VI pdf quiz Part 2
Poxvirus and Hepatitis Quiz
Test your knowledge on poxviruses and hepatitis with our comprehensive quiz! This quiz features a variety of questions designed to challenge your understanding of these viral infections, their transmission, and their management.
Topics covered include:
- Monkeypox and Vaccinia Virus
- Hepatitis A, B, C, D, and E
- Diagnosis and Treatment Procedures
- Vaccination Strategies
A 7-year-old boy has pox-like lesions on his left hand and arm. He has a pet rodent imported from West Africa. Monkeypox is diagnosed in the boy and the rodent. Which of the following statements about monkeypox virus is most correct?
Clinical disease resembles smallpox
Human infections are never fatal
Smallpox vaccination is not protective
Infections are readily transmitted among family members
Virus particles can be distinguished from smallpox virus by electron microscopy
Which of the following best describes the currently licensed smallpox vaccines?
Live attenuated smallpox virus
Inactivated smallpox virus
Live vaccinia virus
Inactivated vaccinia virus
Reassortant vaccine containing both vaccinia and smallpox viruses
Which of the following does not apply to vaccinia virus replication in cultured cells?
Viral replication cycle takes place in the cytoplasm of infected cells.
The uncoating step leading to release of the viral genome requires a newly synthesized viral protein.
Early transcription of more than 50 viral genes occurs within viral cores and precedes viral DNA replication.
Newly formed virus particles mature by budding through the nuclear membrane.
A patient presents with skin lesions similar in appearance to molluscum contagiosum. How is diagnosis of this condition typically made?
Viral culture
Rapid antigen test
PCR for viral DNA
Clinical appearance
Inoculation of chorioallantoic membrane of chick embryos
Which of the following does not fulfill the criteria for exposure to vaccinia?
Smallpox vaccination
Close contact with a recent smallpox vaccine
Intrauterine exposure
Injection of vaccinia immune globulin
A researcher wishes to obtain a full-length genome of variola virus for vaccine studies. Which of the following is the appropriate source of the viral DNA?
Distribution of a full-length viral genome is prohibited
A colleague with a variola virus clone
The American Type Culture Collection
A World Health Organization collaborating center
The Centers for Disease Control and Prevention
A patient presents to the emergency room with vesicular lesions on both hands potentially resembling smallpox. A public health investigation is begun to rule out smallpox. The patient is an immigrant working as a shepherd in several states. What is the most likely cause of his skin lesions?
Vaccinia virus
Variola virus
Monkeypox virus
Tanapox virus
Orf virus
An emergency services worker is considering smallpox vaccination because of the potential for bioterrorism. Which one of the following conditions is not a contraindication for the use of vaccinia (smallpox) vaccine under routine nonemergency conditions?
Pregnancy
Previous smallpox vaccination
Household contact with a person with eczema
Severe allergy to a component of the vaccine
Immunosuppression
Which of the following poxviruses infects only humans?
Monkeypox
Tanapox
Cowpox
Yaba tumor virus
Molluscum contagiosum
Vaccinia virus has all of the following attributes except
Can cause severe localized or disseminated disease.
Is a live, attenuated smallpox virus.
Can induce immunity that lasts only a few years.
Has been in use for more than 200 years.
Gene sequences coding for other viral proteins can be inserted into its genome.
The eradication of smallpox was facilitated by several features of the virus. Which one of the following contributed least to eradication?
It has one antigenic type
Inapparent infection is rare.
Administration of live vaccine reliably induces immunity
It multiplies in the cytoplasm of infected cells.
Vaccination with the vaccinia (smallpox) vaccine protects against infections by the following poxviruses except
Variola
Cowpox
Molluscum contagiosum
Monkeypox
A 24-year-old woman in New York City is admitted to the hospital because of jaundice. On workup, she is found to have HCV infection. The major risk factor for HCV infection in the United States is
Tattoos
Blood transfusion
Injecting drug use
Sexual activity
Working in health care occupations
Which of the following exposures poses a risk for hepatitis infection?
A nurse sustains a needlestick while drawing up insulin to administer to an HBV-infected patient with diabetes.
While cleaning the bathroom, a housekeeper’s intact skin has contact with feces
An operating room technician with chapped and abraded hands notices blood under his gloves after assisting in an operation on a patient with HCV infection.
