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One hundred years after the 1918 pandemic

new concepts for preparing for influenza pandemics

Pavia, Andrew

Current Opinion in Infectious Diseases: August 2019 - Volume 32 - Issue 4 - p 365–371
doi: 10.1097/QCO.0000000000000564

Purpose of review In the 100 years since the influenza pandemic of 1918–1919, the most deadly event in human history, we have made substantial progress yet we remain vulnerable to influenza pandemics This article provides a brief overview of important advances in preparing for an influenza pandemic, viewed largely from the perspective of the healthcare system.

Recent findings We have gained insights into influenza pathogenicity, the animal reservoir and have improved global surveillance for new strains and tools for assessing the pandemic risk posed by novel strains. Public health has refined plans for severity assessment, distribution of countermeasures and nonpharmaceutical approaches. Modest improvements in vaccine technology include cell culture-based vaccines, adjuvanted vaccine and recombinant technology. Conventional infection control tools will be critical in healthcare settings. New evidence suggests that influenza virus may be present in aerosols; the contribution of airborne transmission and role of N95 respirators remains unknown. Baloxavir and pimodivir are new antivirals that may improve treatment, especially for severely ill patients. Optimal use and the risk of resistance require further study.

Summary Despite the progress in pandemic preparedness, gaps remain including important scientific questions, adequate resources and most importantly, the ability to rapidly deliver highly effective vaccines.

Division of Pediatric Infectious Diseases, University of Utah, Salt Lake City, Utah, USA

Correspondence to Andrew Pavia, George and Esther Gross Presidential Professor and Chief, Division of Pediatric Infectious Diseases, University of Utah, 295 Chipeta Way, Salt Lake City, UT 84108, USA. Tel: 1 801 581-6791; e-mail:

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