Weekly Update - Alberta Health Services · Weekly Update February 19, 2013 The purpose of this report is to inform Public Health staff, primary care providers, acute care staff and

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Alberta Respiratory Virus

Surveillance Report Update for Flu Week 6: (Feb 3 - 9, 2013)

An influenza report targeted to the general public is available at: http://www.health.alberta.ca/health-info/influenza-evidence.html

If you have questions about the Alberta Respiratory Virus Surveillance Report, or any of the indicators, please contact:

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Weekly Update February 19, 2013 The purpose of this report is to inform Public Health staff, primary care providers, acute care staff and other community practitioners about recent and historical respiratory virus activity in the province of Alberta. Unless otherwise noted, all data presented are current as of the Saturday prior to the day the report is released.

Summary of What’s New Alberta: RSV continued to have the highest percent positive rate of lab confirmed respiratory viruses in Alberta, and all zones, over the

past few weeks (Figure 1).

The rate of lab confirmed seasonal influenza A(H3) for Alberta was 1.04 (per 100,000) in week 6, and has been showing a declining trend in all zones over the past few weeks (Figure 2).

The number of lab confirmed influenza detections was 95 in week 6 in Alberta: 41 (H3), 30 A(H1N1)pdm09, 7 A(unresolved type), and 17 B (Table 1).

Five outbreaks have since been reported with onset in week 5: 2 pathogens pending in Central zone, 1 pathogen pending and 1 no pathogen confirmed in Edmonton zone, and 1 pathogen pending in North zone. Three outbreaks have been reported with onset in week 6: 1 influenza A(H3) in South zone, 1 RSV in Calgary zone, and 1 pathogen pending in North zone. (Table 2).

The Health Link Alberta call rate for cough remained at ~18 per 100,000 for weeks 4, 5, and 6 in Alberta (Figure 5).

The number of weekly visits for cough or cough/congestion to Edmonton zone Emergency Departments/Urgent Care Centres was 272 in week 5 and 276 in week 6 (UAH, FSHC, RHC, EEHC are not included)(Figure 6).

In week 6 0.97% and 0.91% of patient visits to Alberta sentinel physicians were attributed to ILI (influenza like illness) and LRTI (lower respiratory tract infection), respectively (Figure 7).

Updated public health administered influenza immunization data are in Table 3 and Table 4 and community provider immunization data are available in Table 5 and Table 6.

North America: As per FluWatch (PHAC), although declining over the past few weeks, some ILI indicators have

increased slightly in week 5, including ILI consultation rates. Of note, RSV detections have sharply increased.

As of flu week 5, the National Microbiology Lab (NML) of Canada antigenically characterized 425 influenza samples – 297 A(H3N2), 56 A(H1N1)pdm09, and 72 B. All were similar to the 2012-13 Northern Hemisphere influenza vaccine strains, except 14 B viruses that were B/Brisbane/60/2008 (Victoria lineage). All viruses tested for antiviral resistance to oseltamivir and zanamivir were sensitive. All viruses tested for resistance to amantadine were resistant.

According to FluView (US CDC), as of week 5, influenza activity remained elevated, but declining in most areas. The percentage of deaths due to pneumonia and influenza remained higher than epidemic threshold over the past few weeks.

International: In other areas of the temperate North, countries in Eastern Europe and temperate Asia continue

to report increasing influenza activity. In Northwestern Europe, North Africa, and the Mediterranean, influenza detections have slightly decreased. Whereas the primary influenza strain detected in North America has been A(H3N2), it has been A(H1N1)pdm09 in Europe.

Countries of the tropical zone continue to show declining trends and low level influenza transmission.

Influenza activity remains at inter-seasonal levels in the temperate Southern Hemisphere.

One new infection of novel coronavirus (NCoV) has been reported from the United Kingdom. This is the 10

th case reported to WHO, and although travel history to Pakistan and Saudi Arabia

have been confirmed, this case is considered sporadic.

