Canada’s lack of public data about pediatric flu numbers leaves pediatricians ‘flying blind’

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At least two children have died in Canada after contracting influenza in recent weeks, but Ottawa has so far not released any data on how flu season is affecting pediatric patients across the country – a situation clinicians say is leaving them in the dark and may be compromising the response to emerging problems.

“It’s really concerning that we don’t know what’s going on,” said Manish Sadarangani, a pediatric infectious diseases specialist. “I sort of feel like we’re flying blind.”

“It really helps to know what infections are currently circulating and which infections are causing more severe illness and hospitalization in children,” said Ashley Roberts, a clinical assistant professor of pediatric infectious diseases at the University of British Columbia.

“To not have that active data present for our clinical care is certainly a loss right now,” Dr. Roberts added.

Each week, the Public Health Agency of Canada publishes a FluWatch report that details influenza trends across the country. Last season, for instance, the report helped pediatricians understand and respond to soaring rates of hospital admission for the flu at a time when COVID-19 and respiratory syncytial virus (RSV) were also sickening many kids across Canada.

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But as of Oct. 1, FluWatch reports have not included any information on the number of children who have fallen severely ill as a result of the flu. The reports simply state the data were “not available.”

The lack of information appears to be the result of a decision by PHAC to put a new group in charge of collecting pediatric data on severe outcomes for respiratory viruses.

On Nov. 1, the agency awarded a new contract to the University of Calgary, PHAC spokesperson Tammy Jarbeau wrote in an e-mail. She said the government is working with the group “on the implementation of the contract and the transition” to ensure the new data will be comparable to information collected in previous years.

According to another PHAC spokesperson, Marie-Pier Burelle, the government received the first cache of data on Nov. 24, and the information is being used internally. It should be made public sometime this month, she wrote in an e-mail.

For more than 25 years, Ottawa had been using the same surveillance network, IMPACT, to collect this data. IMPACT, which stands for Canada’s Immunization Monitoring Program ACTive, is run by the Canadian Paediatric Society and has experts based in 12 pediatric sites, representing 90 per cent of tertiary care pediatric beds in the country.

Dr. Sadarangani, a co-principal investigator of IMPACT, said it’s critical to have data on pediatric respiratory virus outcomes for this season, given that last season hospitals saw an unusually high influx of flu, RSV and COVID-19 cases. And it’s expected that a new vaccine to prevent severe illness in infants with RSV will become available next season, so experts will need detailed information on RSV cases this season to help them determine who should get that vaccine and when, he said.

“We really need that data this year, almost more than ever,” Dr. Sadarangani said.

Dr. Roberts, who is not formally affiliated with IMPACT, said the absence of national pediatric data in recent months has “baffled” her colleagues.

Last month, the BC Centre for Disease Control issued a public warning about the flu after two children, reportedly under age 10, died of complications related to the virus. The agency is urging members of the public to get themselves and their loved ones vaccinated to protect them.

In addition to surveillance on respiratory virus outcomes, IMPACT also collected data on adverse events following immunization, vaccine effectiveness and vaccine-preventable diseases such as chicken pox and whooping cough.

Marie Adèle Davis, executive director of the Canadian Paediatric Society, said the government did not include vaccine-preventable diseases in the terms of its new pediatric surveillance data contract. Instead, PHAC put out a separate solicitation bid for tracking that information, which has yet to be awarded. What worries Ms. Davis is that this suggests there is no network tracking trends on a national level.

“No one is monitoring those diseases right now,” she said.

Ms. Davis noted that the government’s bid solicitation for the data surveillance network removed the requirement that the network be run by pediatric infectious disease specialists and involve nurses. She said IMPACT worked for years to develop a robust process to analyze information to ensure that any new data, such as an adverse event from a vaccine or the presence of a new vaccine-preventable disease, are interpreted correctly.

IMPACT’s data are also used for research purposes, including studies on the impact the pandemic had on pediatric flu admissions or rates of influenza in immunocompromised children.

“It was not simply a program where we collected data and submitted it to government,” she said. “It was really about using that data to inform child and youth health policy.”