Displaying publications 1 - 20 of 83 in total

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  1. Wiwanitkit V
    Med J Malaysia, 2011 Mar;66(1):75.
    PMID: 23765153
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  2. Ma NL, Peng W, Soon CF, Noor Hassim MF, Misbah S, Rahmat Z, et al.
    Environ Res, 2021 Feb;193:110405.
    PMID: 33130165 DOI: 10.1016/j.envres.2020.110405
    The recently emerged coronavirus disease (COVID-19), which has been characterised as a pandemic by the World Health Organization (WHO), is impacting all parts of human society including agriculture, manufacturing, and tertiary sectors involving all service provision industries. This paper aims to give an overview of potential host reservoirs that could cause pandemic outbreak caused by zoonotic transmission. Amongst all, continues surveillance in slaughterhouse for possible pathogens transmission is needed to prevent next pandemic outbreak. This paper also summarizes the potential threats of pandemic to agriculture and aquaculture sector that control almost the total food supply chain and market. The history lesson from the past, emerging and reemerging infectious disease including the Severe Acute Respiratory Syndrome (SARS) in 2002, Influenza A H1N1 (swine flu) in 2009, Middle East Respiratory Syndrome (MERS) in 2012 and the recent COVID-19 should give us some clue to improve especially the governance to be more ready for next coming pandemic.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  3. Khor SK, Heymann DL
    Lancet Public Health, 2021 06;6(6):e357-e358.
    PMID: 33964228 DOI: 10.1016/S2468-2667(21)00101-8
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  4. Gopinath SCB, Ismail ZH, Sekiguchi K
    Biotechnol Appl Biochem, 2022 Dec;69(6):2507-2516.
    PMID: 34894363 DOI: 10.1002/bab.2300
    The current world condition is dire due to epidemics and pandemics as a result of novel viruses, such as influenza and the coronavirus, causing acute respiratory syndrome. To overcome these critical situations, the current research seeks to generate a common surveillance system with the assistance of a controlled Internet of Things operated under a Gaussian noise channel. To create the model system, a study with an analysis of H1N1 influenza virus determination on an interdigitated electrode (IDE) sensor was validated by current-volt measurements. The preliminary data were generated using hemagglutinin as the target against gold-conjugated aptamer/antibody as the probe, with the transmission pattern showing consistency with the Gaussian noise channel algorithm. A good fit with the algorithmic values was found, displaying a similar pattern to that output from the IDE, indicating reliability. This study can be a model for the surveillance of varied pathogens, including the emergence and reemergence of novel strains.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  5. Joan SS, Pui-Fong J, Song AA, Chang LY, Yusoff K, AbuBakar S, et al.
    Biotechnol Lett, 2016 May;38(5):793-9.
    PMID: 26758876 DOI: 10.1007/s10529-016-2034-2
    An oral lactococcal-based vaccine which haboured the haemagglutinin1 (HA1) antigen fused to nisP anchor protein for the purpose of surface displaying the HA1 antigen was developed against H1N1 virus.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  6. Tochilina AG, Belova IV, Ilyicheva TN, Marchenko VY, Zhirnov VA, Molodtsova SB, et al.
    Sovrem Tekhnologii Med, 2022;14(5):36-43.
    PMID: 37181836 DOI: 10.17691/stm2022.14.5.04
    The aim of the study was to analyze the genome features of the probiotic strains Bifidobacterium longum 379, Bifidobacterium bifidum 1, and Bifidobacterium bifidum 791 and study their antiviral activity.

    MATERIALS AND METHODS: Whole genome sequencing of three strains of bifidobacteria was performed on the MiSeq platform (Illumina Inc., USA). The genomes were annotated using the Prokka v. 1.11 utility and RAST genomic server. The individual genetic determinants were searched using the ResFinder 3.2, PathogenFinder, PlasmidFinder, RAST, and Bagel 4 software. The antiviral activity of the strains against influenza A viruses was studied using MDCK cells (Madin-Darby canine kidney cells), the epidemic strain of influenza A/Lipetsk/1V/2018 (H1N1 pdm09) (EPI_ISL_332798), the highly pathogenic avian influenza virus A/common gull/Saratov/1676/2018 (H5N6) strain (EPI_ISL_336925), and neutral red vital dye.