Quick Links

Laboratory Data

ILI Outbreak Investigations

Calls to Health Link Alberta

Emergency Department Visits

Sentinel Physician Office Visits (TARRANT)

Data Notes

Current Global Information

FluWatch (PHAC)

FluView (US CDC)

HPA (UK)

WHO

Travel Advisories

http://origin.phac-aspc.gc.ca/fluwatch/

http://www.cdc.gov/flu/weekly/

http://www.hpa.org.uk/Topics/InfectiousDiseases/InfectionsAZ/SeasonalInfluenza/EpidemiologicalData/

http://www.who.int/csr/disease/influenza/en/

http://www.phac-aspc.gc.ca/tmp-pmv/pub-eng.php






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Laboratory Data Figure 1: Respiratory specimen percent positive rates, by virus type, by week, (2012-13)

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

ALBERTA

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

SOUTH

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

CALGARY

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

CENTRAL

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

EDMONTON

0%

10%

20%

30%

40%

50%

60%

70%

35 37 39 41 43 45 47 49 51 1 3 5 7 9 11

Perc

ent P

ositi

ve

Flu Week

NORTH

Adenovirus Coronavirus hMPV Flu A Flu B Parainfluenza

RSV Rhino-enterovirus Mixed

Source: DIAL – Provincial Laboratory (includes specimens received on or before Feb 9, 2013). For more information on data definitions and sources, see Data Notes. “Percent positive” for a virus is defined as the positive specimens for that virus as a percent of the total number of respiratory virus specimens tested.






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Figure 2: Rate of lab confirmed influenza (per 100,000) by subtype, by week specimen classified

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

ALBERTA

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

SOUTH

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

CALGARY

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

CENTRAL

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

EDMONTON

0.01.02.03.04.05.06.07.08.09.0

10.011.012.013.014.015.0

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

Rate

(per

100

,000

)

Flu Week

NORTH

Flu A(H3) current season (2012-13) Flu A(H1N1) current season (2012-13) Flu B current season (2012-13)

---- Flu A(H3) 2 Yr Avg (2010-11, 2011-12) ---- Flu A(H1N1) 2 Yr Avg (2010-11, 2011-12) ---- Flu B 2 Yr Avg (2010-11/2011-12)

Source: The Alberta influenza outbreak response toolkit (includes cases with positive influenza specimens classified on or before Feb 9, 2013). For more

information on data definitions and sources, see Data Notes.






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Table 1: New and cumulative laboratory confirmed influenza cases, by subtype, by zone

Week 6 (Feb 3 - 9, 2013) Cumulative (Aug 26, 2012 - Feb 9, 2013)

Influenza A Influenza B Influenza A Influenza B

A(H3)

A(H1N1)pd

m09

A

(unresolved

type due to

low viral

load) A (total) B A(H3)

A(H1N1)pd

m09

A

(unresolved

type due to

low viral

load) A (total) B (total)

South 8 4 0 12 0 179 22 10 211 12

Calgary 10 5 1 16 4 444 23 30 497 28

Central 5 3 2 10 1 209 15 11 235 36

Edmonton 10 12 3 25 6 545 152 36 733 53

North 8 6 1 15 6 156 35 11 202 22

Alberta Total 41 30 7 78 17 1533 247 98 1878 151

Zones

Source: The Alberta influenza outbreak response toolkit (includes cases with positive influenza specimens classified on or before Feb 9, 2013). For more information on data definitions and sources, see Data Notes.






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Figure 3: Cumulative age-specific rates of lab confirmed influenza (per 100,000) by subtype, Alberta and each zone (Aug 26, 2012 – Feb 9, 2013)

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

ALBERTA

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

SOUTH

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

CALGARY

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

CENTRAL

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

EDMONTON

0.025.050.075.0

100.0125.0150.0175.0200.0225.0250.0

Age

Sp

eci

fic

Rat

e (p

er 1

00,0

00)

Age Group (years)

NORTH

Flu A(H3) A(H1N1)pdm09 Flu B

Source: The Alberta influenza outbreak response toolkit (includes cases with positive influenza specimens classified on or before Feb 9, 2013). For more information on data definitions and sources, see Data Notes.






