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Assessing secondary attack rates among household contacts at the beginning of the influenza A (H1N1) pandemic in Ontario, Canada, April-June 2009: a prospective, observational study.

https://arctichealth.org/en/permalink/ahliterature135284
Source
BMC Public Health. 2011;11:234
Publication Type
Article
Date
2011
Author
Rachel Savage
Michael Whelan
Ian Johnson
Elizabeth Rea
Marie LaFreniere
Laura C Rosella
Freda Lam
Tina Badiani
Anne-Luise Winter
Deborah J Carr
Crystal Frenette
Maureen Horn
Kathleen Dooling
Monali Varia
Anne-Marie Holt
Vidya Sunil
Catherine Grift
Eleanor Paget
Michael King
John Barbaro
Natasha S Crowcroft
Author Affiliation
Ontario Agency for Health Protection and Promotion, Toronto, Ontario, Canada. rachel.savage@oahpp.ca
Source
BMC Public Health. 2011;11:234
Date
2011
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Child
Child, Preschool
Contact Tracing
Family Characteristics
Female
Humans
Infant
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology - transmission
Male
Middle Aged
Ontario - epidemiology
Pandemics
Population Surveillance
Prospective Studies
Risk factors
Seasons
Young Adult
Abstract
Understanding transmission dynamics of the pandemic influenza A (H1N1) virus in various exposure settings and determining whether transmissibility differed from seasonal influenza viruses was a priority for decision making on mitigation strategies at the beginning of the pandemic. The objective of this study was to estimate household secondary attack rates for pandemic influenza in a susceptible population where control measures had yet to be implemented.
All Ontario local health units were invited to participate; seven health units volunteered. For all laboratory-confirmed cases reported between April 24 and June 18, 2009, participating health units performed contact tracing to detect secondary cases among household contacts. In total, 87 cases and 266 household contacts were included in this study. Secondary cases were defined as any household member with new onset of acute respiratory illness (fever or two or more respiratory symptoms) or influenza-like illness (fever plus one additional respiratory symptom). Attack rates were estimated using both case definitions.
Secondary attack rates were estimated at 10.3% (95% CI 6.8-14.7) for secondary cases with influenza-like illness and 20.2% (95% CI 15.4-25.6) for secondary cases with acute respiratory illness. For both case definitions, attack rates were significantly higher in children under 16 years than adults (25.4% and 42.4% compared to 7.6% and 17.2%). The median time between symptom onset in the primary case and the secondary case was estimated at 3.0 days.
Secondary attack rates for pandemic influenza A (H1N1) were comparable to seasonal influenza estimates suggesting similarities in transmission. High secondary attack rates in children provide additional support for increased susceptibility to infection.
Notes
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PubMed ID
21492445 View in PubMed
Less detail

Assessing the relative timeliness of Ontario's syndromic surveillance systems for early detection of the 2009 influenza H1N1 pandemic waves.

