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

2. 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

3. FluWatch 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.

4. FluWatch ILI Collection Methods 2015-16
Multiple Methods of Recruitment
Direct recruitment of primary care sentinel physicians/nurses by FluWatch 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

5. Proportion of Sentinels Submitting Data – Week 10 (peak) 2015-16 Season

6. 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
People not seen by a healthcare professional with influenza
Influenza-like-illness that is managed in an outpatient setting
Influenza-Associated Hospitalization
Deaths
Paediatric hospital sentinel surveillance (2004)
Adult hospital sentinel surveillance (CNISP, 2009; CIRN 2012)
PT hospital-based surveillance (2009)
Public health laboratory data (1993)
National Microbiology Lab (1996)
Sentinel physician ILI surveillance (1996)
Antiviral prescription data (2011)

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

8. FluWatch ILI rate per 1,000 patients (3-week moving average), 2015-16.

9. Next Steps FluWatch modernization
Assess alignment and priority of continued surveillance for all FluWatch 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 FluWatchers pilot.