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Selected Influenza Research Papers
Canadian Influenza Resources
International Influenza Resources
NGO Influenza Resources
Selected Influenza Research Papers
BRITISH MEDICAL JOURNAL
Click on the plus sign beside the resource title for a description
Summary: This study provides a systematic review of the evidence of effectiveness of
physical interventions to interrupt or reduce the spread of respiratory viruses. The review found that routine long term implementation
of some of the measures to interrupt or reduce the spread of respiratory viruses might be difficult. However, many simple and low cost
interventions reduce the transmission of epidemic respiratory viruses. More resources should be invested into studying which physical
interventions are the most effective, flexible, and cost effective means of minimising the impact of acute respiratory tract infections.
Keywords: influenza, H1N1
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Summary: Responding to concerns from doctors in many countries, the BMJ Group has now
made available a forum on pandemic flu through doc2doc.bmj.com - a new international on-line community for doctors.
Keywords: influenza, H1N1
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Summary: This study evaluted the ascertainment of the onset of community transmission of
pH1N1 in England during the early phase of the pandemic by comparing two surveillance systesm: NHS direct telephone health line and
regional laboratory results on patients who tested for pH1N1.
Keywords: influenza, H1N1
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Summary: This study assessed the acceptability of pre-pandemic influenza vaccination
among health care workers in public hospitals in Hong Kong and the effect of the pandemic alert level by the WHO. Health care workers
completed a questionnaire in the two studies. The outcome measured was health care workers- nurses, doctors and allied health professionals
- willingness to accept pre-pandemic influenza vaccination.
Keywords: influenza, H1N1
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Summary: As governments gear up to launch national vaccination programmes against swine flu,
questions are beginning to emerge about how many people will be prepared to take up the offer of the vaccine.
Keywords: influenza, H1N1
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Summary: The number of new cases of A/H1N1 influenza reported in England continues to
fall, but the government forecasts a sharp rise in cases during the winter months. England's cheif medical officer states the incidence
of swine flu is unusual at this time of the year. He also states that a decline in pattern is noted, but that it does not mean it is
truly reducing and an expected second wave is forecasted this winter.
Keywords: influenza, H1N1
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Summary: In a pandemic there are many uncertainties, but without vaccination many
healthcare workers will become infected. Although this will be a mild illness for most, deaths in previously healthy young adults have
occurred. Flu vaccination is likely to reduce this risk and has a well understood safety profile. Vaccination may also help to keep
the healthcare system operating at maximum capacity throughout the pandemic. Evidence from decades of seasonal vaccination suggests
likely benefits and low risk adverse events.
Keywords: influenza, H1N1
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CENTER FOR DISEASE CONTROL (CDC)
Summary: An outbreak of oseltamivir-resistant influenza A (H1N1) occurred in a
long-term care facility. Eight (47%) of 17 and 1 (6%) of 16 residents in 2 wards had oseltamivir-resistant influenza A virus (H1N1)
infections. Initial outbreak response included treatment and prophylaxis with oseltamivir. The outbreak abated, likely because of
infection control measures.
Keywords: influenza, H1N1, oseltamivir, resistant virus
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Summary: Resistance to oseltamivir was observed in influenza A pandemic (H1N1)
2009 virus isolated from an untreated person in Hong Kong, China. Investigations showed a resistant virus with the neuraminidase (NA)
274Y genotype in quasi-species from a nasopharyngeal aspirate. Monitoring for the naturally occurring NA 274Y mutation in this virus
is necessary.
Keywords: influenza, H1N1, oseltamivir, resistant virus
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Summary: Two different influenza vaccines are available this influenza season,
and many people will be recommended to receive both the seasonal influenza vaccine and the 2009 influenza A (H1N1) 2009 monovalent
vaccine. This document is only intended to address the current pandemic situation and might change as the situation unfolds. They
are not intended to be applied to routine use during future seasonal influenza vaccination efforts.
Keywords: influenza, H1N1
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Summary: This document provides interim guidance for state, local, territorial,
and tribal officials to use in developing recommendations for large public gatherings in their communities. Such gatherings can
include college and university commencement exercises, church services, sporting events, concerts, social and cultural celebrations,
weddings, conferences, and other similar activities attended by relatively large groups of people.
Keywords: influenza, H1N1
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Summary: Updated Interim Recommendations for Obstetric Health Care Providers
Related to Use of Antiviral Medications in the Treatment and Prevention of Influenza for 2009-2010 Season.
