Update for Flu week 7 (Feb 14 2, 216) Weekly Update February 24, 216 The purpose of this report is to inform Public Health staff, primary care providers, acute care staff and other community practitioners about recent and historical respiratory virus activity in the province of Alberta. Unless otherwise noted, all data presented are current up to the Saturday prior to the day the report is released. Alberta Influenza A had the highest positivity among specimens tested for respiratory viruses in week 7 (Figure 1). There were 442 new cases of lab confirmed influenza in week 7 in Alberta ; 3 A(H3), 273 A(H1N1)pdm9, 94 A(unresolved subtype), 71 B and 1 unknown subtype (Table 1). So far this season (August 3, 215 February 2, 216), there have been 2,381 cases of lab confirmed influenza; 96 A(H3), 1,719 A(H1N1)pdm9, 195 A(unresolved subtype), 37 B and 1 unknown subtype. In week 7, the overall weekly rates of influenza A in Alberta was 9.2 per 1, Albertans and for influenza B it was 1.8 per 1, Albertans. In week 7, the -2 years age group had the highest rate of influenza A(H1N1) in Alberta (23.3 per 1, Albertans). There were 5 ILI outbreaks reported with onset in week 7 in Alberta (Table 2). The Health Link Alberta weekly call rate for cough/ili was 27 calls per 1, Albertans in week 7 (Figure 6). There were 96 weekly visits with ILI (7.7% of all visits) to Edmonton zone Emergency Departments/Urgent Centres (EDIS/E-triage sites) (Figure 7) and 1,2 weekly visits with ILI (1.1% of all visits) to Calgary zone Emergency Departments/Urgent Centres (SEC sites) in week 7 (Figure 8). In week 7,.9% and.7% were the percentages of patient visits to Alberta sentinel physicians attributed to ILI (influenza like illness) and LRTI (lower respiratory tract infection), respectively (Figure 9). Public health administered influenza immunization data are available in Table 3, Table 4, Table 5, Table 6 and Table 7. North America As per the FluWatch (PHAC) report for week 6, seasonal influenza activity continues to increase in Canada with influenza A(H1N1) predominating. An increasing number of outbreaks were reported with the majority due to influenza A. Young/middle age adults are accounting for an increasing proportion of hospitalizations in the past 3 weeks. Pediatric hospitalization reported by the IMPACT network increased substantially in the past few weeks. As of flu week 6, the National Microbiology Lab (NML) of Canada has antigenically characterized 411 influenza samples 118 A(H3N2), 26 A(H1N1)pdm9, and 87 B. The National Microbiology Laboratory tested 384 viruses for antiviral resistance to oseltamivir and 383 Quick Links Laboratory Data ILI Outbreaks Calls to Health Link Alberta Emergency Department Visits TARRANT Sentinel Physician Visits Immunization Data Data Notes 215-16 Northern Hemisphere Vaccine Recommendations Current Global Information FluWatch (PHAC) FluView (US CDC) HPA (UK) WHO Travel Advisories viruses for antiviral resistance to zanamivir; a ll were sensitive to zanamivir, and all but one were sensitive to oseltamivir. There were 35 influenza A virus samples tested for resistance to amantadine; all but one were resistant. According to the week 6 FluView (US CDC) update, influenza activity increased in the United States. International On February 5, 216 China reported 28 additional cases of lab confirmed avian influenza A (H7N9) to the WHO; including 5 deaths. Onset dates ranged from December 21, 215 to January 25, 216. Twenty five (25) cases reported poultry exposure and exposure history for the other 3 cases is unknown or has no clear exposure to poultry. In January 216, the WHO also reported 5 laboratory-confirmed cases of human infection with avian influenza A (H5N6) virus in China. All of the cases have reported a history of exposure to live poultry. As per the most recent WHO influenza update (February 22, 216), influenza activity continued to increase in the northern hemisphere, with A(H1N1)pdm9 predominating. Influenza A(H1N1)pdm9 activity was increasing in Canada, United States of America, Europe including Belarus, Greece, Ireland, Finland, the Russian Federation and Ukraine. In Northern Asia, the Republic of Korea reported the increasing activity of influenza A(H1N1)pdm9 while influenza A(H3N2) and B were predominant in North China. In western Asia, influenza activity was at high level in Israel and Jordan. In East Africa in Mauritius and Northern Africa in Algeria and Morocco, an increasing influenza A(H1N1)pdm9 were reported. In the tropical zone, influenza activity was mostly low with the exception of Cuba, Jamaica. In the southern hemisphere, influenza activity was low. 1
