Western Quebec's health authority says face masks are again mandatory in hospitals, long-term care facilities and seniors' homes as an early flu outbreak strains the region's emergency rooms.

The Centre intégré de santé et de services sociaux de l'Outaouais (CISSSO) introduced the measure Tuesday. It remains in effect until further notice.

Masks are also mandatory at the Pierre-Janet mental health hospital and the Ressourse rehabilitation centre.

The early arrival of flu season has led to a rise in respiratory viruses, outbreaks and emergency room visits, CISSSO said.

In eastern Ontario, mask rules vary by hospital. Children's hospital CHEO, which issued its own flu warning last week , requires masks in some areas and recommends them elsewhere.

The Ottawa Hospital and Kingston

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