Running Head: EVIDENCE-BASED PAPER RELATED TO EMERGING INFLUENZA
Brandy Everson
Evidence-Based Paper Related to Emerging Influenza
Ferris State University
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EVIDENCE-BASED PAPER RELATED TO EMERGING INFLUENZA
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Abstract
Influenza in the past has been cause of many pandemics that killed thousands of people. The
very old and very young are more at risk to develop influenza. Also people with comorbidities or
living in certain areas may be more at risk to develop influenza. Evidence has proven with the
help of antivirals, vaccinations and hand hygiene we have been able to contain it. Containing
influenza would be difficult without research and careful tracking of the disease. Public
education and initiatives will help us reduce the spread of influenza. Prediction of genetic
changes could help us to predict how the virus will mutate and in the future prevent another
pandemic.
Keywords: Influenza, vaccinations, pandemics, flu
EVIDENCE-BASED PAPER RELATED TO EMERGING INFLUENZA
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Evidence-Based Paper Related to Emerging Influenza
In Africa, 60% of their deaths are a result of infectious diseases. Globally 15% of deaths
are from infectious diseases (Veenema, 2013, p.431). These statistics show why emerging
infectious diseases are a concern. Throughout this paper I will discuss an important disease
which is the influenza virus. I will first discuss how influenza is transmitted. I will explain the
clinical symptoms of influenxa, diagnosis, and therapy. I will identify what increases the
outbreak of influenza. Lastly, I will analyze evidence found on influenza. influenza has the
potential to kill many and I hope throughout this paper you become more educated on how to
reduce the spread of the virus.
Etiology of Influenza
Influenza is a viral infection that can adapt to various hosts such as human or animal.
Every year the virus changes or mutates this can making it more difficult to immunize. Vaccine
for the flu changes every year due to the virus mutating. (Fauci, 2006, p.665-670). The first
record of influenza was the Spanish Flu. Then in Far East during 1957 a new strand of flu was
found. That same year, 1957 they started to immunize for the flu. This flu was not as severe as
the Spanish Flu. In 1968 a flu virus from Hong Kong came to the United States. This same flu
had a reoccurrence in 1970 and 1972. This flu was milder than the previous ones which may be
from improved medical care. 1997 to 1998 the Avian Flu was seen in Hong Kong. In response to
this flu thousands of chickens were slaughtered. 2009 to 2010 the H1N1 or Swine Flu was found
and 74 countries were involved (US Department of Health and Human Services, 2015).
The occurrence of influenza increases in the winter. This time of year when the flu is at
its highest occurrence is called the flu season. The flu season can start in October and go until
May in some areas (CDC, 2014). There are many different types of influenza. Influenza type A
is carried by birds. Migrating birds can be carriers of the disease and can spread the disease while
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not showing any symptoms of it. A form of Influenza type A is the Avian influenza which is
considered a pandemic because people do not have any immunity from it. This type of flu is so
deadly because it mutates rapidly. The influenza virus can also be carried in animals such as pigs
(Fauci, 2006, p.665-670). Ferrets have been used to model influenza. Ferrets show many of the
same symptoms that humans do when they contract influenza. The model showed them that
ferrets without the virus housed with ferrets that had the virus were becoming contaminated.
Mice have been used as well but results are not as reliable (Nicholson, et al., 2003, p. 17361737).
The flu season we are seeing this year is mismatched H3N2 and influenza B. Older adults
have seen the highest incidence of H3N2. The next highest incidence of the flu this year had
been in children under four. The flu this year has had a symptom usually associated with mumps
and that is parotitis. Parotitis is swelling of salivary glands. Despite the high alert for influenza
on the news the CDC does not believe we are experiencing flu pandemic (Centers for Disease
Control and Prevention, 2014).
