FluWatch report: February 2 to 8, 2020 (week 06)

Influenza/Influenza-like Illness (ILI) Activity (geographic spread)

During week 06, influenza activity was reported in all regions (50) in all reporting provinces and territories. Among these regions, 50% reported sporadic activity, 48% reported localized activity, and 2% reported widespread activity (Figure 1).

Figure 1 - Text equivalent

Province	Influenza Surveillance Region	Activity Level
N.L.	Eastern	Sporadic
N.L.	Labrador-Grenfell	Sporadic
N.L.	Central	Sporadic
N.L.	Western	Sporadic
P.E.I.	Prince Edward Island	Sporadic
N.S.	Zone 1 - Western	Localized
N.S.	Zone 2 - Northern	Localized
N.S.	Zone 3 - Eastern	Sporadic
N.S.	Zone 4 - Central	Localized
N.B.	Region 1	Localized
N.B.	Region 2	Localized
N.B.	Region 3	Localized
N.B.	Region 4	Localized
N.B.	Region 5	Sporadic
N.B.	Region 6	Localized
N.B.	Region 7	Localized
Que.	Nord-est	Localized
Que.	Québec et Chaudieres-Appalaches	Localized
Que.	Centre-du-Québec	Widespread
Que.	Montréal et Laval	Localized
Que.	Ouest-du-Québec	Sporadic
Que.	Montérégie	Sporadic
Ont.	Central East	Localized
Ont.	Central West	Localized
Ont.	Eastern	Localized
Ont.	North East	Localized
Ont.	North West	Localized
Ont.	South West	Localized
Ont.	Toronto	Localized
Man.	Northern Regional	Sporadic
Man.	Prairie Mountain	Sporadic
Man.	Interlake-Eastern	Sporadic
Man.	Winnipeg	Sporadic
Man.	Southern Health	Sporadic
Sask.	North	No Data
Sask.	Central	No Data
Sask.	South	No Data
Alta.	North Zone	Sporadic
Alta.	Edmonton	Localized
Alta.	Central Zone	Localized
Alta.	Calgary	Localized
Alta.	South Zone	Localized
B.C.	Interior	Sporadic
B.C.	Fraser	Sporadic
B.C.	Vancouver Coastal	Localized
B.C.	Vancouver Island	Sporadic
B.C.	Northern	Sporadic
Y.T.	Yukon	Sporadic
N.W.T.	North	Sporadic
N.W.T.	South	Sporadic
Nvt.	Qikiqtaaluk	Sporadic
Nvt.	Kivalliq	Sporadic
Nvt.	Kitimeot	Sporadic

Laboratory-Confirmed Influenza Detections

In week 06, the percentage of laboratory tests positive for influenza was similar to the previous week at 30% and remains above the previous peak reported in late December. Influenza A and B continue to co-circulate; however, in many regions in Canada (except the Atlantic Provinces and Quebec), influenza A is circulating at higher levels than influenza B.

The following results were reported from sentinel laboratories across Canada (Figures 2 and 3):

• The percentage of tests positive for influenza B was 14% in week 06. This continues to be three times greater than the average (4.6%) for this time of year.
• The percentage of tests positive for influenza A was 15% in week 06, which is average for this time of year.
• Among subtyped influenza A detections, influenza A(H1N1) accounted for 85% of detections, up from 83% in week 05.

To date this season (weeks 35 to 06), 33,615 laboratory detections of influenza were reported:

• 57% (19,189) were influenza A.
• Among subtyped influenza A detections (4,871), A(H1N1) is the predominant subtype this season (63%).

Detailed information on age and type/subtype has been received for 25,844 laboratory-confirmed influenza cases (Table 1). To date this season (weeks 35 to 06):

• Among cases of influenza A(H3N2) (1,590), the largest proportion were in adults 65 years of age and older (46%).
• Cases of influenza B (11,905) were primarily in younger age groups; 57% of cases were under 19 years of age and 31% between 20 and 44 years of age.
• Among cases of influenza A(H1N1) (2,103), 30% of cases were in adults 65 years of age and older, with approximately equal proportions in adults 20-44 years and 45-64 years (~25%).

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.

