The eosinophil granulocyte was discovered 130 years ago but its roles are still being revealed. The most characteristic feature of the eosinophil is the large secondary granules filled with basic proteins. The purpose of these proteins is still not fully understood. One of the proteins, ECP is a highly basic, cytotoxic, heparin binding ribonuclease that seems to need its ribonuclease site but not activity for its activities. Sensitive assays have been developed for its measurement in biological fluids which have contributed to the understanding of the role of the eosinophils in disease. In vitro studies have shown that high levels of ECP are necessary for development its destructive actions. Diseases engaging high levels of eosinophils might reach these levels locally in the tissue. At those high levels polymorphisms altering expression level and protein sequence might play a role within certain populations. Whether ECP also has roles at lower concentrations, such as the growth inhibitory influences on lymphocytes found in vitro, remain to be shown with in vivo models or clinically. These additional roles for ECP when discovered, might provide critical answers to the functions of eosinophil granulocytes and is therefore well worth waiting for. Excess healthcare burden during 1918-1920 influenza pandemic in Taiwan: implications for post-pandemic preparedness BACKGROUND: It is speculated that the 2009 pandemic H1N1 influenza virus might fall into a seasonal pattern during the current post-pandemic period with more severe clinical presentation for high-risk groups identified during the 2009 pandemic. Hence the extent of likely excess healthcare needs during this period must be fully considered. We will make use of the historical healthcare record in Taiwan during and after the 1918 influenza pandemic to ascertain the scope of potential excess healthcare burden during the post-pandemic period. METHODS: To establish the healthcare needs after the initial wave in 1918, the yearly healthcare records (hospitalizations, outpatients, etc.) in Taiwan during 1918-1920 are compared with the corresponding data from the adjacent "baseline" years of 1916, 1917, 1921, and 1922 to estimate the excess healthcare burden during the initial outbreak in 1918 and in the years immediately after. RESULTS: In 1918 the number of public hospital outpatients exceeded the yearly average of the baseline years by 20.11% (95% CI: 16.43, 25.90), and the number of hospitalizations exceeded the corresponding yearly average of the baseline years by 12.20% (10.59, 14.38), while the excess number of patients treated by the public medics was statistically significant at 32.21% (28.48, 39.82) more than the yearly average of the baseline years. For 1920, only the excess number of hospitalizations was statistically significant at 19.83% (95% CI: 17.21, 23.38) more than the yearly average of the baseline years. CONCLUSIONS: Considerable extra burden with significant loss of lives was reported in 1918 by both the public medics system and the public hospitals. In comparison, only a substantial number of excess hospitalizations in the public hospitals was reported in 1920, indicating that the population was relatively unprepared for the first wave in 1918 and did not fully utilize the public hospitals. Moreover, comparatively low mortality was reported by the public hospitals and the public medics during the second wave in 1920 even though significantly more patients were hospitalized, suggesting that there had been substantially less fatal illnesses among the hospitalized patients during the second wave. Our results provide viable parameters for assessing healthcare needs for post-pandemic preparedness. The 2009 pandemic H1N1 (pH1N1) virus spread swiftly to all parts of the world in a matter of a few months after it was first identified in Mexico in March. In August 2010, World Health Organization (WHO) declared the world to be in the post-pandemic period, when the pH1N1 virus is expected to continue to circulate as a seasonal virus for some years to come [1] . Moreover, active transmission of pandemic influenza virus still persists in some local areas, and it is still unclear whether the pandemic influenza activity has already transitioned into a seasonal pattern [2] . It is further speculated that groups identified during the recent pandemic as at a higher risk of severe or fatal illness will probably remain at a heightened risk during the post-pandemic period, although the number of such cases may decrease. In addition, a small proportion of people infected during the 2009 pandemic developed a severe form of primary viral pneumonia that is not commonly seen during seasonal epidemics and is especially difficult to treat. Therefore, quantitative ascertainment of the likely healthcare burden is an important aspect of post-pandemic preparedness planning.