FluWatch report: February 4 to February 10, 2018 (week 6)
- Overall, influenza activity in Canada remains at peak levels. Activity is starting to slow down in some parts of the country, but at the national level, several indicators of influenza circulation increased in week 06.
- In week 06, the number of laboratory detections of influenza A and B were similar. Detections of influenza A are within expected levels for this time of year, however, circulation of influenza B is greater than observed during the past seven seasons.
- To date this season, the majority of laboratory-confirmed cases, hospitalizations and deaths with influenza have been among adults 65 years of age and older.
- 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
- Severe Outcomes Influenza Surveillance
- Influenza Strain Characterizations
- Antiviral Resistance
- Provincial and International Influenza Reports
- FluWatch Surveillance System Description and Definitions, 2017-18
Influenza/Influenza-like Illness Activity (geographic spread)
In week 06, a similar number of regions reported localized or widespread influenza activity compared to the previous week. Among the 51 regions reporting data for week 06, 6 regions (BC(1), ON(2), QC(3)) reported widespread activity, and 25 regions (BC(1), AB(3), SK(2), MB(1), ON(5), QC(3), NB(1), NS(4), NL(3), PE(1) and NU(1)) reported localized activity.
Figure 1 - Map of overall influenza/ILI activity level by province and territory, Canada, week 2018-06
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.
Laboratory-Confirmed Influenza Detections
In week 06, the overall percentage of tests positive for influenza increased from 31% to 34%. The percentage of tests positive for influenza A had been declining slowly since week 02, but increased in week 06 from 16% to 17%. The percentage of tests positive for influenza B continued to increase to 17% in week 06.
The percentage of influenza A detections for week 06 is within the expected range for this time of year. The percentage of tests positive for influenza B in week 06 continues to be well above expected levels for this time of year. For data on other respiratory virus detections, see the Respiratory Virus Detections in Canada Report.
Figure 2 - Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2017-35 to 2018-06
The shaded area indicates weeks where the positivity rate was at least 5% and a minimum of 15 positive tests were observed, signalling the period of seasonal influenza activity.
To date this season, 38,014 laboratory-confirmed influenza detections have been reported, of which 62% have been influenza A. Influenza A(H3N2) has been the most common subtype detected this season, representing 94% of subtyped influenza A detections. 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, weeks 2017-35 to 2018-06
To date this season, detailed information on age and type/subtype has been received for 33,159 laboratory-confirmed influenza cases (Table 1). Adults 65 years of age and older represent the largest proportion of cases overall (49%), and among cases of influenza A(H3N2) (54%) and influenza B (45%). Adults aged 20-64 represent 33% of cases overall and 31% of influenza A(H3N2) and 35% of influenza B cases. Although much smaller in numbers (466), the majority of influenza A(H1N1) cases are among adults less than 65 years of age, with adults aged 20-64 and children 0-19 years accounting for 54% and 33% of cases respectively.
|Age groups (years)||Cumulative (August 27, 2017 to February 10, 2018)|
|Influenza A||B||Influenza A and B|
|A Total||A(H1) pdm09||A(H3)||A (UnS)Table 1 Footnote 1||Total||#||%|
Syndromic/Influenza-like Illness Surveillance
Healthcare Professionals Sentinel Syndromic Surveillance
In week 06, 3.6% of visits to healthcare professionals were due to influenza-like illness (ILI); a decrease compared to the previous week, and above the 5-year average.
Figure 4 - Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2017-35 to 2018-06
Number of Sentinels Reporting in Week 06: 165
The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2012-13 to 2017-18
Participatory Syndromic Surveillance
FluWatchers is a participatory ILI surveillance system that relies on weekly voluntary submissions of syndromic information from Canadians across Canada.
In week 06, 1,458 participants reported to FluWatchers, of which 4% reported symptoms of cough and fever, and 18% of these consulted a healthcare professional. Among participants who reported cough and fever, 69% reported days missed from work or school, resulting in a combined total of 157 missed days of work or school.
|Number of Participants Reporting||Percentage participants reporting Cough and Fever||Percentage of participants with cough and fever who consulted a healthcare professional||Percentage of participants with cough and fever who reported missed days from work or school||Number of missed days from work or school|
Influenza Outbreak Surveillance
In week 06, the number of reported laboratory-confirmed outbreaks of influenza increased compared to the previous week. In week 06, 122 new influenza outbreaks were reported: 75 in long-term care facilities, 10 in hospitals, and 31 in other settings. In addition, six ILI outbreaks were reported schools. Among the 106 outbreaks with influenza type/subtype reported, 54 (51%) were associated with influenza B, 45 (43%) were associated with influenza A and seven outbreaks were associated with a mix of influenza A and B (7%).