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 equivalent

Surveillance Week	A(Unsubtyped)	A(H3N2)	A(H1N1)pdm09	Influenza B	Percent Positive A	Percent Positive B
35	10	16	0	2	1.3	0.1
36	11	13	2	2	1.1	0.1
37	5	17	2	5	0.9	0.2
38	11	15	3	6	1.0	0.2
39	11	21	2	3	1.0	0.1
40	34	9	1	2	1.2	0.1
41	34	18	0	5	1.4	0.1
42	54	12	1	14	1.6	0.3
43	44	13	7	17	1.6	0.3
44	43	23	16	17	1.8	0.3
45	57	57	20	39	2.2	0.7
46	82	43	23	77	2.7	1.4
47	118	49	33	124	3.1	1.9
48	225	67	42	223	4.9	3.2
49	281	79	41	336	5.3	4.1
50	463	100	73	654	7.7	8.0
51	794	149	169	1094	10.6	10.4
52	1223	267	197	1439	15.0	12.7
1	1620	261	431	1533	15.8	10.3
2	1690	165	493	1463	15.8	9.4
3	1587	131	414	1418	16.2	10.3
4	1736	126	368	1952	15.2	12.7
5	2005	88	428	2270	16.0	13.7
6	1851	57	310	2141	15.5	14.1

Footnote *

Specimens from NWT, YT, and Nvt are sent to reference laboratories in other provinces.

Return to footnote * referrer

Figure 3 - Text equivalent

ProvincesTable Figure 3 - Footnote 1	Cumulative (August 25, 2019 to February 8, 2020)
	A Total	A(H1N1)	A(H3N2)	A(UnS)Table Figure 3 - Footnote 3	B Total	A & B Total
B.C.	1639	183	234	503	1243	2882
Alta.	2731	758	1097	876	2718	5449
Sask.	618	0	0	618	179	797
Man.	726	88	70	568	688	1414
Ont.	5020	1963	334	2723	1422	6442
Que.	7825	0	0	7825	7338	15163
N.B.	352	27	20	305	586	938
N.S.	62	2	1	59	75	137
P.E.I.	40	0	0	40	33	73
N.L.	63	4	24	35	103	166
Y.T.	31	4	8	19	6	37
N.W.T	54	45	8	1	28	82
Nvt.	28	1	0	27	7	35
Canada	19189	3075	1796	13599	14426	33615
PercentageTable Figure 3 - Footnote 2	57%	16%	9%	71%	43%	100%
Table Figure 3 - Footnote 1 Specimens from NWT, YT, and Nvt 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 Table Figure 3 - Footnote 3 referrer

Table 1 - Cumulative numbers of positive influenza specimens by type, subtype and age group reported through case-based laboratory reporting, Canada, weeks 2020-01 to 2020-06

Age groups (years)	Cumulative (August 25, 2019 to February 8, 2020)
	Influenza A				B	Influenza A and B
	A Total	A(H1N1)	A(H3N2)	A (Un subtyped)Table 1 Footnote 1	Total	#	%
0-4	2207	251	154	1802	2648	4855	19%
5-19	1466	142	202	1122	4143	5609	22%
20-44	2943	553	250	2140	3628	6571	25%
45-64	2675	517	248	1910	659	3334	13%
65+	4648	640	736	3272	827	5475	21%
Total	13939	2103	1590	10246	11905	25844	100%
Table 1 Footnote 1 Unsubtyped: The specimen was typed as influenza A, but no result for subtyping was available. Table 1 Return to footnote 1 referrer

Syndromic / Influenza-like Illness Surveillance

Healthcare Professionals Sentinel Syndromic Surveillance

In week 06, 1.9% of visits to healthcare professionals were due to influenza-like illness (ILI) which is below the average for this time of year (Figure 4).

Number of Sentinels Reporting in Week 06: 86

The shaded area represents the maximum and minimum percentage of visits for ILI reported by week from seasons 2014-2015 to 2018-2019

