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Historically, influenza pandemics have struck unpredictably. The last three were in 1968, 1957 and 1918 to 1919. To Dr. [David Chan], pandemic influenza is a global political and medical problem that requires an international solution. What complicates the task is that the same influenza experts who say that a pandemic will surely come also say they do not know when, what strain of virus will cause it or how many people it will sicken and kill. Indeed, Dr. Chan faced such complaints after the first cases of A(H5N1) avian influenza appeared in Hong Kong in 1997. No vaccine was effective against the strain. But the virus was susceptible to a drug, amantadine, and Dr. Chan authorized the equivalent of $1.3 million to buy a large supply of it in case a large outbreak occurred. None of it had to be used. During the SARS outbreak, Dr. Chan was a daily figure on Hong Kong television. The driver, who had also stopped at the light, recognized Dr. Chan and knew from news reports that the W.H.O. wanted her to go to Geneva to work on environmental health. Rolling down his window, he said, ''It's one chance in a lifetime, and think of what you will do for Hong Kong and for China.''

Officials have been racing to develop a vaccine because they worry that if that strain mutated and combined with a human influenza virus to create a new virus, it could spread rapidly. Tens of millions of birds have died from infection with the virus and from culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. The director of the National Institute of Allergy and Infectious Diseases in the United States, Dr. Anthony Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis if a pandemic developed, it would still be several months before that vaccine was tested further and, if licensed, offered to the public. He cautioned: 'We don't have all the vaccine we need to meet the possible demand. The critical issue now is, 'Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?'' 'It keeps changing, it keeps evolving,' he said. 'We don't know how much the vaccine matches.' Another problem lies in initial test results in the United States showing that the new vaccine requires two doses. Moreover, each dose may have to contain several times more material than a conventional human influenza vaccine dose. Vaccine manufacturers already struggle to produce enough human influenza vaccine each winter, even producing a small, single dose for each patient

Most cases have occurred among adult male farmers who have had close contact with diseased pigs or have eaten uncooked pig products. The bacteria are commonly found where pigs are raised. Animals without symptoms carry the bacteria in their tonsils and noses. Sichuan has one of the largest pig populations in China, and news organizations have reported a concurrent outbreak among pigs there. Streptococcus suis infections usually occur sporadically, or in small outbreaks, said Dr. Jorgen Schlundt, a Danish veterinarian who directs the department of zoonoses and food borne diseases at the health agency. Zoonoses are infectious diseases that occur primarily in animals but that can be transmitted to people. Health officials say more tests are needed to determine why the Sichuan outbreak is so large and the death rate so high. Among the questions infectious disease specialists have raised is whether Streptococcus suis has mutated to become more virulent. No evidence suggests that the bacteria have become resistant to antibiotics. Scientists say China should search for other factors that might explain the high death rate

He cautioned: 'We don't have all the vaccine we need to meet the possible demand. The critical issue now is: Can we make enough vaccine, given the well-known inability of the vaccine industry to make enough vaccine?' An earlier human vaccine against A(H5N1) avian influenza virus was prepared after it first appeared in Hong Kong in 1997. That vaccine was never fully developed or used, and the strain has mutated since then. In interviews over recent days, [Anthony Fauci] has said that tests so far have shown that the new vaccine produced a strong immune response among the small group of healthy adults under age 65 who volunteered to receive it, although the doses needed were higher than in the standard influenza vaccine offered each year. The vaccine, developed with genetic engineering techniques, is intended to protect against infection, not to treat those who are sick

The bacteria are commonly found where pigs are raised. Animals without symptoms carry the bacteria in their tonsils and noses. Sichuan Province has one of the largest pig populations in China, and news organizations have reported a concurrent outbreak among pigs in that area. There is no evidence that the illness has been transmitted from one person to another in the outbreak, the health agency said. There was no immediate evidence that China, which came under fire for covering up the outbreak of SARS, or sudden acute respiratory syndrome, in 2002 and 2003, was hiding information about the Streptococcus suis outbreak. Health officials say more laboratory tests are needed to determine why the Sichuan outbreak is so large and the death rate so high. Among the questions infectious disease specialists have raised is whether Streptococcus suis has mutated to become more virulent. Scientists say China should search for other factors that might explain the high death rate. Another unusual feature of the outbreak is that many patients have developed bleeding under the skin, and some have developed toxic shock syndrome