Percent Positive Laboratory Data Update for Flu week 7 (Feb 14 2, 216) Figure 1: Alberta weekly respiratory specimen percent positivity, by virus type ALBERTA 7% 6% 5% 4% 3% 2% 1% % 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 Adenovirus Coronavirus Hmpv Parainfluenza RSV Rhino-enterovirus Mixed FluA FluB Click here for ZONE figures of respiratory virus specimen percent positivity Source: DIAL Provincial Laboratory specimens, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. Percent positive is the number of positive specimens for that virus as a percent of the total number of specimens tested for respiratory viruses. Table 1: New and cumulative laboratory confirmed influenza cases, by subtype, Alberta and Zones Week 7 (14Feb216-2FEB216) Cumulative (3Aug215-2FEB216) Influenza A Influenza B Influenza A Influenza B A (unresolved subtype: result A (unresolved subtype: result A(H3) A(H1N1) pdm9 pending or low viral load) A (total) B (total) Unknown subtype A(H3) A(H1N1) pdm9 pending or low viral load) A (total) B (total) Zones South 8 5 13 5 6 82 11 99 26 Calgary 1 9 21 112 25 1 37 415 45 497 181 1 Central 38 16 54 8 9 235 41 285 39 Edmonton 2 98 29 129 24 32 72 67 819 93 North 39 23 62 9 12 267 31 31 31 Unknown Alberta Total 3 273 94 37 71 1 96 1719 195 21 37 1 Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. Unknown subtype 2
Weekly Rate (per 1,) Figure 2: Alberta weekly rates (per 1,) of lab confirmed influenza, by subtype 25 ALBERTA Update for Flu week 7 (Feb 14 2, 216) Weekly rate (per 1,) 2 15 1 5 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 Flu week Influenza A rate (215-16) Influenza A rate (214-15) Influenza A rate (213-14) Influenza B rate (215-16) Influenza B rate (214-15) Influenza B rate (213-14) Click here for ZONE figures - rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. Figure 3: Alberta weekly rates (per 1,) of lab confirmed respiratory viruses (excluding influenza), by virus type 1 ALBERTA 8 6 4 2 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 Adenovirus rate Coronavirus rate hmpv rate Parainfluenza rate RSV rate Mixed rate Rhino-enterovirus rate Click here for ZONE figures - rates of lab confirmed respiratory viruses Source: DIAL Provincial Laboratory specimens, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 3
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Figure 4: Alberta weekly age-specific rates of lab confirmed influenza (per 1,) by subtype 8 7 6 5 4 3 2 1 ALBERTA Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 ALBERTA Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 ALBERTA Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 Click here for ZONE figures - age specific rates of lab confirmed influenza to < 2 years Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 4
Number of Outbreaks Number of Outbreaks Number of Outbreaks Number of Outbreaks Update for Flu week 7 (Feb 14 2, 216) Influenza-Like-Illness (ILI) Outbreak Investigations Figure 5: AHS investigated ILI outbreaks in Alberta facilities, by onset week and organism type 5 4 3 2 1 4 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 All AHS reported Influenza-Like-Illness Outbreaks* 3 2 Confirmed Influenza A(H3) 1 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 15 1 5 Confirmed Influenza A(H1N1) 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 15 1 5 Confirmed Influenza B 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 Acute Childcare Long term School (K-12) Supportive or Home Living Sites (SL/HL) Other - - - Combined total for the 214-15 season - - - Combined total for the 213-14 season Combined total for the 212-13 season Source: CDRS data extracted on February 23, 216 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. Note: Some outbreaks may involve more than one pathogen. 5
Number of Outbreaks Number of Outbreaks Number of Outbreaks Number of Outbreaks Update for Flu week 7 (Feb 14 2, 216) Figure 5 continued: AHS investigated ILI outbreaks in Alberta facility types, by onset week and organism type 2 15 1 Confirmed Rhino-enterovirus 5 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 15 1 Confirmed RSV 5 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 15 1 Confirmed Parainfluenza 5 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 15 1 5 Confirmed Other ** Respiratory Viruses 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 Acute Childcare Long term School (K-12) Supportive or Home Living Sites (SL/HL) Other - - - Combined total for the 214-15 season - - - Combined total for the 213-14 season Combined total for the 212-13 season ** Other confirmed respiratory viruses include influenza A (unresolved type), adenovirus, coronavirus, and hmpv. Source: CDRS data extracted on February 23, 216 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. Note: Some outbreaks may involve more than one pathogen. 6
