FluWatch report: January 15, 2017 to January 21, 2017 (week 3)

Overall Summary

  • In week 03, activity from several indicators including laboratory detections, outbreaks and hospitalizations declined from the previous week indicating that nationally the influenza season may have reached its peak in week 02.
  • A total of 2,667 positive influenza detections were reported in week 03, a decrease from the previous week.
  • A(H3N2) continues to be the most common type of influenza affecting Canadians.
  • The majority of cases, hospitalizations and deaths have been among adults aged 65+ years.
  • Sixty-six confirmed influenza outbreaks were reported in week 03, with the majority occurring in long-term care facilities and due to influenza A.
  • A total of 417 hospitalizations were reported by participating provinces and territories, down from 467 hospitalizations reported in the previous week.
  • For more information on the flu, see our Flu(influenza) web page.

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Date published: 2017-01-27

Influenza/Influenza-like Illness Activity (geographic spread)

In week 03, all but two reporting regions are reporting influenza or influenza-like illness activity. One region in NS and one region in NB reported no activity. Sporadic influenza activity was reported in 23 regions across ten provinces and territories. Localized activity was reported in twenty regions across seven provinces and territories. Widespread activity was reported in five provinces (three regions in AB, one region in ON, one region in QC, one region in PE and one region in BC). For more details on a specific region, click on the map. 

Figure 1 – Map of overall influenza/ILI activity level by province and territory, Canada, Week 03

Figure 1
Figure 1 Legend

Note: Influenza/ILI activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates and reported outbreaks. Please refer to detailed definitions at the end of the report. Maps from previous weeks, including any retrospective updates, are available in the mapping feature found in the Weekly Influenza Reports.

Figure 1 - Text Description

In week 03, all but two reporting regions are reporting influenza or influenza-like illness activity. One region in NS and one region in NB reported no activity. Sporadic influenza activity was reported in 23 regions across ten provinces and territories. Localized activity was reported in twenty regions across seven provinces and territories. Widespread activity was reported in five provinces (three regions in AB, one region in ON, one region in QC, one region in PE and one region in BC)..

Laboratory Confirmed Influenza Detections

The percentage of tests positive for influenza decreased from 27% in week 02 to 23% in week 03. This is an indication that we may have reached the peak in the percent positive and number of detections for influenza in week 02.  In 2014-15, the previous influenza A(H3N2)-predominant season, the peak occurred in week 52 with 34% of tests positive for influenza. For data on other respiratory virus detections, see the Respiratory Virus Detections in Canada Report on the Public Health Agency of Canada (PHAC) website.

Figure 2 – Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2016-17, Week 03

Figure 2

The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the start and end of seasonal influenza activity.

Figure 2 - Text Description
Figure 2 - Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, 2016-17
Report Week A(Unsubtyped) A(H3) A(H1)pdm09 Influenza B
35 0 <5 0 0
36 <5 0 <5 9
37 <5 17 0 <5
38 11 28 <5 <5
39 14 41 <5 7
40 0 47 <5 <5
41 10 31 0 <5
42 14 49 <5 6
43 16 76 <5 <5
44 19 110 <5 9
45 31 150 <5 11
46 52 140 <5 7
47 54 200 0 9
48 91 272 <5 7
49 148 414 <5 12
50 305 467 <5 18
51 535 750 <5 17
52 857 1064 <5 33
1 1444 1360 <5 38
2 1530 2104 10 39
3 1398 1350 0 47
4 0 0 0 0
5 0 0 0 0
6 0 0 0 0
7 0 0 0 0
8 0 0 0 0
9 0 0 0 0
10 0 0 0 0
11 0 0 0 0
12 0 0 0 0
13 0 0 0 0
14 0 0 0 0
15 0 0 0 0
16 0 0 0 0
17 0 0 0 0
18 0 0 0 0
19 0 0 0 0
20 0 0 0 0
21 0 0 0 0
22 0 0 0 0
23 0 0 0 0
24 0 0 0 0
25 0 0 0 0
26 0 0 0 0
27 0 0 0 0
28 0 0 0 0
29 0 0 0 0
30 0 0 0 0
31 0 0 0 0
32 0 0 0 0
33 0 0 0 0
34 0 0 0 0

