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FluWatch report: February 11 to February 17, 2018 (week 7)

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Organization:

Public Health Agency of Canada

Date published:

2018-02-23

Flu (influenza)

Influenza surveillance

Overall, influenza activity in Canada remains at peak levels.

Influenza activity is decreasing in some parts of the country but at the national level, the decline in activity has been slow.

In week 07, detections of influenza B were greater than those of influenza A.

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.

The World Health Organization (WHO) has released

the recommended composition

of the influenza vaccine for use in the 2018-2019 northern hemisphere influenza season. The recommended strain was changed for the A(H3N2) component and one of the influenza B components.

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 07, there was a slight decrease in the number of regions reporting localized or widespread influenza activity compared to the previous week. Among the 53 regions reporting data for week 07, 5 regions (ON(1), QC(4)) reported widespread activity, and 21 regions (BC(2), AB(2), ON(6), QC(1), NB(2), NS(2), NL(3), PE(1) and NU(2)) reported localized activity.

Figure 1 - Map of overall influenza/ILI activity level by province and territory, Canada, week 2018-07

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

Figure 1 - Map of overall influenza/ILI activity level by province and territory, Canada, week 2018-07

Influenza Surveillance Region

Activity Level

Newfoundland - Central

Localized

Newfoundland - Eastern

Localized

Grenfell Labrador

Sporadic

Newfoundland - Western

Localized

Prince Edward Island

Localized

Nova Scotia - Central (Zone 4)

Localized

Nova Scotia - Western (Zone 1)

Sporadic

Nova Scotia - Northern (Zone 2)

No Activity

Nova Scotia - Eastern (Zone 3)

Localized

New Brunswick - Public Health Region 1

Sporadic

New Brunswick - Public Health Region 2

Localized

New Brunswick - Public Health Region 3

Localized

New Brunswick - Public Health Region 4

Sporadic

New Brunswick - Public Health Region 5

Sporadic

New Brunswick - Public Health Region 6

Sporadic

New Brunswick - Public Health Region 7

Sporadic

Nord-est Québec

Localized

Québec et Chaudieres-Appalaches

Sporadic

Centre-du-Québec

Widespread

Montréal et Laval

Widespread

Ouest-du-Québec

Widespread

Montérégie

Widespread

Ontario - Central East

Widespread

Ontario - Central West

Localized

Ontario - Eastern

Localized

Ontario - North East

Localized

Ontario - North West

Localized

Ontario - South West

Localized

Ontario - Toronto

Localized

Manitoba - Interlake-Eastern

Sporadic

Manitoba - Northern Regional

Sporadic

Manitoba - Prairie Mountain

Sporadic

Manitoba - South

Sporadic

Manitoba - Winnipeg

Sporadic

Saskatchewan - North

Sporadic

Saskatchewan - Central

Sporadic

Saskatchewan - South

Sporadic

Alberta - North Zone

Sporadic

Alberta - Edmonton

Localized

Alberta - Central Zone

Sporadic

Alberta - Calgary

Localized

Alberta - South Zone

Sporadic

British Columbia - Interior

Localized

British Columbia - Fraser

Sporadic

British Columbia - Vancouver Coastal

Sporadic

British Columbia - Vancouver Island

Localized

British Columbia - Northern

Sporadic

Yukon

Sporadic

Northwest Territories - North

Sporadic

Northwest Territories - South

Sporadic

Nunavut - Baffin

Localized

Nunavut - Kivalliq

Localized

Nunavut - Kitimeot

Sporadic

Laboratory-Confirmed Influenza Detections

In week 07, the overall percentage of tests positive for influenza was 33% The percentage of tests positive for influenza A continued to decline slowly. The percentage of tests positive for influenza B continued to increase to 17% in week 07. For the first time this season, detections of influenza B were greater than those of influenza A.

The percentage of influenza A detections for week 07 are below average but remain within the expected range for this time of year. The percentage of tests positive for influenza B in week 07 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 2018-07

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

.

