State Population Health Emergency Operations Centre
Registered Document No: CH003112
Authorised by: Dr Russ Schedlich, D/SHIC. Date: 12 Oct 09
Pandemic (H1N1) 2009
INFLUENZA IN QUEENSLAND 2009 WEEKLY REPORT 41
Influenza in Queensland 2009
Weekly Report for Week 41
Monday 12th October 2009
Table of Contents
Summary ............................................................................................................................ 3
1. Seasonal Influenza ......................................................................................................... 5
2. Pandemic (H1N1) 2009 .................................................................................................. 6
3. Hospitalisations in Queensland ...................................................................................... 8
4. Australian Sentinel Practices Research Network (ASPREN) ........................................ 11
5. FluTracking ................................................................................................................... 12
6. Distribution of Antiviral Drugs ....................................................................................... 13
2009 Calendar Year – By Week ....................................................................................... 17
Acknowledgements........................................................................................................... 18
Online Resources ............................................................................................................. 19
List of Tables
Table 1: Confirmed Pandemic (H1N1) 2009 Indigenous status by Age at Onset ............... 7
Table 2: Counts and rates1 of confirmed cases admitted to hospital (including ICU2), and
ICU2, Queensland ...................................................................................................... 10
List of Figures
Figure 1: Laboratory confirmed Influenza notifications in Queensland from 1st January
2009 to 12th October 2009 ........................................................................................... 5
Figure 2: Laboratory confirmed Pandemic (H1N1) 2009 and other Influenza A notifications
in Queensland, 1st January 2009 to 12th October 2009 .............................................. 5
Figure 3: Percentage of weekly Influenza A notifications that are confirmed Pandemic
(H1N1) 2009 ................................................................................................................ 6
Figure 4: Percentage of Pandemic (H1N1) 2009, Indigenous status by Age-group ........... 7
Figure 5: Reported admissions to hospital and ICU of Queensland Pandemic (H1N1) 2009
notified confirmed cases# by week^ of admission ........................................................ 8
Figure 6: Queensland Pandemic (H1N1) 2009 notified confirmed cases# known to be in
hospital (excluding ICU), and known to be in ICU, by date.......................................... 9
Figure 7: Consultation rates for Influenza like Illness notified to the ASPREN sentinel
network in Queensland 2007-2009 ............................................................................ 11
Figure 8: Percentage of participants reporting fever, cough and absence from normal
duties in Queensland by Week and Month 2009 ....................................................... 12
Figure 9: Interactive maps available at FluTracking, North Queensland........................... 12
Figure 10: Interactive maps available at FluTracking, South-East Queensland................ 12
Figure 11: Total daily Tamiflu (75 mg capsule) dispensed by community pharmacies to
11/10/09 .................................................................................................................... 13
Figure 12: Cumulative number of Tamiflu courses dispensed by Queensland community
pharmacies to 11/10/09 ............................................................................................. 14
Figure 13: Distribution of 75mg Tamiflu courses by Division of General Practice (grouped)
to 11/10/09 (see Figure 14 for key to Division of General Practice codes) ................ 15
Figure 14: Divisions of General Practice in Queensland (source Australian General
Practice Network: http://www.agpn.com.au/divisions-directory/) ............................... 16
This report was prepared by the State Outbreak Control Team - Surveillance 2 of 19
Queensland Health. Any questions or comments about this document should be directed to
EPI@health.qld.gov.au
Summary
Introduction
The purpose of this report is to provide a weekly summary of influenza related data. It is not
intended to be comprehensive but to provide perspectives on influenza activity relevant to
the current stage in the pandemic. The format and content may change as information needs
evolve.
Data are drawn from five main sources, which are listed in the Acknowledgements (page 18)
at the end of this report.
Australia entered the Protect phase of the pandemic on June 22nd, with the focus shifting
from public health intervention, and enhanced case and contact surveillance, to the severity
of illness in hospitalised cases. Testing policy changed to reflect the focus on protecting
vulnerable groups. A consequence of this is a progressively reducing representativeness of
both the testing and notification data.
