Skip to main content

Influenza pandemics: past, present and future challenges

Abstract

Influenza epidemics occur regularly and prediction of their conversion to pandemics and their impact is difficult. Coordination of efforts on a global scale to control or reduce the impact is fraught with potential for under and overreaction. In light of the 1956 pandemic and more recently the SARS and H1N1 pandemics, the public health community took steps toward strengthening global surveillance and a coordinated response in keeping with the continuing memory of the tragedy seen in 1918. The scientific, professional, and technical resources of the 21st century are now advanced far beyond those then available. The H1N1 pandemic which commenced in 2009 progressed differently than predicted; its course was difficult to predict with any degree of certainty. Public responses to national immunization programs against the H1N1 virus have been weak. International movement of diseases can lead to creation of new endemic areas and continuous spread such as that which happened with West Nile Fever and Chikungunya. The lessons learned and the public and political responses to each actual or threatened pandemic will serve public health well in dealing with future challenges.

References

  1. 1.

    World Health Organization. Pandemic (H1N1) 2009–update 105. Available from URL: http://www.who.int/csr/don/2010_06_18/en/ (Accessed 19 June, 2010).

  2. 2.

    Barry JM. The great influenza: the epic story of the deadliest plague in history. New York: Penguin Viking; 2004.

    Google Scholar 

  3. 3.

    Taubenberger JK, Morens DM. 1918 influenza: the mother of all epidemics. Emerg Infect Dis. 2006;12:15–22. Available from URL: http://www.cdc.gov/ncidod/EID/vol12no01/05–0979.htm (Accessed 19 June, 2010).

    Google Scholar 

  4. 4.

    Dowdle WR. Pandemic influenza: confronting a re-emergent threat. The 1976 experience. J Infect Dis 1997;176 Suppl-1:S69–72. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/9240699 (Accessed 18 June, 2010).

    Article  PubMed  Google Scholar 

  5. 5.

    Fouchier RAM, Kuiken T, Schutten M, van Amerongen G, van Doornum GJJ, van den Hoogen BG et al. Aetiology: Koch’s postulates fulfilled for SARS virus. Nature 2003:423:240. Available from URL: http://www.nature.com/nature/journal/v423/n6937/pdf/423240a.pdf (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  6. 6.

    World Health Organization. Severe Acute Respiratory Syndrome (SARS)–multi-country outbreak. Update 31, 16 April 2003. Available from URL: http://www.who.int/csr/don/2003_04_16/en/ (Accessed 18 June, 2010).

    Google Scholar 

  7. 7.

    World Health Organization. Cumulative number of confirmed human cases of Avian influenza A/(H5N1) reported to WHO. (24 September, 2009). Available from URL: http://www.who.int/csr/disease/avian_influenza/country/cases_ table_2009_09_24/en/index.html (Accessed 18 June, 2010).

    Google Scholar 

  8. 8.

    Bishop JF, Murnane MP, Owen R. Australia’s winter with the 2009 pandemic influenza A (H1N1) virus. N Engl J Med. 2009;361:2591–4. Available from URL: http://content.nejm.org/cgi/reprint/NEJMp0910445.pdf (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    de Lamballerie X. Personal communication, June, 2010.

    Google Scholar 

  10. 10.

    Centers for Disease Control and Prevention. 2009 H1N1 early outbreak and disease characteristics. Available from URL: http://www.cdc.gov/h1n1flu/surveillanceqa.htm (Updated 27 October, 2009 and accessed 18 June, 2010).

  11. 11.

    Paris correspondents. First worldwide profile of swine flu victims. Herald Sun (Victoria, Australia). August 26, 2009. Available from URL: http://www.heraldsun.com.au (Accessed 18 June, 2010).

    Google Scholar 

  12. 12.

    Ross T, Zimmer S, Burke D, Crevar C, Carter D, Stark J, et al. Seroprevalence following the second wave of pandemic 2009 H1N1 influenza. PLoS Curr Influenza. 24 Feb, 2010: RRN1148 Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20191082 (Accessed 18 June, 2010).

    Google Scholar 

  13. 13.