Figure 2 - Text Description

Figure 2 - Number of positive influenza tests and percentage of tests positive, by type, subtype and report week, Canada, weeks 2017-35 to 2018-07

Report Week

A(Unsubtyped)

A(H3)

A(H1)pdm09

Influenza B

35

3

20

6

5

36

7

28

1

3

37

7

14

13

4

38

18

31

3

5

39

18

53

1

8

40

24

41

1

5

41

32

50

0

11

42

27

73

1

15

43

44

107

3

21

44

52

114

3

30

45

71

153

7

47

46

113

187

13

75

47

157

272

13

112

48

259

417

33

190

49

370

544

16

274

50

523

633

16

473

51

800

864

51

719

52

1105

856

33

1008

1

1836

925

60

1539

2

1987

808

49

1730

3

1649

870

80

1912

4

1675

632

57

1802

5

1664

542

54

2125

6

1823

502

49

2383

7

1887

305

52

2394

To date this season, 42,773 laboratory-confirmed influenza detections have been reported, of which 60% 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 2018-07

Figure 3 - Text Description

Figure 3 - Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2017-35 to 2018-07

Reporting provinces

Table Figure 3 - Footnote

1

Week (February 11, 2018 to February 17, 2018)

Cumulative (August 27, 2017 to February 17, 2018)

Influenza A

B

Influenza A

B

A & B

Total

A

Total

A

(H1)pdm09

A

(H3)

A(UnS)

Table Figure 3 - Footnote

3

B

Total

A

Total

A

(H1)pdm09

A

(H3)

A(UnS)

Table Figure 3 - Footnote

3

B

Total

BC

76

24

43

9

102

1810

296

1166

348

2000

3810

AB

76

8

48

20

167

5281

113

3862

1306

2452

7733

SK

33

1

13

19

88

1558

42

1082

434

898

2456

MB

18

0

3

15

55

1068

7

349

712

217

1285

ON

476

12

154

310

424

3922

138

2154

1630

3093

7015

QC

1,365

0

0

1,365

1,376

10594

0

0

10594

7434

18028

NB

97

4

18

75

70

890

6

165

719

414

1304

NS

27

0

0

27

20

290

0

0

290

112

402

PE

3

0

3

0

13

67

3

64

0

111

178

NL

40

0

0

40

43

160

0

3

157

118

278

YT

3

0

2

1

0

59

5

37

17

39

98

NT

3

2

1

0

1

126

4

122

0

23

149

NU

3

1

2

0

0

35

2

33

0

2

37

Canada

2220

52

287

1881

2359

25860

616

9037

16207

16913

42773

Percentage

Table Figure 3 - Footnote

2

48%

2%

13%

85%

52%

60%

2%

35%

63%

40%

100%

Table Figure 3 - Footnote 1

Specimens from NT, YT, and NU are sent to reference laboratories in other provinces.

Return to Table Figure 3 - Footnote

1

referrer

Table Figure 3 - Footnote 2

Percentage of tests positive for sub-types of influenza A are a percentage of all influenza A detections.

Return to Table Figure 3 - Footnote

2

referrer

Table Figure 3 - Footnote 3

Unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.

Return to

first

Table Figure 3 - Footnote

3

referrer

Discrepancies in values in Figures 2 and 3 may be attributable to differing data sources.

Cumulative data includes updates to previous weeks.

To date this season, detailed information on age and type/subtype has been received for 34,733 laboratory-confirmed influenza cases (

Table 1

). Adults 65 years of age and older represent the largest proportion of cases overall (48%), and among cases of influenza A(H3N2) (54%) and influenza B (44%). 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 (548), 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 53% and 34% of cases respectively.

Table 1 - Weekly and cumulative numbers of positive influenza specimens by type, subtype and age-group reported through case-based laboratory reporting, Canada, weeks 2017-35 to 2018-07

Age groups (years)

Cumulative (August 27, 2017 to February 17, 2018)

Influenza A

B

Influenza A and B

A Total

A(H1) pdm09

A(H3)

A (UnS)

Table 1 Footnote

1

Total

#

%

0-4

2073

106

604

1363

877

2950

8%

5-19

1761

82

652

1027

1845

3606

10%

20-44

3318

151

1266

1901

1807

5125

15%

45-64

3537

137

1401

1999

2778

6315

18%

65+

10953

72

4600

6281

5784

16737

48%

Total

21642

548

8523

12571

13091

34733

100%

Table 1 Footnote 1

UnS: unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available.

