 - 1. What percentage of the global population is estimated to be affected by annual influenza epidemics?
A) 15–25%
B) 5–15%
C) 20–30%
D) 1–5%
- 2. On average, how many people died of influenza-related illnesses each year in the United States between 1979 and 2001?
A) 10,000
B) 41,400
C) 55,000
D) 29,000
- 3. Unlike seasonal flu, the H1N1 outbreak was noted for its tendency to affect which group of people?
A) Infants exclusively
B) Younger, healthier people
C) Chronically ill patients only
D) The elderly only
- 4. How many pandemic strains occurred during the 20th century?
A) Four
B) Three
C) Two
D) Five
- 5. Where was the new strain of swine flu first identified in 1998?
A) A laboratory in Mexico
B) A factory farm in North Carolina
C) A farm in Southeast Asia
D) A market in Hong Kong
- 6. What caused the majority of deaths during the 1918 flu pandemic?
A) Organ failure
B) Secondary bacterial pneumonia
C) Dehydration
D) Primary viral pneumonia
- 7. What medical advancement has helped reduce fatalities in subsequent pandemics compared to the 1918 outbreak?
A) Steroid treatments
B) Antiviral drugs
C) Widespread vaccination
D) Antibiotic medicines
- 8. Which subtype caused the 1976 swine flu outbreak and the 1977 Russian flu?
A) H1N1
B) H5N1
C) H3N2
D) SARS-CoV
- 9. What is the primary reason the H5N1 bird flu raised global preparedness levels?
A) Its high fatality rate
B) Its resistance to antibiotics
C) Its airborne transmission
D) Its global prevalence
- 10. Approximately what fraction of the 2009 pandemic strain's genetic segments originated from North American swine flu strains?
A) Three-quarters
B) One-half
C) All of them
D) One-quarter
- 11. According to Daniel Jernigan, antibodies against the new flu were found in blood serum from which demographic?
A) People under 20
B) Newborn infants
C) Older people
D) Children under five
- 12. In the 2012 model study, what percentage of respiratory and cardiovascular deaths occurred in people younger than 65 years?
A) 80%
B) 95%
C) 50%
D) 20%
- 13. The 2013 WHO-supported study estimated 2009 pandemic respiratory deaths to be approximately how many times higher than laboratory-confirmed counts?
A) 10-fold
B) 5-fold
C) 2-fold
D) 20-fold
- 14. Compared to an average pre-pandemic season, what was the trend for mortality in persons under 65 during the 2009 pandemic?
A) A shift toward the elderly
B) No significant change
C) A significant decrease in mortality
D) A marked shift toward higher mortality
- 15. What virus causes COVID-19?
A) SARS-CoV-2
B) Influenza A
C) H1N1
D) H5N1
- 16. What is a recommended method for easing flu symptoms?
A) Taking high doses of aspirin
B) Avoiding all forms of medication
C) Adequate liquid intake and rest
D) Complete bed rest in a dark room
- 17. Why should children under 16 avoid taking aspirin?
A) It causes immediate vomiting
B) It makes the virus multiply faster
C) Risk of developing Reye syndrome
D) It interferes with the effectiveness of antibiotics
- 18. What are two common over-the-counter medications that can help reduce symptoms?
A) Aspirin and salicylate
B) Peramivir and antibiotics
C) Paracetamol and ibuprofen
D) Oseltamivir and zanamivir
- 19. What is the recommended course of action for a mild fever with no complications?
A) Fever medication is not recommended
B) Strong doses of antibiotics
C) Hospitalization for observation
D) Immediate administration of antivirals
- 20. Which antivirals are specifically recommended for at-risk groups?
A) Aspirin or salicylate
B) Peramivir or antibiotics
C) Paracetamol or ibuprofen
D) Oseltamivir or zanamivir
- 21. Who is considered part of the at-risk group for severe swine flu?
A) Pregnant and post partum women
B) Athletes in peak physical condition
C) Healthy adults over 30
D) People with broken bones
- 22. What is the ideal time window to administer antivirals for maximum benefit?
A) Within 12 hours of exposure
B) After 72 hours of sickness
C) Only after hospital admission
D) Within 48 hours of symptom start
- 23. What is the recommended substitute if oseltamivir is unavailable?
A) Aspirin
B) Peramivir
C) Zanamivir
D) Ibuprofen
- 24. When is the experimental drug peramivir used?