    RESULTS: The genomes of all studied strains contained determinants responsible for utilization of carbohydrates of plant origin; the genes of key enzymes for the synthesis of tryptophan and folic acid are present in the genomes of B. longum 379 and B. bifidum 791. A feature of the B. bifidum 791 genome is the presence of determinants responsible for the synthesis of thermostable type I bacteriocins - flavucin and lasso peptide. The B. bifidum 791 strain was found to show pronounced antiviral activity against both the strains of influenza A, the supernatant of which suppressed viral replication in vitro up to a dilution of 1:8, and the cells inhibited viral reproduction up to a concentration of 6·106 CFU/ml.

    CONCLUSION: The analysis of complete genomes of B. longum 379, B. bifidum 1, and B. bifidum 791 showed features that determine their strain-specific properties, the findings on which were previously made empirically based on indirect signs. In the genomes of B. longum 379 and B. bifidum 791 strains, in contrast to B. bifidum 1 strain, key enzymes for the synthesis of tryptophan and folic acid were found. These substances have an impact on the human body in many ways, including having a thymoleptic effect (reducing emotional stress, irritability, anxiety, eliminating lethargy, apathy, melancholy, anxiety) and regulating cognitive activity. The presence of determinants responsible for the synthesis of thermostable type I bacteriocins in the genome of B. bifidum 791 strain determines its pronounced antiviral activity.

    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  7. Ali U, Zainal M, Zainol Z, Tai CW, Tang SF, Lee PC, et al.
    Malays J Pathol, 2023 Aug;45(2):215-227.
    PMID: 37658531
    INTRODUCTION: Acute respiratory infection (ARI) contributes to significant mortality and morbidity worldwide and is usually caused by a wide range of respiratory pathogens. This study aims to describe the performance of QIAstat-Dx® Respiratory Panel V2 (RP) and RespiFinder® 2SMART assays for respiratory pathogens detection.

    MATERIALS AND METHODS: A total of 110 nasopharyngeal swabs (NPS) were collected from children aged one month to 12 years old who were admitted with ARI in UKMMC during a one-year period. The two qPCR assays were conducted in parallel.

    RESULTS: Ninety-seven samples (88.2%) were positive by QIAstat-Dx RP and 86 (78.2%) by RespiFinder assay. The overall agreement on both assays was substantial (kappa value: 0.769) with excellent concordance rate of 96.95%. Using both assays, hRV/EV, INF A/H1N1 and RSV were the most common pathogens detected. Influenza A/H1N1 infection was significantly seen higher in older children (age group > 60 months old) (53.3%, p-value < 0.05). Meanwhile, RSV and hRV/EV infection were seen among below one-year-old children. Co-infections by two to four pathogens were detected in 17 (17.5%) samples by QIAstat-Dx RP and 12 (14%) samples by RespiFinder, mainly involving hRV/EV. Bacterial detection was observed only in 5 (4.5%) and 6 (5.4%) samples by QIAstat-Dx RP and RespiFinder, respectively, with Mycoplasma pneumoniae the most common detected.

    CONCLUSION: The overall performance of the two qPCR assays was comparable and showed excellent agreement. Both detected various clinically important respiratory pathogens in a single test with simultaneous multiple infection detection. The use of qPCR as a routine diagnostic test can improve diagnosis and management.

