BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN 2010-11: Number 17, Week 10 March 6 to March 12, 2011
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BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN 2010-11: Number 17, Week 10 March 6 to March 12, 2011 Prepared by BCCDC Influenza & Emerging Respiratory Pathogens Team Continued Elevated Influenza Activity in BC Contents: British Columbia: Sentinel Physicians Page 2 International: Page 7 Children’s Hospital ER Page 2 Medical Services Plan Page 3 Other: Laboratory Surveillance Page 5 List of Acronyms Page 8 ILI Outbreaks Page 6 Web Sites Page 8 Outbreak Report Form Page 9 Canada: FluWatch Activity levels Page 6 NML Strain Characterization Page 6 NML Antiviral Resistance Page 7 Summary During week 10 (March 6 – March 12, 2011), influenza surveillance indicators in BC remained elevated. The sentinel physician ILI rate decreased slightly over the past week, but MSP influenza visits were generally higher over the previous week or remained elevated overall and across all regions (though level of increase differed by region). One pandemic influenza A/H1N1 outbreak was reported in an adult residential facility. Pandemic influenza A/H1N1, A/H3N2, and B were detected sporadically throughout the province, though detections varied by region being higher in Fraser and Vancouver Island Health Authorities. At the BC Public Health Microbiology & Reference Laboratory, 237 respiratory specimens were tested. Influenza was detected in 75 (32%) specimens: pandemic influenza A/H1N1 in 17 (7%), A/H3N2 in 26 (11%), unsubtyped influenza A in 7 (3%), and influenza B in 25 (10%) specimens. Of 237 specimens tested, other respiratory viruses found included: 34 (14%) RSV, 19 (8%) coronavirus, and 15 (6%) rhino/enterovirus. With overall increase in influenza activity in recent weeks, clinicians are reminded that updated 2010-11 influenza antiviral guidance is available on the Association of Medical Microbiology and Infectious Disease, Canada (AMMI Canada) website at the following link: www.ammi.ca/index.php. During the 2010-11 season, the BC Ministry of Health Services has expanded Pharmacare coverage of antiviral treatment for individuals with influenza illness who are at high risk for complications. Report disseminated March 17, 2011 Contributors: Helen Li, Lisan Kwindt, Samson Chan, Naveed Janjua, Danuta Skowronski - 1 - BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN 2010-11: Number 17, Week 10 March 6 to March 12, 2011 British Columbia Sentinel Physicians During week 10, ~ 0.6% of patients presenting to sentinel physicians had ILI, which is lower than the previous week, and still within the expected range for this time of year. Fifty nine percent (27/46) of sentinel physician sites have reported to-date for week 10. Percentage of Patient Visits due to Influenza Like Illness (ILI) per Week Compared to Average Percentage of ILI Visits for the Past 19 Seasons 2.0 Sentinel Physicians, British Columbia, 2010-2011 2.0 2010-11* 1989-90 to 2007-08 seasons (average with 95% confidence interval)† 1.5 1.5 Start of 2010-11 monitoring period 1.0 1.0 %of patient visitsdue toILI 0.5 0.5 0.0 0.0 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 *Data subject to change as reporting becomes increasingly complete Week Number of the Year †Historical values exclude 2008-09 season due to atypical seasonality. BC Children’s Hospital Emergency Room The percentage of BC Children’s Hospital ER visits attributed to “fever and cough” or flu-like illness during week 10 was 11.3%, higher than that reported last week (8.7%). Percentage of Patients Presenting to BC Children's Hospital ER with Presenting Complaint of "Flu," "Influenza," or "Fever/Cough", by Week 40% 2007-2008 2008-2009 30% 2009-2010 2010-2011 20% attributed to ILI to attributed 10% Percentage of total visits visits of total Percentage 0% 3537394143454749511357911131517192123252729313335 Week # Source: BCCH A dmitting, dis charge, transf er database, ADT Data provided by Decision Support Services at Children’s & Women’s Health Centre of BC - 2 - Notes: Data providedby PopulationHeal * Influenza illness istrackedas thepercentage ofallsubmitted MSPgeneral practitioner claims withICD-9 code487 (influenz bulletins). earlier (consult below inthegraphs shown isnot 2009 November oflateOctober/early claims Tobe Authorities. Health Island Vancouver Interior and within each and elevated provincially 10remained inweek claims ServicesPlan(MSP) BCMedical ofallsubmitted aproportion as Influenza illness Medical ServicesPlan 