Question Period Note: COVID-19 Influenza, and RSV Outlook

COVID-19 is co-circulating with other respiratory viruses such as seasonal influenza (flu) and respiratory syncytial virus (RSV) this fall/winter. It is difficult to predict the extent to which these viruses will circulate in a given year and it remains essential to be prepared in case of simultaneous surges.

The health and safety of people in Canada is the Government’s top priority.
As expected, COVID-19 is co-circulating with other respiratory viruses such as seasonal flu and RSV this fall and winter in Canada.
Currently in Canada, influenza and RSV activity is low, which is expected for this time of the year.
In addition to COVID-19 and seasonal flu vaccination, people in Canada are reminded that personal protective measures can help reduce the risk of infection and reduce the spread of respiratory viruses like COVID-19, influenza, and RSV.
The Government of Canada will continue to monitor the respiratory virus situation in Canada, in collaboration with provinces and territories, and elsewhere to provide the best information and advice possible to keep people in Canada safe.
COVID-19
The Government of Canada has a strong monitoring program in place with the provinces and territories to identify and detect COVID-19 variants in Canada.
Canada will receive up to 22.9 million doses of the new mRNA vaccines from Pfizer and Moderna in the fall, and 125, 000 doses of the new non-mRNA from Novavax, pending authorization.
On September 12, 2023, Health Canada authorized this updated COVID-19 vaccine for use in individuals 6 months of age and older (Moderna). The updated Pfizer vaccine was authorized on September 28, 2023. Doses of both vaccines are being distributed to provinces and territories to support their vaccination campaigns.
For fall 2023, the National Advisory Committee on Immunization (NACI) recommends a dose of the updated formulation of COVID-19 vaccine for people in the authorized age groups if it has been at least 6 months from the previous COVID-19 vaccine dose or known SARS-CoV-2 infection (whichever is later). Vaccination for individuals at higher risk for severe COVID-19 is particularly recommended and will help reduce their risk of severe disease.
For the fall/winter season, Canada has a sufficient supply of therapeutics as well as COVID-19 vaccines for every individual who would like one.
Evidence suggests that therapeutics remain effective, and updated vaccines should offer good protection against currently circulating variants.
The Government of Canada will continue to monitor new variants, including their severity and impact on the effectiveness of vaccines and therapeutics.
Influenza
• The flu vaccine is the most effective way to prevent the flu and flu-related complications, such as pneumonia. That is why the Government of Canada works with the provinces and territories to ensure people in Canada have access to flu vaccines every year during flu season.
• Getting the flu vaccine also helps protect family and friends, young and old, and especially those at higher risk of flu-related complications.
• NACI recommends that everyone 6 months of age and older get the annual flu vaccine.
RSV
• RSV is a common respiratory virus and the most common cause of respiratory hospitalizations in children in Canada and worldwide.
• The Government of Canada will continue to monitor the situation in Canada and elsewhere to provide the best information and advice possible to keep people in Canada safe.
IF PRESSED ON RSV VACCINE AVAILABILITY
Although vaccine recommendations are made at the federal level, the primary responsibility for matters related to the administration and delivery of health care services, including RSV vaccination programs, falls within provincial/territorial (PT) responsibility.
The Government of Canada is supporting PT access to Arexvy, the first and currently only RSV vaccine authorized for use in Canada in adults 60 years of age and older, through Public Services and Procurement Canada’s (PSPC) Bulk Procurement Program.
The Government of Canada will continue to engage PT partners to discuss their future program implementation and procurement plans for newly authorized RSV products.