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AHS Influenza-Like-Illness (ILI) Outbreak Investigations Figure 4: AHS investigated ILI outbreaks in Alberta facility types, by onset week, by organism type (2012-13)

02468

101214161820222426283032

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

Nu

mb

er o

f Ou

tbre

aks

All AHS Reported influenza-like-illness

Outbreaks*

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks Confirmed Flu A(H3)

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks

Confirmed Flu A(H1N1)pdm09

Acute Care Childcare Long term Care School (K-12) Supportive or Home Living Sites (SL/HL) Other

"All reported outbreaks include those with a confirmed organism, those where no organism was confirmed, those pending lab confirmation and those where no specimens were tested. Note: Some outbreaks may involve more than one pathogen. Source: CDRS as of Feb 12, 2013 (obtained via the Alberta Outbreak Reporting Form).For more information on data definitions and sources, see Data Notes.






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Figure 4 (cont’d): AHS investigated ILI outbreaks in Alberta facility types, by onset week, by organism type (2012-13)

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks Rhino-enterovirus

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks Confirmed RSV

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks Parainfluenza

0

2

4

6

8

10

12

14

16

18

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

Num

ber o

f Out

brea

ks

Flu Week

Other confirmed Respiratory Viruses **

Acute Care Childcare Long term Care School (K-12) Supportive or Home Living Sites (SL/HL) Other

**Other confirmed respiratory viruses include influenza A (unresolved type), adenovirus, coronavirus, and hMPV. Note: Some outbreaks may involve

more than one pathogen.Source: CDRS as of Feb 12, 2013 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes.






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Table 2: New and Cumulative AHS investigated ILI outbreaks reported (by onset date), by organism, Alberta and Zones

Long

term

care

SL/HLSchool

(K-12)

Acute

Care Childcare Other

Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - 1 - - - - 32 22 7 11 2 -

Confirmed A(H1N1)pdm09 - - - - - - - 1 - 1 - -

Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV 1 - - - - - 14 4 - 3 4 -

Confirmed Parainfluenza - - - - - - 1 3 - 2 - -

Confirmed Rhino-enterovirus - - - - - - 10 - - - - -

Other confirmed viruses** - - - - - - 7 2 3 1 - -Initial report only (laboratory

results pending)1 - - - - - 2 1 1 - 2 -

Unknown (no organism

confirmed or no specimens

available)

- - - - - - 6 5 - - 2 -

Total 2 1 0 0 0 0 72 38 11 18 10 0

Organism

Long

term

care

SL/HLSchool

(K-12)

Acute


Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - 1 - - - - 3 6 1 1 - -

Confirmed A(H1N1)pdm09 - - - - - - - - - - - -

Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV - - - - - - - - - - 3 -

Confirmed Parainfluenza - - - - - - - - - - - -


Other confirmed viruses** - - - - - - - - - - - -Initial report only (laboratory

results pending)- - - - - - - - - - - -



available)

- - - - - - 1 1 - - - -

Total 0 1 0 0 0 0 5 7 1 1 3 0

Organism

Long

term

care

SL/HLSchool

(K-12)

Acute


Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - - - - - - 8 5 2 2 - -


Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV 1 - - - - - 3 - - 1 - -

Confirmed Parainfluenza - - - - - - - - - 2 - -


Other confirmed viruses** - - - - - - 5 - 3 1 - -Initial report only (laboratory

results pending)- - - - - - - - - - - -



available)

- - - - - - - 1 - - - -

Total 1 0 0 0 0 0 18 6 5 6 0 0

ALBERTA

Organism

Week 6 (Feb 3, 2013 - Feb 9, 2013) Cumulative (Aug 26, 2012 - Feb 9, 2013)

SOUTH

CALGARY

Source: CDRS as of Feb 12, 2013(obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. **Other confirmed viruses includeinfluenza A(unresolved type) adenovirus, coronavirus and hMPV.






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Table 2 (cont.): New and Cumulative AHS investigated ILI outbreaks reported (by onset date), by organism, Alberta and Zones

Organism

Long

term

care

SL/HLSchool

(K-12)

Acute


Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - - - - - - 2 1 - 1 - -


Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV - - - - - - 3 1 - - - -

Confirmed Parainfluenza - - - - - - - 2 - - - -


Other confirmed viruses** - - - - - - 1 - - - - -Initial report only (laboratory

results pending)- - - - - - 1 1 - - - -



available)

- - - - - - 1 - - - - -

Total 0 0 0 0 0 0 9 5 0 1 0 0

Organism

Long

term

care

SL/HLSchool

(K-12)

