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The majority of physicians and public health practitioners are familiar with the concept that the vast reservoir of influenza A viruses found in migratory waterfowl represent an ongoing threat to emerge in humans and cause widespread disease. Although these avian influenza A viruses, which include all of the known hemagglutinin (H1-H16) and neuraminidase (N1-N9) subtypes, are generally restricted in their ability to replicate in humans, recent work has shown that a minimal number of mutations can result in viruses likely to transmit efficiently from person to person.1,2 The resulting global epidemic or pandemic of influenza would spread rapidly and almost certainly would have massive public health implications. Among the many hemagglutinin subtypes, viruses of the H5 and more recently H7 subtypes are of particular concern because of their demonstrated ability to cause severe disease in humans.3,4
Treanor JJ. Expanding the Options for Confronting Pandemic Influenza. JAMA. 2014;312(14):1401-1402. doi:10.1001/jama.2014.12558