Update for Flu week 7 (Feb 14 2, 216) Table 2: New and cumulative AHS investigated ILI outbreaks, by onset date and by organism, Alberta and Zones Organism Long Term SL/HL School (K-12) Acute Long Child care Other Term SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - - - 1 1-1 - 1 4 Confirmed A(H1N1)pdm9-1 - - - - 6 3-6 1 2 18 Confirmed Flu B - - - - - - 1-1 - - - 2 Confirmed RSV - - - - - - - 1 - - - - 1 Confirmed Parainfluenza - - - - - - 4 3 - - 1-8 Confirmed Rhino-enterovirus - - - - - - 12 8-1 - - 21 Confirmed other** respiratory viruses 1 - - - - - 7 5 2 1 1-16 Initial report only (lab results pending) 1-1 - - 1 2 1 1-4 1 9 Unknown (none confirmed or no specimen available) - - - - - - 5 4 2-11 1 23 Total 2 1 1 1 38 26 6 9 18 5 12 SOUTH Organism Long Term SL/HL School (K-12) Acute Long Child care Other Term SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - - - - - - - - 1 1 Confirmed A(H1N1)pdm9 - - - - - - - - - - - - Confirmed Flu B - - - - - - - - - - - - Confirmed RSV - - - - - - - - - - - - Confirmed Parainfluenza - - - - - - - - - - - - Confirmed Rhino-enterovirus - - - - - - - 2 - - - - 2 Confirmed other** respiratory viruses - - - - - - - - - - - - Initial report only (lab results pending) - - - - - - - - - - - - Unknown (none confirmed or no specimen available) - - - - - - - - 1 - - - 1 Total 2 1 1 4 CALGARY Organism Long Term ALBERTA Week 7 (14Feb216-2FEB216) SL/HL School (K-12) Acute Long Child care Other Term Cumulative (3Aug215-2FEB216) SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - - - - - - - - - Confirmed A(H1N1)pdm9 - - - - - - - - - 1 - - 1 Confirmed Flu B - - - - - - 1-1 - - - 2 Confirmed RSV - - - - - - - - - - - - Confirmed Parainfluenza - - - - - - - 3 - - - - 3 Confirmed Rhino-enterovirus - - - - - - 1 3 - - - - 4 Confirmed other** respiratory viruses - - - - - - 4 3 1 - - - 8 Initial report only (lab results pending) 1-1 - - 1 1 1 1 - - 1 4 Unknown (none confirmed or no specimen available) - - - - - - 3 1 - - - - 4 Total 1 1 1 1 11 3 1 1 26 ** Other confirmed respiratory viruses include influenza A (unresolved type), adenovirus, coronavirus, and hmpv. Source: CDRS data extracted on February 23, 216 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. Note: Some outbreaks may involve more than one pathogen. 7
Update for Flu week 7 (Feb 14 2, 216) Table 2 continued: New and cumulative AHS investigated ILI outbreaks, by onset date and by organism, Alberta and Zones CENTRAL Organism Long Term SL/HL School (K-12) Acute Long Child care Other Term SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - - - - - - - - - Confirmed A(H1N1)pdm9 - - - - - - - - - - - - Confirmed Flu B - - - - - - - - - - - - Confirmed RSV - - - - - - - - - - - - Confirmed Parainfluenza - - - - - - - - - - - - Confirmed Rhino-enterovirus - - - - - - 1 1 - - - - 2 Confirmed other** respiratory viruses - - - - - - - - - - - - Initial report only (lab results pending) - - - - - - 1 - - - 1-2 Unknown (none confirmed or no specimen available) - - - - - - - - - - - - Total 2 1 1 4 EDMONTON Organism Long Term SL/HL School (K-12) Acute Long Child care Other Term SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - - - 1 1-1 - - 3 Confirmed A(H1N1)pdm9-1 - - - - 6 2-5 1 2 16 Confirmed Flu B - - - - - - - - - - - - Confirmed RSV - - - - - - - - - - - - Confirmed Parainfluenza - - - - - - 4 - - - 1-5 Confirmed Rhino-enterovirus - - - - - - 8 2-1 - - 11 Confirmed other** respiratory viruses 1 - - - - - 2 2-1 1-6 Initial report only (lab results pending) - - - - - - - - - - 3-3 Unknown (none confirmed or no specimen available) - - - - - - 2 3 1-11 1 18 Total 1 1 23 1 1 8 17 3 62 NORTH Organism Long Term Week 7 (14Feb216-2FEB216) SL/HL School (K-12) Acute Long Child care Other Term Cumulative (3Aug215-2FEB216) SL/HL School (K-12) Acute Child care Other Total Confirmed Flu A(H3) - - - - -. - - - - -. Confirmed A(H1N1)pdm9 - - - - -. - 1 - - -. 1 Confirmed Flu B - - - - -. - - - - -. Confirmed RSV - - - - -. - 1 - - -. 1 Confirmed Parainfluenza - - - - -. - - - - -. Confirmed Rhino-enterovirus - - - - -. 2 - - - -. 2 Confirmed other** respiratory viruses - - - - -. 1-1 - -. 2 Initial report only (lab results pending) - - - - -. - - - - -. Unknown (none confirmed or no specimen available) - - - - -. - - - - -. Total 3 2 1 6 ** Other confirmed respiratory viruses include influenza A (unresolved type), adenovirus, coronavirus, and hmpv. Source: CDRS data extracted on February 23, 216 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. Note: Some outbreaks may involve more than one pathogen. 8
Weekly call rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Calls to Health Link Alberta Figure 6: Weekly call rate (per 1,) for cough or influenza-like illness, Alberta and Zones ALBERTA 5 5 SOUTH Weekly call rate (per 1,) 4 3 2 1 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Weekly call rate (per 1,) 4 3 2 1 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Weekly call rate (per 1,) 5 4 3 2 1 CALGARY 35 39 43 47 51 2 6 1 14 18 22 26 3 34 5 4 3 2 1 CENTRAL 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Weekly call rate (per 1,) 5 4 3 2 1 EDMONTON 35 39 43 47 51 2 6 1 14 18 22 26 3 34 current call rate (215-16) 214-15 call rate Weekly call rate (per 1,) 5 4 3 2 1 NORTH 35 39 43 47 51 2 6 1 14 18 22 26 3 34 213-14 call rate 212-13 call rate Source: Sharp Focus - Health Link Alberta calls, data extracted on February 23, 216 via the Alberta Real Time Syndromic Surveillance Net (ARTSSN). For more information on data definitions and sources, see Data Notes. 9
