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  • Canada FluWatch Weekly Reports 2018-2019 Season Week 6

    FluWatch report: November 18, 2018 to November 24, 2018 (Week 47)


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    (PDF format, 909 KB, 9 pages)
    Organization: Public Health Agency of Canada
    Date published: 2018-11-30

    Related Topics





    Overall Summary

    • Influenza activity continued to increase in week 47.
    • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
    • The number of influenza-associated hospitalizations continued to increase in week 47. In particular, the number of pediatric hospitalizations is significantly higher than in recent years.


    On this page

    Influenza/Influenza-like Illness Activity (geographic spread)

    During week 47, influenza activity levels increased slightly compared to the previous week (Figure 1):
    • One region reported widespread activity: in Que.(1),
    • Four regions reported localized activity: in Alta.(1), Ont.(2), and N.B.(1),
    • Sporadic activity was reported by 32 regions, in B.C.(5), Alta.(4), Sask.(3), Man.(3), Ont.(3), Que.(5), N.B.(2), N.S.(1), P.E.I.(1), N.L.(2), N.W.T(2) and Nvt.(1).
    • No activity was reported by 16 regions.



    Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2018-47

    Figure 1 - Text description Laboratory Confirmed Influenza Detections

    In week 47, the following results were reported from sentinel laboratories across Canada (Figure 2):
    • The percentage of tests positive for influenza continued to increase to 15.3% of tests positive.
    • The percentage of tests positive for influenza A is higher for this time of year compared to the same period during the previous eight seasons.
    • In week 47, 950 laboratory detections of influenza were reported, of which 99% were influenza A.
    To date this season 3,176 laboratory-confirmed influenza detections have been reported (Figure 3):
    • 92% have been influenza A.
    • Among the 1,760 influenza A viruses subtyped, 82% have been A(H1N1)pdm09.
    • Provincial and territorial differences in influenza type/subtype distribution are observed (Figure 3).
    To date this season, detailed information on age and type/subtype has been received for 3,155 laboratory-confirmed influenza cases (Table 1):
    • 69% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
    • 70% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
    For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
    Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2018-47

    The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
    Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2018-47

    Figure 3 - Text description
    0-4 632 377 3 252 5 637 20%
    5-19 650 334 5 311 11 661 21%
    20-44 797 399 15 383 9 806 26%
    45-64 565 285 32 248 7 572 18
    65+ 465 206 131 128 14 479 15%
    Total 3109 1601 186 1322 46 3155 100%
    Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
    Return to Table 1 - Note1
    Syndromic/Influenza-like Illness Surveillance

    Healthcare Professionals Sentinel Syndromic Surveillance

    In week 47, 1.9% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
    Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-47

    Number of Sentinels Reporting in Week 47: 84
    The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
    Figure 4 - Text description Participatory Syndromic Surveillance

    In week 47, 2,182 participants reported to FluWatchers, of which 29 (1.3%) reported symptoms of cough and fever (Figure 5).
    Among the 29 participants who reported fever and cough:
    • 28% consulted a healthcare professional;
    • 83% reported days missed from work or school, resulting in a combined total of 66 missed days of work or school.
    Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2018-47

    Number of Participants Reporting in Week 47: 2,182
    Figure 5 - Text description Influenza Outbreak Surveillance

    In week 47, five new laboratory-confirmed influenza outbreaks were reported in long-term care (3) and acute care (2) facilities.
    To date this season, 36 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
    • 19 outbreaks were in LTCF, eight were in schools, and five were in other settings.
    • All of the 30 outbreaks for which the influenza type was available were associated with influenza A.
    • Among the 21 outbreaks for which the influenza A subtype was available:
      • 17 were associated with influenza A(H1N1)pdm09;
      • Four were associated with A(H3N2);
    One new ILI outbreak in a LTCF was reported in week 47.
    To date this season, 25 ILI outbreaks have been reported; 23 occurred in LTCF, one in a school, and one in an acute care facility.
    Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2018-47

    Figure 6 - Text description Severe Outcomes Influenza Surveillance

    Provincial/Territorial Influenza Hospitalizations and Deaths

    To date this season, more than 471 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
    Hospitalizations (Table 2):
    • 99% (471) were associated with influenza A
    • The highest estimated rates of hospitalization are among children under 5 years of age.
    Intensive Care Unit (ICU) cases and deaths:
    • To date this season 49 ICU admissions and nine deaths have been reported.
    Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
    Return to footnote1referrer
    0-4 95 0 7.77
    5-19 64 0 2.31
    20-44 72 0 1.20
    45-64 115 0 2.39
    65+ 125 <5 5.18
    Total 471 <5
    % 99% 1%
    Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
    Return to Table 2 - Footnote1referrer
    Pediatric Influenza Hospitalizations and Deaths

    In week 47, 34 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network. Pediatric hospitalizations reported by IMPACT are at levels not normally seen until late December (4-6 weeks earlier than in recent seasons) (Figure 7).
    To date this season, 145 pediatric hospitalizations have been reported (Figure 8):
    • All but two cases have been associated with influenza A.
    • Among the 109 cases for which the influenza subtype was available, 108 were associated with A(H1N1)pdm09.
    To date this season, 18 ICU admissions, and no deaths have been reported.
    Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2018-47

    Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2018-47

    Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

    Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
    To date this season, 17 hospitalizations have been reported, of which 15 were associated with influenza A and 2 with influenza B.
    Influenza Strain Characterizations

    Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 101 influenza viruses (11 A(H3N2), 80 A(H1N1) and 10 B) that were received from Canadian laboratories.
    Genetic Characterization of Influenza A (H3N2):

    Ten influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
    Sequence analysis of the HA gene of the viruses showed that:
    • One virus belonged to genetic group 3C.2a.
    • Nine viruses belonged to subclade 3C.2a1.
    A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine
    Antigenic Characterization:

    Influenza A(H3N2):

    • One influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
    • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
    • The influenza A (H3N2) virus characterized belonged to genetic group 3C.2a1.
    Influenza A(H1N1):

    • 80 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
    Influenza B:

    Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
    • Ten influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
    • ...
    https://www.canada.ca/en/public-heal...r-24-2018.html


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

  • #2
    FluWatch report: November 25, 2018 to December 1, 2018 (Week 48)


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    (PDF format, 1.2 MB, 9 pages)
    Organization: Public Health Agency of Canada
    Date published: 2018-12-07

    Related Topics



    Overall Summary

    • Influenza activity continued to increase in week 48.
    • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
    • The number of influenza-associated hospitalizations continued to increase in week 48. In particular, the number of pediatric hospitalizations is significantly higher than in recent years.


    On this page

    Influenza/Influenza-like Illness Activity (geographic spread)

    During week 48, influenza activity levels continued to increase (Figure 1):
    • Nine regions reported localized activity: in Alta.(2), Sask.(1), Man.(1), Ont.(2), Que.(1), N.B.(1) and N.S.(1).
    • Sporadic activity was reported by 29 regions in Alta.(3), Sask.(2), Man.(4), Ont.(5), Que.(5), N.B.(3), N.S.(1), N.L.(2), N.W.T(2), Nvt.(1) and Yt.(1).
    • No activity was reported by 10 regions.



    Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2018-48

    Figure 1 - Text description Laboratory Confirmed Influenza Detections

    In week 48, the following results were reported from sentinel laboratories across Canada (Figure 2):
    • The percentage of tests positive for influenza continued to increase to 18.1% of tests positive.
    • The percentage of tests positive for influenza A is higher for this time of year compared to the same period during the previous eight seasons.
    • In week 48, 1,301 laboratory detections of influenza were reported, of which 99% were influenza A.
    To date this season 4,485 laboratory-confirmed influenza detections have been reported (Figure 3):
    • 99% have been influenza A.
    • Among the 2,384 influenza A viruses subtyped, 93% have been A(H1N1)pdm09.
    To date this season, detailed information on age and type/subtype has been received for 4,409 laboratory-confirmed influenza cases (Table 1):
    • 70% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
    • 70% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
    For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
    Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2018-48

    The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
    Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2018-48

    Figure 3 - Text description
    0-4 908 517 3 388 6 914 21%
    5-19 925 467 5 453 13 938 21%
    20-44 1100 551 17 532 12 1112 25%
    45-64 816 392 38 386 9 825 19%
    65+ 604 259 149 196 16 620 14%
    Total 4353 2186 212 1955 56 4409 100%
    Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
    Return to Table 1 - Note1
    Syndromic/Influenza-like Illness Surveillance

    Healthcare Professionals Sentinel Syndromic Surveillance

    In week 48, 2.3% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is slightly above expected levels.
    Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-48

    Number of Sentinels Reporting in Week 48: 86
    The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
    Figure 4 - Text description Participatory Syndromic Surveillance

    In week 48, 2,226 participants reported to FluWatchers, of which 53 (2.3%) reported symptoms of cough and fever (Figure 5).
    Among the 53 participants who reported fever and cough:
    • 21% consulted a healthcare professional;
    • 64% reported days missed from work or school, resulting in a combined total of 89 missed days of work or school.
    Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2018-48

    Number of Participants Reporting in Week 48: 2,226
    Figure 5 - Text description Influenza Outbreak Surveillance

    In week 48, seven new laboratory-confirmed influenza outbreaks were reported in long-term care (4), acute care facilities (2) and other settings (1).
    To date this season, 44 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
    • 23 outbreaks were in LTCF, nine were in schools, six in acute care facilities, and six were in other settings.
    • All of the 36 outbreaks for which the influenza type was available were associated with influenza A.
    • Among the 27 outbreaks for which the influenza A subtype was available:
      • 21 were associated with influenza A(H1N1)pdm09;
      • 6 were associated with A(H3N2),
    Three new ILI outbreaks were reported in week 48.
    To date this season, 31 ILI outbreaks have been reported; 25 occurred in LTCF, three in schools, and three in acute care facilities.
    Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2018-48