Data summarised in this report reflect the most recent complete week at the time of data
extraction. Unless otherwise specified, the week refers to the calendar year week. (See page
17 for the 2009 Calendar Year – By Week reference table). Please note, this report includes
data up to the end of week 41 (different data sources may have different extraction dates).
Key Points
1. Laboratory confirmed influenza (total)
o Year to date, 17868 cases of influenza (including seasonal, Pandemic (H1N1)
2009 and unsubtyped Influenza) have been notified to the Queensland Health
Notifiable Conditions Register (NOCS) (see Figure 1).
o A peak of 4663 notifications had an onset date in week 30.
o The peak age-group for both Pandemic (H1N1) 2009 and Influenza A not
identified as Pandemic (H1N1) 2009 was 10-19 years (Figure 2). NB an
unknown proportion of unsubtyped Influenza A may be the pandemic strain.
2. Pandemic (H1N1) 2009 notifications
o The percentage of weekly notifications attributable to Pandemic (H1N1) 2009
rose sharply to reach a peak of 85.4% in week 28 (Figure 3).
From week 29 to week 41 this has fluctuated between 35.7% and
74.9%.
o The peak age group was 10 – 19 years for both indigenous (29.7%) and non–
indigenous (34.2%) cases. See Table 1 and Figure 4 for further detail.
3. Hospitalisations related to Pandemic (H1N1) 2009 in Queensland
o Reported admissions to hospital (including ICU) of Queensland Pandemic
(H1N1) 2009 notified confirmed cases peaked in week 31 with 201 admissions,
while reported admissions to ICU peaked in week 30, with 28 admissions
(Figure 5).
o A steadily rising trend of Queensland Pandemic (H1N1) 2009 notified
confirmed cases known to be in hospital (excluding ICU) and in ICU is
apparent from late June with a peak in early August. There were 19 notified
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confirmed cases in hospital (excluding ICU) and 10 in ICU as at 1st October
2009 (Figure 6).
o The highest rate of hospitalisation (including ICU) is in the 0-4 year age group,
at 81.6 per 100,000 estimated resident population. For ICU admission only, the
highest rate is in the 50-59 year age group (9.0 per 100,000). Conversely, the
lowest rate of hospitalisation and ICU admission is in the 80 year and over age
group. See Table 2 for further detail.
4. The Australian Sentinel Practices Research Network (ASPREN)
o A small number of Queensland GPs contribute data on consultations related to
Influenza Like Illness (ILI) to this national system which is co-ordinated by the
Discipline of General Practice at the University of Adelaide and The Royal
Australian College of General Practitioners.
o Figure 7 summarise 2007-2009 YTD ILI presentations per 1000 consultations.
A steadily rising trend is apparent from week 20 with an apparent peak in week
31 of 86.0 ILI presentations per 1000 consultations. Data for the latest week
may be incomplete.
5. FluTracking
o FluTracking is a pilot online health surveillance system which aims to detect
epidemics of influenza. It is a joint initiative of The University of Newcastle,
Hunter New England Area Health Service (NSW Health) and Hunter Medical
Research Institute.
o Participation is voluntary and involves the completion of a weekly online survey
during the influenza season.
o Data are collected on basic demographics, symptoms of ILI and absenteeism.
o Figure 8 summarises data to week 40 for Queensland Participants.
• Week 31 shows a peak in self reported fever and cough (6.9%) and
fever and cough combined with absenteeism (4.5%)
o Figures 9 & 10 show the location of Queensland participants in the
‘FluTracking’ program. These have been provided as an example (See
‘FluTracking’ website (http://www.flutracking.net/maps.html) for access to
interactive maps.
