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Worldwide flu outbreak likely, scientists warn

By Associated Press
Published December 14, 2003

NEW YORK - As bad as this year's flu season is, it hasn't brought the worldwide outbreak known as a pandemic. But experts warn that a pandemic is coming, it's just a question of when.

"It's going to happen," said Dr. Greg Poland of the Mayo Clinic. "For the American public in particular, I think it will be horrific."

Many Americans haven't experienced the overwhelming crush of patients at hospitals and doctors' offices and the widespread fear a flu pandemic could bring. And by historical pattern, Poland said it's about time for the next one.

There have been three in the past 100 years, igniting in 1918, 1957 and 1968. There's no way to predict when the next one will appear, but the pattern does give experts pause.

It's all up to a virus that is variable and fickle, constantly changing its genetic makeup, and the time when it hits upon a combination that lets it take off worldwide is a "roll of the genetic dice," said Dr. William Schaffner of Vanderbilt University.

So the lack of a pandemic in the past 35 years basically means "the genetic dice haven't been rolled that way," Schaffner said. "While we're grateful for that, it makes us nervous."

There's plenty to be nervous about. It's estimated that in the industrialized nations alone, the next pandemic is likely to send 1-million to 2.3-million people to the hospital and kill 280,000 to 650,000, according to the World Health Organization. Its impact will probably be greatest in developing countries.

As a practical matter, flu shots probably could not be counted on to prevent a pandemic. For one thing, pandemic virus strains emerge unexpectedly, and there would probably not be enough time to recognize the threat and provide vaccines that target them, Schaffner said. What's more, many countries outside the United States wouldn't have the means to give enough flu shots to stop the spread, Poland said.

The pandemic of 1918-19, known as the Spanish flu, sickened an estimated 20 percent to 40 percent of the worldwide population, with a death toll believed to exceed 20-million. In the United States, some 500,000 people died. An ordinary flu epidemic kills an average of 36,000 Americans.

When the next pandemic shows up, experts say, it will find a population with many more vulnerable people like the elderly, infirm and those with weakened natural defenses than were living 35 years ago. It will also find a trimmed-down hospital system with fewer beds to handle a surge of patients.

But with improvements in health care, might the next pandemic be less serious?

"I want to believe that," Poland said, "but we won't know until it happens."

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