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The next pandemic to impact the U.S. will likely be a respiratory-spread RNA virus, making preparation at both the clinical and public health levels crucial, experts argued.

Instead of relying purely on historical context, these lists of potential pandemic should not be "permanent fixed ideas," reported Amesh A. Adalja, MD, project lead and senior scholar at Johns Hopkins Center for Health Security in Baltimore, and colleagues.

In the report entitled "" the authors said that preparedness needs to go beyond traditional thinking and that "some flexibility is required in the approach to combat any future pandemic."

Because the next pandemic could be respiratory-spread -- "contagious during the incubation period or when individuals only show mild symptoms" -- clinicians need to be looking carefully at this particular class of undiagnosed respiratory infections, because that is very likely where the next pandemic will come from, the team wrote.

"Influenza is the most famous, but there are a whole host of other viruses where clinicians probably don't even know their names," Adalja told 乌鸦传媒. "[These viruses] often go undiagnosed, or they go in the 'wastebasket diagnosis' of a viral respiratory infection. They're mild infections, not many people test for them, but when you look at that class of viruses, many meet the criteria for what can cause a pandemic."

Indeed, the World Health Organization (WHO) is already shifting their thinking about pandemic pathogens, by adding to the WHO list of priority diseases.

But communities may have their very own "Disease X" without even knowing it, making surveillance of these unclassified respiratory infections more important. Adalja said that public health organizations do a great job at influenza surveillance, but nobody is currently collecting data on these other similar types of viruses.

"Maybe it takes more time for the clinician [to do these tests], but it's really important for pandemic preparedness -- to understand what diseases are likely to cause this type of infection in patients," he said.

Adalja characterized the findings of the report as "a call to arms on all levels" -- from the WHO to the Centers for Disease Control and Prevention to clinicians to pharmaceutical companies and manufacturers, adding that most of these respiratory-spread infections that could cause a pandemic "don't have any antiviral medications, and none have vaccines."

One of the points argued in the report calls for a higher priority to be given to development of vaccines for respiratory illnesses, including a universal influenza vaccine, which has received increased attention given the severity of this past year's flu season.

Characterizing the current influenza vaccine protection as "suboptimal at best," Adalja said that having a universal influenza vaccine would help to substantially remove the threat of influenza, another respiratory-spread virus, and that for pandemic preparedness, "it's important to take flu off the table."

Additional questions loom about the U.S. preparedness for future pandemics, with the, as part of a "reorganization." As there are no plans to replace him, this means that no senior administration official is now focused solely on global health security, the Washington Post pointed out.

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