Acute


Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - - - - - - 16 9 2 6 - -

Confirmed A(H1N1)pdm09 - - - - - - - 1 - - - -

Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV - - - - - - 8 2 - 2 1 -

Confirmed Parainfluenza - - - - - - - 1 - - - -


Other confirmed viruses** - - - - - - 1 1 - - - -Initial report only (laboratory

results pending)- - - - - - - - 1 - 1 -



available)

- - - - - - 3 3 - - 2 -

Total 0 0 0 0 0 0 34 17 3 8 4 0

Organism

Long

term

care

SL/HLSchool

(K-12)

Acute


Long

term

care

SL/HLSchool

(K-12)

Acute


Confirmed Flu A(H3) - - - - - - 3 1 2 1 2 -

Confirmed A(H1N1)pdm09 - - - - - - - - - 1 - -

Confirmed Flu B - - - - - - - - - - - -

Confirmed RSV - - - - - - - 1 - - - -

Confirmed Parainfluenza - - - - - - 1 - - - - -

Confirmed Rhino-enterovirus - - - - - - - - - - - -

Other confirmed viruses** - - - - - - - 1 - - - -Initial report only (laboratory

results pending)1 - - - - - 1 - - - 1 -



available)

- - - - - - 1 - - - - -

Total 1 0 0 0 0 0 6 3 2 2 3 0

NORTH

CENTRAL

Week 6 (Feb 3, 2013 - Feb 9, 2013) Cumulative (Aug 26, 2012 - Feb 9, 2013)

EDMONTON

Source: CDRS as of Feb 12, 2013 (obtained via the Alberta Outbreak Reporting Form). For more information on data definitions and sources, see Data Notes. **Other confirmed viruses include influenza A(unresolved type) adenovirus, coronavirus and hMPV.






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Calls to Health Link Alberta Figure 5: Call rate (per 100,000 Population) for cough, by flu week (2012-13)

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

ALBERTA

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

SOUTH

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

CALGARY

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

CENTRAL

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

EDMONTON

0

4

8

12

16

20

24

28

32

36

40

35 39 43 47 51 3 7 11 15 19 23 27 31

We

ekl

y ca

ll ra

te (

pe

r 10

0,0

00

)

Flu Week

NORTH

Weekly Call Rate current year (2012-13) ----- 2 Yr Average Weekly Call Rate (2010-11, 2011-12)

Source: Sharp Focus - Health Link Alberta - via Alberta Real Time Syndromic Surveillance Net (ARTSSN) - calls received on or before Feb 9, 2013.

For more information on data definitions and sources, see Data Notes.






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Emergency Department Visits Figure 6: Visits for cough, cough/congestion, by flu week, Edmonton zone (2012-13)

0

100

200

300

400

500

600

700

800

900

1000

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

Wee

kly

# of

Vis

its

Flu Week

EDMONTON

Weekly Visits current year (2012-13)

------ 2 Yr Average weekly visits (2010-11, 2011-12)

Source: E-triage and EDIS - via Alberta Real Time Syndromic Surveillance Net (ARTSSN) as of Feb 9, 2012. For more

information on data definitions and sources, see Data Notes.

The following facilities have been left out of analysis due to data incomparability across influenza seasons. EDIS: UAH , FSHC and E-Triage: RHC, EEHC






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Sentinel Physician Office Visits (TARRANT) Figure 7: Sentinel physician patient visits (%) with ILI and LRTI, by flu week, Alberta (2012-13)

0.0

0.2

0.4

0.6

0.8

1.0

1.2

1.4

1.6

1.8

2.0

2.2

2.4

2.6

2.8

35 38 41 44 47 50 1 4 7 10 13 16 19 22 25 28 31 34

% o

f Vis

its

Flu Week

ALBERTA

% LRTI current year (2012-13) % ILI current year (2012-13)

------ 2 yr average % LRTI Visits (2010-11, 2011-12) ------ 2 yr average % ILI Visits (2010-11, 2011-12)

South Calgary Central Edmonton North Alberta

48

Number of Physicians

Reporting this Week 5 21 15 6 1

Source: Tarrant Viral Watch program – www.tarrantviralwatch.ca as of Feb 12, 2013. For more information on data definitions and sources, see Data Notes.

