FluWatch report: January 24, 2016 – January 30, 2016 (week 4)
- Overall in week 04, seasonal influenza activity increased from the previous week. Laboratory detections remain lower than average but are now within expected levels for this time of the year.
- An increase in the number of outbreaks was reported in week 04 with the majority due to influenza A.
- Influenza A(H1N1) is the most common influenza subtype circulating in Canada.
- Influenza strains characterized by the National Microbiology Laboratory this season appear to be a good match to the World Health Organization’s recommended vaccine strains.
- For more information on the flu, see our Flu(influenza) web page.
Are you a primary health care practitioner (General Practitioner, Nurse Practitioner or Registered Nurse) interested in becoming a FluWatch sentinel for the 2015-16 influenza season? Contact us at FluWatch@phac-aspc.gc.ca
On this page
- Influenza/ILI Activity (geographic spread)
- Laboratory Confirmed Influenza Detections
- Influenza-like Illness Consultation Rate
- Influenza Outbreak Surveillance
- Sentinel Pediatric Hospital Influenza Surveillance
- Provincial/Territorial Influenza Hospitalizations and Deaths
- Influenza Strain Characterizations
- Antiviral Resistance
- International Influenza Reports
- FluWatch definitions for the 2015-2016 season
Influenza/Influenza-like Illness Activity (geographic spread)
In week 04, influenza/ILI activity continued to increase in Canada. A total of 17 regions across Canada reported sporadic influenza/ILI activity. Localized activity was reported in 12 regions in Canada (one in YK, two in BC, three in AB, two in MB, three in ON and one in NS).
Laboratory Confirmed Influenza Detections
Laboratory confirmed influenza detections continued to increase. The percent positive for influenza increased from 12.1% in week 03 to 16.0% in week 04 (Figure 2). Compared to the previous five seasons, the percent positive (16.0%) reported in week 04 was below the five year average for that week but within expected levels (range 12.4%-26.4%).
In week 04, there were 895 positive influenza tests reported. Influenza A(H1N1) was the most common subtype detected. The majority of influenza detections were reported from Western Canada, where BC and AB accounted for 58% of influenza detections in Canada in week 04. To date, 79% of influenza detections have been influenza A and among those subtyped, the majority have been influenza A(H1N1) [71% (1202/1704)].
Figure 3. Cumulative numbers of positive influenza specimens by type/subtype and province, Canada, 2015-16
Note: Specimens from NT, YT, and NU are sent to reference laboratories in other provinces. Cumulative data includes updates to previous weeks.
To date this season, detailed information on age and type/subtype has been received for 2,056 cases. Adults aged 20-44 years and older accounted for the greatest proportion of influenza cases (Table 1). Adults aged 20-44 and 45-64 years accounted for 51% of reported influenza A(H1N1) cases. Adults aged 65 years and older represented 44% of all reported A(H3N2) cases.
|Age groups (years)||Weekly (January 24 to January 30, 2016)||Cumulative (August 30, 2015 to January 30, 2016)|
|Influenza A||B||Influenza A||B||Influenza A and B|
|A Total||A(H1) pdm09||A(H3)||A Table 1 - Footnote UnS||Total||A Total||A(H1) pdm09||A(H3)||A Table 1 - Footnote UnS||Total||#||%|
|PercentageTable 1 - Footnote 2||68.3%||18.1%||8.1%||73.8%||31.7%||70.1%||26.8%||32.3%||40.9%||29.9%|
For additional data on other respiratory virus detections see the Respiratory Virus Detections in Canada Report on the Public Health Agency of Canada website.
Influenza-like Illness Consultation Rate
The national ILI consultation rate increased from the previous week from 16.0 per 1,000 patient visits in week 03, to 35.9 per 1,000 patient visits in week 04. In week 04, the highest ILI consultation rate was found in those 0-4 years of age (88.4 per 1,000) and the lowest was found in the ≥65 years age group (19.4 per 1,000) (Figure 4).
Influenza Outbreak Surveillance
In week 04, 13 new laboratory confirmed influenza outbreaks were reported: six in long-term care facilities (LTCF), four in hospitals and three in an institutional or community setting. Of the outbreaks with known strains or subtypes, two outbreaks were due to Influenza A(H1N1), one was due to Influenza A(H3N2), three outbreaks were due to influenza A (UnS) and one outbreak was due to influenza B. Additionally, four ILI outbreaks were reported in schools.
To date this season, 63 outbreaks have been reported (29 of which occurred in LTCFs). In comparison, at week 04 in the 2014-15 season, 1,146 outbreaks were reported (589 of which occurred in LTCFs) and in the 2013-14 season, 67 outbreaks were reported (37 of which occurred in LTCFs).
Figure 5. Overall number of new laboratory-confirmed influenza outbreaksFigure 5 - Footnote 1 by report week, Canada, 2015-2016
Sentinel Pediatric Hospital Influenza Surveillance
Paediatric Influenza Hospitalizations and Deaths
In week 04, 38 hospitalizations were reported by the the Immunization Monitoring Program Active (IMPACT) network (Figure 6). Nineteen hospitalizations were due to influenza A(H1N1) (50%), one was due to A(H3N2) (2.7%) nine were due to influenza B (24%) and the remainder were influenza A (UnS).