Keywords: influenza, obstetric, H1N1
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Summary: Map includes both seasonal flu and H1N1 flu activity. A weekly influenza
surveillance report prepared by the Influenza Division of the CDC.
Keywords: influenza, H1N1
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Summary: This guidance document addressses key components of the vaccine safety
monitoring plan for 2009 H1N1 monovalent vaccines and presents suggested roles for state, local, tribal and territorial health
officials involved in this monitoring.
Keywords: influenza, environmental changes, satellite images, H1N1
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Summary: On April 24, in response to reports from the CDC of the first cases of 2009
pandemic influenza A (H1N1) virus infection in the United States, the Chicago Department of Public Health (CDPH) established enhanced
surveillance for 2009 pandemic influenza A (H1N1) virus infections. This report summarizes laboratory-confirmed cases identified
during April 24--July 25 and provides clinical and epidemiologic data for a subset of those cases.
Keywords: influenza, H1N1, surveillance
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Summary: Recommendations by CDC's Advisory Committee on Immunization Practices (ACIP)
regarding the use of vaccine against infection with novel influenza A(H1N1)virus. Specific vaccines against the novel influenza A (H1N1)
virus are being manufactured, and license vaccine is expected to be available in the United States by mid-October 2009. However, the
initial supply of these vaccines might not be enough to meet the demand for vaccine. For this reason, the ACIP recommends that certain
groups at highest risk for infection or influenza-related complications should be the intial targets for vaccination.
Keywords: influenza, H1N1, vaccine, vaccines
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Summary: To track the incidence of influenza-like illness (ILI) and compare the
number of viruses identified as 2009 pandemic influenza A (H1N1) with the number identified as seasonal influenza, New Zealand public
health officials analyzed weekly data from the country's sentinel general practitioner (GP) surveillance system and nonsentinel laboratory
surveillance network for the period extending from the week ending May 3 through the week ending August 2. This report describes the results
of those analyses.
Keywords: influenza, H1N1, surveillance
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Summary: This article reviews infectious diseases and how it relates to the changing
human-constructed and natural environments. The article describes airline travel, population increase and displacement, pollution,
agricultural activity, changing socioeconomic structures and international conflict contributes to infectious diseases (epidemics
and pandemics) worldwide. The researchers discuss advances in the ability to predict these events and, in particular, the critical
role that satellite imaging could in mounting an effective response.
Keywords: influenza, satellite images, H1N1
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Summary: Researchers used a stochastic individual-based model that simulates
influenza virus transmission in a long-term care nursing home department to study the protection offered to patients by different
strategies of prophylaxis with oseltamivir and determined the effect of emerging resistance. Without resistance, postexposure
and continuous prophylaxis reduced the patient infection attack rate from 0.19 to 0.13 (RR 0.67) and 0.05 (RR 0.23), respectively.
Postexposure prophylaxis prevented more infections per dose (118 and 323 daily doses needed to prevent 1 infection, respectively)
and required fewer doses per season than continuous prophylaxis.
Keywords: influenza, H1N1, Oseltamivir, nursing homes
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Summary: As of August 8, 2009, CDC had received reports of 477 deaths associated
with 2009 pandemic influenza A (H1N1) in the United States, including 36 deaths among children aged <18 years. To characterize
these cases, CDC analyzed data from April to August 2009. The results of that analysis indicated that, of 36 children who died,
seven (19%) were aged <5 years, and 24 (67%) had one or more of the high-risk medical conditions. Twenty-two (92%) of the 24
children with high-risk medical conditions had neurodevelopmental conditions. Among 23 children with culture or pathology results
reported, laboratory-confirmed bacterial coinfections were identified in 10 (43%), including all six children who 1) were aged
≥5 years, 2) had no recognized high-risk condition, and 3) had culture or pathology results reported.
Keywords: influenza, H1N1, pediatric, surveillance
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Summary: This document provides guidance to help decrease the spread of flu among
students, faculty, and staff of institutions of higher education (IHE) and post-secondary educational institutions during the
2009-2010 academic year.
Keywords: influenza, H1N1, educational institutions
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Summary: This article investigates mode of transmission and risk factors of an
outbreak of pH1N1 cases among members of a tour group in China. This is a retrospective cohort design, in which index case status
was identified and secondary cases were traced during the follow-up investigation. This outbreak was apparently caused by droplet
transmission during coughing or talking. That airborne transmission was not a factor is supported by lack of secondary cases among
fellow bus and air travelers. The authors suggest the need to prevent transmission by droplet and fomites during a pandemic.