Figure 4 - Text equivalent

Surveillance Week	2019-20	Average	Min	Max
35	0.6%	0.6%	0.4%	0.9%
36	0.4%	0.6%	0.4%	0.9%
37	0.7%	0.7%	0.5%	1.0%
38	1.1%	0.7%	0.6%	1.0%
39	0.8%	0.9%	0.5%	1.2%
40	1.0%	1.2%	0.8%	1.7%
41	0.9%	1.7%	0.8%	2.8%
42	1.1%	1.6%	1.2%	2.1%
43	0.7%	1.2%	0.8%	1.7%
44	0.9%	1.2%	0.7%	1.7%
45	0.7%	1.2%	0.9%	1.5%
46	1.1%	1.4%	1.2%	1.8%
47	1.2%	1.6%	1.1%	2.2%
48	0.9%	1.5%	1.1%	2.2%
49	1.0%	1.7%	1.0%	2.8%
50	1.4%	1.5%	1.1%	1.7%
51	1.1%	1.9%	1.4%	2.7%
52	2.5%	2.0%	1.0%	3.1%
1	2.9%	3.4%	1.9%	5.4%
2	1.5%	3.4%	1.8%	5.7%
3	1.8%	2.3%	1.3%	3.7%
4	1.5%	2.0%	1.1%	2.9%
5	1.6%	2.1%	1.4%	3.1%
6	1.9%	2.4%	1.4%	4.0%

FluWatchers

The proportion of FluWatchers participants reporting symptoms of cough and fever decreased in week 06 compared to the previous week. In week 06, 3,170 participants reported to FluWatchers, of which 3.1% (98) reported symptoms of cough and fever (Figure 5).

Among the 98 participants who reported cough and fever:

• 23% consulted a healthcare professional;
• 83% reported days missed from work or school, resulting in a combined total of 267 missed days of work or school.

If you are interested in becoming a FluWatcher, sign up today.

Number of Participants Reporting in Week 06: 3,170

Figure 5 - Text equivalent

Surveillance Week	% cough and fever
40	2.2%
41	1.8%
42	1.7%
43	2.2%
44	1.6%
45	1.4%
46	1.2%
47	1.5%
48	1.7%
49	2.2%
50	2.1%
51	2.6%
52	4.1%
1	4.3%
2	3.1%
3	3.3%
4	3.1%
5	3.4%
6	3.4%

Online Figure – Geographic distribution of FluWatchers participants reporting cough and fever, Canada, week 2020-06

Click on the map to access the link

Influenza Outbreak Surveillance

In week 06, a total of 26 outbreaks were reported: 8 in long term care facilities, 7 in acute care facilities, 11 in facilities categorized as ‘other’, which includes facilities such as private personal care homes, correctional facilities, and colleges/universities (Figure 6). In addition, 24 ILI outbreaks in schools/daycares were reported.

To date this season, a total of 626 laboratory-confirmed influenza outbreaks have been reported; 60% (376) in long-term care facilities, 26% (160) in facilities categorized as ‘other’, 12% (74) in acute care facilities, and 3% (16) in schools/daycares. Of the 593 outbreaks where influenza type was reported, 90% (531) were due to influenza A. Among the 247 outbreaks for which the influenza A subtype was reported, 53% (131) were associated with A(H3N2). To date this season, 103 ILI outbreaks in schools/daycares have also been reported.

Number of provinces and territories reporting in week 06: 12 out of 13

Figure 6 - Text equivalent

Surveillance Week	Acute Care Facilities	Long Term Care Facilities	Other	Schools and Daycares	Remote and/or Isolated Communities
35	0	0	0	0	0
36	0	0	0	0	0
37	0	0	0	0	0
38	0	1	0	0	0
39	0	1	0	0	0
40	0	2	0	0	0
41	0	2	1	0	0
42	1	0	0	0	0
43	0	0	1	0	0
44	0	0	1	0	0
45	0	2	4	0	0
46	1	4	0	0	0
47	0	2	1	1	0
48	1	6	2	2	0
49	2	8	1	1	0
50	4	10	4	1	0
51	4	15	11	0	0
52	4	37	15	0	0
1	18	75	40	0	0
2	12	86	35	0	0
3	10	47	5	1	0
4	5	48	19	6	0
5	5	22	9	4	0
6	7	8	11	0	0

Severe Outcomes Influenza Surveillance

Provincial/Territorial Influenza Hospitalizations and Deaths

To date this season, 1,553 influenza-associated hospitalizations were reported by participating provinces and territories1.

• 65% of the cases were associated with influenza A.
• Of the 736 cases for which subtype was reported, 63% were associated with influenza A(H3N2).
• The highest cumulative hospitalization rates up to week 06 were among children under 5 years of age (50/100,000 population). and adults 65 years of age and older (49/100,000 population).

152 ICU admissions and 46 deaths have been reported.

• 61% of the ICU admissions and 74% of the deaths were associated with influenza A.