To date this season, 134 laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations have been reported by the IMPACT network: 102 hospitalized cases were due to influenza A and 32 cases were due to influenza B. The majority of hospitalized cases were among children aged 2-4 years (34%). To date, 15 intensive care unit (ICU) admissions have been reported. The majority of ICU admissions were reported in children 2-4 years (40%) and due to influenza A(H1N1) (27%). Less than five influenza-associated deaths have been reported.
|Age Groups||Cumulative (30 Aug. 2015 to 30 January 2016)|
|Influenza A||Influenza B|
|A(H3)||A (UnS)||B Total|
|6-23m||26||15||<5||Table 2 - Footnote x||<5|
|2-4y||36||17||<5||Table 2 - Footnote x||10|
|5-9y||18||9||Table 2 - Footnote x||Table 2 - Footnote x||10|
Figure 6. Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2015-16, paediatric and adult hospitalizations (≤16 years of age, IMPACT; ≥16 years of age, CIRN-SOS)
Not included in Table 2 and Figure 6 are two IMPACT cases that were due to co-infections of influenza A and B.
Adult Influenza Hospitalizations and Deaths
In week 04, 11 hospitalizations were reported by the Canadian Immunization Research Network Serious Outcome Surveillance (CIRN-SOS). The majority of hospitalizations were in adults 65+ years of age (64%) and due to influenza A (91%).
To date this season, 82 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations have been reported by CIRN-SOS (Table 3). The majority of hospitalized cases were due to influenza A (79%) and were among adults ≥65 years of age (54%). Six intensive care unit (ICU) admissions have been reported and among those, five (83%) were due to influenza A. Less than five deaths have been reported this season.
|Age groups (years)||Cumulative (1 Nov. 2015 to 30 Jan. 2016)|
|Influenza A||B||Influenza A and B|
|A Total||A(H1) pdm09||A(H3)||A(UnS)||Total||# (%)|
Figure 7. Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group (≥16 year of age), Canada 2015-16
Note: The number of hospitalizations reported through CIRN-SOS and IMPACT represents a subset of all influenza-associated adult and paediatric hospitalizations in Canada. Delays in the reporting of data may cause data to change retrospectively.
Provincial/Territorial Influenza Hospitalizations and Deaths
Since the start of the 2015-16 season, 421 laboratory-confirmed influenza-associated hospitalizations have been reported. A total of 365 hospitalizations (87%) were due to influenza A and 56 (13%) were due to influenza B. Among cases for which the subtype of influenza A was reported, 75% (176/235) were influenza A(H1N1). The majority (34%) of hospitalized cases were ≥65 years of age. Forty-one ICU admissions have been reported of which 35 (85%) were due to influenza A and 15 (37%) were in the 45-64 age group. A total of 14 deaths have been reported, all due to influenza A. The majority of deaths were reported in adults 65+ of age (57%).
Figure 8. Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada 2015-16
See additional data on Reported Influenza Hospitalizations and Deaths in Canada: 2011-12 to 2015-16 on the Public Health Agency of Canada website.
Influenza Strain Characterizations
During the 2015-16 influenza season, the National Microbiology Laboratory (NML) has characterized 282 influenza viruses [106 A(H3N2), 132 A(H1N1) and 44 influenza B].
Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assays, 15 H3N2 virus were antigenically characterized as A/Switzerland/9715293/2013-like using antiserum raised against cell-propagated A/Switzerland/9715293/2013.
Sequence analysis was done on 91 H3N2 viruses. All viruses belonged to a genetic group for which most viruses were antigenically related to A/Switzerland/9715293/2013.
A/Switzerland/9715293/2013 is the A(H3N2) component of the 2015-16 Northern Hemisphere's vaccine.
Influenza A (H1N1): One hundred and thrity-two H1N1 viruses characterized were antigenically similar to A/California/7/2009, the A(H1N1) component of the 2015-16 influenza vaccine.
Influenza B: Twenty-seven influenza B viruses characterized were antigenically similar to the vaccine strain B/Phuket/3073/2013. Seventeen influenza B viruses were characterized as B/Brisbane/60/2008-like, one of the influenza B components of the 2015-16 Northern Hemisphere quadrivalent influenza vaccine.
The recommended components for the 2015-2016 northern hemisphere trivalent influenza vaccine include: an A/California/7/2009(H1N1)pdm09-like virus, an /Switzerland/9715293/2013(H3N2)-like virus, and a B/Phuket/3073/2013 -like virus (Yamagata lineage). For quadrivalent vaccines, the addition of a B/Brisbane/60/2008-like virus (Victoria lineage) is recommended.
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 testing compared to the reference influenza strains recommended by WHO.
During the 2015-16 season, the National Microbiology Laboratory (NML) has tested 275 influenza viruses for resistance to oseltamivir and 274 influenza for resistance to zanamivir. All viruses were sensitive to zanamivir and oseltamivir. A total of 208 influenza A viruses (99%) were resistant to amantadine (Table 4).
|Virus type and subtype||Oseltamivir||Zanamivir||Amantadine|
|# tested||# resistant (%)||# tested||# resistant (%)||# tested||# resistant (%)|
|A (H3N2)||100||0||100||0||107||106 (99.1%)|
|A (H1N1)||129||0||128||0||102||102 (100%)|
|B||46||0||46||0||NA Table 4 - Footnote *||NA Table 4 - Footnote *|
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 2015-2016 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.
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.
- 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
3 = Localized:
4 = Widespread:
Note: ILI data may be reported through sentinel physicians, emergency room visits or health line telephone calls.
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