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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
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T*
[(2)-6.5(009)-377.9(up)-379.9(until)-383(late)-382.6(summer)-10.5(,)-376(bec)-7.4(ause)-381.4(early)-381.2(estima)-10.7(tes)-380.9(indi-)]TJ
T*
[(ca)-7.1(ted)-500.2(an)-508(uncertaint)-11.9(y)-501.9(ranging)-509.8(from)-503.1(the)-505.8(mildes)-10(t)-500.4(possible)]TJ
T*
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T*
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(5,9-12)Tj
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[(As)-213.9(we)]TJ
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T*
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T*
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T*
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T*
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[(me)-9(asures)-358.1(such)-357.1(as)-353.2(school)-361.8(dismissa)-10.7(ls\))-352.2(an)-7.2(d)-349.3(the)-357.9(public)-357.7(health)]TJ
T*
[(an)-7.2(d)-320.8(economic)-329(benets)-329.4(of)-318.3(inte)-8.2(rventions)-330(would)-322.1(be)-322.8(form)-8(ally)]TJ
T*
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T*
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T*
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T*
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T*
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[(1.3)-502.2(Measures)-336.2(to)-330(Protect)-334.9(Individuals)]TJ
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T*
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T*
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T*
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T*
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73.984 741.713 466.242 .45355 re
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T*
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[(grap)11.6(hic)-485.2(ch)11.6(arac)14.9(ter)11.4(isti)11.6(cs)-483.7(or)-492.5(pa)11.2(rti)13(cul)11.2(ar)-490.2(como)13(rbi)11.8(dit)13.6(ies)-485.5(in)-489(the)]TJ
0 -1.2007 TD
[(gene)10(ral)-302.7(pop)12.4(ula)10.8(tio)15.3(n)-310.8(i)0(s)-311.4(com)13.4(pare)10.8(d)-309.4(wit)11.6(h)-309.4(the)-306.7(fre)11.8(que)10.8(nc)10.2(y)-314.1(amo)13(ng)]TJ
T*
[(peo)11.2(ple)-347.3(wi)11.2(th)-348.9(sev)11.6(ere)-345.2(outc)17.3(omes)-341.8(\(de)9.2(ath)11.6(,)-353.2(I)0(C)11.4(U)-354(adm)11.2(iss)10.6(ion)11.4(,)-353.2(hos)12.2(-)]TJ
T*
[(pita)15.5(liz)14.4(ati)12(on\).)]TJ
7.4718 0 0 6.641 120.1322 609.6754 Tm
[(14-)16.9(16)]TJ
9.9626 0 0 9.9626 140.4283 605.2534 Tm
[(Id)12.2(eall)14.9(y,)-308.8(one)-308.8(wou)10.4(ld)-309.8(als)16.3(o)-319.1(h)0(a)11.2(v)0(e)-310.4(est)11.8(ima)11.6(tes)-306.9(of)]TJ
-6.8969 -1.2007 TD
[(the)-181.5(eff)9.6(ec)10.4(tive)12.6(ness)-176.6(of)-187.4(pr)12.2(eve)10.6(ntio)11.8(n)-185.6(and)-185.8(tre)17.1(atme)10.4(nt)-185.2(in)-181.7(the)-181.5(hig)10.6(h-r)9.8(isk)]TJ
T*
[(gro)11.4(ups)10.4(,)-421.5(sin)9.4(ce)-410.7(pri)10.4(ori)12.2(tizi)13.4(ng)-415.8(gro)11.4(ups)-410.7(for)-412.1(int)12.2(erv)11.2(ent)10.6(ion)-409.7(pres)12.2(up-)]TJ
T*
[(pose)14.5(s)-235.7(tha)11.6(t)-232.9(the)-227(int)12.2(er)11(ven)10.4(tion)11.8(s)-230(wil)10.8(l)-233.7(hel)11.2(p)-235.5(the)12(m.)-228(In)-228.2(prac)10.8(tic)12.4(e,)-225.6(dat)11.6(a)]TJ
T*
[(on)-447.8(int)12.2(erv)11.2(ent)10.6(ion)-443.8(eff)15.3(ect)10.8(ive)12.2(ness)-444.1(in)-443.5(hig)10.6(h-r)9.8(isk)-441.3(gr)11.8(oups)-439.5(may)-443(be)]TJ
0 -1.195 TD
[(dif)10.4(cu)11.6(lt)-301.6(to)-295.9(obta)18.3(in)-301.2(in)-295.5(time)12.4(,)-302(but)-292.7(may)-295.1(be)-300(inf)12.6(erre)16.3(d)-303.7(from)-292.5(exp)11.8(e-)]TJ
0 -1.2007 TD
[(rien)11.4(ce)-444.8(wit)11.6(h)-451.7(s)0(e)11.4(aso)10.6(nal)-445.8(in)11.8(uen)10.2(za,)]TJ
7.4718 0 0 6.641 192.8125 537.9589 Tm
[(14,)20.8(17)]TJ
9.9626 0 0 9.9626 213.9023 533.5369 Tm
[(des)9.2(pit)13.6(e)-447.2(epi)9.8(dem)11.6(iolo)14.2(gic)]TJ
-14.2719 -1.2007 TD
[(diff)14.7(eren)15.5(ces)-270.8(betw)15(een)-272(pan)13.4(demi)9.9(c)-276.5(and)-265.5(seas)11(onal)-264.1(dis)10.8(eas)13.4(e.)]TJ
/F6 1 Tf
13.9476 0 0 13.9476 71.7165 488.6928 Tm
[(1.4)-502.2(Measures)-332.1(to)-334.1(Slow)-333.1(Transmission)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 71.7165 473.7259 Tm
-.014 Tc
[(Deci)-14(s)10.3(i)1.3(ons)-300.9(a)-.6(lso)-304.6(m)-2.6(ust)-298.1(b)-14(e)-291.2(m)-2.6(ade)-301.9(a)-.6(bout)-298.1(i)-14(n)9.2(terventions)-306.6(t)3.5(o)-304.6(p).9(revent)]TJ
T*
[(transmissi)-14.1(o)12.2(n)-.6(.)-361.6(I).2(n)-359.1(t)-2.3(he)-358.9(early)-362.4(phases)-363.6(o)2.6(f)-360.4(a)-359.3(pandemic)-14.1(,)-347.9(t)-2.3(hese)-358.9(may)]TJ
0 -1.195 TD
[(in)-14(c)7.6(l)2.7(ude)-239.3(scr)-14(e)8.4(ening)-238.5(t)3.5(r)-14(a)13.7(vele)-14(r)8.4(s)-232.6(as)-238.3(they)-237.1(enter)-238.7(o)2.7(r)-238.7(l)2.7(eave)-239.3(a)-234(j)-14(u)11.9(r).3(isd)-14(i)10.5(cti)-14(o)12.3(n)]TJ
0 -1.2007 TD
-.0136 Tc
[(and)-556.4(i)1.7(s)-13.6(o)12.1(l)-13.6(a)16.4(ting)-556.8(those)-557.5(w)5.1(h)-13.6(o)-545.4(are)-557.5(s)1.1(ymptomatic.)-554.6(M)-2.4(athematical)]TJ
T*
-.0143 Tc
[(models)-181.7(ind)-14.3(i)10.2(cate)-182.7(that)-178.9(su)-14.3(c)8.7(h)-181.5(me)-14.3(a)12.8(s)-14.3(u)9.6(r)0(es)-181.7(are)-182.7(u).6(nli)-14.3(k)13.4(el)-14.3(y)-169.5(t)3.2(o)-185.4(d).6(elay)-180.5(g)-14.3(l)11.2(obal)]TJ
T*
[(sp)-14.4(r)9.2(e)-.7(ad)-198.6(of)-201.4(inue)-14.4(n)7.2(za)-200.2(by)-197.7(more)-199.8(than)-200(about)-201.8(2)-197.3(weeks.)]TJ
7.4718 0 0 6.641 248.2015 418.3936 Tm
0 Tc
[(18)36.4(-)18.5(2)22(0)]TJ
9.9626 0 0 9.9626 266.7968 413.9715 Tm
[(I)14.3(n)-185.6(20)26.9(09)26.9(,)]TJ
-19.5812 -1.2007 TD