    Flahault A. First estimation of direct H1N1pdm virulence: From reported non consolidated data from Mauritius and New Caledonia. PLoS Curr Influenza. 2009 Aug 23:RRN1010. Available from URL: http://www.ncbi.nlm.nih.gov/ pubmed/20020674 (Accessed 18 June, 2010).

    Google Scholar 

  14. 14.

    Centers for Disease Control and Prevention. Bacterial coinfections in lung tissue specimens from fatal cases of 2009 pandemic Influenza A (H1N1)–United States, May–August 2009. MMWR Morb Mort Wkly Rep. 2009; 58:1–4. (early release) Available from URL: http://www.cdc.gov/mmwr/pdf/ wk/mm58e0929.pdf (Accessed 18 June, 2010).

    Google Scholar 

  15. 15.

    The ANZIC Influenza Investigators. Critical care services and 2009 H1N1 influenza in Australia and New Zealand. N Engl J Med. 2009;361:1925–34. Available from URL: http://content.nejm.org/cgi/content/full/361/20/1925 (Accessed 18 June, 2010).

    Article  Google Scholar 

  16. 16.

    Reed C, Angulo FJ, Swerdlow DL, Lipsitch M, Meltzer MI, Jernigan D, Finelli L. Estimates of the prevalence of pandemic (H1N1) 2009, United States, April-July 2009. Emerg Infect Dis. 2009;15: December. Available from URL: http://www.cdc.gov/eid/content/15/12/pdfs/2004.pdf (Accessed 18 June, 2010).

  17. 17.

    World Health Organization. Transcript of statement by Margaret Chan, Director- General of the World Health Organization. 11 June, 2009. Available from URL: http://www.who.int/mediacentre/influenzaAH1N1_presstranscript_ 20090611.pdf (Accessed 18 June, 2010).

    Google Scholar 

  18. 18.

    Centers for Disease Control and Prevention. Centers for Disease Control and Prevention. 2009 H1N1 flu: situation update. Available from URL: http://www.cdc.gov/h1n1flu/update.htm (Accessed 20 June, 2010).

  19. 19.

    Centers for Disease Control and Prevention. CDC Estimates of 2009 H1N1 influenza cases, hospitalizations, and deaths in the United States, April- December 12, 2009. Available from URL: http://www.cdc.gov/h1n1flu/ estimates/April_December_12.htm#Table (Accessed 18 June, 2010).

    Google Scholar 

  20. 20.

    Boussard E, Flahault A, Vibert JF, Valleron AJ. Sentiweb: French communicable disease surveillance on the world wide web. BMJ. 1996;313:1381–4. Available from URL: http://www.bmj.com/cgi/content/full/313/7069/1381 (Accessed 18 June, 2010).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Sentinelles. Réseau Sentinelles France (weekly epidemiologic record for France). Available from URL: http://www.sentiweb.org (Accessed 18 June, 2010).

  22. 22.

    Paget J, Marquet R, Meijer A. van der Velden K. Influenza activity in Europe during eight seasons (1999–2007): an evaluation of the indicators used to measure activity and assessment of the timing, length and course of peak activity (spread) across Europe. BMC Infect Dis. 2007;7:141 Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/18047685 (Accessed 18 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  23. 23.

    Viboud C, Boëlle PY, Pakdaman K, Carrat F, Valleron AJ, Flahault A. Influenza epidemics in the United States, France, and Australia, 1972–1997. Emerg Infect Dis. 2004;10:32–9. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/15078594 (Accessed 18 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  24. 24.

    Lemaitre M, Carrat F. Comparative age distribution of influenza morbidity and mortality during seasonal influenza epidemics and the 2009 H1N1 pandemic. BMC Infectious Diseases. 2010;10:162 doi:10.1186/1471–2334–10–162. Available from URL: http://www.biomedcentral.com/content/pdf/1471–2334- 10–162.pdf (Accessed 20 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  25. 25.