6. Distribution of Anti Viral Drugs
o Profile of anti viral drug distribution, dispensed from community pharmacies, by
date and Division of General Practice is summarised in Figures 11 to 13. The
cumulative number of Tamiflu courses dispensed by Queensland community
pharmacies to 11th October 2009 is 21349.
o Figure 14 shows the geographical location of the Divisions of General Practice
in Queensland. It should be used to assist in the interpretation of the Tamiflu
distribution data outlined in Figure 13.
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1. Seasonal Influenza
5000
4663
4500
4000
3500
Alert Protect
Notifications
3000 2768
2500 2260
2000
1539
1500 1318
988
1000 744
585 567
446 502
500 169
275 269 208
126 88
6 7 13 10 8 4 12 4 7 5 7 6 4 6 11 37 39 32 35 48 25 18
0
3 4 5 6 7 8 9 1011 1213 1415 1617 1819 2021 222324 2526 2728 2930 3132 3334 353637 3839 4041
Feb Mar Apr May Jun Jul Aug Sep Oct
Week
Source: Data for Figure 1 and 2 has been extracted from Queensland’s Notifiable Condition System
th
(NOCS) on Monday 12 October at 8:35am.
Note: Alert phase commenced end of week 17/start of week 18; Protect phase commenced start of week
26.
st th
Figure 1: Laboratory confirmed Influenza notifications in Queensland from 1 January 2009 to 12 October
2009
3500
3000
2500
Notifications
2000
1500
1000
500
0
< 12 1-4 5-9 10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+
months Age-group
Pandemic (H1N1) 2009 Other Influenza A (non-Pandemic (H1N1) 2009 or unsubtyped)
Figure 2: Laboratory confirmed Pandemic (H1N1) 2009 and other Influenza A notifications in Queensland,
th
1st January 2009 to 12 October 2009
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2. Pandemic (H1N1) 2009
100
90
Percentage of weekly notfications
80
70
60
50
40
30
20
10
0
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41
Jun Jul Aug Sep Oct
Week
th
Source: Data for Figure 3 has been extracted from Queensland’s Notifiable Condition System (NOCS) on Monday 12
October at 8:35am.
Note: Clarification is needed of date of birth for one case, this has been excluded.
Figure 3: Percentage of weekly Influenza A notifications that are confirmed Pandemic (H1N1) 2009
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Table 1: Confirmed Pandemic (H1N1) 2009 Indigenous status by Age at Onset
Age-group at Onset Indigenous Non- Not Total
indigenous Stated /
Unknown
< 12 months 48 91 97 236
1-4 222 364 365 951
5-9 301 506 507 1314
10-19 544 1563 984 3091
20-29 284 1056 1279 2619
30-39 156 352 849 1357
40-49 139 271 697 1107
50-59 101 225 412 738
60-69 27 88 107 222
70-79 5 35 25 65
80+ 2 22 9 33
Grand Total 1829 4573 5331 11733
Source: Data for this table has been extracted from Queensland’s Notifiable Conditions System (NOCS) on Monday
th
12 October at 8:35am.
40
35
30
25
Percentage
20
15
10
5
0
<12 months 1-4 years 5-9 years 10-19 years 20-29 years 30-39 years 40-49 years 50-59 years 60-69 years 70-79 years 80+ years
Age-group
Indigenous Non-indigenous Not Stated / Unknown
th
Source: Data for Figure 4 has been extracted from Queensland’s Notifiable Conditions System (NOCS) on Monday 12
October at 8:35am.
Figure 4: Percentage of Pandemic (H1N1) 2009, Indigenous status by Age-group
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3. Hospitalisations in Queensland
225
200
175
150
ADMISSIONS
125
100
75
50
25
0
22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
W EEK^
ICU Hospital (including ICU)
Source: Data for this graph was primarily sourced from EpiLog between 10.30am and 11.30am on Thursday 01 October 2009, and supplemented with
data from other sources including NetEpi and private hospitals. The dates for one case are being clarified; this case has not been included.
#
Notes: Data used in this graph is expected to change retrospectively, due to variations in the timeliness of data collection, the time between hospital
admission and notification of confirmed test results for some cases, and data cleaning/verification activities.
