Cold and flu season

Flu season is upon us and some experts say symptoms this year could be severe based on the strain (H3N2) observed in the Southern Hemisphere.

A number of questions surround the flu, which has seen record numbers in recent years – 80,000 Americans died in the 2017-’18 season – including the most prevalent strain and whether or not to get the flu shot.

Here’s what you need to know about flu season and the vaccine:

When does flu season start?

Flu season may start as early as October in North America, but generally, it begins sometime in the fall and ends in March. The flu virus, however, can be detected at any point throughout the year, which is important to know if you ever have symptoms, even in the summer. Experts can’t really predict the severity of each flu season, as different strains of the virus can have different impacts on timing and length of the season.

Should I get the flu shot? When?

Yes. With few exceptions, the Centers for Disease Control and Prevention recommends everyone 6 months of age and older to get vaccinated every year. It is the first line of defense in treating the flu. Although people who are moderately or severely ill should wait to recover before getting the shot. Only people with severe, life-threatening allergies to the vaccine or any of its ingredients should avoid the shot. According to the CDC, anyone who is between 2 and 50 years old should get either the shot or the nasal spray. The American Academy of Pediatrics, however, said in 2018 that the flu shot is the preferred choice over the nasal spray for children

You can get vaccinated at any time as fall approaches, but October is probably the best time to get it done. The CDC recommends that everyone get vaccinated by the end of October, which gives your body the roughly two-week period it needs to develop an immune response to the vaccine prior to the start of peak flu season. If you miss this deadline, however, the vaccine can still offer some benefit. So it’s important to get it as long as people are still getting sick. For this flu season (2019-2020), all regular-dose flu shots will be quadrivalent, effective against four different strains of flu.

What if I’m pregnant?

It is highly recommended that all pregnant women get the flu shot. The body changes during pregnancy — heart rate and oxygen consumption increase while lung capacity decreases. That means if a mother-to-be gets the flu, they are more susceptible to life-threatening complications than the general population. So all women who are or expect to be pregnant should get the flu vaccine. This is all the more important considering a recent CDC survey showed that only half of pregnant women get the vaccine.

I heard the flu shot makes you sick. Is that true?

No. The flu vaccine contains an inactivated virus, which means that the virus contained in the vaccine can’t actually infect you. It does take one to two weeks for your immune system to protect you from the flu. So, if someone becomes sick after their shot, it is most likely because their body wasn’t protected from the flu yet, not from the vaccine itself.

Similarly, there are sometimes mismatches between the virus strain someone gets sick with and the strains used to make the vaccine. In these cases, the vaccine might be imperfect at fighting all strains of the flu that might exist, but it’s still the best defense we have.

How do I know if I have the flu?

Flu symptoms often come suddenly, and can vary significantly depending on the person. These include fever, cough, sore throat, nasal congestion, body aches, headaches, and fatigue. While the flu may seem similar to a common cold, colds are usually slower to develop, and less likely to result in fevers.

Some patients with severe infections may have symptoms — like difficulty breathing and confusion — that are cause for concern and might require immediate medical attention to treat them. Medical attention should also be sought for children with the flu who develop bluish skin, aren’t waking up or aren’t eating. In all cases, if the person’s symptoms suddenly worsen after appearing to initially improve, a visit to a clinician is warranted.

I think I have the flu. What do I do next?

In most cases, if symptoms are mild, staying home and leaving only to get medical care is the best course of action. If you must leave the house, wear a face mask, wash your hands, and cover coughs and sneezes with your elbow.

People with severe symptoms, as well as people at high risk from the flu (young children, people 65 and older and pregnant women), should contact their doctors if they develop symptoms. In some cases, people may get antiviral medications, which can lessen symptoms, shorten the time of illness and reduce complications.

How is the shot made?

Manufacturers have many methods of producing flu vaccines. The most common method is the egg-based vaccine, where strains of the virus are injected into eggs and incubated for several days. They are then weakened or killed and afterward purified to be used in a shot or nasal spray.

The next method is through cell-based technology. In these vaccines, the eggs used to incubate the virus are replaced with animal cells. This method is faster in producing vaccines than the older egg-based method.