    Thompson WW, Shay DK, Weintraub E, Brammer L, Cox N, Anderson LJ, et al. Mortality associated with influenza and respiratory syncytial virus in the United States. JAMA. 2003;289:179–86. Available from URL: http://jama.ama-assn.org/cgi/content/abstract/289/2/179 (Accessed 19 June, 2010).

    Article  PubMed  Google Scholar 

  26. 26.

    Centers for Disease Control and Prevention. Seasonal influenza (flu); Estimating deaths from seasonal influenza in the United States. Available from URL: http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm (Accessed 19 June, 2010).

  27. 27.

    Carrat F, Valleron AJ. Influenza mortality among the elderly in France, 1980–90: how many deaths may have been avoided through vaccination? J Epidemiol Community Health. 1995;49:419–25. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/7650467 (Accessed 18 June, 2010).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    Reichert TA, Sugaya N, Fedson DS, Glezen WP, Simonsen L, Tashiro M. The Japanese experience with vaccinating schoolchildren against influenza. New Engl J Med. 2001; 344:889–96. Available from URL: http://content.nejm.org/cgi/content/short/344/12/889 (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  29. 29.

    Centers for Disease Control. Key facts about seasonal flu vaccine. Available from URL: http://www.cdc.gov/Flu/protect/keyfacts.htm (Posted 16 October, 2009 and accessed 18 June, 2010).

  30. 30.

    Skowronski DM, Astell C, Brunham RC, Low DE, Petric M, Roper RL, et al. Severe acute respiratory syndrome (SARS): A year in review. Annu Rev Med. 2005;56:357–81. Available from URL: http://www.ncbi.nlm.nih.gov/sites/pubmed (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Morens DM, Taubenberger JK. Understanding influenza backward. JAMA. 2009;302:679–80. Available from URL: http://www.ncbi.nlm.nih.gov/sites/pubmed (Accessed 18 June, 2010).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  32. 32.

    Taubenberger JK. Genetic characterisation of the 1918 ‘Spanish’ influenza virus. In Phillips H, Killingray D, editors. The Spanish influenza pandemic of 1918–19. New perspectives. London: Routledge; 2003: 39–46, p. 43. Available from URL: http://www.questia.com/PM.qst?a=o&d=104243843 (Accessed 18 June, 2010).

    Google Scholar 

  33. 33.

    Ohadike DC. Diffusion and physiological responses to influenza pandemic of 1918–1919 in Nigeria. Social Science and Medicine. 1991;32:1393–9. Available from URL: http://www.sciencedirect.com/ (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Delater Dr. La grippe dans la nation armée de 1918 à 1921. Revue d’hygiene. 1923;45:409–634.

    Google Scholar 

  35. 35.

    Oxford JS, Sefton A, Jackson R, Innes W, Daniels RS, Johnson NPAS. World War I may have allowed the emergence of “Spanish” influenza. Lancet Infect Dis. 2002;2:111–4. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/11901642 (Accessed 18 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  36. 36.

    Yin S. Avian Flu and Influenza pandemics. Washington: Population Reference Bureau;2006. Available from URL: http://www.prb.org/Articles/2006/Avian FluandInfluenzaPandemics.aspx (Accessed 18 June, 2010).

    Google Scholar 

  37. 37.

    Defressine and Violle, La prophylaxie et le traitement de la grippe, C. R. hébdo, séances Acad. Sci., 1918; 167: 503; and J. Castaigne, Chronique, J. Méd. franç., 1919; 8: 11–14. In: Phillips H, Killingray D. The Spanish influenza pandemic of 1918–19: new perspectives. London: Routledge; 2003.

    Google Scholar 

  38. 38.

    Johnson NPAS. The overshadowed killer. Influenza in Britain in 1918–19. In: Phillips H, Killingray D, editors. The Spanish influenza pandemic of 1918–19: new perspectives. London: Routledge; 2003:132–55, pp.137–38.

    Google Scholar 

  39. 39.

    Becker JJ. La grippe espagnole, memoire d’une guerre. Liberation. 9 October, 2009. Available from URL: http://www.liberation.fr/societe/0101596047-lagrippe- espagnole-memoire-d-une-guerre (Accessed 18 June, 2010).

  40. 40.