Keywords: influenza, H1N1, airborne transmission
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EUROSURVEILLANCE
Summary: Abstract: There are few structured data available to assess the risks
associated with pandemic influenza A(H1N1)v infection according to ethnic groups. In countries of the Americas and the Pacific
where these data are available, the attack rates are higher in indigenous populations, who also appear to be at approximately three
to six-fold higher risk of developing severe disease and of dying. These observations may be associated with documented risk factors
for severe disease and death associated with pandemic H1N1 influenza infection (especially the generally higher prevalence of diabetes,
obesity, asthma, chronic obstructive pulmonary disease and pregnancy in indigenous populations). More speculative factors include
those associated with the risk of infection (e.g. family size, crowding and poverty), differences in access to health services and,
perhaps, genetic factors.
Keywords: influenza, H1N1, indigenous populations, Pacific, populations
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Summary: An observational study was undertaken to examine hand hygiene behaviours by people
passing a hand sanitizer station in the foyer of a public hospital in New Zealand in August 2009. Of the 2,941 subjects observed, 449
(18.0%, 95% confidence interval: 16.6, 19.6) used the hand sanitizer. The results from this study indicate sub-optimal response to the
health promotion initiatives in the setting of a pandemic. These findings suggest the need for more effective health promotion of hand
hygiene and also the need to provide baseline measurements for future evaluation of hygiene practices.
Keywords: influenza, H1N1, hand hygiene, hand sanitizer
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Summary: The recent emergence of seasonal pH1N1 strains resistant to oseltamivir makes
it necessary to monitor carefully the susceptibility of human influenza viruses to neuraminidase inhibitors. This study reported the
prevalence of the oseltamivir resistance among Influenza A viruses (seasonal H1N1, seasonal H3N2, and pH1N1) circulating in south-western
France over the past three years. This resistance may occur in the absence of antiviral drug use and also emerge rapidly under treatment.
Presently two anti-influenza drugs are commercially available: oseltamivir and zanamivir, which selectively inhibit the neuraminidase
of both influenza A and B viruses. Oseltamivir is preferred over zanamivir because it is administered by the oral route. NAIs have been
prescribed worldwide since 1999. In France, their use was limited before the influenza pandemic 2009.
Keywords: influenza, H1N1, oseltamivir resistance, antiviral drug, anti-influenza drugs
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Summary: As of 25 August 2009, 14,940 cases of influenza A (H1N1)v
have been reported in Germany. Germany wants to continue the current reporting system until the number of respiratory infections
increases significantly, as can be expected in autumn again. Then it is planned to stop the case-based reporting by physicians and
get the necessary information from the laboratory-based reporting of confirmed cases as it is done for seasonal influenza viruses
and the sentinel surveillance.
Keywords: influenza, H1N1, surveillance
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Summary: This study describes the assessment of the secondary attack rate (SAR) and
the effectiveness of post-exposure antiviral prophylaxis among household contacts in the first domestic outbreak of a novel
influenza A(H1N1)v between mid-May and early June 2009 in Kobe city, Japan. The authors could not conclude whether antiviral
prophylaxis was effective or not. However, among close contacts with underlying disease who received prophylaxis, none of those
individuals developed a severe form of the disease.
Keywords: influenza, H1N1, antiviral, prohylaxis
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LANCET
Summary: A Montreal biosciences company has developed a genetic assay for in-office use,
to identify oseltamivir-resistant pandemic influenza A(H1N1). The test results, available in 2 working days, could be used to help
guide patient treatment decisions, said the vice president of Warnex Medical Laboratories Inc. Although physicians shouldn’t wait
on test results to initiate treatment, the short turnaround time would give quick notice on any need to switch drugs due to resistance.
The test uses genetic sequencing to detect the H275Y mutation of the neuraminidase gene, which has been shown to cause resistance to
oseltamivir.
Keywords: influenza, H1N1, oseltamivir, resistant
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Summary: Nearly 140 countries or territories have confirmed cases of novel H1N1,
including Africa, the last inhabited continent to be affected. The apparent absence of a dip in infections in the northern hemisphere
as summer progresses is causing concern. The disease caused by novel H1N1 remains mild. But as the number of deaths increases,
pregnant women, people who are overweight, and people with underlying disorders seem most at risk.