A) For children under two years old
B) When other treatments are ineffective or unavailable
C) When the patient has a mild fever
D) As a primary treatment for all patients
- 25. Why did the CDC warn against the indiscriminate use of antivirals?
A) To prevent the emergence of drug-resistant strains
B) To save money on healthcare costs
C) Because they are highly addictive
D) Because they have no effect on viruses
- 26. Which side effect of oseltamivir were children reported to be at increased risk of?
A) Severe allergies
B) Self-injury and confusion
C) Hearing loss
D) High blood pressure
- 27. What percentage of drugs sold by online pharmacies without a physical address did the WHO estimate to be counterfeit?
A) 50%
B) 10%
C) 25%
D) 90%
- 28. What is a known side effect of both oseltamivir and zanamivir?
A) Hair growth
B) Increased energy levels
C) Nausea
D) Improved eyesight
- 29. What did a British report find regarding patient behavior with medication?
A) Patients reported no side effects
B) Patients preferred generic brands over name brands
C) Patients often failed to complete the full course
D) Patients were over-prescribed by doctors
- 30. Did the U.S. CDC recommend face masks in non-health care settings like schools?
A) Only for teachers
B) No
C) Yes
D) Only for students
- 31. In which region is the use of face masks particularly common?
A) Asia
B) South America
C) Europe
D) North America
- 32. How many U.S. students and teachers were confined to their hotel rooms by the Chinese government in May 2009?
A) 240
B) 20
C) 24
D) 47
- 33. What did the US State Department issue as a result of China's anti-flu measures?
A) A trade sanction
B) A declaration of war
C) A travel alert
D) A formal apology
- 34. How many guests were quarantined in a Hong Kong hotel?
A) 2,000
B) 9 million
C) 47
D) 240
- 35. How many passengers were on the cruise ship that Australia ordered to stay at sea?
A) 47
B) 9 million
C) 240
D) 2,000
- 36. Which group of people risked being quarantined upon their return from Mecca?
A) Japanese tourists
B) Russian officials
C) Egyptian Muslims
D) American students
- 37. How long did Japan quarantine 47 airline passengers in mid-May?
A) A month
B) Three days
C) A week
D) Two weeks
- 38. What did India suggest regarding outbound passengers in mid-June?
A) Mandatory vaccinations
B) Pre-screening
C) A complete travel ban
D) Face mask requirements
- 39. What was the original source of the pandemic virus strain?
A) Birds
B) Pigs
C) Rodents
D) Monkeys
- 40. Which organization suggested calling the virus 'North American flu' instead of 'swine flu'?
A) United Nations
B) U.S. National Pork Board
C) CDC
D) World Health Organization
- 41. Which country imposed a ban on animal husbandry products from the Americas on April 27?
A) Indonesia
B) Egypt
C) Norway
D) Azerbaijan
- 42. How many pigs did the Indonesian government initiate an examination for?
A) 47
B) 240
C) 2,000
D) 9 million
- 43. What did the Chinese government announce on 26 April 2009 regarding flu-affected areas?
A) Flights from affected areas were canceled
B) Masks were mandatory for all visitors
C) Visitors with flu-like symptoms would be quarantined
D) Travel from affected areas was banned
- 44. Which airline was mentioned as having taken measures like stepping up cleaning and allowing masks?
A) British Airways
B) United Airlines
C) Delta Air Lines
D) Singapore Airlines
- 45. What did the CDC suggest colleges consider if the virus caused severe illness in the fall of 2009?
A) Suspending classes
B) Mandatory vaccinations for all students
C) Closing all dormitories
D) Testing all students daily
- 46. What action did California school districts take regarding health officials?
A) Launched education campaigns
B) Banned them from campuses
C) Sued them for interference
D) Refused to work with them
- 47. Who suggested that every county should create an 'influenza action team'?
A) The WHO Director
B) A CDC researcher
C) The U.S. President
D) James C. King Jr.
- 48. By 28 October 2009, how many U.S. schools had been temporarily closed?
A) About 100
B) About 2,500
C) About 1,000
D) About 600
- 49. Which symptom is typically described as a 'dry cough' in H1N1 patients?
A) Dizziness
B) Sneezing
C) Cough
D) Runny nose
- 50. According to the CDC, what percentage of U.S. hospitalizations involved people with underlying medical conditions?
A) Less than 20%
B) More than 70%
C) About 30%
D) Exactly 50%
- 51. Which condition is cited as one of the strongest risk factors for H1N1 complications?