Return to table 1 footnote

1

referrer

Syndromic/Influenza-like Illness Surveillance

Healthcare Professionals Sentinel Syndromic Surveillance

In week 07, 4.5% of visits to healthcare professionals were due to influenza-like illness (ILI); an increase 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 07: 163

The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2012-13 to 2017-18

Figure 4 - Text Description

Figure 4 - Percentage of visits for ILI reported by sentinels by report week, Canada, weeks 2017-35 to 2018-07

Report week

2017-18

Average

Min

Max

35

0.4%

0.8%

0.5%

1.2%

36

0.5%

0.8%

0.7%

1.0%

37

0.7%

0.9%

0.7%

1.0%

38

0.7%

1.1%

1.0%

1.4%

39

1.1%

1.1%

0.9%

1.4%

40

1.3%

1.3%

0.9%

1.6%

41

1.7%

1.4%

0.9%

2.4%

42

1.2%

1.4%

1.0%

1.9%

43

1.6%

1.3%

1.0%

1.5%

44

1.5%

1.3%

0.9%

1.6%

45

1.8%

1.3%

1.2%

1.5%

46

1.7%

1.6%

1.0%

2.0%

47

2.2%

1.5%

1.1%

1.9%

48

2.8%

1.6%

0.8%

2.1%

49

1.7%

1.5%

1.0%

2.5%

50

2.2%

2.3%

1.3%

3.7%

51

2.6%

2.5%

1.6%

4.1%

52

4.0%

4.5%

1.7%

7.1%

1

4.4%

3.7%

1.7%

5.2%

2

2.8%

3.0%

1.1%

4.5%

3

2.8%

2.5%

1.3%

3.6%

4

3.1%

2.4%

1.7%

3.5%

5

4.1%

2.7%

2.0%

4.4%

6

3.6%

2.7%

2.1%

3.3%

7

4.5%

2.4%

1.7%

3.0%

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 07, 1,467 participants reported to FluWatchers, of which 4% reported symptoms of cough and fever, and 20% of these consulted a healthcare professional. Among participants who reported cough and fever, 76% reported days missed from work or school, resulting in a combined total of 140 missed days of work or school.

Table 2 - Summary of influenza-like illness symptoms reported by participating Canadians, Canada, week 2018-07

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

1467

4%

20%

76%

140

Influenza Outbreak Surveillance

In week 07, the number of reported laboratory-confirmed outbreaks of influenza decreased compared to the previous week.In week 07, 94 new influenza outbreaks were reported: 55 in long-term care facilities, 11 in hospitals, and 28 in other settings. In addition, four ILI outbreaks were reported schools. Among the 88 outbreaks with influenza type/subtype reported, 47 (53%) were associated with influenza B, 33 (38%) were associated with influenza A and eight outbreaks were associated with a mix of influenza A and B (9%).

To date this season, 1,228 influenza/ILI outbreaks have been reported, of which 729 (60%) occurred in LTC facilities. Among the 1,070 outbreaks for which the influenza type/subtype was reported, 601 (56%) were associated with influenza A and 415 (39%) were associated with influenza B, and 54 (5%) were associated with a mix of A and B. Compared to recent influenza A(H3N2) seasons at week 07, the number of cumulative outbreaks reported this season has been greater than during the 2016-17 season 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 2018-07

Figure 5 - Text Description

Figure 5 - Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2017-35 to 2018-07

Report week

Hospitals

Long Term Care Facilities

Other

35

0

0

0

36

0

1

0

37

0

0

0

38

0

2

0

39

0

1

1

40

1

0

0

41

0

0

1

42

0

2

1

43

3

1

1

44

0

1

0

45

3

1

4

46

0

2

5

47

0

2

5

48

9

11

7

49

4

14

12

50

9

31

16

51

11

48

28

52

5

72

23

1

12

110

38

2

18

99

48

3

14

84

45

4

13

63

24

5

9

54

19

6

10

75

31

7

11

55

28

Severe Outcomes Influenza Surveillance

Provincial/Territorial Influenza Hospitalizations and Deaths

In week 07, 46 influenza-associated hospitalizations were reported by participating provinces and territories1. To date this season, 3,451 influenza-associated hospitalizations have been reported, 77% of which were associated with influenza A, and 2,357 cases (68%) were in adults 65 years of age or older. To date, 317 ICU admissions and 163 deaths have been reported.

Figure 6 - Cumulative numbers of hospitalizations by age-group reported by participating provinces and territories

figure 6 note

1

, weeks 2017-35 to 2018-07

Figure 6 - Text Description

Figure 6 - Cumulative numbers of hospitalizations by age-group reported by participating provinces and territories, weeks 2017-35 to 2018-07

Age Group

Total

0-4 yr

200

5-19 yr

131

20-44 yr

212

45-64 yr

551

65+ yr

2357

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.

