FluWatch report: March 1 to 7, 2015 (Week 9)

Overall summary

  • In week 09, all influenza indicators remained similar to, or declined from the previous week.
  • Elevated influenza activity was mostly reported in the Central and Atlantic provinces
  • Influenza B detections continues to increase steadily, particularly in the West, the Prairies and in Quebec. It is mainly affecting individuals less than 64 years of age. This increase in influenza B is expected as influenza B often shows up later in the flu season.
  • A(H3N2) continues to be the most common influenza virus this season and seniors continue to have the highest number of positive laboratory detections, hospitalizations and deaths.
  • Evidence from the National Microbiology Laboratory (NML) indicates that this year's vaccine will continue to provide protection against the circulating A(H1N1) and B strains.

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

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Organization: Public Health Agency of Canada

Date published: 2015-03-13

Influenza/ILI Activity (geographic spread)

In week 09, no widespread activity was reported. Seventeen regions reported localized activity: AB, ON(7), QC, NB(3), NS(4), and NL. Twenty-seven regions reported sporadic activity: in YK, BC(5), AB(4), SK(2), MB(3), QC(5), NB(3), NS(2), PE and NL. No activity was reported in fourteen regions: NU(3), NT(2), SK, MB(2), NB, NS(3) and NF(2). When compared to the previous week, there was an overall decrease in influenza activity as there were less regions reporting activity and no regions reporting widespread activity.

Figure 1. Map of overall influenza/ILI activity level by province and territory, Canada, Week 09

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 on the Flu Activity website.

   Figure 1 Map of overall influenza/ILI activity level by province and territory, Canada, Week 9 - Text Description

In week 09, no widespread activity was reported. Seventeen regions reported localized activity: AB, ON(7), QC, NB(3), NS(4), and NL. Twenty-seven regions reported sporadic activity: in YK, BC(5), AB(4), SK(2), MB(3), QC(5), NB(3), NS(2), PE and NL. No activity was reported in fourteen regions: NU(3), NT(2), SK, MB(2), NB, NS(3) and NF(2).

Influenza and Other Respiratory Virus Detections

In week 09, the number of positive influenza tests (1,081) and the percentage positive for influenza A (8.6%) continued to decline from the previous week (Figure 2). The percentage of positive influenza B tests continued to increase and was 7.7% in week 09. Influenza B detections were greater than influenza A detections in many provinces (BC, AB, SK, MB, QC and PE). To date, 92% of influenza detections have been influenza A, and 99.4% of those subtyped have been A(H3N2) (Table 1). To date this season, detailed information on age and type/subtype has been received for 31,623 cases (Table 2). Adults ≥65 years of age have predominantly been affected by influenza A, accounting for 62% of influenza A detections. Influenza B, while much smaller in numbers, is mainly affecting individuals less than 64 years of age, accounting to 63% of influenza B detections.

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

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

In week 09, the number of positive influenza tests (1,081) and the percentage positive for influenza A (8.6%) continued to decline from the previous week. The percentage of positive influenza B tests continued to increase and was 7.7% in week 09.

In week 09, detections of all respiratory viruses decreased from the previous week (figure 3). Detections of respiratory syncytial virus (RSV) in week 09 were greater than the detections of influenza A with 757 detections (vs 572 detections of influenza A). In recent weeks, weekly detections of adenovirus, coronavirus, rhinovirus and parainfluenza have been greater than those reported in each of the past three seasons. Weekly detections of hMPV this season have been lower compared to the previous three seasons.

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

Figure 3 RSV: Respiratory syncytial virus; hMPV: Human metapneumovirus
   Figure 3 Number of positive laboratory tests for other respiratory viruses by report week, Canada, 2014-15 - Text Description

In week 09, detections of all respiratory viruses decreased from the previous week (Figure 3). Detections of respiratory syncytial virus (RSV) in week 09 were greater than the detections of influenza A with 757 detections (vs 572 detections of influenza A).