    Figure 6 - Text description Severe Outcomes Influenza Surveillance

    Provincial/Territorial Influenza Hospitalizations and Deaths

    To date this season, more than 588 influenza-assocaited hospitalizations have been reported by participating provinces and territoriesFootnote1.
    Hospitalizations (Table 2):
    • 99% (588) were associated with influenza A
    • The highest estimated rate of hospitalization is among children under 5 years of age.
    Intensive Care Unit (ICU) cases and deaths:
    • To date this season 65 ICU admissions and 9 deaths have been reported.
    Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
    Return to footnote1referrer
    0-4 108 0 22.69
    5-19 75 0 5.41
    20-44 91 0 3.20
    45-64 149 0 6.85
    65+ 165 <5 13.81
    Total 588 <5
    % 99% 1%
    Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
    Return to Table 2 - Footnote1referrer
    Pediatric Influenza Hospitalizations and Deaths

    In week 48, 44 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network. Pediatric hospitalizations reported by IMPACT are at levels not normally seen until late December (approximately 4 weeks earlier than in recent seasons) (Figure 7).
    To date this season, 189 pediatric hospitalizations have been reported (Figure 8):
    • All but three cases have been associated with influenza A.
    • Among the 132 cases for which the influenza subtype was available, 130 (98.5%) were associated with A(H1N1)pdm09.
    To date this season, 28 ICU admissions, and no deaths have been reported.
    Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2018-48

    Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2018-48

    Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

    Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
    To date this season, 23 hospitalizations have been reported:
    • 20 (87%) were associated with influenza A and 3 with influenza B.
    • 11 of the 23 cases (48%) were adults 65 years of age and older.
    Influenza Strain Characterizations

    Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 142 influenza viruses (20 A(H3N2), 112 A(H1N1) and 10 B) that were received from Canadian laboratories.
    Genetic Characterization of Influenza A (H3N2):

    19 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
    Sequence analysis of the HA gene of the viruses showed that:
    • Two viruses belonged to genetic group 3C.2a.
    • 17 viruses belonged to subclade 3C.2a1.
    A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
    Antigenic Characterization:

    Influenza A(H3N2):

    • One influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
    • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
    • The influenza A (H3N2) virus characterized belonged to genetic group 3C.2a1.
    Influenza A(H1N1):

    • 112 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
    Influenza B:

    Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
    • Ten influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
    • ...
    https://www.canada.ca/en/public-heal...er-1-2018.html


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

    Comment


    • #3
      FluWatch report: December 2, 2018 to December 8, 2018 (Week 49)


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      (PDF format, 1.2 MB, 9 pages)
      Organization: Public Health Agency of Canada
      Date published: 2018-12-14

      Related Topics



      Overall Summary

      • Influenza activity continued to increase in week 49.
      • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
      • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.


      On this page

      Influenza/Influenza-like Illness Activity (geographic spread)

      During week 49, influenza activity levels continued to increase (Figure 1):
      • Eight regions reported localized activity: in B.C.(1), Alta.(1), Sask.(1), Man.(1), Ont.(2), Que.(1), and N.B.(1)
      • Sporadic activity was reported by 34 regions: in B.C.(4), Alta.(4), Sask.(2), Man.(5), Ont.(4), Que.(5), N.B.(3), N.L.(2), P.E.I.(1), N.W.T(2), Nvt.(1) and Yt.(1).
      • No activity was reported by 12 regions.



      Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2018-49

      Figure 1 - Text description Laboratory Confirmed Influenza Detections

      In week 49, the following results were reported from sentinel laboratories across Canada (Figure 2):
      • The percentage of tests positive for influenza continued to 19.3%.
      • 1,500 laboratory detections of influenza were reported, of which 99% were influenza A.
      To date this season 6,158 laboratory-confirmed influenza detections have been reported (Figure 3):
      • 99% have been influenza A.
      • Among the 3,209 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
      • Provincial and territorial differences in influenza type/subtype distribution are observed.
      To date this season, detailed information on age and type/subtype has been received for 6,024 laboratory-confirmed influenza cases (Table 1):
      • 70% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
      • 68% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
      For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
      Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2018-49

      The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
      Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2018-49

      Figure 3 - Text description
      0-4 1277 698 4 575 10 1287 21%
      5-19 1247 637 5 605 15 1262 21%
      20-44 1490 724 27 739 13 1503 25%
      45-64 1131 555 43 533 9 1140 19%
      65+ 813 331 167 315 19 832 14%
      Total 5958 2945 246 2767 66 6024 100%
      Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
      Return to Table 1 - Note1
      Syndromic/Influenza-like Illness Surveillance

      Healthcare Professionals Sentinel Syndromic Surveillance

      In week 49, 2.1% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
      Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-49

      Number of Sentinels Reporting in Week 49: 102
      The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
      Figure 4 - Text description Participatory Syndromic Surveillance

      In week 49, 2,218 participants reported to FluWatchers, of which 44 (2.0%) reported symptoms of cough and fever (Figure 5).
      Among the 53 participants who reported fever and cough:
      • 27% consulted a healthcare professional;
      • 80% reported days missed from work or school, resulting in a combined total of 118 missed days of work or school.
      Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2018-49

      Number of Participants Reporting in Week 49: 2,218
      Figure 5 - Text description Influenza Outbreak Surveillance

      In week 49, five new laboratory-confirmed influenza outbreaks were reported in long-term care (2), acute care facilities (1) and other settings (2). Four new ILI outbreaks were also reported in week 49.
      To date this season, 52 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
      • 25 outbreaks were in LTCF, 11 were in schools, seven in acute care facilities, and eight were in other settings.
      • All of the 36 outbreaks for which the influenza type was available were associated with influenza A.
      • Among the 33 outbreaks for which the influenza A subtype was available:
        • 25 were associated with influenza A(H1N1)pdm09;
        • 8 were associated with A(H3N2),
      To date this season, 35 ILI outbreaks have been reported; 26 occurred in LTCF, six in schools, and three in acute care facilities.
      Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2018-49

      Figure 6 - Text description Severe Outcomes Influenza Surveillance

      Provincial/Territorial Influenza Hospitalizations and Deaths

      To date this season, 705 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
      Hospitalizations (Table 2):
      • 99% (702) were associated with influenza A
      • The highest estimated rate of hospitalization is among children under 5 years of age.
      Intensive Care Unit (ICU) cases and deaths:
      • To date this season 90 ICU admissions and 16 deaths have been reported.
      Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
      Return to footnote1referrer
      0-4 131 0 27.5223961
      5-19 88 0 6.3418807
      20-44 115 0 4.0420613
      45-64 182 0 8.3629752
      65+ 186 3 15.5342679
      Total 702 3
      % 100% 0%
      Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the population by age-group in participating provinces and territories.
      Return to Table 2 - Footnote1referrer
      Pediatric Influenza Hospitalizations and Deaths

      In week 49, 37 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network. Pediatric hospitalizations reported by IMPACT are at levels not normally seen until late December (Figure 7).
      To date this season, 228 pediatric hospitalizations have been reported (Figure 8):
      • All but three cases have been associated with influenza A.
      • Among the 154 cases for which the influenza subtype was available, 152 (98.7%) were associated with A(H1N1)pdm09.
      To date this season, 33 ICU admissions, and no deaths have been reported.
      Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2018-49

      Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2018-49

      Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

      Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
      To date this season, 38 hospitalizations have been reported:
      • 33 (87%) were associated with influenza A and 5 with influenza B.
      • 20 of the 38 cases (53%) were adults 65 years of age and older.
      Influenza Strain Characterizations

      Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 182 influenza viruses (25 A(H3N2), 144 A(H1N1) and 13 B) that were received from Canadian laboratories.
      Genetic Characterization of Influenza A (H3N2):

      23 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
      Sequence analysis of the HA gene of the viruses showed that:
      • Three viruses belonged to genetic group 3C.2a.
      • 20 viruses belonged to subclade 3C.2a1.
      A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
      Antigenic Characterization:

      Influenza A(H3N2):

      • Two influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
      • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
      • The two influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1.
      Influenza A(H1N1):

      • 144 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
      Influenza B:

      Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
      • 13 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
      • ...
      https://www.canada.ca/en/public-heal...er-8-2018.html


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

      Comment


      • #4
        FluWatch report: December 9, 2018 to December 15, 2018 (Week 50)


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        Organization: Public Health Agency of Canada
        Date published: 2018-12-21

        Related Topics



        Overall Summary

        • Overall, influenza activity in Canada continued to increase in week 50.
        • All indicators have increased or remained similar compared to the previous week.
        • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
        • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.
        • This is the last FluWatch report for the 2018 calendar year. The next report will be published on Friday, January 4, 2019 and will contain data for weeks 51 and 52.


        On this page

        Influenza/Influenza-like Illness Activity (geographic spread)

        During week 50, influenza activity levels continued to increase (Figure 1):
        • 13 regions reported localized activity: in Alta.(2), Sask.(2), Ont.(3), Que.(2), N.B.(2), N.S.(1), and N.W.T(1)
        • Sporadic activity was reported by 34 regions: in B.C.(5), Alta.(4), Sask.(1), Man.(5), Ont.(4), Que.(4), N.B.(5), N.L.(2), P.E.I.(1), N.W.T(1), Nvt.(1) and Yt.(1).
        • No activity was reported by 6 regions.



        Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2018-50

        Figure 1 - Text description Laboratory Confirmed Influenza Detections

        In week 50, the following results were reported from sentinel laboratories across Canada (Figure 2):
        • The percentage of tests positive for influenza continued to increase to 22.8%.
        • 1,869 laboratory detections of influenza were reported, of which 99% were influenza A.
        To date this season 8,245 laboratory-confirmed influenza detections have been reported (Figure 3):
        • 99% have been influenza A.
        • Among the 4,024 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
        • Provincial and territorial differences in influenza type/subtype distribution are observed.
        To date this season, detailed information on age and type/subtype has been received for 7,914 laboratory-confirmed influenza cases (Table 1):
        • 70% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
        • 66% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
        For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
        Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2018-50

        The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
        Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2018-50

        Figure 3 - Text description
        0-4 1695 865 5 825 10 1705 22%
        5-19 1629 818 6 805 19 1648 21%
        20-44 1903 898 34 971 13 1916 24%
        45-64 1543 726 49 768 11 1554 20%
        65+ 1071 414 181 476 20 1091 14%
        Total 7841 3721 275 3845 73 7914 100%
        Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
        Return to Table 1 - Note1
        Syndromic/Influenza-like Illness Surveillance

        Healthcare Professionals Sentinel Syndromic Surveillance

        In week 50, 1.5% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
        Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-50

        Number of Sentinels Reporting in Week 50: 103
        The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
        Figure 4 - Text description Participatory Syndromic Surveillance

        In week 50, 2,210 participants reported to FluWatchers, of which 82 (3.7%) reported symptoms of cough and fever (Figure 5).
        Among the 82 participants who reported fever and cough:
        • 15% consulted a healthcare professional;
        • 74% reported days missed from work or school, resulting in a combined total of 180 missed days of work or school.
        Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2018-50

        Number of Participants Reporting in Week 50: 2,210
        Figure 5 - Text description Influenza Outbreak Surveillance

        In week 50, 13 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (4), acute care facilities (3), schools (1), and other settings (5). One new ILI outbreak was also reported in week 50.
        To date this season, 67 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
        • 30 outbreaks were in LTCF, 13 were in schools, 10 in acute care facilities, and 14 were in other settings.
        • All of the 55 outbreaks for which the influenza type was available were associated with influenza A.
        • Among the 41 outbreaks for which the influenza A subtype was available:
          • 80% (33) were associated with influenza A(H1N1)pdm09;
          • 20% (8) were associated with A(H3N2),
        To date this season, 36 ILI outbreaks have been reported; 26 occurred in LTCF, seven in schools, and three in acute care facilities.
        Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2018-50

        Figure 6 - Text description Severe Outcomes Influenza Surveillance

        Provincial/Territorial Influenza Hospitalizations and Deaths

        To date this season, 864 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
        Hospitalizations (Table 2):
        • 99% (861) were associated with influenza A
        • The highest estimated rate of hospitalization is among children under 5 years of age.
        Intensive Care Unit (ICU) cases and deaths:
        • To date this season 118 ICU admissions and 22 deaths have been reported.
          • 41% (48) of reported ICU admissions were in adults aged 45-64 years.
          • All reported deaths were associated with influenza A(H1N1)pdm09.
        Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
        Return to footnote1referrer
        0-4 153 0 32.14
        5-19 108 0 7.78
        20-44 135 0 4.75
        45-64 228 0 10.48
        65+ 237 3 19.73
        Total 861 3
        % 100% 0%
        Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
        Return to Table 2 - Footnote1referrer
        Pediatric Influenza Hospitalizations and Deaths

        In week 50, 45 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
        To date this season, 281 pediatric hospitalizations have been (Figure 8):
        • 99% (278) of cases have been associated with influenza A.
        • Among the 174 cases for which the influenza subtype was available, 172 (98.9%) were associated with A(H1N1)pdm09.
        To date this season, 47 ICU admissions, and less than five deaths have been reported.
        • 90% (41) of ICU admissions were in children under the age of 10
        • 98% (46) of ICU admissions have been associated with influenza A.
        Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2018-50

        Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2018-50

        Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

        Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
        To date this season, 55 hospitalizations have been reported:
        • 49 (89%) were associated with influenza A.
        • 29 cases (53%) were adults 65 years of age and older.
        • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 67.2% of hospitalized cases.
        Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2018-50

        Figure 9 - Text description Influenza Strain Characterizations

        Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 264 influenza viruses (29 A(H3N2), 221 A(H1N1) and 14 B) that were received from Canadian laboratories.
        Genetic Characterization of Influenza A (H3N2):

        24 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
        Sequence analysis of the HA gene of the viruses showed that:
        • Three viruses belonged to genetic group 3C.2a.
        • 21 viruses belonged to subclade 3C.2a1.
        A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
        Antigenic Characterization:

        Influenza A(H3N2):

        • Five influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
        • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
        • Two influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Sequencing is pending for the remaining three viruses.
        Influenza A(H1N1):

        • 221 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
        Influenza B:

        Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
        • 14 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
        • ...
        https://www.canada.ca/en/public-heal...r-15-2018.html


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

        Comment


        • #5
          FluWatch report: December 16, 2018 to December 29, 2018 (Week 51-52)


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          Organization: Public Health Agency of Canada
          Date published: 2019-01-04

          Related Topics



          Overall Summary

          • Overall, influenza activity in Canada continued to increase in weeks 51 and 52.
          • All indicators have increased or remained similar compared to the previous week.
          • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
          • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.


          On this page

          Influenza/Influenza-like Illness Activity (geographic spread)

          During week 52, influenza activity levels continued to increase (Figure 1):
          • 7 regions reported localized activity: in Alta.(1), Ont.(4), B.C.(1), and N.B.(1)
          • Sporadic activity was reported by 31 regions: in B.C.(4), Alta.(4), Sask.(3), Man.(5), Ont.(2), N.B.(6), N.S.(3), N.L.(2), P.E.I.(1), and Yt.(1).
          • No activity was reported by 3 regions.
          • No data was reported by 12 regions.



          Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2018-52

          Figure 1 - Text description Laboratory Confirmed Influenza Detections

          In weeks 51 and 52, the following results were reported from sentinel laboratories across Canada (Figure 2):
          • The percentage of tests positive for influenza continued to increase from 25.1% in week 51 to 29.4% in week 52.
          • A total 3,387 laboratory detections of influenza were reported, of which 99% were influenza A.
          To date this season 13,796 laboratory-confirmed influenza detections have been reported (Figure 3):
          • 99% have been influenza A.
          • Among the 6,007 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
          • Provincial and territorial differences in influenza type/subtype distribution are observed.
          To date this season, detailed information on age and type/subtype has been received for 11,531 laboratory-confirmed influenza cases (Table 1):
          • 68% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
          • 63% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
          For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
          Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2018-52

          The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
          Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2018-52

          Figure 3 - Text description
          0-4 2512 1058 12 1442 18 2530 22%
          5-19 2149 968 9 1172 23 2172 19%
          20-44 2634 1118 46 1470 16 2650 23%
          45-64 2302 935 60 1307 18 2320 20%
          65+ 1830 568 214 1048 29 1859 16%
          Total 11427 4647 341 6439 104 11531 100%
          Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
          Return to Table 1 - Note1
          Syndromic/Influenza-like Illness Surveillance

          Healthcare Professionals Sentinel Syndromic Surveillance

          In week 50, 1.6% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). In weeks 51 and 52, an insufficient number of sentinels reported ILI activity. Data will be updated in the report for week 01.
          Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-50

          Number of Sentinels Reporting in Week 50: 115
          The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
          Figure 4 - Text description Participatory Syndromic Surveillance

          In week 52, 1,947 participants reported to FluWatchers, of which 70 (4%) reported symptoms of cough and fever (Figure 5).
          Among the 70 participants who reported fever and cough:
          • 27% consulted a healthcare professional;
          • 63% reported days missed from work or school, resulting in a combined total of 150 missed days of work or school.
          Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2018-52

          Number of Participants Reporting in Week 52: 1,947
          Figure 5 - Text description Influenza Outbreak Surveillance

          In weeks 51 and 52, 15 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (4), acute care facilities (6), schools (1), and other settings (4).
          To date this season, 86 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
          • 37 outbreaks were in LTCF, 17 were in schools, 14 in acute care facilities, and 18 were in other settings.
          • All of the 73 outbreaks for which the influenza type was available were associated with influenza A.
          • Among the 50 outbreaks for which the influenza A subtype was available:
            • 82% (41) were associated with influenza A(H1N1)pdm09;
            • 18% (9) were associated with A(H3N2),
          To date this season, 38 ILI outbreaks have been reported; 28 occurred in LTCF, seven in schools, and three in acute care facilities.
          Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2018-52

          Figure 6 - Text description Severe Outcomes Influenza Surveillance

          Provincial/Territorial Influenza Hospitalizations and Deaths

          To date this season, 1046 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
          Hospitalizations (Table 2):
          • 99.6% (1042) were associated with influenza A
          • The highest estimated rate of hospitalization is among children under 5 years of age.
          Intensive Care Unit (ICU) cases and deaths:
          • To date this season 119 ICU admissions and 24 deaths have been reported.
            • 44% (52) of reported ICU admissions were in adults aged 45-64 years.
            • All reported deaths were associated with influenza A.
          Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
          Return to footnote1referrer
          0-4 179 1 37.82
          5-19 124 0 8.94
          20-44 164 0 5.76
          45-64 272 0 12.50
          65+ 303 3 25.15
          Total 1042 4
          % 99.6 0.4
          Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
          Return to Table 2 - Footnote1referrer
          Pediatric Influenza Hospitalizations and Deaths

          In weeks 51 and 52, 133 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
          To date this season, 414 pediatric hospitalizations have been reported (Figure 8):
          • 99% (408) of cases have been associated with influenza A.
          • Among the 203 cases for which the influenza subtype was available, 199 (98%) were associated with A(H1N1)pdm09.
          To date this season, 71 ICU admissions, and less than five deaths have been reported.
          • 85% (60) of ICU admissions were in children under the age of 10
          • 99% (69) of ICU admissions have been associated with influenza A.
          Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2018-52

          Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2018-52

          Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

          Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
          To date this season, 115 hospitalizations have been reported (Figure 9):
          • 108 (94%) were associated with influenza A.
          • 58 cases (50%) were adults 65 years of age and older.
          • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 84% of hospitalized cases.
          Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2018-52

          Figure 9 - Text description Influenza Strain Characterizations

          Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 395 influenza viruses (30 A(H3N2), 350 A(H1N1) and 15 B) that were received from Canadian laboratories.
          Genetic Characterization of Influenza A (H3N2):

          24 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
          Sequence analysis of the HA gene of the viruses showed that:
          • Three viruses belonged to genetic group 3C.2a.
          • 21 viruses belonged to subclade 3C.2a1.
          A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
          Antigenic Characterization:

          Influenza A(H3N2):

          • Six influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
          • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
          • Four influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Sequencing is pending for the remaining three viruses.
          Influenza A(H1N1):

          • 345 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
          • Five viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
          Influenza B:

          Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
          • One influenza B virus was characterized as B/Colorado/06/2017, which belongs to the Victoria lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
          • 14 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
          • ...
          https://www.canada.ca/en/public-heal...r-29-2018.html


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

          Comment


          • #6
            FluWatch report: December 30, 2018 to January 5, 2019 (Week 1)


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            (PDF format, 1.2 MB, 9 pages)
            Organization: Public Health Agency of Canada
            Date published: 2019-01-11

            Related Topics



            Overall Summary

            • In week 01, laboratory detections declined from the previous week suggesting that nationally the influenza season may have reached peak levels in the last week of December.
            • Overall, influenza activity remains high in Canada.
            • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
            • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.


            On this page

            Influenza/Influenza-like Illness Activity (geographic spread)

            During week 01, all regions reported some level of influenza activity (Figure 1):
            • 1 region reported widespread activity: in Que.(1)
            • 15 regions reported localized activity: in Alta.(2), Sask.(1), Ont.(6), Que.(2), N.L.(1) and N.B.(3)
            • 31 regions reported sporadic activity: in B.C.(5), Alta.(3), Sask.(2), Man.(5), Ont.(1), Que.(3), N.B.(4), N.S.(4), N.L.(3), P.E.I.(1), Nvt.(3), N.W.T.(2) and Yt.(1).



            Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-01

            Figure 1 - Text description Laboratory Confirmed Influenza Detections

            In week 01, the following results were reported from sentinel laboratories across Canada (Figure 2):
            • The percentage of tests positive for influenza decreased to 25.6% in week 01.
            • A total 3,153 laboratory detections of influenza were reported, of which 99% were influenza A.
            To date this season 17,743 laboratory-confirmed influenza detections have been reported:
            • 99% have been influenza A.
            • Among the 6,775 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
            • Provincial and territorial differences in influenza type/subtype distribution are observed (Figure 3).
            To date this season, detailed information on age and type/subtype has been received for 14,897 laboratory-confirmed influenza cases (Table 1):
            • 68% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 45 years of age.
            • 61% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
            For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
            Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-01

            The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
            Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-01

            Figure 3 - Text description
            0-4 3175 1239 15 1921 24 3199 21%
            5-19 2498 1108 15 1375 26 2524 17%
            20-44 3277 1294 55 1928 20 3297 22%
            45-64 3020 1077 70 1873 22 3042 20%
            65+ 2792 673 246 1873 43 2835 19%
            Total 14762 5391 401 8970 135 14897 100%
            Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
            Return to Table 1 - Note1
            Syndromic/Influenza-like Illness Surveillance

            Healthcare Professionals Sentinel Syndromic Surveillance

            In week 1, 3.9% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
            Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2019-01

            Number of Sentinels Reporting in Week 01: 77
            The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
            Figure 4 - Text description Participatory Syndromic Surveillance

            In week 01, 2,240 participants reported to FluWatchers, of which 77 (3.4%) reported symptoms of cough and fever (Figure 5).
            Among the 77 participants who reported fever and cough:
            • 13% consulted a healthcare professional;
            • 77% reported days missed from work or school, resulting in a combined total of 159 missed days of work or school.
            Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-01

            Number of Participants Reporting in Week 01: 2,240
            Figure 5 - Text description Influenza Outbreak Surveillance

            In week 01, 37 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (24), acute care facilities (4), and other settings (9). One new ILI outbreak in a LTCF was also reported reported in week 01.
            To date this season, 152 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
            • 79 outbreaks were in LTCF, 22 were in schools, 21 in acute care facilities, and 30 were in other settings.
            • All of the 119 outbreaks for which the influenza type was available were associated with influenza A.
            • Among the 76 outbreaks for which the influenza A subtype was available:
              • 86% (65) were associated with influenza A(H1N1)pdm09;
              • 14% (11) were associated with A(H3N2),
            To date this season, 39 ILI outbreaks have been reported; 29 occurred in LTCF, seven in schools, and three in acute care facilities.
            Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-01

            Figure 6 - Text description Severe Outcomes Influenza Surveillance

            Provincial/Territorial Influenza Hospitalizations and Deaths

            To date this season, 1348 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
            Hospitalizations (Table 2):
            • 99.6% (1342) were associated with influenza A
            • The highest estimated rate of hospitalization is among children under 5 years of age.
            Intensive Care Unit (ICU) cases and deaths:
            • To date this season 196 ICU admissions and 37 deaths have been reported.
              • 41% (80) of reported ICU admissions were in adults aged 45-64 years.
              • All reported deaths were associated with influenza A.
            0-4 225 2 47.69
            5-19 139 0 10.02
            20-44 194 0 6.82
            45-64 360 0 16.54
            65+ 424 4 35.18
            Total 1342 6 -
            % 94.6% 0.4% -
            Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
            Return to Table 2 - Footnote1referrer
            Pediatric Influenza Hospitalizations and Deaths

            In week 01, 87 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
            To date this season, 540 pediatric hospitalizations have been reported (Figure 8):
            • 99% (535) of cases have been associated with influenza A.
            • Among the 228 cases for which the influenza subtype was available, 222 (97%) were associated with A(H1N1)pdm09.
            To date this season, 95 ICU admissions, and six deaths have been reported.
            • 88% (83) of ICU admissions were in children under the age of 10
            • 99% (93) of ICU admissions have been associated with influenza A.
            • All deaths occurred in children under the age of 10
            Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-01

            Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-01

            Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

            Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
            To date this season, 223 hospitalizations have been reported (Figure 9):
            • 212 (95%) were associated with influenza A.
            • The distribution of cases among adults <65 years of age is similar to adults ≥65 years of age
            • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 70% of hospitalized cases.
            Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-01

            Figure 9 - Text description Influenza Strain Characterizations

            Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 481 influenza viruses (45 A(H3N2), 420 A(H1N1) and 16 B) that were received from Canadian laboratories.
            Genetic Characterization of Influenza A(H3N2):

            33 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
            Sequence analysis of the HA gene of the viruses showed that:
            • Five viruses belonged to genetic group 3C.2a.
            • 27 viruses belonged to subclade 3C.2a1.
            A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
            Antigenic Characterization:

            Influenza A (H3N2):
            • 12 influenza A(H3N2) virus was antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
            • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
            • Four influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Sequencing is pending for the remaining three viruses.
            Influenza A(H1N1):
            • 415 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
            • Five viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
            Influenza B:
            Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
            • Two influenza B virus was characterized as B/Colorado/06/2017, which belongs to the Victoria lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
            • 14 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
            • ...
            https://www.canada.ca/en/public-heal...ry-5-2019.html


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

            Comment


            • #7
              FluWatch report: January 6, 2019 to January 12, 2019 (week 02)


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              Organization: Public Health Agency of Canada
              Date published: 2019-01-18

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              Overall Summary

              • In week 02, laboratory detections continued to decline sharply from the previous week confirming that the influenza season reached peak levels in the last week of December (week 52).
              • Overall, the Central and Eastern regions are reporting higher levels of influenza activity than the rest of the country.
              • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
              • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.


              On this page

              Influenza/Influenza-like Illness Activity (geographic spread)

              During week 02, the following influenza activity levels were reported (Figure 1):
              • 2 regions reported widespread activity: in Que.(2)
              • 17 regions reported localized activity: in Ont.(6), Que.(2), N.L.(3) N.S.(2) and N.B.(4)
              • 32 regions reported sporadic activity: in B.C.(5), Alta.(5), Sask.(3), Man.(5), Ont.(1), Que.(2), N.B.(3), N.S.(2), N.L.(1), P.E.I.(1), Nvt.(1), N.W.T.(2) and Yt.(1).
              • 2 regions reported no activity: in Nvt.(2)



              Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-02

              Figure 1 - Text description Laboratory Confirmed Influenza Detections

              In week 02, the following results were reported from sentinel laboratories across Canada (Figure 2):
              • The percentage of tests positive for influenza decreased to 20.5% in week 02.
              • A total 2,486 laboratory detections of influenza were reported, of which 98% were influenza A.
              To date this season 20,494 laboratory-confirmed influenza detections have been reported:
              • 99% have been influenza A.
              • Among the 7,523 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
              • Provincial and territorial differences in influenza type/subtype distribution are observed (Figure 3).
              To date this season, detailed information on age and type/subtype has been received for 17,295 laboratory-confirmed influenza cases (Table 1):
              • 86% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 65 years of age.
              • 63% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
              For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
              Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-02

              The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
              Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-02