Respiratory Virus Surveillance
Canada is taking a comprehensive, integrated approach to surveillance of respiratory viruses and participates in national and international activities to detect and monitor the spread of COVID-19, respiratory syncytial virus (RSV), and influenza in humans.
Monitoring genetic variations in COVID-19 combined with interprovincial and international spread of the virus continues to be crucial. Surveillance systems in place for variants have been developed to monitor for mutations that can change the virus’s ability to transmit, severity, and immune response. The Public Health Agency of Canada’s (PHAC) National Microbiology Laboratory and provincial and territorial labs monitor for new evolutions of the SARS-CoV-2 virus that may become Variants of Concern or Variants of Interest in Canada. Furthermore, the Canadian COVID-19 Outbreak Surveillance System collects and collates outbreak data provided by contributing PTs to report on aggregated outbreak trends. This information is complemented by other surveillance measures such as analysis of detailed case information from provinces and territories and in-depth scanning of PT websites/press releases and media coverage, reviewed by epidemiologists.
PHAC maintains the Respiratory Virus Detection Surveillance System, Canada’s national surveillance system that monitors the circulation of seasonal respiratory viruses, including RSV, each week. PHAC also maintains FluWatch, Canada’s national surveillance system that monitors circulating flu viruses, activity levels, outbreaks, and hospitalizations.
PHAC works with the Canadian Pediatric Society to support enhanced surveillance pilot projects on pediatric RSV to prepare for new treatments and vaccines to reduce the burden of RSV in vulnerable children.
Vaccination Guidance for COVID-19, Influenza, and RSV
Although the seasonality of the SARS-CoV-2 virus has not been established, other respiratory viruses such as influenza and RSV typically increase in the fall and winter months. Vaccination for influenza and COVID-19 can help increase protection and reduce the impact on the health system while these viruses are circulating.
The National Advisory Committee on Immunization (NACI) recommends that seasonal influenza vaccines may be given concurrently with (i.e., same day) or at any time before or after COVID-19 vaccines.
COVID-19 Vaccine Guidance
For fall 2023, NACI recommends a dose of the XBB.1.5-containing formulation of COVID-19 vaccine for people in the authorized age groups if it has been at least 6 months from the previous COVID-19 vaccine dose or known SARS-CoV-2 infection. Vaccination for individuals at higher risk for severe COVID-19 is particularly recommended and will help reduce their risk of severe disease.
Vaccination of individuals at lower risk for severe disease may provide additional benefit to those at higher risk through indirect protection and could also be beneficial for reducing the risk of Post COVID-19 Condition.
NACI is awaiting further information on the COVID-19 vaccine products that will be available this fall and will provide additional advice and clarification as needed.
Influenza Vaccine Guidance
NACI recommends that everyone 6 months of age and older without contraindications receive an annual influenza vaccine. Influenza vaccination is the most effective way to protect against influenza infection and its complications.
RSV Prevention Guidance
Health Canada authorized nirsevimab (a monoclonal antibody for infants) on April 19, 2023, and authorized Arexvy (a vaccine for older adults) on August 4, 2023. Authorization of a vaccine for use in pregnant people (to protect infants) and older adults is anticipated later this year.
The Canadian Agency for Drugs and Technology in Health has issued guidance on the optimal use of nirsevimab for 2023-2024 in infants entering their first RSV season. It prioritizes infants at risk of severe disease who also have more limited healthcare access, such as those in rural or remote areas requiring air transport for hospitalization.
NACI will provide guidance on the overall strategy to protect infants in the first half of 2024, which will include guidance on the use of the pregnancy vaccine as well as economic analyses to support guidance. NACI advice on adult strategies will follow later in 2024.

Influenza (flu) season in Canada usually occurs from mid-November to mid-May. Typically, RSV activity increases over the fall and winter months, peaking in December/January each year.
Fall 2022 marked the first combined respiratory virus season in which Canada experienced an early and intense influenza season during a time of unusually high detections of RSV, putting increased strain on already stressed healthcare systems.
The seasonality of COVID-19 has not been established as it is still a new virus and continues to rapidly evolve.
In a typical year in Canada, seasonal influenza leads to an estimated average of 12,200 hospitalizations and 3,500 deaths.
RSV is the leading cause of acute lower respiratory tract infections in children, nationally and internationally. Approximately 95% of children less than 2 years old develop at least one RSV infection.
The risk of complications from COVID-19, influenza, and RSV is low for most people in Canada. Individuals who get one of these viruses will usually have mild symptoms and will recover; however, infants, young children, seniors, and those with comorbidities are at a higher risk of severe illness.