Table 1: Weekly and cumulative numbers of positive influenza specimens by type, subtype and province, Canada, 2014-15
Reporting provincesFootnote 1 Weekly (March 1 to March 7, 2015) Cumulative (August 24, 2014 to March 7, 2015)
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 25 1 16 8 28 3433 25 2566 842 204
AB 19 0 15 4 39 3640 10 3477 153 485
SK 4 0 2 2 12 1300 0 836 464 68
MB 5 0 1 4 12 1113 0 384 729 55
ON 228 5 72 151 44 10490 30 4448 6012 285
QC 181 0 0 181 310 11110 4 422 10684 1542
NB 66 0 14 52 27 930 0 141 788 102
NS 35 0 0 35 27 436 0 123 313 87
PE 2 0 2 0 7 113 1 110 2 13
NL 7 0 0 7 3 586 0 53 533 7
Canada 572 6 122 444 509 33151 70 12561 20520 2848
Percentage Footnote 2 52.9% 1.0% 21.3% 77.9% 47.1% 92.1% 0.2% 37.9% 61.9% 7.9%
Table 2. Weekly and cumulative numbers of positive influenza specimens by type, subtype and age-group reported through case-based laboratory reportingFootnote 1,Footnote 3, Canada, 2014-15
Age groups (years) Weekly March 1 to March 7, 2015 Cumulative (August 24, 2014 to March 7, 2015)
Influenza A B Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) A Footnote (Uns) Total A Total A(H1) pdm09 A(H3) A (UnS) Total # %
<5 27 1 2 24 25 2020 15 731 1274 196 2216 7.0%
5-19 12 0 4 8 28 1734 5 899 830 324 2058 6.5%
20-44 32 0 7 25 66 3341 13 1483 1845 449 3790 12.0%
45-64 39 0 6 33 113 3721 14 1443 2264 651 4372 13.8%
65+ 208 0 26 182 176 18104 11 6618 11475 966 19070 60.3%
Unknown 0 0 0 0 0 115 0 97 18 2 117 0.4%
Total 318 1 45 272 408 29035 58 11271 17706 2588 31623 100.0%
PercentageFootnote 2, 43.8% 0.3% 14.2% 85.5% 56.2% 91.8% 0.2% 38.8% 61.0% 8.2%    

Antiviral Resistance

During the 2014-2015 influenza season, the NML has tested 857 influenza viruses for resistance to oseltamivir and 853 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 1,062 influenza A viruses (99.9%) were resistant to amantadine (Table 3).

Table 3. Antiviral resistance by influenza virus type and subtype, Canada, 2014-15
Virus type and subtype Oseltamivir Zanamivir Amantadine
# tested # resistant (%) # tested # resistant (%) # tested # resistant (%)
A (H3N2) 705 1 701 0 1059 1058 (99.9%)
A (H1N1) 4 0 4 0 4 4 (100%)
B 148 0 148 0 NATable 3 - Footnote * NA Table 3 - Footnote *
TOTAL 857 1 853 0 1063 1062

Influenza Strain Characterizations

During the 2014-2015 influenza season, the National Microbiology Laboratory (NML) has characterized 305 influenza viruses [149 A(H3N2), 3 A(H1N1) and 153 influenza B].

Influenza A (H3N2): When tested by hemagglutination inhibition (HI) assay (n=149), one virus was antigenically similar to A/Texas/50/2012, five showed reduced titers to A/Texas/50/2012 and 143 were antigenically similar to A/Switzerland/9715293/2013, which is the influenza A(H3N2) component recommended for the 2015 Southern Hemisphere influenza vaccine. Additionally, 893 A(H3N2) viruses were unable to be tested by HI assay; however, sequence analysis showed that 891 belonged to a genetic group that typically shows reduced titers to A/Texas/50/2012.
Influenza A(H1N1):
Three A(H1N1) viruses characterized were antigenically similar to A/California/7/2009.
Influenza B: Of the 153 influenza B viruses characterized, 146 viruses were antigenically similar to B/Massachusetts/2/2012, three viruses showed reduced titers against B/Massachusetts/2/2012, and four were B/Brisbane/60/2008-like (Figure 4).

Figure 4. Influenza strain characterizations, Canada, 2014-2015, N = 305

Figure 4

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.

The WHO has released the recommended composition of the influenza vaccine for the northern hemisphere for the 2015-2016 season. Trivalent vaccines are recommended to contain 1) an A/California/7/2009 (H1N1)pdm09-like virus 2) an A/Switzerland/9715293/2013 (H3N2)-like virus, and 3) an B/Phuket/3073/2013-like virus(Yamagata lineage). Quadrivalent vaccines are recommended to additionally contain a B/Brisbane/60/2008-like virus (Victoria lineage).

