in the Prairies and Quebec in week 05 (influenza B accounted for 15%-36% of all influenza detections). To date, 96% of influenza detections have been influenza A, and 99.7% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 27,061 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (62%) this season (Table 2) compared to the 2013-14 season when only 15.6% of cases were in adults ≥65 years of age.
            Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
            Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
            In week 05, the number of positive respiratory syncytial virus (RSV) tests decreased to 980 RSV detections and remains the second most frequently detected virus after influenza (Figure 3). In week 05, the percent positive for RSV detections in the Prairies and Quebec surpassed the percent positive for influenza detections in those regions. Detections of RSV since week 38 have been higher than in the previous season. Detections of all other respiratory viruses except adenovirus decreased in week 05. Detections of respiratory viruses (other than RSV) have generally been lower this season compared to the previous season. For more details, see the weekly Respiratory Virus Detections in Canada Report.
            Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
            RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
            Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
            B Total
            1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
            2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
            UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
            172 1 59 112 13 2872 9 2136 737 84
            52 1 38 13 29 3476 5 3325 146 299
            18 0 10 8 5 1238 0 763 475 20
            35 0 9 26 1046 1046 0 366 680 30
            610 2 259 349 13 8429 12 3872 4545 106
            431 1 0 430 92 10151 4 422 9725 535
            150 0 36 114 7 576 0 102 474 24
            47 0 0 47 7 304 0 123 181 26
            20 0 20 0 0 80 1 77 2 1
            22 0 0 22 0 520 0 53 467 3
            1,557 5 431 1,121 172 28692 31 11229 17432 1128
            90.1% 0.3% 27.7% 72.0% 9.9% 96.2% 0.1% 39.1% 60.8% 3.8%
            Total Total
            1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
            2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
            3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
            UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
            72 0 6 66 12 1748 7 681 1060 99 1847 6.8%
            36 0 6 30 26 1586 1 850 735 148 1734 6.4%
            104 1 12 91 23 3002 9 1453 1540 171 3173 11.7%
            105 1 16 88 33 3272 6 1403 1863 259 3531 13.0%
            502 0 87 415 44 16267 7 6329 9931 404 16671 61.6%
            10 0 8 2 0 103 0 87 16 2 105 0.4%
            829 2 135 692 138 25978 30 10803 15145 1083 27061 100.0%
            85.7% 0.2% 16.3% 83.5% 14.3% 96.0% 0.1% 41.6% 58.3% 4.0%
            Antiviral Resistance

            During the 2014-2015 influenza season, the NML has tested 503 influenza viruses for resistance to oseltamivir and 502 influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 783 (99.8%) influenza A viruses were resistant to amantadine (Table 3).
            * NA - not applicable
            428 0 428 0 782 781 (99.9%)
            2 0 2 0 2 2 (100%)
            73 0 72 0 NA * NA *
            503 0 502 0 784 783
            Influenza Strain Characterizations

            During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 172 influenza viruses [81 A(H3N2), 2 A(H1N1) and 89 influenza B]. Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=81), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 75 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 619 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 617 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 89 influenza B viruses characterized, 82 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).
            Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 172

            The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
            The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.


            Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
            Influenza-like Illness (ILI) Consultation Rate

            The national influenza-like-illness (ILI) consultation rate increased to 55.0 consultations per 1,000, which is slightly above expected levels for week 05 (Figure 5). The rate were highest among the 5 to 19 years of age group (64.9 consultations per 1,000) and lowest among the adults ≥65 years of age (33.9 consultations per 1,000)
            Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
            Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
            Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
            Influenza Outbreak Surveillance

            In week 05, 71 new outbreaks of influenza were reported, which is lower than the number of outbreaks reported in the previous week. Fifty-one outbreaks were reported in long-term care facilities (LTCF), 7 in hospitals and 13 in institutional or community settings (Figure 6). An additional 8 outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, five LTCF outbreaks were associated with A(H3N2). To date this season, 910 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There has been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
            Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
            1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
            Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
            Pharmacy Surveillance

            During week 05, the proportion of prescriptions for antivirals decreased to 290.2 antiviral prescriptions per 100,000 total prescriptions (down from 391.1 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups decreased in week 05. The rate was highest amongst seniors at 650.0 per 100,000 total prescriptions and lowest among infants at 91.9 per 100,000 total prescriptions.
            Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
            Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
            Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
            Sentinel Hospital Influenza Surveillance

            Paediatric Influenza Hospitalizations and Deaths (IMPACT)
            In week 05, 16 laboratory-confirmed influenza-associated paediatric (=16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 12 cases of influenza A and four cases of influenza B (Figure 8a). Among the reported cases, 6 (38%) were <2 years of age, 9 (56%) were 2 to 9 years of age and one (6%) was 10-16 years of age. One case was admitted to the ICU. To date this season, 489 hospitalizations have been reported by the IMPACT network, 458 (94%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (142/144) were A(H3N2) (Table 4). To date, 56 cases were admitted to the ICU, of which 34 (61%) were 2 to 9 years of age (Figure 9a). Three deaths have been reported.
            Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
            Adult Influenza Hospitalizations and Deaths (PCIRN)
            In week 05, 89 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 05, 71 cases (80%) were in adults over the age of 65 and 84 cases (94%) had influenza A (Figure 8b). To date this season, 1,532 cases have been reported; 1,505 (98%) with influenza A. The majority of cases (83%) were among adults ≥65 years of age (Table 5). One hundred and five ICU admissions have been reported and 78 cases were adults ≥65 years of age. A total of 81 ICU cases reported to have at least one underlying condition or comorbidity. Of the 72 ICU cases with known immunization status, 24 (33%) reported not having been vaccinated this season. Sixty-six deaths have been reported, 59 (89%) of the deaths were adults >65 years of age (Figure 9b).
            Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
            Total # (%)
            1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
            UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
            72 0 14 58 3 75 (15.3%)
            98 1 31 66 13 111 (22.7%)
            112 1 37 74 4 116 (23.7%)
            117 0 39 78 7 124 (25.4%)
            59 0 21 38 4 63 (12.9%)
            458 2 142 314 31 489
            93.7% 0.4% 31.0% 68.6% 6.3% 100.0%
            Total # (%)
            1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
            UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
            4 0 1 3 0 4(%)
            82 1 34 47 2 84(5%)
            167 0 68 99 3 170(11%)
            1252 3 476 773 22 1274(83%)
            1505 4 579 922 27 1532
            98% 0% 38% 61% 2% 100%
            Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
            A) Paediatric hospitalizations (≤16 years of age, IMPACT)
            Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
            B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
            * See footnote above following the section related to PCIRN-SOS data.
            Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
            Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
            A) Paediatric hospitalizations (≤16 years of age, IMPACT)
            Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
            B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
            Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
            Provincial/Territorial Influenza Hospitalizations and Deaths

            In week 05, 292 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is less than the number reported in week 04 (n=345).Of the 292 hospitalizations, all but four were influenza A, and 73% were in patients ≥65 years of age. Since the start of the 2014-15 season, 4,458 hospitalizations have been reported; 4,368 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.7% (2110/2117) were A(H3N2). The majority of cases (71%) were ≥65 years of age (Table 6). A total of 189 ICU admissions have been reported to date, all with influenza A: 65% (122) were in adults ≥65 years of age and 35%(67) were in adults 20-64 years. A total of 307 deaths have been reported since the start of the season: four children <5 years of age, two children 5-19 years, 21 adults 20-64 years, and 280 adults ≥65 years of age. Adults 65 years of age or older represent 91% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
            * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
            Total # (%)
            1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
            UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
            313 2 121 190 4 317 (7%)
            197 0 100 97 7 204 (5%)
            218 1 117 100 10 228 (5%)
            461 2 231 228 15 476 (11%)
            3125 1 1490 1634 49 3174 (71%)
            54 1 51 2 6 60 (1%)
            4368 7 2110 2251 91 4459
            98.0% 0.2% 48.3% 51.5% 2.0% 100.0%
            See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
            Emerging Respiratory Pathogens

            Human Avian Influenza
            Influenza A(H7N9): Since the last FluWatch report, 83 new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus were reported by the World Health Organization. Globally to February 12, 2015, the WHO reported a total of 571 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 204 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

            PHAC - Avian influenza A(H7N9)
            WHO - Avian Influenza A(H7N9)

            Influenza A(H5N6): Since the last FluWatch report, one new case of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to February 12, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.
            Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
            Since the last FluWatch report, 12 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to February 12, 2015, the WHO has been informed of a total of 977 laboratory-confirmed cases of infection with MERS-CoV, including 359 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV.

            Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
            PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
            WHO - Coronavirus infections

            Avian Influenza A(H5)
            The Canadian Food Inspection Agency (CFIA) is continuing its investigation into an outbreak of highly pathogenic avian influenza H5N2 virus in British Columbia's Fraser Valley. To date, there have been 11 commercial infected premises and one non-commercial infected premise with H5N2. On February 7, 2015 an additional non-commercial farm in the Fraser Valley was confirmed to be infected with highly pathogenic avian influenza H5N1. This is the first time the H5N1 strain of the virus has been detected during the current avian influenza outbreak. The CFIA applies the same disease control measures following detections of H5N1 and H5N2. The infected premise is under quarantine, depopulation of the affected birds has been completed and disposal measures are underway. Avian influenza viruses do not pose risks to food safety when poultry and poultry products are properly handled and cooked. Further information on the outbreak is provided on the following CFIA website.

            CFIA - Notifiable Avian Influenza
            For the latest Travel Health Notice on Avian Influenza (H5N1) visit the following webpage: PHAC - Travel Health Notice.

            .../
            http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

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            Comment


            • #21
              FluWatch report: February 8 to 14, 2015 (Week 6)

              Posted 2015-02-20 For readers interested in the PDF version, the document is available for downloading or viewing:
              FluWatch report: February 8 to 14, 2015 (Week 6) (PDF Version - 385 KB - 10 pages)

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              Overall Summary
              • In week 06, all influenza indicators declined from, or remained similar to, the previous week.
              • Influenza activity in the Central and the Atlantic Provinces continued into week 06 (mainly due to influenza A) while activity in the Western provinces and the Territories declined.
              • For the past few weeks, influenza B detections have been increasing steadily, particularly in the Prairies and in Quebec.
              • A(H3N2) continues to be the most common type of influenza affecting Canadians. Seniors continue to have the highest number of positive laboratory detections, hospitalizations and deaths.
              • Detections of respiratory syncytial virus (RSV) continue to be the second most frequently detected virus after influenza.
              • Evidence from the National Microbiology Laboratory (NML) does indicate that this year?s vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

              Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
              Influenza/ILI Activity (geographic spread)

              In week 06, seven regions reported widespread activity: in MB, ON(2). QC(2), PEI and NL. Twenty-one regions reported localized activity: in AB, MB, ON(5), QC(2), NB(7), and NS(5). Twenty-two regions reported sporadic activity: in YK, NT(2), NU, BC(5), AB(4), SK(3), MB(2), QC(2), NS, and NL. No activity was reported for eight regions: NU(2), MB, NS(3) and NF(2). Compared to the previous week, influenza activity declined overall in the Western provinces while influenza activity increased or remained similar in the Central and Atlantic provinces.
              Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 6



              Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
              Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
              Influenza and Other Respiratory Virus Detections

              In week 06, the number of positive influenza tests (1,625) and the percentage positive for influenza A (16.3%) continued to decline from the previous week The percentage of positive influenza B tests continued to increase and was 3.6 % in week 06, the highest this season thus far (Figure 2). In week 06, influenza B accounted for 33%-52% of influenza detections in AB, SK and QC. To date, 95% of influenza detections have been influenza A, and 99.7% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 28,650 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (61%) this season (Table 2) compared to the 2013-14 season when only 15.6% of cases were in adults ≥65 years of age.
              Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
              Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2013-14
              In week 06, the number of positive respiratory syncytial virus (RSV) tests decreased to 914 RSV detections and remains the second most frequently detected virus after influenza (Figure 3). In week 06, the percent positive for RSV detections were highest in the Prairies and has surpassed the percent positive for influenza detections in those regions. Detections of RSV since week 38 have been higher than in the previous season. Detections of all other respiratory viruses except human metapneumovirus decreased in week 06. Detections of respiratory viruses (other than RSV) have generally been lower this season compared to the previous season.
              For more details, see the weekly Respiratory Virus Detections in Canada Report.
              Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
              RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
              Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2013-2014
              B Total
              1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
              2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
              UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
              174 3 102 69 9 3046 12 2228 806 93
              31 0 22 9 33 3573 8 3412 153 371
              18 0 13 5 12 1610 0 1092 518 46
              32 0 3 29 3 1078 0 369 709 33
              535 5 199 331 37 9422 17 4079 5326 152
              366 0 0 366 181 10517 4 422 10091 716
              89 0 0 89 11 665 0 102 563 35
              49 0 0 49 8 353 0 123 230 34
              18 0 18 0 1 98 1 95 2 2
              17 0 0 17 1 537 0 53 484 4
              1,329 8 357 964 296 30899 42 11975 18882 1486
              81.8% 0.6% 26.9% 72.5% 18.2% 95.4% 0.1% 38.8% 61.1% 4.6%
              Total Total
              1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
              2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
              3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
              UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
              61 0 8 53 18 1875 9 734 1132 119 1994 7.0%
              29 0 4 25 38 1654 1 900 753 191 1845 6.4%
              58 0 7 51 46 3154 11 1545 1598 222 3376 11.8%
              106 0 13 93 58 3480 10 1516 1954 322 3802 13.3%
              441 0 57 384 82 17033 8 6663 10362 490 17523 61.2%
              4 0 3 1 0 108 0 92 16 2 110 0.4%
              699 0 92 607 242 27304 39 11450 15815 1346 28650 100.0%
              74.3% 0.0% 13.2% 86.8% 25.7% 95.3% 0.1% 41.9% 57.9% 4.7%
              Antiviral Resistance

              During the 2014-2015 influenza season, the NML has tested 575 influenza viruses for resistance to oseltamivir and 574 influenza viruses for resistance to zanamivir and all were sensitive to both agents. A total of 856 (99.9%) influenza A viruses were resistant to amantadine (Table 3).
              * NA - not applicable
              491 0 490 0 855 854 (99.9%)
              2 0 2 0 2 2 (100%)
              82 0 82 0 NA * NA *
              575 0 574 0 857 856
              Influenza Strain Characterizations

              During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 194 influenza viruses [95 A(H3N2), 2 A(H1N1) and 97 influenza B].
              Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=95), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 89 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 686 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 684 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 97 influenza B viruses characterized, 90 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).

              Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 194

              The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
              The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.


              Text equivalent for figure 4Influenza strain characterizations, Canada, 2013-2014, N =3
              Influenza-like Illness (ILI) Consultation Rate

              The national influenza-like-illness (ILI) consultation rate decreased to 44.5 consultations per 1,000, which is slightly above expected levels for week 06 (Figure 5). The rate was highest among the 5 to 19 years of age group (60.1 consultations per 1,000) and lowest among the adults ≥65 years of age (36.2 consultations per 1,000)
              Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
              Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
              Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2013-2014
              Influenza Outbreak Surveillance

              In week 06, 74 new outbreaks of influenza were reported, which is slightly higher than the number of outbreaks reported in the previous week. The majority of the outbreaks occurred in the Central and Atlantic provinces. Sixty outbreaks were reported in long-term care facilities (LTCF), four in hospitals and 10 in institutional or community settings (Figure 6). An additional five outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, four LTCF outbreaks were associated with A(H3N2) and five outbreaks were associated with influenza B. To date this season, 970 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There has been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
              Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
              1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
              Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2013-2014
              Pharmacy Surveillance

              During week 06, the proportion of prescriptions for antivirals increased slightly to 298.1 antiviral prescriptions per 100,000 total prescriptions (from 289.9 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in infants and seniors increased in week 06, while the rate in children and adults decreased. The rate was highest amongst seniors at 527.0 per 100,000 total prescriptions and lowest among infants at 135.4 per 100,000 total prescriptions.
              Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
              Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
              Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2013-14
              Sentinel Hospital Influenza Surveillance