              Figure 3 - Text description
              0-4 3679 1351 18 2310 28 3707 21%
              5-19 2698 1168 17 1513 29 2727 16%
              20-44 3676 1412 62 2202 24 3700 21%
              45-64 3601 1253 76 2272 29 3630 21%
              65+ 3464 816 294 2354 67 3531 20%
              Total 17118 6000 467 10651 177 17295 100%
              Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
              Return to Table 1 - Note1
              Syndromic/Influenza-like Illness Surveillance

              Healthcare Professionals Sentinel Syndromic Surveillance

              In week 02, 2.5% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
              Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2019-02

              Number of Sentinels Reporting in Week 02: 97
              The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
              Figure 4 - Text description Participatory Syndromic Surveillance

              In week 02, 2,259 participants reported to FluWatchers, of which 64 (2.8%) reported symptoms of cough and fever (Figure 5).
              Among the 64 participants who reported fever and cough:
              • 19% consulted a healthcare professional;
              • 72% reported days missed from work or school, resulting in a combined total of 142 missed days of work or school.
              Figure 5 – Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-02

              Number of Participants Reporting in Week 02: 2,259
              Figure 5 - Text description Influenza Outbreak Surveillance

              In week 02, 33 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (21), acute care facilities (4), and other settings (8). Two new ILI outbreaks in schools were also reported in week 02.
              To date this season, 206 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
              • 116 outbreaks were in LTCF, 22 were in schools, 26 in acute care facilities, and 42 were in other settings.
              • All of the 194 outbreaks for which the influenza type was available were associated with influenza A.
              • Among the 93 outbreaks for which the influenza A subtype was available:
                • 80% (74) were associated with influenza A(H1N1)pdm09;
                • 20% (19) were associated with A(H3N2),
              To date this season, 44 ILI outbreaks have been reported; 32 occurred in LTCF, nine in schools, and three in acute care facilities.
              Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-02

              Figure 6 - Text description Severe Outcomes Influenza Surveillance

              Provincial/Territorial Influenza Hospitalizations and Deaths

              To date this season, 1,518 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
              Hospitalizations (Table 2):
              • 99.6% (1,512) were associated with influenza A
              • The highest estimated rate of hospitalization is among children under 5 years of age.
              Intensive Care Unit (ICU) cases and deaths:
              • To date this season 227 ICU admissions and 47 deaths have been reported.
                • 42% (97) of reported ICU admissions were in adults aged 45-64 years.
                • All reported deaths were associated with influenza A.
              0-4 252 2 53,36
              5-19 152 0 10,95
              20-44 213 0 7,49
              45-64 413 0 18,98
              65+ 482 4 39,95
              Total 1512 6 -
              99.6% 0.4% -
              Table 2 - Footnote 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
              Return to Table 2 - Footnote1referrer
              Pediatric Influenza Hospitalizations and Deaths

              In week 02, 57 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
              To date this season, 603 pediatric hospitalizations have been reported (Figure 8):
              • 99% (598) of cases have been associated with influenza A.
              • Among the 240 cases for which the influenza subtype was available, 234 (98%) were associated with A(H1N1)pdm09.
              To date this season, 98 ICU admissions, and seven deaths have been reported.
              • 85% (84) of ICU admissions were in children 6 months to 9 years of age
              • 99% (97) of ICU admissions have been associated with influenza A.
              • All deaths occurred in children under the age of 10
              Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-02

              Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-02

              Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

              Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
              To date this season, 278 hospitalizations have been reported (Figure 9):
              • 262 (94%) were associated with influenza A.
              • The distribution of cases among adults <65 years of age is similar to adults ≥65 years of age
              • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 70% of hospitalized cases.
              Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-02

              Figure 9 - Text description Influenza Strain Characterizations

              Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 571 influenza viruses (49 A(H3N2), 506 A(H1N1) and 16 B) that were received from Canadian laboratories.
              Genetic Characterization of Influenza A(H3N2):

              39 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
              Sequence analysis of the HA gene of the viruses showed that:
              • Six viruses belonged to genetic group 3C.2a.
              • 32 viruses belonged to subclade 3C.2a1.
              • One isolate could not be sequenced.
              A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
              Antigenic Characterization:

              Influenza A (H3N2):
              • 17 influenza A(H3N2) viruses were antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
              • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
              • 13 influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Two viruses belonged to genetic group 3C.2a and two to 3C.3a.
              Influenza A(H1N1):
              • 495 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
              • 11 viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
              Influenza B:
              Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
              • Two influenza B viruses were characterized as B/Colorado/06/2017, which belong to the Victoria lineage and are included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
              • 14 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
              • ...
              https://www.canada.ca/en/public-heal...y-12-2019.html


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

              Comment


              • #8
                FluWatch report: January 13, 2019 to January 19, 2019 (week 03)


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                Organization: Public Health Agency of Canada
                Date published: 2019-01-25

                Related Topics



                Overall Summary

                • In week 03, laboratory detections continued to decline from the previous week.Overall, influenza continues to circulate across Canada but the Eastern region is reporting higher levels of influenza activity than the rest of the country.
                • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
                • The majority of lab confirmations and hospitalizations have been among individuals under the age of 65.
                • Based on a recently published Canadian influenza vaccine effectiveness study, mid-season vaccine effectiveness estimates indicate that this year's flu shot is approximately 72% effective against the predominant circulating strain. The study confirmed that significant protection was observed in all age groups, especially young children who have been disproportionately affected by influenza this season.


                On this page

                Influenza/Influenza-like Illness Activity (geographic spread)

                During week 03, the following influenza activity levels were reported (Figure 1):
                • 23 regions reported localized activity: in Alta.(1), Ont.(6), Que.(4), N.L.(2) N.S.(4) P.E.I.(1) and N.B.(5).
                • 26 regions reported sporadic activity: in B.C.(5), Alta.(4), Sask.(3), Man.(5), Que.(2), N.B.(2), N.L.(2), Nvt.(2), and N.W.T.(1).
                • Three regions reported no activity: in Ont.(1), N.W.T.(1) and Nvt.(1).
                • No data was reported by one region: in Y.T.(1).



                Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-03

                Figure 1 - Text description Laboratory Confirmed Influenza Detections

                In week 03, the following results were reported from sentinel laboratories across Canada (Figure 2):
                • The percentage of tests positive for influenza decreased to 20.8% in week 03.
                • A total 2,313 laboratory detections of influenza were reported, of which 98% were influenza A.
                To date this season 20,753 laboratory-confirmed influenza detections have been reported:
                • 99% have been influenza A.
                • Among the 7,565 influenza A viruses subtyped, 94% have been A(H1N1)pdm09.
                • Provincial and territorial differences in influenza type/subtype distribution are observed (Figure 3).
                To date this season, detailed information on age and type/subtype has been received for 18,923 laboratory-confirmed influenza cases (Table 1):
                • 86% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 65 years of age.
                • 62% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
                For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
                Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-03

                The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
                Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-03

                Figure 3 - Text description
                0-4 4072 1412 22 2638 32 4104 22%
                5-19 2884 1198 21 1665 34 2918 15%
                20-44 3975 1482 73 2420 26 4001 21%
                45-64 3887 1325 85 2477 33 3920 21%
                65+ 3896 883 334 2679 84 3980 21%
                Total 18714 6300 535 11879 209 18923 100%
                Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
                Return to Table 1 - Note1
                Syndromic/Influenza-like Illness Surveillance

                Healthcare Professionals Sentinel Syndromic Surveillance

                In week 03, 1.4% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
                Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-19-03

                Number of Sentinels Reporting in Week 03: 99
                The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
                Figure 4 - Text description Participatory Syndromic Surveillance

                In week 03, 2,211 participants reported to FluWatchers, of which 55 (2.5%) reported symptoms of cough and fever (Figure 5).
                Among the 55 participants who reported fever and cough:
                • 13% consulted a healthcare professional;
                • 73% reported days missed from work or school, resulting in a combined total of 108 missed days of work or school.
                Figure 5 - Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-03

                Number of Participants Reporting in Week 03: 2,211
                Figure 5 - Text description Influenza Outbreak Surveillance

                In week 03, 31 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (19), acute care facilities (3), and other settings (9). Thirteen new ILI outbreaks in long-term care facilities (5) and schools (8) were also reported in week 03.
                To date this season, 254 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
                • 148 outbreaks were in LTCF, 22 were in schools, 33 in acute care facilities, and 51 were in other settings.
                • Among the 239 outbreaks for which the influenza type was available 99% (236) were associated with influenza A.
                • Among the 115 outbreaks for which the influenza A subtype was available:
                  • 77% (89) were associated with influenza A(H1N1)pdm09;
                  • 23% (26) were associated with A(H3N2),
                To date this season, 58 ILI outbreaks have been reported; 38 occurred in LTCF, 17 in schools, and three in acute care facilities.
                Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-03

                Figure 6 - Text description Severe Outcomes Influenza Surveillance

                Provincial/Territorial Influenza Hospitalizations and Deaths
                To date this season, 1,637 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
                Hospitalizations (Table 2):
                • 99.6% (1,512) were associated with influenza A
                • The highest estimated rate of hospitalization is among children under 5 years of age.
                Intensive Care Unit (ICU) cases and deaths:
                • To date this season 262 ICU admissions and 56 deaths have been reported.
                  • 43% (113) of reported ICU admissions were in adults aged 45-64 years
                  • All reported deaths were associated with influenza A.
                Table 2 - Note 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
                Return to Table 2 - Note1
                0-4 274 3 58.20
                5-19 156 0 11.24
                20-44 228 0 8.01
                45-64 444 0 20.40
                65+ 529 3 43.73
                Total 1631 6
                % 99.6% 0.4%
                Pediatric Influenza Hospitalizations and Deaths

                In week 03, 68 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
                To date this season, 677 pediatric hospitalizations have been reported (Figure 8):
                • 81% of cases were in children 6 months to 9 years of age.
                • 99% (670) of cases have been associated with influenza A.
                • Among the 256 cases for which the influenza subtype was available, 250 (98%) were associated with A(H1N1)pdm09.
                To date this season, 98 ICU admissions, and 10 deaths have been reported.
                • 87% (100) of ICU admissions were in children 6 months to 9 years of age.
                • 99% (114) of ICU admissions have been associated with influenza A.
                • 80% (8) of deaths occurred in children 2 to 4 years of age.
                • All deaths have been associated with influenza A.
                Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-03

                The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2017-18
                Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-03

                Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

                Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
                To date this season, 324 hospitalizations have been reported (Figure 9):
                • 299 (92%) were associated with influenza A.
                • A similar proportion of hospitalizations are reported among adults <65 years of age and adults ≥65 years of age
                • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 68% of hospitalized cases.
                Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-03

                Figure 9 - Text description Influenza Strain Characterizations

                Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 728 influenza viruses (57 A(H3N2), 654 A(H1N1) and 17 B) that were received from Canadian laboratories.
                Genetic Characterization of Influenza A(H3N2):

                40 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
                Sequence analysis of the HA gene of the viruses showed that:
                • Six viruses belonged to genetic group 3C.2a.
                • 33 viruses belonged to subclade 3C.2a1.
                • One isolate could not be sequenced.
                A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.