[(s)14.7(o)11(m)11.4(e)-572.4(ju)25.9(r)14.3(i)15.3(sd)23.9(i)15.3(c)13.7(t)11.8(i)15.3(o)16.7(n)0(s)-563.6(j)0(u)25.9(d)14.9(g)14.5(e)13.7(d)-576.9(t)11.8(h)14.9(i)15.3(s)-577.1(d)14.9(el)24.7(a)13.4(y)-575.9(a)13.4(d)14.9(e)13.7(q)16.3(ua)22.6(t)17.5(e)-578.1(t)17.5(o)-580.8(j)16.7(u)14.9(s)14.7(t)11.8(i)15.3(f)12.2(y)]TJ
T*
-.0136 Tc
[(string)-13.6(e)9(n)-.1(t)-331.9(b)-13.6(o)13.7(r).7(d)-13.6(e)9.4(r)-335(c).1(ontrols,)-338.3(a)5.4(n)-.1(d)-340.1(e).1(v)3.7(i)-13.6(d)10.9(e).1(nce)-335.6(s)1.1(h)-13.6(o)12.3(ws)-334.6(that)-331.9(the)-335.6(c).1(on-)]TJ
T*
-.0146 Tc
[(trol)-14.6(s)-245(m)-3.2(easurab)-14.6(l)12.7(y)-254.8(d)-14.6(e)8.4(l)2.1(ayed)-261.4(the)-256.9(s)-14.6(t)11.9(a)-1.2(rt)-258.9(of)-258.5(lo)-3.6(cal)-254(t)-2.8(ransm)-3.2(i).7(ssi)-14.6(o)11.7(n)-257.1(o)-3.6(f)-252.8(the)]TJ
T*
-.0139 Tc
[(H)-13.9(1)13.4(N1)-447.1(vi)-13.9(r)10(u)1(s)-443.1(i)-13.9(n)-434.6(s).8(everal)-441.1(re)-13.9(g)8.7(i)1.4(ons.)]TJ
7.4718 0 0 6.641 193.096 370.6015 Tm
0 Tc
(21)Tj
9.9626 0 0 9.9626 204.718 366.1227 Tm
-.0131 Tc
[(Once)-443.2(community)-441.1(trans-)]TJ
-13.35 -1.195 TD
-.0143 Tc
[(miss)-14.3(i)10(o)2.4(n)-188.5(i)-14.3(s)-177.8(e)-.6(stabli)-14.3(s)10(h).6(ed,)-191.1(h).6(owever,)-185.4(t)-2.5(he)-188.4(measures)-193.1(a)4.7(r)-14.3(e)-179.7(l)2.4(ess)-187.4(u)-14.3(s)9.6(e)-.6(ful,)-191.1(so)]TJ
0 -1.2007 TD
-.0138 Tc
[(a)-262.2(k)-1.4(ey)-259.7(rol)-13.8(e)-245.1(for)-255.5(s)-13.8(u)10.1(r).5(vei)-13.8(l)12.5(lance)-261.8(i)1.5(s)-260.9(t)-2(o)-258.9(i)1.5(nform)-258.5(d)1.1(eci)-13.8(s)10.5(i)1.5(on)-256.3(makers)-260.9(abou)-13.8(t)]TJ
T*
0 Tc
[(t)11.8(h)14.9(e)-265.1(e)13.7(x)11.6(t)17.5(en)21.6(t)-261.4(o)11(f)-266.7(i)15.3(n)13.5(f)12.2(e)13.7(c)13.7(t)11.8(i)15.3(o)16.7(n)-271(w)18.7(it)27.1(h)14.9(i)0(n)-255.7(t)11.8(h)14.9(e)13.7(i)15.3(r)-264.5(ju)25.9(r)14.3(i)15.3(s)14.7(d)0(i)24.5(c)13.7(t)17.5(i)0(o)26.3(n)13.5(s.)]TJ
1.0015 -1.2007 TD
[(Othe)12(r)-492.1(non)9.6(pha)14.8(rma)10.6(ceut)14.4(ical)-481.5(int)12.2(erv)11.2(ent)10.6(ion)11.4(s)-491.7(t)0(o)-489.4(slow)-479.5(tra)11(ns-)]TJ
-1.0015 -1.2007 TD
[(miss)10.6(ion)-534.9(in)-534.5(a)-544.3(com)13.4(muni)9.7(ty)-535.7(inc)14.1(lude)-531.5(sch)9.2(ool)-536.1(dis)10.8(mis)13(sal)10.6(s)-543(and)]TJ
T*
[(canc)14.5(ell)13(ati)12(on)-351(of)-346.7(pub)12(lic)-341.2(ga)10.8(the)12(ring)12.2(s;)-344.2(the)12(se)-347.1(mea)10(sur)9.8(es)-347.1(are)-339.8(oft)12.2(en)]TJ
T*
[(unde)11.6(rta)11(ken)-188(reac)15.3(tive)12.6(ly)-195(ba)12.6(sed)-195.6(on)-191.7(tra)11(nsm)11.2(iss)10.6(ion)-193.5(in)-193.1(an)-195(indi)13.6(vid)13.4(ual)]TJ
T*
[(sch)9.2(ool)-325.5(or)-333.2(dis)10.8(tri)13(ct.)-322(Thes)10.8(e)-333.4(deci)12.2(sio)12.6(ns)-330.2(spe)9.2(ci)14.1(call)14.9(y)-336.9(r)0(e)11(l)0(y)-331.6(o)0(n)-334()0(n)10(e)0(-)]TJ
0 -1.195 TD
[(grai)12(ne)10.2(d)-298.1(loc)13(al)-294.3(dat)11.6(a)-293.9(\(se)9(e)-299.2(s)0(i)12.9(deb)10.8(ar:)-291.4(Lo)11(cal)-292(Sur)11.8(vei)12.2(lla)12.6(nce)-289(Data)17.1(\).)]TJ
1.0015 -1.2007 TD
[(Vaccin)-10.1(ation)-367.5(can)-363.4(also)-371(be)-362.6(used)-368.5(to)-364.2(slow)-365.7(tran)-9.6(smission)-373(and)]TJ
-1.0015 -1.2007 TD
[(prote)-8.2(ct)-725.6(nonvacc)-11.9(inated)-731.1(peop)-8(le.)-726.8(Appropri)-9.3(ately)-725.2(targ)-8.6(eting)]TJ
T*
[(vaccin)-9.8(es)-426.8(for)-429.1(this)-427(pur)-7(pose)-429.3(requires)-434.6(identifyin)-12.1(g)-423.7(the)-431.9(groups)]TJ
T*
[(mos)-8.4(t)-227.2(likely)-233.7(to)-227.6(become)-238.7(infected)-238.2(and)-231.3(then)-230.5(infect)-232.7(oth)-7.8(ers)-230.4(in)-227.2(the)]TJ
T*
[(popula)-10.9(tion.)]TJ
7.4718 0 0 6.641 116.674 203.1874 Tm
(22,23)Tj
9.9626 0 0 9.9626 137.4803 198.7653 Tm
[(Althoug)-8.1(h)-400.5(school-ag)-11.9(e)-401.7(children)-406.3(play)-405.8(a)-402.1(key)]TJ
-6.601 -1.2007 TD
[(role)-416.6(in)-415(this)-415.6(process)-11(,)-410.1(their)-419.3(importanc)-11.5(e)-413.1(often)-415.8(decline)-12.1(s)-412.1(a)0(s)-410.1(a)]TJ
T*
[(pande)-9.2(mic)-266.8(wave)-267(progr)-10.6(esses.)-270.2(Chang)-9.2(es)-267.5(in)-261.4(the)-266.8(age)-271.4(distribution)]TJ
0 -1.195 TD
[(of)-306.9(cases)-305.3(can)-306.5(help)-303.9(track)-304.3(this)-301.8(tren)-9.2(d.)]TJ
7.4718 0 0 6.641 201.8834 167.3574 Tm
(22)Tj
/F6 1 Tf
13.9476 0 0 13.9476 71.7165 130.0535 Tm
[(1.5)-502.2(Investment)-332.7(Allocation)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 71.7165 115.0866 Tm
[(De)-7.6(cision)-394.4(mak)-8.4(ers)-389.7(mu)-7.8(st)-388.9(alloc)-8.2(ate)-393.6(limited)-395.9(res)-8.4(ources)-395.6(betw)-7.8(een)]TJ
0 -1.2007 TD
[(meas)-9.4(ures)-471.5(to)-472.3(protect)-472.1(ind)-7.4(ividuals)-475(and)-470.3(meas)-9.4(ures)-471.5(to)-466.6(red)-8.2(uce)]TJ
T*
[(transm)-11.9(ission.)-427.9(In)-421.7(addition)-430.4(to)-421.1(money,)-429.9(resourc)-11.3(e)-418.7(lim)-7.8(itations)]TJ
T*
[(can)-329.2(involve)-333.3(public)-329.2(health)-330(personnel,)-335.1(public)-329.2(attention,)-334.1(and)]TJ
0 -1.195 TD
[(supp)-8.8(lies.)-531.8(For)-531.9(examp)-9(le,)-533.3(the)-528.6(supp)-8.8(ly)-530.8(of)-534.5(antiviral)-534.8(drugs)-535.5(is)]TJ
24.0027 65.999 TD
[(limited)-9(,)-341.8(a)0(s)-341.8(i)0(s)-345.6(the)-346.5(viruss)-346.9(suscepti)-11.3(bility)-346.9(to)-341.4(them)-10.7(,)-341.8(which)-343.5(ca)-7(n)]TJ
0 -1.2007 TD
[(also)-410.9(be)-408.1(conside)-11.1(red)-406.6(a)-407.7(lim)-7.8(ited)-410.9()39.8(resource.)30.5()]TJ
7.4718 0 0 6.641 470.6078 717.2786 Tm
(24)Tj
9.9626 0 0 9.9626 482.1164 712.8565 Tm
[(Co)-9(nsequently,)]TJ
-17.1911 -1.2007 TD
[(using)-348.1(an)-7.2(tivirals)-347.8(to)-347.1(slow)-348.7(transmis)-10.3(sion)-349.5(may)-346.3(hin)-7.4(der)-349.6(their)-345.3(fu)-7.1(-)]TJ
T*
[(ture)-303.7(use)-303.7(for)-303.9(treatm)-9(ent.)]TJ
7.4718 0 0 6.641 398.4944 693.3541 Tm
(19,25)Tj
9.9626 0 0 9.9626 320.8251 676.9698 Tm
[(Limited)-304.5(vacc)-10.2(ine)-304.5(supplies)-306.8(create)-312(a)-299.6(trade-off)-314.3(betwee)-8.8(n)-299.4(vac-)]TJ
-1.0015 -1.2007 TD
[(cinating)-514.8(those)-508.6(at)-509.8(highest)-514.7(risk)-506.6(an)-7.2(d)-502.9(tho)-7.8(se)-506.5(most)-508.8(lik)-6.8(ely)-505.7(to)]TJ
