Local Influenza Surveillance Bulletin

Released December 10, 2012

Influenza Activity: August 26, 2012 to December 1, 2012 (Weeks 35-48)
Figure 1: Number of laboratory confirmed cases of influenza by week and type, Waterloo Region, August 26, 2012 – December 1, 2012
55

No. of Cases by Type
50
45

Influenza A Influenza B

Influenza A – Total pH1N1 H3 H3N2 Other (non-pH1N1) Not sub-typed Influenza B Total
1

103 2
38

40

Number of cases

35
30

2
0

61
0

25 20 15 10
5

103

Weekly Influenza Activity 2 Level No activity Sporadic
35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21

0

Localized Widespread

Week

Figure 2: Number of laboratory confirmed cases of influenza by week, Waterloo Region, 2007-08 to 2012-133
75

Previous 5 seasons average (excluding 2009-2010)
60

2012-13

Number of Cases

45

30

15

0
35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

September

October

November

December

January

February

March

April

May

June

July

August

Week of the Year

Source: iPHIS, Ministry of Health & Long-Term Care, extracted December 10, 2012
1 2

Not sub-typed includes all Influenza A cases that had a sub-type of “blank”, “untypeable” or “not-subtyped”. For definitions of influenza activity levels: http://www.phac-aspc.gc.ca/fluwatch/12-13/def12-13-eng.php 3 The weeks refer to FluWatch weeks, which are established by the Public Health Agency of Canada.

Table 1: Influenza indicators, Waterloo Region and Ontario, August 26, 2012 – December 1, 2012* Indicator Waterloo Region Ontario
Laboratory confirmed influenza cases Population-based rate per 100,000 Number of influenza hospitalizations Population-based hospitalization rate per 100,000 Number of deaths Population-based mortality rate per 100,000

103 18.8 11 2.01 3 0.55

404 3.0 54 0.39 4 0.03

Note: Unless explicitly stated, Region of Waterloo Public Health data is reported according to the week corresponding to the case’s episode date while provincial data is reported according to the week corresponding to the date the case was reported to the respective health unit. Often these dates are the same, but they can differ depending on a number of factors including, but not limited to, the timing of a specimen submission, the current volume of submissions, and the time when the health unit receives the lab result. This may result in a slight discrepancy in the total weekly case counts. * Waterloo Region and Ontario data is current as of December 1, 2012. Sources: iPHIS, Ministry of Health & Long-Term Care, extracted December 10, 2012; Ontario Respiratory Virus Bulletin: Week 48.

Proxy Indicators for Influenza Surveillance
Influenza-Like-Illness
4

The number of Influenza-Like Illness (ILI) visits is a useful indicator of the level of community transmission of influenza and the resulting burden on primary care practices. As such, we are tracking the ILI consultation 5 rate at post-secondary institutions’ health services in Waterloo Region as well as in select primary care practices. ILI information may change on a weekly basis as data is collected from additional primary care practices. As a result, rates reported in the current bulletin may not be the same as those reported in previous bulletins.
7

Figure 3: Influenza-Like-Illness (ILI) consultations per 1,000 patient visits, Waterloo Region, August 26, 2012 – December 1, 2012
8.0

ILI Consultations per 1,000 Patient Visits

6.0

4.0

2.0

0.0 35* 37* 39 41 43 45 47 49 51 1 3 Week
* Insufficient or data quality issues for Waterloo Region for weeks 35, 36, 37, and 38. Source: Post-secondary institution health services’ departments and select local primary care practice, extracted December 10, 2012.

5

7

9

11

13

15

17

19 21*

4

Case definition for ILI is: acute onset of respiratory illness with fever and cough and with one or more of the following - sore throat, arthralgia, myalgia, or prostration which is likely due to influenza. In children under 5, gastrointestinal symptoms may also be present. In patients under 5 or 65 and older, fever may not be prominent. 5 Post-secondary institutions include Conestoga College, Wilfred Laurier University, and University of Waterloo

Figure 4: Influenza-Like-Illness (ILI) consultations per 1,000 patient visits, Ontario, August 26, 2012 – December 1, 2012
45.0
ILI Consultations per 1,000 Patient Visits

40.0 35.0 30.0

25.0 20.0 15.0
10.0 5.0 0.0 35 37 39 41 43 45 47 49 51 1 3 Week 5 7 9 11 13 15 17 19 21

Notes: Provincially, ILI cases are counted through the Public Health Agency of Canada’s sentinel physician FluWatch program. Due to continued data cleaning efforts, the values may change slightly from week-to-week. Source: Public Health Agency of Canada FluWatch sentinel physician sites, extracted December 10, 2012.

Hospital Based Data
Monitoring the number of Emergency Room (ER) visits may provide an indication of the level of community transmission of influenza and the resulting burden on hospitals. The figures below include aggregated data from all three acute care hospitals within the Region of Waterloo: Cambridge Memorial Hospital, Grand River Hospital, and St. Mary’s General Hospital.

Figure 5: Emergency Room Visits per 100,000 population, by week, Waterloo Region, 200820126
8

300
2012-2013 Average 2008-09 to 2011-12

250
Rate of ER visits per 100,000 population

200

150

100

50

0
35* 36* 37* 38* 39 40 41 42 43 44 45 46 47 48 49 50 51 52 1 2 3 4 5 6 7 8 9 10 11 12 13* 14 15 16 17 18 19 20 21 22

September

October

November

December

January

February

March

April

May

June

Week & Month of the Year

* Indicates missing data for one or more hospitals for the reporting week. Source: Cambridge Memorial Hospital, Grand River Hospital, and St. Mary’s General Hospital

6

The weeks refer to FluWatch weeks, which are established by the Public Health Agency of Canada.

School Absenteeism
Monitoring school absenteeism rates is a useful indicator of the level of community transmission of influenza. An absenteeism rate of 10% or greater has been identified as a threshold by the Ministry of Health and Long Term Care (MOHLTC) to signify higher than expected levels of school absenteeism. The figure below shows the per cent absent of all schools and the average per cent absent of the previous three years of all schools in Waterloo Region, by week.

Figure 6: School absenteeism, Waterloo Region, September 4, 2012 – December 1, 2012
2012-13 5.0 4.5 4.0 3.5 Previous 3 year average

Per cent absent

3.0

2.5 2.0 1.5
1.0

0.5 36* 37 38* 39* 40 41* 42* 43 44 45* 46 47* 48 49 50 51 2 3* 4* 5* 6 7 8* 9* 10 12* 13* 14* 15 16* 17 18 19 20 21* 22* 23 24* 25* 26* Surveillance Week

*Indicates incomplete/partial data due to school closure (e.g. PA day, secondary school exams, statutory holiday, school break, or snow day). Source: Waterloo Region District School Board and Waterloo Catholic District School Board

For provincial and national influenza information, please visit the following websites:

Ontario Respiratory Virus Bulletins: http://www.oahpp.ca/resources/ontario-respiratory-virus-bulletin.html Public Health Agency of Canada FluWatch Reports: http://www.phac-aspc.gc.ca/fluwatch/12-13/index-eng.php