    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  8. Wang G, Sabran K
    Sci Rep, 2024 Feb 02;14(1):2759.
    PMID: 38308079 DOI: 10.1038/s41598-024-53292-w
    It has been well established that pandemics affect mental health, yet few studies have been conducted in China regarding this issue following COVID-19's gradual decline and the recent H1N1 influenza outbreak. In response to this research gap, this investigation explores the risk factors linked to depression and anxiety symptoms among young adults in this specific setting. Data were collected via an online cross-sectional survey of 385 young adults living in Anyang city, Henan Province, China, between June 15 and July 21, 2023. Respondents were assessed for anxiety and depression symptoms using the GAD-7 and PHQ-9 scales. Additionally, to examine the factors that influenced the study, we utilized an ordered logit regression model. Results revealed depression and anxiety prevalence rates of 33.3% and 21.6%, respectively. Several factors were found to increase the likelihood of depression and anxiety among young adults, including gender, age, education status, marital status, and attitudes towards epidemics. Participants' concerns about pandemics and viruses had a significant negative impact relationship on depression levels. Women report moderate to severe anxiety more frequently than men. An evident correlation can be observed between the educational attainment level and the influence of depression and anxiety.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  9. Samsudin EZ, Yasin SM, Ruslan NH, Abdullah NN, Noor AFA, Hair AFA
    BMC Infect Dis, 2024 Jan 16;24(1):93.
    PMID: 38229063 DOI: 10.1186/s12879-024-08993-y
    BACKGROUND: Recent pandemics have had far-reaching effects on the world's largest economies and amplified the need to estimate the full extent and range of socioeconomic impacts of infectious diseases outbreaks on multi-sectoral industries. This systematic review aims to evaluate the socioeconomic impacts of airborne and droplet-borne infectious diseases outbreaks on industries.

    METHODS: A structured, systematic review was performed according to the PRISMA guidelines. Databases of PubMed, Scopus, Web of Science, IDEAS/REPEC, OSHLINE, HSELINE, and NIOSHTIC-2 were reviewed. Study quality appraisal was performed using the Table of Evidence Levels from Cincinnati Children's Hospital Medical Center, Joanna Briggs Institute tools, Mixed Methods Appraisal Tool, and Center of Evidence Based Management case study critical appraisal checklist. Quantitative analysis was not attempted due to the heterogeneity of included studies. A qualitative synthesis of primary studies examining socioeconomic impact of airborne and droplet-borne infectious diseases outbreaks in any industry was performed and a framework based on empirical findings was conceptualized.

    RESULTS: A total of 55 studies conducted from 1984 to 2021 were included, reporting on 46,813,038 participants working in multiple industries across the globe. The quality of articles were good. On the whole, direct socioeconomic impacts of Coronavirus Disease 2019, influenza, influenza A (H1N1), Severe Acute Respiratory Syndrome, tuberculosis and norovirus outbreaks include increased morbidity, mortality, and health costs. This had then led to indirect impacts including social impacts such as employment crises and reduced workforce size as well as economic impacts such as demand shock, supply chain disruptions, increased supply and production cost, service and business disruptions, and financial and Gross Domestic Product loss, attributable to productivity losses from illnesses as well as national policy responses to contain the diseases.

    CONCLUSIONS: Evidence suggests that airborne and droplet-borne infectious diseases have inflicted severe socioeconomic costs on regional and global industries. Further research is needed to better understand their long-term socioeconomic impacts to support improved industry preparedness and response capacity for outbreaks. Public and private stakeholders at local, national, and international levels must join forces to ensure informed systems and sector-specific cost-sharing strategies for optimal global health and economic security.