              Paediatric Influenza Hospitalizations and Deaths (IMPACT)
              In week 06, 14 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: seven cases of influenza A and seven cases of influenza B (Figure 8a). Among the reported cases, six (43%) were <2 years of age, seven (50%) were 2 to 9 years of age and one (7%) was 10-16 years of age. One case was admitted to the ICU. To date this season, 503 hospitalizations have been reported by the IMPACT network, 465 (93%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (142/144) were A(H3N2) (Table 4). To date, 57 cases were admitted to the ICU, of which 35 (61%) were 2 to 9 years of age (Figure 9a). Three deaths have been reported.
              Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
              Adult Influenza Hospitalizations and Deaths (PCIRN)
              In week 06, 56 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 06, 41 cases (73%) were in adults over the age of 65 and 46 cases (82%) had influenza A (Figure 8b). To date this season, 1,628 cases have been reported; 1,590 (98%) with influenza A. The majority of cases (83%) were among adults ≥65 years of age (Table 5). One hundred and nineteen ICU admissions have been reported and 89 cases were adults ≥65 years of age. A total of 86 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 82 ICU cases with known immunization status, 30 (37%) reported not having been vaccinated this season. Seventy-four deaths have been reported, 67 (91%) of the deaths were adults >65 years of age (Figure 9b).
              Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
              Total # (%)
              1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
              UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
              74 0 14 60 3 77 (15.3%)
              100 1 31 68 14 114 (22.7%)
              114 1 37 76 8 122 (24.3%)
              118 0 39 79 8 126 (25.0%)
              59 0 21 38 5 64 (12.7%)
              465 2 142 321 38 503
              92.4% 0.4% 30.5% 69.0% 7.6% 100.0%
              Total # (%)
              1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
              UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
              5 0 1 4 0 5(%)
              88 1 37 50 2 90(6%)
              179 0 70 109 8 187(11%)
              1318 3 511 804 28 1346(83%)
              1590 4 619 967 38 1628
              98% 0% 39% 61% 2% 100%
              Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
              A) Paediatric hospitalizations (≤16 years of age, IMPACT)
              Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
              B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
              * See footnote above following the section related to PCIRN-SOS data.
              Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2013-14: Adult hospitalizations (>16 year of age, PCIRN-SOS)
              Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
              A) Paediatric hospitalizations (≤16 years of age, IMPACT)
              Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Paediatric hospitalizations (≤16 years of age, IMPACT)
              B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
              Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2013-14: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
              Provincial/Territorial Influenza Hospitalizations and Deaths

              In week 06, 264 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is less than the number reported in week 05 (n=292). Of the 264 hospitalizations, all but two were influenza A, and 77% were in patients ≥65 years of age. Since the start of the 2014-15 season, 4,817 hospitalizations have been reported; 4,715 (98%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.7% were A(H3N2). The majority of cases (72%) were ≥65 years of age (Table 6). A total of 237 ICU admissions have been reported to date: 55% (130) were in adults ≥65 years of age and 30%(73) were in adults 20-64 years. A total of 342 deaths have been reported since the start of the season: four children <5 years of age, one child 5-19 years, 24 adults 20-64 years, and 313 adults ≥65 years of age. Adults 65 years of age or older represent 92% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
              * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
              Total # (%)
              1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
              UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
              333 2 126 205 4 337 (7%)
              210 1 107 102 13 223 (5%)
              288 1 174 113 12 300 (6%)
              435 1 188 246 9 444 (9%)
              3395 1 1595 1799 57 3452 (72%)
              54 1 50 3 7 61 (1%)
              4715 7 2240 2468 102 4817
              97.9% 0.1% 47.5% 52.3% 2.1% 100.0%
              See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
              Emerging Respiratory Pathogens

              Human Avian Influenza
              Influenza A(H7N9): Since the last FluWatch report, no new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus were reported by the World Health Organization. Globally to February 19, 2015, the WHO reported a total of 571 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 204 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

              PHAC - Avian influenza A(H7N9)
              WHO - Avian Influenza A(H7N9)

              Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to February 19, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.
              Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
              Since the last FluWatch report, 6 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to February 19, 2015, the WHO has been informed of a total of 983 laboratory-confirmed cases of infection with MERS-CoV, including 360 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV

              Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
              PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
              WHO - Coronavirus infections

              Avian Influenza A(H5)
              The Canadian Food Inspection Agency (CFIA) is continuing its investigation into an outbreak of highly pathogenic avian influenza H5N2 virus in British Columbia's Fraser Valley. To date, there have been 11 commercial infected premises and one non-commercial infected premise with H5N2.

              On February 7, 2015 an additional non-commercial farm in the Fraser Valley was confirmed to be infected with highly pathogenic avian influenza H5N1. The CFIA applies the same disease control measures following detections of H5N1 and H5N2. The infected premise is under quarantine, depopulation of the affected birds has been completed and disposal measures are underway. The CFIA has now reduced the size of the restricted zone as progress continues to be made in the control of avian influenza in British Columbia. Avian influenza viruses do not pose risks to food safety when poultry and poultry products are properly handled and cooked. Further information on the outbreak is provided on the following CFIA website.
              CFIA - Notifiable Avian Influenza
              For the latest Travel Health Notice on Avian Influenza (H5N1) visit the following webpage: PHAC ? Travel Health Notice
              ...


              http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

              "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
              -Nelson Mandela

              Comment


              • #22
                FluWatch report: February 15 to 21, 2015 (Week 7)

                Posted 2015-02-27 For readers interested in the PDF version, the document is available for downloading or viewing:
                FluWatch report: February 15 to 21, 2015 (Week 7) (PDF Version - 385 KB - 10 pages)

                ?? Help with PDF documents

                Overall Summary
                • In week 07, all influenza indicators remained similar to, or declined, from the previous week.
                • Overall, elevated activity was mostly reported in the Central and Atlantic provinces.
                • For the past few weeks, influenza B detections have been increasing steadily, particularly in the Prairies and in Quebec. In week 07, influenza B detections were greater than influenza A detections in QC and AB. This increase in influenza B is expected as influenza B often shows up later in the flu season.
                • A(H3N2) continues to be the most common type of influenza affecting Canadians. Seniors continue to have the highest number of positive laboratory detections, hospitalizations and deaths.
                • Detections of respiratory syncytial virus (RSV) continue to be the second most frequently detected virus after influenza.
                • Evidence from the National Microbiology Laboratory (NML) does indicate that this year?s vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

                Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us atFluWatch@phac-aspc.gc.ca
                Influenza/ILI Activity (geographic spread)

                In week 07, six regions reported widespread activity: in ON(2). QC(2), PEI and NL. Twenty regions reported localized activity: in AB, ON(5), QC(2), NB(6), NS(5) and NL. Twenty-six regions reported sporadic activity: in YK, NU(2), BC(5), AB(4), SK(3), MB(4), QC(2), NB, NS(3), and NL. No activity was reported in four regions: NU, MB, NS and NF. No data was reported from NT. Overall, influenza activity in week 07 was similar to the previous week with elevated activity (widespread and localized) mostly reported in the Central and Atlantic provinces.
                Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 7



                Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
                Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
                Influenza and Other Respiratory Virus Detections

                In week 07, the number of positive influenza tests (1,279) and the percentage positive for influenza A (12.2%) continued to decline from the previous week The percentage of positive influenza B tests continued to increase and was 5.3% in week 07, the highest this season thus far (Figure 2). In week 07, influenza B detections were greater than influenza A detections in QC and AB; accounting for 53% and 60% of influenza detections respectively. When comparing by influenza type, the majority of the influenza A cases (62%) were in the elderly while the majority of the influenza B cases (61%) were >45 years of age. To date, 94% of influenza detections have been influenza A, and 99.6% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 29,741 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (61%) this season (Table 2) compared to the 2013-14 season when only 16.1% of cases were in adults ≥65 years of age.
                Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                In week 07, detections of all respiratory viruses decreased from the previous week (Figure 3). Respiratory syncytial virus (RSV) remains the second most frequently detected virus after influenza with 817 detections. Detections of RSV since week 38 have been higher than in the previous season. Weekly detections of human metapneumovirus this season have been lower compared to the previous season.
                For more details, see the weekly Respiratory Virus Detections in Canada Report.
                Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
                RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
                Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2014-2015
                B Total
                1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                117 4 96 17 26 3163 16 2324 823 119
                23 1 16 6 35 3597 9 3436 152 406
                7 0 5 2 6 1279 0 821 458 41
                16 0 3 13 5 1096 0 379 717 38
                372 1 135 236 25 9850 18 4236 5596 183
                241 0 0 241 267 10758 4 422 10332 983
                54 0 0 54 15 719 0 102 617 50
                25 0 0 25 11 378 0 123 255 45
                7 0 7 0 0 105 1 102 2 2
                27 0 0 27 0 564 0 53 511 4
                889 6 262 621 390 31509 48 11998 19463 1871
                69.5% 0.7% 29.5% 69.9% 30.5% 94.4% 0.2% 38.1% 61.8% 5.6%
                Total Total
                1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
                UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                35 0 5 30 19 1928 10 776 1142 140 2068 7.0%
                16 0 5 11 44 1687 1 919 767 249 1936 6.5%
                51 0 7 44 65 3234 11 1579 1644 296 3530 11.9%
                50 0 9 41 81 3580 14 1560 2006 414 3994 13.4%
                319 1 63 255 123 17473 9 6861 10603 625 18098 60.9%
                4 0 2 2 0 113 0 95 18 2 115 0.4%
                475 1 91 383 332 28015 45 11790 16180 1726 29741 100.0%
                58.9% 0.2% 19.2% 80.6% 41.1% 94.2% 0.2% 42.1% 57.8% 5.8%
                Antiviral Resistance

                During the 2014-2015 influenza season, the NML has tested 659 influenza viruses for resistance to oseltamivir and 656 influenza viruses for resistance to zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 956 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
                * NA - not applicable
                565 1 562 0 954 953 (99.9%)
                2 0 2 0 3 3 (100%)
                92 0 92 0 NA * NA *
                659 1 656 0 957 956
                Influenza Strain Characterizations

                During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 243 influenza viruses [110 A(H3N2), 2 A(H1N1) and 131 influenza B].
                Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=110), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 104 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 745 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 743 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Two A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 131 influenza B viruses characterized, 124 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).

                Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 243

                The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
                The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.
                The WHO has released the recommended composition of the influenza vaccine for the northern hemisphere for the 2015-2016 season. Trivalent vaccines are recommended to contain 1) an A/California/7/2009 (H1N1)pdm09-like virus 2) an A/Switzerland/9715293/2013 (H3N2)-like virus, and 3) an B/Phuket/3073/2013-like virus(Yamagata lineage). Quadrivalent vaccines are recommended to additionally contain a B/Brisbane/60/2008-like virus (Victoria lineage).


                Text equivalent for figure 4Influenza strain characterizations, Canada, 2014-2015, N =3
                Influenza-like Illness (ILI) Consultation Rate

                The national influenza-like-illness (ILI) consultation rate decreased to 32.7 consultations per 1,000, which is within expected levels for week 07 (Figure 5). The rate was highest among the 5 to 19 years of age group (83.3 consultations per 1,000) and lowest among the adults ≥65 years of age (18.7 consultations per 1,000).
                Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
                Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                Influenza Outbreak Surveillance

                In week 07, 56 new outbreaks of influenza were reported, a decrease from the previous week. The majority of the outbreaks occurred in the Central and Atlantic provinces. Forty-five outbreaks were reported in long-term care facilities (LTCF), two in hospitals and nine in institutional or community settings (Figure 6). An additional seven outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, three LTCF outbreaks were associated with A(H3N2) and two outbreaks were associated with influenza B. To date this season, 1,015 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There has been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
                Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
                Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                Pharmacy Surveillance

                During week 07, the proportion of prescriptions for antivirals decreased to 226.4 antiviral prescriptions per 100,000 total prescriptions (from 299.6 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups decreased in week 07. The rate was highest among seniors at 407.0 per 100,000 total prescriptions and lowest among infants at 105.7 per 100,000 total prescriptions.
                Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
                Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                Sentinel Hospital Influenza Surveillance

                Paediatric Influenza Hospitalizations and Deaths (IMPACT)
                In week 07, 24 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: 12 cases of influenza A and 12 cases of influenza B (Figure 8a). Among the reported cases, 11 (46%) were <2 years of age, five (46%) were 2 to 9 years of age and two (8%) was 10-16 years of age. Two cases were admitted to the ICU. To date this season, 530 hospitalizations have been reported by the IMPACT network, 480 (91%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (157/159) were A(H3N2) (Table 4). To date, 65 cases were admitted to the ICU, of which 37 (57%) were 2 to 9 years of age (Figure 9a). Three deaths have been reported.
                Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                Adult Influenza Hospitalizations and Deaths (PCIRN)
                In week 07, 60 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 07, 48 cases (80%) were in adults over the age of 65 and 48 cases (80%) had influenza A (Figure 8b). To date this season, 1,717 cases have been reported; 1,663 (97%) with influenza A. The majority of cases (83%) were among adults ≥65 years of age (Table 5). One hundred and twenty-nine ICU admissions have been reported and 97 cases were adults ≥65 years of age. A total of 94 ICU cases (73%) reported to have at least one underlying condition or comorbidity. Of the 91 ICU cases with known immunization status, 33 (36%) reported not having been vaccinated this season. Eighty deaths have been reported, 73 (91%) of the deaths were adults >65 years of age (Figure 9b).
                Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                Total # (%)
                1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                76 0 17 59 3 79 (14.9%)
                105 1 34 70 19 124 (23.4%)
                117 1 39 77 11 128 (24.2%)
                124 0 44 80 10 134 (25.3%)
                58 0 23 35 7 65 (12.3%)
                480 2 157 321 50 530
                90.6% 0.4% 32.7% 66.9% 9.4% 100.0%
                Total # (%)
                1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                5 0 1 4 0 5(%)
                91 1 39 51 3 94(5%)
                183 0 75 108 15 198(12%)
                1384 3 543 838 36 1420(83%)
                1663 4 658 1001 54 1717
                97% 0% 40% 60% 3% 100%
                Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
                A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                * See footnote above following the section related to PCIRN-SOS data.
                Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Adult hospitalizations (>16 year of age, PCIRN-SOS)
                Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
                A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                Provincial/Territorial Influenza Hospitalizations and Deaths

                In week 07, 276 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is slightly more than the number reported in week 06 (n=264).Of the 276 hospitalizations, all but 14 were due to influenza A, and 72% were in patients ≥65 years of age. Since the start of the 2014-15 season, 5,204 hospitalizations have been reported; 5,062 (97%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.5% were A(H3N2). The majority of cases (72%) were ≥65 years of age (Table 6). A total of 254 ICU admissions have been reported to date: 55% (140) were in adults ≥65 years of age and 30% (75) were in adults 20-64 years. A total of 364 deaths have been reported since the start of the season: three children <5 years of age, one child 5-19 years, 24 adults 20-64 years, and 336 adults ≥65 years of age. Adults 65 years of age or older represent 93% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
                * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
                Total # (%)
                1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                353 2 130 221 7 360 (7%)
                213 0 105 108 10 223 (4%)
                248 2 127 119 14 262 (5%)
                549 5 262 282 27 576 (11%)
                3645 1 1686 1958 75 3720 (71%)
                54 1 50 3 9 63 (1%)
                5062 11 2360 2691 142 5204
                97.3% 0.2% 46.6% 53.2% 2.7% 100.0%
                See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
                Emerging Respiratory Pathogens

                Human Avian Influenza
                Influenza A(H7N9): Since the last FluWatch report, one new laboratory-confirmed case of human infection with avian influenza A(H7N9) virus was reported by the World Health Organization. Globally to February 26, 2015, the WHO reported a total of 572 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 204 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

                PHAC - Avian influenza A(H7N9)
                WHO - Avian Influenza A(H7N9)

                Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to February 26, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.
                Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
                Since the last FluWatch report, 47 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to February 26, 2015, the WHO has been informed of a total of 1,030 laboratory-confirmed cases of infection with MERS-CoV, including 381 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV

                Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
                PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
                WHO - Coronavirus infections

                Avian Influenza A(H5)
                Since the last FluWatch report, no new information has been provided by the CFIA. Further information on the outbreak is provided on the following CFIA website.

                CFIA - Notifiable Avian Influenza
                For the latest Travel Health Notice on Avian Influenza (H5N1) visit the following webpage: PHAC ? Travel Health Notice.