A) Obesity
B) Anemia
C) High blood pressure
D) Vitamin deficiency
- 52. What is the second most important cause of secondary bacterial pneumonia for children according to the text?
A) Streptococcus pneumoniae
B) Influenza A
C) H3N2 virus
D) Staphylococcus aureus
- 53. What percentage of all in-hospital deaths in the UK study occurred in previously healthy people?
A) 45%
B) 59%
C) 36%
D) 13%
- 54. What level of C-reactive protein (CRP) was associated with a severe outcome in the UK study?
A) ≥50 mg/L
B) ≥100 mg/L
C) ≤5 mg/L
D) ≤10 mg/L
- 55. How many cases of myocarditis were confirmed in patients infected with A/H1N1 in the report mentioned?
A) Exactly two
B) Zero
C) At least four
D) Ten
- 56. What secondary complication was found in five out of 14 intensive care patients?
A) Kidney infection
B) Liver failure
C) Cardiac arrest
D) Pulmonary emboli
- 57. When did genetic divergence analysis suggest the virus first jumped to humans?
A) 2006
B) 2009
C) 2008
D) 2007
- 58. According to the Mount Sinai School of Medicine, where did the H1N1 virus likely originate?
A) Texas
B) Central Mexico
C) Southern California
D) Asia
- 59. Who was the earliest known human case of the 2009 H1N1 virus?
A) An elderly man
B) A middle-aged woman
C) A 10-year-old girl
D) A 5-year-old boy
- 60. In which town was the first known human case traced?
A) Mexico City
B) Veracruz City
C) La Gloria
D) Cancun
- 61. How is the H1N1 virus typically contracted?
A) Respiratory droplets
B) Consuming pork
C) Contaminated water
D) Mosquito bites
- 62. Who announced the end of the H1N1 pandemic on 10 August 2010?
A) The President of Mexico
B) The Secretary of Health
C) The CDC Director
D) Margaret Chan
- 63. In which month and year did the WHO declare the outbreak a pandemic?
A) August 2010
B) April 2009
C) November 2009
D) June 2009
- 64. What did critics accuse the WHO of doing regarding the pandemic?
A) Exaggerating the danger
B) Ignoring the outbreak
C) Developing the virus
D) Selling illegal vaccines
- 65. How many lab-confirmed deaths were reported to the WHO during the pandemic?
A) 148,000
B) 10,000
C) 18,449
D) 50,000
- 66. Which neurological condition saw a large increase in new cases following the 2009 H1N1 epidemic?
A) Parkinson's disease
B) Narcolepsy
C) Epilepsy
D) Multiple sclerosis
- 67. Which test is recommended for differentiating pandemic H1N1 from regular seasonal flu?
A) Rapid influenza diagnostic test
B) Real-time RT-PCR
C) Direct immunofluorescence assay
D) Indirect immunofluorescence assay
- 68. What is the accuracy level of the new 'CDC Influenza 2009 A (H1N1)pdm Real-Time RT-PCR Panel (IVD)'?
A) 100%
B) 96%
C) 50%
D) 80%
- 69. Who questioned the use of RIDTs, suggesting they may pose a public health risk?
A) Nikki Shindo
B) Paul Schreckenberger
C) The U.S. FDA
D) The World Health Organization
- 70. What percentage of the 2009 pandemic H1N1 strain resulted in death for those infected?
A) 2–3%
B) 0.01–0.03%
C) 10–15%
D) 1–5%
- 71. What percentage of older adults (over 60) had cross-reactive antibody reactions to the new strain in the May 2009 CDC study?
A) 0.3%
B) 50%
C) 33%
D) 6–9%
- 72. Which virologist suggested that the 2009 virus was unlikely to cause severe symptoms for most people?
A) Nancy Cox
B) The WHO director
C) A researcher from Hong Kong
D) Wendy Barclay
- 73. On which database were the genetic sequences of the first isolates shared?
A) CDC Database
B) WHO Public Archive
C) GISAID
D) Nature Genome Bank
- 74. Which of the following animals is mentioned as having been infected with the H1N1 virus?
A) Horse
B) Chicken
C) Cow
D) Cheetah
- 75. Which household pet is specifically mentioned as having been infected with H1N1?
A) Parrots
B) Hamsters
C) Goldfish
D) Cats
- 76. Which organization helped by providing protective items to clinical workers?
