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Influenza Epidemic/ Pandemic
Topic Collection
December 29, 2025

Topic Collection: Influenza Epidemic/ Pandemic

In 2009, the world watched as the pandemic influenza A (H1N1) virus circulated the globe. Many emergency departments, clinics, and physician offices were filled with symptomatic patients and the “worried well” as public health and emergency management agencies modified plans to respond to the evolving pandemic by delivering risk communications to the public, establishing mass vaccination clinics, and distributing personal protective equipment (PPE) and other supplies to protect worker safety. Since that time, the healthcare system has been incorporating lessons learned from the 2009 H1N1 response into continued pandemic influenza planning efforts. New technology in detection, advances in treatment, improved PPE and containment equipment, updated protocols on how to deal with highly infectious diseases, and experience responding to seasonal influenza outbreaks and other large-scale infectious disease outbreaks have all contributed to a more robust capability to respond to the next pandemic. The threats have also grown – an increasing number of novel influenza viruses have demonstrated the ability to occasionally infect humans. The resources included in this Topic Collection can help healthcare professionals and emergency medical planners prepare for the next influenza epidemic or pandemic. It is important to note how important strong healthcare coalitions with tiered response strategies and coordinated incident management are to an effective pandemic influenza response.

ASPR TRACIE has developed several additional Topic Collections with content relevant to specific aspects of epidemic and pandemic influenza planning; they are listed below.

Alternate Care Sites

Coronaviruses (e.g., SARS, MERS and COVID-19)

Crisis Standards of Care

Disaster Ethics

Fatality Management

Healthcare-Related Disaster Legal/Regulatory/Federal Policy

Hospital Surge Capacity and Immediate Bed Availability

Mass Distribution and Dispensing of Medical Countermeasures

Pharmacy

Responder Safety and Health

Virtual Medical Care

 

Each resource in this Topic Collection is placed into one or more of the following categories (click on the category name to be taken directly to that set of resources). Resources marked with an asterisk (*) appear in more than one category. 

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Must Reads

ASPR TRACIE. (2019). Healthcare Coalition Influenza Pandemic Checklist. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This planning tool is intended to assist healthcare coalitions (HCCs) and their partners in assessing their preparedness for an influenza pandemic. It may also be used to orient the response as a pandemic begins. This checklist can help HCCs assess, create, and improve their pandemic preparedness and response plans.
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ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Bessesen, M., Adams, J., Radonovich, L., and Anderson, J. (2015). Disinfection of Reusable Elastomeric Respirators by Health Care Workers: A Feasibility Study and Development of Standard Operating Procedures. American Journal of Infection Control. 43(6): 629-634.
This article describes a Department of Veterans Affairs feasibility study on the ability of personnel to safely disinfect respirators under pandemic conditions by following standard operating procedures.
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Bui, C., Chughtai, A., Adam, D., and MacIntyre, C. (2017). An Overview of the Epidemiology and Emergence of Influenza A Infection in Humans Over Time. Archives of Public Health. 75:15.
The authors reviewed the epidemiology and emergence of all influenza A serotypes known to cause human infection. They found an increase in recent years in the emergence of avian influenza viruses causing infections in humans and suggest a variety of measures to prevent the emergence of zoonotic disease.
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Centers for Disease Control and Prevention. (2016). Influenza Risk Assessment Tool (IRAT). U.S. Department of Health and Human Services.
This tool was developed by the Centers for Disease Control and Prevention and other influenza experts to assess the risk of a human pandemic emerging from influenza A viruses currently circulating in animals. The IRAT uses 10 weighted evaluation criteria to assess the risk of both emergence and public health impact and to classify each virus as low, moderate, or high risk.
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Centers for Disease Control and Prevention. (2023). Isolation Precautions Guideline. U.S. Department of Health and Human Services.
This document provides infection control guidelines for healthcare settings across the continuum of care. It is intended to inform the development, implementation, and evaluation of infection control and prevention programs in healthcare settings.
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Chest Care of the Critically Ill and Injured During Pandemics and Disasters Panel. (2014). Care of the Critically Ill and Injured During Pandemics and Disasters: Chest Consensus Statement. Chest Journal. 146(4), Supplement:p1S-41S, e1S-e177s.
This supplement to Chest Journal includes several articles composing a consensus statement of the American College of Chest Physicians on the care of the critically ill and injured during pandemics and disasters. Individual articles focus on the following: Introduction and Executive Summary; Methodology; Surge Capacity Principles; Surge Capacity Logistics; Evacuation of the ICU; Triage; Special Populations; System-Level Planning, Coordination, and Communication; Business and Continuity of Operations; Engagement and Education; Legal Preparedness; Ethical Considerations; and Infrastructure and Capacity Building and Response, Recovery, and Research in Resource-Poor Settings.
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Fain, B., Viswanathan, K., and Altevogt, B. (2012). Public Engagement on Facilitating Access to Antiviral Medications and Information in an Influenza Pandemic - Workshop Series Summary. The National Academies of Sciences, Engineering, and Medicine.
This report summarizes a series of workshops on the public’s perception of how to facilitate access to antiviral medication and treatment during an influenza pandemic.
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Holloway, R., Rasmussen, S., Zaza, S., et al. (2014). Updated Preparedness and Response Framework for Influenza Pandemics. Morbidity and Mortality Weekly Report. 63(RR06):1-9.
This article describes the Centers for Disease Control and Prevention’s revised framework for pandemic influenza preparedness and response. The authors describe the six intervals along the pandemic curve and eight domains used to organize efforts within each interval.
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Los Angeles County Emergency Medical Services Agency. (2010). Recommended Actions for Hospitals to Prepare for and Respond to Pandemic Influenza.
This document provides guidelines to hospitals to prepare for an influenza pandemic. It includes a summary of recommended actions and their triggers, checklists, sample response guides, general background information, and links to additional resources.
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New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/5/2025.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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Qualls, N., Levitt, A., Kanade, N., et al. (2017). Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. Morbidity and Mortality Weekly Report. 66(1):1-34.
These guidelines update Centers for Disease Control and Prevention recommendations on the use of non-pharmaceutical interventions to slow the spread of infectious respiratory diseases, including influenza.
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Saunders-Hastings, P., and Krewski, D. (2016). Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission. Pathogens. 5(4).
The authors review influenza pandemics throughout history to describe the changing knowledge of the virus and efforts to manage outbreaks. Given the unpredictable nature of when the next pandemic will occur, they encourage continued surveillance, coordination, and resource planning to mitigate risks.
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Trust for America's Health. (2009). Pandemic Flu Preparedness: Lessons from the Frontlines.
This report examines early lessons learned by the healthcare system from the response to the 2009 H1N1 pandemic and highlights ongoing concerns about overall U.S. preparedness for potential outbreaks.
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U.S. Department of Health and Human Services. (2017). Pandemic Influenza Plan: 2017 Update.
This updated plan builds upon the 2005 Pandemic Influenza Plan and its subsequent updates, focusing on the seven domains of: surveillance, epidemiology, and laboratory activities; community mitigation measures; medical countermeasures; health care system preparedness and response activities; communications and public outreach; scientific infrastructure and preparedness; and domestic and international response policy, incident management, and global partnerships and capacity building.
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World Health Organization. (2014). Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care: WHO Guidelines.
This document provides recommendations, best practices and principles for infection prevention and control for acute respiratory infections in health care, particularly those that present as epidemics or pandemics. It includes information on PPE and aerosol-generating procedures. There are also summaries of literature and research reviews on physical interventions for infection control; risk of transmission from aerosol-generating procedures; and effectiveness of vaccination of health care workers to protect patients.
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Antiviral Treatment

