{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T23:03:37Z","timestamp":1772233417499,"version":"3.50.1"},"reference-count":22,"publisher":"Springer Science and Business Media LLC","issue":"4","license":[{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T00:00:00Z","timestamp":1622160000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"crossref","id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Can J Public Health"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Seasonal influenza is an acute respiratory infection that presents a significant annual burden to Canadians and the Canadian healthcare system. Social distancing measures that were implemented to control the 2019\u20132020 novel coronavirus outbreak were investigated for their ability to lessen the incident cases of seasonal influenza.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted an ecological study using data from Canada\u2019s national influenza surveillance system to investigate whether social distancing measures to control COVID-19 reduced the incident cases of seasonal influenza. Data taken from three separate time frames facilitated analysis of the 2019\u20132020 influenza season prior to, during, and following the implementation of COVID-19-related measures and enabled comparisons with the same time periods during three preceding flu seasons. The incidence, which referred to the number of laboratory-confirmed cases of specific influenza strains, was of primary focus. Further analysis determined the number of new laboratory-confirmed influenza or influenza-like illness outbreaks.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Our results indicate a premature end to the 2019\u20132020 influenza season, with significantly fewer cases and outbreaks being recorded following the enactment of many COVID-19 social distancing policies. The incidence of influenza strains A (H3N2), A (unsubtyped), and B were all significantly lower at the tail end of the 2019\u20132020 influenza season as\u00a0compared with preceding seasons (\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0003,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0007,\n                      <jats:italic>p<\/jats:italic>\n                      = 0.0019).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Specific social distancing measures and behaviours may serve as effective tools to limit the spread of influenza transmission moving forward, as they become more familiar.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.17269\/s41997-021-00509-4","type":"journal-article","created":{"date-parts":[[2021,5,28]],"date-time":"2021-05-28T09:02:58Z","timestamp":1622192578000},"page":"620-628","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Changes in the incidence of seasonal influenza in response to COVID-19 social distancing measures: an observational study based on Canada\u2019s national influenza surveillance system"],"prefix":"10.17269","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8577-0589","authenticated-orcid":false,"given":"Andrew","family":"Pierce","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9196-2242","authenticated-orcid":false,"given":"Margaret","family":"Haworth-Brockman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4715-8388","authenticated-orcid":false,"given":"Diana","family":"Marin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6342-1812","authenticated-orcid":false,"given":"Zulma V.","family":"Rueda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4948-4707","authenticated-orcid":false,"given":"Yoav","family":"Keynan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2021,5,28]]},"reference":[{"issue":"10","key":"509_CR1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001885","volume":"12","author":"EI Benchimol","year":"2015","unstructured":"Benchimol, E. I., Smeeth, L., Guttmann, A., Harron, K., Moher, D., Petersen, I., et al. (2015). The REporting of studies Conducted using Observational Routinely-collected health Data (RECORD) Statement. PLOS Medicine, 12(10), e1001885. https:\/\/doi.org\/10.1371\/journal.pmed.1001885.","journal-title":"PLOS Medicine"},{"key":"509_CR2","unstructured":"Canadian Institute for Health Information. (2017). Gender, workforce and health system change in Canada. https:\/\/www.who.int\/hrh\/Oral-Gender-equity-and-womens-economic-empowerment-Porter-and-Bourgeault-16Nov-17h30-18h30.pdf?ua=1. Accessed August 14, 2020."