 

   Figure 4 Influenza strain characterizations, Canada, 2014-2015, N = 305 - Text Description
Strain Number of specimens Percentage
A/Texas/50/2012-like 1 0%
reduced titres to A/Texas/50/2012 5 2%
A/California/07/2009-like 3 1%
A/Switzerland/97 15293/2013-like 143 47%
B/Massachusetts/2/2012-like 146 48%
reduced titres to B/Massachusetts/2/2012 3 1%
B/Brisbane/60/2008-like 4 1%

Influenza-like Illness (ILI) Consultation Rate

The national influenza-like-illness (ILI) consultation rate decreased to 50.5 consultations per 1,000, which is above expected levels for week 09 (Figure 5). The rate was highest among the 5 to 19 years of age group (61.3 consultations per 1,000) and lowest among the adults ≥65 years of age (41.4 consultations per 1,000).

Figure 5. Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2014-2015

Figure 5

No data available for mean rate for weeks 19 to 39 for the 1996-1997 through 2002-2003 seasons. Delays in the reporting of data may cause data to change retrospectively. The calculation of the average ILI consultation rate over 17 seasons was aligned with influenza activity in each season. In BC, AB, and SK, data is compiled by a provincial sentinel surveillance program for reporting to FluWatch. Not all sentinel physicians report every week.

   Figure 5 Influenza-like-illness (ILI) consultation rates by report week, compared to the 1996-97 through to 2012-13 seasons (with pandemic data suppressed), Canada, 2015-16 - Text Description

The national influenza-like-illness (ILI) consultation rate decreased to 50.5 consultations per 1,000, which is above expected levels for week 09.

Influenza Outbreak Surveillance

In week 09, 33 new outbreaks of influenza were reported. The majority of the outbreaks occurred in the Central and Atlantic provinces. Twenty-two outbreaks were reported in long-term care facilities (LTCF), six in hospitals and five in institutional or community settings  (Figure 6). An additional five outbreaks of ILI were reported in schools. Among the outbreaks in which the influenza subtype was known, three LTCF outbreaks were associated with A(H3N2) and one outbreak was associated with influenza B. To date this season, 1,061 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.

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

Figure 6

1 All provinces and territories except NU report outbreaks in long-term care facilities. All provinces and territories with the exception of NU and QC report outbreaks in hospitals. Outbreaks of influenza or influenza-like-illness in other facilities are reported to FluWatch but reporting varies between jurisdictions. Outbreak definitions are included at the end of the report.

   Figure 6 Overall number of new laboratory-confirmed influenza outbreaks by report week, Canada, 2015-2016 - Text Description
Report week Hospitals Long Term Care Facilities Other
35 0 0 0
36 0 0 0
37 0 0 0
38 0 1 0
39 0 5 1
40 0 0 0
41 0 2 0
42 0 3 0
43 0 2 0
44 0 1 0
45 0 2 0
46 0 3 0
47 0 16 1
48 3 17 1
49 2 32 3
50 2 57 13
51 9 94 22
52 8 114 21
53 9 122 35
1 12 152 31
2 8 118 19
3 6 54 14
4 13 64 16
5 7 51 13
6 4 60 10
7 2 45 9
8 0 24 7
9 6 22 10

Pharmacy surveillance

During week 09, the proportion of prescriptions for antivirals decreased to 147.3 antiviral prescriptions per 100,000 total prescriptions (from 150.1 per 100,000). The rate for antivirals since week 48 has been higher than the previous three seasons (Figure 7). The rate in all age groups except infants decreased in week 09. The rate was highest among seniors at 210.1 per 100,000 total prescriptions and lowest among infants at 64.9 per 100,000 total prescriptions.

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

Figure 7

Note: Pharmacy sales data are provided to the Public Health Agency of Canada by Rx Canada Inc. and sourced from major retail drug chains representing over 2,500 stores nationwide (excluding Nunavut) in 85% of Health Regions. Data provided include the number of new antiviral prescriptions (for Tamiflu and Relenza) and the total number of new prescriptions dispensed by Province/Territory and age group. Age-groups: Infant: 0-2y, Child: 2-18y; Adult: 19-64y; Senior: ≥65y

   Figure 7 Proportion of prescription sales for influenza antivirals by age-group and week, Canada, 2015-16 - Text Description

Proportion of antiviral prescriptions per 100,000 total prescriptions in week 09 for the current season compared to previous seasons:
2014-15: 147.3; 2013-14: 48.8; 2012-13: 100.9; 2011-12: 68.7
Proportion of antiviral prescriptions by age-group in week 09 for the 2014-15 season:
Infant: 64.9; child: 153.2; adult: 127.6; senior: 210.1