* Centers for Disease Control and Prevention. (2011). Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 60(RR01):1-24.
This report provides recommendations for treatment and chemoprophylaxis of influenza virus infection. The authors identify populations at greater risk of complications, identify major changes from previous recommendations, describe the mechanism of virus transmission and the clinical signs and symptoms of disease, outline the role of laboratory diagnostics, and provide information on the four approved influenza antiviral agents, including their usage, dosage, adverse events, drug interactions, and possible emergency use authorization.
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Centers for Disease Control and Prevention. (2018). Influenza Antiviral Medications: Summary for Clinicians. U.S. Department of Health and Human Services.
This document provides information on antiviral medications recommended for treatment and chemoprophylaxis of influenza, summarizes influenza antiviral treatment recommendations, identifies treatment considerations for patients hospitalized with suspected or confirmed influenza, describes diagnostic testing for influenza, lists recommended dosage and duration of various antiviral agents for pediatric and adult populations, discusses chemoprophylaxis, and highlights special considerations.
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* Fain, B., Viswanathan, K., and Altevogt, B. (2012). Public Engagement on Facilitating Access to Antiviral Medications and Information in an Influenza Pandemic - Workshop Series Summary. The National Academies of Sciences, Engineering, and Medicine.
This report summarizes a series of workshops on the public’s perception of how to facilitate access to antiviral medication and treatment during an influenza pandemic.
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Heneghan, C., Onakpoya, I., Jones, M., et al. (2016). Neuraminidase Inhibitors for Influenza: A Systematic Review and Meta-Analysis of Regulatory and Mortality Data. Health Technology Assessment. 20(42):1-242.
The authors reviewed regulatory information from 46 trials of oseltamivir and zanamivir for influenza in adults and children. They found that oseltamivir and zanamivir reduce the time to symptom improvement in adults with influenza-like illness. Neither oseltamivir nor zanamivir was found to reduce influenza complications, hospitalizations, or deaths. Oseltamivir increases the risk of nausea, vomiting, and psychiatric events in adults and vomiting in children, but may reduce the risk of diarrhea and cardiac events in adults. The authors found a minimal preventive effect of using oseltamivir or zanamivir as prophylaxis.
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Hurt, A. and Kelly, H. (2016). Debate Regarding Oseltamivir Use for Seasonal and Pandemic Influenza. Emerging Infectious Diseases. 22(6):949-955.
The authors discuss the debate about whether oseltamivir should be stockpiled for an influenza pandemic based on its performance in the treatment of relatively mild illness during seasonal influenza outbreaks.
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Jefferson, T., Jones, M., Doshi, P., et al. (2014). Neuraminidase Inhibitors for Preventing and Treating Influenza in Adults and Children. Cochrane Database of Systematic Reviews.
The authors reviewed available data from randomized, placebo-controlled trials on adults and children with confirmed or suspected exposure to naturally-occurring influenza to determine the effects of neuraminidase inhibitors. They found that two commonly-stockpiled neuraminidase inhibitors – oseltamivir and zanamivir – reduce the time to alleviation of symptoms in adults and that prophylactic use of either drug reduces the risk of developing symptomatic influenza. Neither drug reduced the time to alleviation of symptoms in asthmatic children, and oseltamivir use increased the risk of nausea, vomiting, psychiatric effects, and renal events in adults and vomiting in children.
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Lehnert, R., Pletz, M., Reuss, A., and Schaberg, T. (2016). Antiviral Medications in Seasonal and Pandemic Influenza. Deutsches Arzteblatt International. 113(47):799-807.
This systematic review of randomized and controlled trials and other relevant literature concludes that the benefits of antiviral drugs outweigh their risks. The article summarizes existing public health recommendations and examines research on antiviral prophylaxis and treatment. The authors encourage clinicians to consider the risk profile of patients in some at-risk populations and note the need for additional research on those populations and on the use of antivirals for highly pathogenic influenza viruses.
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Wester, A. and Shetty, A. (2016). Peramivir Injection in the Treatment of Acute Influenza: A Review of the Literature. Infection and Drug Resistance. 9:201-214.
The authors review the literature on the use of peramivir for acute influenza treatment. They found that it is effective against a variety of influenza A and B subtypes and that its injectable form may be favorable for treating critically ill, hospitalized patients. While they found positive results in observational studies in pregnant women, pediatric patients, patients receiving continuous renal replacement therapy, and patients undergoing extracorporeal membrane oxygenation, there is a lack of clinical trials demonstrating the efficacy of peramivir in these populations.
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Avian Influenza

ASPR TRACIE. (2024). Avian Influenza Quick Facts.
This document provides healthcare providers and emergency planners with resource links to improve their readiness for potential human infections with avian influenza A viruses. Users should refer to the websites of the U.S. Department of Agriculture’s Animal and Plant Health Inspection Service (APHIS), the Centers for Disease Control and Prevention (CDC), the Food and Agriculture Organization of the United Nations (FAO), and the World Health Organization (WHO) for the most up-to-date information.
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Centers for Disease Control and Prevention. (2024). Highly Pathogenic Avian Influenza A(H5N1) Virus in Animals: Interim Recommendations for Prevention, Monitoring, and Public Health Investigations. U.S. Department of Health and Human Services.
These interim recommendations outline steps for preventing exposure to avian influenza viruses, including recommendations for the public, farmers, workers, clinicians, and state health departments on surveillance and testing. The webpage defines exposure to avian influenza-infected birds, clinical and public health response criteria, information on collecting clinical specimens for testing, influenza antiviral treatment, and avian influenza chemoprophylaxis.
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Goodwin, T., Mowrer, C., and West, D. (2024). Pediatric Clinical Guidance on Highly Pathogenic Avian Influenza (HPAI) A(H5N1). National Emerging Special Pathogens Training and Education Center and the Pediatric Pandemic Network.
This resource provides a situation update on HPAI A(H5N1), the top five facts pediatricians need to know, and links to additional information and resources.
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Jassem, A., Roberts, A., Tyson, J., et al. (2024). Critical Illness in an Adolescent with Influenza A(H5N1) Virus Infection. The New England Journal of Medicine. doi:10.1056/NEJMc2415890.
This case report describes the diagnosis and treatment of a critically ill 13-year-old patient infected by influenza A(H5N1) virus.
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Jiang, H., Wu, P., Uyeki, T., et al. (2017). Preliminary Epidemiologic Assessment of Human Infections with Highly Pathogenic Avian Influenza A(H5N6) Virus, China. Clinical Infectious Diseases. 64(3): 383-388.
The authors analyzed data on laboratory-confirmed Asian lineage HPAI H5N1, H5N6, and H7N9 and found that epidemiologic characteristics and severity of infections of A(H5N6) were similar to those of A(H5N1) and more severe than A(H7N9).
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Li, Y., Linster, M., Mendenhall, I., et al. (2019). Avian Influenza Viruses in Humans: Lessons from Past Outbreaks. British Medical Bulletin. 132(1):81-95.
This article discusses clinical presentation of avian influenza infection, species barriers, susceptibility, and risk factors for human infection. It also contains information on zoonotic avian influenza A viruses, and details on specific subtypes. The authors discuss pandemic mitigation strategies such as close World Health Organization monitoring of select strains, vaccination, antiviral drugs, and the limitations of these measures.
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Lycett, S., Duchatel, F., and Digard, P. (2019). A Brief History of Bird Flu. Philosophical Transactions of the Royal Society B: Biological Sciences. 374(1775):20180257.
This article reviews what is known as of 2018 about avian influenza A and its genetic makeup, from its relationship with the 1918 H1N1 pandemic strain, to epidemics in birds, to zoonoses. The authors describe the virus’s origin, reassortment, and evolution of avian influenza. Finally, the article describes the ongoing risk to human health and how control in domestic bird populations can mitigate the risks.
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Pan American Health Organization and World Health Organization. (2020). Influenza at the Human-Animal Interface: PAHO Recommendations to Strengthen Intersectoral Work for Surveillance, Early Detection, and Investigation.
This document gives recommendations for influenza virus surveillance, monitoring, early detection, case investigation, and reporting when humans and animals interact. It distinguishes between animal influenza viruses which are not transmitted to or between humans, human seasonal influenza viruses, and zoonotic influenza viruses which can cause illness and death in humans. The document also discusses the reporting obligations under the International Health Regulations of 2005 for states party to them.
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Uyeki, T. and Peiris, M. (2019). Novel Avian Influenza A Virus Infections of Humans. Infectious Disease Clinics of North America. 33(4):907-932.
This article discusses symptoms of infection with avian influenza A viruses, characteristics of testing for influenza A virus, and clinical management of influenza A. It provides background on the epidemiology of avian influenza A, exposure risk factors, human-to-human transmission, and pathogenesis.
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Education, Training, and Exercises

* ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Infectious Disease Annex TTX Template (PDF).
This guide is part of a toolkit that can help emergency planners create an interactive, discussion-based exercise focusing on impacts to healthcare coalition and healthcare facilities caused by large numbers of patients seeking healthcare following exposure to an infectious agent.
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Department of Emergency Health Services. (2018). Emerging Infectious Diseases Videos for Prehospital Providers. University of Maryland Baltimore County.
This instructional series, comprised of nine modules (listed at the top of the page), includes an introduction to infectious diseases, basic infection control concepts, considerations for personal protective equipment (including donning and doffing), personnel decontamination, patient transport, and transfer of patient care for patients with Ebola and other highly infectious diseases.
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Federal Emergency Management Agency, Center for Domestic Preparedness. (n.d.). Barrier Precautions and Controls for Highly Infectious Disease. (Accessed 9/30/19.)
This is a four-day course for emergency medical services, healthcare, and public health professionals who may triage, transport, and treat those with a highly infectious disease. Training includes guided discussions of best practices, demonstrations, practical experiences, and exercises.
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* Illinois Emergency Medical Services for Children. (2010). Use of Strategic National Stockpile [SNS] Ventilators in the Pediatric Patient: Instructional Guidelines with Training Scenarios, 2nd Edition (2010).
These guidelines are intended as a quick reference for just-in-time training and set up of the types of mechanical ventilators included in the Strategic National Stockpile. The guidelines may be used by clinicians with a baseline knowledge of pulmonary physiology and the concepts of ventilation, but who may not be familiar with the stockpiled ventilators or who may not routinely care for children on ventilators.
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* New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/5/2025.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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World Health Organization. (2018). A Practical Guide For Developing and Conducting Simulation Exercises to Test and Validate Pandemic Influenza Preparedness Plans.
Though this guide was developed to support countries in their design and conduct of pandemic influenza exercises, the detailed guidance on scenario elements and exercise evaluation may be valuable to healthcare emergency planners at the state and local level, as well as in the healthcare facility setting.
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Epidemiology and Surveillance

Bui, C., Chughtai, A., Adam, D., and MacIntyre, C. (2017). An Overview of the Epidemiology and Emergence of Influenza A Infection in Humans Over Time. Archives of Public Health. 75:15.
The authors reviewed the epidemiology and emergence of all influenza A serotypes known to cause human infection. They found an increase in recent years in the emergence of avian influenza viruses causing infections in humans and suggest a variety of measures to prevent the emergence of zoonotic disease.
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* Centers for Disease Control and Prevention. (2016). Influenza Risk Assessment Tool (IRAT). U.S. Department of Health and Human Services.
This tool was developed by the Centers for Disease Control and Prevention and other influenza experts to assess the risk of a human pandemic emerging from influenza A viruses currently circulating in animals. The IRAT uses 10 weighted evaluation criteria to assess the risk of both emergence and public health impact and to classify each virus as low, moderate, or high risk.
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* Holloway, R., Rasmussen, S., Zaza, S., et al. (2014). Updated Preparedness and Response Framework for Influenza Pandemics. Morbidity and Mortality Weekly Report. 63(RR06):1-9.
This article describes the Centers for Disease Control and Prevention’s revised framework for pandemic influenza preparedness and response. The authors describe the six intervals along the pandemic curve and eight domains used to organize efforts within each interval.
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* Saunders-Hastings, P., and Krewski, D. (2016). Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission. Pathogens. 5(4).
The authors review influenza pandemics throughout history to describe the changing knowledge of the virus and efforts to manage outbreaks. Given the unpredictable nature of when the next pandemic will occur, they encourage continued surveillance, coordination, and resource planning to mitigate risks.
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General Information

Chest Care of the Critically Ill and Injured During Pandemics and Disasters Panel. (2014). Care of the Critically Ill and Injured During Pandemics and Disasters: Chest Consensus Statement. Chest Journal. 146(4), Supplement:p1S-41S, e1S-e177s.
This supplement to Chest Journal includes several articles composing a consensus statement of the American College of Chest Physicians on the care of the critically ill and injured during pandemics and disasters. Individual articles focus on the following: Introduction and Executive Summary; Methodology; Surge Capacity Principles; Surge Capacity Logistics; Evacuation of the ICU; Triage; Special Populations; System-Level Planning, Coordination, and Communication; Business and Continuity of Operations; Engagement and Education; Legal Preparedness; Ethical Considerations; and Infrastructure and Capacity Building and Response, Recovery, and Research in Resource-Poor Settings.
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Ghebrehewet, S., MacPherson, P., and Ho, A. (2016). Influenza. BMJ. 355.
This web page provides basic information on influenza, including what it is, what the symptoms are, how it is diagnosed and treated, and how epidemics and pandemics occur.
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Iskander, J., Strikas, R., Gensheimer, K., et al. (2013). Pandemic Influenza Planning, United States, 1978-2008. Emerging Infectious Disease. 19(6):879-885.
This article provides a chronology and describes the evolution of pandemic planning since the 1970s.
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Kash, J. and Taubenberger, J. (2015). The Role of Viral, Host, and Secondary Bacterial Factors in Influenza Pathogenesis. The American Journal of Pathology. 185(6):1528-1536.
The authors provide an overview of influenza and describe the viral, host, and bacterial factors that contribute to more severe illness, complications, and mortality.
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Mina, M. and Klugman, K. (2014). The Role of Influenza in the Severity and Transmission of Respiratory Bacterial Disease. Lancet Respiratory Medicine. 2(9):750-763.
The authors review influenza and respiratory bacterial co-infections, describing the historic understanding of such co-infections, disease dynamics and mechanisms, and prevention and treatment strategies.
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* Saunders-Hastings, P., and Krewski, D. (2016). Reviewing the History of Pandemic Influenza: Understanding Patterns of Emergence and Transmission. Pathogens. 5(4).
The authors review influenza pandemics throughout history to describe the changing knowledge of the virus and efforts to manage outbreaks. Given the unpredictable nature of when the next pandemic will occur, they encourage continued surveillance, coordination, and resource planning to mitigate risks.
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Guidance

