21st century challenges in an influenza pandemic

In today’s world, most people would answer the question “What infectious disease scares you the most?” with either the Zika virus, especially if the person is a young woman of childbearing age, or Ebola, after the widespread media coverage of that disease’s devastating spread through West Africa.  If you ask Dr. Anthony Fauci, Director of the NIH’s National Institute of Allergies and Infectious Diseases (MD, USA), he has a short response: “Pandemic influenza” [1].

Infectious disease specialists have a saying about influenza pandemics, “It is not a matter of if; it is only a matter of when.” The possibility of a novel influenza virus with a high attack rate remains one of public health’s greatest challenges. Of particular and pressing immediate concern in 2017 is what Michael Osterholm refers to as an “unprecedented” situation, in which there are more avian influenza virus strains circulating on more continents than ever before, increasing the potential for mutations and human transmission [2] .  For these avian influenzas, we can anticipate that they will spread in flocks, through wild bird migration and human contact with birds.  Which strain and when one will emerge as a true pandemic strain is the great unknown.

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