T*
[(transmit)-423(infection)-420.5(\(see)-421.1(sidebar:)-421.2(Prior)-7.6(itizing)-415.6(V)-5.9(accination)-13.3(\).)]TJ
0 -1.195 TD
[(The)-299.8(key)-299.4(questions)-306.4(for)-298.3(prioritiza)-11.5(tion)-301.2(are:)-294.7(Who)-302.1(is)-300(at)-293.5(high)-8.6(est)]TJ
0 -1.2007 TD
[(risk,)-302.2(an)-7.2(d)-298.1(h)0(o)-8.2(w)-300(readi)-8(ly)-303.2(can)-300.8(th)-7.4(ey)-300.4(be)-305.7(identi)-10(ed?)-303.7(On)-305.1(the)-306.7(other)]TJ
T*
[(hand,)-455.8(who)-456.2(ar)-6.5(e)-452.9(the)-454.6(transm)-11.9(itters?)-455.6(Whe)-9.2(n)-453.1(vaccin)-9.8(e)-452.9(become)-11.1(s)]TJ
T*
[(available)-569.5(in)-568.7(substanti)-10.1(al)-561.8(quantitie)-10.5(s,)-566.1(will)-564.3(transmis)-10.3(sion)-571.4(be)]TJ
T*
[(ongoing)-219.5(at)-208.2(a)-208.6(high)-207.8(level?)-214.4(Will)-211.1(the)-209.9(group)-214.8(drivi)-8.2(ng)-210.9(transmis)-10.3(sion)]TJ
T*
[(early)-335.7(in)-335.3(the)-335.1(pandem)-9.2(ic)-329.5(\(eg,)-338.7(schoolc)-12.3(hildren\))-337.1(still)-334.5(be)-334.2(the)-335.1(key)]TJ
T*
[(driver,)-246.2(or)-242.1(will)-245.6(suscepti)-11.3(ble)-243.5(member)-10.1(s)-241.4(o)0(f)-244.3(that)-244.1(group)-249(have)-242.3(bee)-7.4(n)]TJ
T*
[(largely)-270.3(exha)-9(usted,)-271.7(making)-272.3(their)-271.3(vaccin)-9.8(ation)-270.7(less)-270.2(effective)-12.9(?)]TJ
7.4718 0 0 6.641 530.4754 561.8833 Tm
(22)Tj
9.9626 0 0 9.9626 320.8251 545.4991 Tm
[(Predictions)-413.6(of)-403.6(the)-403.4(likely)-404.4(timing)-407.5(and)-402(magn)-9.8(itude)-407.3(of)-403.6(the)]TJ
-1.0015 -1.2007 TD
[(peak)-400.8(\(or)-403.8(peaks\))-405.6(of)-397.9(diseas)-10(e)-396(incide)-10.2(nce)-402.8(would)-401.8(also)-399.5(faci)-8(litate)]TJ
T*
[(respons)-11.1(e)-350.5(planni)-9.4(ng)-353.2(an)-7.2(d)-349.3(res)-8.4(ource)-359.1(allocation)-364.3(by)-354.8(anticipatin)-13.1(g)]TJ
T*
[(likely)-523.9(periods)-521.3(of)-523.1(intense)-523.9(stre)-8(ss)-516.9(on)-521.8(healthc)-9(are)-516.3(provid)-9(ers.)]TJ
T*
[(Optimally)-259.5(targeting)-258.4(vaccin)-9.8(ation)-253.7(depends)-258(on)-248.6(th)-7.4(e)-248(numbe)-9.7(r)-247.4(o)0(f)]TJ
T*
[(doses)-317.9(availa)-7.4(ble)-317.5(prior)-317.1(to)-313(the)-318.1(peak)-315.5(of)-318.3(transmis)-10.3(sion)-315.3(\(see)-318.7(side)-9.6(-)]TJ
T*
[(bar:)-491.3(Prioritizin)-10.9(g)-491.9(Vaccination)-13.4(\).)-486.4(Ra)-7.4(w)-487.8(surveilla)-10.9(nce)-488.2(data)-492.9(by)]TJ
T*
[(deniti)-10(on)-425(provid)-9(es)-426.8(info)-10.6(rmation)-432.8(abou)-7(t)-426.4(the)-426.2(past)-7.8(,)-421.5(not)-430.3(pre)-8.2(-)]TJ
0 -1.195 TD
[(dictions)-276.6(of)-267.1(the)-266.8(fu)-7.1(ture)-269.6(course)-270.4(of)-272.7(the)-266.8(pande)-9.2(mic.)-267.2(We)-274.5(argue)-270.6(in)]TJ
0 -1.2007 TD
[(section)-424(3.4,)-417.7(however)-10.1(,)-415.8(that)-414.8(ca)-7.1(refully)-419.1(desi)-9.6(gned)-421.3(surveillanc)-12.1(e)]TJ
T*
[(progra)-8.6(ms,)-623(combin)-9.7(ed)-620.1(with)-622.2(mathe)-8.8(matical)-627.1(and)-624(statistical)]TJ
T*
[(modelin)-11.5(g)-218.8(t)0(o)-216.2(infer)-226.8(the)-221.3(number)-223(of)-221.5(infected)-226.8(ind)-7.4(ividuals,)-225(could)]TJ
T*
[(provide)-581.3(conside)-11.1(rable)-574.3(insi)-9.4(ght)-573.3(an)-7.2(d)-571.2(help)-577.1(dec)-8.8(ision)-578.8(maker)-8.8(s)]TJ
T*
[(prioritize)-307(part)-8.2(icular)-304.3(scena)-10.6(rios.)]TJ
1.0015 -1.2007 TD
[(Decisions)-404.4(abou)-7(t)-392.2(prior)-9.8(itizing)-398.5(inte)-8.2(rventions)-404(will)-399.3(need)-399.3(to)]TJ
-1.0015 -1.2007 TD
[(balance)-320.4(proje)-9(cted)-315.7(ben)-7.6(ets)-316.1(of)-318.3(prioritizi)-9.5(ng)-319.1(particu)-9.7(lar)-314.1(group)-10(s)]TJ
0 -1.195 TD
[(against)-500.9(important)-502.8(conside)-11.2(rations)-497.8(of)-494.7(logistics)-503.9(and)-493.1(publi)-7.2(c)]TJ
0 -1.2007 TD
[(acceptan)-11.3(ce.)-246.1(As)-248(in)-250(all)-243.5(matter)-9(s)-247.1(o)0(f)-244.3(publi)-7.2(c)-248(health)-250.3(prioritizat)-11.1(ion,)]TJ
T*
[(the)-357.9(calculat)-10.9(ion)-358.5(of)-358.1(projected)-364.5(ben)-7.6(ets)-361.6(depends)-366.1(on)-356.7(ones)-362.4(as-)]TJ
T*
[(sumption)-11.9(s)-252.7(abou)-7(t)-250(the)-255.5(relat)-9.8(ive)-255.3(value)-254.1(of)-255.7(pre)-8.2(venting)-258.8(mor)-8.8(bidity)]TJ
T*
[(versus)-268.8(mor)-8.8(tality,)-268.4(and)-265.5(abou)-7(t)-267.1(the)-266.8(relative)-270.7(value)-271.1(of)-267.1(preven)-9.2(ting)]TJ
T*
[(mortali)-8.5(ty)-251.2(in)-250(vari)-8(ous)-249.6(group)-10(s.)-253.1(This)-255.1(question)-258.6(has)-252.9(bee)-7.4(n)-248.2(heav)-9(ily)]TJ
T*
[(debated)-9.3(,)]TJ
7.4718 0 0 6.641 343.5023 286.866 Tm
(26)Tj
9.9626 0 0 9.9626 353.2534 282.444 Tm
[(and,)-231.7(in)-232.9(the)-227(ca)-7.1(se)-227.6(of)-232.9(pande)-9.2(mic)-232.7(inuenza)-10.7(,)-228(i)0(t)-229(i)0(s)-231.7(clear)]TJ
-4.2565 -1.2007 TD
[(that)-221.3(unless)-224.6(vaccin)-9.8(es)-216.2(ar)-6.5(e)-219.6(s)0(o)-219(plentif)-10(ul)-218.8(that)-221.3(transmis)-10.3(sion)-224.3(can)-221.1(be)]TJ
0 -1.195 TD
[(comple)-9.6(tely)-419.9(or)-418.5(nearl)-8(y)-416.6(halted,)]TJ
7.4718 0 0 6.641 423.2125 262.9984 Tm
(27)Tj
9.9626 0 0 9.9626 434.8345 258.5763 Tm
[(polic)-8(ies)-422.9(to)-415.4(minimiz)-9.3(e)-418.8(total)]TJ
-12.4452 -1.2007 TD
[(mortali)-8.5(ty)-182.9(may)-192.7(differ)-190.5(fro)-8(m)-187.8(those)-189.9(to)-187.8(minimiz)-9.3(e)-185.4(years)-195.4(of)-187.4(life)-186.8(lost)]TJ
T*
[(or)-173.8(disabili)-9(ty-adjuste)-11.1(d)-172.9(years)-178.3(of)-176(life)-175.4(lost.)]TJ
7.4718 0 0 6.641 452.6928 239.0739 Tm
(28-30)Tj
9.9626 0 0 9.9626 471.7983 234.6519 Tm
[(Moreove)-10.1(r,)-173.8(effort)-10.2(s)]TJ
-16.1555 -1.2007 TD
[(to)-284.5(targ)-8.6(et)-287.5(particul)-10.1(ar)-285.3(groups)-296.8(may)-289.4(result)-289.4(in)-289.8(und)-7.8(eruse)-292.7(of)-284.1(ava)-7.2(il-)]TJ
T*
[(able)-201.7(supplies,)-204.8(be)-197.6(difc)-10(ult)-195.6(to)-199.2(impleme)-10.9(nt,)-202.7(or)-196.6(provok)-10.1(e)-196.8(negative)]TJ