Centers for Disease Control and Prevention. (2022). Interim Guidance for Infection Control Within Healthcare Settings When Caring for Confirmed Cases, Probable Cases, and Cases Under Investigation for Infection with Novel Influenza A Viruses Associated with Severe Disease. U.S. Department of Health and Human Services.
This webpage provides guidance on avian influenza A (H7N9), Asian H5N1, and newly detected avian influenza H5 viruses in the U.S.
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Centers for Disease Control and Prevention. (2024). Interim Guidance for Clinicians on Human Infections with Variant Influenza Viruses. U.S. Department of Health and Human Services.
This document provides interim guidance for clinicians on how to identify, diagnose, report, and manage suspect cases of exposure to variant influenza viruses.
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Centers for Disease Control and Prevention. (2024). Interim Guidance for Influenza Outbreak Management in Long-Term Care and Post-Acute Care Facilities. U.S. Department of Health and Human Services.
This webpage provides guidance to long-term care facilities on preventing transmission of influenza through vaccination, testing, infection control, antiviral treatment, and antiviral chemoprophylaxis.
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New York City Department of Health and Mental Hygiene. (2014). NYC DOHMH Guidance Document for Development of Protocols for Management of Patients Presenting to Hospital Emergency Departments and Clinics with Potentially Communicable Diseases of Public Health Concern.
This document provides guidance for emergency departments and outpatient clinics to develop screening and isolation protocols for patients possibly infected with a highly communicable disease of public health concern. The document focuses on initial patient identification, initial infection control measures, notification and patient evaluation, and identification and management of exposed persons.
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Various Federal Agencies. (2024). Managing Solid Waste Contaminated with a Category A Infectious Substance.
This guidance document is based on extensive federal interagency coordination and stakeholder input and designed to help those who work in healthcare facilities, medical transportation operations, and laboratories better understand infectious waste and how to manage it.
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Guidelines

Centers for Disease Control and Prevention. (2002). Guideline for Hand Hygiene in Health-Care Settings: Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. U.S. Department of Health and Human Services.
These guidelines review data on handwashing and hand antisepsis in healthcare settings and provide recommendations for the promotion of hand hygiene practices and the reduction of pathogen transmission in healthcare settings.
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* Centers for Disease Control and Prevention. (2011). Antiviral Agents for the Treatment and Chemoprophylaxis of Influenza: Recommendations of the Advisory Committee on Immunization Practices (ACIP). Morbidity and Mortality Weekly Report. 60(RR01):1-24.
This report provides recommendations for treatment and chemoprophylaxis of influenza virus infection. The authors identify populations at greater risk of complications, identify major changes from previous recommendations, describe the mechanism of virus transmission and the clinical signs and symptoms of disease, outline the role of laboratory diagnostics, and provide information on the four approved influenza antiviral agents, including their usage, dosage, adverse events, drug interactions, and possible emergency use authorization.
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Centers for Disease Control and Prevention. (2023). Isolation Precautions Guideline. U.S. Department of Health and Human Services.
This document provides infection control guidelines for healthcare settings across the continuum of care. It is intended to inform the development, implementation, and evaluation of infection control and prevention programs in healthcare settings.
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* Illinois Emergency Medical Services for Children. (2010). Use of Strategic National Stockpile [SNS] Ventilators in the Pediatric Patient: Instructional Guidelines with Training Scenarios, 2nd Edition (2010).
These guidelines are intended as a quick reference for just-in-time training and set up of the types of mechanical ventilators included in the Strategic National Stockpile. The guidelines may be used by clinicians with a baseline knowledge of pulmonary physiology and the concepts of ventilation, but who may not be familiar with the stockpiled ventilators or who may not routinely care for children on ventilators.
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Kulkarni, T., Sharma., N., and Diaz-Guzman, E. (2016). Extracorporeal Membrane Oxygenation in Adults: A Practical Guide for Internists. Cleveland Clinic Journal of Medicine. 83(5):373-384.
The authors review current evidence and indications for ECMO. They describe what it is, who could benefit, how to do it, and what the complications are. ECMO was used extensively during the H1N1 pandemic, and the guide has implications on decisions for its use during future influenza pandemics.
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* Los Angeles County Emergency Medical Services Agency. (2009). Recommended Actions for EMS Providers to Prepare For and Respond to Pandemic Influenza.
This document provides pandemic influenza guidelines for emergency medical services responders and management, recommended actions during each pandemic period, and additional resources, such as infection control information, employee health considerations, and patient assessment tools.
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* Los Angeles County Emergency Medical Services Agency. (2010). Recommended Actions for Hospitals to Prepare for and Respond to Pandemic Influenza.
This document provides guidelines to hospitals to prepare for an influenza pandemic. It includes a summary of recommended actions and their triggers, checklists, sample response guides, general background information, and links to additional resources.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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* Qualls, N., Levitt, A., Kanade, N., et al. (2017). Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. Morbidity and Mortality Weekly Report. 66(1):1-34.
These guidelines update Centers for Disease Control and Prevention recommendations on the use of non-pharmaceutical interventions to slow the spread of infectious respiratory diseases, including influenza.
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World Health Organization. (2014). Infection Prevention and Control of Epidemic- and Pandemic-Prone Acute Respiratory Infections in Health Care: WHO Guidelines.
This document provides recommendations, best practices and principles for infection prevention and control for acute respiratory infections in health care, particularly those that present as epidemics or pandemics. It includes information on PPE and aerosol-generating procedures. There are also summaries of literature and research reviews on physical interventions for infection control; risk of transmission from aerosol-generating procedures; and effectiveness of vaccination of health care workers to protect patients.
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Lessons Learned

Office of the Assistant Secretary for Preparedness and Response. (2012). An HHS Retrospective on the 2009 H1N1 Influenza Pandemic to Advance All Hazards Preparedness. U.S. Department of Health and Human Services.
The authors share lessons learned from the 2009 influenza pandemic, grouped into the following categories: surveillance, mitigation measures, vaccination, and communications and education.
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* Patel, A., D’Alessandro, M., Ireland, K., et al. (2017). Personal Protective Equipment Supply Chain: Lessons Learned from Recent Public Health Emergency Responses. (Abstract only.) Health Security. 15(3):244-252.
The authors describe lessons learned from the 2009 H1N1 influenza pandemic and the 2014 Ebola virus epidemic related to the commercial supply chain of pharmaceutical and other healthcare products. They discuss how these lessons learned could inform readiness for future emergencies from a personal protective equipment supply chain and system perspective.
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Trust for America's Health. (2009). Pandemic Flu Preparedness: Lessons from the Frontlines.
This report examines early lessons learned by the healthcare system from the response to the 2009 H1N1 pandemic and highlights ongoing concerns about overall U.S. preparedness for potential outbreaks.
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Non-Pharmaceutical Strategies