    Taubenberger JK, Morens DM. 1918 influenza: the mother of all pandemics, Emerg Infect Dis. 2006;12:15–22. Available from URL: http://www.cdc.gov/ncidod/eid/vol12no01/pdfs/05–0979.pdf (Accessed 18 June, 2010).

    Google Scholar 

  41. 41.

    Préfecture de la Seine. Épidémie de grippe à Paris, 30 juin 1918–26 avril 1919. Paris: Imprimerie des Beaux-Arts; s.d. [1919]. (Service de la statistique municipale; 2e année, no. 2).

    Google Scholar 

  42. 42.

    Ministére de la Guerre. Statistiques médicales. I–Données statistiques relatives à la guerre 1914–1918, Paris, 1922.

    Google Scholar 

  43. 43.

    Phillips H, Killingray D, editors. The Spanish influenza pandemic of 1918–19: new perspectives. London: Routledge; 2003.

    Google Scholar 

  44. 44.

    Patterson KD. Pandemic influenza, 1700–1900: a study in historical epidemiology. Totowa, NJ: Rowman and Littlefield; 1986.

    Google Scholar 

  45. 45.

    Hays JN. Epidemics and pandemics: Their impact on human history. Santa Barbara (CA): ABC-CLIO Inc; 2005:88–89.

    Google Scholar 

  46. 46.

    Thucydides, The Peloponesian War (circa 400 BC), translated by Crawley R, edited by Wick TE, New York: Modern Library. 1982.

  47. 47.

    Burrow J. A history of histories. Epics, chronicles, romances & inquiries from Herodotus & Thucydides to the twentieth century. London: Penguin Books; 2009.

    Google Scholar 

  48. 48.

    Kilbourne ED. Influenza pandemics of the 20th century. Emerg Infect Dis. 2006;12:9–14. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16494710 (Accessed 19 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  49. 49.

    Viboud C, Grais RF, Lafont BA, Miller MA, Simonsen L. Multinational impact of the 1968 Hong Kong influenza pandemic: evidence for a smoldering pandemic, J. Infect. Dis. 2005; 192: 233–48. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/15962218 (Accessed 10 June, 2010).

    Article  PubMed  Google Scholar 

  50. 50.

    Gensheimer KF, Fukuda K, Brammer L, Cox N, Patriarca P, Strikas RA. Preparing for pandemic influenza: the need for enhanced surveillance. Emerg Infect Dis. 1999;5:297–9. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/10221887 (Accessed 10 June, 2010).

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  51. 51.

    Valleron AJ, Boumendil A. Epidemiology and heat waves: analysis of the 2003 episode in France. C R Biol. 2004;327:1125–41. Available from URL: http://www.ncbi.nlm.nih.gov/sites/pubmed (Accessed 19 June 2010).

    Article  PubMed  Google Scholar 

  52. 52.

    Boffey PM. Swine flu vaccination campaign: the scientific controversy mounts. Science. 1976;193:559–63. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/17759577 (Accessed 19 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  53. 53.

    Stöhr K, Esveld M. Public health: Will vaccines be available for the next influenza pandemic? Science. 2004;306, 24 2195=6. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/15618505 (Accessed 19 June, 2010).

    Article  Google Scholar 

  54. 54.

    Schwarzinger M, Flicoteaux R, Cortarenoda S, Obadia Y, Moatti JP. Low acceptability of A/H1N1 pandemic vaccination in French adult population. Did public health policy fuel public dissonance? PLoS One. April 2010; 5:e1099. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20421908 (Accessed 19 June, 2010).

    Google Scholar 

  55. 55.

    Setbon M, Raude J. Factors in Vaccination intention against the pandemic influenza A (H1N1). Eur J Publ Health. 5 May, 2010 [e pub ahead of print] Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20444821?dopt=Abstract (Accessed 19 June, 2010).

    Google Scholar 

  56. 56.

    Valéry P. Regards sur le monde actuel (1931), in Oeuvres, ed. J. Hytier, t. II, Paris: Gallimard (Pléiade), 1960, p. 917.

    Google Scholar 

  57. 57.