Nationally in week 03, 2,667 positive influenza tests were reported, down from 3,477 tests reported in week 02. To date, a total of 15,231 laboratory confirmed influenza detections have been reported, of which 98% have been influenza A. Influenza A(H3N2) is the most common subtype detected, representing over 99% of subtyped influenza A detections (8664/8703). 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 3 – Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, 2016-17, Week 03

Figure 3
Figure 3 - Text Description
Figure 3 - Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, 2016-17
Reporting
provincesTable Figure 3 - Footnote 1
Weekly (January 15, 2017 to January 21, 2017) Cumulative (August 28, 2016 to January 21, 2016)
Influenza A B Influenza A B A & B
Total
A
Total
A
(H1)pdm09
A
(H3)
ATable Figure 3 - Footnote UnS B
Total
A
Total
A
(H1)pdm09
A
(H3)
ATable Figure 3 - Footnote UnS B
Total
BC 417 0 55 362 20 2055 3 935 1117 55 2110
AB 250 0 202 48 4 2762 8 2655 99 40 2802
SK 74 0 58 16 0 929 0 453 476 12 941
MB 18 0 7 11 0 57 0 46 11 10 67
ON 1,048 5 898 145 7 5030 26 4050 954 58 5088
QC 706 0 49 657 15 3577 0 236 3340 98 3675
NB 43 0 0 43 0 115 1 18 96 3 118
NS 12 0 0 12 0 91 0 1 90 0 91
PE 17 0 17 0 0 53 1 52 0 0 53
NL 8 0 4 4 0 43 0 33 10 4 47
YT 6 0 2 4 0 187 0 142 45 1 188
NT 8 0 7 1 0 22 0 21 1 0 22
NU 14 0 8 6 0 28 0 22 6 1 29
Canada 2621 5 1307 1309 46 14949 39 8664 6245 282 15231
PercentageTable Figure 3 - Footnote 2 98% 0% 50% 50% 2% 98% 0% 58% 42% 2% 100%
PercentageTable Figure 3 - Footnote 2                      

To date, detailed information on age and type/subtype has been received for 10, 808 laboratory confirmed influenza cases. Among cases with reported age and type/subtype information, adults aged 65+ accounted for over half of the reported influenza cases and the largest proportion (45%) of influenza A (H3N2) cases. 

Table 1 - Weekly and cumulative numbers of positive influenza specimens by type, subtype and age-group reported through case-based laboratory reportingTable 1 - Footnote 1, Canada, 2016-17, Week 03
Age groups (years) Weekly (January 15 to January 21, 2017) Cumulative (August 28, 2016 to January 21, 2017)
Influenza A B Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) ATable 1 - Footnote UnS Total A Total A(H1) pdm09 A(H3) ATable 1 - Footnote UnS Total # %
<5 147 0 46 101 5 >844 <5 404 440 44 >888 x%
5-19 139 0 40 99 5 >1032 <5 593 439 37 >1069 x%
20-44 193 0 66 127 <5 >1661 <5 944 717 34 >1695 x%
45-64 248 0 94 154 9 1833 6 960 867 36 1869 17%
65+ 691 0 209 482 6 >5227 <5 2336 2891 52 >5279 x%
Total 1418 0 455 963 >25 10605 14 5237 5354 203 10808 100%
PercentageTable 1 - Footnote 2 98% 0% 32% 68% 2% 98% 0% 49% 50% 2%    

Syndromic/Influenza-like Illness Surveillance

Healthcare Professionals Sentinel Syndromic Surveillance

In week 03, 2.1% of visits to healthcare professionals were due to influenza-like illness.

Figure 4 - Percentage of visits for ILI reported by sentinels by report week, Canada, 2016-17

Number of Sentinels Reporting Week 03: 128

Figure 4

Delays in the reporting of data may cause data to change retrospectively. In BC, AB, and SK, data are compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.

Figure 4 - Text Description
Figure 4 - Percentage of visits for ILI reported by sentinels by report week, Canada, 2016-17
Report week % Visits for ILI
35 0.96%
36 0.96%
37 0.98%
38 0.96%
39 0.94%
40 1.03%
41 2.41%
42 1.04%
43 1.01%
44 1.39%
45 1.32%
46 0.97%
47 1.11%
48 1.07%
49 1.08%
50 1.30%
51 1.73%
52 2.84%
1 1.98%
2 2.20%
3 2.08%
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Are you a primary healthcare practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel?
Please visit our Influenza Sentinel page for more details.

