West Nile Virus and Other Mosquito-borne Diseases National Surveillance Report English Edition September 18 to September 24, 2016 (Week 38)

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West Nile Virus and Other Mosquito-borne Diseases National Surveillance Report English Edition September 18 to September 4, 16 (Week 38) Canada Humans During surveillance week 38, ending on September 4, 16, eleven (11) human clinical cases of (WNV) have been reported to the Public Health Agency of Canada (PHAC). Of these, eight cases have been reported in Ontario [Ottawa (1),Toronto (), Windsor-Essex County (), Durham (1), Peel (1),Haldimand-Norfolk (1)] and three cases in Quebec [Montérégie (), Montréal (1)]. As of surveillance week 38, a total of 69 human clinical cases have been reported to PHAC: Alberta (4) [Calgary zone (1) and South zone (3)], Manitoba () [Interlake-Eastern (3), Northern (1), Prairie Mountain (), Southern (8) and Winnipeg (6)], Ontario (34) [Ottawa (1),Toronto (17), Niagara (6), York (), Durham (), Halton (1), Windsor-Essex County (), Peel (),Haldimand-Norfolk (1)] and Quebec (11) [Capitale-Nationale (1), Laurentides (1) *, Laval (3), Montérégie (3), Lanaudière (), Montréal (1) ]. Of these, thirty-seven cases (54 %) were classified as Neurological Syndrome, nineteen cases (7 %) as Non-Neurological Syndrome, and thirteen cases (19 %) were unclassified. Three fatal cases have been reported. In addition, five asymptomatic infections have been reported: Saskatchewan (1) [Mixed-Grass prairie (1)] and Ontario (4) [Toronto (3), Windsor-Essex County (1)]. Mosquitoes As of surveillance week 38, 338 (.3 %) out of 14569 mosquito pools have tested positive for WNV in Canada: Saskatchewan (67), Manitoba (39), Ontario (8) and Quebec (4). Birds As of surveillance week 38, the Canadian Wildlife Health Cooperative, the Québec Ministry of Agriculture, Fisheries and Food, and the Québec Centre for Wildlife Health have examined a total of 66 dead birds for WNV: British Columbia (), Saskatchewan (3), Ontario (49), and Quebec (1), of which 1 (3%) dead birds have tested positive for WNV: British Columbia () [Cranbrook], Sakatchewan (1)[Saskatoon], [Ontario (8) [Bradford (1), Hamilton (1), Sarnia (1), Thorold (1), Toronto (1), Tecumseh (1), Burlington (1), Waterloo (1)] and Quebec () [ Estrie (1), Lanaudière (1), Montérégie (5), Saint-Jean-Baptiste (1), Abitibi-Témiscaminigue (1), Montréal (1)]. The positive birds were identified as American Crows (38%), Red- tailed Hawks (4%), Sharp-shinned Hawks (14%), Merlins (9%), Northern Goshawks (5%), Great- horned Owl (5%) and Cooper s hawk (5%). Domestic Animals As of surveillance week 38, forty-four horses with WNV infection have been reported to the Canadian Food Inspection Agency by various provincial/private animal health laboratories. These are preliminary data under validation: British Columbia (), Alberta (7), Manitoba (1), Ontario () and Saskatchewan (13). In addition, the Quebec Ministry of Agriculture, Fisheries and Food, has reported one horse that tested positive for WNV, in Quebec. United States and U.S. territories As of September 4, 16, the Centers for Disease Control and Prevention have reported a total of 986 human clinical cases of disease in the US, including the following border states: Washington (8), Idaho (6), Montana (5), New York (1), North Dakota (11), Minnesota (34), Michigan (3), and Vermont (3). Of these, 55 (51%) were classified as neuroinvasive disease and 481 (49%) were classified as non- neuroinvasive disease. Detailed information can be accessed via the CDC web site: https://wonder.cdc.gov/mmwr/mmwr_16.asp?mmwr_year=16&mmwr_week=38&mmwr_table=n&request=submit&mmwr_location= Europe and Neighbouring Countries As of September 4, 16, a total of 149 human cases of WNV have been reported in the European Union and 5 cases have been reported in the neighbouring countries. Detailed information can be accessed via the ECDC web site: http://ecdc.europa.eu/en/healthtopics/west_nile_fever/west-nile-fever-maps/pages/index.aspx Eastern equine encephalitis Canada Domestic Animals As of surveillance week 38, one horse with Eastern Equine Encephalitis in Berthierville, Québec, has been reported to the Canadian Food Inspection Agency by a provincial/private animal health laboratory. *This case was acquired during WNV season in 15 Sun Country, Regina Qu Appelle, Five Hills, Cypress, Heartland Health Regions

FIGURE 1: Geographic distribution of WNV in humans (clinical cases) and horses* in Canada *These are preliminary data, under validation

FIGURE : WNV human clinical cases and asymptomatic infections by province/ territory and by report week, as of September 4, 16 Counts 18 16 14 1 8 New Brunswick Nunavut Northwest Territory Yukon Territory British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Nova Scotia Prince Edward Island Newfoundland and Labrador 6 4 17 18 19 1 3 4 5 6 7 8 9 3 31 3 33 34 35 36 37 38 39 4 41 4 43 44 45 46 47 48 49 5 Report Week * FIGURE 3: WNV human clinical cases and asymptomatic infections by report week for selected years, in Canada 5 45 4 35 16 15 13 1 7 3 Counts 5 15 5 17 18 19 1 3 4 5 6 7 8 9 3 31 3 33 34 35 36 37 38 39 4 41 4 43 44 45 46 47 48 49 5 Report Week by Episode Date * clinical cases and asymptomatic infections are grouped by report week, based on episode date. Episode date could include one of the following: onset date, diagnosis date, lab sample date or reporting date.

