Did Horses Act as Intermediate Hosts That Facilitated the Emergence of 1918 Pandemic Influenza?

The ecological factors that led to the 1918 influenza pandemic remain unknown. We hypothesize that horses acted as intermediate hosts spreading a prepandemic avian-origin virus before 1918. This is supported by reports describing a large epizootic of unusually severe equine influenza beginning in 1915. Furthermore, the high horse demand during World War I resulted in one of the biggest equine mobilizations in North America between 1914 and 1918. This extensive movement of horses provided abundant opportunities for virus reassortment between prepandemic avian and human influenza viruses. Archived equine tissues or serum samples will be needed to test this hypothesis.