},{"key":"509_CR3","doi-asserted-by":"publisher","unstructured":"Chiu, N.-C., Chi, H., Tai, Y.-L., Peng, C.-C., Tseng, C.-Y., Chen, C.-C., et al. (2020). Wearing masks, hand hygiene, and social distancing contribute to the decrease of influenza and all-cause pneumonia in coronavirus pandemic: A retrospective national epidemiological surveillance study. Journal of Medical Internet Research. https:\/\/doi.org\/10.2196\/21257.","DOI":"10.2196\/21257"},{"key":"509_CR4","doi-asserted-by":"publisher","first-page":"976","DOI":"10.3201\/eid2605.190995","volume":"26","author":"MW Fong","year":"2020","unstructured":"Fong, M. W., Gao, H., Wong, J. Y., Xiao, J., Shiu, E. Y. C., Ryu, S., & Cowling, B. J. (2020). Nonpharmaceutical measures for pandemic influenza in nonhealthcare settings-social distancing measures. Emerging Infectious Diseases, 26, 976\u2013984. https:\/\/doi.org\/10.3201\/eid2605.190995.","journal-title":"Emerging Infectious Diseases"},{"key":"509_CR5","unstructured":"Government of Canada. (2019). Overview of influenza monitoring in Canada. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/flu-influenza\/influenza-surveillance\/about-fluwatch.html. Accessed August 11, 2020."},{"key":"509_CR6","unstructured":"Government of Canada. (2020a). Fluwatchers. https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/stop-spread-flu-poster.html. Accessed August 15, 2020."},{"key":"509_CR7","unstructured":"Government of Canada. (2020b). Coronavirus disease (COVID-19): Outbreak update. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/2019-novel-coronavirus-infection.html. Accessed July 15, 2020."},{"key":"509_CR8","unstructured":"Government of Canada. (2020c). Flu (Influenza): For health professionals. https:\/\/www.canada.ca\/en\/public-health\/services\/diseases\/flu-influenza\/health-professionals.html. Accessed August 15, 2020."},{"key":"509_CR9","unstructured":"Government of Canada. (2021). FluWatch report: January 24, 2021 to January 30, 2021 (week 04) - Canada.ca. https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/diseases-conditions\/fluwatch\/2020-2021\/week-04-january-24-january-30-2021.html. Accessed February 8, 2021."},{"key":"509_CR10","unstructured":"Infection Prevention & Control Canada. (2020). Seasonal Influenza, Avian Influenza and Pandemic Influenza. https:\/\/ipac-canada.org\/influenza-resources.php. Accessed February 8, 2021."},{"issue":"10127","key":"509_CR11","doi-asserted-by":"publisher","first-page":"1285","DOI":"10.1016\/S0140-6736(17)33293-2","volume":"391","author":"AD Iuliano","year":"2018","unstructured":"Iuliano, A. D., Roguski, K. M., Chang, H. H., Muscatello, D. J., Palekar, R., Tempia, S., et al. (2018). Estimates of global seasonal influenza-associated respiratory mortality: A modelling study. The Lancet, 391(10127), 1285\u20131300. https:\/\/doi.org\/10.1016\/S0140-6736(17)33293-2.","journal-title":"The Lancet"},{"issue":"8","key":"509_CR12","doi-asserted-by":"publisher","first-page":"1928","DOI":"10.3201\/eid2608.201192","volume":"26","author":"SC Kuo","year":"2020","unstructured":"Kuo, S. C., Shih, S. M., Chien, L. H., & Hsiung, C. A. (2020). Collateral benefit of COVID-19 control measures on influenza activity, Taiwan. Emerging Infectious Diseases, 26(8), 1928\u20131930. https:\/\/doi.org\/10.3201\/eid2608.201192.","journal-title":"Emerging Infectious Diseases"},{"key":"509_CR13","doi-asserted-by":"publisher","unstructured":"Marchand-Sen\u00e9cal, X., Kozak, R., Mubareka, S., Salt, N., Gubbay, J. B., Eshaghi, A., et al. (2020). Diagnosis and management of first case of COVID-19 in Canada: Lessons applied from SARS. Clinical Infectious Diseases : An Official Publication of the Infectious Diseases Society of America. https:\/\/doi.org\/10.1093\/cid\/ciaa227.","DOI":"10.1093\/cid\/ciaa227"},{"key":"509_CR14","unstructured":"National Institute on Ageing. (2018). The underappreciated burden of influenza amongst Canada's older population. And what we need to do about it. https:\/\/www.ryerson.ca\/content\/dam\/nia\/white-papers\/burden-of-influenza.pdf. Accessed July 14, 2020."