                ...
                https://www.canada.ca/en/public-heal...y-19-2019.html


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

                Comment


                • #9
                  FluWatch report: January 20, 2019 to January 26, 2019 (week 04)


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                  Organization: Public Health Agency of Canada
                  Date published: 2019-02-01

                  Related Topics



                  Overall Summary

                  • Influenza continues to circulate across Canada with eastern regions reporting higher levels of influenza activity compared to western regions.
                  • At the national level, the influenza season appears to be past the peak of activity, with most indicators showing stable or downward trends in week 04.
                  • Influenza A is the most common influenza virus circulating in Canada, and the majority of these viruses are A(H1N1)pdm09.
                  • Based on a recently published Canadian influenza vaccine effectiveness study, mid-season vaccine effectiveness estimates indicate that this year’s flu shot is approximately 72% effective against the predominant circulating strain. Significant protection was observed in all age groups, especially young children who have been disproportionately affected by influenza this season.


                  On this page

                  Influenza/Influenza-like Illness Activity (geographic spread)

                  During week 04, the following influenza activity levels were reported (Figure 1):
                  • 2 regions reported widespread activity: in Que.(1) and P.E.I.(1).
                  • 19 regions reported localized activity: in Alta.(1), Ont.(6), Que.(3), N.L.(1) N.S.(4) and N.B.(4).
                  • 31 regions reported sporadic activity: in B.C.(5), Alta.(4), Sask.(3), Man.(5), Que.(3), N.B.(3), N.L.(3), Nvt.(3), N.W.T.(1) and Y.T.(1).
                  • One region reported no activity: in N.W.T.(1).



                  Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-04

                  Figure 1 - Text description Laboratory Confirmed Influenza Detections

                  In week 04, the following results were reported from sentinel laboratories across Canada (Figure 2):
                  • The percentage of tests positive for influenza was similar to the previous week at 20.7%.
                  • A total 2,270 laboratory detections of influenza were reported, of which 98% were influenza A.
                  To date this season, 25,764 laboratory-confirmed influenza detections have been reported:
                  • 99% have been influenza A.
                  • Among the 9,479 influenza A viruses subtyped, 93% have been A(H1N1)pdm09.
                  • Provincial and territorial differences in influenza type/subtype distribution are observed (Figure 3).
                  To date this season, detailed information on age and type/subtype has been received for 20,254 laboratory-confirmed influenza cases (Table 1):
                  • 86% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 65 years of age.
                  • 62% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
                  For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
                  Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-04

                  The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
                  Figure 2 - Text description Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-04

                  Figure 3 - Text description
                  0-4 4446 1444 23 2979 34 4480 22%
                  5-19 3035 1220 21 1794 40 3075 15%
                  20-44 4204 1512 77 2615 28 4232 21%
                  45-64 4110 1364 89 2657 39 4149 20%
                  65+ 4213 911 338 2964 105 4318 21%
                  Total 20008 6451 548 13009 246 20254 100%
                  Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
                  Return to Table 1 - Note1
                  Syndromic/Influenza-like Illness Surveillance

                  Healthcare Professionals Sentinel Syndromic Surveillance

                  In week 04, 1.8% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is within expected levels.
                  Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-19-04

                  Number of Sentinels Reporting in Week 04: 93
                  The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
                  Figure 4 - Text description Participatory Syndromic Surveillance

                  In week 04, 2,207 participants reported to FluWatchers, of which 64 (2.9%) reported symptoms of cough and fever (Figure 5).
                  Among the 64 participants who reported fever and cough:
                  • 25% consulted a healthcare professional;
                  • 75% reported days missed from work or school, resulting in a combined total of 147 missed days of work or school.
                  Figure 5 - Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-04

                  Number of Participants Reporting in Week 04: 2,207
                  Figure 5 - Text description Influenza Outbreak Surveillance

                  In week 04, 27 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (12), acute care facilities (6), schools/daycares (1) and other settings (8). Fourteen new ILI outbreaks in long-term care facilities (3) and schools/daycares (11) were also reported in week 04.
                  To date this season, 296 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
                  • 175 outbreaks were in LTCF, 23 were in schools, 39 in acute care facilities, and 59 were in other settings.
                  • Among the 278 outbreaks for which the influenza type was available 99% (274) were associated with influenza A.
                  • Among the 131 outbreaks for which the influenza A subtype was available:
                    • 76% (99) were associated with influenza A(H1N1)pdm09;
                    • 24% (32) were associated with A(H3N2),
                  To date this season, 72 ILI outbreaks have been reported; 41 occurred in LTCF, 28 in schools, and three in acute care facilities.
                  Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-04

                  Figure 6 - Text description Severe Outcomes Influenza Surveillance

                  Provincial/Territorial Influenza Hospitalizations and Deaths
                  To date this season, 1,761 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
                  Hospitalizations (Table 2):
                  • 99.7% (1,755) were associated with influenza A
                  • The highest estimated rate of hospitalization is among children under 5 years of age.
                  Intensive Care Unit (ICU) cases and deaths:
                  Table 2 - Note 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
                  Return to Table 2 - Note1
                  0-4 290 2 61.35
                  5-19 161 0 11.60
                  20-44 243 0 8.54
                  45-64 483 1 22.24
                  65+ 578 3 47.75
                  Total 1755 6
                  % 99.7% 0.3%
                  Pediatric Influenza Hospitalizations and Deaths

                  In week 04, 65 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
                  To date this season, 747 pediatric hospitalizations have been reported (Figure 8):
                  To date this season, 126 ICU admissions, and 10 deaths have been reported.
                  Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-04

                  The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2017-18
                  Figure 7 - Text description Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-04

                  Figure 8 - Text description Adult Influenza Hospitalizations and Deaths

                  Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
                  To date this season, 373 hospitalizations have been reported (Figure 9):
                  Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-04

                  Figure 9 - Text description Influenza Strain Characterizations

                  Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 785 influenza viruses (66 A(H3N2), 701 A(H1N1) and 18 B) that were received from Canadian laboratories.
                  Genetic Characterization of Influenza A(H3N2):

                  42 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
                  Sequence analysis of the HA gene of the viruses showed that:
                  A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                  Antigenic Characterization:

                  Influenza A (H3N2):
                  Influenza A(H1N1):
                  Influenza B:
                  Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
                  • To date this season 319 ICU admissions and 75 deaths have been reported.
                    • 43% (137) of reported ICU admissions were in adults aged 45-64 years.
                    • All but one of the reported deaths were associated with influenza A.
                    • 70% of cases were in children under 5 years of age.
                    • 99% (740) of cases have been associated with influenza A.
                    • Among the 266 cases for which the influenza subtype was available, 259 (97%) were associated with A(H1N1)pdm09.
                    • 63% (80) of ICU admissions were in children under 5 years of age.
                    • 99% (125) of ICU admissions have been associated with influenza A.
                    • 80% (8) of deaths occurred in children 2 to 4 years of age.
                    • All deaths have been associated with influenza A.
                    • 336 (90%) were associated with influenza A.
                    • A similar proportion of hospitalizations are reported among adults <65 years of age (45.5%) and adults ≥65 years of age (55.5%).
                    • The most commonly reported comorbidity among hospitalized cases was endocrine disorders, which were reported in 70% of hospitalized cases.
                    • Seven viruses belonged to genetic group 3C.2a.
                    • 34 viruses belonged to subclade 3C.2a1.
                    • One isolate could not be sequenced.
                    • 20 influenza A(H3N2) viruses were antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                    • Four viruses showed reduced titer with ferret antisera raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                    • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                    • 16 influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Two viruses belonged to genetic group 3C.2a and five to 3C.3a. Sequencing is pending for the remaining isolate.
                    • 686 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
                    • 15 viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
                    • Three influenza B viruses were characterized as B/Colorado/06/2017, which belong to the Victoria lineage and are included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
                    • 15 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
                  • ...
                  • https://www.canada.ca/en/public-heal...y-26-2019.html

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

                  Comment


                  • #10
                    FluWatch report: January 27, 2019 to February 2, 2019 (week 05)


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                    Organization: Public Health Agency of Canada
                    Date published: 2019-02-08

                    Related Topics



                    Overall Summary

                    • Influenza activity in Canada is declining but influenza continues to circulate with eastern regions continuing to report higher levels of influenza activity compared to western regions.
                    • At the national level, the influenza season appears to be past the peak of activity, with most indicators showing stable or downward trends in week 05. Influenza A(H1N1)pdm09 continues to be the most common influenza virus circulating in Canada.
                    • A report on influenza vaccine coverage in Canada for 2017-18 shows that coverage was low among adults (38%) and highest among seniors (71%). These results are similar to recent seasons.
                    • The effectiveness of the influenza vaccine for the 2018-19 season is estimated to be 72% against the predominant circulating strain this season, with significant protection observed in all age groups.