http://www.tarrantviralwatch.ca/






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Influenza Immunizations Table 3: New AHS (Public Health) Delivered Influenza Immunizations, by priority group (Feb 3 - 9, 2013)


0 0 3 0 1 4

0 1 3 1 2 7

3 4 3 6 13 29

11 13 10 19 20 73

1 17 2 9 7 36

1 0 2 0 0 3

0 0 0 0 0 0

1 12 18 20 7 58

Dose #1 61 308 67 159 76 671

Dose #2 62 139 42 156 39 438

Annual 11 70 22 26 16 145

Dose #1 9 34 4 29 17 93

Dose #2 26 25 7 25 10 93

Annual 40 108 11 43 27 229

Dose #1 0 2 0 3 2 7

Dose #2 0 4 0 1 1 6

Annual 1 14 4 5 7 31

2 3 0 4 9 18

8 28 17 34 28 115

Dose #1 9 19 3 8 2 41

Dose #2 6 13 4 4 1 28

Annual 19 47 13 41 17 137

19 39 12 33 25 128

59 335 70 261 204 929

79 363 74 199 97 812

94 181 53 186 51 565

173 687 184 496 369 1,909

346 1,231 311 881 517 3,286

High risk: 9 years up to and including 17 years


Total number of clients who have received an Annual Dose

Total Doses Administered by Public Health

Priority Group

All children 6 months up to and including 23 months*


High risk: 5 years up to and including 8 years*

Healthy: 5 years up to and including 8 years*

Long term care staff AHS/Covenant

Long term care staff Total

Health care workers AHS/Covenant

Health care workers Total

Pregnant women

Residents of long term care 65+

Residents of long term care <65

65 years of age and over

Total number of clients who have received Dose 1 of 2


Healthy: 9 years up to and including 17 years


Source: AHS Zones (doses do not include those delivered by external providers). For more information on data definitions and sources, see Data Notes. *Children under 9 years of age who have not received at least one dose in past years require two doses, given at least 4 weeks apart.






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Table 4: Cumulative AHS Delivered Influenza Immunizations, by priority group (Oct 1, 2012 – Feb 9, 2013)


82 108 146 87 548 971

520 370 326 282 994 2492

636 1830 1270 2620 2491 8847

1642 5479 2686 6253 4936 20996

200 1271 357 1125 394 3347

829 1,021 727 627 1,262 4,466

49 250 153 160 55 667

12,014 36,605 18,207 44,608 14,780 126,214

Dose #1 1,433 8,158 1,647 5,751 1,890 18,879

Dose #2 666 3,076 807 2,648 787 7,984

Annual 618 4,053 905 2,641 988 9,205

Dose #1 384 1,549 350 1,375 1055 4,713

Dose #2 170 553 160 515 180 1,578

Annual 1,849 10,818 1,895 7,198 2,081 23,841

Dose #1 21 95 32 83 120 351

Dose #2 4 26 15 25 7 77

Annual 240 1,671 357 1,108 347 3,723

267 1,732 462 1,241 537 4,239

2,214 12,509 4,227 12,440 5,823 37,213

Dose #1 257 559 144 531 894 2,385

Dose #2 116 168 77 142 92 595

Annual 1,813 9,364 1,894 6,719 2,295 22,085

2,075 10,552 2,645 8,065 4,440 27,777

10,445 65,524 13,930 56,434 21,100 167,433

2,095 10,361 2,173 7,740 3,959 26,328

956 3,823 1,059 3,330 1,066 10,234

34,775 161,219 48,771 148,901 60,032 453,698

37,826 175,403 52,003 159,971 65,057 490,260









Pregnant women





Priority Group








Source: AHS Zones (doses do not include those delivered by external providers). For more information on data definitions and sources, see Data Notes. *Children under 9 years of age who have not received at least one dose in past years require two doses, given at least 4 weeks apart.






