Usually, the virus is spread through the air from coughs or sneezes.This is believed to occur mostly over relatively short distances. It can also be spread by touching surfaces contaminated by the virus and then touching the mouth or eyes. A person may be infectious to others both before and during the time they are sick. The infection may be confirmed by testing the throat, sputum, or nose for the virus.Influenza spreads around the world in a yearly outbreak, resulting in about three to five million cases of severe illness and about 250,000 to 500,000 deaths. In the Northern and Southern parts of the world outbreaks occur mainly in winter while in areas around the equator outbreaks may occur at any time of the year. Death occurs mostly in the young, the old and those with other health problems. Larger outbreaks known as pandemics are less frequent. In the 20th century three influenza pandemics occurred: Spanish influenza in 1918, Asian influenza in 1958, and Hong Kong influenza in 1968, each resulting in more than a million deaths. The World Health Organization declared an outbreak of a new type of influenza A/H1N1 to be a pandemic in June of 2009. Influenza may also affect other animals, including pigs, horses and birds.