Barrios, L., Koonin, L., Kohl, K., and Cetron, M. (2012). Selecting Nonpharmaceutical Strategies to Minimize Influenza Spread: The 2009 Influenza A (H1N1) Pandemic and Beyond. Public Health Reports. 127(6):565-571.
The authors describe the development of guidance on non-pharmaceutical strategies to minimize the spread of the 2009 influenza A (H1N1) pandemic. They recommend a framework to be used by state and local health officials when collaborating with stakeholders including educational officials and large employers to select which non-pharmaceutical measures to use during a future pandemic.
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Fong, M., Gao, H., Wong, J., et al. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Social Distancing Measures. Emerging Infectious Diseases. 26(5).
The authors conducted systematic reviews of available evidence on the effectiveness of various social distancing measures in non-healthcare settings in reducing influenza transmission. The measures reviewed were: isolating ill persons, contact tracing, quarantined of those exposed, school dismissals or closures, workplace measures or closures, and avoiding crowding.
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Martinez, D. and Das, T. (2014). Design of Non-Pharmaceutical Intervention Strategies for Pandemic Influenza Outbreaks. BMC Public Health. 14(1328).
The authors modeled various non-pharmaceutical interventions, social behaviors, and their interactions on outcome measures such as numbers of contacts, infections, and deaths to simulate the effects of the strategies on pandemic influenza outbreaks with varying levels of virus transmissibility.
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* Qualls, N., Levitt, A., Kanade, N., et al. (2017). Community Mitigation Guidelines to Prevent Pandemic Influenza - United States, 2017. Morbidity and Mortality Weekly Report. 66(1):1-34.
These guidelines update Centers for Disease Control and Prevention recommendations on the use of non-pharmaceutical interventions to slow the spread of infectious respiratory diseases, including influenza.
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Ryu, S., Gao, H., Wong, J., et al. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—International Travel-Related Measures. Emerging Infectious Diseases. 26(5).
The authors completed systematic reviews of nonpharmaceutical interventions related to international travel and movement for evidence of effectiveness against pandemic influenza. Measures studied were screening travelers for infection, travel restrictions, and border closures.
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* Saunders-Hastings, P., Reisman, J., and Krewski, D. (2015). Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis. PLoS One. 11(12).
This study reviews existing systematic reviews and meta-analyses on pandemic influenza interventions including vaccines, antivirals, personal protective measures, school closures, and traditional Chinese medicine. Pandemic influenza vaccine was found to be protective against infection, but the authors found insufficient evidence for the effectiveness of each of the other interventions in isolation and hypothesized that a combination of interventions would be most effective.
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Xiao, J., Shiu, E., Gao, H., et al. (2020). Nonpharmaceutical Measures for Pandemic Influenza in Nonhealthcare Settings—Personal Protective and Environmental Measures. Emerging Infectious Diseases. 26(5).
The authors completed systematic reviews of the effectiveness of personal protective and environmental measures in reducing influenza transmission. Measures studied were: hand hygiene, respiratory etiquette, face masks, and surface and object cleaning.
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Pediatric Issues

* American Academy of Pediatrics. (2013). Pediatric Preparedness Resource Kit.
This resource kit was designed to address issues that occurred during 2009 H1N1 planning and allows for pediatricians, public health leaders, and other pediatric care providers to assess what is already happening in their community or state, and help determine what needs to be done before an emergency or disaster. It promotes collaborative discussions and decision making about pediatric preparedness planning at the local and state level and encourages integration of pediatric providers into disaster planning. It also contains a link to the Joint Policy Statement—Guidelines for Care of Children in the Emergency Department, as well as a Preparedness Checklist for Pediatric Practices and guidance for prioritizing vaccination during pandemics.
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* Illinois Emergency Medical Services for Children. (2010). Use of Strategic National Stockpile [SNS] Ventilators in the Pediatric Patient: Instructional Guidelines with Training Scenarios, 2nd Edition (2010).
These guidelines are intended as a quick reference for just-in-time training and set up of the types of mechanical ventilators included in the Strategic National Stockpile. The guidelines may be used by clinicians with a baseline knowledge of pulmonary physiology and the concepts of ventilation, but who may not be familiar with the stockpiled ventilators or who may not routinely care for children on ventilators.
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Personal Protective Equipment and Worker Safety

Bessesen, M., Adams, J., Radonovich, L., and Anderson, J. (2015). Disinfection of Reusable Elastomeric Respirators by Health Care Workers: A Feasibility Study and Development of Standard Operating Procedures. American Journal of Infection Control. 43(6): 629-634.
This article describes a Department of Veterans Affairs feasibility study on the ability of personnel to safely disinfect respirators under pandemic conditions by following standard operating procedures.
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Fisher, E. and Shaffer, R. (2014). Commentary Considerations for Recommending Extended Use and Limited Reuse of Filtering Facepiece Respirators in Health Care Settings. Journal of Occupational and Environmental Hygiene. 11(8):D115-D128.
This article reviews scientific findings on the extended use or reuse of filtering facepiece respirators in healthcare settings. The authors discuss considerations for routine events versus during public health emergencies. The authors express a preference for extended use over reuse and suggest that future recommendations consider new cautions and limitations.
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Kilinc, F. (2015). A Review of Isolation Gowns in Healthcare: Fabric and Gown Properties.
The author provides an overview on occupational exposure to emerging infectious diseases in the healthcare industry and the history and use of isolation gowns as personal protective equipment (PPE). As the second-most used type of PPE, the author discusses properties affecting gown performance and factors influencing their design and development.
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Larson, E. and Liverman, C., eds. (2011). Preventing Transmission of Pandemic Influenza and Other Viral Respiratory Diseases: Personal Protective Equipment for Healthcare Personnel: Update 2010. The National Academies of Sciences, Engineering, and Medicine.
This report was updated following the 2009 H1N1 pandemic to assess current knowledge on personal protective equipment, research progress, and future efforts to protect healthcare personnel.
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Lindsley, W., Martin, S., Thewlis, R., et al. (2015). Effects of Ultraviolet Germicidal Irradiation (UVGI) on N95 Respirator Filtration Performance and Structural Integrity. Journal of Occupational and Environmental Hygiene. 12(8):509-517.
The authors exposed material coupons and straps from four models of N95 filtering facepiece respirators to a range of doses of ultraviolet germicidal irradiation to test particle penetration, flow resistance, bursting strengths of coupon layers, and breaking strength of straps. They found small effects on filtration performance and almost no effect on flow resistance, but a reduction in the strength of respirator materials of more than 90% in some models and a 20-51% reduction in breaking strength of straps. The authors suggest that ultraviolet germicidal irradiation is a possible method to disinfect respirators for reuse, but the respirator model used should first be tested to determine the maximum number of disinfection cycles and the dose required to inactivate the specific pathogen.
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Liverman, C., Domnitz, S., and McCoy, M. (2015). The Use and Effectiveness of Powered Air Purifying Respirators in Health Care: Workshop Summary. The National Academies of Sciences, Engineering, and Medicine.
This report summarizes the proceedings of a workshop examining the current state of practice on the use of powered air purifying respirators in healthcare settings and research on their use and effectiveness.
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National Academies of Sciences, Engineering, and Medicine. (2019). Reusable Elastomeric Respirators in Health Care: Considerations for Routine and Surge Use. The National Academies Press.
This report examines strategies for and pros and cons related to stockpiling and reusing elastomeric respirators during an influenza pandemic or other large aerosol-transmissible outbreak.
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National Institute for Occupational Safety and Health. (2015). NIOSH Personal Protective Equipment Information (PPE-Info). Centers for Disease Control and Prevention.
This website compiles standards information for personal protective equipment from the U.S. government, American National Standards Institute-accredited standard development organizations, and the International Organization for Standardization. Users can search the database by fields including the category of personal protective equipment, hazard type, standard type, and standard organization.
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Occupational Safety and Health Administration. (n.d.). Respiratory Protection. (Accessed 9/9/2024.) U.S. Department of Labor.
This webpage contains standards on respirators, respiratory protection, and the medical evaluation program.
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Occupational Safety and Health Administration. (2009). Pandemic Influenza Preparedness and Response Guidance for Healthcare Workers and Healthcare Employers. U.S. Department of Labor.
This document provides an overview of infection control and other standards appropriate for pandemic influenza.
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* Patel, A., D’Alessandro, M., Ireland, K., et al. (2017). Personal Protective Equipment Supply Chain: Lessons Learned from Recent Public Health Emergency Responses. (Abstract only.) Health Security. 15(3):244-252.
The authors describe lessons learned from the 2009 H1N1 influenza pandemic and the 2014 Ebola virus epidemic related to the commercial supply chain of pharmaceutical and other healthcare products. They discuss how these lessons learned could inform readiness for future emergencies from a personal protective equipment supply chain and system perspective.
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Saunders-Hastings, P., Crispo, J., Sikora, L., et al. (2017). Effectiveness of Personal Protective Measures in Reducing Pandemic Influenza Transmission: A Systematic Review and Meta-Analysis. Epidemics.
This meta-analysis examined the effectiveness of hand hygiene, respiratory etiquette, and use of facemasks in reducing the risk of pandemic influenza transmission. The authors did not find data on the effectiveness of respiratory etiquette, but found that hand hygiene was statistically significant and wearing a face mask was suggestive of preventing infection.
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Smith, J., MacDougall, C., Johnstone, J., et al. (2016). Effectiveness of N95 Respirators Versus Surgical Masks in Protecting Health Care Workers from Acute Respiratory Infection: A Systematic Review and Meta-Analysis. Canadian Medical Association Journal. 188(8):567-574.
The authors conducted a meta-analysis of both clinical studies and surrogate exposure studies comparing N95 respirators to surgical masks to prevent transmission of acute respiratory infections. While the surrogate studies suggested a protective advantage of N95 respirators over surgical masks, the meta-analysis showed insufficient data to definitely determine whether N95 respirators are more protective.
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Plans, Tools, and Templates: EMS

