The thoughtful article by Schoch-Spana et al offers a welcome opportunity to reflect on the most severe pandemic events of natural origin, particularly as we are approaching the centennial of the 1918 Spanish influenza pandemic—the most recent global event that fulfills the proposed GCBR definition. We would like to highlight a few issues that we have pondered over the years while studying hist...

An influenza A virus that originated in pigs caused a pandemic in 2009. The sialidase activity of the neuraminidase (NA) of previous pandemic influenza A viruses are stable at low pH (≤5). Here, we identified the amino acids responsible for this property. We found differences in low-pH stability at pH 5.0 among pandemic (H1N1) 2009 viruses, which enhanced the replication of these viruses. Low-p...

As part of pandemic preparedness planning, the European Commission (EC) and the European Medicines Agency (EMEA) introduced a procedure to allow the submission and evaluation of core pandemic dossiers (for ‘mock-up’ vaccines) during the inter-pandemic period leading to marketing authorisations which could only be used during an officially declared pandemic (World Health Organization [WHO] Phase...

To the Editor: In April 2009, the outbreak of influenza A pandemic (H1N1) 2009 virus was reported. Subsequently, the disease spread throughout the world, and the pandemic alert level was raised to level 6 in June by the World Health Organization. Pandemic (H1N1) 2009 virus infection spread to Thailand and is now found throughout Thailand. Similar to the effects of other viruses, pandemic (H1N1)...

The limited production capacity for vaccines raises the question what the best strategy is for allocating the vaccine to mitigate an influenza pandemic. We developed an age-structured model for spread of an influenza pandemic and validated it against observations from the Asian flu pandemic. Two strategies were evaluated: vaccination can be implemented at the start of the influenza pandemic, or...

Although it is in the Tropics where nearly half of the world population lives and infectious disease burden is highest, little is known about the impact of influenza pandemics in this area. We investigated the mortality impact of the 2009 influenza pandemic relative to mortality rates from various outcomes in pre-pandemic years throughout a wide range of latitudes encompassing the entire tropic...

A twenty-first century novel influenza A (H1N1) pandemic is currently unfolding, and the eventual scope of this public health crisis is not clear. In addition, ongoing surveillance of the avian influenza A (H5N1) virus reveals outbreaks of human-to-human transmission of the virus, with significant mortality. Effective pandemic management depends on pharmaceutical intervention with two different...

BACKGROUND So far, most pandemic influenza reports were based on case studies focusing on severe disease. For public health policy, it is essential to consider the overall impact of the pandemic, including mild diseases. OBJECTIVES The aim of our study is to gain insight into the epidemiology of 2009 pandemic influenza in the community and to estimate the relative impact of pandemic compared ...

We estimate the financial effects of an influenza pandemic on US hospitals, including the cost of deferring elective admissions and the cost of uncompensated care for uninsured patients. Using US pandemic planning assumptions and national data on health care costs and revenues, a 1918-like pandemic would cause US hospitals to absorb a net loss of $3.9 billion, or an average $784,592 per hospita...

Australian federal and state governments were advised several years ago that an influenza pandemic would overwhelm Australian public reference laboratories. It was proposed at the time that currently underused capacity in the private sector be used to enhance pandemic responses. The current outbreak of pandemic influenza has confirmed the predictions of advisors from the private sector. Future ...