Another method uses recombinant technology. In these cases, a certain gene is taken from the flu virus, to be inserted into a different non-flu virus which grows in insect cells. This genetically altered non-flu virus then replicates in insect cells. After the virus has been replicated, manufacturers purify the protein produced from the flu gene, which is used in the vaccine. The advantage of this method is that it doesn’t use eggs, so people with severe egg allergies can be vaccinated.

For all these methods, the FDA must test and approve the vaccines prior to their release to the public.

What are the side effects of the flu shot?

Most side effects are mild and resolve quickly on their own. Soreness in the area of the shot is pretty common. In addition, people may have headaches, fevers and nausea. Seek immediate symptoms if someone is showing signs of a severe allergic reaction, such as difficulty breathing, hoarseness or eye and lip swelling.

Where should I get the flu shot?

Grocery stores, pharmacies, doctor’s offices, and hospitals are all offering flu shots. Experts say it doesn’t matter where you get it, as long as you get it.

Flu season is about to start. Preventing its spread requires good hygiene and high vaccination rates. If you are experiencing any symptoms, avoid contact with other people. If symptoms are starting to get severe, contact your doctor. Working together will be critical in halting flu season.

Dr. Jonathan Steinman is a physician in radiology and writer with the ABC News Medical Unit.



Most viral respiratory infections, like the common cold, usually come and go within a few days, with no lasting effects. But influenza (flu) is a disease that can cause serious health problems and can result in hospitalization or death.

You can fight back by adopting healthy habits and by using medicines and vaccines approved by the U.S. Food and Drug Administration to combat and help prevent the flu.
If you are generally healthy, here’s how to tell if you have a cold or the flu, and when to seek medical care.

Symptoms of Colds and Flu

Flu and cold viruses spread mainly by droplets, when infected people cough, sneeze, or talk. You also can get infected by touching a surface or object that has flu viruses on it, such as a door handle, and then touching your eyes, nose, or mouth. Flu season in the United States may begin as early as October and can last as late as May, and generally peaks between December and February.

Colds: Symptoms of colds usually are a stuffy or runny nose and sneezing. Other symptoms include coughing, a scratchy throat, and watery eyes. There is no vaccine to prevent colds, which come on gradually and often spread through everyday contact.

Flu: Symptoms of the flu come on suddenly and can include fever, headache, chills, dry cough, sore throat, body or muscle aches, tiredness, and feeling generally miserable. Like the viruses that cause a cold, flu viruses can cause a stuffy or runny nose, sneezing, and watery eyes. Young children also may experience nausea and vomiting.

Check with your health care provider promptly if you are at high risk for flu-related complications and you have flu symptoms — or if you have flu symptoms that do not improve. People at high risk include:

  • Children younger than 5 years, but especially those younger than age 2
  • Pregnant women
  • People with certain chronic health conditions (such as asthma, diabetes, or heart or lung disease)
  • People age 65 or older

Rapid Flu Tests Are Available

Some health care providers can give you an FDA-cleared rapid flu test. There are 17 rapid flu tests (11 antigen-based and six molecular-based) on the market with updated performance criteria that the FDA created to provide reasonable assurance that the test is accurate, reliable, and clinically valid.

According to the Centers for Disease Control and Prevention’s flu testing guidelines, you don’t need testing — or to await test results — before your health care provider can prescribe antiviral medication. Your health care provider will decide what to prescribe based on the signs and symptoms you have.

What to Do if You’re Already Sick

Colds usually run their course. When you’re sick, limit exposing yourself to other people. Cover your mouth and nose when you cough or sneeze. Also, stay hydrated and rested. Avoid alcohol and caffeinated products.

There are FDA-approved prescription medications — called antivirals — for treating flu. Also, a cold or flu may lead to a bacterial infection (such as bronchitis, sinusitis, ear infections, and pneumonia) that could require antibiotics.

Most people with the flu who aren’t at high risk have mild illness and do not need medical care or antiviral drugs. Still, your symptoms may last up to two weeks.

How to Safely Take Nonprescription Medicines for Cold or Flu Symptoms

Read medicine labels carefully and follow the directions. People with certain health conditions, such as high blood pressure or diabetes, should check with a doctor or pharmacist before taking a new cough or cold medicine.

Choose the right over-the-counter (OTC, or non-prescription) medicines for your symptoms.