Influenza Outbreak Surveillance

In week 03, sixty-six laboratory confirmed influenza outbreaks were reported: 39 in long-term care (LTC) facilities, 19 in hospitals and 8 in institutional or community (other) settings. Of the outbreaks with known strains or subtypes,  all outbreaks were due to influenza A, of which 17 were due to influenza A(H3N2) and 35 were due to influenza A(UnS).

To date this season, 536 outbreaks have been reported and the majority (68%) have occurred in LTC facilities. In comparison, at week 03 in the 2014-15 season, the previous influenza A(H3N2)-predominant season, 1,036 outbreaks were reported, of which 77% occurred in LTC facilities. 

Figure 5 - Overall number of new laboratory-confirmed influenza outbreaksFigure 5 - Footnote 1 by report week, Canada, 2016-17, Week 3
Figure 5
Figure 5 - Text Description
Figure 5 - Overall number of new laboratory-confirmed influenza outbreaks by report week, Canada, 2016-17
Report week Hospitals Long Term Care Facilities Other
35 0 0 0
36 0 0 0
37 0 2 0
38 1 1 1
39 1 3 1
40 0 0 0
41 0 3 0
42 0 3 1
43 0 3 0
44 2 5 2
45 1 1 0
46 2 6 0
47 1 8 0
48 0 2 0
49 1 14 3
50 4 15 4
51 5 32 13
52 7 64 18
1 15 84 22
2 13 78 24
3 19 39 8
4 0 0 0
5 0 0 0
6 0 0 0
7 0 0 0
8 0 0 0
9 0 0 0
10 0 0 0
11 0 0 0
12 0 0 0
13 0 0 0
14 0 0 0
15 0 0 0
16 0 0 0
17 0 0 0
18 0 0 0
19 0 0 0
20 0 0 0
21 0 0 0
22 0 0 0
23 0 0 0
24 0 0 0
25 0 0 0
26 0 0 0
27 0 0 0
28 0 0 0
29 0 0 0
30 0 0 0
31 0 0 0
32 0 0 0
33 0 0 0
34 0 0 0

Provincial/Territorial Influenza Hospitalizations and Deaths

In week 03, 417 influenza-associated hospitalizations were reported by participating provinces and territories*. Influenza A accounted for all but six reported hospitalizations. A total of ten intensive care unit (ICU) admissions and 24 deaths were reported in week 03. Adults aged 65+ accounted for the largest proportion of hospitalizations (69%). All ICU admissions and deaths in week 03 were reported in adults.

To date this season, 2,479 hospitalizations have been reported, of which 99% were due to influenza A. Among cases for which the subtype of influenza A was reported, almost all (1446/1450) were influenza A(H3N2). Adults 65+ accounted for 70% of the hospitalizations. Eighty-nine ICU admissions and 79 deaths have been reported. The majority of deaths (81%) were reported in adults aged 65+ years. 

Table 2 - Cumulative number of hospitalizations, ICU admissions and deaths by age and influenza type reported by participating provinces and territories, Canada 2016-17, Week 03
Age Groups (years) Cumulative (August 28, 2016 to Jan. 21 2017)
Hospitalizations ICU Admissions Deaths
Influenza A Total Influenza B Total Total [# (%)] Influenza A and B Total % Influenza A and B Total %
Note: Influenza-associated hospitalizations are not reported to PHAC by: BC, NU, and QC. Only hospitalizations that require intensive medical care are reported by SK. ICU admissions
x Supressed to prevent residual disclosure
0-4 168 5 173 (7%) 7  8% 0  0%
5-19 100 5 105 (4%) 6  7% <5 x%
20-44 137 <5 >137 (x%) 7  8% 0  0%
45-64 319 <5 >319 (x%) 28  31% 14 x%
65+ 1725 15 1740 (70%) 41  46% 64 x%
Total 2449 30 2479 (100%) 89  100% 79  100%

Sentinel Hospital Influenza Surveillance

Pediatric Influenza Hospitalizations and Deaths

In week 03, 36 laboratory-confirmed influenza-associated pediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All but two cases were due to influenza A. The number of hospitalizations reported in week 03 is below the six year average for the same time period (Figure 7).