Weekly % of visits with ILI Weekly # of visits with ILI Emergency Department Visits Update for Flu week 7 (Feb 14 2, 216) Figure 7A: Weekly emergency department/urgent care centre (ED/UCC) visits with ILI during screening at triage, Edmonton zone (EDIS and E-triage sites) 14 EDMONTON - EDIS/E-triage sites 12 1 8 6 4 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 ILI positive visits (215-16) 214-15 ILI positive visits 213-14 ILI positive visits 212-13 ILI positive visits Figure 7B: Weekly percentage of all ED/UCC visits with ILI during screening at triage, Edmonton zone (EDIS and E- triage sites) 12. EDMONTON - EDIS/E-triage sites 1. 8. 6. 4. 2.. 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 % of total EDIS visits ILI positive (215-16) 214-15 % ILI positive 213-14 % ILI positive 212-13 % ILI positive Source: EDIS and E-triage emergency department visits, data extracted on February 23, 216 via the Alberta Real Time Syndromic Surveillance Net (ARTSSN). For more information on data definitions and sources, see Data Notes. 1
Weekly % of visits with ILI Weekly # of visits with ILI Update for Flu week 7 (Feb 14 2, 216) Figure 8A: Weekly ED/UCC visits with ILI during screening at triage, Calgary zone (SEC sites) 14 Calgary- SEC sites 12 1 8 6 4 2 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 ILI positive visits (215-16) 214-15 ILI positive visits 213-14 ILI positive visits Figure 8B: Weekly percentage of all ED/UCC visits with ILI during screening at triage, Calgary zone (SEC sites) Calgary- SEC sites 14. 12. 1. 8. 6. 4. 2.. 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 % of total EDIS visits ILI positive (215-16) 214-15 % ILI positive 213-14 % ILI positive Source: SEC emergency department visits, data extracted on February 23, 216 via the Alberta Real Time Syndromic Surveillance Net (ARTSSN). For more information on data definitions and sources, see Data Notes. 11
Weekly % of visits with LRTI Weekly % of visits with ILI TARRANT Sentinel Physician Office Visits Update for Flu week 7 (Feb 14 2, 216) Figure 9A: Alberta weekly sentinel physician patient visits (%) with ILI (Influenza Like Illness) 3. ALBERTA 2.5 2. 1.5 1..5. 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 % of total visits ILI positive (215-16) 214-15 % ILI positive 213-14 % ILI positive 212-13 % ILI positive Figure 9B: Alberta weekly sentinel physician patient visits (%) with LRTI (Lower Respiratory Tract Infection) ALBERTA 3. 2.5 2. 1.5 1..5. 35 38 41 44 47 5 53 3 6 9 12 15 18 21 24 27 3 33 % of total visits LRTI positive (215-16) 214-15 % LRTI positive 213-14 % LRTI positive 212-13 % LRTI positive Source: Tarrant Viral Watch program www.tarrantviralwatch.ca, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 12
Update for Flu week 7 (Feb 14 2, 216) Table 3: New AHS (Public Health) delivered influenza immunizations by risk group for week 7 (Feb 14 2, 216 1 ) Priority Group South Calgary Central Edmonton North Alberta Health care workers AHS/Covenant 2 2 1 8 1 23 Health care workers Total 3 11 13 3 13 7 Pregnant women 2 6 7 12 2 29 65 years of age and over 2 4 2 7 6 21 All children 6 months up to and including 23 months 2 Dose #1 55 327 71 183 78 714 Dose #2 5 187 73 181 37 528 Annual 15 85 24 34 22 18 All children 24 months up to and including 59 months 2 Dose #1 17 24 13 41 12 17 Dose #2 14 22 17 16 12 81 Annual 3 68 23 54 14 189 All children 5 years up to and including 8 years of age 2 Dose #1 7 1 8 15 5 45 Dose #2 17 14 9 14 7 61 Annual 31 41 28 45 22 167 All 9 years up to and including 64 years of age 77 178 12 38 171 836 Total number of clients who have received Dose 1 of 2 79 361 92 239 95 866 Total number of clients who have received Dose 2 of 2 81 223 99 211 56 67 Total number of clients who have received an Annual Dose 16 393 199 49 25 1,492 Total Doses Administered 32 977 39 94 41 3,28 1 Source: AHS Zones (doses do not include those delivered by community providers). For more information on data definitions and sources, see Data Notes. 2 Children under 9 years of age who have not received at least one dose in past years require two doses, given at least 4 weeks apart. 13
Update for Flu week 7 (Feb 14 2, 216) Table 4: Cumulative AHS (Public Health) delivered influenza immunizations, by risk group as of Feb 2, 216 1 Priority Group South Calgary Central Edmonton North Alberta Health care workers AHS/Covenant 988 2,818 1,245 2,73 2,744 1,498 Health care workers Total 3,76 6,235 2,69 6,877 6,636 25,433 Pregnant women 263 1,314 334 1,29 358 3,559 65 years of age and over 8,225 23,846 12,35 33,27 12,248 89,381 All children 6 months up to and including 23 months 2 Dose #1 1,688 7,899 1,916 6,613 1,919 2,35 Dose #2 985 3,67 1,111 3,295 848 9,99 Annual 848 7,318 1,1 3,44 1,39 13,61 All children 24 months up to and including 59 months 2 Dose #1 34 1,261 311 1,16 421 3,493 Dose #2 163 48 163 492 152 1,45 Annual 2,38 13,635 2,54 1,185 2,792 31,46 All children 5 years up to and including 8 years of age 2 Dose #1 195 665 16 635 517 2,172 Dose #2 95 379 81 22 97 872 Annual 2,517 17,513 2,784 11,385 4,511 38,71 All 9 years up to and including 64 years of age 1,913 65,84 15,443 63,235 24,633 18,28 Total number of clients who have received Dose 1 of 2 2,223 9,825 2,387 8,48 2,857 25,7 Total number of clients who have received Dose 2 of 2 1,243 4,529 1,355 4,7 1,97 12,231 Total number of clients who have received an Annual Dose 28,15 135,665 36,746 129,43 52,217 382,181 Total Doses Administered 31,616 15,19 4,488 141,818 56,171 42,112 1 Source: AHS Zones (doses do not include those delivered by community providers). For more information on data definitions and sources, see Data Notes. 2 Children under 9 years of age who have not received at least one dose in past years require two doses, given at least 4 weeks apart. 14