                .../

                http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

                "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                -Nelson Mandela

                Comment


                • #23
                  FluWatch report: February 22 to 28, 2015 (Week 8)

                  Posted 2015-03-06 For readers interested in the PDF version, the document is available for downloading or viewing:
                  FluWatch report: February 22 to 28, 2015 (Week 8) (PDF Version - 385 KB - 10 pages)

                  ?? Help with PDF documents

                  Overall Summary
                  • In week 08, all influenza indicators except the influenza-like illness consultation rate remained similar to, or declined from the previous week.
                  • Elevated influenza activity was mostly reported in the Central and Atlantic provinces and in a few regions in the Western provinces.
                  • Influenza B detections continues to increase steadily, particularly in the Prairies and in Quebec. This increase in influenza B is expected as influenza B often shows up later in the flu season.
                  • A(H3N2) continues to be the most common influenza virus this season and seniors continue to have the highest number of positive laboratory detections, hospitalizations and deaths.
                  • Evidence from the National Microbiology Laboratory (NML) indicates that this year's vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

                  Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
                  Influenza/ILI Activity (geographic spread)

                  In week 08, two regions in Quebec reported widespread activity. Twenty-three regions reported localized activity: BC(2), AB(2), MB, ON(7), QC(2), NB(4), NS(3), PE and NL. Twenty-five regions reported sporadic activity: in YK, NU, NT(2), BC(3), AB(3), SK(3), MB(3), QC(2), NB(3), NS(3), and NL. No activity was reported in seven regions: NU, MB, NS(3) and NL(2). Overall when compared to the previous week, there was a decrease in widespread activity. The majority of widespread and localized activity was reported in the Central and Atlantic provinces; however, more regions reported localised activity compared to the previous week.
                  Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 8



                  Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
                  Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
                  Influenza and Other Respiratory Virus Detections

                  In week 08, the number of positive influenza tests (1,242) and the percentage positive for influenza A (11.1%) continued to decline from the previous week. The percentage of positive influenza B tests continued to increase and was 5.9% in week 08 (Figure 2). Influenza B detections were greater than influenza A detections in QC and AB; accounting for 57% and 63% of influenza detections respectively. To date, 93% of influenza detections have been influenza A, and 99.5% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 30,350 cases. A significantly greater proportion of laboratory detections of influenza have been reported in adults ≥65 years of age (61%) this season (Table 2) compared to the 2013-14 season when only 16.3% of cases were in adults ≥65 years of age.
                  Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                  Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                  In week 08, detections of all respiratory viruses except parainfluenza and human metapneumovirus (hMPV) decreased from the previous week (Figure 3). Detections of respiratory syncytial virus (RSV) in week 08 were greater than the detections of influenza A with 867 detections (vs 818 detections of influenza A). In recent weeks, weekly detections of adenovirus, coronavirus, rhinovirus and parainfluenza have been greater than those reported in each of the past three seasons. Weekly detections of hMPV this season have been lower compared to the previous three seasons.
                  For more details, see the weekly Respiratory Virus Detections in Canada Report.
                  Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
                  RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
                  Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2014-2015
                  B Total
                  1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                  2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                  UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                  36 1 28 7 22 3408 24 2550 834 176
                  23 0 15 8 39 3621 10 3455 156 446
                  17 0 0 11 6 1293 0 0 1293 51
                  12 0 3 9 5 1108 0 382 726 43
                  341 7 113 221 48 10245 25 4357 5863 236
                  200 0 0 200 260 10929 4 422 10503 1232
                  145 0 26 119 25 864 0 128 736 43
                  23 0 0 23 15 401 0 123 278 60
                  6 0 6 15 0 579 0 53 526 4
                  15 0 0 15 0 579 0 53 526 4
                  818 8 191 613 424 32559 64 11578 20917 2329
                  65.9% 1.0% 23.3% 74.9% 34.1% 93.3% 0.2% 35.6% 64.2% 6.7%
                  Total Total
                  1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                  2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                  3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
                  UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                  28 2 3 23 21 1936 12 723 1201 162 2098 6.9%
                  13 4 4 5 35 1682 5 895 782 269 1951 6.4%
                  26 0 5 21 60 3251 13 1460 1778 369 3620 11.9%
                  53 0 9 44 85 3609 13 1428 2168 512 4121 13.6%
                  245 0 43 202 136 17677 10 6543 11124 766 18443 60.8%
                  2 0 2 0 0 115 0 97 18 2 117 0.4%
                  367 6 66 295 337 28270 53 11146 17071 2080 30350 100.0%
                  52.1% 1.6% 18.0% 80.4% 47.9% 93.1% 0.2% 39.4% 60.4% 6.9%
                  Antiviral Resistance

                  During the 2014-2015 influenza season, the NML has tested 764 influenza viruses for resistance to oseltamivir and 759 influenza viruses for resistance to zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 1042 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
                  * NA - not applicable
                  651 1 646 0 1038 1037 (99.9%)
                  3 0 3 0 4 4 (100%)
                  110 0 110 0 NA * NA *
                  764 1 759 0 1042 1041
                  Influenza Strain Characterizations

                  During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 277 influenza viruses [125 A(H3N2), 3 A(H1N1) and 149 influenza B].
                  Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=125), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 119 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 827 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 825 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.
                  Influenza A(H1N1): Three A(H1N1) viruses characterized were antigenically similar to A/California/7/2009.
                  Influenza B: Of the 149 influenza B viruses characterized, 142 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).

                  Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 277

                  The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
                  The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.
                  The WHO has released the recommended composition of the influenza vaccine for the northern hemisphere for the 2015-2016 season. Trivalent vaccines are recommended to contain 1) an A/California/7/2009 (H1N1)pdm09-like virus 2) an A/Switzerland/9715293/2013 (H3N2)-like virus, and 3) an B/Phuket/3073/2013-like virus(Yamagata lineage). Quadrivalent vaccines are recommended to additionally contain a B/Brisbane/60/2008-like virus (Victoria lineage).


                  Text equivalent for figure 4Influenza strain characterizations, Canada, 2014-2015, N =3
                  Influenza-like Illness (ILI) Consultation Rate

                  The national influenza-like-illness (ILI) consultation rate increased to 52.0 consultations per 1,000, which is above expected levels for week 08 (Figure 5). The rate was highest among the 5 to 19 years of age group (67.7 consultations per 1,000) and lowest among the adults ≥65 years of age (34.6 consultations per 1,000)
                  Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                  Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
                  Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                  Influenza Outbreak Surveillance

                  In week 08, 31 new outbreaks of influenza were reported, a decrease from the previous week. The majority of the outbreaks occurred in the Central and Atlantic provinces. Twenty-four outbreaks were reported in long-term care facilities (LTCF) and seven in institutional or community settings (Figure 6). Among the outbreaks in which the influenza subtype was known, two LTCF outbreaks were associated with A(H3N2). To date this season, 1,039 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There have been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
                  Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                  1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
                  Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                  Pharmacy Surveillance

                  During week 08, the proportion of prescriptions for antivirals decreased to 157.8 antiviral prescriptions per 100,000 total prescriptions (from 221.8 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups decreased in week 08. The rate was highest among seniors at 260.3 per 100,000 total prescriptions and lowest among infants at 45.2 per 100,000 total prescriptions.
                  Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                  Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
                  Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                  Sentinel Hospital Influenza Surveillance

                  Paediatric Influenza Hospitalizations and Deaths (IMPACT)
                  In week 08, nine laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: four cases of influenza A and five cases of influenza B (Figure 8a). A greater proportion of cases have been reported with influenza B in recent weeks, following the trend in laboratory detections. Among the reported cases, four (44%) were <2 years of age, three (44%) were 2 to 9 years of age and one (11%) was 10-16 years of age. One case was admitted to the ICU.
                  To date this season, 541 hospitalizations have been reported by the IMPACT network, 486 (90%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (157/159) were A(H3N2) (Table 4). To date, 66 cases were admitted to the ICU, of which 36 (55%) were 2 to 9 years of age (Figure 9a). A total of 38 ICU cases reported to have at least one underlying condition or comorbidity. Three deaths have been reported.
                  Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                  Adult Influenza Hospitalizations and Deaths (PCIRN)
                  In week 08, 67 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 08, 50 cases (75%) were in adults over the age of 65 and 53 cases (79%) had influenza A (Figure 8b).
                  To date this season, 1,810 cases have been reported; 1,741 (96%) with influenza A. The majority of cases (82%) were among adults ≥65 years of age (Table 5). One hundred and thirty-six ICU admissions have been reported and 103 cases were adults ≥65 years of age. A total of 97 ICU cases (71%) reported to have at least one underlying condition or comorbidity. Of the 94 ICU cases with known immunization status, 33 (35%) reported not having been vaccinated this season. Ninety-three deaths have been reported, 85 (91%) of the deaths were adults >65 years of age (Figure 9b).
                  Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                  Total # (%)
                  1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                  UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                  76 0 16 60 3 79 (14.6%)
                  107 1 35 77 20 127 (23.5%)
                  120 1 39 80 12 132 (24.4%)
                  125 0 44 81 12 137 (25.3%)
                  58 0 23 35 8 66 (12.2%)
                  486 2 157 327 55 541
                  89.8% 0.4% 32.3% 67.3% 10.2% 100.0%
                  Total # (%)
                  1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                  UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                  5 0 1 4 0 5(%)
                  91 1 40 56 4 101(6%)
                  195 0 79 116 19 214(12%)
                  1444 3 576 865 46 1490(82%)
                  1741 4 696 1041 69 1810
                  96% 0% 40% 60% 4% 100%
                  Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
                  A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                  Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                  B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                  * See footnote above following the section related to PCIRN-SOS data.
                  Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Adult hospitalizations (>16 year of age, PCIRN-SOS)
                  Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
                  A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                  Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                  B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

