Shanta M. Zimmer, M.D., and Donald S. Burke, M.D.Volume 361:279-285 July 16, 2009 Number 3
On April 17, 2009, officials at the Centers for Disease Control and Prevention (CDC) confirmed two cases of swine influenza in children living in neighboring counties in California.1
Here we take a perspective from systems biology to review the series of evolutionary and epidemiologic events, starting in 1918, that led to the emergence of the current swine-origin influenza A (H1N1) strain (S-OIV), which is widely known as swine flu. This article is one of two historical articles on influenza A (H1N1) viruses in this issue of the Journal.2 Our review focuses on the key steps that characterize this viral evolution (Figure 1).
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