Update for Flu week 7 (Feb 14 2, 216). Table 5: Public Health Community provider* (excluding FNIHB**) and Alberta Health Physicians delivered influenza immunizations by risk group*** Priority Group Unassigned South Calgary Central Edmonton North Alberta Zone Health care workers AHS/Covenant 3,934 19,619 5,215 18,762 414 47,944 Health care workers Total 5,386 29,839 7,23 28,29 643 71,388 Pregnant women 529 1,576 1 418 48 2,671 65 years of age and over 3,238 22,194 3,79 15,246 384 44,141 All children 6 months up to and including 23 months Dose #1 4 79 91 Dose #2 1 53 55 19 Annual 6 358 167 531 All children 24 months up to and including 59 months Dose #1 2 3 45 77 Dose #2 14 23 37 Annual 26 769 656 22 1,473 All children 5 years up to and including 8 years of age Dose #1 3 31 4 74 Dose #2 1 17 13 31 Annual 64 1,349 1 96 59 2,433 All 9 years up to and including 64 years of age 5,2 48,912 2,398 26,953 5,9 88,274 Total number of clients who have received Dose 1 of 2 9 14 176 325 Total number of clients who have received Dose 2 of 2 2 84 91 177 Total number of clients who have received an Annual Dose 14,251 14,997 12,88 72,69 6,165 21,911 Physician administered Doses (Physician's claims)*** 42 393 27 168 7 637 Total Doses Administered 14,34 15,614 12,835 73,125 6,172 212,5 *Includes Physicians, AHS non-public health and non-ahs community providers. Data from Public Health zones from Oct 1, 215 to Jan 31, 216. ** FNIHB = First Nation Inuit Health Branch. *** Data from Alberta Health Physician's claims files for Week 5 to 7 (Jan 31 to Feb 2, 216). 174 15
Update for Flu week 7 (Feb 14 2, 216) Table 6: Cumulative influenza immunization delivered by AHS public health (Oct 4, 215 to Feb 2, 216) + Public Health community providers (Oct 1, 215 to Jan 31, 216)* and Alberta Health Physicians ** by risk group Priority Group South Calgary Central Edmonton North Unassigned Zone Alberta Health care workers AHS/Covenant 4,922 22,437 6,46 21,465 3,158 58,442 Health care workers Total 8,462 36,74 9,839 35,167 7,279 96,821 Pregnant women 792 2,89 434 1,78 46 6,23 65 years of age and over 11,463 46,4 15,114 48,273 12,632 133,522 All children 6 months up to and including 23 months Dose #1 1,692 7,978 1,916 6,74 1,919 2,29 Dose #2 986 3,723 1,111 3,35 848 1,18 Annual 854 7,676 1,1 3,571 1,39 14,141 All children 24 months up to and including 59 months Dose #1 342 1,291 311 1,25 421 3,57 Dose #2 163 494 163 515 152 1,487 Annual 2,334 14,44 2,54 1,841 2,814 32,933 All children 5 years up to and including 8 years of age Dose #1 198 696 16 675 517 2,246 Dose #2 96 396 81 233 97 93 Annual 2,581 18,862 2,785 12,345 4,57 41,143 All 9 years up to and including 64 years of age 15,915 114,716 17,841 9,188 29,642 268,32 Total number of clients who have received Dose 1 of 2 2,232 9,965 2,387 8,584 2,857 26,25 Total number of clients who have received Dose 2 of 2 1,245 4,613 1,355 4,98 1,97 12,48 Total number of clients who have received an Annual Dose 42,41 24,662 49,554 22,93 58,382 593,92 Physician administered Doses (Physician's claims)** 42 393 27 168 7 637 Total Doses Administered 45,92 255,633 53,323 214,943 62,343 632,162 *Includes Physicians, AHS non-public health and non-ahs community providers. Data from Public Health zones from Oct 1, 215 to Jan 31, 216. ** Data from Alberta Health Physician's claims files for Week 5 to 7 (Jan 31 to Feb 2, 216). 16
Update for Flu week 7 (Feb 14 2, 216) Table 7: Influenza immunization doses as of February 2, 216 administered by zone and provider type Unassigned Provider Type South Calgary Central Edmonton North Alberta Zone Public Health 31,616 15,19 4,488 141,818 56,171 42,112 Pharmacist 1 38,79 196,826 49,413 155,47 31,527 471,963 Physician 2 6,524 54,37 2,858 3,286 291 94,266 Physician 3 42 393 27 168 7 637 AHS non-public Health 2 4,656 28,238 6,912 21,41 949 62,156 Other non-ahs 2 3,82 22,676 3,38 21,27 4,925 54,991 Total Doses Administered 84,71 452,459 12,736 37,35 93,87 1,14,125 ¹ Data provided by Alberta Health, for doses administered up to Feb 2, 216. ² Monthly data from Public Health zones for the months of Oct, 215 to Jan 216. 3 Data from Alberta Health Physician's claims files for Week 5 to 7 (Jan 31 to Feb 2, 216). 17
