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 2015-16 FluWatch Team: Liza Lee, Joy Pulickal, Myriam Saboui, Claire Sevenhuysen, and FluWatch provincial/territorial and sentinel practice 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 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.

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

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

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)

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

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

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.