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Canada FluWatch Weekly Reports 2014-2015 Season Week 20

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  • Pathfinder
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    FluWatch report: May 17 to May 23, 2015 (Week 20)

    Posted 2015-05-29 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: May 17 to May 23, 2015 (Week 20) (PDF Version - 915 KB - 10 pages)

    ? ? Help with PDF documents

    Overall Summary
    • Influenza B continues to be the most common influenza virus circulating in Canada; however, influenza B is past its peak and remains within expected levels for this time of year.
    • Overall, influenza activity in Canada continues to decrease as we approach the end of the influenza season.
    • Based on laboratory detections, influenza B is having a greater impact on adults less than 65 years of age compared to influenza A(H3N2), which predominated earlier in the season.
    • As of week 20, 7,602 hospitalizations and 579 deaths have been reported from participating regions, which is more than were reported last year at this time (4,867 hospitalizations and 293 deaths).

    Please Note: This is the final weekly report for the 2014-15 influenza season. Bi-weekly reports will start on June 12th (for weeks 21 and 22). Laboratory detections reported through the RVDSS will be updated weekly on the FluWatch website.
    Influenza/ILI Activity (geographic spread)

    In week 20, nine regions reported localized activity: BC, ON(5), QC and NL(2). Twenty-one regions reported sporadic activity: BC(3), AB(5), SK(3), MB(2), ON(2), QC(5), and NB.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 20
    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 233 in week 19 to 124 in week 20. Influenza B remained the predominant virus in week 20, representing 98% of influenza detections. All jurisdictions reported declining levels of influenza detections this week. To date, 81% of influenza detections have been influenza A (Table 1). To date this season, detailed information on age and type/subtype has been received for 37,126 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. Adults under the age of 64 years accounted for 59% 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 20, detections for all other respiratory viruses decreased from the previous week and are approaching inter-seasonal levels (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, 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.
    0 0 0 0 14 3525 28 2629 868 480
    1 0 1 0 21 3702 14 3533 155 957
    0 0 0 0 9 1315 0 839 476 334
    0 0 0 0 6 1124 1 390 733 220
    2 0 0 2 33 11164 50 4714 6400 1498
    0 0 0 0 32 11449 4 422 11023 3902
    0 0 0 0 0 1195 0 193 1002 530
    0 0 0 0 0 511 1 123 387 261
    0 0 0 0 0 131 1 128 2 108
    0 0 0 0 6 629 0 123 506 76
    3 0 1 2 121 34745 99 13094 21552 8366
    2.4% 0.0% 33.3% 66.7% 97.6% 80.6% 0.3% 37.7% 62.0% 19.4%
    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.
    0 0 0 0 10 2091 22 809 1260 541 2632 7.1%
    0 0 0 0 17 1781 6 956 819 774 2555 6.9%
    0 0 0 0 20 3443 17 1673 1753 1094 4537 12.2%
    0 0 0 0 15 3874 22 1659 2193 1783 5657 15.2%
    1 0 1 0 30 18746 15 7290 11441 2872 21618 58.2%
    0 0 0 0 0 120 0 101 19 7 127 0.3%
    1 0 1 0 92 30055 82 12488 17485 7071 37126 100.0%
    1.1% 0.0% 100.0% 0.0% 98.9% 81.0% 0.3% 41.6% 58.2% 19.0%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,561 influenza viruses for resistance to oseltamivir and 1,559 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 1,427 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    901 1 900 0 1408 1407 (99.9%)
    18 0 18 0 20 20 (100%)
    642 0 641 0 NA * NA *
    1561 1 1559 0 1428 1427
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 961 influenza viruses [198 A(H3N2), 21 A(H1N1) and 742 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=198), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 192 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,160 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,158 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Twenty-one A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 742 influenza B viruses characterized, 683 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 56 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 961

    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 byWHO.
    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, 2014-2015, N =3
    Influenza-like Illness (ILI) Consultation Rate

    In week 20, the national influenza-like-illness (ILI) consultation rate decreased from the previous week to 16.1 consultations per 1,000 (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
    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 20, four new outbreaks of influenza were reported. Two outbreaks were reported in long-term care facilities (LTCF) and two in institutional or community settings (Figure 6). To date this season, 1,275 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 laboratory-confirmed 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 20, nine laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All cases were 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, two (22%) were <2 years of age, three (33%) were 2 to 9 years of age and four (44%) were 10 to 16 years of age. One ICU admission was reported.
    To date this season, 697 hospitalizations have been reported by the IMPACT network, 510 (73%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (162/165) were A(H3N2) (Table 4). To date, 88 cases were admitted to the ICU, of which 48 (55%) were 2 to 9 years of age (Figure 9a). A total of 55 ICU cases reported to have at least one underlying condition or comorbidity. Five 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)
    Surveillance has ended for the 2014-2015 influenza season.
    This season, 2,228 cases have been reported; 1,912 (86%) with influenza A. The majority of cases (81%) were among adults ≥65 years of age (Table 5). One hundred and seventy two ICU admissions have been reported and 128 cases were adults ≥65 years of age. Among the 172 ICU admissions, 27 were due to influenza B (12 in adults 45 to 64 years of age and 15 in adults over the age of 65). A total of 123 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 123 ICU cases with known immunization status, 40 (33%) reported not having been vaccinated this season. One hundred and thirty-five deaths have been reported, 124 (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.
    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.
    82 0 19 63 14 96 (13.8%)
    114 2 36 76 40 154 (22.1%)
    124 1 38 85 49 173 (24.8%)
    129 0 44 85 51 180 (25.8%)
    61 0 25 36 33 94 (13.5%)
    510 3 162 345 187 697
    73.2% 0.6% 31.8% 67.6% 26.8% 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 (%)
    106 1 56 49 16 122 (5%)
    217 3 99 115 76 293 (13%)
    1586 4 760 822 223 1809 (81%)
    1912 8 916 988 316 2228
    86% 0% 48% 52% 14% 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 20, 38 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*. Of the 38 hospitalizations, 25 (66%) were due to influenza A and 22 (58%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 7,602 hospitalizations have been reported; 6,565 (86%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.1% were A(H3N2). The majority of cases (70%) were ≥65 years of age (Table 6). A total of 391 ICU admissions have been reported to date: 52% (n=203) were in adults ≥65 years of age and 75% were due to influenza A. A total of 579 deaths have been reported since the start of the season: three children <5 years of age, four children 5-19 years, 43 adults 20-64 years, and 529 adults ≥65 years of age. Influenza A has been reported in 91% of deaths. 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, and QC. 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.
    426 6 150 270 85 511 (7%)
    258 0 120 138 93 351 (5%)
    322 4 169 149 80 402 (5%)
    720 12 354 354 203 923 (12%)
    4783 5 2291 2487 554 5337 (70%)
    56 1 52 3 22 78 (1%)
    6565 28 3136 3401 1037 7602
    86.4% 0.4% 47.8% 51.8% 13.6% 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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  • Pathfinder
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    FluWatch report: May 10 to May 16, 2015 (Week 19)

    Posted 2015-05-22 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: May 10 to May 16, 2015 (Week 19) (PDF Version - 916 KB - 10 pages)

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    Overall Summary
    • Influenza B continues to be the most common influenza virus circulating in Canada; however, influenza B is past its peak and remains within expected levels for this time of year.
    • Overall, influenza activity in Canada continues to decrease; however, elevated activity was still reported in week 19 (mostly in parts of Central Canada and Newfoundland).
    • Based on laboratory detections, influenza B is having a greater impact on adults less than 65 years of age compared to influenza A(H3N2), which predominated earlier in the season.
    • As of week 19, 7,549 hospitalizations and 576 deaths have been reported from participating regions, which is more than were reported last year at this time (4,862 hospitalizations and 291 deaths).

    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 19, one region in QC and one region in NL reported widespread activity. Eight regions reported localized activity: MB, ON(5), QC, and NL. Twenty-three regions reported sporadic activity: BC(4), AB(5), SK(3), MB(2), ON(2), QC(4), NL, NB, and NS.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 19
    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 314 in week 18 to 220 in week 19. Influenza B remained the predominant virus in week 19, representing 93% of influenza detections. Most jurisdictions reported stable or declining levels of influenza detections over recent weeks. To date, 81% of influenza detections have been influenza A, and 99.2% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 36,997 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. Adults under the age of 64 years accounted for 59% 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 19, detections for all other respiratory viruses decreased from the previous week and are approaching inter-seasonal levels (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, 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.
    3 0 0 3 33 3525 28 2629 868 466
    1 0 0 1 25 3701 14 3531 156 937
    0 0 0 0 11 1315 0 839 476 311
    0 0 0 0 17 1124 1 390 733 214
    3 0 3 0 49 11162 50 4714 6398 1456
    4 0 0 4 50 11449 4 422 11023 3870
    0 0 0 0 6 1195 0 193 1002 530
    0 0 0 0 1 511 1 123 387 261
    0 0 0 0 0 131 1 128 2 108
    5 0 0 5 12 629 0 123 506 70
    16 0 3 13 204 34742 99 13092 21551 8223
    7.3% 0.0% 18.8% 81.3% 92.7% 80.9% 0.3% 37.7% 62.0% 19.1%
    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.
    0 0 0 0 7 2091 22 809 1260 524 2615 7.1%
    0 0 0 0 14 1781 6 956 819 755 2536 6.9%
    1 0 1 0 32 3443 16 1672 1755 1065 4508 12.2%
    4 0 0 4 36 3874 22 1659 2193 1762 5636 15.2%
    2 0 1 1 44 18745 15 7289 11441 2830 21575 58.3%
    0 0 0 0 0 120 0 101 19 7 127 0.3%
    7 0 2 5 133 30054 81 12486 17487 6943 36997 100.0%
    5.0% 0.0% 28.6% 71.4% 95.0% 81.2% 0.3% 41.5% 58.2% 18.8%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,499 influenza viruses for resistance to oseltamivir and 1,444 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 1,390 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    901 1 888 0 1372 1371 (99.9%)
    17 0 15 0 19 19 (100%)
    581 0 541 0 NA * NA *
    1499 1 1444 0 1391 1390
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 898 influenza viruses [195 A(H3N2), 18 A(H1N1) and 685 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=195), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 189 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,143 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,141 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Eighteen A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 685 influenza B viruses characterized, 643 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 39 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 898

    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 byWHO.
    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, 2014-2015, N =3
    Influenza-like Illness (ILI) Consultation Rate

    In week 19, the national influenza-like-illness (ILI) consultation rate increased from the previous week to 23.8 consultations per 1,000 (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
    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 19, 10 new outbreaks of influenza were reported. Eight outbreaks were reported in long-term care facilities (LTCF) and two in institutional or community settings (Figure 6). Among the outbreaks in which the influenza type was known (n=3), all were associated with influenza B. To date this season, 1,273 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 laboratory-confirmed 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 19, three laboratory-confirmed influenza-associated paediatric (=16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All cases were 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, two (67%) were <2 years of age and one (33%) was 10 to 16 years of age. No ICU admissions were reported.
    To date this season, 685 hospitalizations have been reported by the IMPACT network, 509 (74%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (161/164) were A(H3N2) (Table 4). To date, 85 cases were admitted to the ICU, of which 48 (57%) were 2 to 9 years of age (Figure 9a). A total of 56 ICU cases reported to have at least one underlying condition or comorbidity. Four 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)
    Surveillance has ended for the 2014-2015 influenza season.
    This season, 2,228 cases have been reported; 1,912 (86%) with influenza A. The majority of cases (81%) were among adults ≥65 years of age (Table 5). One hundred and seventy two ICU admissions have been reported and 128 cases were adults ≥65 years of age. Among the 172 ICU admissions, 27 were due to influenza B (12 in adults 45 to 64 years of age and 15 in adults over the age of 65). A total of 123 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 123 ICU cases with known immunization status, 40 (33%) reported not having been vaccinated this season. One hundred and thirty-five deaths have been reported, 124 (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.
    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.
    81 0 18 63 14 95 (13.9%)
    114 2 36 76 36 150 (21.9%)
    124 1 38 85 47 171 (25.0%)
    129 0 44 85 50 179 (26.1%)
    61 0 25 36 29 90 (13.1%)
    509 3 161 345 176 685
    74.3% 0.6% 31.6% 67.8% 25.7% 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 (%)
    106 1 56 49 16 122 (5%)
    217 3 99 115 76 293 (13%)
    1586 4 760 822 223 1809 (81%)
    1912 8 916 988 316 2228
    86% 0% 48% 52% 14% 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 19, 37 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is lower than the number reported the previous week. Of the 37 hospitalizations, 20 (54%) were due to influenza A and 15 (41%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 7,549 hospitalizations have been reported; 6,540 (87%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.2% were A(H3N2). The majority of cases (70%) were ≥65 years of age (Table 6). A total of 389 ICU admissions have been reported to date: 53% (n=203) were in adults ≥65 years of age and 76% were due to influenza A. A total of 576 deaths have been reported since the start of the season: three children <5 years of age, four children 5-19 years, 43 adults 20-64 years, and 526 adults ≥65 years of age. Influenza A has been reported in 91% of deaths. 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, and QC. 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.
    425 5 150 270 83 508 (7%)
    258 0 120 138 90 348 (5%)
    321 4 168 149 77 398 (5%)
    718 12 352 354 197 915 (12%)
    4762 4 2274 2484 541 5303 (70%)
    56 1 52 3 21 77 (1%)
    6540 26 3116 3398 1009 7549
    86.6% 0.4% 47.6% 52.0% 13.4% 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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    FluWatch report: May 3 to May 9, 2015 (Week 18)

    Posted 2015-05-15 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: May 3 to May 9, 2015 (Week 18) (PDF Version - 915 KB - 10 pages)

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    Overall Summary
    • Influenza B continues to be the most common influenza virus circulating in Canada; however, influenza B is past its peak and remains within expected levels for this time of year.
    • Overall, influenza activity in Canada continues to decrease; however, elevated activity was still reported in week 18 (mostly in Central Canada and parts of British Columbia).
    • Influenza B is having a greater impact on adults less than 65 years of age compared to influenza A(H3N2), which predominated earlier in the season.
    • As of week 18, 7,448 hospitalizations and 562 deaths have been reported from participating regions, which is more than were reported last year at this time (4,731 hospitalizations and 275 deaths).