  • Nasal decongestants help unclog a stuffy nose.
  • Cough suppressants help relieve coughs.
  • Expectorants help loosen mucus.
  • Antihistamines help stop a runny nose and sneezing.
  • Pain relievers can help ease fever, headaches, and minor aches.

Check the medicine’s side effects. Medications can cause drowsiness and interact with food, alcohol, dietary supplements, and other medicines. Tell your doctor and pharmacist about every medical product and supplement you are taking.

Check with a health care professional before giving medicine to children.

How to Avoid Getting Sick

Get vaccinated against the flu. The best way to prevent the flu is by getting vaccinated every year. The vaccine changes each year and contains flu virus strains that are expected to be prevalent during the upcoming flu season. The protection from the previous year’s vaccine will diminish over time and may be too low to protect you into the next year, even if the flu virus strains circulating the next year are the same as those contained in the previous year’s vaccine.

With rare exceptions, the CDC recommends that everyone ages 6 months and older should be vaccinated against flu. The flu vaccine provides protection from the flu and its potential complications, which can result in hospitalization and sometimes death.

Annual vaccination is especially important for people at high risk for developing serious complications from flu: health care workers, and anyone who lives with or cares for people at high risk for serious flu-related complications.

Although children younger than 6 months are too young to be vaccinated, they have the highest risk for being hospitalized because of flu and flu-related complications compared to children of other ages. Therefore, the CDC recommends that parents, grandparents, caregivers, and all household members 6 months or older should be vaccinated because they will be less likely to get the flu and spread it to the unvaccinated child. If possible, keep infants away from crowds for the first few months of life.

Wash your hands often. Teach children to do the same. Both colds and flu can be passed through contaminated surfaces, including the hands. Wash hands with warm water and soap for at least 20 seconds. Try not to touch your eyes, nose, or mouth. Clean and disinfect frequently touched surfaces, especially when someone is ill.

Limit exposure to infected people. Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it

The 2019-2020 Flu Season: Everything You Need to Know

  • RELATED: Flu Symptoms in Children

If I suspect it, should I take my child for a flu test?

Seeing a doctor is a must for kids under age 5 and for those who are at a high risk of breathing or heart complications. But any child who feels poorly should go to the doctor, says Dr. Milstone. If last year’s flu season taught us anything, it’s that a well child can take a turn for the worse very quickly. He urges parents to go to their regular doctor rather than to urgent care.

“As a doctor, you can often just look at a patient you know well and see that he’s in bad shape and needs close observation or to be hospitalized. Walk-in clinics frequently have rotating staff that may not work often with children and have never seen your child, and the same person won’t be able to see you the next day,” he says.

Flu testing, on the other hand, is not always a must. The rapid flu test—a somewhat uncomfortable Q-tip swab that goes deep into your child’s nostril—can produce false negatives, and the results usually do not change how a child is treated. Doctors always err on the side of caution and diagnose, monitor, and treat children for flu based on their symptoms, not the test, says Dr. Campbell.

  • RELATED: Flu Symptoms in Babies and When to Call the Doctor

What are the signs that my child needs to go straight to the hospital?

If he seems to have trouble breathing, has bluish skin, is not drinking enough, is not interacting, or is so irritable that he doesn’t want to be held, you should head to the E.R. or call 911. If your child’s fever goes away and then suddenly spikes again, it could be a sign of a bacterial infection that requires emergency care, says Dr. Campbell.

You should also seek medical attention if your child experiences these symptoms: ribs pulling in with each breath, chest pain, severe muscle pain, signs of dehydration (not urinating for eight hours, dry mouth, no tears), fever about 104 degrees F, severe weakness, persistent dizziness or confusion, seizures, or escalating chronic medical conditions.

More than one third of children who die from the flu lose their lives before getting admitted to the hospital, according to the CDC. When in doubt, go.

  • RELATED: Baby 911: When to Call the Doctor or Go to the ER

Should my child take Tamiflu?

This antiviral flu medication blocks certain proteins that spread viral particles from cell to cell and shortens the illness by about a day. Although the CDC recommends it for children at high risk for flu complications, the upside is less clear for healthy kids. One in 20 children experience vomiting after taking Tamiflu, and for many kids, another day on the couch is preferable to a day spent hovering over the toilet. The decision is ultimately up to you and your pediatrician.