Percent Positive Percent Positive Percent Positive Percent Positive Percent Positive Appendix Zones figure 1: Weekly respiratory specimen percent positivity, by virus type and zone 7% 6% 5% 4% 3% 2% 1% % 7% 6% 5% 4% 3% 2% 1% % SOUTH 35 39 43 47 51 3 7 11 15 19 23 27 31 CENTRAL 35 39 43 47 51 3 7 11 15 19 23 27 31 Update for Flu week 7 (Feb 14 2, 216) 7% 6% 5% 4% 3% 2% 1% % 7% 6% 5% 4% 3% 2% 1% % CALGARY 35 39 43 47 51 3 7 11 15 19 23 27 31 EDMONTON 35 39 43 47 51 3 7 11 15 19 23 27 31 NORTH 7% Adenovirus Coronavirus 6% Hmpv 5% Parainfluenza 4% RSV 3% Rhino-enterovirus 2% Mixed 1% FluA % FluB 35 39 43 47 51 3 7 11 15 19 23 27 31 Click here to return to Alberta figure - respiratory virus specimen percent positivity Source: DIAL Provincial Laboratory specimens, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. Percent positive is the number of positive specimens for that virus as a percent of the total number of specimens tested for respiratory viruses. 18
Weekly rate (per 1,) Weekly rate (per 1,) Weekly rate (per 1,) Weekly rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 2: Weekly rates (per 1,) of lab confirmed influenza, by subtype and Zone 4 35 3 25 2 15 1 5 SOUTH 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Flu week Weekly rate (per 1,) 4 35 3 25 2 15 1 5 CALGARY 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Flu week 4 35 3 25 2 15 1 5 CENTRAL 4 EDMONTON 35 3 25 2 15 1 5 35 39 43 47 51 2 6 1 14 18 22 26 3 34 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Flu week Flu week NORTH 4 35 Influenza A rate (215-16) 3 Influenza A rate (214-15) 25 Influenza A rate (213-14) 2 15 Influenza B rate (215-16) 1 Influenza B rate (214-15) 5 Influenza B rate (213-14) 35 39 43 47 51 2 6 1 14 18 22 26 3 34 Flu week Click here to return to Alberta figure rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 19
Weekly Rate (per 1,) Weekly Rate (per 1,) Weekly Rate (per 1,) Weekly Rate (per 1,) Weekly Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 3: Weekly rates (per 1,) of lab confirmed respiratory viruses (excluding influenza), by virus type and Zone SOUTH CALGARY 14 14 12 1 8 6 4 2 35 39 43 47 51 3 7 11 15 19 23 27 31 CENTRAL 14 12 1 8 6 4 2 35 39 43 47 51 3 7 11 15 19 23 27 31 NORTH 14 12 1 8 6 4 2 35 39 43 47 51 3 7 11 15 19 23 27 31 12 1 8 6 4 2 35 39 43 47 51 3 7 11 15 19 23 27 31 EDMONTON 14 12 1 8 6 4 2 35 39 43 47 51 3 7 11 15 19 23 27 31 Adenovirus rate Coronavirus rate hmpv rate Parainfluenza rate RSV rate Rhino-enterovirus rate Mixed rate Click here to return to Alberta figure - rates of lab confirmed respiratory viruses Source: DIAL Provincial Laboratory specimens, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 2
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 4: Weekly age-specific rates of lab confirmed influenza (per 1,) by subtype, South zone 8 7 6 5 4 3 2 1 SOUTH Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 SOUTH Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 SOUTH Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years to < 2 years Click here to return to Alberta figure - age specific rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 21
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 4 continued: Weekly age-specific rates of lab confirmed influenza (per 1,) by subtype, Calgary zone 8 7 6 5 4 3 2 1 CALGARY Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 CALGARY Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 CALGARY Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years Click here to return to Alberta figure - age specific rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 22
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 4: Weekly age-specific rates of lab confirmed influenza (per 1,) by subtype, Central zone 8 7 6 5 4 3 2 1 CENTRAL Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 CENTRAL Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 CENTRAL Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years Click here to return to Alberta figure - age specific rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 23
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 4: Weekly age-specific rates of lab confirmed influenza (per 1,) by subtype and Zone 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 8 7 6 5 4 3 2 1 EDMONTON Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 EDMONTON Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 EDMONTON Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years to < 2 years to < 2 years Click here to return to Alberta figure - age specific rates of lab confirmed influenza Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 24
Age Specific Rate (per 1,) Age Specific Rate (per 1,) Age Specific Rate (per 1,) Update for Flu week 7 (Feb 14 2, 216) Zones figure 4: Weekly age-specific rates of lab confirmed influenza (per 1,) by subtype and Zone 8 7 6 5 4 3 2 1 NORTH Influenza A(H1N1)PDM9 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 11 1 9 8 7 6 5 4 3 2 1 NORTH Influenza A(H3) 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 to < 2 years 8 7 6 5 4 3 2 1 NORTH Influenza B 35 38 41 44 47 5 1 4 7 1 13 16 19 22 25 28 31 34 Click here to return to Alberta figure - age specific rates of lab confirmed influenza to < 2 years Source: CDRS influenza cases, data extracted on February 23, 216. For more information on data definitions and sources, see Data Notes. 25