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Table 5: Community Provider* Delivered Influenza Immunizations by Risk Group (Excluding FNIHB): Report 1 (Sept 30 – Dec 31, 2012)


288 302 1040 98 20 1748

493 6070 2136 5245 35 13979

2836 12590 4162 14672 395 34655

4991 18463 5468 17993 738 47653

392 1469 37 449 29 2376

331 4,799 1404 4819 95 11,448

43 600 408 801 66 1,918

9,214 42,135 8,436 26,633 1,701 88,119

Dose #1 1 61 1 144 0 207

Dose #2 0 33 0 84 0 117

Annual 0 138 3 180 0 321

Dose #1 0 72 0 85 0 157

Dose #2 0 23 0 49 0 72

Annual 11 514 7 441 0 973

Dose #1 3 25 0 16 0 44

Dose #2 3 10 0 4 0 17

Annual 7 185 17 172 0 381

206 1,300 151 894 43 2,594

3,687 18,842 2,897 13,472 1,743 40,641

Dose #1 0 30 0 37 0 67

Dose #2 1 9 0 17 0 27

Annual 28 479 49 575 0 1,131

938 5,507 500 3,042 264 10,251

10,038 68,033 7,720 40,237 6,174 132,202

4 188 1 282 0 475

4 75 0 154 0 233

30,379 168,534 29,233 114,953 10,888 353,987

30,387 168,797 29,234 115,389 10,888 354,695

Priority Group





Pregnant women















Total Doses Administered by Public Health *physician, pharmacist, other non-AHS community provider, AHS non-public health)






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Table 6: AHS Public Health + Community Provider* Delivered Influenza Immunizations by Risk Group (Excluding FNIHB): Report (Sept 30 – Dec 31, 2012) + AHS Public Health to Feb 9, 2013


370 410 1186 185 568 2719

1013 6440 2462 5527 1029 16471

3472 14420 5432 17292 2886 43502

6633 23942 8154 24246 5674 68649

592 2740 394 1574 423 5723

1,160 5,820 2131 5446 1,357 15,914

92 850 561 961 121 2,585

21,228 78,740 26,643 71,241 16,481 214,333

Dose #1 1,434 8,219 1,648 5,895 1,890 19,086

Dose #2 666 3,109 807 2,732 787 8,101

Annual 618 4,191 908 2,821 988 9,526

Dose #1 384 1,621 350 1,460 1055 4,870

Dose #2 170 576 160 564 180 1,650

Annual 1,860 11,332 1,902 7,639 2,081 24,814

Dose #1 24 120 32 99 120 395

Dose #2 7 36 15 29 7 94

Annual 247 1,856 374 1,280 347 4,104

473 3,032 613 2,135 580 6,833

5,901 31,351 7,124 25,912 7,566 77,854

Dose #1 257 589 144 568 894 2,452

Dose #2 117 177 77 159 92 622

Annual 1,841 9,843 1,943 7,294 2,295 23,216

3,013 16,059 3,145 11,107 4,704 38,028

20,483 133,557 21,650 96,671 27,274 299,635

2,099 10,549 2,174 8,022 3,959 26,803

960 3,898 1,059 3,484 1,066 10,467

65,154 329,753 78,004 263,854 70,920 807,685

68,213 344,200 81,237 275,360 75,945 844,955

Priority Group





Pregnant women
















*physician, pharmacist, other non-AHS community provider, AHS non-public health






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Data Notes

LABORATORY DATA Information on laboratory confirmed respiratory virus activity is based on two web-based applications supported by the Canadian Network for Public Health Intelligence (CNPHI):

1) The Alberta Provincial Public Health Laboratory DIAL system (Data Integration for Alberta Laboratories) – a specimen based system. Data are based on specimens obtained from residents of Alberta according to the date the sample was received at the Provincial laboratory.

2) The Alberta Influenza Outbreak Response Toolkit – an influenza case based system. Data are based on Alberta residents according to the date the sample was classified as influenza sub-type.

