influenza surveillance at irid immunization and respiratory infections division centre for...
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Influenza Surveillanceat IRID
Immunization and Respiratory Infections DivisionCentre for Infectious Disease Prevention & Control
Public Health Agency of Canada
Impact of InfluenzaIn Canada: • 10-25% of population affected yearly (higher
infection rates in children and elderly)• 70-75,000 hospitalizations• 6-7,000 deaths due to pneumonia and influenza• 500-1,500 deaths due to influenza
0
2000
4000
6000
8000
10000
12000
14000
1992
01
1993
01
1994
01
1995
01
1996
01
1997
01
1998
01
1999
01Year & Month
P&I Morbidity
Canada’s National Influenza Surveillance Program
Primary Objectives : 1) Early detection and monitoring of influenza outbreaks
2) Provide timely and up-to-date reporting of influenza activity in Canada and abroad to professionals & public
3) Monitor circulating strains of influenza virus, including new sub-types
4) Contribute to the information for vaccine composition for following season
Influenza Surveillance
ILI ConsultationsSentinel Physicians
Laboratories Number of Influenza tests and positives
National Microbiology Laboratory
Strain Characterization
Provincial/Territorial Epidemiologists
Influenza activity levels (outbreaks etc)
Data Provider Indicator
Uses of Surveillance Data
• estimating disease impact – influenza-like illness clinic visits– influenza and pneumonia
hospitalizations and deaths– all cause mortality– other health and economic impacts
• monitoring viral evolution – identification of predominant strains– detection of new strains/subtypes
Influenza prevention and control policies
Vaccine composition program development and timing
Number of Influenza regions reporting widespread or localized activity
0
5
10
15
20
25
30
8-30
9-13
9-27
10-1
1
10-2
5
11-8
11-2
2
12-6
12-2
0
1-3
1-17
1-31
2-14
2-28
3-13
3-27
4-10
4-24 5-
8
5-22 6-
5
6-19 7-
3
7-17
7-31
8-14
2003 Report week ending 2004
Number of regions
Localized activity Widespread activity
0
100
200
300
400
500
600
700
800
900
1000
35 41 47 53 6 12 18 43 49 3 9 15 21 37 43 49 3 9 15 21 27 35 41 47 1 7 13 19 25 39 45 51 5 11 17 23 29 35 36 42 48 2 8 14 20 26 32 39 45 51 5 11 17 23 29 35
Nu
mb
er
of
Ca
se
s /
No
mb
re d
e c
as
Influenza A
Influenza B
Week Influenza Season 1997/98 1998/99 1999-2000 2000/01 2001/02 2002/03 2003/04
Predominant strain(s)/ viruses similar to/ viruses similar to/ viruses similar to/ viruses similar to/ viruses similar to/ viruses similar to/ viruses similar to/
Souche(s) Analogues à : Analogues à : Analogues à : Analogues à : Analogues à : Analogues à : Analogues à :prédominante(s) A/Sydney/5/97(H3N2) A/Sydney/5/97(H3N2) A/Sydney/5/97(H3N2) A/NewCaledonia/20/99- A/Panama/2007/99 (H3N2) A/(H1N2) A/Fujian/411/02 (H3N2) B/Beijing/184/93 B/Beijing/184/93 (H1N1) A/H1N2 B/Hong Kong/330/01
Seasonal Distributuion of Laboratory Confirmed Influenza Infections by influenza type, Canada 1997-2004
Influenza Tests, % positive, & ILI rates, Canada, by report week, 2003-2004
0
500
1000
1500
2000
2500
3000
3500
4000
4500
8-30
9-13
9-27
10-1
1
10-2
5
11-8
11-2
2
12-6
12-2
0
1-3
1-17
1-31
2-14
2-28
3-13
3-27
4-10
4-24 5-
8
5-22 6-
5
6-19 7-
3
7-17
7-31
8-14
2003 Report week ending 2004
Number of tests
0
10
20
30
40
50
60
70
80
% Positive
Number of tests % Positive ILI Rate
Proportion of lab-confirmed influenza by age-group, Canada, 2003-2004
Age unknown1%
<5 years33%
5-9 years5%
10-14 years5%
15-24 years11%
25-44 years11%
45-64 years9%
65 years25%
Influenza Strain Identification
B/ Sichuan/ 379/ 99-like [33]
H1N2[1]
A/ Panama/ 2007/ 99 (H3N2)-like
[25]
A/ Fujian/ 411/ 02-like (H3N2) [776]
A/ New Caledonia/ 20/ 99-
like (H1N1) [3]
B/ Hong Kong/ 330/ 01-like
[7]
Influenza Activity Level by Provincial and Territorial Influenza Surveillance Regions, Canada,
Week 03 2004
New Initiatives….• Impact of influenza in children -
hospitalizations • Sentinel hospital-based surveillance• Trained nurse monitor at each centre
identifies eligible cases and completes detailed case report forms Admissions by Age-group
2004-05
29%
30%
19%
14%
8%
0-5 months
6-23 months
2-4 years
5-9 years
10-16 years
New Initiatives..
Canadian Network for Public Health Intelligence (CNPHI)
• CNPHI is a secure internet-based suite of applications and resources.
• It is primarily directed towards strategic public health information and intelligence sharing.
• Included applications: – Atlantic Canada FluWatch Application – Canadian Integrated Outbreak Surveillance Centre
(CIOSC).
Canadian Integrated Outbreak Surveillance Centre (CIOSC)
• Goal: To enhance public health’s capacity to anticipate and detect health risks associated with communicable disease threats.
SRI Alerts: An SRI alert is an operational definition used to ensure that individuals meeting specific criteria are identified in a systematic way to allow for implementation of appropriate infection control and public health measures until SARS or other emerging respiratory pathogen has been ruled out as a cause of the illness
Severe Respiratory Illness (SRI) Surveillance
SRI Alerts
An SRI alert is sent under the following situations:
• An individual is hospitalized with an SRI and has a potential epidemiologic link to a source of emerging respiratory pathogen
• Clusters of SRI are identified within a health care unit
• An individual has been identified with laboratory evidence of a SARS-CoV infection (or other emerging respiratory infection)
• An individual has been identified with a laboratory confirmed influenza A/ H5N1 or other novel influenza virus infection
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