Clinical Profile of Influenza
Influenza can be transmitted from person to person from droplets in the air when
transmitted human to human. Droplets are put in the air by sneezing or coughing. Fomites are
another way to transfer Influenza (Nicholson, et al., 2003). Examples of fomites could be
telephones of computer keyboards (Mayo Clinic, 2015). The virus can last on nonporous
surfaces for up to 24 hours and on cloth for up to 12 hours (Belser, et al., 2010). A person is
contagious 24 hours before symptoms occur and up until 5-10 days after the symptoms start
(Mayo Clinic, 2015). Hospitalized patients are put in negative pressure rooms to isolate them
from others (Veenema, 2013, 436). This type of isolation in the hospital is called droplet
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precautions. Symptoms of influenza are fever or feverish feeling with chills, weakness, sore
throat, cough, muscle aches. Children may experience diarrhea or vomiting (Centers for Disease
Control and Prevention, 2014).
Diagnostic
Current diagnostic testing is limited because they have low sensitivity. Diagnostic studies
are a PCR, viral culture and serologic studies. Rapid influenza tests will help track areas that
have larger concentration of influenza (Nicholson, et al., 2003, p. 1736). Rapid diagnostic test
(RIDTs) can have results in fifteen minutes. Rapid tests can be different in what they detect.
Some rapid tests distinguish between strain A and B and some do not. Rapid tests are not as
reliable if used after four of five days. The rapid test is not definitive and treatment may be
dependent on a PCR or viral culture (CDC, 2014). Most often Influenza is diagnosed by
symptoms such as fever and cough (Nicholson, et al., 2003, p. 1736).
Treatment
The first line of treatment is rest, fluids and pain relievers such as Tylenol (Mayo Clinic,
2015). Therapy for Influenza is antivirals such as Osteltamivir and Zanamivir are used for
treatment of Influenza. Typical treatment for influenza such as anti-viral medications would also
work for the Avian flu. (Veenema, 2013). Treatment is most effective if given within 48 hours.
Anti-viral medications can be taken after 48 hours and will still reduce the amount of time a
person has flu like symptoms. Treatment can reduce the chances of being hospitalized (CDC,
2014). Zanamivir is an inhaled antiviral that can cause bronchospasm. Osteltmavir is an oral antiviral. A common side effect is gastrointestinal symptoms which can be prevented by taking
medication with food (Nicholson, et al., 2003, p. 1736-1737). Teenagers can experience self-
EVIDENCE-BASED PAPER RELATED TO EMERGING INFLUENZA
harm thoughts as a complication of Osteltmavir. Some forms of influenza are resistant to
Osteltmavir medication (Mayo Clinic, 2015).
Prevention
Prevention of influenza is vaccinations. Vaccinations are made from a virus grown in
hens. They take the virus and inactivate it by chemical called formaldehyde. Since vaccinations
the incidence in flu in people who have been vaccinated was reduced by 52%. Elderly
admissions and people with comorbidities are also reduced by 52% when they were vaccinated.
A new vaccination you can take intranasal is a live virus. The live virus can imitate the actual
virus which may better combat the disease better (Nicholson, et al., 2003, p. 1736-1737).
Inactive virus can be given intramuscularly to people as young as six months. Prevention does
not end with vaccinations. You can also do basic things such as hand washing, coughing or
sneezing into your sleeve or Kleenex and avoiding large groups of people when you’re
contagious (Mayo Clinic, 2015).
Factors/Situations that Promote Influenza
There are some factors that can increase a person’s chances of getting Influenza. The
single most important is the strength of a person’s immune system. Some other causes of
increase influenza are changing environment, malnutrition, international travel and age. Access
to health care can also be a huge factor to protecting yourself against influenza.
Immune System
An immune system has many ways it can ward of an infection when working properly.
Vaccinations have helped the population to have stronger immune systems since it tricks the
body into thinking it already has had the virus. A person may have a compromised immune
system if they have a chronic health condition such as HIV, Cancer, or donor transplant. If a
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person has been on several different types of antibiotics they can also reduce the ability for their
immune system to fight Influenza. Over use of antibiotics can be detrimental because it
decreases the natural bacterial flora that is part of the immune system. Very young or very old
may have more of a chance contracting Influenza. The very young because their immune
systems have not been as exposed as an adult and the very old because many have comorbidities
(Veenema, 2013).