Data Notes Update for Flu week 7 (Feb 14 2, 216) LABORATORY DATA Laboratory confirmed (non-influenza) respiratory virus activity is based on the Alberta Provincial Public Health Laboratory s DIAL system (Data Integration for Alberta Laboratories) a specimen based system. Data are based on specimens obtained from residents of Alberta according to the date the sample was received at the Provincial laboratory. Respiratory samples submitted for testing at the Alberta Provincial Laboratory are first tested for influenza A & B. Those with a negative influenza result ar e then tested using the respiratory virus panel (RVP) which tests for the presence of non-influenza respiratory viruses. Samples from physicians participating in the Tarrant program and patients admitted to intensive or critical care units are tested for both noninfluenza and influenza viruses. Definition for mixed a single sample where multiple (non-influenza) viral organisms were isolated. Laboratory confirmed influenza activity is based on influenza cases entered into CDRS. Data are based on Alberta residents according to the lab report date. Where this date is missing, the date from the NDR or SRI (onset date or case inves tigation opened date) form is used if available. ILI OUTBREAK INVESTIGATIONS Upon notification of an outbreak, the Alberta Health (AH)/Alberta Health Services (AHS) Outbreak Reporting Form (AORF) is completed by a communicable disease nurse, sent to AH and entered into the CDRS database. Outbreaks reported by First Nations and Inuit Health Branch (FNIHB) to AH are not included in this report. The AORF form includes information about the type and location of the outbreak, the facility, and the causative organism. Note that zone specific outbreaks are those reported by that zone, however specific cases may reside or have been exposed and/or infected outside of that zone. Not all outbreaks result in an organism being confirmed and for those that are confirmed, there may be a delay between reporting and identification of the organism; outbreaks are classified by the organism listed as the ILI Organism Confirmed on the AORF. This report does not inc lude outbreaks suspected or confirmed to be caused by bacteria (i.e. pertussis, invasive pneumococcal disease) or viruses causing rashlike illness such as measles, rubella (German measles) or chickenpox. In this report, outbreaks are reported according to the onset date of the first case; where onset date is not available, the date the investigation is opened is used. The AHS Surveillance and Reporting team obtains the data via CDRS which is housed and maintained by AH. CALLS TO HEALTH LINK ALBERTA Health Link Alberta is a 24 hour a day, 7 day a week nurse-operated service that provides the public with advice and information about health symptoms and concerns. The original data source for calls to Health Link Alberta for cough is the Health Link da tabase called Sharp Focus (obtained via the Alberta Real Time Syndromic Surveillance Net - ARTSSN). Note that one individual may place multiple calls. The Health Link protocols selected for inclusion in this report are as follows: cough/hoarseness/stridor (PED), cough/hoarseness (ADULT), influenza-like illness (a temporary protocol used when surges of influenza occur above normal) and zzzinfluenza -like illness (for historical data only). Of note, the jump in the South zone call rate in week 43 of the historical data (213-14) was likely related to a measles outbreak that began around the same time. EMERGENCY DEPARTMENT VISITS Information on Edmonton zone emergency department/urgent care centre visits with ILI screenings at triage are provided by the ARTSSN data repository for facilities using; Emergency Department Information System (EDIS), Electronic triage (E-triage) and Sunrise Emergency (SEC) systems. When patients present at emergency departments, they are screened for ILI by the triage nurse. This screening tool is not mandatory for EDIS or E-triage. Compliance for EDIS and SEC sites tends to be consistently high. The e-triage reporting historically has had low compliance but has been improving and represents a relatively small portion of the total emergency department visits for Edmonton facilities. 26