To date this season, 236 laboratory-confirmed influenza-associated pediatric hospitalizations were reported by the IMPACT network. Children aged 0-2 years accounted for approximately 41% of hospitalizations. Influenza A accounted for 93% (n=219) of the reported hospitalizations, of which 44% (n=96) were influenza A(H3N2) and the remainder were A(UnS). Additionally, 40 intensive care unit (ICU) admissions have been reported, of which the largest proportion (27%) was reported in children 10-16 years. A total of 25 ICU cases reported at least one underlying condition or comorbidity. No deaths have been reported this season.

In 2014-15, the previous influenza A(H3N2)-predominant season, there were 446 hospitalizations, 50 ICU admissions and three deaths reported as of week 03. 

Figure 6 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by type and age-group reported by the IMPACT network, Canada, 2016-17, Week 03

Figure 6
Figure 6 - Text Description
Figure 6 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by type and age-group reported by the IMPACT network, Canada, 2016-17
Age Group Total
0-5 mo 44
6-23 mo 53
2-4 yr 60
5-9 yr 40
10-16 yr 38

Figure 7 – Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, 2016-17, Week 03

Figure 6

The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2015-16.

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

Figure 7 - Text Description
Figure 7 - Number of pediatric (≤16 years of age) hospitalizations reported by IMPACT sentinel hospital network, by week, Canada, 2016-17
Report week 2016-17 Average Min Max
35 0 0 0 0
36 1 0 0 0
37 0 1 0 2
38 0 1 0 2
39 3 0 0 1
40 2 0 0 1
41 0 1 0 2
42 4 1 0 1
43 4 1 0 3
44 5 2 1 4
45 3 3 2 4
46 8 5 1 13
47 1 5 0 9
48 7 10 1 22
49 10 15 2 28
50 20 24 4 47
51 18 35 4 71
52 36 47 7 92
1 47 37 3 75
2 29 36 6 60
3 36 37 2 67
4 #N/A 34 5 47
5 #N/A 39 10 57
6 #N/A 38 15 79
7 #N/A 41 15 118
8 #N/A 48 25 134
9 #N/A 59 12 172
10 #N/A 48 17 114
11 #N/A 45 17 118
12 #N/A 39 14 96
13 #N/A 33 14 57
14 #N/A 27 12 56
15 #N/A 25 14 56
16 #N/A 22 10 41
17 #N/A 18 9 37
18 #N/A 15 6 28
19 #N/A 10 5 18
20 #N/A 9 4 18
21 #N/A 6 2 10
22 #N/A 4 1 7
23 #N/A 2 0 4
24 #N/A 2 0 5
25 #N/A 1 0 3
26 #N/A 1 0 2
27 #N/A 0 0 2
28 #N/A 1 0 1
29 #N/A 0 0 2
30 #N/A 0 0 0
31 #N/A 0 0 0
32 #N/A 0 0 1
33 #N/A 0 0 0
34 #N/A 1 0 2

Adult Influenza Hospitalizations and Deaths

In week 03, a total of 104 laboratory-confirmed influenza-associated adult (≥20 years of age) hospitalizations were reported by the Canadian Immunization Research Network (CIRN). All cases were due to influenza A and the greatest proportion of cases  (74%) occurred in adults aged 65+.

To date this season, 607 laboratory-confirmed influenza-associated adult (≥20 years of age) hospitalizations have been reported by CIRN. All but four hospitalized cases were due to influenza A. Adults aged 65+ accounted for 78% of hospitalizations. To date, greater than 37 intensive care unit (ICU) admissions have been reported. A total of 26 ICU cases reported at least one underlying condition or comorbidity. A total of 12 deaths have been reported this season, all in adults aged 65+. The median age of reported deaths was 72 years. 

Figure 8 - Cumulative numbers of adult hospitalizations (≥20 years of age) with influenza by type and age-group reported by CIRN, Canada, 2016-17, Week 03

Figure 8
Figure 8 - Text Description
Figure 8 - Cumulative numbers of adult hospitalizations (≥20 years of age) with influenza by type and age-group reported by the CIRN network, Canada, 2016-17
Age Group Total
20-44 yr 36
45-64 yr 100
65+ yr 471

Figure 9 – Percentage of hospitalizations, ICU admissions and deaths with influenza by age-group (≥20 years of age) reported by CIRN, Canada 2016-17, Week 03

Figure 9

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.

