FluWatch report: March 12, 2017 – March 18, 2017 (week 11)
- Overall, the slow decline in influenza activity in Canada has continued in week 11.However, many parts of Canada, particulary the Eastern and Atlantic regions are still reporting elevated activity in week 11.
- In week 11, the number of laboratory detections, outbreaks and the number of geographic regions with influenza activity, decreased from the previous week.
- Although adult sentinel hospitalizations decreased from the previous week, the number of hospitalizations and deaths reported by participating provinces and territories increased.
- Influenza B detections and outbreaks in Canada are slowly increasing.
- Although declining for most indicators, influenza A(H3N2) continues to be the most common subtype of influenza affecting Canadians.
- The majority of laboratory detections, hospitalizations and deaths have been among adults aged 65+ years.
- For more information on the flu, see our Flu(influenza) web page.
On this page
- Influenza/ILI Activity (geographic spread)
- Laboratory Confirmed Influenza Detections
- Syndromic/Influenza-like Illness Surveillance
- Influenza Outbreak Surveillance
- Provincial/Territorial Influenza Hospitalizations and Deaths
- Sentinel Hospital Influenza Surveillance
- Influenza Strain Characterizations
- Antiviral Resistance
- Provincial and International Influenza Reports
- FluWatch definitions for the 2016-2017 season
Influenza/Influenza-like Illness Activity (geographic spread)
In week 11, one region in NL, reported no influenza or influenza-like illness activity. Sporadic influenza activity was reported in 29 regions across 11 provinces and territories. Localized activity was reported in 21 regions across nine provinces.No regions reported any widespread activity in week 11. For more details on a specific region, click on the map.
Laboratory Confirmed Influenza Detections
In week 11, the number (1,197) and the percentage of tests positive for influenza (16%) decreased from the previous week. Peak influenza detections occurred in week 02 at 27%. Although declining, influenza A continues to account for the majority of detections; however, influenza B detections have been steadily increasing for the past few weeks. Influenza B activity is very low compared to the same time period in the previous two seasons. 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 11
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.
To date this season, 32,836 laboratory confirmed influenza detections have been reported, of which 96% have been influenza A. Influenza A(H3N2) is the most common subtype detected. 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 11
To date, detailed information on age and type/subtype has been received for 23,013 laboratory-confirmed influenza cases (Table 1). Among cases with reported age and type/subtype information, adults aged 65+ accounted for almost half of the reported influenza cases. Among cases of influenza A(H3N2), adults aged 65+ represented 49% of cases, followed by adults aged 20-64 (34% of cases). In the previous influenza A(H3N2)-predominant season in 2014-15, adults aged 65+ represented 58% of cases and adults aged 20-64 represented 27% of cases.
|Age groups (years)||Weekly (March 12 to March 18, 2017)||Cumulative (August 28, 2016 to March 18, 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||#||%|
|PercentageTable 1 - Footnote 2||83%||x%||x%||82%||17%||96%||0%||48%||51%||4%|
Syndromic/Influenza-like Illness Surveillance
Healthcare Professionals Sentinel Syndromic Surveillance
In week 11, 1.7% of visits to healthcare professionals were due to influenza-like illness, compared to 1.8% in the previous week.
Figure 4 - Percentage of visits for ILI reported by sentinels by report week, Canada, 2016-17, week 11
Number of Sentinels Reporting Week 11: 101
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.
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 11, 42 laboratory confirmed influenza outbreaks were reported (three less than the previous week). Among the reported outbreaks: 21 were in long-term care (LTC) facilities, seven in hospitals and 12 in institutional or community (other) settings. Of the outbreaks with known strains or subtypes, 11 were due to influenza A(H3N2), eight were due to influenza A(UnS) and seven outbreaks were due to influenza B. An additional two outbreaks due to ILI were reported in a school.
To date this season, 991 outbreaks have been reported and the majority (66%) have occurred in LTC facilities. Compared to the same period in the most recent previous A(H3N2) predominant season (2014-15), 1,552 outbreaks were reported, of which 74% occurred in LTC facilities.
Figure 5 - Text Description
|Report week||Hospitals||Long Term Care Facilities||Other|
Provincial/Territorial Influenza Hospitalizations and Deaths
In week 11, 261 influenza-associated hospitalizations were reported by participating provinces and territories, up from 254 reported in the previous week *. Influenza A accounted for 88% of hospitalizations. The weekly percentage of influenza B associated hospitalizations has been steadily increasing for the past few weeks (from 1.2% in week 02 to 11.5% in week 11). The largest proportion of hospitalizations were among adults aged 65+ years (71%). A total of ten intensive care unit (ICU) admissions were reported in week 11. An increase in the number of deaths was reported in week 11, with 35 deaths reported. All deaths were reported in adults aged 65+ years.
To date this season, 5,139 hospitalizations have been reported, of which 97% were due to influenza A. Among cases for which the subtype of influenza A was reported, almost all (2770/2787) were influenza A(H3N2). Adults 65+ accounted for 69% of the hospitalizations. A total of 193 ICU admissions and 277 deaths have been reported. The majority of deaths was reported in adults aged 65+ years.
|Age Groups (years)||Cumulative (August 28, 2016 to March 18 2017)|
|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 are not distinguished among hospital admissions reported from ON. The hospitalization or death does not have to be attributable to influenza, a positive laboratory test is sufficient for reporting.
x Supressed to prevent residual disclosure
Sentinel Hospital Influenza Surveillance
Pediatric Influenza Hospitalizations and Deaths
In week 11, 17 laboratory-confirmed influenza-associated pediatric (≤16 years of age) hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network. All but three cases were due to influenza A. The number of weekly hospitalizations reported since week 05 have been below the six year average for the same time period (Figure 7).