https://arctichealth.org/en/permalink/ahliterature107181
Source
Can J Public Health. 2013 Jul-Aug;104(4):340-7
Publication Type
Article
Author
Anna Chu
Rachel Savage
Michael Whelan
Laura C Rosella
Natasha S Crowcroft
Don Willison
Anne-Luise Winter
Richard Davies
Ian Gemmill
Pia K Mucchal
Ian Johnson
Author Affiliation
Public Health Ontario. rachel.savage@oahpp.ca.
Source
Can J Public Health. 2013 Jul-Aug;104(4):340-7
Language
English
Publication Type
Article
Keywords
Algorithms
Antiviral agents - therapeutic use
Humans
Influenza A Virus, H1N1 Subtype - isolation & purification
Influenza, Human - diagnosis - epidemiology
Laboratories - statistics & numerical data
Ontario - epidemiology
Pandemics
Population Surveillance - methods
Reproducibility of Results
Telemedicine - utilization
Time Factors
Abstract
Building on previous research noting variations in the operation and perceived utility of syndromic surveillance systems in Ontario, the timeliness of these different syndromic systems for detecting the onset of both 2009 H1N1 pandemic (A(H1N1)pdm09) waves relative to laboratory testing data was assessed using a standardized analytic algorithm.
Syndromic data, specifically local emergency department (ED) visit and school absenteeism data, as well as provincial Telehealth (telephone helpline) and antiviral prescription data, were analyzed retrospectively for the period April 1, 2009 to January 31, 2010. The C2-MEDIUM aberration detection method from the US Centers for Disease Control and Prevention's EARS software was used to detect increases above expected in syndromic data, and compared to laboratory alerts, defined as notice of confirmed A(H1N1)pdm09 cases over two consecutive days, to assess relative timeliness.
In Wave 1, provincial-level alerts were detected for antiviral prescriptions and Telehealth respiratory calls before the laboratory alert. In Wave?2, Telehealth respiratory calls similarly alerted in advance of the laboratory, while local alerts from ED visit, antiviral prescription and school absenteeism data varied in timing relative to the laboratory alerts. Alerts from syndromic data were also observed to coincide with external factors such as media releases.
Alerts from syndromic surveillance systems may be influenced by external factors and variation in system operations. Further understanding of both the impact of external factors on surveillance data and standardizing protocols for defining alerts is needed before the use of syndromic surveillance systems can be optimized.
PubMed ID
24044464 View in PubMed
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Community-acquired respiratory viruses and co-infection among patients of Ontario sentinel practices, April 2009 to February 2010.

https://arctichealth.org/en/permalink/ahliterature121721
Source
Influenza Other Respir Viruses. 2013 Jul;7(4):559-66
Publication Type
Article
Date
Jul-2013
Author
Adriana Peci
Anne-Luise Winter
Jonathan B Gubbay
Danuta M Skowronski
Elizabeth I Balogun
Cedric De Lima
Natasha S Crowcroft
Anu Rebbapragada
Author Affiliation
Public Health Ontario, Toronto, ON, Canada.
Source
Influenza Other Respir Viruses. 2013 Jul;7(4):559-66
Date
Jul-2013
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Coinfection - epidemiology - virology
Community-Acquired Infections - epidemiology - virology
Female
Humans
Infant
Infant, Newborn
Influenza, Human - complications
Male
Middle Aged
Molecular Diagnostic Techniques
Ontario - epidemiology
Prevalence
Respiratory Tract Infections - epidemiology - virology
Risk factors
Viruses - classification - isolation & purification
Young Adult
Abstract
Respiratory viruses are known to cocirculate but this has not been described in detail during an influenza pandemic.
To describe respiratory viruses, including co-infection and associated attributes such as age, sex or comorbidity, in patients presenting with influenza-like illness to a community sentinel network, during the pandemic A(H1N1)pdm09 in Ontario, Canada.
Respiratory samples and epidemiologic details were collected from 1018 patients with influenza-like illness as part of respiratory virus surveillance and a multiprovincial case-control study of influenza vaccine effectiveness.
At least one virus was detected in 668 (65?6%) of 1018 samples; 512 (50?3%) had single infections and 156 (15?3%) co-infections. Of single infections, the most common viruses were influenza A in 304 (59?4%) samples of which 275 (90?5%) were influenza A(H1N1)pdm09, and enterovirus/rhinovirus in 149 (29?1%) samples. The most common co-infections were influenza A and respiratory syncytial virus B, and influenza A and enterovirus/rhinovirus. In multinomial logistic regression analyses adjusted for age, sex, comorbidity, and timeliness of sample collection, single infection was less often detected in the elderly and co-infection more often in patients
PubMed ID
22883216 View in PubMed
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Estimated epidemiologic parameters and morbidity associated with pandemic H1N1 influenza.