T*
[(public)-226.8(res)-8.4(ponse)-228(if)-228.6(some)-228(ind)-7.4(ividuals)-230.3(disagr)-9.6(ee)-228.6(with)-223.8(the)-227(choic)-11(e)]TJ
T*
[(of)-386.6(whom)-387.9(to)-386.9(prior)-9.8(itize.)-388.7(In)-387.5(the)-386.3(U.S.,)-389.6(a)-385(publi)-7.2(c)-384.6(engag)-10(ement)]TJ
T*
[(process)-284.1(in)-278.4(200)-8(6)-273.9(docu)-8(mented)-285.1(publi)-7.2(c)-276.5(prefere)-11.1(nces)-280(for)-281.2(group)-10(s)]TJ
0 -1.195 TD
[(that)-272.5(should)-277(be)-271.6(prior)-9.8(itized)-276.6(in)-272.7(the)-272.5(event)-277(of)-272.7(a)-271.2(pandem)-9.2(ic.)]TJ
7.4718 0 0 6.641 517.7195 167.3574 Tm
(31)Tj
/F6 1 Tf
13.9476 0 0 13.9476 310.8472 130.0535 Tm
[(1.6)-498.1(Timing)-336.6(of)-334.8(Responses)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 310.8472 115.0866 Tm
[(Finally,)-341(decision)-343(makers)-341.2(must)-334.1(dete)-8.4(rmine)-335.7(whe)-9.6(n)-333.6(t)0(o)-330(set)-335.3(po)-8.2(l-)]TJ
0 -1.2007 TD
[(icies)-211.7(in)-204.5(motion)-11.3(,)-205.2(when)-212.3(to)-204.8(chang)-9.6(e)-202.5(existi)-8.6(ng)-205.2(po)-8.2(licies,)-212.5(and)-208.6(which)]TJ
T*
[(decisions)-493.3(to)-483.7(dela)-9.6(y.)-479.6(A)-484.7(key)-487.2(less)-8.4(on)-481.9(of)-489(the)-483.1(1976)-486.7(swi)-8.2(ne)-484.9(u)]TJ
T*
[(outbreak)-324.7(was)-323.2(that)-323.7(certai)-8.8(n)-316.5(decision)-12.9(s)-321(can)-323.6(and)-322.4(should)-322.5(be)-322.8(de-)]TJ
0 -1.195 TD
[(layed)-340.8(until)-343.2(evidenc)-11.5(e)-333.4(a)0(c)-7.1(cumulates)-11.3(.)]TJ
7.4718 0 0 6.641 441.5243 71.7165 Tm
(32)Tj
9.9626 0 0 9.9626 452.3526 67.2945 Tm
[(Decis)-9.4(ions)-338.1(that)-340.8(ca)-7.1(nnot)]TJ
ET
71.717 741.713 466.242 .45355 re
f
BT
/F3 1 Tf
8.9663 0 0 8.9663 467.0928 748.1761 Tm
[(LIPSITCH)-336(ET)-333.4(AL.)]TJ
/F2 1 Tf
7.9702 0 0 7.9702 71.7165 45.3543 Tm
[(Volume)-330.8(9,)-331.2(Number)-324.8(2,)-331.2(2011)]TJ
57.5026 0 TD
(91)Tj
ET
endstream
endobj
104 0 obj
<>stream
0 0 0 1 k
/GS1 gs
73.984 731.452 466.242 .51025 re
f
73.984 125.575 466.242 .51022 re
f
73.984 125.575 .51024 606.387 re
f
539.716 125.575 .51025 606.387 re
f
BT
/F7 1 Tf
12.9515 0 0 12.9515 179.2629 704.0125 Tm
0 Tc
0 Tw
[(Local)-335.6(Surveillance)-340.1(Data:)-337.5(When)-336.6(Is)-330.3(It)-336(Necessary?)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 79.937 678.9542 Tm
[(In)-296.5(an)-291.8(ideal)-295.9(situatio)-11.3(n,)-288.4(ever)-9.2(y)-291.4(public)-295.1(health)-295.8(autho)-8(rity)-289.8(could)]TJ
0 -1.2007 TD
[(ac)-7.1(cess)-335.7(its)-339.5(own)-338.1(high-qualit)-13.6(y,)-331.6(loca)-7.8(l)-330.4(data)-339.2(to)-335.7(synthesiz)-11.1(e)-333.4(into)]TJ
0 -1.195 TD
[(evide)-10.4(nce)-334.6(relevant)-335.1(for)-332.4(its)-333.8(disease)-337.7(control)-334.7(decision)-12.9(s.)-332.8(Gath-)]TJ
0 -1.2007 TD
[(eri)-7.8(ng,)-456(proc)-8.6(essing,)-460.1(an)-7.2(d)-451.7(inte)-8.2(rpreting)-462.2(data,)-459.1(howe)-10(ver,)-455.8(cost)]TJ
T*
[(mon)-9.6(ey,)-773.1(time,)-773.3(and)-771.9(expe)-8.6(rtise,)-772.7(an)-7.2(d)-770.4(few)-774.9(jurisdictions)]TJ
T*
[(wor)-7.2(ldwide)-361(can)-357.7(undertak)-10.5(e)-356.2(these)-357.9(activ)-8.2(ities)-355.9(ind)-7.4(ependently.)]TJ
T*
[(De)-7.6(cision)-422.8(makers)-420.8(must)-419.5(inste)-10.6(ad)-415.6(rely)-417.3(on)-419.3(a)-419.1(heteroge)-11.7(neous)]TJ
T*
[(mi)-7.4(x)-301.4(o)0(f)-301.2(local,)-304.5(regiona)-12.3(l,)-296.7(an)-7.2(d)-298.1(globa)-7.8(l)-302(data)-299.4(sourc)-11(es.)]TJ
1.0015 -1.2007 TD
[(Local)-554.1(auth)-7.6(orities,)-558.6(particu)-9.7(larly)-554.7(elected)-556.1(ofcia)-11.9(ls,)-549.4(may)]TJ
-1.0015 -1.2007 TD
[(want)-443.4(data)-436(on)-442.1(the)-437.6(progres)-10.6(s)-434.8(o)0(f)-437.8(the)-437.6(local)-440.7(epidemic)-444.6(for)-440.5(a)]TJ
0 -1.195 TD
[(vari)-8(ety)-305.7(of)-306.9(reason)-10.4(s.)-310(In)-307.9(addition)-9.3(,)-307.7(from)-309.6(a)-305.3(publi)-7.2(c)-304.9(health)-312.9(and)]TJ
0 -1.2007 TD
[(evide)-10.4(nce-base)-11.3(d)-389.1(dec)-8.8(ision-makin)-14.4(g)-389.5(per)-8.2(spective,)-397.3(3)-393.4(basi)-8.6(c)-390.3(ar-)]TJ
T*
[(gum)-10.4(ents)-304.7(favor)-301.7(geogr)-11.6(aphically)-309(distribute)-10.5(d)-303.7(surveillanc)-12.1(e.)]TJ
1.0015 -1.2007 TD
[(First,)-467.4(infec)-11.2(tion)-466.2(may)-465.8(remain)-470.3(geogra)-9.6(phicall)-8.2(y)-462.1(focal)-468(for)]TJ
-1.0015 -1.2007 TD
[(we)-7.4(eks)-346.1(to)-347.1(mon)-9.6(ths.)-345.9(In)-347.7(2009,)-350.6(transmis)-10.3(sion)-349.5(remain)-9.4(ed)-346.9(focal)]TJ
T*
[(with)-7.6(in)-460.5(Mex)-9(ico)-460.7(for)-463.3(at)-464.2(least)-464.6(1)-456(mon)-9.6(th,)-463.1(probably)-467.3(longer.)]TJ
T*
[(On)-9.2(ce)-422.1(the)-426.2(virus)-424.2(sprea)-8.6(d)-423.3(t)0(o)-421.1(other)-429.3(countries,)-429.3(transm)-11.9(ission)]TJ
T*
[(was)-328.8(again)-333.9(initially)-332.7(conned)-332.8(to)-330(certain)-331(areas.)-329.2(When)-331.4(early)]TJ
0 -1.195 TD
[(tran)-9.6(smission)-555.1(is)-550.4(geographic)-13.3(ally)-546.3(circumsc)-13.3(ribed,)-551.7(the)-551.4(rst)]TJ
0 -1.2007 TD
[(estima)-10.7(tes)-284.1(of)-278.4(key)-282.3(parame)-9.9(ters)-281.2(that)-283.9(serve)-284.7(to)-278.8(inform)-286.4(dec)-8.8(ision)]TJ
T*
[(mak)-8.4(ers)-378.3(wor)-7.2(ldwide)-383.7(must)-379.7(rely)-383.2(on)-379.5(data)-384.7(from)-383.6(areas)-380.1(of)-380.9(on-)]TJ
T*
[(going)-386.3(transmis)-10.3(sion.)-378.3(In)-376.2(the)-380.7(UK,)-377.3(even)-379.9(by)-371.8(th)-7.4(e)-373.2(end)-378.9(of)-375.2(the)]TJ
T*
[(sum)-10.2(mer)-364.6(2009)-367.2(wave)-369.4(of)-363.8(transmis)-10.3(sion,)-366.9(sero)-8.8(prevalenc)-10.9(e)-361.8(was)]TJ
T*
[(high)-8.6(er)-501.2(in)-500.4(London)-505(and)-504.5(the)-500.2(West)-504.1(Midlands)-505.6(than)-504.1(else-)]TJ
T*
[(whe)-9.6(re.)]TJ
7.4718 0 0 6.641 105.3354 396.4534 Tm
(65)Tj
9.9626 0 0 9.9626 89.9149 380.0692 Tm
[(Secon)-11(d,)-406.6(even)-414(when)-417.1(infection)-420.5(spreads)-417.1(virtually)-415.7(every-)]TJ