    Gaydos JC, Top FH, Hodder RA, Russell PK. Swine influenza A outbreak, Fort Dix, New Jersey, 1976. Emerg Infect Dis 2006;12:23–8. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16494712 (Accessed 19 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Krause R. The swine flu episode and the fog of epidemics. Emerg Infect Dis. 2006;12:40–3. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16494715 (Accessed 19 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  59. 59.

    Sencer DJ, Millar JD. Reflections on the 1976 swine flu vaccination program. Emerg Infect Dis 2006;12:29–33. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16494713 (Accessed 19 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  60. 60.

    Neustadt RE, Fineberg HV. The epidemic that never was: policy-making in the swine flu scare. New York: Vintage Books; 1983.

    Google Scholar 

  61. 61.

    Dowdle WR. Influenza pandemic periodicity, virus recycling, and the art of risk assessment. Emerg Infect Dis. 2006;12:34–9. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/16494714 (Accessed 18 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  62. 62.

    Crosby AW. Epidemic and peace, 1918. Westport: Greenwood Press; 1976.

    Google Scholar 

  63. 63.

    Dowdle WR. The 1976 experience. J Infect Dis. 1997;176(suppl 1):S69–72. Available from URL: http://www.journals.uchicago.edu/doi/abs/10.1086/514180 (Accessed 19 June, 2010).

    Article  Google Scholar 

  64. 64.

    Tulchinsky TH. Personal communication, April, 2010

    Google Scholar 

  65. 65.

    Thomas RE, Jefferson T, Lasserson TJ. Influenza vaccination for healthcare workers who work with the elderly. The Cochrane Collaboration, John Wiley & Sons Limited; 2010. Available from URL: http://www.thecochranelibrary.com/SpringboardWebApp/userfiles/ccoch/file/CD005187.pdf (Accessed 20 June, 2010).

    Google Scholar 

  66. 66.

    Hayward AC, Harling R, Wetten S, Johnson AM, Munro S, Smedley J, et al. Effectiveness of an influenza vaccine programme for care home staff to prevent death, morbidity and health service use among residents: cluster randomized controlled trial. BMJ. 2006;333:1241. Available from URL: http://www.bmj.com/cgi/content/abstract/333/7581/1241 (Accessed 20 June, 2010).

    Article  PubMed  PubMed Central  Google Scholar 

  67. 67.

    Lemaitre M, Meret T, Rothan-Tondeur M, Belmin J, Lejonc JL, Luquel L, et al. Effect of influenza vaccination of nursing home staff on mortality of residents: a cluster-randomized trial. J Am Geriatr Soc. 2009;57:1580–6. Available from URL: http://www3.interscience.wiley.com/journal/122538809/abstract?CRETRY=1&SRETRY=0 (Accessed 20 June, 2010).

    Article  PubMed  Google Scholar 

  68. 68.

    Centers for Disease Control and Prevention. Seasonal influenza vaccination health resources for professionals: 2009–10 recommendations of the Advisory Committee on Immunization practices (ACIP). Available from URL: http://198.246.98.21/flu/professionals/vaccination/index.htm (Accessed 20 June, 2010).

    Google Scholar 

  69. 69.

    La Montagne JR, Noble GR, Quinnan GV, Curlin GT, Blackwelder WC, Smith JI, et al. Summary of clinical trials of inactivated vaccine–1978. Rev. Infect. Dis. 1983;5:723–36. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/6353529 (Accessed 20 June, 2010).

    Article  PubMed  Google Scholar 

  70. 70.

    Stowe J, Andrews N, Wise L, Miller E. Investigation of the temporal association of Guillain-Barré syndrome with influenza vaccine and influenza-like illness using the United Kingdom general practice research database. Am J Epidemiol. 2009;169:382–8. Available from URL: http://aje.oxfordjournals.org/cgi/content/full/kwn310 (Accessed 20 June, 2010).

    Article  PubMed  Google Scholar 

  71. 71.

