FluWatch report: August 16 to August 29, 2015 (Weeks 33 & 34)

Influenza/ILI Activity (geographic spread)

In week 34, sporadic influenza activity was reported ON, QC and NS. Overall, there is low influenza/ILI activity in Canada.

Influenza and Other Respiratory Virus Detections

Influenza detections remain at inter-seasonal levels. A few jurisdictions reported low numbers of influenza detections in week 34 (Table 1). In the summer months (weeks 27 to 34), 82 influenza detections were reported and the majority (65%) were influenza A(H3N2). For the 2014-15 season, detailed information on age and type/subtype has been received for 37,487 cases (Table 2). Adults ≥65 years of age have predominantly been affected by influenza A, accounting for 62% of influenza A detections.

Similar to influenza, detections for all other respiratory viruses remain at inter-seasonal levels (figure 3). In weeks 33 and 34, rhinovirus was the predominant virus among other respiratory viruses.

For more details, see the weekly Respiratory Virus Detections in Canada Report.

Antiviral Resistance

During the 2014-2015 influenza season, the NML has tested 1,937 influenza viruses for resistance to oseltamivir and 1,935 influenza viruses for resistance to zanamivir. All viruses were sensitive to zanamivir and one influenza A(H3N2) virus was resistant to oseltamivir. A total of 1,502 influenza A viruses (99.9%) were resistant to amantadine (Table 3).

Influenza Strain Characterizations

During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 1,171 influenza viruses [221 A(H3N2), 24 A(H1N1) and 926 influenza B].

Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=221), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 215 were antigenically similar to A/Switzerland/9715293/2013. Additionally, 1,224 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 1,222 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012. Influenza A(H1N1): 24 A(H1N1) viruses characterized were antigenically similar to A/California/7/2009. Influenza B: Of the 926 influenza B viruses characterized, 815 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and 108 were B/Brisbane/60/2008-like (Figure 4).

Influenza-like Illness (ILI) Consultation Rate

The national influenza-like-illness (ILI) consultation rate increased from 5.1 consultations per 1,000 in week 32 to 9.2 per 1,000 in week 33 and 10.9 per 1,000 in week 34 (Figure 5). The rates for week 33 to 34 have been slightly above the expected range for this time of year.

Influenza Outbreak Surveillance

In week 34, no outbreaks of influenza were reported (Figure 6). To date this season, 1,282 outbreaks in LTCFs have been reported and the majority of those with known subtypes were attributable to A(H3N2). There have been a higher number of reported influenza outbreaks to date this season compared to the same period in previous seasons.

Pharmacy surveillance

Pharmacy surveillance for sales of influenza antivirals has ended for the 2014-2015 influenza season (Figure 7).

Sentinel Hospital Influenza Surveillance

Paediatric Influenza Hospitalizations and Deaths (IMPACT)

In weeks 33 and 34, no laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. No ICU admissions were reported.

To date this season, 714 hospitalizations have been reported by the IMPACT network, 511 (72%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 98% (164/167) were A(H3N2) (Table 4). To date, 104 cases were admitted to the ICU, of which 58 (56%) were 2 to 9 years of age (Figure 9a). A total of 68 ICU cases reported to have at least one underlying condition or comorbidity. Five deaths have been reported.

Note: The number of hospitalizations reported through IMPACT represents a subset of all influenza-associated paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.

Adult Influenza Hospitalizations and Deaths (CIRN)

Surveillance has ended for the 2014-2015 influenza season.

This season, 2,228 cases have been reported; 1,912 (86%) with influenza A. The majority of cases (81%) were among adults ≥65 years of age (Table 5). One hundred and seventy two ICU admissions have been reported and 128 cases were adults ≥65 years of age. Among the 172 ICU admissions, 27 were due to influenza B (12 in adults 45 to 64 years of age and 15 in adults over the age of 65). A total of 123 ICU cases (72%) reported to have at least one underlying condition or comorbidity. Of the 123 ICU cases with known immunization status, 40 (33%) reported not having been vaccinated this season. One hundred and thirty-five deaths have been reported, 124 (92%) of the deaths were adults >65 years of age (Figure 9B).

Note: The number of hospitalizations reported through CIRN represents a subset of all influenza-associated adult hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.

Provincial/Territorial Influenza Hospitalizations and Deaths

In week 34, 13 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territories^{Footnote *}. Of the 13 hospitalizations, eight (62%) were due to influenza A and nine (69%) were in patients ≥65 years of age.