Sentinel Hospital Influenza Surveillance

Paediatric Influenza Hospitalizations and Deaths (IMPACT)

In week 09, seventeen laboratory-confirmed influenza-associated paediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network: six cases of influenza A and eleven cases of influenza B (Figure 8a). A greater proportion of cases have been reported with influenza B in recent weeks, following the trend in laboratory detections. Among the reported cases, five (29%) were <2 years of age, nine (53%) were 2 to 9 years of age and three (17%) were 10-16 years of age. No ICU admissions were reported.

To date this season, 565 hospitalizations have been reported by the IMPACT network, 496 (88%) of which were cases of influenza A. Among cases for which the influenza A subtype was reported, 99% (159/161) were A(H3N2) (Table 4). To date, 69 cases were admitted to the ICU, of which 36 (52%) were 2 to 9 years of age (Figure 9a). A total of 38 ICU cases reported to have at least one underlying condition or comorbidity. Three 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)

In week 09, 63 laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations were reported by the PHAC/CIHR Influenza Research Network (PCIRN) Serious Outcomes Surveillance (SOS) network. Among the cases in week 09, 46 cases (73%) were in adults over the age of 65 and 43 cases (68%) had influenza A (Figure 8b).  

To date this season, 1,898 cases have been reported; 1,801 (95%) with influenza A. The majority of cases (82%) were among adult ≥65 years of age (Table 5). One hundred and forty ICU admissions have been reported and 107 cases were adults ≥65 years of age. A total of 99 ICU cases (71%) reported to have at least one underlying condition or comorbidity. Of the 99 ICU cases with known immunization status, 35 (35%) reported not having been vaccinated this season. One hundred and six deaths have been reported, 97 (92%) of the deaths were adults >65 years of age (Figure 9b).

Note: The number of hospitalizations reported through PCIRN 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 March 7, 2015)
Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) AFootnote (Uns) Total # (%)
0-5m 79 0 16 63 4 83 (14.7%)
6-23m 109 1 36 72 23 132 (23.4%)
2-4y 121 1 40 80 15 136 (24.1%)
5-9y 127 0 44 83 16 143 (25.3%)
10-16y 60 0 23 37 11 71 (12.6%)
Total 496 2 159 335 69 565
% Footnote 1 87.8% 0.4% 32.1% 67.5% 12.2% 100.0%
Table 5 - Cumulative numbers of adult hospitalizations with influenza reported by the PCIRN-SOS network, Canada, 2014-15
Age groups Cumulative (November 15, 2014 to March 7, 2015)
Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) AFootnote (Uns) Total # (%)
16-20 3 0 1 2 0 3 (%)
20-44 102 1 45 56 6 108 (6%)
45-64 207 0 88 119 24 231 (12%)
65+ 1489 3 632 854 67 1556 (82%)
Total 1801 4 766 1031 97 1898
% Footnote 1 95% 0% 43% 57% 5% 100%

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

8A) Paediatric hospitalizations (≤16 years of age, IMPACT)

Figure 8A
   Figure 8A Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2015-16 - Text Description
Report week Influenza A Influenza B
35 0 0
36 0 0
37 2 0
38 1 0
39 1 0
40 1 0
41 2 0
42 1 0
43 3 1
44 4 0
45 4 0
46 9 3
47 8 1
48 15 4
49 30 2
50 42 2
51 53 1
52 65 2
53 48 2
1 53 5
2 41 2
3 34 1
4 25 1
5 13 4
6 10 7
7 14 12
8 5 6
9 6 11

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

8B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

Figure 8B Note: Data for week 46 is based on data collected for 1 day only and do not represent the number of hospitalizations for the entire week.
   Figure 8B Number of cases of influenza reported by sentinel hospital networks, by week, Canada, 2015-16 - Text Description
Report week Influenza A Influenza B Untyped
35 n/a n/a n/a
36 n/a n/a n/a
37 n/a n/a n/a
38 n/a n/a n/a
39 n/a n/a n/a
40 n/a n/a n/a
41 n/a n/a n/a
42 n/a n/a n/a
43 n/a n/a n/a
44 n/a n/a n/a
45 n/a n/a n/a
46 3 0 0
47 10 0 0
48 34 0 0
49 44 0 0
50 99 4 0
51 141 0 1
52 235 3 0
53 235 3 0
1 229 2 0
2 159 0 0
3 144 3 1
4 98 9 0
5 117 5 0
6 79 13 0
7 67 17 1
8 64 18 2
9 43 20 0