    Hurwitz ES, Schonberger LB, Nelson DB, Hollman RC. Guillain-Barre syndrome and the 1978–1979 influenza vaccine. N Engl J Med. 1981;304:1557–61. Available from URL: http://content.nejm.org/cgi/content/abstract/304/26/1557 (Accessed 20 June, 2010).

    CAS  Article  PubMed  Google Scholar 

  72. 72.

    Patel M, Dennis A, Flutter C, Khan Z. Pandemic (H1N1) 2009 influenza. Br J Anaesth. 2010;104:128–42. Available from URL: http://www.ncbi.nlm.nih.gov/pubmed/20053625 (Accessed 20 June 2010).

    CAS  Article  PubMed  Google Scholar 

  73. 73.

    Kumar A, Zarychanski R, Pinto R, Cook DJ, Marshall J, Lacraoix, et al. Critically ill patients with 2009 influenza A(H1N1) infection in Canada. JAMA. 2009;302:1872–9. Available from URL: http://www.ncbi.nlm.nih.gov/sites/pubmed (Accessed 20 June, 2009).

    CAS  Article  PubMed  Google Scholar 

  74. 74.

    Centers for Disease Control and Prevention. Seasonal influenza (flu); Estimating deaths from seasonal influenza in the United States. Available from URL: http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm (Accessed 19 June, 2010).

  75. 75.

    Shetty P. H1N1 vaccine could staunch further financial loss. Lancet Infect Dis. 2009;9:592. Available from URL: http://www.thelancet.com/journals/laninf/article/PIIS1473–3099(09)70243–9/fulltext (Accessed 20 June, 2010).

    Article  Google Scholar 

  76. 76.

    Syal R. Swine flu ‘could kill millions unless rich nations give £900m’. The Observer. 20 September, 2009. Available from URL: http://www.guardian.co.uk/world/2009/sep/20/swine-flu-costs-un-report (Accessed 20 June, 2010).

    Google Scholar 

  77. 77.

    Murard L. L’organisation internationale de la lutte contre les épidémies (1851-2005). In: Flahault A, Zylberman P. Editors. Des épidémies et des hommes. Paris; De La Martinière; 2008. (pp. 83–92).

    Google Scholar 

  78. 78.

    World Health Organization. WHO extends its SARS-related travel advice to Beijing and Shanxi province in China and to Toronto, Canada. Available from URL: http://www.who.int/ (Accessed 20 June, 2010).

  79. 79.

    Triggle N. What comes next in the flu fight? BBC News. 11 June, 2009. Available from URL: http://news.bbc.co.uk/2/hi/health/8093482.stm (Accessed 20 June, 2010).

    Google Scholar 

  80. 80.

    Godlee F. Editorial: Conflicts of interest and pandemic flu. BMJ. 2010;340:c2947. Available from URL: http://www.bmj.com/cgi/content/full/340/jun03_4/c2947 (Accessed 20 June, 2010).

    Article  Google Scholar 

  81. 81.

    World Health Organization. WHO Director General’s letter to BMJ editors. 8 June, 2010. Available from URL: http://www.who.int/mediacentre/news/statements/2010/letter_bmj_20100608/en/index.html (Accessed 20 June, 2010).

    Google Scholar 

  82. 82.

    Roos R. US H1N1 vaccine uptake estimated at 75 million. CIDRAP. Available from URL: http://www.cidrap.umn.edu/cidrap/content/influenza/swineflu/news/feb0410vac.html (Accessed 20 June, 2010).

    Google Scholar 

  83. 83.

    Public Health Agency of Canada. Government of Canada announces significant contribution to WHO global pandemic relief efforts. News release. 28 January, 2010. Available from URL: http://www.phac-aspc.gc.ca/media/nr-rp/2010/2010_0128-eng.php (Accessed 20 June, 2010).

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to Antoine Flahault MD, PhD.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Flahault, A., Zylberman, P. Influenza pandemics: past, present and future challenges. Public Health Rev 32, 319–340 (2010). https://doi.org/10.1007/BF03391605

Download citation

Key Words

  • influenza A (H1N1)
  • influenza policy
  • global influenza monitoring
  • pandemic 1918
  • 1976
  • vaccination
  • SARS
  • antivirals