                  Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                  Provincial/Territorial Influenza Hospitalizations and Deaths

                  In week 08, 213 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is less than the number reported in week 07 (n=276).Of the 213 hospitalizations, all but 16 were due to influenza A, and 73% were in patients ≥65 years of age. Since the start of the 2014-15 season, 5,493 hospitalizations have been reported; 5,312 (97%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.5% were A(H3N2). The majority of cases (71%) were ≥65 years of age (Table 6). A total of 274 ICU admissions have been reported to date: 54% (n=149) were in adults ≥65 years of age and 30% (n=83) were in adults 20-64 years. A total of 389 deaths have been reported since the start of the season: three children <5 years of age, one child 5-19 years, 32 adults 20-64 years, and 353 adults ≥65 years of age. Adults 65 years of age or older represent 91% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
                  * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
                  Total # (%)
                  1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                  UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                  363 2 132 229 8 371 (7%)
                  218 0 107 111 16 234 (4%)
                  263 3 133 127 18 281 (5%)
                  581 5 279 297 35 616 (11%)
                  3832 1 1765 2066 94 3926 (71%)
                  55 1 51 3 10 65 (1%)
                  5312 12 2467 2833 181 5493
                  96.7% 0.2% 46.4% 53.3% 3.3% 100.0%
                  See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
                  Emerging Respiratory Pathogens

                  Human Avian Influenza
                  Influenza A(H7N9): Since the last FluWatch report, no new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus were reported by the World Health Organization. Globally to March 6, 2015, the WHO reported a total of 572 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 204 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

                  PHAC - Avian influenza A(H7N9)
                  WHO - Avian Influenza A(H7N9)

                  Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to March 5, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.
                  Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
                  Since the last FluWatch report, 10 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to March 6, 2015, the WHO has been informed of a total of 1,040 laboratory-confirmed cases of infection with MERS-CoV, including 383 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV

                  Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
                  PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
                  WHO - Coronavirus infections

                  Avian Influenza A(H5)
                  Since the last FluWatch report, no new information has been provided by the CFIA. Further information on the outbreak is provided on the following CFIA website.

                  CFIA - Notifiable Avian Influenza

                  .../

                  http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

                  "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                  -Nelson Mandela

                  Comment


                  • #24
                    FluWatch report: March 1 to 7, 2015 (Week 9)

                    Posted 2015-03-13 For readers interested in the PDF version, the document is available for downloading or viewing:
                    FluWatch report: March 1 to 7, 2015 (Week 9) (PDF Version - 913 KB - 10 pages)

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                    Overall Summary
                    • In week 09, all influenza indicators remained similar to, or declined from the previous week.
                    • Elevated influenza activity was mostly reported in the Central and Atlantic provinces
                    • Influenza B detections continues to increase steadily, particularly in the West, the Prairies and in Quebec. It is mainly affecting individuals less than 64 years of age. This increase in influenza B is expected as influenza B often shows up later in the flu season.
                    • A(H3N2) continues to be the most common influenza virus this season and seniors continue to have the highest number of positive laboratory detections, hospitalizations and deaths.
                    • Evidence from the National Microbiology Laboratory (NML) indicates that this year's vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

                    Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
                    Influenza/ILI Activity (geographic spread)

                    In week 09, no widespread activity was reported. Seventeen regions reported localized activity: AB, ON(7), QC, NB(3), NS(4), and NL. Twenty-seven regions reported sporadic activity: in YK, BC(5), AB(4), SK(2), MB(3), QC(5), NB(3), NS(2), PE and NL. No activity was reported in fourteen regions: NU(3), NT(2), SK, MB(2), NB, NS(3) and NF(2). When compared to the previous week, there was an overall decrease in influenza activity as there were less regions reporting activity and no regions reporting widespread activity.
                    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 9



                    Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
                    Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
                    Influenza and Other Respiratory Virus Detections

                    In week 09, the number of positive influenza tests (1,081) and the percentage positive for influenza A (8.6%) continued to decline from the previous week (Figure 2). The percentage of positive influenza B tests continued to increase and was 7.7% in week 09. Influenza B detections were greater than influenza A detections in many provinces (BC, AB, SK, MB, QC and PE). To date, 92% of influenza detections have been influenza A, and 99.4% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 31,623 cases (Table 2). Adults =65 years of age have predominantly been affected by influenza A, accounting for 62% of influenza A detections. Influenza B, while much smaller in numbers, is mainly affecting individuals less than 64 years of age, accounting to 63% of influenza B detections.
                    Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                    Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                    In week 09, detections of all respiratory viruses decreased from the previous week (Figure 3). Detections of respiratory syncytial virus (RSV) in week 09 were greater than the detections of influenza A with 757 detections (vs 572 detections of influenza A). In recent weeks, weekly detections of adenovirus, coronavirus, rhinovirus and parainfluenza have been greater than those reported in each of the past three seasons. Weekly detections of hMPV this season have been lower compared to the previous three seasons.
                    For more details, see the weekly Respiratory Virus Detections in Canada Report.
                    Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
                    RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
                    Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2014-2015
                    B Total
                    1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                    2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    25 1 16 8 28 3433 25 2566 842 204
                    19 0 15 4 39 3640 10 3477 153 485
                    4 0 2 2 12 1300 0 836 464 68
                    5 0 1 4 12 1113 0 384 729 55
                    228 5 72 151 44 10490 30 4448 6012 285
                    181 0 0 181 310 11110 4 422 10684 1542
                    66 0 14 52 27 930 0 142 788 102
                    35 0 0 35 27 436 0 123 313 87
                    2 0 2 0 7 113 1 110 2 13
                    7 0 0 7 3 586 0 53 533 7
                    572 6 122 444 509 33151 70 12561 20520 2848
                    52.9% 1.0% 21.3% 77.6% 47.1% 92.1% 0.2% 37.9% 61.9% 7.9%
                    Total Total
                    1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                    2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                    3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
                    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    27 1 2 24 25 2020 15 731 1274 196 2216 7.0%
                    12 0 4 8 28 1734 5 899 830 324 2058 6.5%
                    32 0 7 25 66 3341 13 1483 1845 449 3790 12.0%
                    39 0 6 33 113 3721 14 1443 2264 651 4372 13.8%
                    208 0 26 182 176 18104 11 6618 11475 966 19070 60.3%
                    0 0 0 0 0 115 0 97 18 2 117 0.4%
                    318 1 45 272 408 29035 58 11271 17706 2588 31623 100.0%
                    43.8% 0.3% 14.2% 85.5% 56.2% 91.8% 0.2% 38.8% 61.0% 8.2%
                    Antiviral Resistance

                    During the 2014-2015 influenza season, the NML has tested 857 influenza viruses for resistance to oseltamivir and 853 influenza viruses for resistance to zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 1,062 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
                    * NA - not applicable
                    705 1 701 0 1059 1058 (99.9%)
                    4 0 4 0 4 4 (100%)
                    148 0 148 0 NA * NA *
                    857 1 853 0 1063 1062
                    Influenza Strain Characterizations

                    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 305 influenza viruses [149 A(H3N2), 3 A(H1N1) and 153 influenza B]. Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=149), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 143 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 893 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 891 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Three A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B:Of the 153 influenza B viruses characterized, 146 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).
                    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 305

                    The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
                    The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.
                    The WHO has released the recommended composition of the influenza vaccine for the northern hemisphere for the 2015-2016 season. Trivalent vaccines are recommended to contain 1) an A/California/7/2009 (H1N1)pdm09-like virus 2) an A/Switzerland/9715293/2013 (H3N2)-like virus, and 3) an B/Phuket/3073/2013-like virus(Yamagata lineage). Quadrivalent vaccines are recommended to additionally contain a B/Brisbane/60/2008-like virus (Victoria lineage).


