An influenza pandemic is a worldwide outbreak or epidemic caused by a strain of influenza virus to which few if any humans have immunity developed by prior exposure. Influenza pandemics occur predictably but at unpredictable intervals; three occurred during the 20th century. The most serious pandemic on record, the “Spanish flu ” of 1918-1919 caused an estimated 20-100 million deaths worldwide and over 500,000 deaths in the United States. Many pandemics are believed to occur when a strain of influenza circulating among birds (avian influenza), acquires the ability to cause serious illness and to spread effectively among people. Beginning in 1997 and continuing through 2005,