Number of provinces and territories reporting in week 06: 9 out of 9

Footnote ‡

Influenza-associated hospitalizations are reported by Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Northwest Territories, Nova Scotia, Prince Edward Island and Yukon. Only hospitalizations that require intensive medical care are reported by Saskatchewan.

Return to footnote 1 referrer

Figure 7 - Text equivalent

Surveillance Week	0-4 yrs	5-19 yrs	20-44 yrs	45-64 yrs	65+ yrs
35	0.0	0.0	0.0	0.0	0.0
36	0.0	0.0	0.0	0.0	0.2
37	0.0	0.0	0.0	0.1	0.2
38	0.0	0.0	0.0	0.1	0.4
39	0.2	0.0	0.0	0.1	0.6
40	0.2	0.0	0.0	0.1	0.8
41	0.4	0.2	0.1	0.2	1.1
42	0.8	0.2	0.1	0.2	1.3
43	1.0	0.2	0.2	0.3	1.6
44	1.5	0.2	0.2	0.5	2.1
45	1.9	0.4	0.4	0.8	2.8
46	1.9	0.4	0.6	1.1	3.3
47	3.1	0.6	0.8	1.5	4.6
48	5.0	1.1	1.0	1.6	5.7
49	7.1	1.9	1.3	2.0	7.5
50	11.1	3.0	1.8	2.3	10.1
51	14.3	3.7	2.5	3.5	13.6
52	18.7	5.7	3.7	4.5	19.1
1	27.7	6.4	4.7	6.4	27.8
2	33.8	7.6	5.9	8.3	34.0
3	38.6	8.3	6.9	9.7	39.7
4	43.0	9.5	8.0	11.4	44.2
5	48.3	10.6	9.0	12.6	47.8
6	50.4	11.2	9.2	12.9	49.4

Pediatric Influenza Hospitalizations and Deaths

In week 06, 111 pediatric (≤16 years of age) laboratory-confirmed influenza-associated hospitalizations were reported by the Immunization Monitoring Program Active (IMPACT) network (Figure 8). The number of cases due to influenza B remains high; however, in recent weeks, a growing proportion of cases have been due to influenza A.

The elevated number of cases this season compared to previous seasons is likely due to the concurrent circulation of influenza A and B. The number of influenza A-associated pediatric hospitalizations is above the average for this time of year which is expected when A(H1N1) is the predominant circulating virus. The number of hospitalizations with influenza B remains well above average compared to previous seasons.

To date this season (weeks 35 to 06):

• 883 pediatric hospitalizations have been reported by the IMPACT network, of which 51% (449) were associated with influenza A and 49% (434) with influenza B.
• The largest proportion of hospitalizations (65%) were among children under 5 years of age (Figure 9).
• Among cases in children under 5 years of age (578), 56% were associated with influenza A, compared to cases in children 5 to 16 years of age (305), among whom 60% were associated with influenza B.
• 127 ICU admissions were reported, of which 53% were associated with influenza A.
• Less than five pediatric deaths have been reported.

The shaded area represents the maximum and minimum number of cases reported by week from seasons 2014-15 to 2018-19

Figure 8 - Text equivalent

Surveillance week	2019-2020	Average	Min	Max
35	0	0	0	1
36	2	0	0	1
37	0	1	0	2
38	0	1	0	2
39	1	1	0	3
40	0	1	0	2
41	2	1	0	3
42	2	2	0	5
43	1	5	2	12
44	2	5	1	15
45	3	10	2	37
46	6	13	1	41
47	6	13	2	36
48	26	18	2	40
49	23	22	3	47
50	39	29	4	50
51	60	41	5	84
52	99	54	14	89
1	108	55	21	94
2	101	40	12	63
3	83	44	28	64
4	90	53	34	93
5	118	47	25	70
6	111	49	15	79

Adult Influenza Hospitalizations and Deaths

Surveillance of laboratory-confirmed influenza-associated adult (≥16 years of age) hospitalizations by the Canadian Immunization Research Network (CIRN) Serious Outcomes Surveillance (SOS) network began on November 1^st  for the 2019-20 season.

To date this season, 533 hospitalizations, 49 intensive care unit admissions, and 25 deaths have been reported (Figure 10).

• The majority of hospitalizations have been due to influenza A (83%), and among those subtyped (148) 92% were influenza A(H1N1).
• Among cases with influenza A, the largest proportion of hospitalizations were in adults 65-79 years of age (34%) and adults 80 years of age and older (32%). Among the 88 cases with influenza B, 34% were between 16 and 34 years of age (Figure 11).
• 86% of hospitalized cases reported at least one type of comorbid condition.