    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  10. Oxford J, Berezin EN, Courvalin P, Dwyer DE, Exner M, Jana LA, et al.
    Am J Infect Control, 2014 Apr;42(4):423-5.
    PMID: 24679569 DOI: 10.1016/j.ajic.2013.10.016
    We investigated the survival of a pandemic strain of influenza A H1N1 on a variety of common household surfaces where multiple samples were taken from 4 types of common household fomite at 7 time points. Results showed that influenza A H1N1sw virus particles remained infectious for 48 hours on a wooden surface, for 24 hours on stainless steel and plastic surfaces, and for 8 hours on a cloth surface, although virus recovery from the cloth may have been suboptimal. Our results suggest that pandemic influenza A H1N1 can survive on common household fomites for extended periods of time, and that good hand hygiene and regular disinfection of commonly touched surfaces should be practiced during the influenza season to help reduce transmission.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype/isolation & purification*; Influenza A Virus, H1N1 Subtype/physiology*
  11. Bhowmick S, Chakravarty C, Sellathamby S, Lal SK
    Arch Virol, 2017 Apr;162(4):919-929.
    PMID: 27942972 DOI: 10.1007/s00705-016-3153-8
    The matrix protein 2 (M2) is a spliced product of segment 7 genome of influenza A virus. Previous studies indicate its role in uncoating of the viral ribonucleoprotein complex during viral entry and in membrane scission while budding. Despite its crucial role in the viral life cycle, little is known about its subcellular distribution and dynamics. In this study, we have shown that the M2 protein is translocated from the membrane to the cytoplasm by a retrograde route via endosomes and the Golgi network. It utilizes retromer cargo while moving from the endosome to the trans-Golgi network and prevents endosome fusion with the lysosome. Further, M2 interacts with the endoplasmic-reticulum-resident AAA-ATPase p97 for its release into the cytoplasm. Our study also revealed that the M2 protein in the cellular milieu does not undergo ubiquitin-mediated proteasomal degradation. The migration of M2 through this pathway inside the infected cell suggests possible new roles that the M2 protein may have in the host cytoplasm, apart from its previously described functions.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype/genetics; Influenza A Virus, H1N1 Subtype/metabolism*
  12. Bux S, Mohd Ramli N, Ahmad Sarji S, Kamarulzaman A
    Biomed Imaging Interv J, 2010 Oct-Dec;6(4):e35.
    PMID: 21611071 MyJurnal DOI: 10.2349/biij.6.4.e35
    This is a retrospective descriptive study of the chest imaging findings of 118 patients with confirmed A(H1N1) in a tertiary referral centre. About 42% of the patients had positive initial chest radiographic (CXR) findings. The common findings were bi-basal air-space opacities and perihilar reticular and alveolar infiltrates. In select cases, high-resolution computed tomography (CT) imaging showed ground-glass change with some widespread reticular changes and atelectasis.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  13. Hussain AI, Cordeiro M, Sevilla E, Liu J
    Vaccine, 2010 May 14;28(22):3848-55.
    PMID: 20307595 DOI: 10.1016/j.vaccine.2010.03.005
    Currently MedImmune manufactures cold-adapted (ca) live, attenuated influenza vaccine (LAIV) from specific-pathogen free (SPF) chicken eggs. Difficulties in production scale-up and potential exposure of chicken flocks to avian influenza viruses especially in the event of a pandemic influenza outbreak have prompted evaluation and development of alternative non-egg based influenza vaccine manufacturing technologies. As part of MedImmune's effort to develop the live attenuated influenza vaccine (LAIV) using cell culture production technologies we have investigated the use of high yielding, cloned MDCK cells as a substrate for vaccine production by assessing host range and virus replication of influenza virus produced from both SPF egg and MDCK cell production technologies. In addition to cloned MDCK cells the indicator cell lines used to evaluate the impact of producing LAIV in cells on host range and replication included two human cell lines: human lung carcinoma (A549) cells and human muco-epidermoid bronchiolar carcinoma (NCI H292) cells. The influenza viruses used to infect the indicators cell lines represented both the egg and cell culture manufacturing processes and included virus strains that composed the 2006-2007 influenza seasonal trivalent vaccine (A/New Caledonia/20/99 (H1N1), A/Wisconsin/67/05 (H3N2) and B/Malaysia/2506/04). Results from this study demonstrate remarkable similarity between influenza viruses representing the current commercial egg produced and developmental MDCK cell produced vaccine production platforms. MedImmune's high yielding cloned MDCK cells used for the cell culture based vaccine production were highly permissive to both egg and cell produced ca attenuated influenza viruses. Both the A549 and NCI H292 cells regardless of production system were less permissive to influenza A and B viruses than the MDCK cells. Irrespective of the indicator cell line used the replication properties were similar between egg and the cell produced influenza viruses. Based on these study results we conclude that the MDCK cell produced and egg produced vaccine strains are highly comparable.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype/growth & development*; Influenza A Virus, H1N1 Subtype/immunology; Influenza A Virus, H1N1 Subtype/physiology
  14. Norzailin AB, Norhafizah E
    Med J Malaysia, 2015 Apr;70(2):93-7.
    PMID: 26162384 MyJurnal
    OBJECTIVE: 1.To evaluates and recognizes findings in chest radiograph in patients with laboratory-confirmed S-OIV (H1N1) infection treated at UKMMC. 2. To evaluate whether the findings on initial chest radiographs of influenza A (H1N1) patients can help to predict the prognosis.

