Influenza



InfluenzaJean HarkenFerris State UniversityAbstractEmerging disease are a drain on the society and kill many people each year. Influenza in one of those emerging diseases. The influenza virus has taken the lives of millions over the years. While in these days the mortality is much less than in years past, there are still great strides that need to be made to reduce the spread. With several different strains of the influenza and the slight changes the virus makes to itself it is no wonder why the disease is not stopped of even under control. The virus spans many years and while progress is being made with immunizations, hand hygiene, antivirals and education, there is still a lot of work that needs to be done before we get a total grasp of this virus. While we take precautions and preventions to keep this virus under control. It is only a matter of time before this disease expands and mutates again and the next pandemic emerges. InfluenzaInfluenza (also known as the flu) can be very mild or can turn deadly. Regardless of the severity of the disease, people seem to be contracting it more frequently despite the vaccinations that are available. There are a couple possible reasons for this. One would be the low number of people who are receiving the vaccination, despite the availability of the vaccination. Another could be the rapid mutation of the virus once in the host and immunizations are not targeted for the mutations. Whatever the cause of the rapid spread of the disease, this disease can be very dangerous and even fatal. The key to preventing an epidemic of this disease is prevention, reduction of transmission and early treatment.Transmission of InfluenzaInfluenza is highly infectious and easily contracted virus. Due to the nature of the disease it is transmitted through close contact with another person who is carrying the virus. It is also transmitted my touching surfaces contaminated by the virus, or by coming in contact with the infected droplets from an infected person coughing or sneezing (Dolin, 2014). The flu is more prevalent during the cold months of the year due to close contact and remaining indoors among much of the population. The Immunocompromised and special populations such as elderly and pregnant are at a higher risk of contracting the flu (Dolin, 2014). When a population that has no immunity to a flu strain, there is often large outbreaks of the flu that often times can lean to many deaths (Dolin, 2014). Clinical Presentation and Diagnosis of InfluenzaThe most common diagnosis during the winter months is the flu. People present with a variety of symptoms. Many of the symptoms that people present with are similar to most other respiratory illnesses. Patients most often notice a non-productive cough, general malaise, fever, sore throat or headache (Bell, 2005). Occasionally people also presented with nausea and vomiting and stomach discomfort leading researchers to believe the virus replicated itself in the gastrointestinal tract (Erlikh, Abraham, & Kondamudi, 2010). There are several tests that can be done to test for influenza. The most common diagnostic test is the rapids test. This test can be done in an Emergency Room, Urgent Care or Primary Care Physician (PCP) office. One problem with this test is just because you have a negative test does not mean you do not have the flu (Erlikh et al., 2010). The rapid test consists of a swab being inserted into the nares and secretions from the nares. One reason a false negative can be obtained to due to the variable sensitivity of the test, or due to the virus already being far enough down the respiratory tract that a nasal swab no longer detects it (Erlikh et al., 2010). A more accurate test is a blood test called the real-time reverse transcriptase polymerase chain reaction test (PCR) the downfall to this test is depending on where the test is run, there is a least a twenty four hour tune around time for results. Often times if the rapid test is negative, the patient has many symptoms of influenza and the physician still suspects influenza despite a negative rapid result. Treatment / TherapyIt is recommended that all people who test positive with the PCR confirmatory test for the flu, be treated with antivirals (Harper et al., 2009). Antiviral drugs are not antibiotics, which many people think. These are drugs that are specific to treat viral infections. These antiviral drugs can reduce the time that a person exhibits symptoms of the flu, and can also reduce the risk of developing more serious complications of the flu (CDC, 2014). The key to using an antiviral is to start it as soon as possible for the best effects. There may be other treatments that are necessary should complications of the flu arise. Taking antiviral drugs in someone in your household has influenza may reduce the chances of you contracting this virus, but is absolutely not a replacement for receiving the vaccination (PubMed Health, 2013). Many people believe that