  • RELATED: All-Natural Cold & Cough Remedies

What else will make my child feel better?

Rest and time are most important, but the following symptom soothers can help too.

  • OTC pain relievers: Don’t hesitate to use acetaminophen or ibuprofen to help with fever or muscle aches—it will make your child more comfortable, and when taken as directed, there are no downsides, explains Dr. Swanson.
  • Honey: Studies suggest that a dose of honey before bed may improve nighttime cough and sleep quality, and may help antiviral medications fight the flu better. (Just remember: Honey should be given only to children over 12 months of age, as it can cause botulism in infants.)
  • Gatorade: Let kids pick their color—it will help entice them to drink. You can also consider waking them in the middle of the night to take sips to avoid dehydration.
  • Ice pops: To soothe throats that are sore from coughing, make your own pops with water and pureed fruit, or buy Pedialyte freezer pops, which contain electrolytes that may be lost due to vomiting, diarrhea, or excessive sweating, suggests Katie Lockwood, M.D., a pediatrician at Children’s Hospital of Philadelphia.
  • Ginger lollipops: Just the sight of candy makes most kids feel a little brighter. Even better, ginger is known to help with nausea and is an easy thing to try when upset tummies are troubling kids.
  • By Kelley King Heyworth and Stephanie Wood

Parents Magazine

As for the crowding argument, Dr. McCullers said, “That never made sense.” People work all year round and crowd into buses and subways and planes no matter what the season.

“We needed some actual data,” Dr. McCullers added.

But getting data was surprisingly difficult, Dr. Palese said.

The ideal study would expose people to the virus under different conditions and ask how likely they were to become infected. Such a study, Dr. Palese said, would not be permitted because there would be no benefit to the individuals.

There were no suitable test animals. Mice can be infected with the influenza virus but do not transmit it. Ferrets can be infected and transmit the virus, but they are somewhat large, they bite and they are expensive, so researchers would rather not work with them.

To his surprise, Dr. Palese stumbled upon a solution that appeared to be a good second best.

Reading a paper published in 1919 in the Journal of the American Medical Association on the flu epidemic at Camp Cody in New Mexico, he came upon a key passage: “It is interesting to note that very soon after the epidemic of influenza reached this camp, our laboratory guinea pigs began to die.” At first, the study’s authors wrote, they thought the animals had died from food poisoning. But, they continued, “a necropsy on a dead pig revealed unmistakable signs of pneumonia.”

Dr. Palese bought some guinea pigs and exposed them to the flu virus. Just as the paper suggested, they got the flu and spread it among themselves. So Dr. Palese and his colleagues began their experiments.

By varying air temperature and humidity in the guinea pigs’ quarters, they discovered that transmission was excellent at 41 degrees. It declined as the temperature rose until, by 86 degrees, the virus was not transmitted at all.

The Flu Season

While seasonal influenza (flu) viruses are detected year-round in the United States, flu viruses are most common during the fall and winter. The exact timing and duration of flu seasons can vary, but influenza activity often begins to increase in October. Most of the time flu activity peaks between December and February, although activity can last as late as May.

The figure below shows peak flu activity in the United States by month for the 1982-1983 through 2017-2018 flu seasons. The “peak month of flu activity” is the month with the highest percentage of respiratory specimens testing positive for influenza virus infection during that influenza season. During this 36-year period, flu activity most often peaked in February (15 seasons), followed by December (7 seasons), January (6 seasons) and March (6 seasons).

Peak Month of Flu Activity
1982-1983 through 2017-2018

When is the flu season in the United States?

In the United States, flu season occurs in the fall and winter. While influenza viruses circulate year-round, most of the time flu activity peaks between December and February, but activity can last as late as May. The overall health impact (e.g., infections, hospitalizations, and deaths) of a flu season varies from season to season. CDC collects, compiles, and analyzes information on influenza activity year-round in the United States and produces FluView, a weekly surveillance report, and FluView Interactive, which allows for more in-depth exploration of influenza surveillance data. The Weekly U.S. Influenza Summary Update is updated each week from October through May.

How does CDC monitor the progress of the flu season?