                    Text equivalent for figure 4Influenza strain characterizations, Canada, 2014-2015, N =3
                    Influenza-like Illness (ILI) Consultation Rate

                    The national influenza-like-illness (ILI) consultation rate decreased to 50.5 consultations per 1,000, which is above expected levels for week 09 (Figure 5). The rate was highest among the 5 to 19 years of age group (61.3 consultations per 1,000) and lowest among the adults =65 years of age (41.4 consultations per 1,000)
                    Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                    Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
                    Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                    Influenza Outbreak Surveillance

                    In week 09, 33 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Twenty-two outbreaks were reported in long-term care facilities (LTCF), six in hospitals and five in institutional or community settings (Figure 6). An additional five outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, three LTCF outbreaks were associated with A(H3N2) and one outbreak was associated with influenza B. To date this season, 1,061 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There have been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
                    Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                    1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
                    Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                    Pharmacy Surveillance

                    During week 09, the proportion of prescriptions for antivirals decreased to 147.3 antiviral prescriptions per 100,000 total prescriptions (from 150.1 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups except infants decreased in week 09. The rate was highest among seniors at 210.1 per 100,000 total prescriptions and lowest among infants at 64.9 per 100,000 total prescriptions.
                    Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                    Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 3,000 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y.
                    Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                    Sentinel Hospital Influenza Surveillance

                    Paediatric Influenza Hospitalizations and Deaths (IMPACT)
                    In week 09, seventeen laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: six cases of influenza A and eleven cases of influenza B (Figure 8a). A greater proportion of cases have been reported with influenza B in recent weeks, following the trend in laboratory detections. Among the reported cases, five (29%) were <2 years of age, nine (53%) were 2 to 9 years of age and three (17%) were 10-16 years of age. No ICU admissions were reported.
                    To date this season, 565 hospitalizations have been reported by the IMPACT network, 496 (88%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (159/161) were A(H3N2) (Table 4). To date, 69 cases were admitted to the ICU, of which 36 (52%) were 2 to 9 years of age (Figure 9a). A total of 38 ICU cases reported to have at least one underlying condition or comorbidity. Three deaths have been reported.
                    Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                    Adult Influenza Hospitalizations and Deaths (PCIRN)
                    In week 09, 63 laboratory-confirmed influenza-associated adult (=16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 09, 46 cases (73%) were in adults over the age of 65 and 43 cases (68%) had influenza A (Figure 8b).
                    To date this season, 1,898 cases have been reported; 1,801 (95%) with influenza A. The majority of cases (82%) were among adults =65 years of age (Table 5). One hundred and forty ICU admissions have been reported and 107 cases were adults =65 years of age. A total of 99 ICU cases (71%) reported to have at least one underlying condition or comorbidity. Of the 99 ICU cases with known immunization status, 35 (35%) reported not having been vaccinated this season. One hundred and six deaths have been reported, 97 (92%) of the deaths were adults >65 years of age (Figure 9B).
                    Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                    Total # (%)
                    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    79 0 16 63 4 83 (14.7%)
                    109 1 36 72 23 132 (23.4%)
                    121 1 40 80 15 136 (24.1%)
                    127 0 44 83 16 143 (25.3%)
                    60 0 23 37 11 71 (12.6%)
                    496 2 159 335 69 565
                    87.8% 0.4% 32.1% 67.5% 12.2% 100.0%
                    Total # (%)
                    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    3 0 1 2 0 3 (%)
                    102 1 45 56 6 108 (6%)
                    207 0 88 119 24 231 (12%)
                    1489 3 632 854 67 1556 (82%)
                    1801 4 766 1031 97 1898
                    95% 0% 43% 57% 5% 100%
                    Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
                    A) Paediatric hospitalizations (≤16 years of age, IMPACT)

                    Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)

                    B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                    * See footnote above following the section related to PCIRN-SOS data.
                    Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Adult hospitalizations (>16 year of age, PCIRN-SOS)
                    Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
                    A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                    Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                    B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

                    Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                    Provincial/Territorial Influenza Hospitalizations and Deaths

                    In week 09, 182 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is less than the number reported in week 08 (n=213). Of the 182 hospitalizations, all but 28 were due to influenza A, and 74% were in patients =65 years of age. Since the start of the 2014-15 season, 5769 hospitalizations have been reported; 5541 (97%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.5% were A(H3N2). The majority of cases (72%) were =65 years of age (Table 6). A total of 282 ICU admissions have been reported to date: 54% (n=153) were in adults =65 years of age and 31% (n=88) were in adults 20-64 years. A total of 413 deaths have been reported since the start of the season: three children <5 years of age, two children 5-19 years, 24 adults 20-64 years, and 384 adults =65 years of age. Adults 65 years of age or older represent 93% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
                    * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
                    Total # (%)
                    1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                    UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    374 2 136 236 12 386 (7%)
                    237 2 119 116 31 268 (5%)
                    346 3 202 141 27 373 (6%)
                    518 3 216 299 29 547 (9%)
                    4010 1 1843 2166 118 4128 (72%)
                    56 1 52 3 11 67 (1%)
                    5541 12 2568 2961 228 5769
                    96.0% 0.2% 46.3% 53.4% 4.0% 100.0%
                    See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.
                    Emerging Respiratory Pathogens

                    Human Avian Influenza
                    Influenza A(H7N9): Since the last FluWatch report, 59 new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus were reported by the World Health Organization. Globally to March 13, 2015, the WHO reported a total of 631 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 221 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

                    PHAC - Avian influenza A(H7N9)
                    WHO - Avian Influenza A(H7N9)

                    Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to March 13, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.
                    Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
                    Since the last FluWatch report, 20 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to March 13, 2015, the WHO has been informed of a total of 1,060 laboratory-confirmed cases of infection with MERS-CoV, including 394 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV

                    Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:
                    PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
                    WHO - Coronavirus infections

                    Avian Influenza A(H5)
                    As of March 9, 2015, the CFIA has removed the avian influenza Primary Control Zone PCZ in British Columbia. Permits are no longer required for the movement of birds and bird products in British Columbia. Surveillance by the CFIA has not detected the H5N2 and H5N1 strains of the virus in domestic poultry since February 2, 2015.

                    CFIA - Notifiable Avian Influenza

                    .../

                    http://www.phac-aspc.gc.ca/fluwatch/.../index-eng.php

                    "Safety and security don't just happen, they are the result of collective consensus and public investment. We owe our children, the most vulnerable citizens in our society, a life free of violence and fear."
                    -Nelson Mandela

                    Comment


                    • #25
                      FluWatch report: March 8 to 14, 2015 (Week 10)

                      Posted 2015-03-20 For readers interested in the PDF version, the document is available for downloading or viewing:
                      FluWatch report: March 8 to 14, 2015 (Week 10) (PDF Version - 824 KB - 10 pages)

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                      Overall Summary
                      • Elevated influenza activity was mostly reported in the Central and Atlantic provinces and in a few regions in the Western provinces. Widespread activity was reported in regions in Quebec and Newfoundland and Labrador.
                      • Influenza B detections continue to increase steadily, particularly in the West, the Prairies and in Quebec and is mainly affecting individuals less than 65 years of age. This week, overall detections for influenza B surpassed that of influenza A. This increase in influenza B is expected as influenza B often shows up later in the flu season.
                      • Despite the late-season circulation of influenza B, influenza A(H3N2) remains the most common influenza virus detected this season to date and seniors continue to be affected.
                      • Evidence from the National Microbiology Laboratory (NML) indicates that this year's vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

                      Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2014-15 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
                      Influenza/ILI Activity (geographic spread)

                      In week 10, three regions reported widespread activity: QC(2) and NL. Seventeen regions reported localized activity: BC(3), AB, ON(7), QC, NB and NS(4). Twenty-eight regions reported sporadic activity: in YK, NT, NU, BC(2), AB(4), SK(3), MB(3), QC(3), NB(6), NS(3), and PE. No activity was reported in ten regions : NL(3). NS(2), MB(2), NT and NU(2).
                      Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 10



                      Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available on the FluWatch website.
                      Text equivalent for figure 1Map of overall Influenza activity level by province and territory, Canada
                      Influenza and Other Respiratory Virus Detections

