A rather disturbing NEJM case report to kick us off for 2025 – a previously healthy 13 year old girl with severe respiratory infection due to influenza A (H5N1) bird flu in Canada. The girl came through ECMO and survived. But it’s a salutary lesson of what influenza – and especially H5N1 influenza – can do! There’s a lot of flu around at the moment (of various types), so please get your flu vaccine if you haven’t done so already – it’s good for you and those around you if you do.

We’ve been ‘promised’ an H5N1 pandemic for many years now, and it does rather feel like it’s a matter of time. There’s a sense that H5N1 is building in animal populations – as illustrated by trends in wastewater surveillance. Whilst we don’t fully know exactly what it takes for a ‘bird flu’ to adapt itself to become an efficient transmitter in human populations, perhaps the most worrying feature of this care report was the detection of several mutations in the genome of the infecting virus that have been linked to more efficient spread in humans.

So, what can we do to improve our preparedness for an influenza pandemic? Learning the pertinent lessons from COVD-19, ensuring that it won’t come as a surprise, and continuing to invest in effective surveillance systems are all part of this. On a personal note, we can all help by getting the flu vaccine (if you haven’t done so already). Whilst it’s effectiveness varies by type of influenza (and it’s not going to protect you from bird flu), it’s definitely worth the effort!