FluWatch report: August 24 to September 6, 2014 (Weeks 35 and 36)

Overall summary

Influenza activity in Canada remains at inter-seasonal levels with only sporadic detections of influenza.
In weeks 35 and 36 no outbreaks or hospitalizations were reported.
This is the first FluWatch report of the 2014-15 influenza season.

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

Influenza/ILI Activity (geographic spread)

In weeks 35 and 36, most regions in Canada reported no influenza/ILI activity. During these two weeks, one region in Quebec reported sporadic activity; and in week 36, two other regions (BC(1) and ON(1)) reported sporadic activity (Figure 1). In week 35, six regions did not report data, and in week 36, one region did not report.

Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 36

Figure 1 Legend — Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 36

Figure 1 Map of overall influenza/ILI activity level by province and territory, Canada, Week 30 - Text Description

In week 36, three regions (BC(1), ON(1) and QC(1)) reported sporadic activity. No data was reported for one region (PE).

Influenza and Other Respiratory Virus Detections

The number of positive influenza tests continued at inter-seasonal levels in week 35 (5 detections) and week 36 (4 detections), with <1% of tests positive since early July (Figure 2). Most jurisdictions have reported only sporadic numbers of influenza detections in recent weeks (Table 1, Table 2).

Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15

In weeks 35 and 36, detections of most other respiratory viruses were at inter-seasonal levels (RSV, coronavirus, and human metapneumovirus). Detections of parainfluenza, adenovirus and rhinovirus were in keeping with their usual pattern of seasonal circulation (figure 3).

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

Figure 3 Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15 - Text Description

Table 1: Weekly and cumulative numbers of positive influenza specimens by type, subtype and province, Canada, 2014-15
Reporting provinces^{Footnote 1}	Two weeks (August 24 to September 6, 2014)					Cumulative (August 24 to September 6, 2014)
	Influenza A				B	Influenza A				B
	A Total	A(H1)pdm09	A(H3)	A ^{Footnote (Uns)}	B Total	A Total	A(H1)pdm09	A(H3)	A(UnS)	B Total
BC	0	0	0	0	0	0	0	0	0	0
AB	0	0	0	0	0	0	0	0	0	0
SK	0	0	0	0	0	0	0	0	0	0
MB	0	0	0	0	0	0	0	0	0	0
ON	2	0	1	1	1	2	0	1	1	1
QC	3	0	0	3	3	3	0	0	3	3
NB	0	0	0	0	0	0	0	0	0	0
NS	0	0	0	0	0	0	0	0	0	0
PE	0	0	0	0	0	0	0	0	0	0
NL	0	0	0	0	0	0	0	0	0	0
Canada	5	0	1	4	4	5	0	1	4	4
Percentage ^{Footnote 2}	55.6%	0.0%	20.0%	80.0%	44.4%	55.6%	0.0%	20.0%	80.0%	44.4%
Footnote 1 Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks. Return to footnote 1 referrer Footnote 2 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections. Return to footnote 2 referrer Footnote 3 Unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available. Return to footnote Uns referrer

Table 2. Weekly and cumulative numbers of positive influenza specimens by type, subtype and age-group reported through case-based laboratory reporting

Data suppressed for the 2014-15 season due to small values. Table 2 will be updated when additional data are received.

Influenza Strain Characterizations

The National Microbiology Laboratory (NML) has not yet reported any influenza strain characterizations for the 2014-15 season (Figure 4).

Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 0

The National Microbiology Laboratory (NML) has not yet conducted antigenic characterization of influenza viruses collected during the 2014-15 season.

The NML receives a proportion of the number of influenza positive specimens from provincial laboratories for strain characterization and antiviral resistance testing. Characterization data reflect the results of haemagglutination inhibition (HAI) testing compared to the reference influenza strains recommended by WHO.

The recommended components for the 2014-2015 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an A/Texas/50/2012 (H3N2)-like virus, and a B/Massachusetts/2/2012-like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus is recommended.

Antiviral Resistance

The NML has not yet reported antiviral resistance results for influenza viruses collected during the 2014-15 season (Table 3).

**Table 3. Antiviral resistance by influenza virus type and subtype, Canada, 2014-15**
Virus type and subtype	Oseltamivir		Zanamivir		Amantadine
Virus type and subtype	# tested	# resistant (%)	# tested	# resistant (%)	# tested	# resistant (%)
A (H3N2)	0	0	0	0	0	0
A (H1N1)	0	0	0	0	0	0
B	0	0	0	0	NA^{Table 3 - Footnote *}	NA ^{Table 3 - Footnote *}
TOTAL	0	0	0	0	0	0
Table 3 - Footnote * NA - not applicable Return to Table 3 - Footnote * referrer

Influenza-like Illness (ILI) Consultation Rate

The national influenza-like-illness (ILI) consultation rate increased from 8.0 consultations per 1,000 patient visits in week 34 to 13.6 per 1,000 in week 35 and decreased slightly to 12.3 per 1,000 in week 36 (Figure 5). The rates since mid-June have been above the expected range for this time of year.

Influenza Outbreak Surveillance

No new outbreaks of influenza were reported in weeks 35 and 36 (Figure 6).

Figure 6: Overall number of new laboratory-confirmed influenza outbreaks by report week, Canada, 2014-2015

**Figure 6: Overall number of new laboratory-confirmed influenza outbreaks by report week, Canada, 2014-2015**
Report week	Hospitals	Long Term Care Facilities
35	0	0
36	0	0

Pharmacy surveillance

In weeks 35 and 36, the proportion of prescriptions for antivirals was at inter-seasonal levels (Figure 7).

