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The detection of even a single case of human-to-human transmission of the avian influenza virus could necessitate heightened pandemic alerts that have high economic cost to countries that are affected [ 40].
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In particular, the 2009 swine-like influenza A [A(H1N1 pdm09] pandemic heightened our awareness.
Avian influenza's spread and fears about pandemic influenza heightened this perceived inequity; experts argued that developing countries would have little access to vaccine for pandemic influenza without major changes in global vaccine production (4, 5 ).
During 2009, emergence of influenza A(H1N1 pdm09 as a pandemic virus heightened public awareness of the potential for human influenza viruses to mutate.
Factors such as increasing international travel, the globalization of food supplies and commerce and the occurrence of multinational epidemics including the 2009 Influenza A pandemic have heightened awareness of global health issues.
Furthermore, heightened awareness surrounding the current pandemic may have affected patient care-seeking behavior or physician diagnostic practices, thus potentially creating bias in year-to-year comparisons.
The possibility of an imminent influenza pandemic has been heightened by the appearance and spread of avian influenza A (H5N1), which has a case-fatality ratio of >50% (3 ).
The spread of highly pathogenic avian influenza (H5N1) and the documented illness and deaths of >300 persons in >12 countries (7 ) has heightened concerns that an influenza pandemic may be imminent.
It is further speculated that groups identified during the recent pandemic as at a higher risk of severe or fatal illness will probably remain at a heightened risk during the post-pandemic period, although the number of such cases may decrease.
The recent outbreak of pandemic H1N1 influenza has heightened the need to improve vaccine responses.
Before this latest pandemic, awareness had been heightened by the emergence of the highly pathogenic (H5N1) strain (1 ).
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