Changing Environment
Climate and severe changes in weather can increase influenza. This is because the
increase in mosquitos which are known for carrying virus’s. Wet weather in general tends to be a
breeding ground for diseases. Zoonotic diseases are the cause of 75% of infectious diseases and
with more areas becoming more urban we are seeing a rise in cross contamination between
humans and animals. Other factors associated with urbanization and the increase of influenza is
poor sanitation and crowded living conditions. Some cities most at risk for influenza are New
York, London and Cairo. With urbanization increasing so has travelling which has made
containing the virus difficult.
Analysis of Evidence
Evidence suggests that the Influenza is rapidly changing and almost impossible to
maintain immunity against. To prevent a pandemic you must understand the potential of a virus
to create subtypes with some of the same characteristics of the original virus. This means that we
need to continue to research so that way we can predict genetic changes. The use of animal
studies has shown us that is not only contagious by droplets but also can be spread through
contact. The amount of cases where the Avian influenza has moved from birds to humans is
increasing (Veenema, 2013). Monitoring outbreaks will help to predict and contain it from
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reoccurring again. The 2009 H1N1 taught how a single person on an airplane can contaminate
many people. By tracking the people who developed H1N1 they were able to determine many of
them became after their flight (Besser et al., 2010)
Improving diagnostic tests to give results quickly will help to start treatment sooner.
Public health measures should be taken to encourage and monitor how many people are getting
vaccinated against Influenza (Fauci, 2006, p.665-670). As stated from Belser (2010) “clinical
trials have shown reduced incidence of influenza infection among contacts of vaccinated
individuals, suggesting that vaccination interrupts the transmission chain by bolstering herd
immunity,” (p.12, para 12). Health initiatives that focus on improved sanitation conditions in
heavily populated areas and health care access to everyone will help aid this battle.
If we were to experience a pandemic would we be ready? In the 20th century there were
four or five pandemics (Nicholson, et al., 2003). Statistics show that many people die from
Influenza. To help prevent more deaths we should invest in emergency preparedness. Hospitals
may have staff shortages, medication may be in short supply, and may run out of medical
equipment with high patient census. There is a spreadsheet used that can help determine how
many will need to be admitted to the hospital and how long the flu will last (Veenema, 2013, p.
435). There are two ways the CDC monitors the amount of deaths from influenza. The two
tracking methods count death certificates that list influenza or pneumonia under the cause of
death. The first is tracking method is “122 Cities Mortality Reporting System” and the data
collected from the National Center for Health Statistics. These two methods are not exact and is
only estimation. Knowing the cause of death can be difficult with influenza since they may have
comorbidities and influenza would only complicate it (CDC, 2014).
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Conclusion
Influenza has been a focus of the CDC and other disease control organizations. This is
because how quickly this virus can mutate and become something we have no protection against.
With their careful monitoring we have been able to control it and have not seen another Spanish
Flu. As people we have power to help control influenza by doing something as little as washing
our hands. If you have fevers stay indoors and do not go to work that day. Seek medical attention
when you have reoccurring temperatures. Bottom line, use common sense so that you do not pass
an illness to someone who may not recover as well as you, such as the elderly lady you bump
into while grocery shopping. The CDC and similar organizations can only do so much and if
people do not take time to become educated and help the battle against infectious diseases, the
battle will be lost.
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References
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http://www.cdc.gov/flu/about/disease/symptoms.htm
Department of Health and Human Services. (2015). Pandemic Flu History. Retrieved from
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De Wit, Emmie, & Fouchier, Ron A.M. (2008). Emerging influenza. Journal of Clinical
Virology, 41(1), 1-6.
Fauci, A. (2006). Emerging and Re-Emerging Infectious Diseases: Influenza as a Prototype of
the Host-Pathogen Balancing Act. Cell, 124(4), 665-670.
Mayo Clinic. (2015). Diseases and Conditions Influenza (Flu). Retrieved from
http://www.mayoclinic.org/diseases-conditions/flu/basics/causes/con-20035101
Veenema, T.G. (2013). Disaster nursing and emergency preparedness for chemical, biological
and radiological terrorism and other hazards (3rd ed.). New York, NY: Springer
Publishing Co.