Maintaining Canadas Flu Watch Influenzalike Illness ILI surveillance

Maintaining Canada’s Flu. Watch Influenza-like Illness (ILI) surveillance system - Challenges and Opportunities Dr. Christina Bancej, Public Health Agency of Canada on behalf of the 2015 -16 Flu. Watch Team: Liza Lee, Joy Pulickal, Myriam Saboui, Claire Sevenhuysen, and Flu. Watch provincial/territorial and sentinel practice partners

Flu. Watch Canada’s National Influenza Surveillance System Established in 1996 as a routine surveillance program to monitor seasonal influenza Current objectives: 1. Early detection of influenza virus activity in Canada 2. Provision of timely up-to-date information of influenza activity in Canada 3. Monitoring of circulating strains of influenza virus and assess their sensitivity to antiviral medications. 4. Contribute virological surveillance information to the World Health Organization (WHO) First P/T launch CNPHI Outbreak Summary Laboratory surveillance: detections & characterization 1993 Paediatric hospital sentinel surveillance Sentinel physician ILI surveillance P/T outbreak &activity level surveillance 1996 1999 2004 Adult hospital sentinel surveillance (CNISP) Adult hospital sentinel surveillance (CIRN) P/T hospitalizations & deaths Pharmacy surveillance 2009 2011 2012 2

Flu. Watch ILI Definition for the 2015 -16 Season • Acute onset of respiratory illness with fever and cough, and with one or more of the following: – sore throat, arthralgia (joint pain), myalgia (muscle pain), or prostration (extreme exhaustion) which is likely due to influenza; • In children under 5 years, gastrointestinal symptoms may also be present; and • In patients under 5 years or 65 years and older, fever may not be prominent. 3

Flu. Watch ILI Collection Methods 2015 -16 • Multiple Methods of Recruitment – Direct recruitment of primary care sentinel physicians/nurses by Flu. Watch program – Partner with provincial networks of primary care sentinel physicians – Add-in primary care sentinel surveillance data collection to VE research • Weekly voluntary electronic data submission of minimum data set using Excel template – # ILI cases by age group • Incentive to participate – CME credits – Professional interest/access to situational analysis/links with lab 4

Proportion of Sentinels Submitting Data – Week 10 (peak) 2015 -16 Season 100% 90% 80% 70% 60% 50% % Participating 40% 30% 20% 10% 0% YT NT NU BC AB SK MB ON QC NB NS PE NL 5

Challenges • • Primary care self-regulating profession, health care a provincial responsibility Recruitment, retention, representativeness Standardized application of the case definition Data timeliness and reliability – voluntary provision of data Stability and validity of the estimates Technological change Limited incentives to participate Comprehensiveness/coverage Paediatric hospital sentinel surveillance (2004) Deaths Public health laboratory data (1993) National Microbiology Lab (1996) Influenza. Associated Hospitalization Adult hospital sentinel surveillance (CNISP, 2009; CIRN 2012) PT hospital-based surveillance (2009) Influenza-like-illness that is managed in an outpatient setting Sentinel physician ILI surveillance (1996) Antiviral prescription data (2011) People not seen by a healthcare professional with influenza 6

Flu. Watch influenza-like illness (ILI) consultation rates by age group and week, Canada, 2015 -16 7

Flu. Watch ILI rate per 1, 000 patients (3 -week moving average), 2015 -16. 90, 00 Extra ordinary High 80, 00 Moderate 70, 00 ILI rate/10000 60, 00 50, 00 40, 00 Low 30, 00 20, 00 Below seasonal threshold 10, 00 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 Epidemiological Week 15 17 19 21 23 25 27 29 31 33 8

Next Steps • Flu. Watch modernization – Assess alignment and priority of continued surveillance for all Flu. Watch indicators – ILI deemed required element, but must • Renew P/T commitment to ILI surveillance • Invest in core surveillance • Assess new technologies for population-based ILI surveillance e. g. , the Flu. Watchers pilot. 9