A child drinks out of the same cup as her mother, who has an HAV infection
A shopper eats a sandwich prepared by a worker with an asymptomatic HBV infection
An epidemic of jaundice caused by HEV occurred in New Delhi. HEV is
A major cause of bloodborne hepatitis
Found in rodents and pigs.
The cause of a disease that resembles hepatitis C.
Capable of establishing chronic infections
Associated with an increased risk of liver cancer
HDV (delta agent) is found only in patients who have either acute or chronic infection with HBV. Which of the following is most correct?
HDV depends on HBV surface antigen for virion formation
HDV is a defective mutant of HBV
HDV induces an immune response indistinguishable from that induced by HBV
HDV is related to HCV.
HDV contains a circular DNA genome
The following statements about HCV infection and associated chronic liver disease in the United States are correct except
HCV is responsible for 40% of chronic liver disease
Chronic infection develops in most (70–90%) HCVinfected persons
HCV-associated liver disease is the major cause for liver transplantation
HCV viremia occurs transiently during early stages of infection
HCV-infected patients are at high risk (5–20%) for liver cancer
A middle-aged man complained of acute onset of fever, nausea, and pain in the right upper abdominal quadrant. There was jaundice, and dark urine had been observed several days earlier. A laboratory test was positive for HAV IgM antibody. The physician can tell the patient that
He probably acquired the infection from a recent blood transfusion.
He will probably develop chronic hepatitis.
He will be at high risk of developing hepatocellular carcinoma.
He may transmit the infection to family members by person-to-person spread for up to 2 weeks.
He will be resistant to infection with hepatitis E.
Several different viruses can cause hepatitis. One of the following statements applies to all four viruses: HAV, HCV, HDV, and HEV.
It contains a single-stranded RNA genome
It is transmitted primarily by the parenteral route
It is transmitted primarily by the fecal–oral route
It is associated with fulminant hepatitis
It undergoes sequence variation during chronic infection
A 30-year-old student goes to the emergency room because of fever and anorexia for the past 3 days. She appears jaundiced. Her liver is enlarged and tender. A laboratory test shows elevated aminotransferases. She reports a history of having received hepatitis B vaccine 2 years ago but has not had hepatitis A vaccine. The results of her hepatitis serologic tests are as follows: HAV IgM-negative, HAV IgG-positive, HBsAgnegative, HBsAb-positive, HBcAb-negative, HCV Ab-positive. The most accurate conclusion is that she probably
Has been infected with HAV and HCV in the past and has hepatitis B now
Has been infected with HAV in the past, has not been infected with HBV, and has hepatitis C now
Has been infected with HAV and HCV in the past, has not been infected with HBV, and has hepatitis E now
Has hepatitis A now and has been infected with both HBV and HCV in the past
Has hepatitis A now, has not been infected with HBV, and had hepatitis C in the past
A 36-year-old nurse is found to be both HBsAg positive and HBeAg positive. The nurse most likely
Has acute hepatitis and is infectious.
Has both HBV and HEV infections.
Has a chronic HBV infection.
Has cleared a past HBV infection.
Was previously immunized with HBV vaccine prepared from healthy HBsAg-positive carriers.
The following persons are at increased risk for HAV infection and should be routinely vaccinated except for which group?
Men who have sex with men
Users of illegal drugs (both injecting and noninjecting)
Teachers in elementary schools
Persons who have an occupational risk for infection
Persons who have a clotting factor disorder
Susceptible persons who have chronic liver disease
There is global variation in the prevalence of HBV infection. Which of the following geographic areas has low endemicity (HBsAg prevalence of < 2%)?
Southeast Asia
The Pacific Islands
Eastern Europe
Australia
Sub-Saharan Africa
Which of the following persons are not recommended to receive hepatitis B vaccine because they have a risk factor for HBV infection?
Sexually active persons who are not in long-term, mutually monogamous relationships
Injection drug users
Pregnant women
Persons who live in a household with a person who is HBsAg positive
Persons seeking treatment for a sexually transmitted disease
Which of the following statements regarding HBIG is not true?
