Canada:
Widespread influenza activity is reported in all regions in Alberta and Saskatchewan. Localized influenza activity is reported in two regions of British Columbia and two regions of Manitoba. Sporadic influenza activity is reported in two regions in British Columbia, two regions in Nova Scotia, two regions in Ontario, one region in Manitoba and the Yukon in week 46. During the week ending November 15 (week 46), sentinel physicians reported 34 cases of influenza-like illness (ILI) per 1000 patient visits, which is within baseline rates for week 46. During the one week period, November 9 to November 15, Health Canada received 1811 reports of laboratory tests for influenza, including 388 (21.42%) influenza A detections and 0 (0%) influenza B detections (see table). The National Microbiology Laboratory has antigenetically characterized 69 influenza viruses to date; 43 A/Fujian/411/02(H3N2)-like, 25 A/Panama/2007/99(H3N2)-like and 1 A/New Caledonia/20/99(H1N1)-like. During week 46, influenza outbreaks were reported in eight schools (seven in Alberta and one in British Columbia), 10 LTC facilities (four in Alberta, three in Saskatchewan, two in Manitoba and one in British Columbia) and four lodges in Alberta.

United States:
During the week ending November 8, 2003 (week 45), one state (Texas) reported widespread influenza activity, one state (Colorado) reported regional activity, eight states reported local influenza activity and 22 states reported sporadic activity. ILI visits accounted for 3.2% of patient visits to sentinel physicians, which is above the national baseline of 2.5%. Sentinel cities reported that 6.2% of deaths were attributed to pneumonia and influenza, which is below the epidemic threshold of 7.1% for this week. During week 44, the CDC received 1,056 reports of influenza tests and 203 (19.2%) were positive. Thirty influenza A (H3N2) and 170 unsubtyped influenza A viruses and three influenza B viruses were identified.
CDC: <http://www.cdc.gov/ncidod/diseases/flu/weekly.htm>

International:
WHO: Since the beginning of October, outbreaks of influenza in a number of countries in Europe and North America have been due largely to A(H3N2) viruses. Influenza activity has continued to increase during November in Finland, France, Israel, Norway, Portugal, Spain, the UK and the USA. In Europe, most H3N2 viruses that have been characterized antigenically so far this season were A/Fujian/411/2002-like; in the UK, 2/3 of isolates characterized so far were A/Fujian/411/2002-like and one third were A/Panama/2007/99-like. In the US, more than 3/4 of the A(H3N2) isolates were A/Fujian/411/2002-like; the rest are A/Panama/2007/99-like. The new drift variant A/Fujian/411/2002-like virus is related to the A/Panama/2007/99(H3N2)-like strain included in the current vaccine and antibodies induced against this vaccine strain cross react with A/Fujian/411/2002-like strains, but generally at a reduced level. It is expected that the current season’s influenza vaccine will provide cross protection for the A/Fujian/411/2002-like variant but the degree of protection is unknown.
EISS: In week 46, EISS is reporting widespread influenza activity in western Europe and low or no activity in central Europe.
WHO: <http://rhone.b3e.jussieu.fr/flunet/www/index.html>
EISS: <http://www.eiss.org>  

Total number of influenza tests performed and number of positive tests by province/territory of testing laboratory, Canada, 2003-2004

Specimens from NT, YT, and NU are sent to reference laboratories in other provinces.

Note: Cumulative data includes updates to previous weeks; due to reporting delays, the sum of weekly report totals do not add up to cumulative totals.

Abbreviations: Newfoundland/Labrador (NL), Prince Edward Island (PE), New Brunswick (NB), Nova Scotia (NS), Quebec (QC), Ontario (ON), Manitoba (MB), Saskatchewan (SK), Alberta (AB), British Columbia (BC), Yukon (YT), Northwest Territories (NT), Nunavut (NU)

Respiratory virus laboratory detections in Canada, by geographic regions, are available weekly on the following website:
< http://www.phac-aspc.gc.ca/bid-bmi/dsd-dsm/rvdi-divr/index.html>

Number of influenza surveillance regions† reporting widespread or localized influenza activity, Canada, by report week, 2003-2004 (N=52)

† sub-regions within the province or territory as defined by the provincial/territorial epidemiologist. Graph may change as late returns come in.

Influenza Activity Level by Provincial and Territorial Influenza Surveillance Regions, Canada, November 9 to November 15, 2003 (Week 46)
	No Data No Activity Sporadic Activity Localized Activity Widespread Activity
Note: Influenza activity levels, as represented on this map, are assigned and reported by Provincial and Territorial Ministries of Health, based on laboratory confirmations, sentinel ILI rates (see graphs and tables) and outbreaks. Please refer to detailed definitions for the 2003-2004 season. For areas where no data is reported, late reports from these provinces and territories will appear on the FluWatch website. Select single maps by report week to get this updated information. <http://dsol-smed.phac-aspc.gc.ca/dsol-smed/fluwatch/fluwatch.phtml?lang=e> Click on the map to view provinces/territories and maps for other weeks.

Influenza tests reported and percentage of tests positive, Canada, by report week, 2003-2004

Percent positive influenza tests, compared to other respiratory viruses by reporting week, Canada, 2003-2004

Influenza strain characterization, Canada, cumulative, 2003-2004 influenza season by the Respiratory Viruses Section at the National Microbiology Laboratory
[N=69]

NACI recommended components of the 2003-2004 Canadian vaccine include: an A/New Caledonia/20/99 (H1N1)–like virus, an A/Panama/2007/99 (H3N2)-like virus and either a B/Hong Kong/330/2001-like or B/Shangdong/7/97-like virus. Note: the influenza A(H1N2) virus strain is a reassortment virus derived from the influenza A (H1N1) and A(H3N2) virus strains. This strain circulated widely during the 2001-2002 season and like last season the current vaccine is expected to provide protection against this virus.
See http://www.phac-aspc.gc.ca/publicat/ccdr-rmtc/03vol29/acs-dcc-4/index.html

Influenza-like illness (ILI) reporting rates, Canada, by report week, 2003-2004 compared to 1996/97 through 2002/2003 seasons

Note: No data available for mean rate in previous years for weeks 21 to 39 (1996-1997 through 2002-2003 seasons). During weeks 20-39, 2002-2003/ 2003-2004 seasons, ILI is reported once every two weeks, on even weeks only

Number of Outbreaks in Long Term Care Facilities by Report Week, Canada, 2003-2004

Please note that the above graphs may change as late returns come in.

Definitions for the 2003-2004 season

[FluWatch]