To date this season, 1,130 influenza/ILI outbreaks have been reported, of which 674 (60%) occurred in LTC facilities. Among the 982 outbreaks for which the influenza type/subtype was reported, 568 (58%) were associated with influenza A and 368 (38%) were associated with influenza B, and 46 (5%) were associated with a mix of A and B. Compared to recent influenza A(H3N2) seasons at week 06, the number of cumulative outbreaks reported this season has been greater than during the 2016-17 and 2012-13 seasons, and lower compared to the 2014-15 season.
Figure 5 - Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2017-35 to 2018-06
Severe Outcomes Influenza Surveillance
Provincial/Territorial Influenza Hospitalizations and Deaths
In week 06, 88 influenza-associated hospitalizations were reported by participating provinces and territories1. To date this season, 3,252 influenza-associated hospitalizations have been reported, 78% of which were associated with influenza A, and 2,231 cases (69%) were in adults 65 years of age or older. To date, 292 ICU admissions and 142 deaths have been reported.
Figure 6 - Cumulative numbers of hospitalizations by age-group reported by participating provinces and territoriesfigure 6 note 1, weeks 2017-35 to 2018-06
- Figure 6 note 1
Influenza-associated hospitalizations are reported by NL, PE, NS, NB, MB, AB, YT and NT. Only hospitalizations that require intensive medical care are reported by SK.
Pediatric Influenza Hospitalizations and Deaths
In week 06, the number of laboratory-confirmed influenza-associated pediatric (≤16 years of age) hospitalizations reported by the Immunization Monitoring Program Active (IMPACT) network increased compared to the previous week. In week 06, 76 hospitalizations were reported of which influenza A and B made up almost equal proportion of cases. The number of weekly hospitalizations has been above the seven-season average since week 45.
To date this season, 594 pediatric hospitalizations have been reported by the IMPACT network, 378 (64%) of which were associated with influenza A. Children 0-23 months accounted for the largest proportion of influenza A hospitalizations (39%). Among the 216 hospitalizations due to influenza B, children 5-9 years accounted for the largest proportion of cases (31%).
Additionally, 97 ICU admissions and five deaths have been reported to date. Children aged 0-23 months accounted for 30% of ICU cases. Among the ICU cases with available information, 66% were due to influenza A and approximately 30% had no reported previous or concurrent medical conditions.
Figure 7 - Cumulative numbers of pediatric hospitalizations (≤16 years of age) with influenza by type and age-group reported by the IMPACT network, Canada, weeks 2017-35 to 2018-06
Figure 8 - Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, weeks 2017-35 to 2018-06
- Figure 8 Footnote 1
The shaded area represents the maximum and minimum number of cases reported by week from seasons 2010-11 to 2017-18
Influenza Strain Characterizations
During the 2017-18 influenza season, the National Microbiology Laboratory (NML) has characterized 1,443 influenza viruses [810 A(H3N2), 72 A(H1N1)pdm09 and 561 B viruses] that were received from Canadian laboratories.
Among influenza viruses characterized by hemagglutination inhibition assay during the 2017-18 season, most viruses were antigenically similar to the cell-culture propagated reference strains recommended by WHO.
|Strain Characterization Results||Count||Description|
|Influenza A (H3N2)|
|A/Hong Kong/4801/2014-like||148||Viruses antigenically similar to A/Hong Kong/4801/2014, the A(H3N2) component of the 2017-18 Northern Hemisphere's trivalent and quadrivalent vaccine.|
|Reduced titer to A/Hong Kong/4801/2014||15||These A(H3N2) viruses reacted poorly with antisera raised against cell-propagated A/Hong Kong/4801/2014, suggesting some antigenic differences.|
|Influenza A (H1N1)|
|A/Michigan/45/2015-like||72||Viruses antigenically similar to A/Michigan/45/2015, the A(H1N1) component of the 2017-18 Northern Hemisphere's trivalent and quadrivalent influenza vaccine.|
|6||Viruses antigenically similar to B/Brisbane/60/2008.