The overall health impact (e.g., infections, hospitalizations, and deaths) of a flu season varies from season to season. CDC collects, compiles, and analyzes information on influenza activity year-round in the United States and produces FluView, a weekly surveillance report, and FluView Interactive, which allows for more in-depth exploration of influenza surveillance data. The Weekly U.S. Influenza Summary Update is updated each week from October through May. The U.S. influenza surveillance system is a collaborative effort between CDC and its many partners in state and local health departments, public health and clinical laboratories, vital statistics offices, health care providers, and clinics and emergency departments. Information in five categories is collected from eight different data sources that allow CDC to:

  • Find out when and where influenza activity is occurring
  • Track influenza-related illness
  • Determine what influenza viruses are circulating
  • Detect changes in influenza viruses
  • Measure the impact influenza is having on hospitalizations and deaths in the United States

These surveillance components allow CDC to determine when and where influenza activity is occurring, determine what types of influenza viruses are circulating, detect changes in the influenza viruses collected and analyzed, track patterns of influenza-related illness, and measure the impact of influenza in the United States. All influenza activity reporting by states, laboratories, and health care providers is voluntary. For more information about CDC’s influenza surveillance activities, see the Overview of Influenza Surveillance in the United States.

Why is there a week-long lag between the data and when it’s reported?

Influenza surveillance data collection is based on a reporting week that starts on Sunday and ends on the following Saturday of each week. Each surveillance participant is requested to summarize the weekly data and submit it to CDC by the following Tuesday afternoon. The data are then downloaded, compiled, and analyzed at CDC. The data are used to update FluView and FluView Interactive on the following Friday.

Do other respiratory viruses circulate during the flu season?

In addition to flu viruses, several other respiratory viruses also circulate during the flu season and can cause symptoms and illness similar to those seen with flu infection. These respiratory viruses include rhinovirus (one cause of the “common cold”) and respiratory syncytial virus (RSV), which is the most common cause of severe respiratory illness in young children as well as a leading cause of death from respiratory illness in those aged 65 years and older.

Why flu season spikes in the fall and winter

  • For the past 35 years, flu activity in the US has peaked in February.
  • But the flu season typically lasts from October through February in the US and the rest of the Northern Hemisphere.
  • The flu virus has a protective gel-like coating that protects it in cold weather and makes it easier to spread from person to person.
  • This article was reviewed by Tania Elliott, MD, who specializes in infectious diseases related to allergies and immunology for internal medicine at NYU Langone Health.
  • Visit Insider’s homepage for more stories.

For the past 35 years, flu activity in the US has peaked in February, according to the Centers for Disease Control and Prevention, so the shortest month of the year might not feel that way for the many infected.

But February isn’t the only month you can contract the flu. In fact, it’s always flu season somewhere in the world.

In the Northern Hemisphere, including the US, “flu season typically picks up around October, and it can usually peak between December and February,” says Amanda Simanek, associate professor of epidemiology at the University of Wisconsin-Milwaukee’s Joseph J. Zilber School of Public Health.

“But we can see cases as late as into April and May,” she adds.

In the Southern Hemisphere, it’s the opposite. Flu season typically runs from April to September and often peaks during August, although it varies by region. These are the winter months for the Southern Hemisphere, which brings us to a common theme: Influenza and winter go together like hot chocolate and marshmallows.

Why flu season is in the fall and winter

The flu tends to spike in the fall and winter for a major reason: the temperature.

“The virus survives better in cool, dry temperatures,” Simanek said. And that’s thanks to a protective gel-like coating that surrounds the flu virus while it’s in the air.

The flu is an airborne infectious disease. So in order to spread, the virus needs to survive long enough in the air to travel from one person to the next. And that’s where the virus’s gel-like coating helps when it’s cold outside.

In colder temperatures, that capsule, which is made of fats and oils called lipids, hardens into a shell around the virus. This protects the virus and keeps it alive long enough to spread between victims.

For comparison, this isn’t as easy to do when it’s warm outside because the lipid coating degrades, exposing the virus to the environment where it can easily get destroyed before finding a host.

Once the virus is inside you, your body temperature degrades the coating, releasing the virus. After that, the virus starts to wreak havoc and replicate in hopes of infecting you and the next bystander.

It doesn’t help that people tend to congregate inside in close quarters when it’s cold and dreary outside, making it that much easier to spread those tiny respiratory droplets containing the virus.