HBIG provides temporary protection when administered in standard doses
HBIG typically is used instead of hepatitis B vaccine for postexposure immunoprophylaxis to prevent HBV infection
No evidence exists that HBV, HCV, or HIV have ever been transmitted by HBIG in the United States
MHBIG is not used as protection against HCV infection
Each of the following statements concerning HAV is correct except
The hepatitis A vaccine contains inactivated HAV as the immunogen
HAV commonly causes asymptomatic infection in children
The diagnosis of hepatitis A is usually made by isolating HAV in cell culture
γ-Globulin is used to prevent hepatitis A in exposed persons
Which of the following serologic patterns is suggestive of a patient with chronic hepatitis B with a pre-core mutation?
HBsAg positive, HBsAb negative, anti-HBc positive, HBeAg positive, HBV DNA positive
HBsAg positive, HBsAb negative, anti-HBc positive, HBeAg positive, HBV DNA positive
HBsAg positive, HBsAb positive, anti-HBc positive, HBeAg negative, HBV DNA positive
) HBsAg negative, HBsAb positive, anti-HBc positive, HBeAg negative, HBV DNA negative
A 35-year-old man addicted to intravenous drugs has been a carrier of HBsAg for 10 years. He suddenly develops acute fulminant hepatitis and dies within 10 days. Which of the following laboratory tests would contribute most to diagnosis?
Anti-HBs antibody
HBeAg
Anti-HBc antibody
Anti-delta virus antibody
Each of the following statements concerning HCV and HDV is correct except
HDV is transmitted primarily by the fecal–oral route
HCV is an RNA virus
HDV is a defective virus that can replicate only in a cell that is also infected with HBV
People infected with HCV commonly become chronic carriers of HCV and are predisposed to hepatocellular carcinoma
Which of the following statements about HBV is false?
Replication involves reverse transcriptase.
Infected persons may have large numbers of noninfectious viral particles circulating in their bloodstream
Infection can result in cirrhosis
Asymptomatic infections can last for years
In the United States, the incidence of infection has been steadily increasing over the past few years
. Treatment of hepatitis C can involve drugs of which of the following classes?
Protease inhibitors, polymerase inhibitors, and interleukins
Non-nucleoside polymerase inhibitors, protease inhibitors, and interferons
Transcription inhibitors and interferons
Protease inhibitors, polymerase inhibitors, and interferons
Reverse transcriptase inhibitors and interferons
Which of the following statements about rhinoviruses is correct?
There are three antigenic types.
Amantadine protects against infection
They do not survive on environmental surfaces
They are the most frequent causative agent of the common cold.
They share physicochemical similarities with coronaviruses
A 26-year-old man develops myopericarditis with mild congestive heart failure that increases over several weeks. Coxsackievirus B5 infection is diagnosed. Which of the following clinical syndromes is not associated with coxsackievirus infections?
Herpangina
Myocarditis or pericarditis
Aseptic meningitis
Acute hemorrhagic conjunctivitis
Progressive postpolio muscle atrophy
A 3-month-old child develops fever, restlessness, and unusual crying. These are followed by apparent lethargy. Physical examination shows a normal-appearing infant who is minimally responsive to stimuli. A lumbar puncture yields cerebrospinal fluid with 200 white blood cells per microliter, predominantly lymphocytes. Acute aseptic meningitis is diagnosed, probably caused by an enterovirus. Enteroviruses are characterized by
Transmission primarily by the fecal–oral route
Latency in sensory ganglia and reactivation primarily in immunocompromised patients
The presence of a DNA polymerase enzyme
The entry of cells following binding to the intercellular adhesion molecule-1 (ICAM-1) receptor
Undergoing antigenic shift and drift
Picornavirus vaccines have been used for several decades in the prevention of human disease. Which of the following statements is correct?
The live, attenuated poliovirus vaccine produces gastrointestinal tract resistance.
There is an effective killed vaccine against the three major types of rhinoviruses
The live, attenuated poliovirus vaccine induces protective immunity against the closely related coxsackie B viruses.
None of the available echovirus vaccines should be given to immunocompromised patients
Only the live attenuated poliovirus vaccine is currently recommended for use in the United States.
Which of the following properties of enteroviruses is not shared by rhinoviruses?
Single-stranded RNA genome
Production by cleavage of viral proteins from a polyprotein precursor
Resistance to lipid solvents
Stability at acid pH (pH 3.0)
Icosahedral symmetry
. The use of live oral polio vaccine has been replaced by inactivated polio vaccine in many countries. Which of the following is the primary reason?
