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The growth in obesity and diabetes and the threat of antibiotic resistance to mild to severe influenza, scientists have warned.
Scientists looked at what led to the 1918 Spanish flu, which spread rapidly around the globe as a result of the first world war, to infecting the third world population and causing between 50 and 100 million deaths.
They say the world is far better prepared for a flu outbreak today than in 1918 because of a better understanding of how flu spreads and improved surveillance of infections. But they warn that the rise of chronic diseases, coupled with changing population and antibiotic resistance, could exacerbate an outbreak.
Scientists do not know when or how big the next flu pandemic will. "But we know that there will be one," Dr. Kirsty Short, virologist at the University of Queensland, told The Telegraph.
"As our population is aging and chronic diseases are becoming prevalent, it could turn even a mild pandemic into a chronic one," she said.
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