Respiratory samples submitted for testing at the Alberta Provincial Laboratory are first tested for influenza A & B. Those with a negative influenza result are then tested using the respiratory virus panel or RVP which tests for the presence of the non-influenza respiratory viruses presented in this report. Samples from physicians participating in the Tarrant program and patients admitted to intensive or critical care units are tested for both non-influenza and influenza viruses. Definition for “mixed” – a single sample where multiple viral organisms were isolated. ILI OUTBREAK INVESTIGATIONS Upon notification of an outbreak, the Alberta Health (AH)/Alberta Health Services (AHS) Outbreak Reporting Form (AORF) is completed by a communicable disease nurse, sent to AH and entered into the CDRS database. Outbreaks reported by First Nations and Inuit Health Branch (FNIHB) to AH are not included in this report. The AORF form includes information about the type and location of the outbreak, the facility, and causative organism. Note that zone specific outbreaks are those reported by that zone, however specific cases may reside or have been exposed and/or infected outside of that zone. Not all outbreaks result in an organism being confirmed and for those that are confirmed, there may be a delay between reporting and identification of the organism; outbreaks are classified by the organism listed as the ILI Organism Confirmed on the AORF. This report does not include outbreaks suspected or confirmed to be caused by bacteria (i.e. pertussis, invasive pneumococcal disease) or viruses causing rash-like illness such as measles, rubella (German measles) or chickenpox. In this report, outbreaks are reported according to the onset date of the first case; where onset date is not available, the date the investigation is opened is used. The AHS Public Health Surveillance team obtains the data via CDRS which is housed and maintained by AH.

CALLS TO HEALTH LINK ALBERTA Health Link Alberta is a 24 hour a day, 7 day a week nurse-operated service that provides the public with advice and information about health symptoms and concerns. The original data source for calls to Health Link Alberta for cough is the Health Link database called Sharp Focus (obtained via the Alberta Real Time Syndromic Surveillance Net - ARTSSN). Note that one individual may place multiple calls.

The Health Link protocols selected for inclusion are as follows: cough/hoarseness/stridor (PED), cough/hoarseness (ADULT).

EMERGENCY DEPARTMENT VISITS Information on Edmonton zone emergency department and urgent care centre visits with cough/congestion chief complaints are provided by the Alberta Real Time Syndromic Surveillance Net (ARTSSN) data repository. When patients present in emergency departments, a presenting/chief complaint is recorded at triage. The original data sources fed to the ARTSSN data repository are EDIS (Emergency Department Information System) for the following Edmonton Zone emergency departments and urgent care centres: Royal Alexandra Hospital, Westview Health Centre, Sturgeon Community Hospital, Northeast Community Health Centre, Leduc Community Hospital, Grey Nuns Community Hospital, University of Alberta Hospital, Fort Saskatchewan Health Centre, and Misericordia Hospital, and E-Triage for the following: Devon General hospital, Health First Strathcona, East Edmonton Health Centre, Redwater Health Centre. SENTINEL PHYSICIAN OFFICE VISITS (TARRANT) Tarrant Viral Watch is an Alberta Health funded program intended to monitor ILI (Influenza-like Illness) and LRTI (Lower Respiratory Tract Infections) in the community. Volunteer sentinel physician offices provide data to the Tarrant program, which in turn provide them to AHS Public Health Surveillance on a weekly basis. ILI is defined as a respiratory illness with acute onset, with fever, and cough, and with 1 or more of sore throat, arthralgia, myalgia or prostration-which may be due to influenza virus (presentation may vary in pediatric and elderly populations). LRTI is defined as any acute infection with significant involvement of the respiratory tract below the larynx, as identified by history, physical signs and/or radiological findings. If a patient has ILI with lower tract involvement, they are coded as LRTI. Note that the definition of ILI may vary from other definitions.






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INFLUENZA IMMUNIZATIONS Influenza immunization data are reported by AHS zones. Numbers are available to the AHS Public Health Surveillance team at the beginning of the week for the doses administered the previous week (Sunday to Saturday). It includes those doses administered by AHS (Public Health) only. Clients can only exist in one priority group. Immunization coverage rates will be reported at the end of the influenza season. POPULATION NUMBERS Population data values used to calculate rates were obtained from the Alberta Health (AH) Interactive Health Data Application (IHDA). http://www.ahw.gov.ab.ca/IHDA_Retrieval/ - Demographics, Population Estimates category. Click on View Data Notes for a detailed description of definitions and methodology. For the 2010-11 influenza season, 2010 population estimates were used. For the 2011-12 season, 2011 population estimates were used. For the current (2012-13) influenza season, 2012 population estimates were used. * Flu week numbers are the same as those defined by the Public Health Agency of Canada’s (PHAC) FluWatch.

http://www.ahw.gov.ab.ca/IHDA_Retrieval/

Documents

Weekly Update - Alberta Health Services · Weekly Update February 19, 2013 The purpose of this report is to inform Public Health staff, primary care providers, acute care staff and