-1.0015 -1.195 TD
[(whe)-9.6(re,)-461.7(its)-459(cha)-9.2(racteristics)-470.5(may)-465.8(differ)-463.6(ac)-7.1(ross)-463.1(regions)-11(,)-461.3(re-)]TJ
0 -1.2007 TD
[(sultin)-9.8(g)-355.4(i)0(n)-358.1(diff)-8(erent)-359.7(loca)-7.8(l)-353.2(prioritie)-10.5(s)-355.2(for)-360.8(contro)-10(l.)-353.6(In)-359.1(2009,)]TJ
T*
[(many)-685.6(risk)-677.3(factor)-9(s)-673.8(for)-679.5(seve)-8.8(re)-677.6(outcome)-10.7(race/ethn)-12.7(ici-)]TJ
T*
[(ty)-6.5(,)]TJ
7.4718 0 0 6.641 89.8582 336.6991 Tm
(45,135)Tj
9.9626 0 0 9.9626 116.6173 332.2771 Tm
[(income)-12.3(,)]TJ
7.4718 0 0 6.641 147.6283 336.6991 Tm
(35)Tj
9.9626 0 0 9.9626 161.2913 332.2771 Tm
[(comorbi)-9.3(dities,)]TJ
7.4718 0 0 6.641 216.7936 336.6991 Tm
(14,135)Tj
9.9626 0 0 9.9626 243.6094 332.2771 Tm
[(healthc)-9(are)-624.4(ac-)]TJ
-16.4286 -1.2007 TD
[(ces)-9(s,)]TJ
7.4718 0 0 6.641 96.8315 324.7369 Tm
(14,135)Tj
9.9626 0 0 9.9626 122.7968 320.3149 Tm
[(and)-550(exposure)-551.1(to)-546.3(bac)-7.8(terial)-546.4(co-inf)-10.6(ections)]TJ
7.4718 0 0 6.641 282.5574 324.7369 Tm
(76)Tj
9.9626 0 0 9.9626 290.0409 320.3149 Tm
()Tj
-21.0892 -1.2007 TD
[(vari)-8(ed)-409.5(geogra)-9.6(phicall)-8.2(y)-405.2(o)0(n)-413.6(scales)-413.8(rangi)-8.6(ng)-410.1(from)-412(nei)-8.6(ghbor-)]TJ
T*
[(hoo)-8.6(d)-337.9(t)0(o)-341.4(conti)-8.6(nent.)-346.1(Global)-348.2(awareness)-347.8(of)-346.7(these)-346.5(and)-339.4(oth)-7.8(er)]TJ
T*
[(risk)-284.7(factors)-284.5(depends)-286.4(on)-277.1(having)-286.6(some)-279.2(form)-281.2(of)-278.4(surve)-10.4(illance)]TJ
0 -1.195 TD
[(ava)-7.2(ilable)-431.4(in)-426.4(po)-8.2(pulations)-437.1(where)-431.1(risk)-432.7(factor)-9(s)-429.2(are)-425.2(conc)-10.6(en-)]TJ
0 -1.2007 TD
[(trate)-9(d.)-287.1(Aware)-9.1(ness)-296.1(of)-289.8(local)-292.7(disp)-8.4(arities)-294.1(in)-289.8(infec)-11.2(tion)-289.8(ra)-6.5(tes)-289.8(or)]TJ
T*
[(seve)-8.8(re)-307.7(diseas)-10(e)]TJ
7.4718 0 0 6.641 131.7543 253.0204 Tm
(35,71)Tj
9.9626 0 0 9.9626 151.6535 248.5983 Tm
[(with)-7.6(in)-306.9(a)-305.3(juri)-7(sdiction)-316.5(can)-312.2(also)-308.4(improve)]TJ
-7.1985 -1.2007 TD
[(res)-8.4(ource)-307.8(allocation.)]TJ
1.0015 -1.2007 TD
[(Third,)-343.3(some)-341.8(decision)-12.9(s,)-332.8(such)-340(as)-341.8(school)-339(dismis)-10.4(sals)-338.9(\(and)]TJ
-1.0015 -1.2007 TD
[(reop)-8.6(enings)-11.4(\))-451.9(i)0(n)-454.8(res)-8.4(ponse)-461.3(to)-455.2(within-)-9.6(school)-458.5(transm)-11.9(ission,)]TJ
T*
[(requ)-9(ire)-468.8(very)-468(deta)-8.8(iled,)-468.9(real-time)-478.1(local)-469.1(data.)-470.5(Durin)-8.8(g)-463.5(the)]TJ
T*
[(200)-8(9)-245.5(pande)-9.2(mic,)-255.8(these)-255.5(decisions)-260(had)-252.7(to)-250.4(be)-248.8(made)-253.9(b)-6.5(ased)-250.6(on)]TJ
0 -1.195 TD
[(lim)-7.8(ited)-359.7(data)-367.7(with)-360.4(kno)-8.6(wn)-360.4(biases.)-367.5(One)-365.3(exampl)-9.3(e)-356.2(i)0(s)-362.6(school)]TJ
0 -1.2007 TD
[(abse)-10.2(nces,)-206.4(which)-207(can)-204.1(be)-203.3(due)-206.8(either)-206.4(to)-204.8(inuen)-12.1(za)-203.5(infection)-209.9(or)]TJ
T*
[(to)-335.7(fear)-339.1(of)-335.3(ac)-7.1(quiring)-339.6(inuenza)-346.5(at)-333.4(school.)-339.4(Mor)-9(e)-333.4(generally,)]TJ
T*
[(dec)-8.8(isions)-285.3(abou)-7(t)-284.1(specic)-287.2(tacti)-8(cs)-284.5(to)-278.8(contr)-9.6(ol)-279.6(tran)-9.6(smission)-293.3(in)]TJ
23.5133 53.9976 TD
[(particu)-9.7(lar)-416.6(settings)-10.9(such)-419.7(as)-421.5(schools,)-421.4(hospi)-8.8(tals,)-416.2(or)-418.5(other)]TJ
0 -1.2007 TD
[(instit)-8.6(utions,)-271.9(or)-270.6(aircr)-8.6(aft)-264.3(or)-270.6(oth)-7.8(er)-267.8(vehicles)-10.7(nece)-9.4(ssarily)-270.6(rely)]TJ
0 -1.195 TD
[(on)-339.7(local)-338.2(data.)-339.6(Su)-8.2(rveillance)-346.7(to)-335.7(trigger)-345.3(and)-339.4(guide)-342(such)-340(in-)]TJ
0 -1.2007 TD
[(terve)-8.8(ntions)-563.1(has)-565.9(bee)-7.4(n)-561.2(called)-565.3()39.8(contr)-9.6(ol-focused)29.5()-563.4(surveil-)]TJ
T*
[(lance)-8.6(,)-341.8(i)0(n)-352.4(contrast)-351(to)-347.1(the)-352.2()39.8(strategy-)-11.7(focused)32.6()-347.1(surveilla)-10.9(nce)]TJ
7.4718 0 0 6.641 530.5321 635.5841 Tm
(3)Tj
9.9626 0 0 9.9626 314.192 619.1998 Tm
[(that)-306.7(is)-300(discuss)-10.8(ed)-301.4(throug)-9.6(hout)-305.9(most)-303.9(of)-301.2(this)-307.5(article.)]TJ
1.0015 -1.2007 TD
[(These)-499(factors)-495(favorin)-11.1(g)-491.9(local)-491.9(data)-492.9(mu)-7.8(st)-491.3(be)-493.5(balanced)]TJ
-1.0015 -1.2007 TD
[(again)-9.6(st)-280.8(resourc)-11.3(e)-282.2(limitati)-8.6(ons)-285.1(and)-282.5(compe)-9.2(ting)-286.3(public)-289.4(health)]TJ
T*
[(prioritie)-10.5(s.)-532(For)-537.6(many)-537.6(questions)-12.1(speci)-10.8(cally,)-532.9(tho)-7.8(se)-529.2(for)]TJ
T*
[(estima)-10.7(ting)-843.9(overall)-847.2(seve)-8.8(rityhigh)-9.7(-quality)-848.4(data)-845.7(from)]TJ
0 -1.195 TD
[(with)-7.6(in)-403.6(a)-407.7(coun)-9.4(try)-407.5(or)-407.1(a)-407.8(group)-414(of)-409.3(coun)-9.4(tries)-408.1(with)-411.6(broa)-7.6(dly)]TJ
0 -1.2007 TD
[(simila)-10(r)-258.8(health)-261.7(systems)-272.9(are)-260.2(likely)-267.8(adequate)-263.4(an)-7.2(d)-258.2(ofte)-8.2(n)-259.6(more)]TJ
T*
[(reliable)-227(than)-219.5(loca)-7.8(l)-216.6(data)-219.7(from)-224.3(an)-217.8(ind)-7.4(ividual)-222.2(jurisdic)-10.9(tion.)-221.9(As)]TJ
T*
[(noted)-339(in)-329.7(section)-338.7(3.1,)-332.3(sharin)-10.6(g)-326.9(o)0(f)-335.3(data)-333.5(across)-333.6(hemis)-9.6(pheres)]TJ
T*
[(can)-562.6(be)-556.1(particu)-9.7(larly)-554.7(valua)-9.7(ble,)-556.8(given)-562.9(the)-557.1(seasonalit)-15.4(y)-553.2(o)0(f)]TJ
T*
[(transmis)-10.3(sion.)]TJ
7.4718 0 0 6.641 365.1589 504.0566 Tm
(86,87)Tj
9.9626 0 0 9.9626 324.17 487.6723 Tm
[(To)-311.8(avoid)-320.8(making)-317.8(mi)-7.4(sleading)-321.4(compa)-9.6(risons,)-320.8(consumer)-12.1(s)]TJ
-1.0015 -1.2007 TD
[(of)-215.8(local)-213.1(surve)-10.4(illance)-215.6(data)-219.7(should)-220.1(also)-211.7(kno)-8.6(w)-209(the)-215.6(factor)-9(s)-212.9(that)]TJ