    MATERIAL AND METHODS: Total of 109 adult patients presenting to the Universiti Kebangsaan Malaysia Medical Centre (UKMMC) with flu-like symptoms who were positive for influenza A and these patients had underwent chest radiographs (CXR). The initial CXRs were evaluated for the pattern (consolidation, ground-glass, and reticulation), distribution, and extend of abnormality. The disease is classifies by the clinical severity (mild, moderate or severe illness) and adverse outcome (ventilated, death or recovered well).

    RESULTS: The initial CXRs were normal in 56% of cases. The predominant radiographic finding was consolidation, most commonly involving the middle and lower zones (35% of cases). There is no significant association between initial CXR findings with the patient clinical outcome either fully recovered or death/ ventilated.

    CONCLUSION: Normal chest radiographs is the most common radiographic finding in S-OIV (H1N1) infection and the most common abnormal lung finding is consolidation. Initial chest radiographs did not determine the patient clinical outcome and a normal initial radiograph could not exclude adverse outcome.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  15. Ishaqui AA, Khan AH, Syed Sulaiman SA, Alsultan MT, Khan I, Al Nami H
    Pak J Pharm Sci, 2019 May;32(3 (Supplementary)):1225-1233.
    PMID: 31326884
    The aim of the study is to assess and compare the impact of antiviral drug alone and in combination with antibiotic for prevention of Influenza-A H1N1 induced acute kidney injury (AKI) in hospitalized patients. Hospitalized admitted patients with confirmed diagnosis of Influenza-A H1N1 infection were divided into two groups: group 1, which received antiviral (oseltamivir) drug alone and group 2, which received antiviral (oseltamivir) in combination with empirically prescribed antibiotic. Patients of both groups were assessed for incidences of AKI by two criteria i.e Acute Kidney Injury Network (AKIN) and RIFLE. A total of 329 patients (176 for group 1 and 153 for group 2) were enrolled. According to RIFLE criteria, 23(13%) of group 1 and 9(6%) patients of groups 2 were suffered from AKI with statistically significant difference (P<0.05). Also as per AKIN criteria, the incidence of AKI is statistically significantly difference (P<0.05) between both groups with 18(10%) patients and 6(4%) patients of group 1 and 2 respectively. Length of hospitalization was statistically less (P<0.05) in group 2 patients. The incidences of AKI in Influenza-A H1N1 treated with antiviral and antibiotic combination was statistically less as compared to patients who were given antiviral alone for treatment of influenza infection.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  16. Do TD, Gui MM, Ng KY
    PeerJ, 2021;9:e10806.
    PMID: 33604187 DOI: 10.7717/peerj.10806
    This article presents the assessment of time-dependent national-level restrictions and control actions and their effects in fighting the COVID-19 pandemic. By analysing the transmission dynamics during the first wave of COVID-19 in the country, the effectiveness of the various levels of control actions taken to flatten the curve can be better quantified and understood. This in turn can help the relevant authorities to better plan for and control the subsequent waves of the pandemic. To achieve this, a deterministic population model for the pandemic is firstly developed to take into consideration the time-dependent characteristics of the model parameters, especially on the ever-evolving value of the reproduction number, which is one of the critical measures used to describe the transmission dynamics of this pandemic. The reproduction number alongside other key parameters of the model can then be estimated by fitting the model to real-world data using numerical optimisation techniques or by inducing ad-hoc control actions as recorded in the news platforms. In this article, the model is verified using a case study based on the data from the first wave of COVID-19 in the Republic of Kazakhstan. The model is fitted to provide estimates for two settings in simulations; time-invariant and time-varying (with bounded constraints) parameters. Finally, some forecasts are made using four scenarios with time-dependent control measures so as to determine which would reflect on the actual situations better.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype
  17. Muhammad Ismail HI, Teh CM, Lee YL, National Paediatric H1N1 Study Group
    Brain Dev, 2015 Jan;37(1):120-9.
    PMID: 24746706 DOI: 10.1016/j.braindev.2014.03.008
    In 2009, pandemic influenza A H1N1 emerged in Mexico and subsequently spread worldwide. In Malaysia, there were more than a thousand of confirmed cases among children. The general clinical characteristics of these children have been well-published. However, the description of neurologic complications is scarce.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  18. Mazurkova NA, Troshkova, Shishkina LN, Stavskiĭ EA, Drozdov IG
    PMID: 21449080
    AIM: To develop nutrient medium for MDCK and Vero cells based on soy hydrolysate obtained using bromeline and to assess of growth characteristics of influenza virus vaccine strains cultivated on them.

