title: A composite epidemic curve for seasonal influenza in Canada with an international comparison.
abstract: BACKGROUND
  Empirical data on laboratory-confirmed seasonal influenza is limited by very low and possibly non-systematic case ascertainment as well as geographical variation.
  
  
  OBJECTIVE
  To provide a visual representation of an influenza epidemic at the community and regional level using empirical data and to describe the epidemic characteristics.
  
  
  METHODS
  Weekly influenza A confirmations were obtained from the Canadian FluWatch program and American FluView program for the 1997/1998-2006/2007 seasons; 1- year data were also available for Europe (FluNet, WHO). For seasons where at least 80% of the influenza A strains were antigenically similar, a composite epidemic curve was created by centring the local epidemics relative to their epidemic midpoint.
  
  
  RESULTS
  The range in timing of the regional peaks varied from 5 to 13 weeks. Once the epidemic curves were centred relative to their peak, the composite epidemic curves were similar for Canada, the United States and Europe, and the epidemic growth rates were similar for most subgroups (city size; regions; H1N1 versus H3N2 seasons). During the exponential growth period, the number of cases increased by a factor of 1.5-2.0 per week, averaging 1.8. Exponential growth was evident approximately 10 weeks before the peak. Evidence of sustained transmission occurred from mid-September to early June.
  
  
  CONCLUSIONS
  The shape of the composite curve created in this study clearly demonstrates a consistency in the epidemic pattern across geographically disparate locales. Laboratory confirmation will likely play an increasing role in the development of better methods for early detection and summary measures of influenza activity.
authors: Infectious Disease and Emergency Preparedness Branch, Public Health Agency of Canada, Ottawa, ON, Canada. dena_schanzer@phac-aspc.gc.ca
authors: Dena L
authors: DL
authors: Schanzer
authors: Joanne M
authors: JM
authors: Langley
authors: Trevor
authors: T
authors: Dummer
authors: Cecile
authors: C
authors: Viboud
authors: Theresa W S
authors: TW
authors: Tam
mesh_terms: D002170:Canada / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005843:Geography; D006801:Humans; D015994:Incidence; D053118:Influenza A Virus, H1N1 Subtype / Q000302:isolation & purification; D053122:Influenza A Virus, H3N2 Subtype / Q000302:isolation & purification; D007251:Influenza, Human / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D012621:Seasons; D014481:United States / Q000453:epidemiology