    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 18, one region in BC and one region in NL reported widespread activity. Ten regions reported localized activity: BC(2), ON(6), and QC(2). Twenty-six regions reported sporadic activity: NT, BC, AB(5), SK(3), MB(4), ON, QC(4), NL, NB(5), and NS. Twenty regions reported no activity: YK, NT, NU(3), BC, MB, NL(2), NB(2), NS(8), and PE.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 18
    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 381 in week 17 to 299 in week 18. Influenza B remained the predominant virus in week 18, representing 89% of influenza detections. Most jurisdictions reported stable or declining levels of influenza detections over recent weeks. To date, 81% of influenza detections have been influenza A, and 99.3% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 36,794 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. Adults under the age of 64 years accounted for 59% 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 18, detections for all other respiratory viruses except rhinovirus and human metapneumovirus decreased from the previous week (Figure 3). The percent positive for rhinovirus increased from 13% in week 17 to 20% in week 18.
    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.
    3 0 3 0 18 3522 28 2629 865 433
    1 0 0 1 31 3700 14 3531 155 912
    0 0 0 0 5 1314 0 839 475 286
    2 1 0 1 12 1124 1 390 733 197
    8 0 1 7 87 11157 48 4710 6399 1400
    16 0 0 16 83 11445 4 422 11019 3820
    0 0 0 0 19 1195 0 193 1002 524
    0 0 0 0 2 511 1 123 387 260
    0 0 0 0 0 131 1 128 2 108
    2 0 0 2 10 624 0 123 501 58
    32 1 4 27 267 34723 97 13088 21538 7998
    10.7% 3.1% 12.5% 84.4% 89.3% 81.3% 0.3% 37.7% 62.0% 18.7%
    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.
    1 0 0 1 10 2092 22 809 1261 508 2600 7.1%
    0 0 0 0 20 1783 6 957 820 751 2534 6.9%
    3 0 0 3 25 3441 16 1671 1754 1018 4459 12.1%
    6 0 0 6 39 3869 21 1658 2190 1705 5574 15.1%
    9 0 0 9 78 18739 15 7286 11438 2761 21500 58.4%
    0 0 0 0 0 120 0 101 19 7 127 0.3%
    19 0 0 19 172 30044 80 12482 17482 6750 36794 100.0%
    9.9% 0.0% 0.0% 100.0% 90.1% 81.7% 0.3% 41.5% 58.2% 18.3%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,446 influenza viruses for resistance to oseltamivir and 1,444 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 1,365 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    890 1 888 0 1350 1349 (99.9%)
    15 0 15 0 16 16 (100%)
    541 0 541 0 NA * NA *
    1446 1 1444 0 1366 1365
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 849 influenza viruses [190 A(H3N2), 17 A(H1N1) and 642 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=190), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 184 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,129 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,127 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Seventeen A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 642 influenza B viruses characterized, 602 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 37 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 849

    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 byWHO.
    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, 2014-2015, N =3
    Influenza-like Illness (ILI) Consultation Rate

    In week 18, the national influenza-like-illness (ILI) consultation rate increased from the previous week to 23.1 consultations per 1,000 (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
    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 18, 14 new outbreaks of influenza were reported: two due to influenza B, one due to influenza A and 11 for which the influenza type was not provided. Eleven outbreaks were reported in long-term care facilities (LTCF) and three in institutional or community settings (Figure 6). To date this season, 1,265 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 laboratory-confirmed 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 18, six laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All cases were 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, three (50%) were <2 years of age and three (50%) were 2 to 9 years of age. One ICU case was reported.
    To date this season, 681 hospitalizations have been reported by the IMPACT network, 509 (75%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (161/164) were A(H3N2) (Table 4). To date, 86 cases were admitted to the ICU, of which 49 (57%) were 2 to 9 years of age (Figure 9a). A total of 56 ICU cases reported to have at least one underlying condition or comorbidity. Four 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)
    Surveillance has ended for the 2014-2015 influenza season.
    This season, 2,228 cases have been reported; 1,912 (86%) with influenza A. The majority of cases (81%) were among adults ≥65 years of age (Table 5). One hundred and seventy two ICU admissions have been reported and 128 cases were adults ≥65 years of age. Among the 172 ICU admissions, 27 were due to influenza B (12 in adults 45 to 64 years of age and 15 in adults over the age of 65). A total of 123 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 123 ICU cases with known immunization status, 40 (33%) reported not having been vaccinated this season. One hundred and thirty-five deaths have been reported, 124 (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.
    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.
    81 0 18 63 13 94 (13.8%)
    114 2 36 76 35 149 (21.9%)
    124 1 38 85 47 171 (25.1%)
    129 0 44 85 50 179 (26.3%)
    61 0 25 36 27 88 (12.9%)
    509 3 161 345 172 681
    74.7% 0.6% 31.6% 67.8% 25.3% 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 (%)
    106 1 56 49 16 122 (5%)
    217 3 99 115 76 293 (13%)
    1586 4 760 822 223 1809 (81%)
    1912 8 916 988 316 2228
    86% 0% 48% 52% 14% 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 18, 78 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is lower than the number reported the previous week. Of the 78 hospitalizations, 46 (59%) were due to influenza A and 38 (49%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 7,448 hospitalizations have been reported; 6,510 (87%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.3% were A(H3N2). The majority of cases (70%) were ≥65 years of age (Table 6). A total of 382 ICU admissions have been reported to date: 53% (n=202) were in adults ≥65 years of age and 34% (n=128) were in adults 20-64 years. A total of 562 deaths have been reported since the start of the season: three children <5 years of age, four children 5-19 years, 43 adults 20-64 years, and 512 adults ≥65 years of age. Influenza A has been reported in 92% of deaths. 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, and QC. 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.
    424 4 150 270 76 500 (7%)
    256 0 118 138 86 342 (5%)
    319 4 168 147 70 389 (5%)
    711 11 347 353 185 896 (12%)
    4744 3 2260 2481 500 5244 (70%)
    56 1 52 3 21 77 (1%)
    6510 23 3095 3392 938 7448
    87.4% 0.4% 47.5% 52.1% 12.6% 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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    FluWatch report: April 26 to May 2, 2015 (Week 17)

    Posted 2015-05-08 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: April 26 to May 2, 2015 (Week 17) (PDF Version - 913 KB - 10 pages)

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    Overall Summary
    • Influenza B continues to be the most common influenza virus circulating in Canada; however, influenza B is past its peak and remains within expected levels for this time of year.
    • Overall, influenza activity in Canada continues to decline; however, elevated activity was still reported in week 17 (mostly in Central Canada and parts of the Atlantic Provinces).
    • Influenza B is having a greater impact on adults less than 65 years of age, compared to influenza A(H3N2), which predominated earlier in the season.
    • Fewer influenza hospitalizations were reported this week compared to the previous week. The majority of hospitalizations were due to influenza A and in adults ≥65 years of age.

    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 17, one region in QC and one region in NL reported widespread activity. Twelve regions reported localized activity: SK, MB, ON(7), QC, NL and NB. Twenty-five regions reported sporadic activity: NT, BC(4), AB(5), SK(2), MB(3), QC(4), NL, NB(4), and NS. Nineteen regions reported no activity: YK, NT, NU(3), BC, MB, NL, NB(2), NS(8), and PE.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 17
    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 17, the percentage positive for influenza A (0.9%) and B (9.2%) declined from the previous week (Figure 2). Influenza B remained the predominant virus in week 17, representing 90% of influenza detections. Most jurisdictions reported stable or declining levels of influenza detections over recent weeks. To date, 82% 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 36,155 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, they account for 59% 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 17, detections for all other respiratory viruses decreased from the previous week (Figure 3). In recent weeks, detections of human metapneumovirus and parainfluenza have been higher than those reported in each of the past 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 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.
    2 0 0 2 30 3519 28 2626 865 415
    0 0 0 0 37 3699 14 3531 154 881
    1 0 0 1 16 1314 0 839 475 272
    0 0 0 0 20 1122 0 390 732 185
    9 0 8 1 80 11149 48 4709 6392 1297
    21 0 0 21 129 11408 4 422 11003 3737
    2 0 1 1 21 1195 0 193 1002 505
    0 0 0 0 4 511 1 123 387 258
    0 0 0 0 0 131 1 128 2 108
    2 0 0 2 7 622 0 123 499 48
    37 0 9 28 344 34691 96 13084 21511 7706
    9.7% 0.0% 24.3% 75.7% 90.3% 81.8% 0.3% 37.7% 62.0% 18.2%
    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.
    4 0 0 4 13 2091 22 809 1260 489 2580 7.1%
    1 0 0 1 21 1783 6 957 820 709 2492 6.8%
    2 0 0 2 33 3436 16 1669 1751 970 44406 12.1%
    3 0 1 2 41 3863 21 1658 2184 1626 5489 15.1%
    13 0 2 11 95 18721 15 7280 11426 2646 21367 58.6%
    0 0 0 0 0 120 0 101 19 7 127 0.3%
    23 0 3 20 203 30014 80 12474 17460 6447 36461 100.0%
    10.2% 0.0% 13.0% 87.0% 89.8% 82.3% 0.3% 41.6% 58.2% 17.7%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,382 influenza viruses for resistance to oseltamivir and 1,379 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 1,351 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    876 1 874 0 1338 1337 (99.9%)
    10 0 10 0 14 14 (100%)
    496 0 495 0 NA * NA *
    1382 1 1379 0 1352 1351
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 750 influenza viruses [185 A(H3N2), 15 A(H1N1) and 550 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=185), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 179 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,105 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,103 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Fifteen A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 550 influenza B viruses characterized, 523 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 24 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 750