Keywords: influenza, H1N1, pandemic, containment
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Summary: Stockpiling of drugs can be an important part of the preparation for the next
influenza pandemic. Economic evaluations can help to guide policy makers on the economic feasibility of stockpiling. Extending these
studies to account for the probability of a pandemic, shelf life of vaccine or antiviral, management of the stockpile, optimum stockpile
inventory, and other pandemic preparation strategies might provide policy makers with additional information to make informed decisions
for the use of scarce health-care resources to yield greatest benefits..
Keywords: influenza, H1N1, pandemic, stockpile, inventory
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NATURE
Summary: Researchers describe the scientific and public-health challenges they
face in battling the H1N1 virus. This article contains an overview of the H1N1 Pandemic in Mexico, Australia, Japan, Argentina,
Vietnam, United States, India, and Sub-Saharan Africa.
Keywords: influenza, H1N1
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NEW ENGLAND JOURNAL OF MEDICINE
Summary: Abstract - Background: There is an urgent need for a vaccine that is
effective against the 2009 pandemic influenza A (H1N1) virus. Methods: A split-virus, inactivated candidate vaccine against the
2009 H1N1 virus was manufactured, and we evaluated its safety and immunogenicity in a randomized clinical trial. Subjects were
between 3 and 77 years of age, stratified into four age groups. The immunization schedule consisted of two vaccinations, 21 days
apart. Subjects were injected with placebo or with vaccine, with or without alum adjuvant, at doses of 7.5 μg, 15 μg, or 30 μg.
Serologic analysis was performed at baseline and on days 21 and 35. Results: A total of 2200 subjects received one dose, and 2103
(95.6%) received the second dose, of vaccine or placebo. No severe adverse side effects associated with the vaccine were noted.
Keywords: influenza, H1N1
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Summary: In December 2009, the Department of Health and Human Services will present to
Congress its first-ever national health security strategy, outlining high-priority activities and areas of investment for strengthening
the capability of the United States to prepare for, and respond to, and recover from large-scale public health emergencies. The strategy
is being developed in parallel with a national debate over health care reform, since national health security will not be achievable
without key elements of reform.
Keywords: influenza, H1N1, public health, emergencies
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Influenza H1N1 - NEJM editorial (pdf)
Swine Influenza A (H1) - NEJM article (pdf)
Novel Swine-Origin Influenza A (H1N1)pdf)
Oseltamivir-Resistant Influenza (pdf)
H1N1 Electronic Monitoring (pdf)
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PLoS ONE
Summary: Since the spring of 1977, two subtypes of influenza A virus (H3N2 and H1N1)
have been seasonally infecting the human population. Here, the authors describe the distribution of patient ages within the populations
that exhibit symptomatic disease caused by each of subtype of seasonal influenza viruses. When the information is pooled across multiple
geographical locations and seasons, differences emerge between these subtypes. The authors report that the symptomatic flu due to H1N1
is distributed mainly in a younger population relative to H3N2. (The median age of the H3N2 patients is 23 years while H1N1 patients
are 9 years old.) These characteristic spectra of age groups are consistent with previous reports from various regional population
studies and also findings on the evolutionary dynamics of each subtype.
Keywords: influenza, H1N1
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Summary: Using the online resource Newseum, the authors investigated
front-page newspaper coverage of four prominent medical stories, and a high-profile non-medical news story as a control,
reported in the US in 2007. In total, 1630 front pages were searched. Each medical story appeared on the front pages of 85 to 117
(67.5%–78.7%) ranked newspaper titles that had a cumulative daily circulation of 23.1 to 33.4 million, or 61.8% to 88.4% of all
newspapers. In contrast, the non-medical story achieved front-page coverage in 152 (99.3%) newspaper titles with a total circulation
of 41.0 million, or 99.8% of all newspapers. Front-page medical stories varied in their sources, but the Washington Post,
Los Angeles Times, New York Times and the Associated Press together supplied 61.7% of the total coverage of target
front-page medical stories.
Keywords: influenza, H1N1
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Summary: A molecular model of the swine influenza A/H1N1 type-I neuraminidase was
built using the pathogenic avian H5N1 type-I neuraminidase as a basis, due to the higher sequence identify betwen A/H1N1 and H5N1
(91.47%) compated to Spanish H1N1 (88.37%) neuraminidase.
Keywords: influenza, H1N1
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PUBLIC HEALTH AGENCY OF CANADA
Summary: When considering your options about vaccination there are a number of factors
that you should think about. This chart explains the risk of getting the flu versus the benefits and risks of getting an H1N1 flu vaccine
and/or taking antiviral medication if you do get the flu.
