Influenza (Seasonal)

Key facts

• Influenza is an acute viral infection that spreads easily from person to person.
• Influenza circulates worldwide and can affect anybody in any age group.
• Influenza causes annual epidemics that peak during winter in temperate regions.
• Influenza is a serious public health problem that causes severe illnesses and deaths for higher risk populations.
• An epidemic can take an economic toll through lost workforce productivity, and strain health services.
• Vaccination is the most effective way to prevent infection.

Overview

Seasonal influenza is an acute viral infection caused by an influenza virus.

There are three types of seasonal influenza – A, B and C. Type A influenza viruses are further typed into subtypes according to different kinds and combinations of virus surface proteins. Among many subtypes of influenza A viruses, currently influenza A(H1N1) and A(H3N2) subtypes are circulating among humans. Influenza viruses circulate in every part of the world. Type C influenza cases occur much less frequently than A and B. That is why only influenza A and B viruses are included in seasonal influenza vaccines.

Signs and symptoms

Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and runny nose. Most people recover from fever and other symptoms within a week without requiring medical attention. But influenza can cause severe illness or death in people at high risk (see below). The time from infection to illness, known as the incubation period, is about two days.

Who is at risk?

Yearly influenza epidemics can seriously affect all age groups, but the highest risk of complications occur among children younger than age two, adults age 65 or older, and people of any age with certain medical conditions, such as chronic heart, lung, kidney, liver, blood or metabolic diseases (such as diabetes), or weakened immune systems.

Transmission

Seasonal influenza spreads easily and can sweep through schools, nursing homes or businesses and towns. When an infected person coughs, infected droplets get into the air and another person can breath them in and be exposed. The virus can also be spread by hands infected with the virus. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.

Treatment

Antiviral drugs for influenza are available in some countries and effectively prevent and treat the illness. There are two classes of such medicines, 1) adamantanes (amantadine and remantadine), and 2) inhibitors of influenza neuraminidase (oseltamivir and zanamivir). Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. WHO monitors antiviral susceptibility in the circulating influenza viruses.

Seasonal epidemics

Influenza epidemics occur yearly during autumn and winter in temperate regions. Illnesses result in hospitalizations and deaths mainly among high-risk groups (the very young, elderly or chronically ill). Worldwide, these annual epidemics result in about three to five million cases of severe illness, and about 250 000 to 500 000 deaths. Most deaths associated with influenza in industrialized countries occur among people age 65 or older. In some tropical countries, influenza viruses circulate throughout the year with one or two peaks during rainy seasons.

Disease effects

Influenza can cause serious public health and economic problems. In developed countries, epidemics can result in high levels of worker absenteeism and productivity losses. In communities, clinics and hospitals can be overwhelmed when large numbers of sick people appear for treatment during peak illness periods. While most people recover from a bout of influenza, there are large numbers of people who need hospital treatment and many who die from the disease every year. Little is known about the effects of influenza epidemics in developing countries.

Prevention

The most effective way to prevent the disease or severe outcomes from the illness is vaccination. Safe and effective vaccines have been available and used for more than 60 years. Among healthy adults, influenza vaccine can prevent 70% to 90% of influenza-specific illness. Among the elderly, the vaccine reduces severe illnesses and complications by up to 60%, and deaths by 80%.

Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with or care for high risk individuals.

WHO recommends annual vaccination for (in order of priority):

• nursing-home residents (the elderly or disabled)
• elderly individuals
• people with chronic medical conditions
• other groups such as pregnant women, health care workers, those with essential functions in society, as well as children from ages six months to two years.

Influenza vaccination is most effective when circulating viruses are well-matched with vaccine viruses. Influenza viruses are constantly changing, and the WHO Global Influenza Surveillance Network (GISN), a partnership of National Influenza Centres around the world, monitors the influenza viruses circulating in humans. WHO annually recommends a vaccine composition that targets the three most representative strains in circulation.

Definition of Influenza

The flu is caused by viruses that infect the respiratory tract which are divided into three types, designated A, B, and C. Most people who get the flu recover completely in 1 to 2 weeks, but some people develop serious and potentially life-threatening medical complications, such as pneumonia. Much of the illness and death caused by influenza can be prevented by annual influenza vaccination.

In focus: external review of pandemic response begins

An in-depth review by external experts to assess the global response to the pandemic and identify lessons for the future is underway. The Review Committee will also examine the general functioning of the International Health Regulations.

Report of the review meetinf of the first comitee

The abuse of mediatic coverage on Swine Flu AH1N1

A dramatic documentary that tells the evidence in detail and numbers behind the swine flu and all the media attention received.
It is no secret that the swine flu pandemic is one of the most attention received in the history of mankind. The media has supported a monstrous campaign about a disease that has become even less  victims that common diseases existed for decades and with no newspapers headers.
For more information, see this interesting documentary covering forgotten aspects of influenza A (H1N1), the origins of Tamiflu and its side effects, the names of the people involved and events that bring us closer to the reality of a big lie. (in spanish)

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Antigenic shift

 

The genetic change that enables a flu strain to junp from one animal species to another, including humans, is called “antigenic shift”.