    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 byWHO.
    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, 2014-2015, N =3
    Influenza-like Illness (ILI) Consultation Rate

    In week 17, the national influenza-like-illness (ILI) consultation rate declined from the previous week to 18.7 consultations per 1,000 (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, 2014-2015
    Influenza Outbreak Surveillance

    In week 17, eight new outbreaks of influenza were reported. All outbreaks were reported in long-term care facilities (LTCF) (Figure 6). and three of the eight outbreaks were associated with influenza B. To date this season, 1,254 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 17, nine laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All cases were 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 and five (56%) were 2 to 9 years of age. No ICU cases were reported.
    To date this season, 676 hospitalizations have been reported by the IMPACT network, 509 (75%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (161/164) were A(H3N2) (Table 4). To date, 83 cases were admitted to the ICU, of which 46 (55%) were 2 to 9 years of age (Figure 9a). A total of 54 ICU cases reported to have at least one underlying condition or comorbidity. Four 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 17, five laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network. All reported cases were influenza B. Three cases (60%) were in adults over the age of 65 (Figure 8b).
    To date this season, 2,228 cases have been reported; 1,912 (86%) with influenza A. The majority of cases (81%) were among adults ≥65 years of age (Table 5). One hundred and seventy two ICU admissions have been reported and 128 cases were adults ≥65 years of age. Among the 172 ICU admissions, 27 were due to influenza B (12 in adults 45 to 64 years of age and 15 in adults over the age of 65). A total of 123 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 123 ICU cases with known immunization status, 40 (33%) reported not having been vaccinated this season. One hundred and thirty-five deaths have been reported, 124 (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.
    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.
    81 0 18 63 12 93 (13.8%)
    114 2 36 76 34 148 (21.9%)
    124 1 38 85 45 169 (25.0%)
    129 0 44 85 49 178 (26.3%)
    61 0 25 36 27 88 (13.0%)
    509 3 161 345 167 676
    75.3% 0.6% 31.6% 67.8% 24.7% 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 (%)
    106 1 56 49 16 122 (5%)
    217 3 99 115 76 293 (13%)
    1586 4 760 822 223 1809 (81%)
    1912 8 916 988 316 2228
    86% 0% 48% 52% 14% 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 17, 88 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is lower than the number reported the previous week. Of the 88 hospitalizations, 53 (60%) were due to influenza A and 45 (51%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 7,375 hospitalizations have been reported; 6,471 (88%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.3% were A(H3N2). The majority of cases (71%) were ≥65 years of age (Table 6). A total of 384 ICU admissions have been reported to date: 53% (n=202) were in adults ≥65 years of age and 33% (n=128) were in adults 20-64 years. A total of 555 deaths have been reported since the start of the season: three children <5 years of age, four children 5-19 years, 42 adults 20-64 years, and 506 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.
    422 3 150 269 73 495 (7%)
    277 2 133 142 95 372 (5%)
    385 4 232 149 104 489 (7%)
    614 9 261 344 124 738 (10%)
    4717 3 2245 2469 488 5205 (71%)
    56 1 52 3 20 76 (1%)
    6471 22 3073 3376 904 7375
    87.7% 0.3% 47.5% 52.2% 12.3% 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 May 5, 2015, the WHO reported a total of 651 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 225 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)

    Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
    Since the last FluWatch report, no new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to May 5, 2015, the WHO has reported a total of 1,110 laboratory-confirmed cases of infection with MERS-CoV, including 422 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 the second outbreak of highly pathogenic avian influenza H5N2 virus in Oxford County, Ontario. To date, there has been three infected commercial premises. Individual quarantines and Avian Influenza Control Zones have been established. No human cases have been reported. Avian influenza viruses do not pose risks to food safety when poultry and poultry products are properly handled and cooked. Avian influenza rarely affects humans that do not have consistent contact with infected birds. 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

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    FluWatch report: April 12 to April 18, 2015 (Week 15)

    Posted 2015-04-23 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: April 12 to April 18, 2015 (Week 15) (PDF Version - 908 KB - 10 pages)

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    Overall Summary
    • Influenza B continued to be the most common influenza virus circulating in Canada. More influenza B detections have been observed to date this season, compared to the same time last season.
    • The number of influenza A and B detections remained similar to the previous week. Other circulating respiratory viruses continue to decrease with the end of the 2014-15 influenza season approaching.
    • Elevated influenza activity was mostly reported in the Central and Atlantic provinces. Widespread activity was reported in two regions in Quebec.
    • Influenza B is having a greater impact on adults less than 65 years of age, compared to influenza A(H3N2), which circulated earlier in the 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 15, two regions in QC reported widespread activity. Thirteen regions reported localized activity: MB(2), ON(6), QC(2), NB(2) and NS. Twenty-seven regions reported sporadic activity: in NU, BC(5), AB(5), SK(3), MB(3), ON. QC(2), NB(4), NS(2) and PE. Twelve regions reported no activity activity: in YK, NT(2), NU(2), NB, and NS(6).
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 15
    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 15, the percentage positive for influenza A (2.1%) and B (11.9%) declined from the previous week (Figure 2). Influenza B detections were greater than influenza A in all provinces with the exception of British Columbia. More influenza B has been observed to date this season (6,821) compared to the same time during the 2013-14 season (5,027). To date, 83.5% of influenza detections have been influenza A, and 99.3% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 35,725 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, they account for 59% 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 15, detections for all other respiratory viruses remained similar to, or decreased from, the previous week (Figure 3). Overall, the detections of other respiratory viruses have been declining since peaking in week 5.
    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 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.
    24 3 20 1 22 3512 28 2623 861 364
    3 0 1 2 44 3689 13 3520 156 803
    0 0 0 0 17 1312 0 839 473 208
    1 0 0 1 25 1122 0 390 732 144
    34 1 18 15 144 11114 45 4683 6386 1047
    15 0 0 15 279 11397 4 422 10971 3433
    15 0 6 9 45 1188 0 189 999 435
    6 0 0 5 6 511 0 123 387 245
    4 0 4 0 5 130 1 127 2 107
    3 0 0 3 6 616 0 123 493 35
    105 4 49 51 593 34591 91 13039 21460 6821
    15.0% 3.8% 46.7% 48.6% 85.0% 83.5% 0.3% 37.7% 62.0% 16.5%
    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.
    1 0 0 1 28 2083 20 808 1255 426 2509 7.0%
    1 0 0 1 51 1779 6 955 818 679 2458 6.9%
    2 0 1 1 43 3429 16 1662 1751 864 4293 12.0%
    8 0 2 6 90 3854 18 1652 2184 1467 5321 14.9%
    25 0 6 19 197 18677 15 7257 11405 2341 21018 58.8%
    0 0 0 0 0 119 0 100 19 7 126 0.4%
    37 0 9 28 409 29941 75 12434 17432 5784 35725 100.0%
    8.3% 0.0% 24.3% 75.7% 91.7% 83.8% 0.3% 41.5% 58.2% 16.2%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,260 influenza viruses for resistance to oseltamivir and 1,258 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 1,308 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    855 1 853 0 1298 1297 (99.9%)
    9 0 9 0 11 11 (100%)
    396 0 396 0 NA * NA *
    1260 1 1258 0 1309 1308
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 666 influenza viruses [180 A(H3N2), 10 A(H1N1) and 476 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=180), six viruses were antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 174 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,071 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,069 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Ten A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 476 influenza B viruses characterized, 452 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 19 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 666

    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 byWHO.
    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 in week 15 to 31.94 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, 2014-2015
    Influenza Outbreak Surveillance