Keywords: influenza, H1N1, flu, vaccine
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Summary: Pregnant women are not more likely to get the H1N1 flu, but if they do catch it, they are more likely to suffer
complications, like pneumonia and severe respiratory distress. This puts both the mother and the baby’s health at risk. Severe
complications from the flu could lead to early delivery or miscarriage.
Keywords: influenza, H1N1, pregnancy, breastfeeding, flu virus
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Summary: As with the seasonal flu, children less than five years old and especially those
less than two, are more likely to catch the H1N1 flu virus, and if they do catch it, they are more likely to develop severe complications,
like pneumonia or breathing problems.
Keywords: influenza, H1N1, children
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Summary: Healthy people over 65 years of age don't seem to be at high risk of catching
the H1N1 flu or of developing serious complications. However, seniors with chronic medical conditions or weakened immune systems may be
at increased risk of catching H1N1 and of developing serious complications from the flu, such as pneumonia or respiratory distress.
Keywords: influenza, H1N1, seniors, elderly, flu, virus
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Summary: Everyone is at risk of catching the H1N1 flu virus but individuals with chronic
medical conditions may be at increased risk of catching H1N1 and of developing serious complications from the flu, such as pneumonia
or respiratory distress.
Keywords: influenza, H1N1, medical, complications, health, pneumonia
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Summary: Description of move to meet in Winnipeg next week to share and discuss best
practices for treating severe H1N1 infections, as well as investment of 2.7 million to the Influenza Research Network to evaluate the
safety and efficacy of the pandemic vaccine, as well as to monitor and evaluate vaccine implementation programs.
Keywords: influenza, H1N1, vaccine, healthcare workers, PHAC
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Summary: Annex from the Public Health Agency of Canadas Canadian Pandemic
Influenza Plan for the Health Sector
Keywords: influenza, H1N1, antiviral, recommendations
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WORLD HEALTH ORGANIZATION (WHO)
Summary: The World Health Organization (WHO) posted surveillance and status updates
for regions where the pandemic H1N1 is just gaining a foothold, including the Mideast, Africa, and parts of Asia and the Pacific, which
showed Southeast Asia as the hardest hit of those areas.
Keywords: influenza, H1N1, WHO
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Summary: This guidance document is an update of WHO Global Influenza
Preparedness Plan, the role of WHO and recommendations for national measures before and during pandemics,
published by WHO March 2005.
Keywords: influenza, H1N1, WHO
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Canadian Influenza Resources
H1N1 Flu vaccine: Dosing
Recommendations (October 21, 2009)
H1N1 flu virus frequently asked questions
(October 21, 2009)
Canadian Planning Recommendations for
the Use of Anti-Influenza (Antiviral) Drugs (pdf)
Interim Guidance from PHAC
for emergency use of oseltamivir (Tamiflu) in children under one year of age
Interim Guidance from PHAC for
Ambulatory Care of Influenza-like illness
Interim Clinical
Guidance from PHAC for Pregnant and Breastfeeding Women with Influenza-like Illness
Public Health Agency of Canada
FightFLU.ca Provided by the Public Health Agency of Canada
Health Canada
Canadian Centre for Occupational Health and Safety - Pandemic
Planning
Ministry of Health and
Long-Term Care - Ontario
Ministry of Health and
Long-Term Care - Ontario (scroll down to "influenza" for the resource list)
The Ontario Agency for Health Protection and Promotion
BC Centre for Disease Control
Government of Canada Pandemic Preparedness - SafeCanada.ca
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International Influenza Resources
UK Pandemic Plan (pdf)
US Health and Human Services Pandemic Guidelines (pdf)
Centers for Disease Control
World Health Organization
World Health Organization - H1N1
UK Department of Health
UK Department of Health - specific resources
for health care and social services including editable posters
UK Health Protection
Agency
Pan American Health Organization
Facemasks and Respirators in an
Influenza Pandemic (pdf)
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NGO Influenza Resources
Pandemic Planning Toolkit - provided through Roche
Pharmaceuticals
Please note that this is a commercial site and it is included because of its
information on the antiviral oseltamivir (Tamiflu). This medication is manufactured by Roche who also control content on the webpage. The
inclusion of this site on this list is not an endorsement of one pharmaceutical company over another, nor does it endorse the use of oseltamivir
in this H1N1 outbreak.
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