Influenza A virus subtype H1N1 in the context of "RNA virus"

A pandemic (/pænˈdɛmɪk/ pan-DEM-ik) is an epidemic of an infectious disease that has a sudden increase in cases and spreads across a large region, for instance multiple continents or worldwide, affecting a substantial portion of the human population. Widespread endemic diseases with a stable number of infected individuals such as recurrences of seasonal influenza are generally excluded as they occur simultaneously in large regions of the globe rather than being spread worldwide.

Throughout human history, there have been a number of pandemics of diseases such as smallpox. The Black Death, caused by the Plague, caused the deaths of up to half of the population of Europe in the 14th century. The term pandemic had not been used then, but was used for later epidemics, including the 1918 H1N1 influenza A pandemic—more commonly known as the Spanish flu—which is the deadliest pandemic in history. The most recent pandemics include the HIV/AIDS pandemic, the 2009 swine flu pandemic and the COVID-19 pandemic. Almost all these diseases still circulate among humans though their impact now is often far less.

The 2009 swine flu pandemic, caused by the H1N1/swine flu/influenza virus and declared by the World Health Organization (WHO) from June 2009 to August 2010, was the third recent flu pandemic involving the H1N1 virus (the first being the 1918–1920 Spanish flu pandemic and the second being the 1977 Russian flu). The first identified human case was in La Gloria, Mexico, a rural town in Veracruz. The virus appeared to be a new strain of H1N1 that resulted from a previous triple reassortment of bird, swine, and human flu viruses which further combined with a Eurasian pig flu virus, leading to the term "swine flu".

Unlike most strains of influenza, the pandemic H1N1/09 virus did not disproportionately infect adults older than 60 years; this was an unusual and characteristic feature of the H1N1 pandemic. Even in the case of previously healthy people, a small percentage develop pneumonia or acute respiratory distress syndrome (ARDS). This manifests itself as increased breathing difficulty and typically occurs three to six days after initial onset of flu symptoms. The pneumonia caused by flu can be either direct viral pneumonia or a secondary bacterial pneumonia. A November 2009 New England Journal of Medicine article recommended that flu patients whose chest X-ray indicates pneumonia receive both antivirals and antibiotics. In particular, it is a warning sign if a child seems to be getting better and then relapses with high fever, as this relapse may be bacterial pneumonia.

The 1977 Russian flu was an influenza pandemic that was first reported by the Soviet Union in 1977 and lasted until 1979. The outbreak in northern China started in May 1977, slightly earlier than that in the Soviet Union. The pandemic mostly affected a population younger than 25 or 26 years of age, and was described as mild. It was caused by an H1N1 flu strain which highly resembled a virus strain circulating worldwide from 1946 to 1957. Genetic analysis and several unusual characteristics of the 1977 Russian flu have prompted many researchers to say that the virus was released to the public through a laboratory accident, or resulted from a live-vaccine trial escape.

The Russian flu first reached the United Kingdom in 1977, and the United States in January 1978. The first outbreak in the United States took place in Cheyenne, Wyoming, but more than 70% of those infected were students. The flu spread in schools and military bases throughout the United States, but most of those infected were below the age of 26. In the United States, the death rate in affected individuals was low.

Influenza A virus, or IAV is a pathogen with strains that cause seasonal flu in humans; it can also infect birds and some mammals. Strains of IAV circulate constantly in bats, pigs, horses, and dogs, while other mammals may be infected occasionally. It has also been the cause of a number of pandemics, most notably the Spanish Flu pandemic from 1918–1920.

Subtypes of IAV are defined by the combination of the molecules on the surface of the virus which provoke an immune response; for example, "H1N1" denotes a subtype that has a type-1 hemagglutinin (H) protein and a type-1 neuraminidase (N) protein. Variations within subtypes affect how easily the virus spreads, the severity of illness, and its ability to infect different hosts. The virus changes through mutation and genetic reassortment, allowing it to evade immunity and sometimes jump between species.

An emergent virus (or emerging virus) is a virus that is either newly appeared, notably increasing in incidence/geographic range or has the potential to increase in the near future. Emergent viruses are a leading cause of emerging infectious diseases and raise public health challenges globally, given their potential to cause outbreaks of disease which can lead to epidemics and pandemics. As well as causing disease, emergent viruses can also have severe economic implications. Recent examples include the SARS-related coronaviruses, which have caused the 2002–2004 outbreak of SARS (SARS-CoV-1) and the 2019–2023 pandemic of COVID-19 (SARS-CoV-2). Other examples include the human immunodeficiency virus, which causes HIV/AIDS; the viruses responsible for Ebola; the H5N1 influenza virus responsible for avian influenza; and H1N1/09, which caused the 2009 swine flu pandemic (an earlier emergent strain of H1N1 caused the 1918 Spanish flu pandemic). Viral emergence in humans is often a consequence of zoonosis, which involves a cross-species jump of a viral disease into humans from other animals. As zoonotic viruses exist in animal reservoirs, they are much more difficult to eradicate and can therefore establish persistent infections in human populations.

Emergent viruses should not be confused with re-emerging viruses or newly detected viruses. A re-emerging virus is generally considered to be a previously appeared virus that is experiencing a resurgence, for example measles. A newly detected virus is a previously unrecognized virus that had been circulating in the species as endemic or epidemic infections. Newly detected viruses may have escaped classification because they left no distinctive clues and/or could not be isolated or propagated in cell culture. Examples include human rhinovirus (a leading cause of common colds which was first identified in 1956), hepatitis C (eventually identified in 1989), and human metapneumovirus (first described in 2001, but thought to have been circulating since the 19th century). As the detection of such viruses is technology driven, the number reported is likely to expand.

A cytokine storm, also called hypercytokinemia, is a pathological reaction in humans and other animals in which the innate immune system causes an uncontrolled and excessive release of pro-inflammatory signaling molecules called cytokines. Cytokines are a normal part of the body's immune response to infection, but their sudden release in large quantities may cause multisystem organ failure and death.

Cytokine storms may be caused by infectious or non-infectious etiologies, especially viral respiratory infections such as H1N1 influenza, H5N1 influenza, SARS-CoV-1, SARS-CoV-2, Influenza B, and parainfluenza virus. Other causative agents include the Epstein-Barr virus, cytomegalovirus, group A streptococcus, and non-infectious conditions such as graft-versus-host disease. The viruses can invade lung epithelial cells and alveolar macrophages to produce viral nucleic acid, which stimulates the infected cells to release cytokines and chemokines, activating macrophages, dendritic cells, and others.