Karl G. Nicholson*, John M. Wood, Maria Zambon

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    758 Citations (Scopus)


    Although most influenza infections are self-limited, few other diseases exert such a huge toll of suffering and economic loss. Despite the importance of influenza, there had been, until recently, little advance in its control since amantadine was licensed almost 40 years ago. During the past decade, evidence has accrued on the protection afforded by inactivated vaccines and the safety and efficacy in children of live influenza-virus vaccines. There have been many new developments in vaccine technology. Moreover, work on viral neuraminidase has led to the licensing of potent selective antiviral drugs, and economic decision modelling provides further justification for annual vaccination and a framework for the use of neuraminidase inhibitors. Progress has also been made on developing near-patient testing for influenza that may assist individual diagnosis or the recognition of widespread virus circulation, and so optimise clinical management. Despite these advances, the occurrence of avian H5N1, H9N2, and H7N7 influenza in human beings and the rapid global spread of severe acute respiratory syndrome are reminders of our vulnerability to an emerging pandemic. The contrast between recent cases of H5N1 infection, associated with high mortality, and the typically mild, self-limiting nature of human infections with avian H7N7 and H9N2 influenza shows the gaps in our understanding of molecular correlates of pathogenicity and underlines the need for continuing international research into pandemic influenza. Improvements in animal and human surveillance, new approaches to vaccination, and increasing use of vaccines and antiviral drugs to combat annual influenza outbreaks are essential to reduce the global toll of pandemic and interpandemic influenza.

    Original languageEnglish
    Pages (from-to)1733-1745
    Number of pages13
    JournalThe Lancet
    Issue number9397
    Publication statusPublished - 22 Nov 2003

    Bibliographical note

    Funding Information:
    KGN has received fees or honoraria from Roche Pharmaceuticals, Wyeth, and Berna Biotech for speaking at meetings on influenza; research has been supported by Chiron Vaccines, Aventis Pasteur, Wyeth, and Berna Biotech. Solvay and Berna Biotech have provided H9 avian influenza viruses free of charge for a project on candidate pandemic vaccines. MZ has received honoraria from Berna Biotech to speak at pharmaceutical-industry conferences on influenza and has been supported in attendance at an international WHO workshop on virus neutralisation sponsored by GlaxoSmithKline. The Health Protection Agency has received funding from Chiron Vaccines, Wyeth Vaccines, Aventis Pasteur, Roche, and GlaxoSmithKline, to carry out analytical work on a contractual basis in MZ's laboratory. JMW has no conflicts of interest to declare in relation to this paper. None of these sources of funding had any role in the writing of this seminar.


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