It is more cost effective to use the inactivated vaccine
Circulating poliovirus strains have changed and the live vaccine is no longer effective in many countries
There is a greater risk of vaccine-induced disease than wild virus–induced disease in areas where poliovirus has been eradicated
Only a single dose of inactivated vaccine is necessary compared with multiple doses of the oral vaccine
Outbreaks of hand-foot-and-mouth disease, characterized by oral ulcerations and vesicular rashes, occur and may result in infant deaths. The disease is caused by
Foot-and-mouth disease virus
Chickenpox virus
Nonpolio enteroviruses
Rhinoviruses
Rubella virus
Epidemiologic studies indicate that a core group of enteroviruses is consistently circulating in the United States. Which of the following statements is most accurate?
Members of the core group all display an epidemic pattern of outbreaks of disease
The group includes about half of the known enteroviruses
Disease occurs predominantly in adolescents and adults
Members of the group are all classified as coxsackie A and B viruses
This core group determines the majority of enterovirus disease
Each of the following statements concerning rhinoviruses is correct except
Rhinoviruses are members of the picornavirus family and resemble poliovirus in their structure and replication
The immunity provided by the rhinovirus vaccine is excellent because there is only one serotype.
Rhinoviruses grow better at 33°C than at 37°C; thus, they tend to cause disease in the upper respiratory tract rather than the lower respiratory tract
Rhinoviruses are one of the most frequent causes of the common cold
Live, attenuated oral polio vaccine (OPV) and inactivated polio vaccine (IPV) are both available. In which one of the following situations is the use of OPV preferred?
Adult immunization
Routine infant vaccination
Mass immunization programs in areas of high poliomyelitis endemicity
Patients who are receiving immunosuppressive therapy
Family contacts of immunocompromised patients
Which of the following statements about enteroviral meningitis is true?
Vaccines are generally available to protect against the disease
The main symptom is muscle paralysis
Transmission is usually by the fecal–oral route.
The causative agents do not survive well in the environment
Recovery is rarely complete
. The major barrier to the control of rhinovirus upper respiratory infections by immunization is
The large number of rhinovirus serotypes
The poor local and systemic immune response to these viruses
The side effects of the vaccine
The inability to grow the viruses in cell culture
Each of the following clinical syndromes is associated with infection by picornaviruses except
Myocarditis or pericarditis
Hepatitis
Mononucleosis
Meningitis
This virus is the most important cause of gastroenteritis in infants and young children. It causes infections that are often severe and may be life threatening, especially in infants.
Echovirus
Norwalk virus
Rotavirus, group A
Orbivirus
Parvovirus
An outbreak of epidemic gastroenteritis occurred at a wooded summer camp 24 hours after a party for visiting families. Some of the visiting parents also became ill. Samples taken 2 weeks later from the well that was the source of drinking water at the camp were negative for fecal coliforms. The most likely source of the outbreak was
Mosquitoes or ticks, present in high numbers in the area
Contaminated food served at the party
A nearby stream used for fishing
A visiting parent who was developing pneumonia
The swimming pool
This viral gastroenteritis agent has a segmented, doublestranded RNA genome and a double-shelled capsid. It is a member of which virus family?
Adenoviridae
Astroviridae
Caliciviridae
Reoviridae
Coronaviridae
Rotavirus and Norwalk virus are distinctly different viruses. However, they share which one of the following characteristics?
Fecal–oral mode of transmission
They mainly cause disease in infants and young children
They induce generally mild disease in young children
Infection patterns show no seasonal variation
A double-stranded RNA genome
Because rotavirus infections can be serious, a vaccine would be beneficial. Which of the following is most correct regarding a rotavirus vaccine?
A killed human rotavirus group A vaccine is licensed for use in the United States
Live attenuated vaccines are licensed for use in the United States
Vaccine development is complicated by rapid antigenic variation by the virus.
Available antiviral drugs make a vaccine unnecessary
Vaccine development is complicated because the virus cannot be grown in cell culture
Rotaviruses and astroviruses share a number of characteristics. Which of the following is not shared?
Multiple serotypes exist
Can cause gastroenteritis in infants and children
Can cause gastroenteritis in elderly institutionalized patients
Live vaccine available
Fecal–oral route of transmission
A 20-year-old man was on a 3-week tour of Italy with other college students. One day he abruptly became ill with nausea and vomiting followed 5 hours later by abdominal cramps and watery diarrhea. No fever was noted. Which of these viruses is the most likely cause of the man’s illness?
