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FluWatch report: January 28, 2018 to February 3, 2018 (week 5)

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Public Health Agency of Canada

Date published: 2018-02-09

Related Topics
Overall Summary
  • Overall, influenza activity in Canada remains at peak levels but there are signs that activity is starting to slow down in parts of the country.
  • In week 05, the total number of detections of influenza B were similar to the total number of detections of influenza A.
  • An increasing proportion of weekly pediatric hospitalizations reported by the IMPACT network are due to influenza B. In week 05, influenza A and B accounted for an equal proportion of hospitalizations.
  • To date this season, the majority of lab confirmations, hospitalizations and deaths have been among adults 65 years of age and older.
  • For more information on the flu, see our Flu(influenza) web page.

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Influenza/Influenza-like Illness Activity (geographic spread)

In week 05, a similar number of regions reported localized or widespread influenza activity compared to the previous week. Among the 46 regions reporting data for week 05, 7 regions (BC(1), ON(2), QC(3), PE(1)) reported widespread activity, and 25 regions (BC(2), AB(3), SK(1), ON(5), QC(3), NB(4), NS(3), NL(3), and NU(1)) reported localized activity.

Figure 1 - Map of overall influenza/ILI activity level by province and territory, Canada, week 2018-05

Figure 1

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 2018-05
Influenza Surveillance Region Activity Level
Newfoundland - Central  Localized
Newfoundland - Eastern  Localized
Grenfell Labrador Sporadic
Newfoundland - Western  Localized
Prince Edward Island Widespread
Nova Scotia - Central (Zone 4) Localized
Nova Scotia - Western (Zone 1) Localized
Nova Scotia - Northern (Zone 2) Sporadic
Nova Scotia - Eastern (Zone 3) Localized
New Brunswick - Public Health Region 1 Localized
New Brunswick - Public Health Region 2 Localized
New Brunswick - Public Health Region 3 Localized
New Brunswick - Public Health Region 4 Localized
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 Widespread
Centre-du-Québec Widespread
Montréal et Laval Localized
Ouest-du-Québec Widespread
Montérégie  Localized
Ontario - Central East Widespread
Ontario - Central West Widespread
Ontario - Eastern Localized
Ontario - North East Localized
Ontario - North West  Localized
Ontario - South West  Localized
Ontario - Toronto Localized
Manitoba - Interlake-Eastern  No Data
Manitoba - Northern Regional No Data
Manitoba - Prairie Mountain No Data
Manitoba - South No Data
Manitoba - Winnipeg No Data
Saskatchewan - North  Sporadic
Saskatchewan - Central Localized
Saskatchewan - South Sporadic
Alberta - North Zone Sporadic
Alberta - Edmonton Localized
Alberta - Central Zone  Localized
Alberta - Calgary Sporadic
Alberta - South Zone  Localized
British Columbia - Interior Widespread
British Columbia - Fraser  Localized
British Columbia - Vancouver Coastal Sporadic
British Columbia - Vancouver Island Localized
British Columbia - Northern Sporadic
Yukon Sporadic
Northwest Territories - North No Data
Northwest Territories - South No Data
Nunavut - Baffin Localized
Nunavut - Kivalliq No Activity
Nunavut - Kitimeot Sporadic

Laboratory-Confirmed Influenza Detections

In week 05, the overall percentage of tests positive for influenza was 31%. Since week 02, the percentage of tests positive for influenza A has been slowly declining to 16% from the peak in week 01 (19%). The percentage of tests positive for influenza B increased this week to 15%.

The percentage of influenza A detections for week 05 is average for this time of year. The percentage of tests positive for influenza B in week 05 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 2018-05

Figure 2

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 2018-05
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 1625 480 45 1961

To date this season, 33,095 laboratory-confirmed influenza detections have been reported, of which 64% 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 2018-05

Figure 3
Figure 3 - Text Description
Figure 3 - Cumulative numbers of positive influenza specimens by type/subtype and province/territory, Canada, weeks 2017-35 to 2018-05
Reporting
provincesTable Figure 3 - Footnote 1		 Week (January 28, 2018 to February 3, 2018) Cumulative (August 27, 2017 to February 3, 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 165 26 104 35 141 1627 247 1054 326 1675 3302
AB 93 7 60 26 142 5108 96 3754 1258 2092 7200
SK 46 3 22 21 74 1390 38 973 379 613 2003
MB 42 0 10 32 33 1017 7 340 670 135 1152
ON 419 9 229 181 409 2957 108 1687 1162 2241 5198
QC 1267 0 0 1267 1083 7807 0 0 7807 4788 12595
NB 0 0 0 0 0 643 2 11 530 182 825
NS 42 0 0 42 12 233 0 0 233 55 288
PE 6 0 6 0 14 59 3 56 0 84 143
NL 30 0 0 30 24 83 0 3 80 55 138
YT 17 1 8 8 2 44 3 27 14 39 83
NT 2 0 2 0 1 119 1 118 0 19 138
NU 2 0 2 0 0 28 0 28 0 2 30
Canada 2131 46 443 1642 1935 21115 505 8151 12459 11980 33095
PercentageTable Figure 3 - Footnote 2 52% 2% 21% 77% 48% 64% 2% 39% 59% 36% 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 29,037 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) (53%) 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 (445), 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 2018-05
Age groups (years) Cumulative (August 27, 2017 to February 3, 2018)
Influenza A B Influenza A and B
A Total A(H1) pdm09 A(H3) A (UnS)Table 1 Footnote 1 Total # %
0-4 1752 85 557 1110 642 2394 8%
5-19 1518 65 607 846 1371 2889 10%
20-44 2967 126 1162 1679 1390 4357 15%
45-64 3091 111 1258 1722 2178 5269 18%
65+ 9595 58 4104 5433 4533 14128 49%
Total 18923 445 7688 10790 10114 29037 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 05, 4% of visits to healthcare professionals were due to influenza-like illness (ILI); a 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 2018-05