https://arctichealth.org/en/permalink/ahliterature146969
Source
CMAJ. 2010 Feb 9;182(2):131-6
Publication Type
Article
Date
Feb-9-2010
Author
Ashleigh R Tuite
Amy L Greer
Michael Whelan
Anne-Luise Winter
Brenda Lee
Ping Yan
Jianhong Wu
Seyed Moghadas
David Buckeridge
Babak Pourbohloul
David N Fisman
Author Affiliation
Research Institute of The Hospital for Sick Children, and the Dalla Lana School of Public Health, Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario.
Source
CMAJ. 2010 Feb 9;182(2):131-6
Date
Feb-9-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Age Distribution
Age Factors
Aged
Aged, 80 and over
Child
Child, Preschool
Disease Outbreaks
Humans
Infant
Infant, Newborn
Infectious Disease Incubation Period
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology - transmission
Markov Chains
Middle Aged
Monte Carlo Method
Ontario - epidemiology
Patient Admission - statistics & numerical data
Proportional Hazards Models
Risk
Young Adult
Abstract
In the face of an influenza pandemic, accurate estimates of epidemiologic parameters are required to help guide decision-making. We sought to estimate epidemiologic parameters for pandemic H1N1 influenza using data from initial reports of laboratory-confirmed cases.
We obtained data on laboratory-confirmed cases of pandemic H1N1 influenza reported in the province of Ontario, Canada, with dates of symptom onset between Apr. 13 and June 20, 2009. Incubation periods and duration of symptoms were estimated and fit to parametric distributions. We used competing-risk models to estimate risk of hospital admission and case-fatality rates. We used a Markov Chain Monte Carlo model to simulate disease transmission.
The median incubation period was 4 days and the duration of symptoms was 7 days. Recovery was faster among patients less than 18 years old than among older patients (hazard ratio 1.23, 95% confidence interval 1.06-1.44). The risk of hospital admission was 4.5% (95% CI 3.8%-5.2%) and the case-fatality rate was 0.3% (95% CI 0.1%-0.5%). The risk of hospital admission was highest among patients less than 1 year old and those 65 years or older. Adults more than 50 years old comprised 7% of cases but accounted for 7 of 10 initial deaths (odds ratio 28.6, 95% confidence interval 7.3-111.2). From the simulation models, we estimated the following values (and 95% credible intervals): a mean basic reproductive number (R0, the number of new cases created by a single primary case in a susceptible population) of 1.31 (1.25-1.38), a mean latent period of 2.62 (2.28-3.12) days and a mean duration of infectiousness of 3.38 (2.06-4.69) days. From these values we estimated a serial interval (the average time from onset of infectiousness in a case to the onset of infectiousness in a person infected by that case) of 4-5 days.
The low estimates for R0 indicate that effective mitigation strategies may reduce the final epidemic impact of pandemic H1N1 influenza.
Notes
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PubMed ID
19959592 View in PubMed
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Estimates of influenza vaccine effectiveness for 2007-2008 from Canada's sentinel surveillance system: cross-protection against major and minor variants.

