Influenza shows cyclic appearance of extremely virulent strains that cause __________ mortality, such as that of 1918, which infected 20% of the world's population and killed more people than World War I.

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The sentence mentions "extremely virulent strains" that cause high mortality, such as the 1918 strain that infected a large part of the world's population and caused more deaths than the war. This is characteristic of a pandemic, which is the spread of a disease over a large region or even globally. Choices A, B, and E do not fit the context, and while influenza can cause epidemics (regional outbreaks), it does not necessarily imply high mortality.

Influenza Shows Cyclic Appearance of Extremely Virulent Strains That Cause