0 -1.195 TD
[(differ)-611.6(among)-607.7(juri)-7(sdictions)-11.5(.)-603.6(I)0(n)-603.8(the)-608.3(spring-summ)-16.2(er)-603.6(of)]TJ
0 -1.2007 TD
[(2009,)-208.3(the)-204.2(city)-210.7(of)-204.5(Mil)-8(waukee,)-209.5(Wiscons)-11.7(in,)-204.8(conrm)-13.5(ed)-204.7(abou)-7(t)]TJ
T*
[(3)-234.1(tim)-7(es)-233.3(as)-239.4(many)-236(ca)-7(ses)-235.7(as)-239.4(did)-233.7(Ne)-7.6(w)-231.7(York)-238.2(City,)-239.2(even)-243.3(though)]TJ
T*
[(New)-210.9(York)-209.7(has)-213.1(about)-211.5(8)-205.6(tim)-7(es)-204.9(the)-209.9(popula)-10.9(tion.)-210.5(This)-209.5(was)-209.3(due)]TJ
T*
[(not)-288(to)-290.2(a)-282.6(greate)-9.6(r)-281.6(inc)-8.6(idence)-290.6(in)-289.8(Milwauke)-8.9(e,)-288.2(but)-287(to)-284.5(diff)-8(erent)]TJ
T*
[(decision)-12.9(s)-207.2(regardin)-11.1(g)-207.4(whom)-211.5(to)-210.5(test.)-210.1(Milwauk)-11.3(ee)-205.8(tested)-215.2(many)]TJ
T*
[(mildly)-370(ill)-361(ind)-7.4(ividuals,)-367.2(whi)-8(le)-362.2(New)-364.5(York)-369.1(City)-369.7(focused)-371.4(on)]TJ
T*
[(hospi)-8.8(talized)-364.3(cases.)]TJ
7.4718 0 0 6.641 384.4912 384.5479 Tm
(44)Tj
9.9626 0 0 9.9626 395.5463 380.0692 Tm
[(Clearly)-9(,)-358.9(without)-362.5(kno)-8.6(wledge)-363(of)-358.1(sur-)]TJ
-8.1659 -1.195 TD
[(veillanc)-10.5(e)-293.6(differenc)-12.9(es,)-290.6(it)-297.3(is)-288.7(ea)-7.1(sy)-293.7(to)-290.2(mi)-7.4(sinterpret)-300(diff)-8(erences)]TJ
0 -1.2007 TD
[(in)-301.2(ca)-7.1(se)-301.6(numbe)-9.7(rs.)]TJ
1.0015 -1.2007 TD
[(The)-385.2(above)-389.2(conside)-11.2(rations)-389.7(sugg)-9.6(est)-386.6(that)-386.3(to)-381.3(prepa)-8.4(re)-381.7(for)]TJ
-1.0015 -1.2007 TD
[(future)-305.1(pan)-9.4(demics:)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 314.192 309.77 Tm
()Tj
/F2 1 Tf
9.9626 0 0 9.9626 322.696 308.3527 Tm
[(decision)-348.7(mak)-8.4(ers)-344.2(should)-345.3(be)-345.5(edu)-7.6(cated)-347.9(about)-342.3(the)-346.5(limita-)]TJ
T*
[(tions)-485.6(of)-489(loca)-7.8(l)-484.1(data)-487.2(and)-487.4(the)-488.8(cost-benet)-494.4(trad)-8.2(e-off)-488.2(of)]TJ
T*
[(gathering)-312.1(high-quality)-310.7(data)-305.1(at)-299.2(th)-7.4(e)-299.2(local)-304.1(level;)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 314.192 273.8834 Tm
()Tj
/F2 1 Tf
9.9626 0 0 9.9626 322.696 272.5228 Tm
[(national)-477.5(publi)-7.2(c)-470(healt)-9.2(h)-468.8(agenc)-10.8(ies)-474.1(should)-476.2(main)-9(tain)-475.2(the)]TJ
T*
[(epidemiolog)-12.5(ic)-426.2(and)-424.8(labor)-8(atory)-428.7(capacity)-428.5(to)-426.8(study)-428.5(focal)]TJ
T*
[(outbreaks,)-549.3(includi)-9.4(ng)-541(those)-542.7(in)-540.2(area)-7.8(s)-537.3(that)-540(lack)-541.4(high)-8.6(-)]TJ
T*
[(quality)-385.1(routin)-10.1(e)-378.9(surve)-10.4(illance)-386.3(or)-384.4(loca)-7.8(l)-381.7(capacity)-388.6(for)-383.6(such)]TJ
T*
[(investigat)-12.3(ions;)-304.3(and)]TJ
/F8 1 Tf
6.9738 0 0 6.9738 314.192 214.129 Tm
()Tj
/F2 1 Tf
9.9626 0 0 9.9626 322.696 212.7117 Tm
[(high-quality)-572.5(routin)-10.1(e)-566.7(surveillanc)-12.1(e)-561(systems)-574.5(should)-572.9(be)]TJ
T*
[(geogra)-9.6(phically)-271.1(distribute)-10.5(d)-263.9(within)-269(and)-265.5(among)-271.9(count)-9(ries)]TJ
T*
[(to)-290.2(improve)-294.7(the)-289.6(likelih)-8.8(ood)-293.1(that)-289.6(some)-296.3(systems)-295.7(will)-291.2(be)-288.6(in)]TJ
0 -1.195 TD
[(place)-308.8(in)-301.2(popula)-10.9(tions)-309.2(that)-306.7(experienc)-11.9(e)-299.3(e)0(a)-7(rly)-305.9(waves)-309.2(of)-301.2(in-)]TJ
0 -1.2007 TD
[(fection.)-364.3(Thi)-8(s)-355.2(app)-8(roach)-359.4(should)-368.1(improve)-368.6(the)-363.6(timeliness)]TJ
T*
[(of)-312.6(estimates)-317.6(of)-312.6(key)-310.8(parame)-9.9(ters)-315.3(for)-309.6(nati)-8.6(onal)-309.6(or)-310.4(inte)-8.2(rna-)]TJ
T*
[(tional)-305.3(use.)]TJ
ET
73.984 741.713 466.242 .45355 re
f
BT
/F3 1 Tf
8.9663 0 0 8.9663 73.9842 748.1761 Tm
[(IMPROVING)-333.2(DECISION)-337.5(MAKING)-336.7(DURING)-331.8(A)-336.1(PANDEMIC2009)-334(INFLUENZA)-333.6(A/H1N1)]TJ
/F2 1 Tf
7.9702 0 0 7.9702 73.9842 45.3543 Tm
[(92)-29188.1(Biosecurity)-323.7(and)-335.2(Bioterro)11.2(rism:)-334.4(Biodefens)8.9(e)-337.7(Strategy,)-323.6(Practice,)-332.6(and)-328.1(Science)]TJ
ET
endstream
endobj
110 0 obj
<>stream
0 0 0 1 k
/GS1 gs
310.847 632.523 227.112 .51019 re
f
BT
/F2 1 Tf
9.9626 0 0 9.9626 71.7165 501.8455 Tm
0 Tc
0 Tw
[(wait)-253.9(can)-255.3(be)-248.8(revi)-7.6(sed)-252.5(in)-250(light)-256.8(of)-250(new)-255.7(evidenc)-11.5(e)-248(o)0(n)-254.3(severity)-258.8(and)]TJ
0 -1.2007 TD
[(inte)-8.2(rvention)-316.2(effective)-12.9(ness.)-313.6(During)-312.9(the)-312.4(2009)-310.3(pande)-9.2(mic,)-312.7(for)]TJ
T*
[(examp)-9(le,)-214.6(early)-216.2(decision)-12.9(s)-212.9(t)0(o)-210.5(close)-220.3(schools)-221.9(in)-210.2(the)-215.6(U.S)-7.6(.)-210.9(i)0(n)-210.2(Apri)-7.6(l)]TJ
24.0027 24.7823 TD
[(were)-320.8(quickly)-321.5(revi)-7.6(sed)-320.8(as)-319.1(evidence)-327.8(grew)-320(to)-318.7(suggest)-327.9(an)-314.5(illne)-9.4(ss)]TJ
0 -1.2007 TD
[(severity)-218.9(in)-210.2(th)-7.4(e)-208.2(U.S.)-212.8(lo)-6.5(wer)-215(than)-213.8(that)-215.6(rst)-213.1(reported)-221.3(in)-210.2(Mex)-9(ico.)]TJ
T*
[(\(Later,)-290.9(it)-285.9(became)-293.3(clear)-292.3(that)-283.9(the)-289.6(seve)-8.8(rity)-284.1(in)-289.8(Mexico)-293.3(was)-289(also)]TJ
T*
[(lower)-306.8(than)-304.9(it)-297.3(initi)-8.4(ally)-301.6(appea)-9.4(red.)]TJ
7.4718 0 0 6.641 433.5306 693.3541 Tm
(33)Tj
9.9626 0 0 9.9626 441.014 688.9321 Tm
(\))Tj
12.9515 0 0 12.9515 310.8472 655.9935 Tm
(2)Tj
/F1 1 Tf
.499 0 TD
[(.)-498.5(Sources)-337.4(of)-336.4(Surveillance)-334.8(and)]TJ
-.499 -1.1512 TD
[(Epidemiologic)-336.2(Data)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 310.8472 617.2156 Tm
[(This)-442.8(sec)-9(tion)-443.4(descri)-10(bes)-444.6(data)-441.7(so)-8.4(urcescur)-12.3(rently)-443.2(or)-447(poten)-9(-)]TJ
0 -1.2007 TD
[(tially)-359.8(ava)-7.2(ilableth)-7.9(at)-361.8(provide)-365.1(the)-363.6(evidentiar)-10.3(y)-359.7(basis)-363.8(for)-366.5(the)]TJ
