Abstract

In economically developed countries, deaths peak in winter months.  With very particular exceptions, deaths due to the diseases that cause the large majority of human mortality maximize in the same month within a country or region.  The deaths under the peak and above the baseline have special properties that allow us to attribute them to the viral pathogen, influenza.  This winter dance of death is synchronized is a very special way, it behaves as though it is driven everywhere by the same underlying process.  In addition, the force of mortality is not constant throughout the developed world.  Rather, it appears to vary according to a pattern determined by temperature and possibly other meteorologic factors.  Influenza has been called the last great plague of humankind.   Yet, our strategy for control is inadequate even for the interpandemic form of this disease.   There are many signs that we are edging closer to the next pandemic, the appearance of a new form of influenza to which few humans will be immune. The 1918 influenza pandemic killed more humans in a shorter time than any other pathogen.  If an equally virulent form should emerge as many as 250 million people could die.  How has such a terrible scourge managed to maintain such a low profile for so long?