                    On this page

                    Influenza/Influenza-like Illness Activity (geographic spread)

                    During week 05, fewer regions reported high levels of activity compared to the previous week. The following influenza activity levels were reported (Figure 1):
                    • 17 regions reported localized activity: in Alta.(1), Ont.(6), Que.(3), N.L.(1), N.S.(3) and N.B.(3).
                    • 34 regions reported sporadic activity: in B.C.(5), Alta.(4), Sask.(3), Man.(5), Ont.(1), Que.(3), N.B.(4), N.S.(1), N.L.(3), P.E.I.(1), Nvt.(3) and Y.T.(1).
                    • Two regions in N.W.T reported no activity.



                    Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-05

                    Figure 1 - Text equivalent Laboratory-Confirmed Influenza Detections

                    In week 05, the following results were reported from sentinel laboratories across Canada (Figures 2 and 3):
                    • The percentage of tests positive for influenza was similar to the previous week at 19.7%.
                    • A total 2,002 laboratory detections of influenza were reported, of which 98% were influenza A.
                    To date this season, 27,645 laboratory-confirmed influenza detections have been reported:
                    • 99% have been influenza A.
                    • Among the 10,014 influenza A viruses subtyped, 92% have been A(H1N1)pdm09.
                    • Influenza B often circulates later in the season in Canada (Feb-Apr). Fewer influenza B detections have been reported this season compared to recent seasons at this time of year.
                    To date this season, detailed information on age and type/subtype has been received for 21,728 laboratory-confirmed influenza cases (Table 1):
                    • 86% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 65 years of age.
                    • 62% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
                    For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
                    Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-05

                    The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
                    Figure 2 - Text equivalent Figure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-05

                    Figure 3 - Text equivalent
                    0-4 4775 1493 26 3256 42 4817 22%
                    5-19 3242 1251 25 1966 46 3288 15%
                    20-44 4450 1563 87 2800 32 4482 21%
                    45-64 4367 1418 98 2851 43 4410 20%
                    65+ 4609 966 384 3259 122 4731 22%
                    Total 21443 6691 620 14132 285 21728 100%
                    Table 1 - Note 1 UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.
                    Return to Table 1 - Note1
                    Syndromic/Influenza-like Illness Surveillance

                    Healthcare Professionals Sentinel Syndromic Surveillance

                    In week 05, 1.5% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is low compared to previous seasons.
                    Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2019-05

                    Number of Sentinels Reporting in Week 05: 106
                    The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
                    Figure 4 - Text equivalent Participatory Syndromic Surveillance

                    In week 05, 2,196 participants reported to FluWatchers, of which 66 (3.0%) reported symptoms of cough and fever (Figure 5).
                    Among the 66 participants who reported fever and cough:
                    • 27% consulted a healthcare professional;
                    • 83% reported days missed from work or school, resulting in a combined total of 190 missed days of work or school.
                    • 68% reported having been vaccinated for influenza this season.
                    Figure 5 - Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-05

                    Number of Participants Reporting in Week 05: 2,196
                    Figure 5 - Text equivalent Influenza Outbreak Surveillance

                    In week 05, 24 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (16), acute care facilities (3), and other settings (5). Ten new ILI outbreaks in long-term care facilities (1) and schools/daycares (9) were also reported in week 05.
                    To date this season, 322 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
                    • 193 (60%) outbreaks were in LTCF, 23 were in schools, 42 in acute care facilities, and 64 were in other settings.
                    • Among the 301 outbreaks for which the influenza type was available 98% (296) were associated with influenza A.
                    • Among the 140 outbreaks for which the influenza A subtype was available:
                      • 74% (104) were associated with influenza A(H1N1)pdm09;
                      • 26% (36) were associated with A(H3N2),
                    To date this season, 82 ILI outbreaks have been reported; 42 occurred in LTCF, 37 in schools, and three in acute care facilities.
                    Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-05

                    Figure 6 - Text equivalent Severe Outcomes Influenza Surveillance

                    Provincial/Territorial Influenza Hospitalizations and Deaths
                    To date this season, 1,833 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
                    Hospitalizations (Table 2):
                    • 99.7% (1,828) were associated with influenza A
                    • The highest estimated rate of hospitalization is among children under 5 years of age.
                    Intensive Care Unit (ICU) cases and deaths:
                    • To date this season 336 ICU admissions and 77 deaths have been reported.
                      • 43% (145) of reported ICU admissions were in adults aged 45-64 years.
                      • All but one of the reported deaths were associated with influenza A.
                    0-4 297 2 62.82
                    5-19 166 0 11.96
                    20-44 250 0 8.79
                    45-64 503 0 23.11
                    65+ 612 3 50.55
                    Total 1828 5
                    % 99.7% 0.3%
                    Table 2 - Note 1 Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
                    Return to Table 2 - Note1
                    Pediatric Influenza Hospitalizations and Deaths

                    In week 05, 56 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
                    To date this season, 802 pediatric hospitalizations have been reported (Figure 8):
                    • 69.5% of cases were in children under 5 years of age.
                    • 99% (795) of cases have been associated with influenza A.
                    • Among the 279 cases for which the influenza subtype was available, 270 (97%) were associated with A(H1N1)pdm09.
                    To date this season, 135 ICU admissions, and 10 deaths have been reported.
                    • 63% (85) of ICU admissions were in children under 5 years of age.
                    • All but one of the ICU admissions have been associated with influenza A.
                    • 80% (8) of deaths occurred in children 2 to 4 years of age.
                    • All deaths have been associated with influenza A.
                    Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-05

                    The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2017-18
                    Figure 7 - Text equivalent Figure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-05

                    Figure 8 - Text equivalent Adult Influenza Hospitalizations and Deaths

                    Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
                    To date this season, 430 hospitalizations, 47 ICU admissions and 16 deaths have been reported (Figure 9):
                    • 388 (90%) hospitalizations were associated with influenza A.
                    • A similar proportion of hospitalizations are reported among adults <65 years of age (43.3%) and adults ≥65 years of age (56.7%).
                    • Similar to other indicators this season, hospitalizations among adults peaked in week 01, but has been stable over the past three weeks.
                    • Among hospitalized cases with available information (367), the most commonly reported comorbidity was endocrine disorders, which were reported in 88% of hospitalized cases. However, 84% of cases reported more than one type of comorbid condition.
                    Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-05

                    Figure 9 - Text equivalent Influenza Strain Characterizations

                    Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 972 influenza viruses (69 A(H3N2), 882 A(H1N1) and 21 B) that were received from Canadian laboratories.
                    Genetic Characterization of Influenza A(H3N2):

                    42 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
                    Sequence analysis of the HA gene of the viruses showed that:
                    • Seven viruses belonged to genetic group 3C.2a.
                    • 34 viruses belonged to subclade 3C.2a1.
                    • One isolate could not be sequenced.
                    A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                    Antigenic Characterization:

                    Influenza A (H3N2):
                    • 23 influenza A(H3N2) viruses were antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                    • Four viruses showed reduced titer with ferret antisera raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                    • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                    • 17 influenza A (H3N2) viruses characterized belonged to genetic group 3C.2a1. Three viruses belonged to genetic group 3C.2a and five to 3C.3a. Sequencing is pending for the remaining isolates.
                    Influenza A(H1N1):
                    • 861 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
                    • 21 viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
                    Influenza B:
                    Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
                    • Four influenza B viruses were characterized as B/Colorado/06/2017, which belong to the Victoria lineage and are included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
                    • 17 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
                    ...
                    https://www.canada.ca/en/public-heal...ry-2-2019.html


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

                    Comment


                    • #11
                      FluWatch report: February 3, 2019 to February 9, 2019 (week 06)


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                      Organization: Public Health Agency of Canada
                      Date published: 2019-02-15

                      Related Topics

                      Overall Summary
                      • Influenza activity in Canada continues to decline slowly. Influenza activity is past the peak in most regions in western Canada, but continues to circulate in eastern regions.
                      • At the national level, most indicators of influenza activity declined in week 06.
                      • Influenza A(H1N1)pdm09 continues to be the most common influenza virus circulating in Canada. There is currently very little influenza B circulation compared to previous seasons.
                      • The higher proportion of laboratory detections, hospitalizations and outbreaks among people in younger age-groups reflects the increased impact of A(H1N1)pdm09 on people under 65 years of age compared to the past two seasons.

                      On this pageInfluenza/Influenza-like Illness Activity (geographic spread)

                      During week 06, fewer regions reported high levels of activity compared to the previous week. The following influenza activity levels were reported (Figure 1):
                      • 16 regions reported localized activity: in Alta.(2), Ont.(6), Que.(3), N.S.(3) and N.B.(2).
                      • 34 regions reported sporadic activity: in B.C.(5), Alta.(3), Sask.(3), Man.(4), Que.(4), N.B.(5), N.S.(1), N.L.(3), P.E.I.(1), Nvt.(3), N.W.T(1), and Y.T.(1).
                      • Three regions: in Man.(1), N.L.(1), and N.W.T(1) reported no activity.