    In week 15, 21 new outbreaks of influenza were reported. Similar to previous weeks, the majority of the outbreaks occurred in the Central and Atlantic provinces. Nineteen outbreaks were reported in long-term care facilities (LTCF), and two in institutional or community settings (Figure 6). Among the outbreaks in which the influenza type was known (n=3), all outbreaks were associated with influenza B. To date this season, 1,231 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 15, 19 laboratory-confirmed influenza-associated paediatric (=16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. Seventeen cases were 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, three (16%) were <2 years of age, eleven (58%) were 2 to 9 years of age and five (26%) were 10-16 years of age. One ICU admission was reported.
    To date this season, 665 hospitalizations have been reported by the IMPACT network, 502 (80%) 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, 82 cases were admitted to the ICU, of which 45 (55%) were 2 to 9 years of age (Figure 9a). A total of 54 ICU cases reported to have at least one underlying condition or comorbidity. Four 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 15, 16 laboratory-confirmed influenza-associated adult (=16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (CIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 15, 12 cases (75%) were in adults over the age of 65 (Figure 8b). One death was reported in week 15 in an adult over the age of 65 years.
    To date this season, 2,179 cases have been reported; 1,908 (88%) with influenza A. The majority of cases (81%) were among adults =65 years of age (Table 5). One hundred and sixty two ICU admissions have been reported and 117 cases were adults =65 years of age. Among the 162 ICU admissions, 19 were due to influenza B (ten in adults 45 to 64 years of age and nine in adults over the age of 65). A total of 113 ICU cases (70%) reported to have at least one underlying condition or comorbidity. Of the 118 ICU cases with known immunization status, 38 (32%) reported not having been vaccinated this season. One hundred and thirty deaths have been reported, 120 (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.
    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.
    81 0 18 63 8 91 (13.7%)
    109 1 35 73 29 142 (21.4%)
    123 1 40 82 32 165 (24.8%)
    129 0 44 85 33 175 (26.3%)
    60 0 25 35 25 92 (13.8%)
    502 2 162 338 127 665
    79.8% 0.4% 32.3% 67.3% 20.2% 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 (%)
    105 1 55 49 15 120 (6%)
    215 2 97 116 65 280 (13%)
    1585 4 755 826 190 1775 (81%)
    1908 7 908 993 271 2179
    88% 0% 48% 52% 12% 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 15, 191 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which more than the number reported the previous week. Of the 191 hospitalizations, 156 (82%) were due to influenza A and 125 (64%) were in patients =65 years of age.
    Since the start of the 2014-15 season, 7,086 hospitalizations have been reported; 6,345 (90%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.4% were A(H3N2). The majority of cases (71%) were =65 years of age (Table 6). A total of 368 ICU admissions have been reported to date: 52% (n=193) were in adults =65 years of age and 34% (n=124) were in adults 20-64 years. A total of 527 deaths have been reported since the start of the season: three children <5 years of age, four children 5-19 years, 42 adults 20-64 years, and 478 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.
    416 2 150 264 60 476 (7%)
    275 2 132 141 81 356 (5%)
    380 4 228 148 92 472 (7%)
    597 6 255 336 99 696 (10%)
    4621 2 2190 2429 391 5012 (71%)
    56 1 52 3 18 74 (1%)
    6345 17 3007 3321 741 7086
    89.5% 0.3% 47.4% 52.3% 10.5% 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 April 23, 2015, the WHO reported a total of 651 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 225 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 April 23, 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, no new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to April 23, 2015, the WHO has reported a total of 1,106 laboratory-confirmed cases of infection with MERS-CoV, including 421 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 the second outbreak of highly pathogenic avian influenza H5N2 virus in Oxford County, Ontario. To date, there has been two infected commercial premise. All premises located within the 10 km Avian Influenza Control Zone have been placed under quarantine. No human cases have been reported. Avian influenza viruses do not pose risks to food safety when poultry and poultry products are properly handled and cooked. Avian influenza rarely affects humans that do not have consistent contact with infected birds. Further information on the outbreak is provided on the following CFIA website:

    CFIA - Notifiable Avian Influenza
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    FluWatch report: April 5 to April 11, 2015 (Week 14)

    Posted 2015-04-17 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: April 5 to April 11, 2015 (Week 14) (PDF Version - 908 KB - 10 pages)

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    Overall Summary
    • In week 14, influenza B continued to be the predominant influenza virus circulating in all provinces and territories.
    • The number of influenza A and B detections remained similar to the previous week. Other circulating respiratory viruses continue to decrease with the end of the 2014-15 flu season approaching.
    • Influenza B is having a greater impact on adults less than 65 years of age, compared to influenza A(H3N2), which circulated earlier in the season.
    • 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 14, no regions reported widespread activity. Twenty-three regions reported localized activity: BC, AB, MB, ON(6), QC(4), NB(3), NS(4), PE and NL(2). Twenty-four regions reported sporadic activity: in YK, NT(2), BC(4), AB(4), SK(3), MB(2), ON. QC(2), NB(4), and NS. Eleven regions reported no activity: NU(3), MB(2), NS(4), and NL(2).
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 14
    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 14, the percentage positive for influenza A (2.2%) and B (12.2%) declined from the previous week (Figure 2). Influenza B detections were greater than influenza A in all provinces. More influenza B has been observed to date this season (6,130) compared to the same time during the 2013-14 season (5,027). To date, 85% of influenza detections have been influenza A, and 99.3% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 35,137 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, they account for 60% 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 14, detections for all other respiratory viruses remained similar to, or decreased from, the previous week (Figure 3). Overall, the detections of other respiratory viruses have been declining since peaking in week 5.
    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 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.
    3 0 0 3 21 3498 25 2603 870 342
    6 0 4 2 46 3686 13 3519 154 758
    0 0 0 0 9 1312 0 839 473 176
    0 0 0 0 16 1121 0 390 731 119
    43 0 25 18 110 11077 43 4659 6375 884
    24 0 0 24 271 11376 4 422 10950 3119
    26 0 3 23 72 1173 0 183 990 390
    2 0 0 2 14 505 0 123 382 239
    2 0 2 0 12 123 1 120 2 74
    1 0 0 1 5 613 0 123 490 29
    107 0 34 73 576 34484 86 12981 21417 6130
    15.7% 0.0% 31.8% 68.2% 84.3% 84.9% 0.2% 37.6% 62.1% 15.1%
    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.
    5 0 1 4 32 2081 19 807 1255 392 2473 7.0%
    3 0 1 2 31 1775 6 953 816 577 2352 6.7%
    3 0 2 1 36 3426 16 1659 1751 804 4230 12.0%
    6 0 3 3 74 3845 17 1646 2182 1354 5199 14.8%
    25 0 8 17 188 18637 13 7232 11392 2120 20757 59.1%
    0 0 0 0 0 121 0 100 21 5 126 0.4%
    42 0 15 27 361 29885 71 12397 17417 5252 35137 100.0%
    10.4% 0.0% 35.7% 64.3% 89.6% 85.1% 0.2% 41.5% 58.3% 14.9%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,197 influenza viruses for resistance to oseltamivir and 1,192 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 1,284 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    846 1 843 0 1275 1274 (99.9%)
    9 0 9 0 10 10 (100%)
    342 0 340 0 NA * NA *
    1197 1 1192 0 1285 1284
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 611 influenza viruses [179 A(H3N2), 10 A(H1N1) and 422 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=179), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 173 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,054 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,052 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.
    Influenza A(H1N1): Ten A(H1N1) viruses characterized were antigenically similar to A/California/7/2009.
    Influenza B: Of the 422 influenza B viruses characterized, 400 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 19 were B/Brisbane/60/2008-like (Figure 4).