* ASPR TRACIE. (2019). Healthcare Coalition Influenza Pandemic Checklist. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This planning tool is intended to assist healthcare coalitions (HCCs) and their partners in assessing their preparedness for an influenza pandemic. It may also be used to orient the response as a pandemic begins. This checklist can help HCCs assess, create, and improve their pandemic preparedness and response plans.
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ASPR TRACIE. (2023). EMS Infectious Disease Playbook.
This playbook (updated in 2023) synthesizes multiple sources of information in a single planning document addressing the full spectrum of infectious agents to create a concise reference resource for emergency medical services (EMS) agencies developing their service policies. The information can be incorporated into agency standard operating procedures and reviewed by the EMS medical director.
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  • Bridget Kanawati Thank you for your interest in this resource. Unfortunately, funding restrictions preclude our being able to provide printed versions of our resources so all of our products, including this one, are only available electronically. ASPR TRACIE Team
    3/26/2020 2:12:42 PM
  • Frances Thorpe I agree with Tracy, is there a way to order this publication in hard copy format? The information contained in this publication highlights agency infection control policies and is a great resource to have in the department library.
    3/26/2020 12:21:37 PM
  • Tracy Miller Is there any way to order a printed and bound version?
    8/9/2018 5:16:09 PM
Centers for Disease Control and Prevention. (2006). Emergency Medical Service and Non-Emergent (Medical) Transport Organizations Pandemic Influenza Planning Checklist. U.S. Department of Health and Human Services.
This planning checklist is intended to assist emergency medical services and other transport providers assess and improve their influenza pandemic preparedness.
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* Los Angeles County Emergency Medical Services Agency. (2009). Recommended Actions for EMS Providers to Prepare For and Respond to Pandemic Influenza.
This document provides pandemic influenza guidelines for emergency medical services responders and management, recommended actions during each pandemic period, and additional resources, such as infection control information, employee health considerations, and patient assessment tools.
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* National Emerging Special Pathogens Training and Education Center. (2024). EMS Procedural Guidelines for Special Pathogens.
These model procedural guidelines, created by NETEC's EMS/Patient Transport Work Group, are designed to help EMS agencies develop standard operating procedures for the transport and management of patients suspected or confirmed to have a high-consequence infectious disease. The guidelines address personal protective equipment (PPE) donning and doffing, EMS provider down, PPE breaches, biohazard spills, waste management, ambulance modification, and ambulance cleaning and disinfection. They complement ASPR TRACIE's EMS Infectious Disease Playbook (https://files.asprtracie.hhs.gov/documents/aspr-tracie-transport-playbook-508.pdf).
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Plans, Tools, and Templates: Hospitals

American College of Emergency Physicians. (n.d.). National Strategic Plan for Emergency Department Management of Outbreaks of Novel H1N1 Influenza. (Accessed 10/3/2019.)
This plan can help healthcare providers manage an H1N1 outbreak or other large scale epidemic or pandemic. Developed during the 2009 H1N1 pandemic, it provides a checklist/template for hospital preparedness.
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* ASPR TRACIE. (2019). Healthcare Coalition Influenza Pandemic Checklist. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This planning tool is intended to assist healthcare coalitions (HCCs) and their partners in assessing their preparedness for an influenza pandemic. It may also be used to orient the response as a pandemic begins. This checklist can help HCCs assess, create, and improve their pandemic preparedness and response plans.
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* ASPR TRACIE. (2021). Step-by-Step Guide to Implementing the Coalition Infectious Disease Annex TTX Template (PDF).
This guide is part of a toolkit that can help emergency planners create an interactive, discussion-based exercise focusing on impacts to healthcare coalition and healthcare facilities caused by large numbers of patients seeking healthcare following exposure to an infectious agent.
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Centers for Disease Control and Prevention. (2016). Healthcare System Preparedness and Response. U.S. Department of Health and Human Services.
This guide is intended to assist community hospitals in identifying issues with response capabilities and resource availability during an influenza pandemic as well as to develop strategies to address them.
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* Los Angeles County Emergency Medical Services Agency. (2010). Recommended Actions for Hospitals to Prepare for and Respond to Pandemic Influenza.
This document provides guidelines to hospitals to prepare for an influenza pandemic. It includes a summary of recommended actions and their triggers, checklists, sample response guides, general background information, and links to additional resources.
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Minnesota Department of Health, Association for Professionals in Infection Control and Epidemiology - Minnesota, and Health Care Coalitions of Minnesota. (2019). High Consequence Infectious Disease (HCID) Toolbox for Frontline Health Care Facilities.
This toolbox includes a variety of resources to assist frontline facilities in their readiness activities related to patients with high consequence infectious diseases. Included are planning and training tools, exercise templates, and the components (e.g., screening guide, checklists, posters) to create a readiness binder.
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* New York City Department of Health and Mental Hygiene. (n.d.). Mystery Patient Drill Toolkit. (Accessed 3/5/2025.)
This toolkit is intended for use by hospital emergency departments, and tests how long it takes for a potential patient with a highly infectious disease to be identified and for staff to begin exposure mitigation procedures; how long it takes for a patient to be transferred to an isolation room; and the capability of the facility to make notifications internally and to the health department. The Toolkit includes scenarios for Ebola Virus Disease, Middle East Respiratory Syndrome, and Measles, but may be modified to suit healthcare facilities of any nature and any type of disease outbreak.
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New York City Health + Hospitals. (2019). Frontline Hospital Planning Guide: Special Pathogens.
This planning guide from New York City Health + Hospitals provides high-level planning information for frontline hospital multidisciplinary teams to support planning and training for the initial care of suspected special pathogen patients while determining whether and when they will be transferred to another facility for further assessment and treatment.
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Plans, Tools, and Templates: Long Term Care/Assisted Living/Home Health

Centers for Disease Control and Prevention. (2006). Home Health Care Services Pandemic Influenza Planning Checklist. U.S. Department of Health and Human Services.
This checklist can help public and private healthcare organizations assess and better their pandemic influenza preparedness and planning.
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New Jersey Hospital Association (2010). Planning Today for a Pandemic Tomorrow: A Tool for Nursing Facilities.
This tool is intended to assist nursing facilities in developing their pandemic preparedness and response plans. It consists of several modules, which are to be used as a guide to facilitate discussion and to ensure that key points related to a specific topic, such as human resources, are identified and addressed in the planning process. It also includes sample policies and procedures and a module on ethics/values.
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Plans, Tools, and Templates: Other