Calicivirus
Rotavirus
Reovirus
Adenovirus
Astrovirus
A 36-year-old man enjoyed a meal of raw oysters. Twenty-four hours later, he became ill, with a sudden onset of vomiting, diarrhea, and headache. The most likely cause of his gastroenteritis is
Astrovirus
Hepatitis A virus
Norwalk virus
Rotavirus, group A
Echovirus
Which statement about rotaviral gastroenteritis is false?
The name of the causative agent was suggested by its appearance
Most of the estimated 600,000 deaths occurring worldwide from this disease are from dehydration
Most cases of the disease occur in infants and children
The causative agent infects mainly the stomach
The disease is transmitted by the fecal–oral route
Which of the following statements about noroviruses is false?
They cause almost half the cases of viral gastroenteritis in the United States.
They can be responsible for epidemics of gastroenteritis
They generally produce an illness lasting 1–2 weeks.
Similar viruses are widespread among marine animals.
They typically cause disease in children and adults rather than infants.
Each of the following statements regarding rotaviruses is correct except
The rotavirus vaccine contains recombinant RNA polymerase as the immunogen.
Rotaviruses are a leading cause of diarrhea in young children
Rotaviruses are transmitted primarily by the fecal–oral route
Rotaviruses belong to the reovirus family, which has a double-stranded segmented RNA genome.
A 74-year-old man develops fever, malaise, and a sore throat followed shortly thereafter by nausea, vomiting, and then stupor. Eastern equine encephalitis is diagnosed. Control of this disease in humans could be accomplished by eradication of which of the following?
Horses
Birds
Sandflies
Mosquitoes
Ticks
Which of the following descriptions of or statements about Lassa fever is correct?
It is found in eastern Africa
Human-to-human transmission does not occur
It seldom causes death or complications
It occurs from contact with the house rat Mastomys natalensis
There is no drug that is effective in treating Lassa fever
Arboviruses are transmitted by bloodsucking arthropods from one vertebrate host to another. Arboviruses are found in the following virus families except which of the following?
Togaviridae
Flaviviridae
Bunyaviridae
Arenaviridae
Reoviridae
A microbiologist was performing a necropsy in a laminar flow biosafety cabinet on a blue-jay submitted as part of a state’s arbovirus surveillance program. He lacerated his thumb while using a scalpel to remove the bird’s brain. Four days later, he developed a headache, myalgia, and malaise followed by chills, sweats, and lymph node swelling. Two days later, a rash began on his face and spread to the trunk, arms, and legs, persisting for about 3 days. He sought medical care and reported a history of dengue fever and vaccinations with yellow fever and Japanese B encephalitis vaccines. A serum sample taken the day of the injury contained anti-flavivirus immunoglobulin G (IgG) antibody by enzyme-linked immunosorbent assay. A serum sample collected 13 days after the onset of illness showed an increased titer of antiflavivirus IgG antibody and the presence of West Nile virus IgM antibody. The physician could conclude that the most likely cause of the microbiologist’s illness was which virus?
Dengue virus
Yellow fever virus
West Nile virus
St. Louis encephalitis
Not identifiable until neutralizing antibody titers from paired sera could be assessed against a panel of arboviruses
Which of the following statements about dengue virus is not true?
It is the most important mosquito-borne viral disease affecting humans
It is distributed worldwide in tropical regions.
It can cause a severe hemorrhagic fever.
There is a single antigenic type.
One form of disease is characterized by increased vascular permeability.
Which of the following diseases occurring in the United States lacks a known insect vector?
Hantavirus pulmonary syndrome
West Nile fever
La Crosse encephalitis
Colorado tick fever
St. Louis encephalitis
Each of the following statements concerning arboviruses is correct except
The pathogenesis of dengue hemorrhagic shock syndrome is associated with the heterotypic anamnestic response.
Wild birds are the reservoir for encephalitis viruses but not for yellow fever virus
Ticks are the main mode of transmission for both encephalitis viruses and yellow fever virus
There is a live, attenuated vaccine that effectively prevents yellow fever.
Which of the following statements about hantaviruses in the United States is correct?
They are limited in range to southwestern states
They are carried only by deer mice
They infect human beings with a fatality rate that can be above 30%
They were first identified in the early 1970s.