So if the flu virus spreads most in colder temperatures, does that mean warming global temperatures could lead to a milder flu season in the future? Experts aren’t yet entirely sure.

But some research suggests that mild winters with mild flu seasons can cause a rebound effect, where the next year’s flu season is more severe. That’s because with fewer infections during the previous year, more people are susceptible the following year.

That’s what seems to have happened after the 2011-12 flu season. The 2011-12 flu season was relatively mild. But the following year, the 2012-13 flu season was “moderately severe,” according to the CDC.

“It’s possible that climate change that causes swings in temperature from season to season could have an impact on the severity of influenza transmission,” Simanek says.

Yes, you can get the flu when it’s not flu season

Once the weather warms up and the spring flowers start to bloom, flu activity tends to drop off. But that doesn’t mean you can’t still get the flu.

“When you come into contact with a flu virus or respiratory virus to which you are susceptible, you can certainly catch that, no matter what season it is,” says Lisa Maragakis, MD, senior director of infection prevention for the Johns Hopkins Health System.

Plus, when it’s summer in North America, it’s winter in the Southern Hemisphere. So, for example, if you travel to Australia during their winter, you could be exposed to the flu there.

Related stories about the flu:

  • How to prevent the flu, according to doctors
  • When the flu is most contagious
  • How long the flu should last and when you should see a doctor
  • The flu vaccine is not 100% effective but you should still get it every year

A DEADLY outbreak of a flu-like illness could kill 80 million people across the world in less than two days, experts have warned.

The world is not prepared for the “very real threat” of a pandemic, according to a panel led by the ex-chief of the World Health Organisation.

4 This graphic from a new report shows global examples of emerging and re-emerging diseases

In a stark report, 15 public health leaders criticised a “cycle of panic and neglect” which they say has characterised responses to health emergencies.

Scientists have previously warned about the possibility of an unknown deadly plague dubbed Disease X that could wipe out millions.

The Global Preparedness Monitoring Board (GPMB) today said the world is now at an “acute risk” of pandemics.

“The threat of a pandemic spreading around the globe is a real one,” the group said in a report released on Wednesday.

“A quick-moving pathogen has the potential to kill tens of millions of people, disrupt economies and destabilise national security.”

The report highlights the danger of a lethal respiratory pathogen, which could kill between 50 and 80 million people.

As the world has become more interconnected, such a pathogen could spread around the globe within 36 to 50 hours, the report says.

Newly emerging diseases by continent


  • Cryptosporidiosis – an intestinal disease caused by microscopic parasites
  • E.coli O104:H4 – a strain of bacteria that caused outbreak in Germany in 2011
  • Variant Creutzfeldt–Jakob disease (vCJD) – brain disease caused by eating infected beef

North America

  • Enterovirus D68 – group of viruses that can cause polio and hand, food and mouth disease
  • Heartland virus – viral disease spread by infected tick bites
  • Hantavirus pulmonary syndrome – severe and sometimes fatal respiratory disease caused by infected rodents
  • Cryptosporidiosis
  • H3N2v influenza – strain of flu that started in pigs
  • Cyclosporiasis – intestinal illness caused by microscopic parasites
  • E. coli O157:H7 – form of the bacteria
  • 2009 H1N1 influenza – swine flu
  • Bourbon virus – understood to be spread through tick or insect bite

South America

  • Hantavirus pulmonary syndrome


  • Human monkeypox – similar to smallpox transmitted from rodents or primates
  • Ebola virus
  • Zika virus
  • HIV
  • Hepatitis C


  • Akhmeta virus (AKMV) – a form of pox virus
  • Middle East respiratory syndrome coronavirus (MERS-CoV) – viral respiratory disease, sometimes known as camel flu
  • Severe Fever with Thrombocytopenia Syndrome Bunyavirus (SFTSV) – a type of haemorrhagic fever
  • E. coli O157:H7 – strain of bacteria
  • H5N6 influenza – strain of bird flu
  • H10N8 influenza – strain of bird flu
  • H7N9 influenza – strain of bird flu
  • H5N1 influenza – strain of bird flu
  • Severe acute respiratory syndrome (SARS) – outbreaks in 2002 and 2004
  • Nipah virus – transmitted from animals, contaminated food or directly between infected people


  • Hendra virus – virus that infects large fruit bats that can be passed to horses and people


The unknown killer virus could wipe out nearly 5% of the global economy and lead to social chaos.