Figure 9 - Text Description
Figure 9 - Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group (≥20 year of age), CIRN, Canada, 2016-17
Age-group (years) Hospitalizations (n= >607) ICU admissions (n= <37) Deaths (n= <12)
- Supressed due to small values
20-44 5.9% 10.0% 0.0%
45-64 16.5% 12.2% 0.0%
65+ 77.6% 78.0% 100.0%

During the 2016-17 influenza season, the National Microbiology Laboratory (NML) has characterized 412 influenza viruses [372 A(H3N2), 10 A(H1N1), 30 influenza B].  All but one influenza A virus (n=371) and all (n=30) influenza B viruses characterized were antigentically or genetically similar to the vaccine strains included in both the trivalent and quadrivalent vaccines. Sixteen influenza B viruses were similar to the strain which is included only in the quadrivalent vaccine.

Table 3 – Influenza strain characterizations, Canada, 2016-17, Week 03
Strain Characterization ResultsTable 3 - Footnote 1 Count Description
Influenza A (H3N2)
Antigenically
A/Hong Kong/4801/2014-like
132 Viruses antigenically similar to A/Hong Kong/4801/2014, the A(H3N2) component of the 2016-17 Northern Hemisphere's trivalent and quadrivalent vaccine.
GeneticallyTable 3 - Footnote 2
A/Hong Kong/4801/2014-like
239

Viruses belonging to genetic group 3C.2a. A/Hong Kong/4801/2014-like virus belongs to genetic group 3C.2a and is the influenza A(H3N2) component of the 2016-17 Northern Hemisphere's trivalent and quadrivalent vaccine.

Additionally, genetic characterization of the 132 influenza A (H3N2) viruses that underwent HI testing determined that 92 viruses belonged to genetic group 3C.2a and 21 viruses belonged to genetic group 3C.3a. Sequencing is pending for the remaining four isolates.The majority of viruses belonging to genetic group 3C.3a are inhibited by antisera raised against A/Hong Kong/4801/2014Table 3 - Footnote 3.

Antigenically
A/Indiana/10/2011-likeTable 3 - Footnote 4
1

Viruses antigenically similar to A/Indiana/10/2011, a candidate H3N2v vaccine virus.

Influenza A (H1N1)
A/California/7/2009-like 10 Viruses antigenically similar to A/California/7/2009, the A(H1N1) component of the 2016-17 Northern Hemisphere's trivalent and quadrivalent vaccine influenza vaccine.
Influenza B
B/Brisbane/60/2008-like
(Victoria lineage)
14 Viruses antigenically similar to B/Brisbane/60/2008, the influenza B component of the 2016-17 Northern Hemisphere's trivalent and quadrivalent influenza vaccine
B/Phuket/3073/2013-like
(Yamagata lineage)
16 Viruses antigenically similar to B/Phuket/3073/2013, the additional influenza B component of the 2016-17 Northern Hemisphere quadrivalent influenza vaccine.

During the 2016-17 season, the National Microbiology Laboratory (NML) has tested 313 influenza viruses for resistance to oseltamivir, 312 to zanamivir and 127 to amantadine. All viruses were sensitive to oseltamivir and zanamivir. All 127 influenza A viruses were resistant to amantadine (Table 4).

Table 4 – Antiviral resistance by influenza virus type and subtype, Canada, 2016-17, Week 03
Virus type and subtype Oseltamivir Zanamivir Amantadine
# tested # resistant (%) # tested # resistant (%) # tested # resistant (%)
A (H3N2) 273 0 (0%) 273 0 (0%) 118 118 (100%)
A (H3N2v) 1 0 (0%) 1 0 (0%) 1 1 (100%)
A (H1N1) 10 0 (0%) 9 0 (0%) 8 8 (100%)
B 29 0 (0%) 29 0 (0%) N/ATable 4 - Footnote * N/ATable 4 - Footnote *
TOTAL 313 0 (0%) 312 0 (0%) 127 127 (100%)

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 ILIFootnote * 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 regionFootnote

4 = Widespread:

  1. evidence of increased ILIFootnote * 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 regionFootnote

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


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