https://arctichealth.org/en/permalink/ahliterature125320
Source
J Infect Dis. 2012 Jun 15;205(12):1858-68
Publication Type
Article
Date
Jun-15-2012
Author
Naveed Z Janjua
Danuta M Skowronski
Gaston De Serres
Jim Dickinson
Natasha S Crowcroft
Marsha Taylor
Anne-Luise Winter
Travis S Hottes
Kevin Fonseca
Hugues Charest
Steven J Drews
Suzana Sabaiduc
Nathalie Bastien
Yan Li
Jennifer L Gardy
Martin Petric
Author Affiliation
British Columbia Centre for Disease Control, Canada.
Source
J Infect Dis. 2012 Jun 15;205(12):1858-68
Date
Jun-15-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Antigens, Viral - analysis
Canada - epidemiology
Child
Child, Preschool
Cluster analysis
Cross Protection
Female
Genotype
Hemagglutination inhibition tests
Humans
Infant
Influenza A virus - classification - genetics - immunology - isolation & purification
Influenza B virus - classification - genetics - immunology - isolation & purification
Influenza Vaccines - administration & dosage - immunology
Influenza, Human - epidemiology - prevention & control
Male
Middle Aged
Molecular Sequence Data
Nasopharynx - virology
Nose - virology
Real-Time Polymerase Chain Reaction
Sentinel Surveillance
Sequence Analysis, DNA
Young Adult
Abstract
To estimate influenza vaccine effectiveness (VE) for the 2007-2008 season and assess the sentinel surveillance system in Canada for monitoring virus evolution and impact on VE.
Nasal/nasopharyngeal swabs and epidemiologic details were collected from patients presenting to a sentinel physician within 7 days of influenza-like illness onset. Cases tested positive for influenza A/B virus by real-time polymerase chain reaction; controls tested negative. Hemagglutination inhibition (HI) and gene sequencing explored virus relatedness to vaccine. VE was calculated as 1 minus the odds ratio for influenza in vaccinated versus nonvaccinated participants, with adjustment for confounders.
Of 1425 participants, 21% were vaccinated. Influenza virus was detected in 689 (48%), of which isolates from 663 were typed/subtyped: 189 (29%) were A/H1, 210 (32%) were A/H3, and 264 (40%) were B. Of A/H1N1 isolates, 6% showed minor HI antigenic mismatch to vaccine, with greater variation based on genetic identity. All A/H3N2 isolates showed moderate antigenic mismatch, and 98% of influenza B virus isolates showed major lineage-level mismatch to vaccine. Adjusted VE for A/H1N1, A/H3N2, and B components was 69% (95% confidence interval [CI], 44%-83%), 57% (95% CI, 32%-73%), and 55% (95% CI, 32%-70%), respectively, with an overall VE of 60% (95% CI, 45%-71%).
Detailed antigenic and genotypic analysis of influenza viruses was consistent with epidemiologic estimates of VE showing cross-protection. A routine sentinel surveillance system that combines detailed virus and VE monitoring annually, as modeled in Canada, may guide improved vaccine selection and protection.
PubMed ID
22492921 View in PubMed
Less detail

Humoral and cell-mediated immunity to pandemic H1N1 influenza in a Canadian cohort one year post-pandemic: implications for vaccination.

https://arctichealth.org/en/permalink/ahliterature129191
Source
PLoS One. 2011;6(11):e28063
Publication Type
Article
Date
2011
Author
Lisa E Wagar
Laura Rosella
Natasha Crowcroft
Beth Lowcock
Paulina C Drohomyrecky
Julie Foisy
Jonathan Gubbay
Anu Rebbapragada
Anne-Luise Winter
Camille Achonu
Brian J Ward
Tania H Watts
Author Affiliation
Department of Immunology, University of Toronto, Toronto, Ontario, Canada.
Source
PLoS One. 2011;6(11):e28063
Date
2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Antibodies, Viral - immunology
Antibody Formation - immunology
CD8-Positive T-Lymphocytes - immunology
Canada - epidemiology
Case-Control Studies
Cohort Studies
Cross Reactions - immunology
Flow Cytometry
Humans
Immunity, Cellular - immunology
Immunity, Humoral - immunology
Immunologic Memory - immunology
Influenza A Virus, H1N1 Subtype - immunology
Influenza, Human - epidemiology - immunology - prevention & control
Male
Middle Aged
Pandemics - prevention & control
Polymerase Chain Reaction
Self Report
Tissue Donors
Vaccination
Young Adult
Abstract
We evaluated a cohort of Canadian donors for T cell and antibody responses against influenza A/California/7/2009 (pH1N1) at 8-10 months after the 2nd pandemic wave by flow cytometry and microneutralization assays. Memory CD8 T cell responses to pH1N1 were detectable in 58% (61/105) of donors. These responses were largely due to cross-reactive CD8 T cell epitopes as, for those donors tested, similar recall responses were obtained to A/California 2009 and A/PR8 1934 H1N1 Hviruses. Longitudinal analysis of a single infected individual showed only a small and transient increase in neutralizing antibody levels, but a robust CD8 T cell response that rose rapidly post symptom onset, peaking at 3 weeks, followed by a gradual decline to the baseline levels seen in a seroprevalence cohort post-pandemic. The magnitude of the influenza-specific CD8 T cell memory response at one year post-pandemic was similar in cases and controls as well as in vaccinated and unvaccinated donors, suggesting that any T cell boosting from infection was transient. Pandemic H1-specific antibodies were only detectable in approximately half of vaccinated donors. However, those who were vaccinated within a few months following infection had the highest persisting antibody titers, suggesting that vaccination shortly after influenza infection can boost or sustain antibody levels. For the most part the circulating influenza-specific T cell and serum antibody levels in the population at one year post-pandemic were not different between cases and controls, suggesting that natural infection does not lead to higher long term T cell and antibody responses in donors with pre-existing immunity to influenza. However, based on the responses of one longitudinal donor, it is possible for a small population of pre-existing cross-reactive memory CD8 T cells to expand rapidly following infection and this response may aid in viral clearance and contribute to a lessening of disease severity.
Notes
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PubMed ID
22132212 View in PubMed
Less detail