^ The week is from Monday to Sunday. Please refer to the 2009 Calendar Year – By Week reference table for actual dates. The most recent
week only represents part of the week.
#
Figure 5: Reported admissions to hospital and ICU of Queensland Pandemic (H1N1) 2009 notified confirmed cases by week^ of admission
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225
200
175
NOTIFIED CONFIRMED CASES
150
125
100
75
50
25
0
25
26
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
1
M A Y J U N E J U L Y A U G S E P T O
C
T
DATE
ICU Hospitalised (excluding ICU)
Source: Data for this graph was primarily sourced from EpiLog between 10.30am and 11.30am on Thursday 01 October 2009, and supplemented with
data from other sources including NetEpi and private hospitals. The dates for one case are being clarified; this case has not been included.
#
Notes: Data used in this graph is expected to change retrospectively, due to variations in the timeliness of data collection, the time between hospital
admission and notification of confirmed test results for some cases, and data cleaning/verification activities.
Figure 6: Queensland Pandemic (H1N1) 2009 notified confirmed cases# known to be in hospital (excluding ICU), and known to be in ICU, by date
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1 2 2
Table 2: Counts and rates of confirmed cases admitted to hospital (including ICU ), and ICU , Queensland
All hospital
ICU2 only
Age group
Estimated (including ICU2)
resident
(years)
population1
No. Rate1 No. Rate1
0-4 252,501 206 81.6 6 2.4
5-9 267,854 101 37.7 3 1.1
10 - 19 544,626 150 27.5 8 1.5
20 - 29 524,558 151 28.8 25 4.8
30 - 39 564,186 128 22.7 28 5.0
40 - 49 559,633 146 26.1 26 4.6
50 - 59 478,185 179 37.4 43 9.0
60 - 69 299,567 80 26.7 16 5.3
70 - 79 205,607 43 20.9 6 2.9
80 and over 112,497 18 16.0 1 0.9
Total 3,809,214 1,202 31.6 162 4.3
Source:
EpiLog (01 Oct 2009), private hospital data (receipted by 11.00am, 01 Oct 2009) and NetEpi (10 Jul 2009)
1. Rates are per 100,000 estimated resident population, and are for the time period from the reporting of the first case of
pandemic (H1N1) 2009 in Australia (9 May 2009) to the time of data extraction.
Population estimates sourced from:
Australian Bureau of Statistics. Populations by age and sex, regions of Australia. Cat. no. 3235.0 (released 11 Aug 2009).
Canberra:ABS, 2009. Viewed 15 August 2009,
http://www.abs.gov.au/AUSSTATS/abs@.nsf/ViewContent?readform&view=ProductsbyCatalogue&Action=Expand&Num=3.2
2. Data received from private hospitals may include special care units other than ICU.
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4. Australian Sentinel Practices Research Network (ASPREN)
Data related to Influenza-like illness consultations from The Australian Sentinel Practices Research
Network (ASPREN) is provided voluntarily by Qld General Practitioners.
100
90
Alert Protect
80
Rate/1000 Consultations
70
60
50
40
30
20
10
0
1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52
Week
2007 2008 2009
Source: ASPREN website on the day of reporting
https://www.dmac.adelaide.edu.au/aspren/asprenMISServlet?page=index
Note: Alert phase commenced end of week 17/start of week 18; Protect phase commenced start of
week 26.