remedies such as chicken soup or lots of fluids will help you recover faster. Although they may prevent dehydration or other ailments that may go along with the flu, there is no evidence that any home remedy helps a person to recover faster (PubMed Health, 2013). PreventionShould an epidemic erupt, there are many things that you can do to reduce the risks or transmitting the flu. The more important thing is hand hygiene, the use of soap and water or hand sanitizer frequently (PubMed Health, 2013). Use your own glass or bottle, sharing these containers also shares the germs that are on them. Avoid intimate contact such as kissing or any form of embracing if you or other people are contagious. Use tissues and dispose of them properly, do not use clothe handkerchiefs. Especially use these types of paper products when coughing or sneezing, they prevent the spread of the droplets (PubMed Health, 2013). Evidence of the Emerging DiseaseTypes of influenzaInfluenza can be as easy as A, B and C, or at least those are the three types, and they have proven to be anything but easy. The focus is mainly on type A and type B. While C though it exists tends to cause mild illness not leading to mortality or large outbreaks at this time (Centers for Disease Control, 2014). Influenza’s A and B both have many strains to them. Influenza A is broken down based on two main proteins hemagglutin (H) and neuraminidase (N). There are eighteen different (H) and eleven different (N) and these can be broken down into different strains. The most common types of influenza A, that are pretty known at this time are the H1N1, H3N2, and Avian. The Avian flu has not been seen in the United States. The H1N1 emerged as a new strain of influenza A and became an epidemic in 2009. It was the first large outbreak of influenza in over forty years. While influenza B does not have the different proteins or subtypes, it can also be broken down into strains (Centers for Disease Control, 2014). How the Virus ChangesFlu virus’ can change in two different ways, either they “shift” or they “drift”. When changes are slow and happen over a period of time, is when the drift occurs. The antigenic drift is what causes the strain of the flu to be different each year and require a new vaccination. This is also the reason that a person can contract the flu more than one time. The body is not able to produce antigens against the new strains when these small changes take place. A shift occurs when more than one strain infects one cell. The antigenic shift is a mutation that allows humans to transmit a virus that was otherwise known to animals (U.S. Department of Health and Human Services, 2014). History of InfluenzaInfluenza has been around for quite a long time, dating back to 1918 when the pandemic was known as the Spanish flu (U.S. Department of Health and Human Services, 2014). This was the first documented case where several million people died. Most of the globe was plagued by this pandemic. It spread like wildfire and was seen the greatest through the shipping lanes and on trade routes. It is still not known for sure where the original strain of the flu originated. The possible origination was thought to be in China as a rare genetic shift, but that was not totally confirmed. Due to the large mortality rates in Spain in was names the Spanish flu, but it quickly showed the power is possessed and stuck many military camps across the United States (U.S. Department of Health and Human Services, 2014). There were outbreaks in 1957 and 1968 as well, but nothing compared to the pandemic of 1918. The next pandemic that most people now remember was in 2009 when the H1N1 virus surfaced. There were many deaths from this virus, although most were said to be from pneumonia or lung failure (Australian Government Department of Health and Again, 2011). This particular virus came on in the spring of 2009 and seemed to wreak the greatest havoc on the younger population. One problem with this disease was that the vaccine that was offered in this year had no effect on the current strain. New vaccines were being rushed into play while utilizing both live and dead viruses. A guideline was then put into place by the Centers for Disease Control on who was to be vaccinated first as the new vaccine became available (, 2013). Factors Promoting InfluenzaIf there were no known factors promoting the spread of influenza, then the disease would eventually disappear. One major factor is the number of people who delay seeking antiviral treatment on the onset of symptoms (Ryoo et al., 2013). Many people ignore the symptoms thinking that they will go away, or go to work with symptoms, therefore spreading germs to anyone that they come in contact with. Secondly in the United States, a lack of money or insurance for healthcare services often hinders people from seeking care. It is recommended that anyone over the age of six months be immunized against the influenza virus. There are many people who