TABLE 1: human clinical cases and asymptomatic infections by province/territory for the current report week and year to date, 16 season Newfoundland and Labrador neurological non-neurological Week 38: September 18 to September 4, 16 Unclassified/ unspecified Total clinical cases 1 Number of travel-related cases asymptomatic infection 3 Prince Edward Island Nova Scotia New Brunswick Quebec 3 3 Ontario 5 1 8 Manitoba Saskatchewan Alberta British Columbia Yukon Territory Northwest Territory Nunavut Total 8 1 11 Newfoundland and Labrador neurological non-neurological Year to date: January 1 to September4, 16 Unclassified/ unspecified Total clinical cases 1 Number of travel-related cases asymptomatic infection 3 Prince Edward Island Nova Scotia New Brunswick Quebec 8* 3 11* Ontario 8 4 34 3 4 Manitoba 6 5 9 Saskatchewan 1 Alberta 1 3 4 1 British Columbia Yukon Territory Northwest Territory Nunavut Total 37 19 13 69 4 5 1 Total clinical cases is the sum of both probable and confirmed: neurological and non-neurological s, along with any unclassified or unspecified cases. Likely related to travel outside the Province/Territory. These cases are included in either the total clinical cases or asymptomatic infections. 3 Satisfies diagnostic test criteria in the absence of clinical criteria. This category could include asymptomatic blood donors whose blood is screened using a nucleic acid amplification test, by blood operators (i.e. Canadian Blood Services or Hema-Quebec) and is subsequently brought to the attention of public health officials. Blood operators in Canada perform a supplementary specific nucleic acid amplification test following any positive donor screen test result. * One of the cases was acquired in 15.

TABLE : Number of mosquito pools tested and number of positive mosquito pools by province/territory, 16 season Province Year to date: January 1 to September 4, 16 * Number of positive mosquito Number of mosquito pools pools tested Percentage of positive mosquito pools (%) Quebec 4 871.76 Ontario 8 1177 1.78 Manitoba 39 1394.8 Saskatchewan 67 597 11. Total 338 14569.3 *In 16, mosquito surveillance is conducted by the following provinces only: Quebec, Ontario, Manitoba and Saskatchewan Province / Territory TABLE 3: Number of WNV positive mosquito pools/ total number of WNV mosquito pools tested by report week and by province/ territory, 16 season ǂ Report week of 16 18 19 1 3 4 5 6 7 8 9 3 31 3 33 34 35 36 37 38 Newfoundland and Labrador Prince Edward Island New Brunswick Nova Scotia Quebec /59 /67 /65 /78 4/69 /79 6/76 4/67 /78 1/89 /79 /65 Ontario /6 /5 /1 /49 /9 /19 /46 /54 /56 /8 1/795 /688 5/649 /97 3/947 36/88 4/886 9/96 17/836 19/767 7/76 Manitoba /4 /8 /3 /17 /56 /58 /69 / 4/113 7/19 5/41 6/46 15/143 1/65 1/4 /9 /8 Saskatchewan /1 /9 /8 /14 1/6 /37 /31 3/6 /68 16/6 31/144 4/55 /8 /6 Alberta British Columbia Yukon Territory Northwest Territory Nunavut Total /6 /5 /1 /53 /98 /194 /486 /66 /634 3/956 1/999 6/897 17/983 39/135 54/1378 88/145 51/73 34/54 18/96 19/854 7/771 ǂ Detailed mosquito surveillance data can be accessed through Provincial/ Territorial websites. _These jurisdictions do not maintain regular mosquito surveillance. Mosquito surveillance has ended.

FIGURE 4: Reported number of dead birds tested positive for WNV by province/ territory and by report week, 16 season in Canada Number of dead birds testing positive 18 16 14 1 8 6 4 Nunavut Northwest Territory Yukon Territory British Columbia Alberta Saskatchewan Manitoba Ontario Quebec Nova Scotia New Brunswick Prince Edward Island Newfoundland and Labrador 17 18 19 1 3 4 5 6 7 8 9 3 31 3 33 34 35 36 37 38 39 4 41 4 43 44 45 46 47 48 49 5 Report Week FIGURE 5: Percentage of dead birds tested positive for WNV by report week in 1, 15 and 16, and number of dead birds tested positive for WNV, by report week, 16, in Canada % Positive 9 8 7 6 5 4 3 % positive 1 % positive 15 % positive 16 # positve 16 17 18 19 1 3 4 5 6 7 8 9 3 31 3 33 34 35 36 37 38 39 4 41 4 43 44 45 46 47 48 Report Week 19 18 17 16 15 14 13 1 11 9 8 7 6 5 4 3 1 # Positive Not all provinces are conducting dead bird surveillance as part of their own WNV surveillance program. However, WNV positive dead birds may be identified through the National Wildlife Disease Surveillance Program of the Canadian Wildlife Health Cooperative (CWHC)