OTTAWA - Swine flu is surging across Canada, with Ontario and Quebec now starting to catch up to the hard-hit western provinces, says the chief public health officer.

"At the moment, certainly the reports we're getting from Ontario, Quebec is that there is increasing activity," Dr. David Butler-Jones said Wednesday.

"And certainly in the West, the vast majority of the positive tests ... are coming up with H1, which suggests that over the last two weeks we're starting to see an important increase.

"We're definitely in the next wave now."

Overall flu activity has been steadily increasing for several weeks, particularly in British Columbia, Alberta, Saskatchewan and the Northwest Territories.

A swine-flu outbreak that began in B.C.'s Lower Mainland has been creeping north for several weeks now, Butler-Jones said.

The Prairie provinces are also seeing an uptick in H1N1.

"Two, three weeks ago, the number of H1s amongst the tests for influenza-like illness were a tiny minority," Butler-Jones said.

"Now it's increasing, which again suggests that H1 is the bulk of many of the infections there as well."

A southeastern Saskatchewan health region has opened a flu assessment site to ease the burden the virus is putting on emergency rooms.

One hospital in the province has even been forced to postpone elective procedures and surgeries as it copes with the crush of people with flu-like illnesses.

Meanwhile, Manitoba is seeing an "unprecedented" uptake of the swine flu vaccine with the immunization of almost 40,000 people across the province in 48 hours, health officials said Wednesday.

As of Tuesday, some 38,400 people across the province had been immunized against the virus - a rate not seen with any other vaccination program so far.

In Ontario, children's hospitals in Toronto and Ottawa have been swamped recently as worried parents bring in their children over swine flu concerns.

Those fears may have been stoked by the recent deaths of two children from the H1N1 virus in the province.

Evan Frustaglio, a 13-year-old hockey player from Toronto, died Monday after falling sick on the weekend and 10-year-old Vanetia Warner of Cornwall died Saturday after being ill for several days.

Toronto's Hospital for Sick Children says it is seeing as many cases as it usually does during peak flu season, which tends to come much later in the year.

But most cases have been mild and children are being sent home with their parents.

Still, the virus appears to have even health-care workers skittish.

They are turning out in droves for the new H1N1 vaccine, said Dr. Michael Gardam, director of infectious diseases prevention and control at the Ontario Agency for Health Protection and Promotion.

"My experience at (University Health Network) has been I have never seen people (health-care workers) want a flu shot so much in my life," he said.

"When we rolled it out on Friday, there was a crowd waiting ... to get the computer system up and running so they could start.

"And we're trying to give the flu shots right now to sort of our high-risk areas, where they're likely to encounter flu patients. But they can't get there - they're getting stopped in the halls before they get there by people who want to get their shots."

Meanwhile, the Atlantic provinces have seen "sporadic" H1N1 flu activity, Butler-Jones said. But he adds it's only a matter of time before swine-flu cases spike across the country.

"I wouldn't say sort of one province is worse than another," Butler-Jones said.

"We're very quickly moving to a setting where virtually all provinces and territories will be seeing an increase in cases."

The autumn bout of the H1N1 virus comes as the federal government has approved a new H1N1 vaccine.

Some six million doses of the swine-flu vaccine will have been shipped to the provinces and territories by the end of the week.

But the new vaccine contains adjuvants, or compounds that boost the immune system's response to vaccine, allowing for smaller doses. That has some people worried.

Until now there had been no licensed flu vaccine containing adjuvant in Canada, although adjuvants have been used for years in Europe in flu vaccines targeted at seniors.

There are no data on the use of adjuvanted flu vaccine in pregnant women, and only limited data on the safety of the additives in vaccines given to children.

The federal government says a non-adjuvanted vaccine should be available next week.

More than 1,600 people have been hospitalized since the virus appeared in April, with some 300 cases being admitted to intensive-care units and most of those ICU patients being put on ventilators.

But the number may actually be higher since the Public Health Agency of Canada has stopped counting confirmed cases of H1N1 a while ago.

By comparison, the Public Health Agency of Canada's website says the common flu sends about 20,000 Canadians to hospital each year. Between 4,000 and 8,000 Canadians die of influenza and its complications annually, depending on the severity of the season.

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