Figure 7. Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2014-15

Sentinel Hospital Influenza Surveillance

Paediatric Influenza Hospitalizations and Deaths (IMPACT)

No laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations have been reported by the Immunization Monitoring Program Active (IMPACT) network for the 2014-15 season (Figure 8a).

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

Adult Influenza Hospitalizations and Deaths (PCIRN)

Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network has not yet begun for the 2014-15 season (Figure 8B).

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.

Table 4 - Cumulative numbers of paediatric hospitalizations with influenza reported by the IMPACT network, Canada, 2014-15
Age groups	Cumulative (Aug. 24, 2014 to September 6, 2014)
	Influenza A				B	Influenza A and B
	A Total	A(H1) pdm09	A(H3)	A^{Footnote (Uns)}	Total	# (%)
0-5m	0	0	0	0	0	0
6-23m	0	0	0	0	0	0
2-4y	0	0	0	0	0	0
5-9y	0	0	0	0	0	0
10-16y	0	0	0	0	0	0
Total	0	0	0	0	0	0
%^{Footnote 1}	0.0%	0.0%	0.0%	0.0%	0.0%	0.0%
Footnote 1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections. Return to footnote 1 referrer Footnote uns unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available. Return to footnote UnS referrer

Table 5 - Cumulative numbers of adult hospitalizations with influenza reported by the PCIRN-SOS network, Canada, 2014-15

PCIRN-SOS surveillance for the 2014-15 season has not yet begun.

Figure 8A — Figure 8 - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15

**A) Paediatric hospitalizations (≤16 years of age, IMPACT)**

**Figure 8 A) Paediatric hospitalizations (≤16 years of age, IMPACT)**
Report week	Influenza A	Influenza B
35	0	0
36	0	0

Figure 8B - Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2014-15

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

**Figure 8 B) Adult hospitalizations (≥16 year of age, CIRN)**
Report week	Influenza A	Influenza B	Untyped
35	n/a	n/a	n/a
36	n/a	n/a	n/a

Figure 9a — Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15

**A) Paediatric hospitalizations (≤16 years of age, IMPACT)**

Figure 9 A) Paediatric hospitalizations (≤16 years of age, IMPACT)
Age-group (years)	Hospitalizations(n=0)	ICU admissions(n=0)
0-5m	0	0
6-23m	0	0
2-4y	0	0
5-9y	0	0
10-16y	0	0

Figure 9b — Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15

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

Figure 9 B) Adult hospitalizations (≥16 year of age, CIRN)
Age-group (years)	Hospitalizations (n=0)	ICU admissions(n=0)	Deaths (n=0)
16-20	0	0	0
20-44	0	0	0
45-64	0	0	0
65+	0	0	0

Provincial/Territorial Influenza Hospitalizations and Deaths

No laboratory-confirmed influenza-associated hospitalizations have been reported from participating provinces and territories^{Footnote *} since the start of the 2014-15 season.

Footnote *

Note: Influenza-associated hospitalizations are not reported to PHAC by the following Provinces and Territory: BC, NU, and QC. Only hospitalizations that require intensive medical care are reported by Saskatchewan. ICU admissions are not distinguished among hospital admissions reported from Ontario. Data may also include cases reported by the IMPACT and CIRN networks. The number of new influenza-associated hospitalizations and deaths reported for the current week may include cases from Ontario that occurred in previous weeks, as a result of retrospective updates to the cumulative total. It is important to note that the hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.

Return to footnote * referrer

Table 6. Cumulative number of hospitalizations with influenza reported by the participating provinces and territories, Canada, 2014-15
Age groups	Cumulative (24 August 2014 to 1 August 2015)
	Influenza A				B	Influenza A and B
	A Total	A(H1) pdm09	A(H3)	A^{Footnote (Uns)}	Total	# (%)
0-4 years	0	0	0	0	0	0
5-19 years	0	0	0	0	0	0
20-44 years	0	0	0	0	0	0
45-64 years	0	0	0	0	0	0
65+ years	0	0	0	0	0	0
Unknown	0	0	0	0	0	0
Total	0	0	0	0	0	0
Percentage^{Footnote 1}	0%	0%	0%	0%	0%	0%
Footnote 1 Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections. Return to footnote 1 referrer Footnote 2 unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available. Return to footnote UnS referrer

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): No new cases of human infection with influenza A(H7N9) have been reported by the World Health Organization since the last FluWatch report. Globally to September 11, 2014, the WHO has been informed of a total of 453 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 175 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)

Globally, from September 2012 to September 11, 2014, the WHO has been informed of a total of 841 laboratory-confirmed cases of infection with MERS-CoV, including 298 deaths. All cases have either occurred in the Middle East or have had direct links to a primary case infected in the Middle East. The public health risk posed by MERS-CoV in Canada remains low (see the PHAC Assessment of Public Health Risk).

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

International Influenza Reports

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:

evidence of increased ILI^{Footnote *} and
lab confirmed influenza detection(s) together with
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:

evidence of increased ILI^{Footnote *} and
lab confirmed influenza detection(s) together with
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.

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Date modified:: 2014-09-12

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FluWatch report: August 24 to September 6, 2014 (Weeks 35 and 36)

Overall summary

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Influenza/ILI Activity (geographic spread)

Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 36

Influenza and Other Respiratory Virus Detections

Figure 2. Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2014-15

Figure 3. Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15