In this graphic you can see the explanation:

 

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Airports are using thermal imaging cameras to see if travelers have fevers.

 

 

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Influenza pandemic alert raised to phase 6

 

11.June.2009

Dr Margaret Chan
Director-General of the World Health Organization

  

“Ladies and gentlemen,

A characteristic feature of pandemics is their rapid spread to all parts of the world. In the previous century, this spread has typically taken around 6 to 9 months, even during times when most international travel was by ship or rail.

Countries should prepare to see cases, or the further spread of cases, in the near future. Countries where outbreaks appear to have peaked should prepare for a second wave of infection.

Guidance on specific protective and precautionary measures has been sent to ministries of health in all countries. Countries with no or only a few cases should remain vigilant.

Countries with widespread transmission should focus on the appropriate management of patients. The testing and investigation of patients should be limited, as such measures are resource intensive and can very quickly strain capacities.

WHO has been in close dialogue with influenza vaccine manufacturers. I understand that production of vaccines for seasonal influenza will be completed soon, and that full capacity will be available to ensure the largest possible supply of pandemic vaccine in the months to come.

Pending the availability of vaccines, several non-pharmaceutical interventions can confer some protection.

WHO continues to recommend no restrictions on travel and no border closures.

Influenza pandemics, whether moderate or severe, are remarkable events because of the almost universal susceptibility of the world’s population to infection.

We are all in this together, and we will all get through this, together.

Thank you.”

 

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Swine Influenza Symptoms A(H1N1)

Although uncomplicated influenza-like illness (fever, cough or sore throat) has been reported in many cases, mild respiratory illness (nasal congestion,  rhinorrhea) without fever and occasional severe disease also has been reported. Other symptoms reported with swine influenza A virus infection include vomiting, diarrhea, myalgia, headache, chills, fatigue, and dyspnea. Conjunctivitis is rare, but has been reported. Severe disease (pneumonia, respiratory failure) and fatal outcomes have been reported with swine influenza A virus infection. The potential for exacerbation of underlying chronic medical conditions or invasive bacterial infection with swine influenza A virus infection should be considered.

 

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Advice on the use of masks in the community setting in Influenza A (H1N1) outbreaks

Background
At present, evidence suggests that the main route of human-to-human transmission of the new Influenza A (H1N1) virus is via respiratory droplets, which are expelled by speaking, sneezing or
coughing.
Any person who is in close contact (approximately 1 metre) with someone who has influenza-like symptoms (fever, sneezing, coughing, running nose, chills, muscle ache etc) is at risk of being
exposed to potentially infective respiratory droplets.
In health-care settings, studies evaluating measures to reduce the spread of respiratory viruses suggest that the use of masks could reduce the transmission of influenza.2 Advice on the use of
masks in health-care settings is accompanied by information on additional measures that may have impact on its effectiveness, such as training on correct use, regular supplies and proper
disposal facilities. In the community, however, the benefits of wearing masks has not been established, especially in open areas, as opposed to enclosed spaces while in close contact with
a person with influenza-like symptoms.
Nonetheless, many individuals may wish to wear masks in the home or community setting, particularly if they are in close contact with a person with influenza-like symptoms, for example
while providing care to family members. Furthermore, using a mask can enable an individual with influenza-like symptoms to cover their mouth and nose to help contain respiratory droplets,
a measure that is part of cough etiquette.
Using a mask incorrectly however, may actually increase the risk of transmission, rather than reduce it. If masks are to be used, this measure should be combined with other general measures to help prevent the human-to-human transmission of influenza, training on the correct use of masks and consideration of cultural and personal values.

General advice
It is important to remember that in the community setting the following general measures may be more important than wearing a mask in preventing the spread of influenza.

For individuals who are well:
Maintain distance of at least 1 metre from any individual with influenza-like symptoms, and:
• refrain from touching mouth and nose;
• perform hand hygiene frequently, by washing with soap and water or using an alcoholbased
handrub 3 , especially if touching the mouth and nose and surfaces that are
potentially contaminated;
• reduce as much as possible the time spent in close contact with people who might be ill;
• reduce as much as possible the time spent in crowded settings;
• improve airflow in your living space by opening windows as much as possible.

For individuals with influenza-like symptoms:
• stay at home if you feel unwell and follow the local public health recommendations;
• keep distance from well individuals as much as possible (at least 1 metre);
• cover your mouth and nose when coughing or sneezing, with tissues or other suitable
materials, to contain respiratory secretions. Dispose of the material immediately after use
or wash it. Clean hands immediately after contact with respiratory secretions!
• improve airflow in your living space by opening windows as much as possible.
If masks are worn, proper use and disposal is essential to ensure they are potentially
effective and to avoid any increase in risk of transmission associated with the incorrect
use of masks. The following information on correct use of masks derives from the practices in
health-care settings4:
• place mask carefully to cover mouth and nose and tie securely to minimise any gaps
between the face and the mask
• while in use, avoid touching the mask
− whenever you touch a used mask, for example when removing or washing, clean
hands by washing with soap and water or using an alcohol-based handrub
• replace masks with a new clean, dry mask as soon as they become damp/humid
• do not re-use single-use masks
− discard single-use masks after each use and dispose of them immediately upon
removing.