Since the start of the 2014-15 season, 8,021 hospitalizations have been reported; 6,850 (85%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.2% were A(H3N2). The majority of cases (70%) were ≥65 years of age (Table 6). A total of 397 ICU admissions have been reported to date: 52% (n=205) were in adults ≥65 years of age and 74% were due to influenza A. A total of 606 deaths have been reported since the start of the season: three children <5 years of age, five children 5-19 years, 47 adults 20-64 years, and 550 adults ≥65 years of age. Influenza A has been reported in 91% of deaths. Adults 65 years of age or older represent 91% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.

See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2009-10 to 2014-15 on the Public Health Agency of Canada website.

Emerging Respiratory Pathogens

Human Avian Influenza
Influenza A(H7N9): There have been no reported cases of human infection with avian influenza A(H7N9) since July 18, 2015. Globally to September 2, 2015, the WHO reported a total of 678 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 275 deaths. Documents related to the public health risk of influenza A(H7N9), as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

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

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)

Since the last FluWatch report, a number of confirmed cases of MERS-CoV continue to be reported in Saudi Arabia. Most of these cases have been associated with a hospital outbreak in the Riyadh Region. Jordan has also reported a travel-linked case of MERS-CoV from Saudi Arabia. Additional cases have since been reported in Jordan and are linked to a MERS-CoV outbreak currently occurring in a hospital in Amman city.

There have been no new cases reported in South Korea since July 4, 2015.

Globally, from September 2012 to September 2, 2015, the WHO has reported a total of 1,478 laboratory-confirmed cases of infection with MERS-CoV, including 516 deaths.

Documents related to the public health risk of MERS-CoV, as well as guidance for health professionals and advice for the public is updated regularly on the following websites:

• PHAC - Middle East respiratory syndrome coronavirus (MERS-CoV)
• WHO - Coronavirus infections

International Influenza Reports

• World Health Organization influenza update
• World Health Organization FluNet
• WHO Influenza at the human-animal interface
• Centers for Disease Control and Prevention seasonal influenza report
• European Centre for Disease Prevention and Control - epidemiological data
• South Africa Influenza surveillance report
• New Zealand Public Health Surveillance
• Australia Influenza Report
• Pan-American Health Organization Influenza Situation Report

FluWatch definitions for the 2014-2015 season

Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU).

Influenza-like-illness (ILI): Acute onset of respiratory illness with fever and cough and with one or more of the following - sore throat, arthralgia, myalgia, or prostration which is likely due to influenza. In children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent.

ILI/Influenza outbreaks

Schools:

Greater than 10% absenteeism (or absenteeism that is higher (e.g. >5-10%) than expected level as determined by school or public health authority) which is likely due to ILI.
Note: it is recommended that ILI school outbreaks be laboratory confirmed at the beginning of influenza season as it may be the first indication of community transmission in an area.

Hospitals and residential institutions:

two or more cases of ILI within a seven-day period, including at least one laboratory confirmed case. Institutional outbreaks should be reported within 24 hours of identification. Residential institutions include but not limited to long-term care facilities ( LTCF) and prisons.

Workplace:

Greater than 10% absenteeism on any day which is most likely due to ILI.

Other settings:

two or more cases of ILI within a seven-day period, including at least one laboratory confirmed case; i.e. closed communities.

Note that reporting of outbreaks of influenza/ILI from different types of facilities differs between jurisdictions.

Influenza/ILI activity level

1 = No activity: no laboratory-confirmed influenza detections in the reporting week, however, sporadically occurring ILI may be reported

2 = Sporadic: sporadically occurring ILI and lab confirmed influenza detection(s) with no outbreaks detected within the influenza surveillance region ^{Footnote †}

3 = Localized:

1. evidence of increased ILI^{Footnote *} and
2. lab confirmed influenza detection(s) together with
3. outbreaks in schools, hospitals, residential institutions and/or other types of facilities occurring in less than 50% of the influenza surveillance region^{Footnote †}

4 = Widespread:

1. evidence of increased ILI^{Footnote *} and
2. lab confirmed influenza detection(s) together with
3. outbreaks in schools, hospitals, residential institutions and/or other types of facilities occurring in greater than or equal to 50% of the influenza surveillance region^{Footnote †}

Note: ILI data may be reported through sentinel physicians, emergency room visits or health line telephone calls.

We would like to thank all the Fluwatch surveillance partners who are participating in this year's influenza surveillance program.