T*
[(decisions)-311.2(outline)-11.1(d)-298.1(i)0(n)-301.2(sec)-9(tion)-301.2(1)-302.4(and)-305.3(shown)-308.4(in)-301.2(Figur)-8.8(e)-299.2(1)0(.)]TJ
/F6 1 Tf
13.9476 0 0 13.9476 310.8472 564.3778 Tm
[(2.1.)-500.2(Conrmed)-332.2(Cases)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 310.8472 549.4676 Tm
[(Awarene)-10.3(ss)-317.7(of)-318.3(the)-318.1(novel)-320.4(inuenza)-323.7(stra)-8.4(in)-312.6(rs)-8.6(t)-312.6(arose)-325.5(from)-315.3(it)-7.1(s)]TJ
T*
[(detection)-432.4(in)-420.7(young)-425.2(pati)-7.2(ents)-424.2(in)-420.7(Cal)-7(ifornia)-428.5(who)-422(presen)-11.7(ted)]TJ
T*
[(with)-235.2(in)-8.8(uenzalik)-8.7(e)-236.7(illness)-241.7(\(ILI\))-237.8(and)-237(we)-7.4(re)-233.7(tested)-243.7(for)-235.6(in)-8.8(uenza)]TJ
T*
[(as)-330.4(part)-332.6(of)-329.6(routin)-10.1(e)-327.7(surveilla)-10.9(nce.)-329.2(Soon)-334.7(after)-8.6(,)-330.4(laborator)-8.7(y)-325.5(data)]TJ
T*
[(on)-356.7(ca)-7.1(ses)-360.9(of)-358.1(severe)-362(atypi)-8.4(cal)-360.2(pneumo)-11.5(nia)-356.1(in)-358.1(y)-6.9(oung)-361.4(adults)-363.2(in)]TJ
T*
[(Mexico)-350.2(conrme)-11.1(d)-343.6(the)-340.8(pre)-8.2(sence)-345.9(of)-346.7(the)-340.8(pan)-9.4(demic)-346.3(strain)-349.4(of)]TJ
0 -1.195 TD
[(H1N1)-239.5(\(pH1N)-9.9(1\).)-242.5(These)-242.9(early)-244.7(cases)-242.7(con)-10.8(rmed)-241.5(that)-244.1(pH1N1)]TJ
ET
71.717 731.452 227.168 .51025 re
f
71.717 530.929 227.168 .51019 re
f
71.717 530.929 .51024 201.033 re
f
298.375 530.929 .51022 201.033 re
f
BT
/F7 1 Tf
12.9515 0 0 12.9515 120.5858 704.0125 Tm
[(Prioritizing)-341.3(Vaccination)]TJ
/F2 1 Tf
9.9626 0 0 9.9626 77.726 678.9542 Tm
[(Vaccines)-209.3(have)-208.2(2)-199.9(effects:)]TJ
/F5 1 Tf
9.0764 0 TD
[(direct)-204.8(prot)-8.2(ection)]TJ
/F2 1 Tf
6.1003 0 TD
[(of)-204.5(the)-204.2(vaccinate)-10.7(d)]TJ
-15.1767 -1.2007 TD
[(individu)-9.3(al)-436.6(against)-444(infect)-10.8(ion)-438.2(and)-441.9(its)-436.2(cons)-9.6(equences)-443.2(an)-7.2(d)]TJ
/F5 1 Tf
0 -1.195 TD
[(indirect)-419.7(protection)]TJ
/F2 1 Tf
7.301 0 TD
[(of)-415(the)-414.8(population)-10.5(,)-410.1(i)0(n)-415(which)-417.5(certai)-8.8(n)]TJ
-7.301 -1.2007 TD
[(individu)-9.3(als)-456(are)-459.3(vaccin)-9.8(ated)-458.3(to)-455.2(reduce)-466.6(their)-459.1(risk)-455.4(of)-460.5(be-)]TJ
T*
[(coming)-444(infec)-11.2(ted)-437.6(an)-7.2(d)-434.6(subse)-11(quently)-443.4(passin)-10.2(g)-440.7(o)0(n)-436.4(the)-443.2(in-)]TJ
T*
[(fection.)-415.6(The)-413.6(abil)-6.6(ity)-412.2(of)-409.3(im)-7.4(mune)-413(ind)-7.4(ividuals)-418.1(to)-409.7(prote)-8.2(ct)]TJ
T*
[(others)-306.5(against)-307.4(infect)-10.8(ion)-301.6(is)-305.7(often)-302(ca)-7.1(lled)]TJ
/F5 1 Tf
15.0743 0 TD
[(herd)-302.2(imm)-8(unity.)]TJ
/F2 1 Tf
-14.0784 -1.2007 TD
[(Whe)-9.2(n)-453.1(vaccin)-9.8(e)-452.9(availa)-7.4(bility)-455(is)-453.7(lim)-7.8(ited,)-456.8(the)-454.6(choic)-11(e)-452.9(o)0(f)]TJ
-.9958 -1.2007 TD
[(whom)-336.7(to)-335.7(vaccin)-9.8(ate)-331(rs)-8.6(t)-329.7(i)0(s)-334.2(part)-8.2(ly)-331.6(a)-333.8(strategi)-10(c)-333.4(decision)-343(to)]TJ
T*
[(focus)-309(on)-311.2(either)-308.8(direct)-314.5(protection)-318.4(or)-304.7(on)-305.5(her)-8.2(d)-303.7(immu)-9.6(nity.)]TJ
0 -1.195 TD
[(Table)-296.8(1)-296.7(descri)-10(bes)-296.7(key)-299.4(differenc)-12.9(es)-295.9(in)-295.5(these)-301(stra)-8.4(tegies)-297.5(an)-7.2(d)]TJ
0 -1.2007 TD
[(in)-301.2(the)-301(info)-10.6(rmation)-307.6(required)-309.2(to)-301.6(impleme)-10.9(nt)-304.7(them.)]TJ
ET
71.66 426.387 466.299 .51022 re
f
71.66 67.408 .51025 359.49 re
f
537.505 67.408 .45349 359.49 re
f
72.17 67.408 465.335 .45358 re
f
200.409 409.323 .51022 17.065 re
f
200.92 409.323 336.586 .22675 re
f
200.409 392.372 .51022 16.951 re
f
364.309 392.372 .51025 16.951 re
f
72.17 391.861 465.335 .51025 re
f
72.17 351.099 138.501 .51025 re
f
200.409 351.099 .51022 40.989 re
f
200.92 351.099 173.65 .51025 re
f
364.309 351.099 .51025 40.989 re
f
364.819 351.099 172.687 .51025 re
f
72.17 299.225 138.501 .51025 re
f
200.409 299.225 .51022 51.874 re
f
200.92 299.225 173.65 .51025 re
f
364.309 299.225 .51025 51.874 re
f
364.819 299.225 172.687 .51025 re
f
72.17 197.518 138.501 .45352 re
f
200.409 197.518 .51022 101.707 re
f
200.92 197.518 173.65 .45352 re
f
364.309 197.518 .51025 101.707 re
f
364.819 197.518 172.687 .45352 re
f
72.17 67.861 138.501 .51022 re
f
200.409 67.861 .51022 129.657 re
f
200.92 67.861 173.65 .51022 re
f
364.309 67.861 .51025 129.657 re
f
364.819 67.861 172.687 .51022 re
f
BT
8.9663 0 0 8.9663 71.7165 434.4377 Tm
[(Table)-334.8(1.)-501.9(Considerations)-339.9(in)-332.8(the)-335.8(Use)-335(of)-332.8(Vaccines)-341.6(for)-328.6(Direct)-341.4(Protection)-332.2(of)-339.1(Vulnerable)-335.5(People)-336.5(vs.)-328.8(Herd)-337.4(Immunity)]TJ
/F5 1 Tf
32.2911 -2.036 TD
(Strategy)Tj
-11.9629 -2.017 TD
[(Direct)-335.6(Protection)-13187.8(Herd)-332.3(Immunity)]TJ
/F2 1 Tf
-19.7212 -2.0549 TD
[(Goal)-13046.1(To)-334.6(protect)-334.3(the)-335.8(vaccinated)-340.5(directly)]TJ
14.941 -1.2203 TD
[(against)-264.5(infection,)-269.8(illness,)-263.7(hospitalization,)]TJ
0 -1.2266 TD
[(or)-335.1(death)]TJ
18.2859 2.447 TD
[(To)-334.6(protect)-334.3(the)-335.8(population)-331.8(\(including)-343.5(the)]TJ
0 -1.2203 TD
[(nonvaccinated\))-335.8(against)-340.4(infection)-336.5(\(and)-334.9(its)]TJ
0 -1.2266 TD
[(consequences\))-337.1(by)-333.9(reducing)-341.6(transmission)]TJ
-33.2269 -2.1182 TD
[(Criteria)-333.5(for)-335(who)-336.7(should)-336.5(receive)]TJ
0 -1.2266 TD
[(priority)-338.6(for)-334.9(vaccination)]TJ
14.941 1.2266 TD
[(Individuals)-339.4(who)-336.7(will)-329.1(benet)-339.8(most)]TJ
0 -1.2266 TD
[(from)-245.8(the)-241(vaccines)-251.4(effects:)-248.6(groups)-240.6(at)-246.8(high)]TJ
0 -1.2203 TD
[(per)-336.4(capita)-332.4(risk)-338.5(of)-332.8(severe)-338.1(outcomes)]TJ
T*
[(\(infection)-343.3(risk)]TJ
/F8 1 Tf
5.4883 0 TD
()Tj
/F2 1 Tf