                      In week 10, the number of positive influenza tests (1,010) and the percentage positive for influenza A (6.6%) continued to decline from the previous week (Figure 2). The percentage of positive influenza B tests continued to increase and was 10.0% in week 10. Influenza B detections were greater than influenza A detections in many provinces (BC, AB, SK, MB, QC, PE and NS). To date, 91% of influenza detections have been influenza A, and 99.4% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 32,237 cases (Table 2). Adults ≥65 years of age have predominantly been affected by influenza A, accounting for 62% of influenza A detections. Influenza B, while much smaller in numbers, is mainly affecting individuals less than 65 years of age, accounting for 61% of influenza B detections.
                      Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                      Text equivalent for figure 2Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15
                      In week 10, detections of all respiratory viruses decreased from the previous week (Figure 3). Since week 04, detections of parainfluenza have been greater than those reported in each of the past three seasons. Weekly detections of hMPV this season have been lower compared to the previous three seasons.
                      For more details, see the weekly Respiratory Virus Detections in Canada Report.
                      Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15
                      RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
                      Text equivalent for figure 3Overall Number of Influenza Outbreaks, Canada, by Report Week, 2014-2015
                      1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                      2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                      19 0 18 1 23 3452 25 2584 843 227
                      8 0 5 3 45 3648 12 3484 152 531
                      3 0 0 3 11 1304 0 836 468 85
                      5 0 0 5 6 1118 0 385 733 61
                      173 3 58 112 82 10684 34 4511 6139 379
                      98 0 0 98 349 11208 4 422 10782 1891
                      74 0 12 62 38 1004 0 154 850 140
                      14 0 0 14 40 450 0 123 327 127
                      3 0 3 0 10 116 1 113 2 23
                      6 0 0 6 3 592 0 53 539 10
                      403 3 96 304 607 33576 76 12665 20835 3474
                      39.9% 0.7% 23.8% 75.4% 60.1% 90.6% 0.2% 37.7% 62.1% 9.4%
                      1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
                      2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                      3 Table 2 includes specimens for which demographic information was reported. These represent a subset of all positive influenza cases reported.
                      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                      13 0 2 11 26 2033 15 796 1222 226 2259 7.0%
                      3 0 2 1 32 1738 5 937 796 360 2098 6.5%
                      8 0 2 6 45 3350 14 1631 1705 500 3850 11.9%
                      18 0 0 18 122 3741 15 1608 2118 786 4527 14.0%
                      80 0 4 76 208 18194 11 7064 11119 1192 19386 60.1%
                      0 0 0 0 0 115 0 97 18 2 117 0.4%
                      122 0 10 112 433 29171 60 12133 16978 3066 32237 100.0%
                      22.0% 0.0% 8.2% 91.8% 78.0% 90.5% 0.2% 41.6% 58.2% 9.5%
                      Antiviral Resistance

                      During the 2014-2015 influenza season, the NML has tested 946 influenza viruses for resistance to oseltamivir and 943 influenza viruses for resistance to zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 1,144 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
                      * NA - not applicable
                      773 1 770 0 1141 1140 (99.9%)
                      169 0 169 0 4 4 (100%)
                      4 0 4 0 NA * NA *
                      946 1 943 0 1145 1144
                      Influenza Strain Characterizations

                      During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 373 influenza viruses [152 A(H3N2), 5 A(H1N1) and 216 influenza B].
                      Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=152), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 146 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 913 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 911 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Five A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 216 influenza B viruses characterized, 207 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and six were B/Brisbane/60/2008-like (Figure 4).
                      Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 373

                      The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.
                      The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.
                      The WHO has released the recommended composition of the influenza vaccine for the northern hemisphere for the 2015-2016 season. Trivalent vaccines are recommended to contain 1) an A/California/7/2009 (H1N1)pdm09-like virus 2) an A/Switzerland/9715293/2013 (H3N2)-like virus, and 3) an B/Phuket/3073/2013-like virus(Yamagata lineage). Quadrivalent vaccines are recommended to additionally contain a B/Brisbane/60/2008-like virus (Victoria lineage).


                      Text equivalent for figure 4Influenza strain characterizations, Canada, 2014-2015, N =3
                      Influenza-like Illness (ILI) Consultation Rate

                      The national influenza-like-illness (ILI) consultation rate remained similar to the previous week and was at 49.3 consultations per 1,000, which is within expected levels (Figure 5). The rate was highest among the 0 to 4 years of age group (60.7 consultations per 1,000) and lowest among the 5 to 19 years age group (35.1 consultations per 1,000).
                      Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                      Note: No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.
                      Text equivalent for figure 5Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015
                      Influenza Outbreak Surveillance

                      In week 10, 38 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Thirty-two outbreaks were reported in long-term care facilities (LTCF), and six in institutional or community settings (Figure 6). An additional thirteen outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, one LTCF outbreak was associated with A(H3N2) and five outbreaks were associated with influenza B. To date this season, 1,093 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There have been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.
                      Figure 6. Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                      1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.
                      Text equivalent for figure 6Overall number of new influenza outbreaks by report week, Canada, 2014-2015
                      Pharmacy Surveillance

                      During week 10, the proportion of prescriptions for antivirals decreased to 108.4 antiviral prescriptions per 100,000 total prescriptions (from 137.9 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups except infants decreased in week 10. The rate was highest among seniors at 142.9 per 100,000 total prescriptions and lowest among infants at 68.8 per 100,000 total prescriptions.
                      Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                      Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 2,500 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y, Senior: ≥65y
                      Text equivalent for figure 7Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15
                      Sentinel Hospital Influenza Surveillance

                      Paediatric Influenza Hospitalizations and Deaths (IMPACT)
                      In week 10, 17 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: four cases of influenza A and 13 cases of influenza B (Figure 8a). A greater proportion of cases have been reported with influenza B in recent weeks, following the trend in laboratory detections. Among the reported cases, five (29%) were <2 years of age, seven (41%) were 2 to 9 years of age and five (30%) were 10-16 years of age. One ICU admission was reported.
                      To date this season, 579 hospitalizations have been reported by the IMPACT network, 495 (86%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (162/164) were A(H3N2) (Table 4). To date, 72 cases were admitted to the ICU, of which 38 (53%) were 2 to 9 years of age (Figure 9a). A total of 39 ICU cases reported to have at least one underlying condition or comorbidity. Three deaths have been reported.
                      Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                      Adult Influenza Hospitalizations and Deaths (PCIRN)
                      In week 10, 44 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 10, 32 cases (73%) were in adults over the age of 65 and 25 cases (57%) had influenza B (Figure 8b).
                      To date this season, 1,961 cases have been reported; 1,832 (93%) with influenza A. The majority of cases (82%) were among adults ≥65 years of age (Table 5). One hundred and forty seven ICU admissions have been reported and 110 cases were adults ≥65 years of age. A total of 105 ICU cases (71%) reported to have at least one underlying condition or comorbidity. Of the 107 ICU cases with known immunization status, 37 (35%) reported not having been vaccinated this season. One hundred and thirteen deaths have been reported, 103 (91%) of the deaths were adults >65 years of age (Figure 9B).
                      Note: The number of hospitalizations reported through PCIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
                      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                      79 0 17 62 6 85 (14.7%)
                      107 1 35 71 23 130 (22.5%)
                      121 1 40 80 19 140 (24.2%)
                      128 0 45 83 21 149 (25.7%)
                      60 0 25 35 15 75 (13.0%)
                      495 2 162 331 84 579
                      85.5% 0.4% 32.7% 66.9% 14.5% 100.0%
                      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                      3 0 1 2 1 4 (%)
                      103 1 47 55 7 110 (6%)
                      210 0 88 122 31 241 (12%)
                      1516 3 643 870 90 1606 (82%)
                      1832 4 779 1049 129 1961
                      93% 0% 43% 57% 7% 100%
                      Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15
                      A) Paediatric hospitalizations (≤16 years of age, IMPACT)

                      Text equivalent for figure 8aNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)

                      B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

                      * See footnote above following the section related to PCIRN-SOS data.
                      Text equivalent for figure 8bNumber of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15: Adult hospitalizations (>16 year of age, PCIRN-SOS)
                      Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15
                      A) Paediatric hospitalizations (≤16 years of age, IMPACT)
                      Text equivalent for figure 9aPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Paediatric hospitalizations (≤16 years of age, IMPACT)
                      B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

                      Text equivalent for figure 9bPercentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15: Adult hospitalizations (≥16 year of age, PCIRN-SOS)
                      Provincial/Territorial Influenza Hospitalizations and Deaths

                      In week 10, 139 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is less than the number reported in week 09 (n=182). Of the 139 hospitalizations, all but 35 were due to influenza A, and 72% were in patients ≥65 years of age. Since the start of the 2014-15 season, 5,998 hospitalizations have been reported; 5,709 (95%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.5% were A(H3N2). The majority of cases (72%) were ≥65 years of age (Table 6). A total of 302 ICU admissions have been reported to date: 54% (n=164) were in adults ≥65 years of age and 32% (n=96) were in adults 20-64 years. A total of 436 deaths have been reported since the start of the season: three children <5 years of age, three children 5-19 years, 26 adults 20-64 years, and 404 adults ≥65 years of age. Adults 65 years of age or older represent 93% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.
                      * Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, QC, and NB. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and PCIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
                      1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.
                      UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.