B/Brisbane/60/2008 is the influenza B component of the 2017-18 Northern Hemisphere's trivalent and quadrivalent influenza vaccine.
|Reduced titer to B/Brisbane/60/2008
|18||These B/Victoria lineage viruses reacted poorly with antisera raised against cell-propagated B/Brisbane/60/2008, suggesting some antigenic differences.|
|537||Viruses antigenically similar to B/Phuket/3073/2013, the additional influenza B component of the 2017-18 Northern Hemisphere quadrivalent influenza vaccine.|
Genetic Characterization of A(H3N2) viruses
During the 2017-18 season, 647 A(H3N2) viruses did not grow to sufficient titers for antigenic characterization by HI assay. Therefore, genetic characterization was performed to determine to which genetic group they belong. Sequence analysis showed that 570 A(H3N2) viruses belonged to genetic group 3C.2a, 75 viruses belonged to subclade 3C.2a1 and two viruses belonged to the clade 3C.3a.
Additionally, of the 148 influenza A(H3N2) viruses that were characterized antigenically as similar to A/Hong Kong/4801/2014, 132 belonged to genetic group 3C.2a and 15 viruses belonged to subclade 3C.2a1. The 15 viruses that showed reduced titer to A/Hong Kong/4801/2014 belonged to genetic clade 3C.3a. Sequencing is pending for the remaining virus isolate.
A/Hong Kong/4801/2014-like virus belongs to genetic group 3C.2a and is the influenza A/H3N2 component of the 2017-18 Northern Hemisphere influenza vaccine.
Genetic Characterization of Influenza B viruses
Among the viruses characterized antigenically as having reduced titer to ferret antisera produced against cell-propagated B/Brisbane/60/2008, sequence analysis showed that all 18 viruses had a two amino acid deletion in the HA gene.
During the 2017-18 season, the National Microbiology Laboratory (NML) has tested 736 influenza viruses for resistance to oseltamivir and 732 viruses for resistance to zanamivir. All but one of the A(H1N1) viruses were sensitive to oseltamivir and all but one influenza B viruses were sensitive to zanamivir (Table 4).
|Virus type and subtype||Oseltamivir||Zanamivir|
|# tested||# resistant (%)||# tested||# resistant (%)|
|A (H3N2)||390||0 (0%)||386||0 (0%)|
|A (H1N1)||60||1 (1.7%)||60||0 (0%)|
|B||286||0 (0%)||286||1 (0.3%)|
|TOTAL||736||1 (0.1%)||732||1 (0.1%)|
Note: Since the 2009 pandemic, all circulating influenza A viruses have been resistant to amantadine, and it is therefore not currently recommended for use in the treatment of influenza. During the 2017-18 season, the subset of influenza A viruses that were tested for resistance to amantadine were resistant.
Provincial and International Influenza Reports
Provincial Influenza Reports
- Alberta - Influenza Surveillance Report
- British Columbia - Influenza Surveillance
- Manitoba - Seasonal Influenza Reports
- New Brunswick - Influenza Surveillance Reports
- Newfoundland and Labrador - Surveillance and Disease Reports
- Nova Scotia - Respiratory Watch Report
- Ontario - Respiratory Pathogen Bulletin
- Prince Edward Island - Influenza Summary
- Saskatchewan - Influenza Reports
- Québec - Flash Grippe
International Influenza Reports
- Australia - Influenza Surveillance Report
- European Centre for Disease Prevention and Control - Surveillance reports and disease data on seasonal influenza
- New Zealand - Influenza Weekly Update
- Public Health England - Weekly national flu reports
- Pan-American Health Organization - Influenza Situation Report
- United States Centres for Disease Control and Prevention - Weekly Influenza Surveillance Report
- World Health Organization - Influenza update
- World Health Organization - FluNet
FluWatch Surveillance System Description and Definitions, 2017-18
The FluWatch report is compiled from a number of data sources. Surveillance information contained in this report is a reflection of the surveillance data available to FluWatch at the time of production. Delays in reporting of data may cause data to change retrospectively. For a description of FluWatch surveillance components and definitions, see System Description and Definitions.
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).
We would like to thank all the FluWatch surveillance partners who are participating in this year's influenza surveillance program.
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