It was the second time in less than a month that [William Rehnquist], 80, went to Virginia Hospital Center because of a fever. He spent two nights at the same hospital in Arlington, Va., after being admitted July 12. The cause of the fever in July was not disclosed. Rehnquist has released only sketchy information about his thyroid cancer, which he disclosed in October. He said he is being treated with radiation and chemotherapy and that surgeons had created a hole in his windpipe, a procedure known as a tracheotomy, to ease his breathing

Officials have been racing to develop a vaccine because they worry that if that strain mutated and combined with a human influenza virus to create a new virus, it could spread rapidly. Tens of millions of birds have died from infection with the virus and from culling to prevent the spread of the virus. About 100 people have been infected, and about 50 have died from this strain of the avian influenza virus, called A(H5N1). So far there has been no sustained human-to-human transmission, but that is what health officials fear, because it could cause a pandemic. The director of the National Institute of Allergy and Infectious Diseases in the United States, Dr. Anthony Fauci, said that while the vaccine that has undergone preliminary tests could be used on an emergency basis if a pandemic developed, it would still be several months before that vaccine was tested further and, if licensed, offered to the public. In Taiwan, Dr. Kuo Hsu-sung, director general of the Center for Disease Control, said that the authorities in Taiwan were so concerned about the long-term risks of an influenza pandemic, as well as the annual harm from more routine outbreaks of human influenza, that the island planned to build its own human influenza vaccine factory. But building a factory and putting it into production will take four years, Kuo warned. For now, Taiwan has a supply of Tamiflu, the only medicine known to work against bird flu, adequate to treat 1 percent of its population

Mr. [Bush], 59, remains in the ''superior'' fitness category for a man his age, the doctors said. They also said Mr. Bush, who exercises six times a week, was ''fit for duty'' and expected to remain so for the rest of his term. Mr. Bush's parents, former President George H.W. Bush, and his wife, Barbara, suffered from overactivity of the thyroid gland, a condition that can cause unintended weight loss. Their son's thyroid function tests were reported as normal yesterday. Mr. Bush, who stopped running because of knee problems, bicycles 15 to 20 miles at 15 to 18 miles per hour and has suffered scrapes and bruises in falls from his bike. Mr. Bush's workouts also include exercising on a treadmill and an elliptical trainer, free-weight resistance training and stretching, the doctors said

[Bush], 59, remains in the 'superior' fitness category for a man his age, the doctors said. They also said Bush, who exercises six times a week, was 'fit for duty' and expected to remain so for the rest of his term. Bush's parents, former President George H.W. Bush, and his wife, Barbara, suffered from overactivity of the thyroid gland, a condition that can cause unintended weight loss. Their son's thyroid function tests were reported as normal yesterday. Bush, who stopped running because of knee problems, bicycles 15 to 20 miles at 15 to 18 miles per hour and has suffered scrapes and bruises in falls from his bike. Bush's workouts also include exercising on a treadmill and an elliptical trainer, free-weight resistance training and stretching, the doctors said

Chief Justice [William H. Rehnquist] has released only sketchy information about his thyroid cancer, which he disclosed last October. He said that he was being treated with radiation and chemotherapy, and that surgeons had created a hole in his windpipe, a procedure known as a tracheotomy, to ease his breathing. The chief justice did not say what type of thyroid cancer he had. Most patients with thyroid cancer do not need a tracheotomy. The fact that he had the procedure led many thyroid experts not connected with his case to say that they strongly believed that he had anaplastic thyroid cancer, the most aggressive type of that disease