Figure 7: Consultation rates for Influenza like Illness notified to the ASPREN sentinel network in
Queensland 2007-2009
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5. FluTracking
8
7
6
5
Percentage
4
3
2
1
0
18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40
Apr May Jun Jul Aug Sep Oct
Week
Fever and cough Fever, cough and absence
Source: FluTracking cumulative data http://www.flutracking.net/index.html
Figure 8: Percentage of participants reporting fever, cough and absence from normal duties in Queensland by Week and
Month 2009
Figure 9: Interactive maps available at FluTracking, Figure 10: Interactive maps available at FluTracking,
North Queensland South-East Queensland
Source: http://www.flutracking.net/maps.html
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6. Distribution of Antiviral Drugs
1000
900
Daily Tamiflu Courses Dispensed
800
700
600
500
400
300
200
100
0
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 1 2 3 4 5 6 7 8 9 10 11
July August September Oct
Date
Figure 11: Total daily Tamiflu (75 mg capsule) dispensed by community pharmacies to 11/10/09
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25000
20000
Cumulative Total
15000
10000
5000
0
2 3 4 5 6 7 8 9 1011 121314 151617 181920 212223 242526 27282930 31 1 2 3 4 5 6 7 8 9 1011 12131415 161718 192021 222324 252627 28293031 1 2 3 4 5 6 7 8 9 101112 131415 16171819 202122 232425 262728 2930 1 2 3 4 5 6 7 8 9 1011
July August September Oct
Date
Figure 12: Cumulative number of Tamiflu courses dispensed by Queensland community pharmacies to 11/10/09
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3000
2500
Number of Tamiflu Courses
2000
1500
1000
500
0
2 4 5 6 7 8 9 1 2 7 4 8 9 0
/4
0 40 40 40 40 40 40 /4
1 41 41 41 41 41 42
01 10 1 6/
4 4 4
3/
41
Division of General Practice (code)
Figure 13: Distribution of 75mg Tamiflu courses by Division of General Practice (grouped) to 11/10/09 (see Figure
14 for key to Division of General Practice codes)
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Figure 14: Divisions of General Practice in Queensland (source Australian General Practice Network:
http://www.agpn.com.au/divisions-directory/)
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2009 Calendar Year – By Week
Week Date Beginning Date Ending Week Date Beginning Date Ending
1 29/12/2008 4/01/2009 28 6/07/2009 12/07/2009
2 5/01/2009 11/01/2009 29 13/07/2009 19/07/2009
3 12/01/2009 18/01/2009 30 20/07/2009 26/07/2009
4 19/01/2009 25/01/2009 31 27/07/2009 2/08/2009
5 26/01/2009 1/02/2009 32 3/08/2009 9/08/2009
6 2/02/2009 8/02/2009 33 10/08/2009 16/08/2009
7 9/02/2009 15/02/2009 34 17/08/2009 23/08/2009
8 16/02/2009 22/02/2009 35 24/08/2009 30/08/2009
9 23/02/2009 1/03/2009 36 31/08/2009 6/09/2009
10 2/03/2009 8/03/2009 37 7/09/2009 13/09/2009
11 9/03/2009 15/03/2009 38 14/09/2009 20/09/2009
12 16/03/2009 22/03/2009 39 21/09/2009 27/09/2009
13 23/03/2009 29/03/2009 40 28/09/2009 4/10/2009
14 30/03/2009 5/04/2009 41 5/10/2009 11/10/2009
15 6/04/2009 12/04/2009 42 12/10/2009 18/10/2009
16 13/04/2009 19/04/2009 43 19/10/2009 25/10/2009
17 20/04/2009 26/04/2009 44 26/10/2009 1/11/2009
18 27/04/2009 3/05/2009 45 2/11/2009 8/11/2009
19 4/05/2009 10/05/2009 46 9/11/2009 15/11/2009
20 11/05/2009 17/05/2009 47 16/11/2009 22/11/2009
21 18/05/2009 24/05/2009 48 23/11/2009 29/11/2009
22 25/05/2009 31/05/2009 49 30/11/2009 6/12/2009
23 1/06/2009 7/06/2009 50 7/12/2009 13/12/2009
24 8/06/2009 14/06/2009 51 14/12/2009 20/12/2009
25 15/06/2009 21/06/2009 52 21/12/2009 27/12/2009
26 22/06/2009 28/06/2009 53 28/12/2009 3/01/2010
27 29/06/2009 5/07/2009
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Acknowledgements
The data for this report are drawn from various sources.
