As pandemic influenza H1N1 spread around the world in 2009, disease severity was one of the main areas of interest. The case fatality ratio (CFR) is a representative measurement of severity of a disease that directly captures virulence (ie, the conditional risk of death for patients with a disease or infection), whereas mortality (ie, the risk of death in a population) depends not only on the disease severity but also the risk of infection in a population. Because there have been several conflicting estimates of the CFR for pandemic H1N1,1, 2, 3, 4, 5, 6 I offer an interpretation of these reports and identify key areas that need to be clarified.
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