Although some alternative barriers to standard medical masks are frequently used (e.g. cloth mask, scarf, paper masks, rags tied over the nose and mouth), there is insufficient information
available on their effectiveness. If such alternative barriers are used, they should only be used once or, in the case of cloth masks, should be cleaned thoroughly between each use (i.e. wash
with normal household detergent at normal temperature). They should be removed immediately after caring for the ill. Hands should be washed immediately after removal of the mask.

 

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Clean hands protect against infection

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Washington Man Is Third U.S. H1N1 Death

(CBS/AP) Washington state health officials say a man in his 30s is the first person in the state - and the third in the U.S. - to die from what appears to be complications of the H1N1 virus, also known as swine flu.
The state Department of Health says in a news release that, like the first two U.S. H1N1 victims, the Snohomish County man had underlying heart conditions and also viral pneumonia at the time of his death May 6, but that he also had swine flu and it is considered a factor in the death.
"This death is tragic. Our thoughts are with all those affected by this man's passing," said Governor Chris Gregoire. "It's a sobering reminder that influenza is serious, and can be fatal."
The man was not further identified.
He reportedly began showing symptoms on April 30, and was treated with medications.
Health officials cautioned that the number of cases of swine flu in Washington are expected to continue rising for some time to come, and urged people to continue to practice preventive measures, such as frequent hand washing.
"We're working with local and federal partners to track this outbreak," said Secretary of Health Mary Selecky, "and while most illnesses from this new flu strain have been fairly mild, we must remember that influenza claims about 36,000 lives every year nationwide. That's why we urge people to take this outbreak, and the seasonal flu we see every year, very seriously."
Health officials said earlier Saturday that an additional 18 cases of swine flu have been confirmed in Washington, bringing the state's total to 101.

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Important Update: About antiviral drugs against influenza A(H1N1)

 

For what purposes can antiviral drugs be used against influenza A(H1N1)?

So far most people who have contracted the new A (H1N1) virus have experienced influenza-like symptoms (such as sore throat, cough, runny nose, fever, malaise, headache, joint/muscle pain) and recovered without antiviral treatment.

Antiviral drugs may reduce the symptoms and duration of illness, just as they do for seasonal influenza. They also may contribute to preventing severe disease and death. Influenza A (H1N1) is a new virus and only a small number of people with the infection have been treated for it with antiviral drugs. WHO is in touch with public health authorities and clinicians in affected countries and is gathering information about how effective the drugs are.

To which antiviral drugs does this influenza virus respond?

There are two classes of antiviral drugs for influenza: inhibitors of neuraminidase such as oseltamivir and zanamivir; and adamantanes, such as amantadine and rimantadine. Tests on viruses obtained from patients in Mexico and the United States have indicated that current new H1N1 viruses are sensitive to neuraminidase inhibitors, but that the viruses are resistant to the other class, the adamantanes.

Could the virus become resistant to oseltamivir and zanamivir?

Resistance can develop to antiviral drugs used for influenza. Therefore, WHO and its partners are monitoring antiviral drug resistance.

Under what circumstances should antiviral drugs be administered?

Antiviral drugs are to be used according to national pandemic influenza preparedness plans. Public health authorities in some countries have decided to treat patients likely to have this disease as a part of public health measures.

Where antiviral drugs are available for treatment, clinicians should make decisions based on assessment of the individual patient's risk. Risks versus benefits should also be evaluated on a case by case basis.

What is WHO doing about getting antiviral drugs to countries as preparation for a pandemic?

WHO’s first priority is to provide an emergency stock of antiviral drugs to countries that have no or insufficient stock of the drugs and lack the capacity to procure these drugs themselves.

WHO is also working with Member States, donors and other groups that have stockpiles and are willing to share these with WHO for distribution to countries in need.

Which drug will be provided, and how much of it does WHO have available?

WHO had a global stockpile of approximately 5 million adult treatment courses of oseltamivir. Part of this stockpile has already been distributed through the WHO Regional Offices, which are handling allocation and distribution. WHO is currently distributing the remaining 3 million adult treatment courses of this stockpile to developing countries in need.

WHO continues to assess needs and to work with manufacturers to secure more donations of antivirals. More antiviral drugs will be distributed once these donations are received.

Which countries will receive the drug, and how will they be selected?

WHO has arranged the first deployment of antiviral drugs from the WHO stockpile to 72 countries. Priority was given to vulnerable countries, taking into consideration national manufacturing and procurement capacity. As necessary, other countries will be supported through regional office stockpiles.

What if the initial emergency deployment turns out to be inadequate?

WHO is in discussion with manufacturers regarding the potential need for scaling up production. It is WHO’s understanding that manufacturers have plans for producing large numbers of treatments quickly.

WHO will work on behalf of its Member States to secure further antivirals as needed, either through donations or purchase at the lowest possible price.

 

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