EpiLog
This system collates information regarding hospitalisations and Intensive Care Unit
admissions relevant to Pandemic (H1N1) 2009 and has been developed by the Division of
the Chief Health Officer and the Information Division, Queensland Health.
FluTracking
FluTracking is a pilot online health surveillance system which aims to detect epidemics of
influenza. It is a joint initiative of The University of Newcastle, Hunter New England Area
Health Service (NSW Health) and Hunter Medical Research Institute.
Pharmacy Guild of Queensland
Queensland’s Notifiable Conditions System (NOCS)
Queensland Health’s notifiable conditions register.
The Australian Sentinel Practices Research Network (ASPREN)
ASPREN is a network of sentinel general practitioners co-ordinated by the Royal
Australian College of General Practitioners and directed by the Discipline of General
Practice. Their Web-site developed and maintained by Data Management & Analysis
Centre, Discipline of Public Health, University of Adelaide.
Cover Page pictures:
Accessed 30-Jul-09
New England Journal of Medicine
http://h1n1.nejm.org/
and
Media Bistro
http://www.mediabistro.com/agencyspy/original/swine-flu-virus
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Online Resources
British Medical Journal Pandemic website
http://pandemicflu.bmj.com/ WHO
http://www.who.int/csr/disease/influenza/en/
http://www.bmj.com/cgi/content/full/339/jul14_3/b2840
The Lancet
Centers for Disease Control
http://www.thelancet.com/H1N1-flu
Morbidity and Mortality Weekly
Intensive-Care Patients With Severe Novel Influenza A
http://download.thelancet.com/flatcontentassets/H1N1-
(H1N1) Virus Infection — Michigan, June 2009
flu/preparedness/preparedness-54.pdf
http://www.cdc.gov/mmwr/PDF/wk/mm5827.pdf
New England Journal of Medicine CDC
http://h1n1.nejm.org/ http://www.cdc.gov/flu/
Public Health Agency of Canada
Life Scientist
http://www.phac-aspc.gc.ca/alert-alerte/swine-
http://www.lifescientist.com.au/tag/H1N1
porcine/surveillance-eng.php
Medical Journal of Australia National Center for Biotechnology Information
http://www.mja.com.au/ http://www.ncbi.nlm.nih.gov/genomes/FLU/FLU.html
J.Craig Center, Swine Origin Influenza Virus Sequencing
Journal of American Medical Association
Project
http://jama.ama-assn.org/cgi/search?fulltext=H1N1
http://msc.jcvi.org/soiv/index.shtml
National Institute of Allergy and Infectious Diseases,
National Institutes of Health
Pubmed http://www3.niaid.nih.gov/topics/Flu/
http://www.ncbi.nlm.nih.gov/sites/entrez?db=PubMed
http://www3.niaid.nih.gov/LabsAndResources/resources/
mscs/Influenza/
Global Patterns in Seasonal Activity of Influenza
A/H3N2, A/H1N1, and B from 1997 to 2005: Viral
Coexistence and Latitudinal Gradients
Nature News
Brian S. Finkelman, Cécile Viboud, Katia Koelle,
http://www.nature.com/news/index.html
Matthew J. Ferrari, Nita Bharti, and Bryan T. Grenfell
http://www.pubmedcentral.nih.gov/articlerender.fcgi?arti
d=2117904
The possible roles of solar ultraviolet-B radiation and
vitamin D in reducing case-fatality rates from the 1918–
1919 influenza pandemic in the United States Age-prioritised use of antivirals during an influenza
William B. Grant and Edward Giovannucci pandemic
Dermato-Endocrinology, Vol. 1, Issue 4, July/August 2009 Merler S., Ajelli M. and Rizzo C
(Epub) BMC Infectious Diseases (2009), 9:117
http://www.landesbioscience.com/journals/dermatoendocrin http://www.biomedcentral.com/1471-2334/9/117/abstract
ology/article/9063
(free registration to log-in and download)
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