    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 611

    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 byWHO.
    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 in week 14 to 49.4 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, 2014-2015
    Influenza Outbreak Surveillance

    In week 14, 26 new outbreaks of influenza were reported. Similar to previous weeks, the majority of the outbreaks occurred in the Central and Atlantic provinces. Twenty outbreaks were reported in long-term care facilities (LTCF), one in hospitals and five in institutional or community settings (Figure 6). Among the outbreaks in which the influenza type was known (n=8), six outbreaks were associated with influenza B. To date this season, 1,212 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 14, 15 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. Fourteen cases were 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, one (7%) was <2 years of age, ten (67%) were 2 to 9 years of age and four (27%) were 10-16 years of age. One ICU admission was reported.
    To date this season, 643 hospitalizations have been reported by the IMPACT network, 502 (80%) 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, 82 cases were admitted to the ICU, of which 45 (55%) were 2 to 9 years of age (Figure 9a). A total of 54 ICU cases reported to have at least one underlying condition or comorbidity. Four 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 14, 30 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 14, 21 cases (70%) were in adults over the age of 65 and 23 cases (77%) had influenza B (Figure 8b).
    To date this season, 2,147 cases have been reported; 1,896 (88%) with influenza A. The majority of cases (82%) were among adults ≥65 years of age (Table 5). One hundred and fifty seven ICU admissions have been reported and 119 cases were adults ≥65 years of age. Among the 157 ICU admissions, 15 were due to influenza B (seven in adults 45 to 64 years of age and eight in adults over the age of 65). A total of 111 ICU cases (71%) reported to have at least one underlying condition or comorbidity. Of the 120 ICU cases with known immunization status, 38 (32%) reported not having been vaccinated this season. One hundred and twenty four deaths have been reported, 114 (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.
    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.
    81 0 18 63 8 89 (13.8%)
    109 1 35 73 29 140 (21.8%)
    123 1 40 82 32 160 (24.9%)
    129 0 44 85 33 167 (26.0%)
    60 0 25 35 25 87 (13.5%)
    502 2 162 338 127 643
    79.8% 0.4% 32.3% 67.3% 20.2% 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 (%)
    105 1 55 49 12 117 (5%)
    214 2 94 118 61 275 (13%)
    1574 3 749 822 177 1751 (82%)
    1896 6 899 991 251 2147
    88% 0% 47% 52% 12% 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 14, 122 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is similar to the number reported the previous week. Of the 122 hospitalizations, 84 (69%) were due to influenza A and 78 (64%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 6,847 hospitalizations have been reported; 6,195 (91%) 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 358 ICU admissions have been reported to date: 53% (n=190) were in adults ≥65 years of age and 33% (n=119) were in adults 20-64 years. A total of 511 deaths have been reported since the start of the season: four children <5 years of age, three children 5-19 years, 41 adults 20-64 years, and 463 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.
    408 2 146 260 51 459 (7%)
    273 2 133 138 72 345 (5%)
    372 3 223 146 78 450 (7%)
    579 4 241 334 85 664 (10%)
    4507 2 2109 2396 348 4855 (71%)
    56 1 52 3 18 74 (1%)
    6195 14 2904 3277 652 6847
    90.5% 0.2% 46.9% 52.9% 9.5% 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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    FluWatch report: March 29 to April 04, 2015 (Week 13)

    Posted 2015-04-10 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: March 29 to April 04, 2015 (Week 13) (PDF Version - 902 KB - 10 pages)

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    Overall Summary
    • The majority of influenza activity continues to occur in the Central and Atlantic province however, less activity was reported this week from these regions.
    • The number of influenza A and B detections decreased this week.
    • Influenza B is having a greater impact on adults less than 65 years of age, compared to influenza A(H3N2), which circulated earlier in the season.
    • 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 13, no regions reported widespread activity. Eighteen regions reported localized activity: AB, MB, ON(6), QC(3), NB(2), NS(3), PE and NL. Twenty-nine regions reported sporadic activity: in YK, NT(2), BC(3), AB(4), SK(3), MB(4), ON. QC(3), NB(5), and NS(3). Eleven regions reported no activity: NU(3), BC(2), NS(3), and NL(3).
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 13



    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 13, the percentage positive for influenza A (3.4%) continued to decline from the previous week while the percentage of positive influenza B tests continued to increase (12.9%) (Figure 2).Influenza B detections were greater than influenza A in all provinces except NS. More influenza B has been observed to date this season (5,521) compared to the same time during the 2013-14 season (4,371). To date, 86% of influenza detections have been influenza A, and 99.3% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 34,604 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, they account for 60% 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 13, detections for all other respiratory viruses remained similar to, or decreased from, the previous week (Figure 3). Overall, the detections of other respiratory viruses have been declining since peaking in week 5.
    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.
    B Total B Total
    7 0 0 7 24 3495 25 2603 867 321
    14 0 11 3 45 3680 13 3513 154 712
    1 0 0 1 10 1312 0 839 473 150
    1 0 1 0 13 1121 0 390 731 103
    60 1 25 34 104 11028 43 4633 6352 758
    20 0 0 20 274 11352 4 422 10926 2848
    30 0 5 25 62 1147 0 180 967 318
    16 0 0 16 16 503 0 123 380 225
    1 0 1 0 16 121 1 118 2 62
    2 0 0 2 5 612 0 123 489 24
    152 1 43 108 569 34371 86 12944 21341 5521
    21.1% 0.7% 28.3% 71.1% 78.9% 86.2% 0.3% 37.7% 62.1% 13.8%
    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.
    3 0 0 3 32 2073 18 805 1250 351 2424 7.0%
    4 0 0 4 35 1770 6 951 813 536 2306 6.7%
    6 0 0 6 54 3419 16 1652 1751 748 4167 12.0%
    7 0 1 6 98 3835 17 1639 2179 1247 5082 14.7%
    46 0 17 29 168 18602 13 7215 11374 1897 20499 59.2%
    0 0 0 0 0 121 0 100 21 5 126 0.4%
    66 0 18 48 387 29820 70 12362 17388 4784 34604 100.0%
    14.6% 0.0% 27.3% 72.7% 85.4% 86.2% 0.2% 41.5% 58.3% 13.8%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,121 influenza viruses for resistance to oseltamivir and zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 1,235 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    834 1 834 0 1230 1229 (99.9%)
    6 0 6 0 6 6 (100%)
    281 0 281 0 NA * NA *
    1121 1 1121 0 1236 1235
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 558 influenza viruses [179 A(H3N2), 9 A(H1N1) and 370 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=179), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 173 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1,035 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,033 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.
    Influenza A(H1N1): Nine A(H1N1) viruses characterized were antigenically similar to A/California/7/2009.
    Influenza B: Of the 370 influenza B viruses characterized, 351 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 16 were B/Brisbane/60/2008-like (Figure 4).

    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 558

    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 byWHO.
    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 in week 13 to 31.2 consultations per 1,000, which is within 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, 2014-2015
    Influenza Outbreak Surveillance

    In week 13, 25 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Nineteen outbreaks were reported in long-term care facilities (LTCF), one in hospitals and five in institutional or community settings (Figure 6). Among the outbreaks in which the influenza type was known (n=9), seven outbreaks were associated with influenza B. To date this season, 1,192 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

    Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).
    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 13, 10 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All 10 cases were 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, two (20%) were <2 years of age, five (50%) were 2 to 9 years of age and three (30%) were 10-16 years of age. Three ICU admissions were reported.
    To date this season, 629 hospitalizations have been reported by the IMPACT network, 502 (80%) 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, 82 cases were admitted to the ICU, of which 46 (56%) were 2 to 9 years of age (Figure 9a). A total of 54 ICU cases reported to have at least one underlying condition or comorbidity. Four 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 13, 24 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 13, 20 cases (83%) were in adults over the age of 65 and 14 cases (58%) had influenza B (Figure 8b).
    To date this season, 2,101 cases have been reported; 1,887 (90%) with influenza A. The majority of cases (82%) were among adults ≥65 years of age (Table 5). One hundred and fifty four ICU admissions have been reported and 116 cases were adults ≥65 years of age. Among the 154 ICU admissions, 12 were due to influenza B (six in adults 45 to 64 years of age and six in adults over the age of 65). A total of 110 ICU cases (73%) reported to have at least one underlying condition or comorbidity. Of the 112 ICU cases with known immunization status, 38 (34%) reported not having been vaccinated this season. One hundred and twenty three deaths have been reported, 113 (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.
    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.
    81 0 18 63 8 89 (14.1%)
    109 1 35 73 29 138 (21.9%)
    123 1 40 82 32 155 (24.6%)
    129 0 44 85 33 162 (25.8%)
    60 0 25 35 25 85 (13.5%)
    502 2 162 338 127 629
    79.8% 0.4% 32.3% 67.3% 20.2% 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 (%)
    105 1 54 50 10 115 (5%)
    215 1 92 122 52 267 (13%)
    1564 3 734 827 151 1715 (82%)
    1887 5 881 1001 214 2101
    90% 0% 47% 53% 10% 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 13, 120 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is less than the number reported the previous week. Of the 120 hospitalizations, 84 (70%) were due to influenza A and 82 (68%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 6,679 hospitalizations have been reported; 6,108 (91.5%) 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 352 ICU admissions have been reported to date: 53% (n=188) were in adults ≥65 years of age and 33% (n=116) were in adults 20-64 years. A total of 493 deaths have been reported since the start of the season: four children <5 years of age, three children 5-19 years, 40 adults 20-64 years, and 446 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.
    401 2 143 256 45 446 (7%)
    267 2 130 135 65 332 (5%)
    371 3 223 145 72 443 (7%)
    572 5 239 328 73 645 (10%)
    4441 2 2066 2373 298 4739 (71%)
    56 1 52 3 18 74 (1%)
    6108 15 2853 3240 571 6679
    91.5% 0.2% 46.7% 53.0% 8.5% 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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    FluWatch report: March 22 to 28, 2015 (Week 12)

    Posted 2015-04-02 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: March 22 to 28, 2015 (Week 12) (PDF Version - 902 KB - 10 pages)

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    Overall Summary
    • The majority of influenza activity continues to occur in the Central and Atlantic provinces.
    • Influenza B detections continue to increase steadily across Canada while detections of influenza A continues to steadily decrease. This increase in influenza B is expected as influenza B often shows up later in the flu season.
    • Influenza B is having a greater impact on adults less than 65 years of age, compared to influenza A(H3N2), which circulated earlier in the season.
    • 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 12, two regions in Quebec reported widespread activity. Twenty-two regions reported localized activity: BC, AB, MB(2), ON(7), QC(2), NB(3), NS(5) and NL. Twenty-eight regions reported sporadic activity: in YK, NT(2), BC(4), AB(4), SK(3), MB(2), QC(2), NB(4), NS(3), PE and NF(2). No activity was reported in six regions : NU(3). MB, NS, and NL.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 12



    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 12, the percentage positive for influenza A (4.7%) continued to decline from the previous week while the percentage of positive influenza B tests continued to increase (11.5%) (Figure 2). Influenza B detections were greater than influenza A in all provinces except NL. To date, 87% of influenza detections have been influenza A, and 99.3% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 33,953 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, they account for 60% 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 12, detections for all other respiratory viruses remained similar to, or decreased from, the previous week (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, 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.
    26 0 19 7 32 3488 25 2603 860 297
    4 0 3 1 58 3666 13 3502 151 667
    4 0 2 2 11 1311 0 839 472 131
    1 0 1 0 18 1119 0 389 730 90
    88 2 40 46 104 10959 41 4606 6312 626
    43 0 0 43 365 11332 4 422 10906 2574
    75 0 11 64 80 1117 0 175 942 256
    23 0 0 23 29 487 0 123 364 209
    0 0 0 0 20 120 1 117 2 46
    7 0 0 7 6 610 0 53 557 19
    271 2 76 193 723 34209 84 12829 21296 4915
    27.3% 0.7% 28.0% 71.2% 72.7% 87.4% 0.2% 37.5% 62.3% 12.6%
    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.
    5 1 0 4 31 2069 19 804 1246 305 2374 7.0%
    4 0 0 4 33 1760 6 945 809 482 2242 6.6%
    6 0 1 5 61 3407 16 1650 1741 669 4076 12.0%
    5 0 1 4 133 3814 17 1631 2166 1107 4921 14.5%
    72 0 15 57 178 18514 13 7176 11325 1701 20215 59.5%
    0 0 0 0 1 120 0 99 21 5 125 0.4%
    92 1 17 74 437 29684 71 12305 17308 4269 33953 100.0%
    17.4% 1.1% 18.5% 80.4% 82.6% 87.4% 0.2% 41.5% 58.3% 12.6%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,094 influenza viruses for resistance to oseltamivir and 1,090 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 1,235 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    831 1 827 0 1230 1229 (99.9%)
    6 0 6 0 6 6 (100%)
    257 0 257 0 NA * NA *
    1094 1 1090 0 1236 1235
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 490 influenza viruses [176 A(H3N2), 9 A(H1N1) and 305 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=176), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 170 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 1025 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1023 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): Nine A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 305 influenza B viruses characterized, 291 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 14 were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 490

    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 byWHO.
    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 in week 12 to 20.5 consultations per 1,000, which is below 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, 2014-2015
    Influenza Outbreak Surveillance

    In week 12, 33 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Thirty-one outbreaks were reported in long-term care facilities (LTCF) and two in institutional or community settings (Figure 6). Among the outbreaks in which the influenza type was known (n=12), eight outbreaks were associated with influenza B. To date this season, 1,173 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 12, the proportion of prescriptions for antivirals decreased to 110.0 antiviral prescriptions per 100,000 total prescriptions (from 135.8 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 12. The rate was highest among seniors at 176.7 per 100,000 total prescriptions and lowest among infants at 10.4 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 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 12, 23 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All 23 cases were 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 (22%) were <2 years of age, ten (43%) were 2 to 9 years of age and eight (35%) were 10-16 years of age. Three ICU admissions were reported.
    To date this season, 621 hospitalizations have been reported by the IMPACT network, 503 (81%) 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, 79 cases were admitted to the ICU, of which 44 (56%) were 2 to 9 years of age (Figure 9a). A total of 51 ICU cases reported to have at least one underlying condition or comorbidity. Four 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 12, 40 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 12, 30 cases (75%) were in adults over the age of 65 and 25 cases (63%) had influenza B (Figure 8b).
    To date this season, 2,071 cases have been reported; 1,876 (91%) with influenza A. The majority of cases (82%) were among adults ≥65 years of age (Table 5). One hundred and fifty one ICU admissions have been reported and 113 cases were adults ≥65 years of age. A total of 110 ICU cases (73%) reported to have at least one underlying condition or comorbidity. Of the 114 ICU cases with known immunization status, 38 (33%) reported not having been vaccinated this season. One hundred and twenty one deaths have been reported, 111 (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.
    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.
    81 0 18 63 7 88 (14.2%)
    109 1 35 73 29 138 (22.2%)
    124 1 40 83 28 152 (24.5%)
    129 0 44 85 31 160 (25.8%)
    60 0 25 35 23 83 (13.4%)
    503 2 162 339 118 621
    81.0% 0.4% 32.2% 67.4% 19.0% 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 (%)
    104 1 54 49 10 114 (6%)
    214 1 92 121 48 262 (13%)
    1555 3 732 820 136 1691 (82%)
    1876 5 879 992 195 2071
    91% 0% 47% 53% 9% 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 12, 148 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories*, which is similar to the number reported the previous week. Of the 148 hospitalizations, 97 (66%) were due to influenza A and 97 (65%) were in patients ≥65 years of age.
    Since the start of the 2014-15 season, 6,499 hospitalizations have been reported; 6,008 (92.4%) 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 340 ICU admissions have been reported to date: 54% (n=183) were in adults ≥65 years of age and 32% (n=110) were in adults 20-64 years. A total of 479 deaths have been reported since the start of the season: three children <5 years of age, three children 5-19 years, 40 adults 20-64 years, and 433 adults ≥65 years of age. Adults 65 years of age or older represent 90% 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.
    398 2 143 253 34 432 (7%)
    266 2 130 134 56 322 (5%)
    366 3 220 143 66 432 (7%)
    564 4 234 326 63 627 (10%)
    4358 2 2024 2332 254 4612 (71%)
    56 1 52 3 18 74 (1%)
    6008 14 2803 3191 491 6499
    92.4% 0.2% 46.7% 53.1% 7.6% 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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    FluWatch report: March 15 to 21, 2015 (Week 11)