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% MSP weekbeginning 13 Mar 2010 corresponds to sentinel ILI week11 Data current toMar14,2011 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 1 Aug, 2010 1 Aug, 2010 15 Aug, 2010 B 15 Aug, 2010 29 Aug, 2010 RITISH 29 Aug, 2010 12 Sep, 2010 12 Sep, 2010 th SurveillanceandEpidemiology, Ministry ofHealthServices 26 Sep, 2010 26 Sep, 2010 C 10 Oct, 2010 OLUMBIA 10 Oct, 2010 Claims*BritishColumbia Influenza Illness 24 Oct, 2010 24 Oct, 2010 7 Nov, 2010 in maximum abovethe10-year levelwas Influenzaillness Authority. Health 7 Nov, 2010 2010-11: Number17,Week10 21 Nov, 2010 March 6to12,2011 21 Nov, 2010 5 Dec, 2010 I 5 Dec, 2010 NFLUENZA 19 Dec, 2010 19 Dec, 2010 Northern 2 Jan, 2011 2 Jan, 2011 tter reveal current low-level trends, the ~9% peak in MSP in the~9%peak trends, current low-level tter reveal - 3 16 Jan, 2011 16 Jan, 2011 30 Jan, 2011 30 Jan, 2011 13 Feb, 2011 S 13 Feb, 2011 URVEILLANCE 27 Feb, 2011 27 Feb, 2011 13 Mar, 2011 13 Mar, 2011 27 Mar, 2011 27 Mar, 2011 10 Apr, 2011 10 Apr, 2011 24 Apr, 2011 24 Apr, 2011 8 May, 2011 B 8 May, 2011 22 May, 2011 ULLETIN 22 May, 2011 5 Jun, 2011 5 Jun, 2011 19 Jun, 2011 19 Jun, 2011 3 Jul, 2011 3 Jul, 2011 17 Jul, 2011 17 Jul, 2011 31 Jul, 2011 31 Jul, 2011 a). 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 1 Aug, 2010 1 Aug, 2010 15 Aug, 2010 15 Aug, 2010 29 Aug, 2010 29 Aug, 2010 12 Sep, 2010 12 Sep, 2010 26 Sep, 2010 26 Sep, 2010 10 Oct, 2010 10 Oct, 2010 24 Oct, 2010 24 Oct, 2010 7 Nov, 2010 7 Nov, 2010 21 Nov, 2010 21 Nov, 2010 5 Dec, 2010 5 Dec, 2010 19 Dec, 2010 19 Dec, 2010 Interior Interior Fraser 2 Jan, 2011 2 Jan, 2011 B 16 Jan, 2011 16 Jan, 2011 RITISH 30 Jan, 2011 30 Jan, 2011 13 Feb, 2011 13 Feb, 2011 27 Feb, 2011 27 Feb, 2011 13 Mar, 2011 13 Mar, 2011 27 Mar, 2011 27 Mar, 2011 C 10 Apr, 2011 10 Apr, 2011 OLUMBIA 24 Apr, 2011 24 Apr, 2011 8 May, 2011 8 May, 2011 22 May, 2011 22 May, 2011 2010-11: Number17,Week10 March 6to12,2011 5 Jun, 2011 5 Jun, 2011 19 Jun, 2011 19 Jun, 2011 I 3 Jul, 2011 3 Jul, 2011 NFLUENZA 17 Jul, 2011 17 Jul, 2011 31 Jul, 2011 31 Jul, 2011 - 4 S 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% 0.0% 0.5% 1.0% 1.5% 2.0% 2.5% 3.0% URVEILLANCE 1 Aug, 2010 1 Aug, 2010 15 Aug, 2010 15 Aug, 2010 29 Aug, 2010 29 Aug, 2010 12 Sep, 2010 12 Sep, 2010 26 Sep, 2010 26 Sep, 2010 10 Oct, 2010 10 Oct, 2010 24 Oct, 2010 24 Oct, 2010 7 Nov, 2010 7 Nov, 2010 B Vancouver Island ULLETIN 21 Nov, 2010 21 Nov, 2010 Vancouver Coastal 5 Dec, 2010 5 Dec, 2010 19 Dec, 2010 19 Dec, 2010 2 Jan, 2011 2 Jan, 2011 16 Jan, 2011 16 Jan, 2011 30 Jan, 2011 30 Jan, 2011 13 Feb, 2011 13 Feb, 2011 27 Feb, 2011 27 Feb, 2011 13 Mar, 2011 13 Mar, 2011 27 Mar, 2011 27 Mar, 2011 10 Apr, 2011 10 Apr, 2011 24 Apr, 2011 24 Apr, 2011 8 May, 2011 8 May, 2011 22 May, 2011 22 May, 2011 5 Jun, 2011 5 Jun, 2011 19 Jun, 2011 19 Jun, 2011 3 Jul, 2011 3 Jul, 2011 17 Jul, 2011 17 Jul, 2011 31 Jul, 2011 31 Jul, 2011 BRITISH COLUMBIA INFLUENZA SURVEILLANCE BULLETIN 2010-11: Number 17, Week 10 March 6 to March 12, 2011 Laboratory Reports Two hundred and thirty seven respiratory specimens were tested at the BC Public Health Microbiology & Reference Laboratory in week 10. Influenza was detected in 75 (31.6%) submitted specimens: seventeen (7.2% of submitted specimens) were pandemic A/H1N1, 26 (11.0%) were A/H3N2, 25 (10.5%) were type B, and 7 (3.0%) were unsubtyped. Five pandemic H1N1s were detected in specimens submitted as part of a facility outbreak investigation submitted from Fraser HA. In addition there were sporadic detections of influenza B from all HAs but predominantly from Fraser HA, A/H3N2 from all HAs except Northern, and pandemic A/H1N1 from all HAs except Interior. During this week, of 237 specimens tested for other respiratory viruses, 34 (14.3%) were positive for RSV, 19 (8.0%) for coronavirus, and 15 (6.3%) for rhino/enterovirus. Other respiratory viruses were also sporadically detected. Influenza and Other Virus Detections Among Respiratory Specimens Submitted to BC Public Health Microbiology & Reference Laboratory PHSA, 2010-2011 160 35 150 pH1N1 Influenza A/H3N2 140 Influenza A (unsubtyped) 30 130 Influenza B Rhino/Enterovirus Start of 2010-11 120 Respiratory syncytial virus monitoring period 25 110 Other respiratory virus % positive influenza (incl pH1N1) 100 90 20 80 70 15 % positive 60 50 # of viruses detected 10 40 30 20 5 10 0 0 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40 42 44 46 48 50 52 2 4 6 8 10 Week # Before week 14 testing for other viruses was performed on a subset of specimens.