.7714 0 TD
(severity\))Tj
12.0262 3.6673 TD
[(Individuals)-333(at)-335.3(high)-334.3(risk)-338.5(of)-332.8(becoming)-338.2(infected)]TJ
0 -1.2266 TD
[(and)-334.4(transmitting)-337.6(infection)-336.5(to)-334.5(others)]TJ
0 -1.2203 TD
[(\(initially,)-333.7(schoolchildren;)-337.5(also,)-338(certain)]TJ
T*
[(healthcare)-334.4(workers\))]TJ
-33.2269 -2.1245 TD
[(Data)-337(used)-330.6(to)-334.5(identify)]TJ
0 -1.2203 TD
[(priority)-338.6(groups)]TJ
14.941 1.2203 TD
[(Predictors)-339(of)-332.8(high)-334.3(risk)-338.5(of)-332.8(severe)]TJ
0 -1.2203 TD
[(outcome)-479.7(\(eg,)-476.6(risk)-471.3(factors)-478(for)-474.1(death)-475.7(or)]TJ
0 -1.2266 TD
[(hospitalization,)-342.4(compared)-331.5(with)-339.6(the)]TJ
0 -1.2203 TD
[(general)-339.6(population\))]TJ
0 -1.8905 TD
[(Evidence)-353(that)-351.6(the)-348.4(vaccine)-350.8(is)-347.5(effective)-351.9(in)]TJ
0 -1.2203 TD
[(the)-348.4(high-risk)-350.8(groups)-348.1(\(difcult)-345.2(to)-347.1(obtain)]TJ
T*
[(in)-320.2(the)-316.8(pandemic)-316.6(setting,)-319.2(but)-313(possible)-322.1(to)]TJ
0 -1.2266 TD
[(extrapolate)-337.5(from)-334.3(seasonal)-336(vaccines\))]TJ
18.2859 9.2251 TD
[(Incidence)-336.3(rate)-334.4(and/or)-334.9(force)-335.3(of)-339.2(infection)]TJ
0 -1.2203 TD
[(by)-333.9(age)-332.7(group)]TJ
6.7246 0 0 5.9768 421.1715 279.8362 Tm
(22)Tj
8.9663 0 0 8.9663 375.0802 258.9165 Tm
[(Estimates)-332.1(of)-339.2(potentially)-336.7(infectious)-334.3(contacts)]TJ
T*
[(per)-330.1(day)-335.2(in)-332.8(different)-338.7(groups)]TJ
6.7246 0 0 5.9768 470.3243 251.9432 Tm
(136,137)Tj
8.9663 0 0 8.9663 77.159 185.1023 Tm
[(Factors)-335.5(favoring)]TJ
T*
[(the)-335.8(strategy)]TJ
14.941 1.2203 TD
[(Convincing)-340(data)-336.1(on)-331.5(who)-336.7(is)-334.8(at)-335.3(highest)]TJ
0 -1.2203 TD
[(risk)-338.5(\(Note:)-331.6(Predictors)-339.1(of)-332.8(high)-334.3(risk)]TJ
0 -1.2266 TD
[(need)-336.1(not)-333(be)-338(causal,)-331.6(only)-340(reliable)]TJ
0 -1.2203 TD
[(markers)-336.4(of)-339.2(high)-334.3(risk.\))]TJ
0 -1.8905 TD
[(Good)-335.4(immunogenicity)-344.3(of)-332.8(the)-335.8(vaccine)]TJ
0 -1.2203 TD
[(in)-339.2(the)-329.5(high-risk)-338.1(groups)]TJ
0 -1.8906 TD
[(Limited)-338.1(quantities)-339.2(of)-332.8(vaccine)]TJ
T*
[(Late)-336.7(availability)-331.6(of)-339.2(vaccine)]TJ
18.2859 10.5593 TD
[(High-risk)-337(groups)-335.5(are)-332.9(unknown)-340(or)-328.8(vaccine)]TJ
0 -1.2203 TD
[(has)-330.1(limited)-336.6(effectiveness)-342(in)-332.8(them)]TJ
0 -1.2266 TD
[(\(eg,)-331.1(the)-335.8(elderly)-338.6(during)-334.9(seasonal)-336(inuenza)]TJ
6.7246 0 0 5.9768 519.1369 167.1874 Tm
(17)Tj
8.9663 0 0 8.9663 525.8833 163.1622 Tm
(\))Tj
-16.8189 -1.8906 TD
[(Large)-332.9(supplies)-335.4(of)-339.2(vaccine)-331.9(available)-335.7(in)-332.8(time)]TJ
0 -1.2203 TD
[(to)-334.5(signicantly)-337.2(reduce)-332.6(transmission)]TJ
6.7246 0 0 5.9768 499.0676 139.2377 Tm
(7,22,23)Tj
8.9663 0 0 8.9663 375.0802 118.3181 Tm
[(Evidence)-334.1(available)-335.7(on)-331.5(the)-335.8(key)-339.3(transmitters)]TJ
6.7246 0 0 5.9768 523.729 123.307 Tm
(22)Tj
8.9663 0 0 8.9663 375.0802 107.3763 Tm
[(\(Note:)-331.6(This)-338.6(may)-332.4(change)-336.7(over)-335.1(time,)-335.2(as)-334.3(most)]TJ
T*
[(affected)-334.5(groups)-335.5(become)-335.6(increasingly)-342.6(immune)]TJ
T*
[(and)-334.4(contribute)-337.9(less)-329.7(to)-334.5(transmission)]TJ
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71.717 741.713 466.242 .45355 re
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BT
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[(adults,)-306.6(a)-299.6(chara)-10(cteristic)-308(of)-301.2(pre)-8.2(vious)-302.3(pande)-9.2(mics.)]TJ
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T*
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T*
[(and)-311(more)-308(labor)-8(atories)-315.5(acquired)-315.8(the)-306.7(capacity)-314.7(to)-307.3(test)-312.2(for)-309.6(the)]TJ
T*
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T*
[(became)-276.2(increasingly)-280.5(common,)-275.4(includi)-9.4(ng)-267.8(for)-264.1(mi)-7.4(ld)-264.3(cases.)-271.6(By)]TJ
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[(one)-280.4(estima)-10.7(te,)-276.5(the)-283.9(fraction)-287.4(of)-278.4(cases)-282.6(dete)-8.4(cted)-281.6(in)-278.4(the)-283.9(U.S.)-281.1(was)]TJ
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[(incre)-9(asing)-304.1(10%)-302.3(per)-304.1(day)-308.6(during)-305.1(late)-302.9(Apri)-7.6(l)-296.3(t)0(o)-307.3(early)-301.6(May.)]TJ
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[(include)-10.9(d)-411.9(age,)-414(gen)-9.4(der,)-412.6(como)-9.8(rbidities,)-420.6(outcome)-418.9(\(ie,)-417.6(hospi)-8.8(-)]TJ
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[(sympto)-11.3(m)-256.1(onse)-9.6(t,)-256.1(geogra)-9.6(phic)-265.5(location,)-263.8(an)-7.2(d)-258.2(the)-261.2(like.)-260.9(By)-262.1(mid-)]TJ
T*
[(May,)-295.6(however)-10.1(,)-290.6(the)-295.3(proportion)-300.3(of)-295.5(cases)-293.9(tested)-300.6(had)-292.5(decl)-9.2(ined)]TJ
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[(conrme)-11.1(d)-502.9(c)0(a)-7.1(ses)-508.8(of)-506.1(hospitalize)-12.5(d,)-503.3(ICU-ad)-9.3(mitted,)-513.2(or)-503.9(fatal)]TJ
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[(Progr)-8.4(am)-424.8(\(hospitali)-10.9(zations\),)-430.1(New)-427.1(York)-431.7(City,)]TJ
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(35,36)Tj
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[(and)-424.8(the)]TJ
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[(later)-305.7(phases)-306.3(of)-301.2(surve)-10.4(illance)-306.7(in)-301.2(H)-6.1(ong)-302.4(Kong.)]TJ
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[(con)-10.8(rmed,)-293.1(or)-287.7(rep)-8.2(orted,)]TJ
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T*
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