Canada’s FluWatch Surveillance Program - Outbreak Surveillance Dr. Christina Bancej & Dr. Yan Li, Public Health Agency of Canada on behalf of the 2015-16 FluWatch Team: Liza Lee, Joy Pulickal, Myriam Saboui, Claire Sevenhuysen and provincial/territorial /regional FluWatch partners

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

FluWatch ILI/Influenza Outbreak Definition Schools: Greater than 10% absenteeism (or absenteeism that is higher (e.g. >5-10%) than expected level as determined by school or public health authority) which is likely due to ILI. Hospitals and residential institutions: two or more cases of ILI within a seven-day period, including at least one laboratory confirmed case. Residential institutions include but not limited to long-term care facilities (LTCF) and prisons. Workplace: Greater than 10% absenteeism on any day which is most likely due to ILI. Other settings: two or more cases of ILI within a seven-day period, including at least one laboratory confirmed case; i.e. closed communities. Reporting of outbreaks of influenza/ILI from different types of facilities differs between jurisdictions.

Outbreaks – Data Collection Collected nationally since 1999 Submitted weekly by provincial and local health authorities through one of two mechanisms Upload to Canadian Network for Public Health Intelligence (CNPHI) – Influenza activity and outbreak reporting portal (MB, NF, NS, NB) Excel dataset submitted to FluWatch email account (BC, AB, SK, ON, QC, PEI, YK, NWT, NU) Data elements include number of outbreaks by strain/sub-type, setting, and jurisdiction CNPHI outbreak summaries for sharing more detailed outbreak information on a sub-set of outbreaks within a jurisdiction, between jurisdictions, or nationally. Mandatory data elements include: Infectious Agent Confirmation (lab/suspect/unknown) Disease (predominant) Exposure/Transmission setting (community, household, hospital, agriculture facility, etc. ) Location of cases (localized, more than one HU/RHA etc.) Primary mode of transmission

FluWatch Overall number of new laboratory-confirmed influenza outbreaks by report week, Canada, 2015-2016

FluWatch Outbreaks Indicator – Scalable, Correlates with Laboratory Detections, Sensitive to Thresholds

Strengths Jurisdictions highly motivated to provide data. Outbreak definition includes requirement of lab confirmation, or ILI (schools). Permits early detection of elevated or unusual flu activity. Correlates with laboratory detections and other established surveillance indicators. Provides target group information to inform preparedness planning, vaccination guidance. Collect minimum data– type/subtype; type of facility; jurisdiction. For subset of outbreaks have access to very detailed case data via CNPHI, allowing linkage of outbreaks across jurisdictions, query, line listing, analytics, links to Public Health Alerts. Enhances outbreak data accessibility at local, provincial, national level. Demonstrated utility for situational awareness, briefing public health leadership.

Limitations Definitions not uniformly applied/implemented. Multiple systems for data collection and they are not interoperable. Detailed outbreak summaries are not linkable to aggregate outbreak reporting. Data providers dislike duplicate entry requirements. Timeliness (in some cases rely on retrospective updating). With aggregate data, obtain initial signal, but not followed for duration of outbreak. Much unharnessed potential

Next Steps FluWatch modernization Assess alignment and priority of continued surveillance for all FluWatch indicators