},{"key":"509_CR15","unstructured":"Public Health Agency of Canada. (2016). Canadian immunization guide chapter on influenza and statement on seasonal influenza vaccine for 2016-2017.\u00a0https:\/\/www.canada.ca\/en\/public-health\/services\/immunization\/national-advisory-committee-on-immunization-naci\/canadian-immunization-guide-chapter-on-influenza-statement-on-seasonal-influenza-vaccine-2016-2017-advisory-committee-statement.html#t1. Accessed August 13, 2020."},{"key":"509_CR16","unstructured":"Public Health Agency of Canada. (2019a). Surveillance annex: Canadian pandemic influenza preparedness: Planning guidance for the health sector. https:\/\/www.canada.ca\/en\/public-health\/services\/flu-influenza\/canadian-pandemic-influenza-preparedness-planning-guidance-health-sector\/surveillance-annex.html#a22. Accessed July 15, 2020."},{"key":"509_CR17","unstructured":"Public Health Agency of Canada. (2019b). Vaccine uptake in Canadian adults 2019. https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/healthy-living\/2018-2019-influenza-flu-vaccine-coverage-survey-results.html. Accessed August 10, 2020."},{"key":"509_CR18","unstructured":"Statistics Canada. (2020). Population estimates, quarterly. https:\/\/www150.statcan.gc.ca\/t1\/tbl1\/en\/tv.action?pid=1710000901. Accessed February 22, 2021."},{"key":"509_CR19","unstructured":"Vogel, L. (2020). COVID-19: A timeline of Canada\u2019s first-wave response. Canadian Medical Association Journal. https:\/\/cmajnews.com\/2020\/06\/12\/coronavirus-1095847\/. Accessed July 15, 2020."},{"key":"509_CR20","unstructured":"World Health Organization. (2020a). 2019\u20132020 influenza season: Repurposing surveillance systems for COVID-19. https:\/\/www.euro.who.int\/en\/health-topics\/communicable-diseases\/influenza\/news\/news\/2020\/5\/20192020-influenza-season-repurposing-surveillance-systems-for-covid-19. Accessed August 10, 2020."},{"key":"509_CR21","unstructured":"World Health Organization. (2020b). Q&A on coronaviruses (COVID-19). https:\/\/www.who.int\/emergencies\/diseases\/novel-coronavirus-2019\/question-and-answers-hub\/q-a-detail\/q-a-coronaviruses. Accessed July 22, 2020."},{"key":"509_CR22","unstructured":"World Health Organization. (2020c). WHO FLUMART OUTPUTS. https:\/\/apps.who.int\/flumart\/Default?ReportNo=12. Accessed July 23, 2020."}],"container-title":["Canadian Journal of Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-021-00509-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.17269\/s41997-021-00509-4\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.17269\/s41997-021-00509-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,6,24]],"date-time":"2021-06-24T10:12:47Z","timestamp":1624529567000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.17269\/s41997-021-00509-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,5,28]]},"references-count":22,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2021,8]]}},"alternative-id":["509"],"URL":"https:\/\/doi.org\/10.17269\/s41997-021-00509-4","relation":{"has-preprint":[{"id-type":"doi","id":"10.21203\/rs.3.rs-93953\/v1","asserted-by":"object"}]},"ISSN":["0008-4263","1920-7476"],"issn-type":[{"value":"0008-4263","type":"print"},{"value":"1920-7476","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,5,28]]},"assertion":[{"value":"29 September 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 March 2021","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 May 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The views expressed herein do not necessarily represent the views of the Public Health Agency of Canada.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable as this paper is secondary analysis of publicly available data","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"All authors consent to having this information published.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publication"}}]}}