Number of Sentinels Reporting in Week 05: 141

Figure 4

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 2018-05
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 2.7% 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%
1 4.7% 3.7% 1.7% 5.2%
2 3.2% 3.0% 1.1% 4.5%
3 3.0% 2.5% 1.3% 3.6%
4 3.3% 2.4% 1.7% 3.5%
5 4.2% 2.7% 2.0% 4.4%

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 05, 1,491 participants reported to FluWatchers, of which 4% reported symptoms of cough and fever, and 19% of these consulted a healthcare professional. Among participants who reported cough and fever, 77% reported days missed from work or school, resulting in a combined total of 108 missed days of work or school.

Table 2 - Summary of influenza-like illness symptoms reported by participating Canadians, Canada, week 2018-05
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
1491 4% 19% 77% 108

Influenza Outbreak Surveillance

In week 05, the number of reported laboratory-confirmed outbreaks of influenza decreased compared to the previous week. In week 05, 78 new influenza outbreaks were reported: 50 in long-term care facilities, 9 in hospitals, and 19 in other settings. In addition, seven ILI outbreaks were reported schools. Among the 75 outbreaks with influenza type/subtype reported, 33 (44%) were associated with influenza B, 38 (51%) were associated with influenza A and four outbreaks were associated with a mix of influenza A and B (5%).

To date this season, 1,004 influenza/ILI outbreaks have been reported, of which 595 (59%) occurred in LTC facilities. Among the 872 outbreaks for which the influenza type/subtype was reported, 523 (60%) were associated with influenza A) and 310 (36%) were associated with influenza B, and 39 (4%) were associated with a mix of A and B. Compared to recent influenza A(H3N2) seasons at week 05, 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 2018-05

Figure 5
Figure 5 - Text Description
Figure 5 - Number of new outbreaks of laboratory-confirmed influenza by report week, Canada, weeks 2017-35 to 2018-05
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 50 19

Severe Outcomes Influenza Surveillance

Provincial/Territorial Influenza Hospitalizations and Deaths

In week 05, 84 influenza-associated hospitalizations were reported by participating provinces and territories1. To date this season, 3,108 influenza-associated hospitalizations have been reported, 78% of which were associated with influenza A, and 2,139 cases (69%) were in adults 65 years of age or older. To date, 285 ICU admissions and 130 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 2018-05

Figure 6
Figure 6 - Text Description
Figure 6 - Cumulative numbers of hospitalizations by age-group reported by participating provinces and territories, weeks 2017-35 to 2018-05
Age Group Total
0-4 yr 179
5-19 yr 118
20-44 yr 193
45-64 yr 479
65+ yr 2139
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 05, the number of laboratory-confirmed influenza-associated pediatric (≤16 years of age) hospitalizations reported by the Immunization Monitoring Program Active (IMPACT) network decreased compared to the previous week. In week 05, 57 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, 511 pediatric hospitalizations have been reported by the IMPACT network, 334 (65%) of which were associated with influenza A. Children 0-23 months accounted for the largest proportion of influenza A hospitalizations (40%). Among the 177 hospitalizations due to influenza B, children 5-9 years accounted for the largest proportion of cases (31%).

Additionally, 83 ICU admissions and five deaths have been reported to date. Sixty-six percent of ICU cases were due to influenza A. Children aged 0-23 months and 10-16 years each accounted for 30% of ICU cases.

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 2018-05

Figure 7
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 2018-05
Age Group Total
0-5 mo 59
6-23 mo 119
2-4 yr 129
5-9 yr 117
10-16 yr 87

Figure 8 - Number of pediatric hospitalizations (≤16 years of age) with influenza reported by the IMPACT network, by week, Canada, weeks 2017-35 to 2018-05

Figure 8
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 2018-05
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 56 40 5 75
2 39 35 4 62
3 57 38 4 67
4 94 35 7 47
5 57 40 11 59
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 1,178 influenza viruses [655 A(H3N2), 58 A(H1N1)pdm09 and 465 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 2018-05
Strain Characterization Results Count Description
Influenza A (H3N2)
A/Hong Kong/4801/2014-like 134 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 9 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 58 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)		 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
(Victoria lineage)		 14 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)		 445 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, 512 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 445 A(H3N2) viruses belonged to genetic group 3C.2a, 66 viruses belonged to subclade 3C.2a1 and one virus belonged to the clade 3C.3a.

Additionally, of the 143 influenza A(H3N2) viruses that were characterized antigenically as similar to A/Hong Kong/4801/2014, 109 belonged to genetic group 3C.2a and 15 viruses belonged to subclade 3C.2a1. The nine viruses that showed reduced titer belonged to genetic clade 3C.3a. Sequencing is pending for the remaining 10 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 14 viruses had a two amino acid deletion in the HA gene.

Antiviral Resistance

During the 2017-18 season, the National Microbiology Laboratory (NML) has tested 662 influenza viruses for resistance to oseltamivir and 659 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 2018-05
Virus type and subtype Oseltamivir Zanamivir
# tested # resistant (%) # tested # resistant (%)
A (H3N2) 360 0 (0%) 357 0 (0%)
A (H1N1) 46 1 (2.2%) 46 0 (0%)
B 256 0 (0%) 256 0 (0%)
TOTAL 662 1 (0.2%) 659 1 (0.2%)

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

International Influenza Reports

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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