Laboratory-confirmed influenza B infection in immunized long-term care facility residents receiving oseltamivir prophylaxis in Ontario.

https://arctichealth.org/en/permalink/ahliterature106769
Source
Infect Control Hosp Epidemiol. 2013 Nov;34(11):1225-8
Publication Type
Article
Date
Nov-2013
Author
Anne-Luise Winter
Adriana Peci
Alireza Eshaghi
Michelle Baird
Nader Memari
Erik Kristjanson
Elizabeth Balogun
Rachel R Higgins
Aimin Li
David J Farrell
Jonathan B Gubbay
Author Affiliation
Ontario Agency for Health Protection and Promotion, Toronto, Ontario, Canada.
Source
Infect Control Hosp Epidemiol. 2013 Nov;34(11):1225-8
Date
Nov-2013
Language
English
Publication Type
Article
Keywords
Antiviral agents - therapeutic use
Disease Outbreaks
Humans
Influenza B virus - drug effects - genetics - isolation & purification
Influenza Vaccines
Influenza, Human - drug therapy - epidemiology - prevention & control - virology
Inhibitory Concentration 50
Long-Term Care
Microbial Sensitivity Tests
Middle Aged
Ontario - epidemiology
Oseltamivir - therapeutic use
Phylogeny
Post-Exposure Prophylaxis
Abstract
We report on an influenza B outbreak in an Ontario long-term care facility in which 2 immunized residents receiving oseltamivir prophylaxis for at least 5 days developed laboratory-confirmed influenza B infection. All isolates were tested for the most common oseltamivir resistance, and none of them had resistance identified.
PubMed ID
24113612 View in PubMed
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Parotitis in a child infected with triple-reassortant influenza A virus in Canada in 2007.

https://arctichealth.org/en/permalink/ahliterature151732
Source
J Clin Microbiol. 2009 Jun;47(6):1896-8
Publication Type
Article
Date
Jun-2009
Author
Nathalie Bastien
Donalda Bowness
Laura Burton
Erika Bontovics
Anne-Luise Winter
Graham Tipples
Debby Minielly
Betty Gregg
Christine Cramer
Christine Schincariol
Yan Li
Author Affiliation
National Microbiology Laboratory, Public Health Agency of Canada, 1015 Arlington Street, Winnipeg, Manitoba, Canada R3E 3R2.
Source
J Clin Microbiol. 2009 Jun;47(6):1896-8
Date
Jun-2009
Language
English
Publication Type
Article
Keywords
Animals
Child
Family Health
Hemagglutination inhibition tests
Humans
Influenza A Virus, H3N2 Subtype - genetics - isolation & purification
Influenza, Human - complications - virology
Male
Ontario
Parotitis - virology
Reassortant Viruses - genetics - isolation & purification
Abstract
Swine H3N2 influenza virus designated A/Ontario/1252/2007 was isolated from a child with parotitis. Diagnosis was confirmed by viral isolation and serological assays. A/Ontario/1252/2007 was related to H3N2 triple reassortants that emerged in swine in the United States in 1998. Three of five tested household members were also seropositive for A/Ontario/1252/2007.
Notes
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PubMed ID
19339469 View in PubMed
Less detail

Perceived usefulness of syndromic surveillance in Ontario during the H1N1 pandemic.