A) The National Health Service
B) The United Nations
C) Direct Relief
D) The Red Cross
- 77. By 19 November 2009, in how many countries had doses of the vaccine been administered?
A) Less than 5 countries
B) Over 50 countries
C) Exactly 10 countries
D) Over 16 countries
- 78. What was the estimated overall effectiveness of the H1N1 vaccine according to a 2011 US Flu Vaccine Effectiveness Network study?
A) 62%
B) 80%
C) 56%
D) 43%
- 79. According to the CDC, roughly how many lives were saved in the US by the H1N1 vaccine?
A) 10,000
B) 50
C) 300
D) 1,000
- 80. What was the estimated vaccine effectiveness for people over 65 years old?
A) 20%
B) 43%
C) 56%
D) 62%
- 81. Who was the WHO spokeswoman that announced a review of the organization's actions?
A) Fiona Godlee
B) Fadela Chaib
C) Margaret Chan
D) Keiji Fukuda
- 82. When did the Council of Europe launch an enquiry into the influence of pharmaceutical companies on the H1N1 campaign?
A) March 2010
B) April 2010
C) June 2010
D) January 2010
- 83. Who was the WHO's top influenza expert who expressed concern about communication failures?
A) Margaret Chan
B) Fiona Godlee
C) Wolfgang Wodarg
D) Keiji Fukuda
- 84. How many experts did Margaret Chan appoint to review the WHO's handling of the H1N1 pandemic?
A) 10
B) 5
C) 29
D) 100
- 85. Who published an editorial in the BMJ in June 2010 criticizing the WHO?
A) Keiji Fukuda
B) Margaret Chan
C) Wolfgang Wodarg
D) Fiona Godlee
- 86. What is one objective employers were encouraged to communicate during the pandemic?
A) Reducing employee health benefits
B) Mandating office attendance
C) Increasing daily production quotas
D) Reducing transmission among staff
- 87. According to the CDC, what percentage of the workforce might have been unable to work at the pandemic's peak?
A) 10%
B) 25%
C) 60%
D) 40%
- 88. Besides reducing transmission, what was another objective employers were asked to consider?
A) Lowering employee wages
B) Maintaining business operations
C) Closing all retail locations
D) Hiring temporary staff indefinitely
- 89. What strategy did the CDC advise individuals to prepare for regarding their workplace?
A) Overtime work
B) Hazard pay negotiations
C) Reporting to a different office location
D) Remote work
- 90. How many samples of the 2009 pandemic H1N1 flu showed resistance to oseltamivir by December 2012?
A) 500
B) 314
C) 100
D) 996
- 91. What percentage of seasonal H1N1 flu strains developed resistance to oseltamivir?
A) 85%
B) 10%
C) 50%
D) 99.6%
- 92. In what publication did the Cochrane Collaboration publish their review of antivirals on 8 December 2009?
A) Science
B) The Lancet
C) Nature
D) BMJ
- 93. What term was used to describe the situation in Mexico before the outbreak was officially discovered?
A) False alarm
B) Pandemic
C) Localized infection
D) Silent epidemic
- 94. What happened to Mexico City shortly after the official announcement of the outbreak?
A) It was effectively shut down
B) It requested international military aid
C) It was completely evacuated
D) It remained open with no restrictions
- 95. What action regarding the border was rejected during the 2009 H1N1 outbreak?
A) Mandatory quarantine of all citizens
B) Free medical testing
C) Closing the border
D) Sending medical supplies
- 96. Where did the first confirmed H1N1/09 pandemic flu death in the U.S. occur?
A) San Diego County Hospital
B) Imperial County Medical Center
C) Texas Children's Hospital
D) Mexico City General Hospital
- 97. What is the estimated total number of deaths in the U.S. from the 2009 pandemic according to the Infectious Diseases Society of America?
A) 36,000
B) 12,469
C) 1,812
D) 7,070
- 98. Which of the following is cited as a reason for inaccuracy in reporting early outbreak cases?
A) Lack of internet access
B) Over-testing of healthy populations
C) Selection bias
D) Global cooling trends
- 99. Which influenza virus was the predominant strain during the decade of the 1990s?
A) H3N2
B) H2N2
C) H5N1
D) H1N1
- 100. How did the Children's Hospital of Philadelphia increase emergency department space?
A) Built a new wing
B) Closed the cafeteria
C) Used parking lot tents
D) Used the main lobby as a waiting room
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