Return to figure 6 note

1

referrer

Pediatric Influenza Hospitalizations and Deaths

In week 07, 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 07, 89 hospitalizations were reported of which 52 (60%) were due to influenza A. The number of weekly hospitalizations has been above the seven-season average since week 45.

To date this season, 686 pediatric hospitalizations have been reported by the IMPACT network, 431 (63%) of which were associated with influenza A. Children 0-23 months accounted for the largest proportion of influenza A hospitalizations (39%). Among the 255 hospitalizations due to influenza B, children 5-9 years accounted for the largest proportion of cases (30%).

Additionally, 114 ICU admissions and six deaths have been reported to date. Children aged 0-23 months and 10-16 years each accounted for 27% of ICU cases. Among the ICU cases with available information, 65% were due to influenza A and approximately 43% 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 2018-07

Figure 7 - Text Description

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 2018-07

Age Group

Total

0-5 mo

74

6-23 mo

156

2-4 yr

179

5-9 yr

159

10-16 yr

118

Figure 8 - Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, weeks 2017-35 to 2018-07

Figure 8 - Text Description

Figure 8 - Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, weeks 2017-35 to 2018-07

Report Week

2017-2018

Average

Min

Max

35

0

0

0

0

36

1

0

0

1

37

0

0

0

2

38

1

0

0

2

39

2

1

0

3

40

0

0

0

2

41

3

1

0

2

42

1

1

0

4

43

7

1

0

3

44

1

3

1

6

45

4

3

2

4

46

8

5

1

13

47

13

4

0

9

48

16

9

2

23

49

23

15

3

28

50

26

23

4

47

51

39

32

4

72

52

60

47

7

92

1

57

40

5

75

2

39

35

4

62

3

50

38

4

67

4

93

35

7

47

5

67

40

11

59

6

79

38

15

79

7

89

40

17

120

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

Return to figure 8 note

1

referrer

Influenza Strain Characterizations

During the 2017-18 influenza season, the National Microbiology Laboratory (NML) has characterized 1,701 influenza viruses [895 A(H3N2), 86 A(H1N1)pdm09 and 720 B viruses] that were received from Canadian laboratories.

Antigenic Characterization

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.

Table 3 - Influenza antigenic strain characterizations, Canada, weeks 2017-35 to 2018-07

Strain Characterization Results

Count

Description

Influenza A (H3N2)

A/Hong Kong/4801/2014-like

166

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

18

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

86

Viruses antigenically similar to A/Michigan/45/2015, the A(H1N1) component of the 2017-18 Northern Hemisphere's

trivalent

and

quadrivalent

influenza vaccine.

Influenza B

B/Brisbane/60/2008-like

(Victoria lineage)

7

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

(Victoria lineage)

24

These B/Victoria lineage viruses reacted poorly with antisera raised against cell-propagated B/Brisbane/60/2008, suggesting some antigenic differences.

B/Phuket/3073/2013-like

(Yamagata lineage)

689

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, 711 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 632 A(H3N2) viruses belonged to genetic group 3C.2a, 77 viruses belonged to subclade 3C.2a1 and two viruses belonged to the clade 3C.3a.

Additionally, of the 184 influenza A(H3N2) viruses that were characterized antigenically as similar to A/Hong Kong/4801/2014, 144 belonged to genetic group 3C.2a and 16 viruses belonged to subclade 3C.2a1. The 18 viruses that showed reduced titer to A/Hong Kong/4801/2014 belonged to genetic clade 3C.3a. Sequencing is pending for the six remaining virus isolates.

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 22 viruses had a two amino acid deletion in the HA gene. Sequencing is pending for the two remaining virus isolates.

Antiviral Resistance

During the 2017-18 season, the National Microbiology Laboratory (NML) has tested 790 influenza viruses for resistance to oseltamivir and 786 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

).

Table 4 - Antiviral resistance by influenza virus type and subtype, Canada, weeks 2017-35 to 2018-07

Virus type and subtype

Oseltamivir

Zanamivir

# tested

# resistant (%)

# tested

# resistant (%)

A (H3N2)

401

0 (0%)

397

0 (0%)

A (H1N1)

67

1 (1.5%)

67

0 (0%)

B

322

0 (0%)

322

1 (0.3%)

TOTAL

790

1 (0.1%)

786

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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2021-05-10