    MATERIALS AND METHODS: Physico-chemical characteristics of hydrolysate were assessed according to FS 42-3874-99. Growth characteristics of nutrient medium based on soy hydrolysate and vaccine strains of influenza virus A/Solomon Islands/03/06 (H1N1), A/Wisconsin/67/2005 (H3N2) and B/Malaysia/2506/2004 were studied on MDCK and Vero cells.

    RESULTS: MDCK and Vero cells grew well on medium based on soy hydrolysate obtained using bromeline with decreased (to 2% and 3% respectively) content of fetal calf serum and allowed effective production of vaccine strains of influenza virus.

    CONCLUSION: Technology for producing of nutrient medium based on hydrolysate of soy flour obtained using bromeline was developed. This medium could successively used for cultivation of continued cell cultures MDCK and Vero used as substrate for tissue culture-based vaccines against influenza.

    Matched MeSH terms: Influenza A Virus, H1N1 Subtype/growth & development*
  19. Zairina AR, Nooriah MS, Yunus AM
    Med J Malaysia, 2011 Aug;66(3):207-13.
    PMID: 22111442 MyJurnal
    A cross-sectional survey was conducted with the objective to explore a community's knowledge and practices towards prevention of Influenza A (H1N1) in three residential areas in Tampin. Respondents were randomly selected from a list of residences and interviewed face-to-face using a structured questionnaire. A total of 221 respondents (80.9%) were involved with the majority (64.7%) comprising female and who had attained secondary level of education (86.0%). The main source of information was from television/radio. The total score for knowledge questions was 15 and practice questions were 25. A total of 60.2% attained "adequate knowledge" and 52.0% "good practice". Mean (SD) for knowledge score was 11.6 (2.3) and practice was 18.1 (4.1). Ethnicity, education, income and practice score were identified as predictors for knowledge score. Income and knowledge scores were predictors for practice score. There was positive correlation between knowledge and practice scores.
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
  20. Lee CK
    Med J Malaysia, 2010 Mar;65(1):1-2.
    PMID: 21265237
    In a short period of two months, the novel influenza A/H1N1 virus has circumnavigated the entire planet leaving behind in its wake approximately 3000 reported deaths worldwide. Fortunately, in many areas around the world, September 2009 brought a lull in the number of new H1N1 infections. This brought welcomed relief in many countries that had earlier experienced high respiratory disease activity in their communities. However, based on previous influenza pandemics, this reprieve may well be short-lived. As the Northern hemisphere approaches its winter months, many experts are now predicting a second wave of influenza A/H1N1 infections. This prediction maybe well placed as all 3 influenza pandemics in the last century reported second or even subsequent waves of new infections, all of which appeared to be more severe than the primary event (ref). The timing of these second waves have varied from 6 months to 3 years and invariably seemed to be linked to the winter months. It is unclear precisely what changes caused the increased severity seen during the second waves; one possibility is the progressive adaptation of the novel influenza virus to its new human host . Molecular analysis, for example, suggests that the 1918 Spanish influenza virus that emerged during the second wave had undergone changes in the hemagglutinin binding site that increased the binding specificity for human receptors. This is thought to have increased the replicative capacity and hence, the pathogenicity of the virus. It is also evident that as the H1N1 2009 pandemic virus continues to spread, opportunities for adaptation that increases virulence will also increase. Nonetheless, the changes needed for such adaptation and for increased virulence are unpredictable and by no means inevitable
    Matched MeSH terms: Influenza A Virus, H1N1 Subtype*
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