    Posted 2015-03-27 For readers interested in the PDF version, the document is available for downloading or viewing:
    FluWatch report: March 15 to 21, 2015 (Week 11) (PDF Version - 824 KB - 10 pages)

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    Overall Summary
    • The majority of influenza activity is occurring in the Central and Atlantic provinces.
    • Influenza B detections continue to increase steadily across Canada while detections of influenza A continues to steadily decrease. 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 11, four regions reported widespread activity: QC(3) and NL. Twenty-two regions reported localized activity: BC(2), AB, MB, ON(7), QC(2), NB(3), NS(5) and PE. Twenty-four regions reported sporadic activity: in YK, NT(2), BC(3), AB(4), SK(3), MB(2), QC, NB(3), NS(3), and NF(2). No activity was reported in eight regions : NU(3). MB(2), NB, NS, and NL.
    Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 11



    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 11, the number of positive influenza tests (958) and the percentage positive for influenza A (5.4%) continued to decline from the previous week (Figure 2). The percentage of positive influenza B tests continued to increase and was 11.5% in week 11. Influenza B detections were greater than influenza A detections in many provinces (BC, AB, SK, MB, QC, PE and NS). To date, 89% 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 33,253 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 60% 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 11, detections for all other respiratory viruses remained similar to, or decreased from, the previous week, except those for rhinovirus (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, 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.
    10 0 0 10 38 3462 25 2584 853 265
    14 0 11 3 78 3662 13 3497 152 609
    0 0 0 0 10 1306 0 837 469 108
    0 0 0 0 11 1118 0 388 730 72
    138 3 46 89 98 10854 39 4561 6254 494
    81 0 0 81 318 11289 4 422 10863 2209
    38 0 10 28 36 1042 0 164 878 176
    14 0 0 14 53 464 0 123 341 180
    4 0 4 0 3 120 1 117 2 26
    11 0 0 11 3 603 0 53 550 13
    310 3 71 236 648 33920 82 12746 21092 4152
    32.4% 1.0% 22.9% 76.1% 67.6% 89.1% 0.2% 37.6% 62.2% 10.9%
    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 33 2059 17 801 1241 267 2326 7.0%
    6 1 4 1 30 1757 6 946 805 430 2187 6.6%
    18 0 3 15 68 3388 16 1644 1728 592 3980 12.0%
    24 0 1 23 114 3803 17 1626 2160 944 4747 14.3%
    105 1 16 88 227 18419 12 7143 11264 1471 19890 59.8%
    1 0 1 0 0 120 0 99 21 3 123 0.4%
    167 2 27 138 472 29546 68 12259 17219 3707 33253 100.0%
    26.1% 1.2% 16.2% 82.6% 73.9% 88.9% 0.2% 41.5% 58.3% 11.1%
    Antiviral Resistance

    During the 2014-2015 influenza season, the NML has tested 1,024 influenza viruses for resistance to oseltamivir and 1,021 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 1,223 influenza A viruses (99.9%) were resistant to amantadine (Table 3).
    * NA - not applicable
    811 1 809 0 1218 1217 (99.9%)
    6 0 5 0 6 6 (100%)
    207 0 207 0 NA * NA *
    1024 1 1021 0 1224 1223
    Influenza Strain Characterizations

    During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 414 influenza viruses [174 A(H3N2), 5 A(H1N1) and 235 influenza B].
    Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=174), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 168 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 971 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 969 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 235 influenza B viruses characterized, 225 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and seven were B/Brisbane/60/2008-like (Figure 4).
    Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 414

    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 byWHO.
    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 in week 11 to 28.9 consultations per 1,000, which is within 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, 2014-2015
    Influenza Outbreak Surveillance

    In week 11, 63 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Forty-nine outbreaks were reported in long-term care facilities (LTCF), five in hospitals and nine in institutional or community settings (Figure 6). An additional two outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known (n=11), ten outbreaks were associated with influenza B (one in a hospital, seven in LTCFs, and two in an institutional or community setting). To date this season, 1,142 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 11, the proportion of prescriptions for antivirals was 119.1 antiviral prescriptions per 100,000 total prescriptions which was similar to the previous week. The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups except seniors decreased in week 11. The rate was highest among seniors at 189.5 per 100,000 total prescriptions and lowest among infants at 50.5 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 11, 14 laboratory-confirmed influenza-associated paediatric (=16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: five cases of influenza A and nine 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, three (21%) were <2 years of age, ten (71%) were 2 to 9 years of age and one (7%) was 10-16 years of age. One ICU admission was reported.
    To date this season, 595 hospitalizations have been reported by the IMPACT network, 502 (84%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (163/165) were A(H3N2) (Table 4). To date, 74 cases were admitted to the ICU, of which 39 (53%) were 2 to 9 years of age (Figure 9a). A total of 49 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 11, 28 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 11, 20 cases (74%) were in adults over the age of 65 and 18 cases (67%) had influenza B (Figure 8b).
    To date this season, 2,009 cases have been reported; 1,852 (92%) with influenza A. The majority of cases (82%) were among adults =65 years of age (Table 5). One hundred and forty nine ICU admissions have been reported and 112 cases were adults =65 years of age. A total of 107 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 114 ICU cases with known immunization status, 37 (32%) reported not having been vaccinated this season. One hundred and seventeen deaths have been reported, 107 (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.
    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.
    81 0 18 63 6 87 (14.6%)
    109 1 35 73 24 133 (22.4%)
    122 1 40 81 23 145 (24.4%)
    130 0 45 85 25 155 (26.1%)
    60 0 25 35 15 75 (12.6%)
    502 2 163 337 93 595
    84.4% 0.4% 32.5% 67.1% 15.6% 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 (%)
    104 1 48 55 8 112 (6%)
    214 0 89 125 38 252 (13%)
    1531 3 661 867 110 1641 (82%)
    1852 4 799 1049 157 2009
    92% 0% 43% 57% 8% 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 11, 148 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories* which is slightly more than the number reported in week 10 (n=139). Of the 148 hospitalizations, all but 49 were due to influenza A, and 67% were in patients =65 years of age.
    Since the start of the 2014-15 season, 6,249 hospitalizations have been reported; 5,877 (95%) 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 321 ICU admissions have been reported to date: 54% (n=172) were in adults =65 years of age and 32% (n=102) were in adults 20-64 years. A total of 462 deaths have been reported since the start of the season: three children <5 years of age, three children 5-19 years, 38 adults 20-64 years, and 418 adults =65 years of age. Adults 65 years of age or older represent 90% 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.
    389 2 139 248 28 417 (7%)
    259 2 127 130 43 302 (5%)
    364 3 218 143 43 407 (7%)
    547 4 226 317 52 599 (10%)
    4262 2 1958 2302 191 4453 (71%)
    56 1 52 3 15 71 (1%)
    5877 14 2720 3143 372 6249
    94.0% 0.2% 46.3% 53.5% 6.0% 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.
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    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.
    378 2 137 239 19 397 (7%)
    247 2 123 122 35 282 (5%)
    353 3 208 142 33 386 (6%)
    534 4 221 309 40 574 (10%)
    4141 2 1899 2240 151 4292 (72%)
    56 1 52 3 11 67 (1%)
    5709 14 2640 3055 289 5998
    95.2% 0.2% 46.2% 53.5% 4.8% 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.

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    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 jurisdict