* ASPR TRACIE. (2019). Healthcare Coalition Influenza Pandemic Checklist. U.S Department of Health and Human Services, Office of the Assistant Secretary for Preparedness and Response.
This planning tool is intended to assist healthcare coalitions (HCCs) and their partners in assessing their preparedness for an influenza pandemic. It may also be used to orient the response as a pandemic begins. This checklist can help HCCs assess, create, and improve their pandemic preparedness and response plans.
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* Centers for Disease Control and Prevention. (2016). Influenza Risk Assessment Tool (IRAT). U.S. Department of Health and Human Services.
This tool was developed by the Centers for Disease Control and Prevention and other influenza experts to assess the risk of a human pandemic emerging from influenza A viruses currently circulating in animals. The IRAT uses 10 weighted evaluation criteria to assess the risk of both emergence and public health impact and to classify each virus as low, moderate, or high risk.
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* Holloway, R., Rasmussen, S., Zaza, S., et al. (2014). Updated Preparedness and Response Framework for Influenza Pandemics. Morbidity and Mortality Weekly Report. 63(RR06):1-9.
This article describes the Centers for Disease Control and Prevention’s revised framework for pandemic influenza preparedness and response. The authors describe the six intervals along the pandemic curve and eight domains used to organize efforts within each interval.
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National Ebola Training and Education Center. (n.d.). NETEC Exercise Templates. (Accessed 9/9/2024.)
This web page includes links to various Homeland Security Exercise and Evaluation Program-compliant templates to assist healthcare coalitions, frontline facilities, assessment hospitals, state-designated Ebola treatment centers, regional Ebola and special pathogen treatment centers, and their respective response partners in the planning and conduct of exercises on the identification, assessment, treatment, management, transport, and transfer of high risk patients. The site includes templates for drills, tabletops, functional, and full-scale exercises. There is also a beginners guide to assist users new to exercise planning.
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Office of the Assistant Secretary for Preparedness and Response. (2005). Pandemic Flu: National Pandemic Strategy. U.S. Department of Health and Human Services.
The National Strategy for Pandemic Influenza provides strategies to stop, slow or limit the spread of a pandemic to the United States; limit the domestic spread of a pandemic, and mitigate disease, suffering and death; and sustain infrastructure and minimize economic and societal impacts. It aims to do so through preparedness and communication; surveillance and detection; and response and containment.
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San Francisco Department of Public Health. (2011). Infectious Disease Emergency Response Plan.
This plan contains the following sections: command, plans section (by unit), operations section, logistics, and finance. Four annexes that focus on different threats are included, as are sample forms and other appendices.
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U.S. Department of Health and Human Services. (2017). Pandemic Influenza Plan: 2017 Update.
This updated plan builds upon the 2005 Pandemic Influenza Plan and its subsequent updates, focusing on the seven domains of: surveillance, epidemiology, and laboratory activities; community mitigation measures; medical countermeasures; health care system preparedness and response activities; communications and public outreach; scientific infrastructure and preparedness; and domestic and international response policy, incident management, and global partnerships and capacity building.
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Plans, Tools, and Templates: Physician Offices

American Academy of Family Physicians. (2015). Checklist to Prepare Physicians' Offices for Pandemic Influenza.
This checklist identifies universal early preparations, describes actions for areas with suspected or known pandemic influenza, outlines telephone and office triage, notes referral or transfer and waste disposal procedures, and lists required equipment and supplies for physician offices to consider when preparing for pandemic influenza.
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* American Academy of Pediatrics. (2013). Pediatric Preparedness Resource Kit.
This resource kit was designed to address issues that occurred during 2009 H1N1 planning and allows for pediatricians, public health leaders, and other pediatric care providers to assess what is already happening in their community or state, and help determine what needs to be done before an emergency or disaster. It promotes collaborative discussions and decision making about pediatric preparedness planning at the local and state level and encourages integration of pediatric providers into disaster planning. It also contains a link to the Joint Policy Statement—Guidelines for Care of Children in the Emergency Department, as well as a Preparedness Checklist for Pediatric Practices and guidance for prioritizing vaccination during pandemics.
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Centers for Disease Control and Prevention. (n.d.). Abbreviated Pandemic Influenza Plan Template for Primary Care Provider Offices: Guidance from Stakeholders. (Accessed 6/3/2024.) U.S. Department of Health and Human Services.
The planning tool, based on discussion during an August 2009 CDC-sponsored stakeholder meeting, identifies considerations in a wide range of subject areas that primary care office staff should keep in mind when developing their office pandemic plans.
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Centers for Disease Control and Prevention. (n.d.). Assist in Medical Office Telephone Evaluation of Patients with Possible Influenza for Health Care Settings. (Accessed 1/10/2025.) U.S. Department of Health and Human Services.
This flowchart can aid medical staff in triaging calls. The tool may identify high-risk patients for consideration of initiation of antiviral treatment prior to an office visit.
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Centers for Disease Control and Prevention. (2012). Medical Office Preparedness Planner: A Tool for Primary Care Provider Offices. U.S. Department of Health and Human Services.
This document was created to help primary care providers develop pandemic influenza response plans. It includes a monthly planning calendar, as well as a detailed plan template for practices to fill in.
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Research

Nguyen, J., Yang, W., Ito, K., et al. (2016). Seasonal Influenza Infections and Cardiovascular Disease Mortality. JAMA Cardiology. 1(3):274-281.
The authors analyzed vital statistics and emergency department visit data for cardiovascular deaths during non-pandemic influenza seasons from 2006 to 2012 in New York City. They found a 2.3% increase in cardiovascular disease mortality, a 2.4% increase in ischemic heart disease mortality, and a 5.5% increase in myocardial infarction mortality in those 65 years and older associated with an increase from the 25th to 75th percentiles in the number of influenza-related emergency department visits in the previous 21 days.
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Resource Allocation and Management

