JAMA
Vol. 302 No. 6, pp. 599-704, August 12, 2009

Commentary
Understanding Influenza Backward

David M. Morens, MD; Jeffery K. Taubenberger, MD, PhD
JAMA. 2009;302(6):679-680.

[First 150 words per JAMA convention]
The novel 2009 influenza A(H1N1) pandemic virus has been an unexpected trigger for pandemic preparedness plans in the United States and elsewhere.1 It is appropriate to ask how the novel virus might behave epidemiologically in coming months, including the possibility of multiple recurrences or “waves.” Spring circulation of the novel virus in the Northern Hemisphere at the end of the 2008-2009 influenza season inevitably has led to comparisons with events in 1918-1919, which in some settings were preceded and followed by outbreaks of respiratory illnesses. Some also believe that the 1918 pandemic began with a premonitory “herald wave,” a term related to an old hypothesis, which influenza and dengue fever appeared to have supported, that as new viruses begin to circulate in human populations they inevitably acquire mutations that increase transmissibility and virulence. Evidence for unusual influenza activity in the years . . .

Author Affiliations: Office of the Director (Dr Morens) and Viral Pathogenesis and Evolution Section, Laboratory of Infectious Diseases (Dr Taubenberger), National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland.