“…The causes of the high lethality and profound lung pathology that were consequences of 1918 influenza cases remain largely unknown. The emergence of novel influenza viruses and associated epidemics in human populations is thought to occur largely from zoonotic transfer from animal strains (4,43,46,63,(74)(75)(76), and additional influenza pandemics have occurred in 1957 with the "Asian" influenza virus (H2N2) and in 1968 with the "Hong Kong" influenza virus (H3N2), which were estimated to be responsible for approximately 70,000 and 34,000 additional influenza-related deaths, respectively, in the United States (49,56,60,62,78). This is further evidenced by the recent emergence of highly pathogenic avian H5N1 influenza viruses in Hong Kong in 1997, which showed unusually high lethality in humans.…”