https://arctichealth.org/en/permalink/ahliterature128521
Source
J Public Health (Oxf). 2012 Jun;34(2):195-202
Publication Type
Article
Date
Jun-2012
Author
Rachel Savage
Anna Chu
Laura C Rosella
Natasha S Crowcroft
Monali Varia
Michelle E Policarpio
Norman G Vinson
Anne-Luise Winter
Karen Hay
Richard F Davies
Ian Gemmill
Don Willison
Ian Johnson
Author Affiliation
Surveillance and Epidemiology, Public Health Ontario, Toronto, ON, Canada.
Source
J Public Health (Oxf). 2012 Jun;34(2):195-202
Date
Jun-2012
Language
English
Publication Type
Article
Keywords
Data Collection
Health Personnel
Humans
Influenza A Virus, H1N1 Subtype
Influenza, Human - epidemiology
Ontario - epidemiology
Pandemics
Population Surveillance - methods
Abstract
Despite the growing popularity of syndromic surveillance, little is known about if or how these systems are accepted, utilized and valued by end users. This study seeks to describe the use of syndromic surveillance systems in Ontario and users' perceptions of the value of these systems within the context of other surveillance systems.
Ontario's 36 public health units, the provincial ministry of health and federal public health agency completed a web survey to identify traditional and syndromic surveillance systems used routinely and during the pandemic and to describe system attributes and utility in monitoring pandemic activity and informing decision-making.
Syndromic surveillance systems are used by 20/38 (53%) organizations. For routine surveillance, laboratory, integrated Public Health Information System and school absenteeism data are the most frequently used sources. Laboratory data received the highest ratings for reliability, timeliness and accuracy ('very acceptable' by 92, 51 and 89%). Hospital/clinic screening data were rated as the most reliable and timely syndromic data source (50 and 43%) and ED visit data the most accurate (48%). During the pandemic, laboratory data were considered the most useful for monitoring the epidemiology and informing decision-making while ED screening and visit data were considered the most useful syndromic sources.
End user perceptions are valuable for identifying opportunities for improvement and guiding further investments in public health surveillance.
PubMed ID
22194318 View in PubMed
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Respiratory viral infections in institutions from late stage of the first and second waves of pandemic influenza A (H1N1) 2009, Ontario, Canada.

https://arctichealth.org/en/permalink/ahliterature126808
Source
Influenza Other Respir Viruses. 2012 May;6(3):e11-5
Publication Type
Article
Date
May-2012
Author
Sandra Asner
Adriana Peci
Alex Marchand-Austin
Anne-Luise Winter
Romy Olsha
Erik Kristjanson
Donald E Low
Jonathan B Gubbay
Author Affiliation
The Hospital for Sick Children, Toronto, ON, Canada.
Source
Influenza Other Respir Viruses. 2012 May;6(3):e11-5
Date
May-2012
Language
English
Publication Type
Article
Keywords
Adolescent
Aged
Aged, 80 and over
Child
Child Day Care Centers
Child, Preschool
Disease Outbreaks
Enterovirus - genetics - isolation & purification
Humans
Influenza A Virus, H1N1 Subtype - genetics - isolation & purification
Influenza, Human - epidemiology - virology
Male
Nursing Homes
Ontario - epidemiology
Pandemics
Respiratory Tract Infections - epidemiology - virology
Rhinovirus - genetics - isolation & purification
Schools
Abstract
We report the impact of respiratory viruses on various outbreak settings by using surveillance data from the late first and second wave periods of the 2009 pandemic. A total of 278/345(78·5%) outbreaks tested positive for at least one respiratory virus by multiplex PCR. We detected A(H1N1)pdm09 in 20·6% of all reported outbreaks of which 54·9% were reported by camps, schools, and day cares (CSDs) and 29·6% by long-term care facilities (LCFTs), whereas enterovirus/human rhinovirus (ENT/HRV) accounted for 62% outbreaks of which 83·7% were reported by long-term care facilities (LCTFs). ENT/HRV was frequently identified in LTCF outbreaks involving elderly residents, whereas in CSDs, A(H1N1)pdm09 was primarily detected.
PubMed ID
22353417 View in PubMed
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