Influenza
From 1918 to 1919, a flu outbreak, later termed a pandemic, was the most notorius and lethal of its kind. The exact number of deaths is unknown, but it estimated to be from 50 to 100 million people. This outbreak has been described as “the greatest medical holocaust in history” was comparable in impact to the Black Death. (Langford, 2002, p. 1-20)
Influenza, also known as ‘the flu’, is a highly contagious illness caused by influenza viruses that infect upper respiratory tract and lungs. It may present with symptoms that range from mild to severe illness and even, at worse, death. The three types of influenza are A, B and C. Influenza A and B are the viruses that affect the general population almost every winter in the United States. The development of new influenza viruses can cause a flu pandemic. Influenza C only cause only mild symptoms, not epidemics. Although Influenza B is not broken down, Influenza A is made up of different strains: currently classified as H1N1 and H3N2. In the first several months of 2009, a newer H1N1 emerged causing the first influenza pandemic in more than four decades. In a typical year’s normal two flu seasons (one for each global hemisphere), there may be up to five million cases of severe illness and around 500,000 deaths worldwide. Some would define this as a yearly influenza epidemic. (Lozano, 2012)
The flu typically comes on suddenly. Symptoms can include single symptoms or a multitude of symptoms to include – high body temperatures, rigor, cough, sore throat, nasal congestion, myalgia, headaches, fatigue. Additionally, some people experience vomiting and diarrhea, though this is more common in children than in adults. The vast majority who are affected by the flu will feel better in days, but others will develop complications as a result of the flu.
A wide range of complications can be caused by the flu. Young children, adults ages 65 years and older, pregnancy women, residents of long term care facilities and people with certain chronic medical comorbidities are among those groups of people that are at high risk of significant health complications. In addition, American Indians and Alaskan Natives are likely to suffer, although it is unknown exactly why. People with weakened immune systems, such as those with HIV infection or have received a transplanted organ may suffer from particularly severe disease. Some of the most common flu related complications are pneumonia, bronchitis, and infections or the ears, nose and throat. The flu can also make chronic conditions worse; for example, people affected by chronic lung disease may have an exacerbation while they are ill with flu and people that have heart failure may have an exacerbation of this condition that is triggered by the flu. ("CDC," 2014)
Flu is typically spread by several different means: direct contact, indirect contact, droplet and airborne. Direct contact happens when an infected host comes in direct contact with a susceptible host. Indirect contact may include droplet or airborne transmission. In most cases, this illness is spread by droplets made when people with the flu sneeze, cough or talk. It is estimated that people with the flu can spread it to others up to 6 feet away. These droplets can land in mouths and noses of those around them, even going into their lungs. Additionally, but with less frequency, someone may become ill by touching a surface or object that has the virus on it then touch their own mouth or nose. Some can become infected but remain asymptomatic – however, despite this they still may be able to transmit the virus to others. Symptoms may not start for several days after the virus enters the body.
Soap and water are the primary tools in which people can reduce their risk of becoming infected or spreading the flu. As an alternative if these are unavailable, a hand sanitizer that includes alcohol, should be utilized. Surfaces that are commonly used should be cleaned and disinfected particularly if ill. This would include home, work and school. If sick, one needs to remain home from school or work to avoid spreading to others.
People that become ill with the flu should get lots of rest, hydrate, avoid drinking alcoholic beverages and using tobacco. If they are symptomatic they can take medications such as acetaminophen or ibuprofen to relieve fever and muscle aches associated with the illness. In recent years, antiviral agents have gained popularity in treating the flu. Although they are thought to be generally effective, there are concerns about side effects (nausea, vomiting, diarrhea, headache) and development of drug resistance with prolonged or repeated use. In addition, the patient must seek care from a health care provider to obtain a prescription but also start the medication when symptoms initially appear to maximize its effects. The use of an antiviral may shorten the time a person is sick by a couple days. In addition, they may help prevent complications of the flu such as pneumonia. (Whitley & Monto, 2006)
To further discuss the flu – we can examine the triangle of epidemiology which consists of the environment, the host and the cause/causative agent.
Public health nurses may join other clinicians in surveillance and data collection; this can be done at the local, state and federal level. Health Departments may collect data from clinicians and hospitals in their area, then share that information with the Centers for Disease Control (CDC). Hospitals in metropolitan area of Portland, Oregon (Clackamas, Washington and Multnomah counties) submit data to the Oregon Public Health Division when a patient is admitted with a confirmed case of the flu. Additionally, these facilities are requested to submit laboratory samples to the State Public Health Laboratory for influenza testing. With regards to outpatient providers, such a family physician, information is gathered through the Outpatient Influenza-Like Illness Surveillance Network (ILINET). ILINET includes over 3,000 health care providers nationwide who submit the information to the Centers for Disease Control on the total patient visits and the number of patients diagnosed with influenza like illness. Other providers in Oregon also provide specimens to the Oregon State Public Health Laboratory in compliance with the program guidelines regarding Sentinel providers. The Oregon Community Health Information Network (OCHIN) is a cooperative network of federally recognized health facilities and rural clinics in Oregon, over one hundred, throughout the state. OCHIN provides diagnosis data to the Oregon Health Authority so they can monitor rates of respiratory illness and influenza like illness among its patients. ("OHA," 2016)
The Centers for Disease Control, Influenza Division, in collaboration with the World Health Organization, plays a crucial part in comprehensive monitoring for early discovery and identification of emerging viruses as well as unusual influenza A virus that have the possibility for a pandemic. In addition, they research the make-up of the new viruses, how it may respond different treatments and its genetic makeup.
The future of influenza, both locally and globally remains unknown. Up to 20% of the populace may acquire influenza in any given year and on average, the flu is guilty of approximately 20,000 deaths in the United States. ("ACIP," 2001) Research on best practice treatment remains ongoing and new approaches are in constant development. For now, the very basics of good handwashing and vaccination remain the cornerstones of the best preventative care. References
Flu. (2016). Retrieved from http://public.health.oregon.gov/DiseasesConditions/CommunicableDisease/DiseaseSurveillanceData/Influenza/Pages/about_influ_surveil.aspx
Key Facts about Influenza (Flu) & Flu Vaccine. (2014). Retrieved from www.cdc.gov
Langford, C. (2002). The age pattern of mortality in the 1918-1919 influenza pandemic. Medical History, 46(), . http://dx.doi.org/Retrieved from
Lozano, R. (2012, 15 December). Global and regional mortality from 235 cases of death for 20 age groups. Lancet, 380. http://dx.doi.org/10.1016/S0140-6736(12)61728-0
Prevention and control of influenza. Recommendations o the Advisory Committee on Immunization Practices. (2001). Morbidity and Mortality Weekly, 50(), 1-49.
Whitley, R., & Monto, A. (2006). Prevention and treatment of influenza in high-risk groups: children, pregnant women, immunocompromised hosts and nursing home residents. Journal of Infectious Disease, 194(S2:S133-8). http://dx.doi.org/10.1086/507548