do not receive the vaccine and for many reasons. In order to begin to tackle this pandemic, as a society all individuals need to get immunized (Mayo Clinic Staff, n.d.). While as a society we are getting better at washing hands, and utilizing hand sanitizers, until be stay in when we have symptoms of the virus, it will continue to spread.This influenza virus will also continue to spread as long as there is sub adequate healthcare in other countries. When looking at where the majority of illness and diseases come from, they come from countries other than the United States. Although many countries are doing what they can to decrease the spread of influenza they are all at varying stages. Although there have been great strides in other countries, there are still many that are greatly lacking (Centers for Disease Control, 2010). Technology has not enabled us to get in front of the antigenic shift and antigenic drift. Without being able to predict who and when this will happen, we are unable to stop new strains of influenza from forming. Although in the United States, death rates may be lower than in many other countries, there is still a long way to go (Oshitani et al., 2010). There is no way that can currently measure how largely or intently a pandemic would impact the world in this day in age. While we are getting better with the treatment and management of symptoms, there is always a chance that a new and rare strain could pop out of nowhere and mess with the population. While we are better prepared than we have ever been in the past, there are still great strides that need to be taken to keep the influenza virus at bay. Many of the other countries do not have access to antiviral drugs to assist is treatment of the current symptoms and they certainly do not have the medications to given to people in the homes of the infected person to keep others from transmitting the virus. In many countries there are many people that live under one roof that makes the disease spread faster than if people were spread out. Once we can get a grasp on containing the spread in humans, we then have to work on animals and how we can keep the virus from shifting and mutating and transmitting to humans. This could be a very difficult task to attempt to manage all of the animals in the world. Although we are doing what we can to keep this virus from becoming a pandemic, it remains an emerging disease with only a matter of time before a new and even more catastrophic strain arises.ConclusionThe influenza virus has been around for many years. This virus has a very high mortality rate though significantly less than in years prior. Many people die from complications of the virus rather than the virus itself. This virus has mutated and transformed over the years making it difficult to keep up with. Although there has been a huge amount of progress over the last several years, this virus still to this day claims the lives of many. Until as a nation we can get on the same paths when it comes to medications, vaccinations, and hygiene this beast will never go away. As a nation we are doing what we can to control the spread of this disease through education and use of medications but the influenza virus remains a problem to this day.ReferencesAustralian Government Department of Health and Again (2011). History on Pandemics. Retrieved from , M. (2005, November 1). Diagnosing and Treating Patients with Suspected Influenza. American Family Physicians, 72, 1789-1792. Retrieved from for Disease Control (2014). Treating Influenza (Flu). Retrieved from for Disease Control (2014). Types of Influenza Viruses. Retrieved from , R. (2014). Patient information: Influenza symptoms and treatment. Retrieved from , I., Abraham, S., & Kondamudi, V. (2010, November 1). Management of Influenza. American Family Physicians, 82, 1087-1095. Retrieved from , S., Bradley, J., Englund, J., File, T., Gravestein, S., Hayden, F., ... Zimmerman, R. (2009). Seasonal Influenza in Adults and Children - Diagnosis, Treatment, Chemoprophylaxis and Institutional Outbreak Management: Clinical Practice Guidelines of the Infectious Diseases Society of America. Clinical Infectious Disease, 48, 1003-1032. Clinic Staff (n.d.). Influenza (flu). Retrieved from (2013). What is the history of swine flu in humans? Retrieved from , H., Kamigaki, T., & Suziki, A. (2010). Major Issues and Challenges of Influenza Pandemic Preparedness in Developing Countries. Retrieved from Health (2013). Influenza Treatments. Retrieved from , S., Kim, W., Sohn, C., Seo, D., Oh, B., Lee, J., ... Kim, K. (2013, September 7). Factors promoting the prolonged shedding of the pandemic (H1N1) 2009 influenza virus in patients treated with oseltamivir for 5 days. Influenza Other Respir Viruses, 7, 833-837. . Department of Health and Human Services (2014). How the Flu Virus Changes. Retrieved from . Department of Health and Human Services (2014). Pandemic Flu History. 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