Update for Flu week 7 (Feb 14 2, 216) New facilities are constantly being opened or added to the system as such the facilities included do not all have the same start date for their historical data. For this reason two historical years are included for the EDIS/E-triage figures whereas only one historical year is included for the SEC data. Of note, within the EDIS/E-triage data three facilities do not have the complete 2 year historical and only contribute partially to the historical data. These facilities are Fort Saskatchewan Health Centre, Strathcona Hospital and East Edmonton Health Centre, their data start dates are January 213, May 214 and November 212 respectively. SENTINEL PHYSICIAN OFFICE VISITS (TARRANT) Tarrant Viral Watch is an Alberta Health funded program intended to monitor ILI (Influenza -like Illness) and LRTI (Lower Respiratory Tract Infections) in the community. Volunteer sentinel physician offices provide data to the Tarrant program, which in turn provide them to AHS on a weekly basis. ILI is defined as a respiratory illness with acute onset, fever, and cough, and with 1 or more of sore throat, arthralgia, myalgia or prostration-which may be due to influenza virus (presentation may vary in pediatric and elderly populations). LRTI is defined as any acute infection with significant involvement of the respiratory tr act below the larynx, as identified by history, physical signs and/or radiological findings. If a patient has ILI with lower trac t involvement, they are coded as LRTI. Note that the definition of ILI may vary from other definitions. INFLUENZA IMMUNIZATIONS Influenza immunization data are reported by AHS zones. Numbers are available to the AHS Public Health Surveillance team at the beginning of the week for the doses administered the previous week (Sunday to Saturday). It includes those doses administered by AHS (Public Health) only. Clients can only exist in one priority group. Immunization coverage rates will be reported at th e end of the influenza season. POPULATION NUMBERS Population data values used to calculate rates were estimated by AHS Patient Based Funding reflecting the March 31 populations for each year represented. Historical population values prior to 212 are interpolations of actual population values (that is, annual values prior to March 31, 213) from the Alberta Health Insurance Plan (AHCIP) Registration File. Forecast values (that is, for points in time after March 31, 213) are estimated using the March 31, 213 AHCIP Registration. The annual historical population files provided by Alberta Health (AH) include individuals registered under the Alberta Health Insurance Plan for only pa rt of that fiscal year, but not as of March 31. AH marks these records (i.e., about 97,, or 2.8% in 26/7, representing residents that have died, moved, opted out, and so forth) as "inactive" and we exclude them. Individuals in the Alberta Health Insurance Pla n aged 121 years or older have their date of birth (DOB) checked against additional sources and are "corrected", if possible; otherwise they are removed from the database. Finally, an extremely small volume of individuals with a missing or obviously invalid postal c ode, date of birth, or gender (e.g., about 6, or.2% in 26/7) have been excluded. Slight differences between values provided at this level of aggregation and data provided at other levels of aggregation may occur because of round-off error. 213 populations are still considered projecti ons. 215-16 NORTHERN HEMISPHERE INFLUENZA SEASON VACCINE COMPOSITION RECOMMENDATION S It is recommended that trivalent vaccines for use in the 215-216 influenza season (northern hemisphere winter) contain the following: an A/California/7/29 (H1N1)pdm9-like virus; an A/Switzerland/9715293/213 (H3N2)-like virus; a B/Phuket/373/213-like virus It is recommended that quadrivalent vaccines containing two influenza B viruses contain the above three viruses and a B/Brisbane/6/28-like virus. 27
Update for Flu week 7 (Feb 14 2, 216) FLU WEEKS Flu weeks are the same as those defined by the Public Health Agency of Canada s (PHAC) FluWatch : Week Start End 35 August 3, 215 September 5, 215 36 September 6, 215 September 12, 215 37 September 13, 215 September 19, 215 38 September 2, 215 September 26, 215 39 September 27, 215 October 3, 215 4 October 4, 215 October 1, 215 41 October 11, 215 October 17, 215 42 October 18, 215 October 24, 215 43 October 25, 215 October 31, 215 44 November 1, 215 November 7, 215 45 November 8, 215 November 14, 215 46 November 15, 215 November 21, 215 47 November 22, 215 November 28, 215 48 November 29, 215 December 5, 215 49 December 6, 215 December 12, 215 5 December 13, 215 December 19, 215 51 December 2, 215 December 26, 215 52 December 27, 215 January 2, 216 1 January 3, 216 January 9, 216 2 January 1, 216 January 16, 216 3 January 17, 216 January 23, 216 4 January 24, 216 January 3, 216 5 January 31, 216 February 6, 216 6 February 7, 216 February 13, 216 7 February 14, 216 February 2, 216 8 February 21, 216 February 27, 216 9 February 28, 216 March 5, 216 Week Start End 1 March 6, 216 March 12, 216 11 March 13, 216 March 19, 216 12 March 2, 216 March 26, 216 13 March 27, 216 April 2, 216 14 April 3, 216 April 9, 216 15 April 1, 216 April 16, 216 16 April 17, 216 April 23, 216 17 April 24, 216 April 3, 216 18 May 1, 216 May 7, 216 19 May 8, 216 May 14, 216 2 May 15, 216 May 21, 216 21 May 22, 216 May 28, 216 22 May 29, 216 June 4, 216 23 June 5, 216 June 11, 216 24 June 12, 216 June 18, 216 25 June 19, 216 June 25, 216 26 June 26, 216 July 2, 216 27 July 3, 216 July 9, 216 28 July 1, 216 July 16, 216 29 July 17, 216 July 23, 216 3 July 24, 216 July 3, 216 31 July 31, 216 August 6, 216 32 August 7, 216 August 13, 216 33 August 14, 216 August 2, 216 34 August 21, 216 August 27, 216 28