They are contracted mainly in bat caves.
Which of the following statements regarding the prevention and treatment of influenza is correct?
Booster doses of vaccine are not recommended
Drugs that inhibit neuraminidase are active only against influenza A
As with some other live vaccines, the attenuated influenza vaccine should not be given to pregnant women
The influenza vaccine contains several serotypes of virus.
The virus strains in the influenza vaccine do not vary from year to year.
Which of the following statements about the neuraminidase of influenza virus is not correct?
Is embedded in the outer surface of the viral envelope
Forms a spike structure composed of four identical monomers, each with enzyme activity
Facilitates release of virus particles from infected cells
Lowers the viscosity of the mucous film in the respiratory tract
Is antigenically similar among all mammalian influenza viruses
The type-specific antigen (A, B, or C) of influenza viruses is found on which viral constituent?
Hemagglutinin
Neuraminidase
Nucleocapsid
Polymerase complex
Major nonstructural protein
Lipid in the viral envelope
A 70-year-old nursing home patient refused the influenza vaccine and subsequently developed influenza. She died of acute pneumonia 1 week after contracting the flu. The most common cause of acute postinfluenza pneumonia is which of the following?
Legionella
Staphylococcus aureus
Measles
Cytomegalovirus
Listeria
Which of the following statements concerning antigenic drift in influenza viruses is correct?
It results in major antigenic changes
It is exhibited only by influenza A viruses
It is caused by frameshift mutations in viral genes
It results in new subtypes over time.
It affects predominantly the matrix protein
. A 32-year-old male physician developed a “flulike” syndrome with fever, sore throat, headache, and myalgia. To provide laboratory confirmation of influenza, a culture for the virus was ordered. Which of the following would be the best specimen for isolating the virus responsible for this infection?
Stool
Nasopharyngeal swab
Vesicle fluid
Saliva
Blood
Which of the following statements about isolation of influenza viruses is correct?
Diagnosis of an influenza virus infection can only be made by isolating the virus
Isolation of influenza virus is done using newborn mice.
Isolation of virus can help determine the epidemiology of the disease
Primary influenza virus isolates grow readily in cell culture
The principal reservoir for the antigenic shift variants of influenza virus appears to be which of the following?
Chronic human carriers of the virus
Sewage
Pigs, horses, and fowl
Mosquitoes
Rodents
Highly pathogenic H5N1 avian influenza (HPAI) can infect humans with a high mortality rate, but it has not yet resulted in a pandemic. The following are characteristics of HPAI, except for one. Which one is not?
Efficient human-to-human transmission
Presence of avian influenza genes
Efficient infection of domestic poultry
Contains segmented RNA genome
Which of the following statements about diagnostic testing for influenza is true?
Clinical symptoms reliably distinguish influenza from other respiratory illnesses.
Viral culture is the “gold standard” diagnostic test because it is the most rapid assay
Patient antibody responses are highly specific for the strain of infecting influenza virus
Reverse transcription polymerase chain reaction is preferred for its speed, sensitivity, and specificity
The mechanism of “antigenic drift” in influenza viruses includes all but one of the following
Can involve either hemagglutinin or neuraminidase antigens
Mutations caused by viral RNA polymerase
Can predominate under selective host population immune pressures
Reassortment between human and animal or avian reservoirs
Can involve genes encoding structural or nonstructural proteins
Each of the following statements concerning the prevention and treatment of influenza is correct except
The inactivated influenza vaccine contains H1N1 virus but the live, attenuated influenza vaccine contains H3N2 virus
The vaccine is recommended to be given each year because the antigenicity of the virus drifts.
Oseltamivir is effective against both influenza A and influenza B viruses
The main antigen in the vaccine that induces protective antibody is the hemagglutinin
Each of the following statements concerning the antigenicity of influenza A virus is correct except
Antigenic shifts, which represent major changes in antigenicity, occur infrequently and are caused by the reassortment of segments of the viral genome
Antigenic shifts affect both the hemagglutinin and the neuraminidase
The worldwide epidemics caused by influenza A virus are caused by antigenic shifts
The protein involved in antigenic drift is primarily the internal ribonucleoprotein
Which of the following infectious agents is most likely to cause a pandemic?
Streptococcus pyogenes
Influenza A virus
Influenza B virus
Respiratory syncytial virus
Influenza C virus
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