Epidemic-prone viral diseases like Ebola, flu and SARS are increasingly tough to manage in a world dominated by lengthy conflicts and forced migration, the report states.

While some governments and agencies have made efforts to prepare for disease outbreaks since the devastating 2014-2016 Ebola outbreak in West Africa that left over 10,o00 dead, those efforts are “grossly insufficient”, the report said.

In the case of a pandemic, many national health systems – particularly in poor countries – would collapse.

“Poverty and fragility exacerbate outbreaks of infectious disease and help create the conditions for pandemics to take hold,” said Axel van Trotsenburg, acting chief executive of the World Bank and a member of the panel.

Tedros Adhanom Ghebreyesus, director-general of the WHO, said governments should invest in strengthening health systems.

He suggested boosting funds for research into new technologies, improving coordination and rapid communication systems, and monitor progress continually.

Re-emerging/re-surging diseases by continent


  • Marburg virus – hemorrhagic fever similar to Ebola
  • Ebola virus – viral infection first detected close to the River Ebola

North America

  • Powassan virus – brain infection transmitted by ticks
  • West Nile virus – disease spread through mosquitoes
  • Measles
  • Human monkey-pox – similar to smallpox transmitted from rodents or primates
  • Listeriosis – bacterial infection that can cause sepsis, brain infection and death
  • Adenovirus 14 – acute respiratory illness dubbed the killer cold virus
  • Lyme disease – bacterial infection spread by ticks
  • MDR/XDR tuberculosis – drug-resistant tuberculosis
  • Chikungunya – virus is spread by infected mosquito bite
  • Acute flaccid myelitis – polio-like condition that affects the nervous system
  • Dengue fever – mosquito-borne tropical disease
  • Cholera – infection that causes severe diarrhoea caused by drinking contaminated water
  • Antimicrobial resistant threats:
    • CRE
    • MRSA
    • C. difficile
    • N. gonorrhoeae

South America

  • Zika virus
  • Cholera
  • Drug-resistant malaria
  • Yellow fever – viral haemorrhagic disease transmitted by infected mosquitoes


  • Diphtheria – highly contagious infection that can affect the nose, throat and skin
  • Typhoid fever – bacterial infection that can spread throughout the body, affecting many organs
  • MDR/XDR tuberculosis
  • Nipah virus
  • Cholera
  • Enterovirus 71
  • Drug-resistant malaria


  • Yellow fever
  • Ebola virus
  • Lassa fever – viral haemorrhagic illness transmitted from contact with bodily fluids of infected person
  • MDR/XDR tuberculosis
  • Chloera
  • Rift Valley fever – viral disease spread through contact with infected animals
  • Drug-resistant malaria
  • Plague – caused by bacteria usually found in small mammals and their fleas
  • Human African trypanosomiasis – insect-borne parasitic disease, also known as sleeping sickness
  • Marburg virus


The WHO also warned earlier this year that another pandemic of flu – which is caused by airborne viruses – is inevitable, and said the world should prepare for it.

The latest report cited the 1918 “Spanish flu” pandemic, which killed an estimated 50 million people.

Studies have shown most of the fatalities were among those under the age of 65.

The virus is thought to have used the body’s own immune system to work against it.




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This caused fatal “cytokine storms” in victims – an overproduction of immune cells that can overwhelm the body.

The stronger the immune system, the more devastating the effects of the Spanish Flu on an infected person.

If Disease X spawns from an influenza strain it could have a similarly devastating effect on younger populations.

4 An outbreak of a flu-like illness could kill 80 million people across the world in less than two days, experts have warnedCredit: Getty – Contributor 4 Some governments have made efforts to prepare for disease outbreaks since the devastating 2014-2016 Ebola outbreak in West AfricaCredit: Reuters 4 As many as 50 million people died worldwide as a result of the devastating Spanish Flu outbreak in 1918Credit: Credit: Everett Collection Historical / Alamy Stock Photo UK Professor Tony Moore explains why killer fungal infection caused by germ Candida auris could potentially become a world-wide pandemic

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