                      Figure 1 – Map of overall influenza/ILI activity by province and territory, Canada, week 2019-06

                      Figure 1 - Text descriptionLaboratory Confirmed Influenza Detections

                      In week 06, the following results were reported from sentinel laboratories across Canada (Figure 2 and Figure 3):
                      • The percentage of tests positive for influenza decreased slightly compared to the previous week at 18.1%.
                      • A total 1,684 laboratory detections of influenza were reported, of which 98% were influenza A.
                      To date this season, 29,374 laboratory-confirmed influenza detections have been reported:
                      • 99% have been influenza A.
                      • Among the 10,418 influenza A viruses subtyped, 91% have been A(H1N1)pdm09.
                      • Influenza B often circulates later in the season in Canada (Feb-Apr). Fewer influenza B detections have been reported this season compared to recent seasons at this time of year.
                      To date this season, detailed information on age and type/subtype has been received for 22,979 laboratory-confirmed influenza cases (Table 1):
                      • 85% of all influenza A(H1N1)pdm09 detections have been reported in individuals younger than 65 years of age.
                      • 61% of all influenza A(H3N2) detections have been reported in adults 65 years of age and older.
                      For more detailed weekly and cumulative influenza data, see the text descriptions for Figures 2 and 3 or the Respiratory Virus Detections in Canada Report.
                      Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2018-35 to 2019-06

                      The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
                      Figure 2 - Text descriptionFigure 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2018-35 to 2019-06

                      Figure 3 - Text description
                      0-4 5035 1529 32 3474 47 5082 22%
                      5-19 3414 1274 31 2109 56 3470 15%
                      20-44 4663 1617 98 2948 41 4704 20%
                      45-64 4588 1482 109 2997 44 4632 20%
                      65+ 4957 1013 430 3514 134 5091 22%
                      Total 22657 6915 700 15042 322 22979 100%
                      Table 1 - Note 1UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available;
                      Return to Table 1 - Note1
                      Syndromic/Influenza-like Illness Surveillance

                      Healthcare Professionals Sentinel Syndromic Surveillance

                      In week 06, 1.1% of visits to healthcare professionals were due to influenza-like illness (ILI) (Figure 4). The percentage of visits for ILI is low compared to previous seasons.
                      Figure 4 – Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2018-35 to 2018-19-06

                      Number of Sentinels Reporting in Week 06: 98
                      The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2013-14 to 2017-18
                      Figure 4 - Text descriptionParticipatory Syndromic Surveillance

                      In week 06, 2,207 participants reported to FluWatchers, of which 57 (2.6%) reported symptoms of cough and fever (Figure 5).
                      Among the 57 participants who reported fever and cough:
                      • 11% consulted a healthcare professional;
                      • 82% reported days missed from work or school, resulting in a combined total of 114 missed days of work or school.
                      • 69% reported having been vaccinated for influenza this season.
                      Figure 5 - Percentage of participants reporting cough and fever, Canada, weeks 2018-40 to 2019-06

                      Number of Participants Reporting in Week 06: 2,207

                      Figure 5 - Text descriptionInfluenza Outbreak Surveillance

                      In week 06, 27 new laboratory-confirmed influenza outbreaks were reported: long-term care facilities (LTCF) (17), acute care facilities (5), and other settings (5). Six new ILI outbreaks in schools/daycares were also reported in week 06. The number of new outbreaks reported each week continues to decline from the peak in week 01.
                      To date this season, 357 laboratory-confirmed influenza outbreaks have been reported (Figure 6):
                      • 215 (60%) outbreaks were in LTCF, 23 were in schools, 48 in acute care facilities, and 71 were in other settings.
                      • Among the 332 outbreaks for which the influenza type was available 98% (327) were associated with influenza A.
                      • Among the 149 outbreaks for which the influenza A subtype was available, 71% (106) were associated with influenza A(H1N1)pdm09;
                      To date this season, 89 ILI outbreaks have been reported; 43 occurred in LTCF, 43 in schools, and three in acute care facilities.
                      Figure 6 – Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2018-35 to 2019-06

                      Figure 6 - Text descriptionSevere Outcomes Influenza Surveillance

                      Provincial/Territorial Influenza Hospitalizations and Deaths
                      To date this season, 1,933 influenza-associated hospitalizations have been reported by participating provinces and territoriesFootnote1.
                      Hospitalizations (Table 2):
                      • 99.7% (1,927) were associated with influenza A
                      • The highest estimated rate of hospitalization is among children under 5 years of age.
                      Intensive Care Unit (ICU) cases and deaths:
                      • To date this season 356 ICU admissions and 82 deaths have been reported.
                        • 44% (156) of reported ICU admissions were in adults aged 45-64 years.
                        • All the ICU admissions, and all but one of the deaths were associated with influenza A.
                      Table 2 - Note 1Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan. The cumulative rate of hospitalizations is calculated using the total population by age-group in participating provinces and territories.
                      Return to Table 2 - Note1
                      0-4 302 2 63.87
                      5-19 173 0 12.47
                      20-44 269 0 9.45
                      45-64 526 0 24.17
                      65+ 657 4 54.33
                      Total 1927 6
                      % 99.7% 0.3%
                      Pediatric Influenza Hospitalizations and Deaths

                      In week 06, 36 pediatric (≤16 years of age) hospitalizations with influenza have been reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 7).
                      To date this season, 845 pediatric hospitalizations have been reported (Figure 8):
                      • 69% of cases were in children under 5 years of age.
                      • 99% (836) of cases have been associated with influenza A.
                      • Among the 285 cases for which the influenza subtype was available, 273 (96%) were associated with A(H1N1)pdm09.
                      To date this season, 140 ICU admissions, and 10 deaths have been reported.
                      • 63% (86) of ICU admissions were in children under 5 years of age.
                      • All but one of the ICU admissions have been associated with influenza A.
                      • 80% (8) of deaths occurred in children 2 to 4 years of age.
                      • All deaths have been associated with influenza A.
                      Figure 7 – Number of pediatric (≤16 years of age) hospitalizations reported by the IMPACT network, by week, Canada, weeks 2018-35 to 2019-06

                      The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2017-18
                      Figure 7 - Text descriptionFigure 8 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by age-group reported by the IMPACT network, Canada, weeks 2018-35 to 2019-06

                      Figure 8 - Text descriptionAdult Influenza Hospitalizations and Deaths

                      Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1st for the 2018-19 season.
                      To date this season, 481 hospitalizations, 50 ICU admissions and 17 deaths have been reported (Figure 9):
                      • 436 (91%) hospitalizations were associated with influenza A.
                      • A greater proportion of hospitalizations have been reported among adults ≥65 years of age (57.2%) compared to adults <65 years of age (42.8%).
                      • Hospitalizations among adults peaked in week 01 then declined, followed by a plateau in week 03-05, and increased slightly in week 06.
                      • Among hospitalized cases with available information (428), the most commonly reported comorbidity was endocrine disorders, which were reported in 87% of hospitalized cases. However, 83% of cases reported more than one type of comorbid condition.
                      Figure 9 - Cumulative numbers of adult hospitalizations (>20 years of age) with influenza by age-group reported by CIRN, Canada, 2018-19, weeks 2018-44 to 2019-06

                      Figure 9 - Text descriptionInfluenza Strain Characterizations

                      Since September 1, 2018, the National Microbiology Laboratory (NML) has characterized 1,103 influenza viruses (87 A(H3N2), 992 A(H1N1) and 24 B) that were received from Canadian laboratories.
                      Genetic Characterization of Influenza A(H3N2):

                      45 influenza A(H3N2) viruses did not grow to sufficient hemagglutination titer for antigenic characterization by hemagglutination inhibition (HI) assay. Therefore, NML has performed genetic characterization to determine the genetic group identity of these viruses.
                      Sequence analysis of the HA gene of the viruses showed that:
                      • Seven viruses belonged to genetic group 3C.2a.
                      • 37 viruses belonged to subclade 3C.2a1.
                      • One isolate could not be sequenced.
                      A/Singapore/INFIMH-16-0019/2016-like virus belongs to genetic group 3C.2a1 and is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                      Antigenic Characterization:

                      Influenza A (H3N2):
                      • 33 influenza A(H3N2) viruses were antigenically characterized as A/Singapore/INFIMH-16-0019/2016-like by HI testing using antiserum raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                      • Nine viruses showed reduced titer with ferret antisera raised against egg-propagated A/Singapore/INFIMH-16-0019/2016.
                      • A/Singapore/INFIMH-16-0019/2016-like virus is the influenza A(H3N2) component of the 2018-19 Northern Hemisphere influenza vaccine.
                      • 22 influenza A(H3N2) viruses characterized belonged to genetic group 3C.2a1. Seven viruses belonged to genetic group 3C.2a and seven to 3C.3a. Sequencing is pending for the remaining isolates.
                      Influenza A(H1N1):
                      • 966 A(H1N1) viruses characterized were antigenically similar to A/Michigan/45/2015, which is the influenza A(H1N1) component of the 2018-19 Northern Hemisphere influenza vaccine.
                      • 26 viruses showed reduced titer with ferret antisera raised against cell culture-propagated A/Michigan/45/2015
                      Influenza B:
                      Influenza B viruses can be divided into two antigenically distinct lineages represented by B/Yamagata/16/88 and B/Victoria/2/87 viruses. The recommended influenza B components for the 2018-19 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage).
                      • Seven influenza B viruses were characterized as B/Colorado/06/2017, which belong to the Victoria lineage and are included as an influenza B component of the 2018-19 Northern Hemisphere influenza vaccine
                      • 17 influenza B viruses were characterized as B/Phuket/3073/2013-like, which belongs to the Yamagata lineage and is included as an influenza B component of the 2018-19 Northern Hemisphere quadrivalent influenza vaccine.
                      • ...
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                      -Nelson Mandela

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