To date this season, 458 laboratory-confirmed influenza-associated pediatric hospitalizations were reported by the IMPACT network. Children aged 0-23 months accounted for approximately 39% of hospitalizations. Influenza A accounted for 91% (n=419) of the reported hospitalizations, of which 34% (n=141) were influenza A(H3N2) and the remainder were A(UnS). Additionally, 74 intensive care unit (ICU) admissions have been reported. Children aged 10-16 years accounted for 30% of ICU cases followed by children aged 0-23 months (27%). A total of 47 ICU cases reported at least one underlying condition or comorbidity. Less than five deaths have been reported this season.
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 11
Figure 6 - Text Description
Figure 7 – Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, 2016-17, week 11
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
Adult Influenza Hospitalizations and Deaths
In week 11, 42 laboratory-confirmed influenza-associated adult (≥20 years of age) hospitalizations were reported by the Canadian Immunization Research Network (CIRN). All but nine cases were due to influenza A and the majority of cases (69%) occurred in adults aged 65+. The number of hospitalizations due to influenza B has been increasing since week 05.
To date this season, 1,222 laboratory-confirmed influenza-associated adult (≥20 years of age) hospitalizations have been reported by CIRN. Influenza A accounted for 98% of hospitalizations. Adults aged 65+ accounted for 78% of hospitalizations. To date, 81 intensive care unit (ICU) admissions have been reported. A total of 55 ICU cases reported at least one underlying condition or comorbidity. The median age of patients admitted to the ICU was 69 years. Approximately 51 deaths have been reported this season, the majority in adults aged 65+. The median age of reported deaths was 85 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 11
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 11
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.
Influenza Strain Characterizations
During the 2016-17 influenza season, the National Microbiology Laboratory (NML) has characterized 1,420 influenza viruses [1272 A(H3N2), 28 A(H1N1), 120 influenza B]. All but one influenza A virus (n=1271) and 40 influenza B viruses characterized were antigenically or genetically similar to the vaccine strains included in both the trivalent and quadrivalent vaccines. Eighty influenza B viruses were similar to the strain which is only included in the quadrivalent vaccine.
The World Health Organization (WHO) has released the recommended composition of the influenza vaccine for use in the 2017-2018 northern hemisphere influenza season. Trivalent vaccines are recommended to contain: 1) an A/Michigan/45/2015 (H1N1)pdm09-like virus; 2) an A/Hong Kong/4801/2014 (H3N2)-like virus; and 3) a B/Brisbane/60/2008-like virus (Victoria lineage). Quadrivalent vaccines are recommended to contain the above three viruses and a B/Phuket/3073/2013-like virus (Yamagata lineage).
|Strain Characterization ResultsTable 3 - Footnote 1||Count||Description|
|Influenza A (H3N2)|
|319||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
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 319 influenza A (H3N2) viruses that underwent HI testing determined that 272 viruses belonged to genetic group 3C.2a and 47 viruses belonged to genetic group 3C.3a. The majority of viruses belonging to genetic group 3C.3a are inhibited by antisera raised against A/Hong Kong/4801/2014Table 3 - Footnote 3.
A/Indiana/10/2011-likeTable 3 - Footnote 4
Viruses antigenically similar to A/Indiana/10/2011, a candidate H3N2v vaccine virus.
|Influenza A (H1N1)|
|A/California/7/2009-like||28||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.|
|40||Viruses antigenically similar to B/Brisbane/60/2008, the influenza B component of the 2016-17 Northern Hemisphere's trivalent and quadrivalent influenza vaccine|
|80||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 760 influenza viruses for resistance to oseltamivir and zanamivir and 180 influenza viruses for resistance to amantadine. All but one influenza A(H3N2) virus were sensitive to oseltamivir and all viruses were sensitive to zanamivir. All 180 influenza A viruses were resistant to amantadine (Table 4).
|Virus type and subtype||Oseltamivir||Zanamivir||Amantadine|
|# tested||# resistant (%)||# tested||# resistant (%)||# tested||# resistant (%)|
|A (H3N2)||635||1 (0.2%)||635||0 (0%)||155||155 (100%)|
|A (H3N2v)||1||0 (0%)||1||0 (0%)||1||1 (100%)|
|A (H1N1)||25||0 (0%)||24||0 (0%)||24||24 (100%)|
|B||99||0 (0%)||100||0 (0%)||N/ATable 4 - Footnote *||N/ATable 4 - Footnote *|
|TOTAL||760||1 (0.1%)||760||0 (0%)||180||180 (100%)|
Provincial and 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
- Alberta Health - Influenza Surveillance Report
- BC - Centre for Disease Control (BCCDC) - Influenza Surveillance
- New Brunswick - Influenza Surveillance Reports
- Newfoundland and Labrador - Surveillance and Disease Reports
- Nova Scotia - Flu Information
- Public Health Ontario - Ontario Respiratory Pathogen Bulletin
- Quebec - Système de surveillance de la grippe
- Manitoba - Epidemiology and Surveillance - Influenza Reports
- Saskatchewan - influenza Reports
- PEI - Influenza Summary
FluWatch definitions for the 2016-2017 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
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 ILIFootnote * 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 regionFootnote †
4 = Widespread:
- evidence of increased ILIFootnote * 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 regionFootnote †
Note: ILI data may be reported through sentinel physicians, emergency room visits or health line telephone calls.
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