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

9A) Paediatric hospitalizations (≤16 years of age, IMPACT)

Figure 9a
   Figure 9A Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15 A) Paediatric hospitalizations (≤16 years of age, IMPACT) - Text Description
Age-group (years) Hospitalizations(n=565) ICU admissions(n=69)
0-5m 14.7% 4.3%
6-23m 23.4% 20.3%
2-4y 24.1% 31.9%
5-9y 25.3% 20.3%
10-16y 12.6% 23.2%

9B) Adult hospitalizations (≥16 year of age, PCIRN-SOS)

Figure 9b
   Figure 9B Percentage of hospitalizations, ICU admissions and deaths with influenza reported by age-group, Canada, 2014-15 B) Adult hospitalizations (≥16 year of age, CIRN) - Text Description
Age-group (years) Hospitalizations (n=1893) ICU admissions(n=140) Deaths (n=106)
16-20 0.2% 0.0% 0.0%
20-44 5.7% 6.4% 2.8%
45-64 12.2% 17.1% 5.7%
65+ 82.0% 76.4% 91.5%

Provincial/Territorial Influenza Hospitalizations and Deaths

In week 09, 182 laboratory-confirmed influenza-associated hospitalizations were reported from participating provinces and territoriesFootnote *which is less than the number reported in week 08 (n=213). Of the 182 hospitalizations, all but 28 were due to influenza A, and 74% were in patients ≥65 years of age. Since the start of the 2014-15 season, 5769 hospitalizations have been reported; 5541 (97%) with influenza A. Among cases for which the subtype of influenza A was reported, 99.5% were A(H3N2). The majority of cases (72%) were ≥65 years of age (Table 6). A total of 282 ICU admissions have been reported to date: 54% (n=153) were in adults ≥65 years of age and 31% (n=88) were in adults 20-64 years. A total of 413 deaths have been reported since the start of the season: three children <5 years of age, two children 5-19 years, 24 adults 20-64 years, and 384 adults ≥65 years of age.Adults 65 years of age or older represent 93% of all deaths reported this season. Detailed clinical information (e.g. underlying medical conditions) is not known for these cases.

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 7 March, 2015)
Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) AFootnote (Uns) Total # (%)
0-4 years 374 2 136 236 12 386 (7%)
5-19 years 237 2 119 116 31 268 (5%)
20-44 years 346 3 202 141 27 373 (6%)
45-64 years 518 3 216 299 29 547 (9%)
65+ years 4010 1 1843 2166 118 4128 (72%)
Unknown 56 1 52 3 11 67 (1%)
Total 5541 12 2568 2961 228 5769
Percentage Footnote 1 96.0% 0.2% 46.3% 53.4% 4.0% 100.0%

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): Since the last FluWatch report, 59 new laboratory-confirmed cases of human infection with avian influenza A(H7N9) virus were reported by the World Health Organization. Globally to March 13, 2015, the WHO reported a total of 631 laboratory-confirmed human cases with avian influenza A(H7N9) virus, including 221 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:

Influenza A(H5N6): Since the last FluWatch report, no new cases of human infection with avian influenza A (H5N6) virus from China has been reported by the World Health Organization. Globally to March 13, 2015, the WHO has been informed of a total of three cases of avian influenza A (H5N6) virus, including two deaths.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV)
Since the last FluWatch report, 20 new laboratory-confirmed cases of MERS-CoV have been reported by the World Health Organization. Globally, from September 2012 to March 13, 2015, the WHO has been informed of a total of 1,060 laboratory-confirmed cases of infection with MERS-CoV, including 394 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) and for the latest global risk assessment posted by the WHO on February 5, 2015: WHO MERS-CoV.

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:

Avian Influenza A(H5)
As of March 9, 2015, the CFIA has removed the avian influenza Primary Control Zone PCZ in British Columbia. Permits are no longer required for the movement of birds and bird products in British Columbia. Surveillance by the CFIA has not detected the H5N2 and H5N1 strains of the virus in domestic poultry since February 2, 2015.

For the latest Travel Health Notice on Avian Influenza (H5N1) visit the following webpage: PHAC - Travel Health Notice.

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:

  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.

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

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