Bayram, J., Sauer, L., Catlett, C., et al. (2013). Critical Resources for Hospital Surge Capacity: An Expert Consensus Panel. PLoS Currents.
The authors convened an expert consensus panel representing health providers, administrators, emergency planners, and specialists, and asked them to review four disaster scenarios and prioritize 132 hospital resources. The number of hospital resources considered to be critical varied by scenario: 58 for the pandemic influenza scenario, 51 for radiation exposure, 41 for explosives, and 35 for nerve gas scenario.
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* Fain, B., Viswanathan, K., and Altevogt, B. (2012). Public Engagement on Facilitating Access to Antiviral Medications and Information in an Influenza Pandemic - Workshop Series Summary. The National Academies of Sciences, Engineering, and Medicine.
This report summarizes a series of workshops on the public’s perception of how to facilitate access to antiviral medication and treatment during an influenza pandemic.
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Koonin, L. and Hanfling, D. (2013). Broadening Access to Medical Care During a Severe Influenza Pandemic: The CDC Nurse Triage Line Project. Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science. 11(1):75-80.
The authors describe the Centers for Disease Control and Prevention's Nurse Triage Line Project and its goals of using a coordinated network of nurse triage telephone lines during a pandemic to assess the health status of callers, help callers determine the most appropriate site for care, disseminate information, provide clinical advice, and provide access to antiviral medications to those who need it.
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Meltzer, M., Patel, A., Ajao, A., et al. (2015). Estimates of the Demand for Mechanical Ventilation in the US During an Influenza Pandemic. Clinical Infectious Diseases. 60(suppl_1):S52-S57.
The authors created a spreadsheet model to explore potential demand for invasive mechanical ventilation during an influenza pandemic. They used four standardized pandemic scenarios, each with a low and high clinical severity. They found that the number of deaths prevented varied greatly by scenario and was influenced by the shape of the epidemic curve and the effectiveness of ventilation as well as the distribution of ventilators throughout the healthcare system along with trained staff and resources to support their use.
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O'Hagan, J., Wong, K., Campbell, A., et al. (2015). Estimating the United States Demand for Influenza Antivirals and the Effect on Severe Influenza Disease during a Potential Pandemic. Clinical Infectious Diseases. 60 (Suppl 1):S30-41.
Following the detection of a novel influenza strain A (H7N9), the authors modeled the use of antiviral treatment in the U.S. to mitigate severe disease across a range of hypothetical pandemic scenarios. The model included estimates of attack rate, healthcare-seeking behavior, prescription rates, and other related data. Based on these inputs, the total antiviral regimens estimated to be available in the U.S. (as of April 2013) were deemed sufficient to meet treatment needs for the scenarios considered.
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Spaulding, A., Radi, D., Macleod, H., et al. (2012). Design and Implementation of a Statewide Influenza Nurse Triage Line in Response to Pandemic H1N1 Influenza. Public Health Reports. 127(5): 532-540.
The Minnesota Department of Health developed several tools to support healthcare providers during the 2009 H1N1 influenza pandemic, including MN FluLine, a nurse triage line, that reached many rural and uninsured residents, and, according to the authors, may have prevented up to 11,000 in-person health-care encounters.
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Watson, S., Chen, Y., Nguyen-Van-Tam, J., et al. (2017). Evidence Synthesis and Decision Modeling to Support Complex Decisions: Stockpiling Neuraminidase Inhibitors for Pandemic Influenza Usage. F1000Research. 5:2293.
The authors designed a decision model to determine whether the benefits of stockpiling antivirals for an influenza pandemic outweigh the negative consequences of not stockpiling. They estimated both the cost-effectiveness benefits as well as the health benefits, which were measured as deaths averted by stockpiling. While they found that the probability of not using a stockpile was greater than using it, stockpiling was justified due to the catastrophic losses that would occur from a severe pandemic without it.
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Zaza, S., Koonin, L., Ajao, A., et al. (2016). A Conceptual Framework for Allocation of Federally Stockpiled Ventilators During Large-Scale Public Health Emergencies. (Registration required.) Health Security. 14(1):1-6.
The authors describe a conceptual framework for the distribution of ventilators stockpiled by the federal government during a large-scale emergency. They identify necessary planning steps to aid in the optimal allocation of ventilators to individual hospitals.
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Vaccines

Centers for Disease Control and Prevention. (2024). Interim Updated Planning Guidance on Allocating and Targeting Pandemic Influenza Vaccine During an Influenza Pandemic. U.S. Department of Health and Human Services.
This document provides guidance on the allocation of influenza vaccine during the early stages of a pandemic when demand may exceed production capacity. It offers general principles on pandemic vaccination and a framework based on targeted groups and pandemic severity.
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  • Sheran Kaplan-Hicks This link is broken and does not provide access to this document.
    10/15/2019 12:32:50 PM
Li, Z., Swann, J., and Keskinocak, P. (2018). Value of Inventory Information in Allocating a Limited Supply of Influenza Vaccine During a Pandemic. PLOS One. 13(10):e0206293.
The authors describe using a population-based allocation model versus a model based on population plus inventory demand to simulate the value of information on vaccine inventory levels during an influenza pandemic. They find that the population plus inventory approach may reduce the attack rate, decrease the amount of unused vaccine, and maintain or increase the percentage of the population vaccinated, suggesting that greater visibility of the vaccine supply chain would be beneficial.
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Manzoli, L., Ioannidis, J., Flacco, M., et al. (2012). Effectiveness and Harms of Seasonal and Pandemic Influenza Vaccines in Children, Adults and Elderly. Human Vaccines and Immunotherapeutics. 8(7):851-862.
The authors completed an umbrella review and reanalyzed data from 15 previously published meta-analyses to determine how different analyses and study selection criteria could explain differences in findings or interpretations. They found statistically significant efficacy and effectiveness – high for laboratory-confirmed cases in children and adults and modest for clinically-confirmed cases and for the elderly – of seasonal influenza vaccines. They identified a scarcity of data on the efficacy of live-attenuated vaccine in those less than two years old, suboptimal quality of harms data, and a lack of meta-analysis on the effect of H1N1 vaccination on clinical outcomes.
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* Saunders-Hastings, P., Reisman, J., and Krewski, D. (2015). Assessing the State of Knowledge Regarding the Effectiveness of Interventions to Contain Pandemic Influenza Transmission: A Systematic Review and Narrative Synthesis. PLoS One. 11(12).
This study reviews existing systematic reviews and meta-analyses on pandemic influenza interventions including vaccines, antivirals, personal protective measures, school closures, and traditional Chinese medicine. Pandemic influenza vaccine was found to be protective against infection, but the authors found insufficient evidence for the effectiveness of each of the other interventions in isolation and hypothesized that a combination of interventions would be most effective.
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U.S. Food and Drug Administration. (2020). Vaccine Development – 101. (Added 12/23/2020.) U.S. Department of Health and Human Services.
This webpage describes the steps that vaccine developers follow when seeking FDA approval of a vaccine.
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Agencies and Organizations

Administration for Strategic Preparedness and Response. ASPR's Response to H5N1 Bird Flu.
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Center for Infectious Disease Research and Policy. Pandemic Influenza.
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Centers for Disease Control and Prevention. Information on Bird Flu.
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Centers for Disease Control and Prevention. Influenza.
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Centers for Disease Control and Prevention. Pandemic Influenza.
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Centers for Infectious Disease Research and Policy. Influenza.
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European Centre for Disease Prevention and Control. Avian Influenza.
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Institute for Diseases and Disaster Management. Tools and Resources. NYC Health + Hospitals.
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National Emerging Special Pathogens Training and Education Center.
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National Institute of Allergy and Infectious Diseases. Influenza.
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U.S. Department of Labor, Occupational Safety and Health Administration. Pandemic Influenza.
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World Health Organization. Pandemic Influenza Preparedness (PIP) Framework.
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This ASPR TRACIE Topic Collection was refreshed at the end of 2020. It was comprehensively reviewed in September 2017 by the following subject matter experts (listed in alphabetical order): Eric Alberts, Manager of Emergency Preparedness, Orlando Health; Julie Bulson, DNP, MPA, RN, NE-BC, Director, Emergency Preparedness, Spectrum Health; Matt Gneuhs, Program Manager, Emergency Preparedness and Response, Cincinnati Children’s; Michael Gurnick, Chair, Ashland Branch, Massachusetts MRC Region 4A; John Hick, MD, HHS ASPR, and Hennepin County Medical Center; Jodi Keller, RN, Associate Director of Healthcare System Emergency Preparedness, Central Ohio Trauma System; Lisa Koonin, DrPH, MN, MPH, Deputy Director, Influenza Coordination Unit, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; Anita Patel, PharmD, MS, Senior Advisor and Lead, Pandemic Medical Care and Countermeasures, Influenza Coordination Unite, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention; Terri Postma, MD, Medical Officer, Centers for Medicare and Medicaid Services; and Mary Russell, EdD, MSN, Emergency Services, Boca Raton Regional Hospital. 

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