Influenza Strain Characterizations

From September 1, 2019 to February 6, 2020, the National Microbiology Laboratory (NML) has characterized 555 influenza viruses (235 A(H1N1), 145 A(H3N2) and 175 influenza B) that were received from Canadian laboratories.

Influenza A(H3N2)

Over recent years, circulating strains of A(H3N2) have evolved, and are increasingly difficult to characterize by hemagglutination inhibition (HI) assay. Genetic characterization is established by sequencing the hemagglutinin (HA) gene of the influenza viruses to compare their genetic properties.

Antigenic Characterization:

Among the 41 influenza A(H3N2) viruses antigenically characterized to date, the majority (85%) showed reduced titer by HI assay to A Kansas/14/2017 using antiserum raised against egg-propagated A Kansas/14/2017. Six viruses were characterized as A Kansas/14/2017-like (Figure 12 a).

Genetic Characterization:

Nearly all (98%) of the 135 A(H3N2) viruses genetically characterized this season belonged to genetic group 3C.2a1b based on sequence analysis of the HA gene. Three viruses belonged to the genetic group 3C.3a (Figure 13).

Group 3C.2a1b viruses analysed represent:

• 90% (28 out of 31) viruses that were also antigenically characterized.
• 100% (104 out of 104) viruses which did not grow to sufficient hemagglutination titer for antigenic characterization by HI assay.

A/Kansas/14/2017 belongs to genetic group 3C.3a and is the influenza A(H3N2) component of the 2019-20 Northern Hemisphere influenza vaccine.

Influenza A(H1N1)

Among the 235 A(H1N1) viruses characterized to date, 62% were antigenically similar to A/Brisbane/02/2018 by HI testing using antiserum raised against egg-propagated A/Brisbane/02/2018 (Figure 12 b).

A/Brisbane/02/2018 is the influenza A(H1N1) component of the 2019-20 Northern Hemisphere influenza vaccine.

Influenza B

Among the 175 influenza B viruses antigenically characterized this season, the vast majority (173) belonged to the B/Victoria lineage. Two viruses were antigenically characterized as similar to B/Phuket/3073/2013 (B/Yamagata lineage).

The majority (91%, 157) of B/Victoria lineage viruses showed reduced titer by HI assay to B/Colorado/06/2017 using antiserum raised against cell culture-propagated B/Colorado/06/2017 (Figure 12 c).

Sequence analysis of 105 B/Victoria lineage viruses with reduced titre to B/Colorado/06/2017 showed that 100% had a three amino acid deletion (162-164) in the HA gene. Sequencing is pending for the remaining viruses.

The recommended influenza B components for the 2019-20 Northern Hemisphere influenza vaccine are B/Colorado/06/2017 (Victoria lineage) and B/Phuket/3073/2013 (Yamagata lineage). B/Phuket/3073/2013 is included in the quadrivalent influenza vaccine.

Antiviral Resistance

The National Microbiology Laboratory (NML) also tests influenza viruses received from Canadian laboratories for antiviral resistance. From September 1, 2019 to February 6, 2020, the following results were reported:

Oseltamivir:

371 influenza viruses (132 A(H3N2), 117 A(H1N1) and 122 B) were tested for resistance to oseltamivir:

• All influenza A(H3N2) and B viruses were sensitive to oseltamivir.
• Among the A(H1N1) viruses tested, 116 (99%) were sensitive to oseltamivir and one virus was resistant to oseltamivir with the H275Y mutation in the neuraminidase gene.

Zanamivir:

371 influenza viruses (132 A(H3N2), 117 A(H1N1) and 122 B) were tested for resistance to zanamivir:

• All influenza viruses tested were sensitive to zanamivir.

Amantadine:

High levels of resistance to amantadine persist among influenza A(H1N1) and influenza A(H3N2) viruses. All viruses tested this season were resistant.

Vaccine Monitoring

Vaccine monitoring refers to activities related to the monitoring of influenza vaccine coverage and effectiveness.

Vaccine Coverage

Influenza vaccine coverage estimates for the 2019-20 season are anticipated to be available in February or March 2020.

Vaccine Effectiveness

Influenza vaccine effectiveness estimates for the 2019-20 season are anticipated to be available in February or March 2020.