Why all the fuss? Influenza.

RainbowLPN · Dec 15, 2003

Every year many people die on complications of the flu. One thing the media does not tell people is the fact that what we are getting vacinated against is only a guess of what might make us sick. I feel it is very important for the people that would be most affected by the flu get the vacine, but there is no reason to scare people like the media has. Also the fact that you may still get some type of flu even if you are vacinated should also be revealed.

mother/babyRN, RN · Dec 15, 2003

Yep. and duly noted....

Erin RN · Dec 15, 2003

Although influenza is influenza is influenza..I wondering about the mutations..Doesn't it make sense that a particular mutation could increase both virulence/ pathogenicity of that particular strain. Meaning the virus is much more easily able to infect people therefore more people are coming down with it? I do not know whether or not mutations could cause people to become more ill or for longer since I am not an infectious disease specialist but it would make sense that the more people infected would of course result in higher mortality numbers. Maybe the fact that this strain is more virulent would account for the reason that many "healthy" individuls are falling ill that have never contracted the illness before..

mattsmom81 · Dec 15, 2003

I would sure like to see more education vs speading of paranoia.

Particularly on the wisdom of keeping in a good state of health so we can ward off these viruses or at least limit their effects.

When to go to the doc, when to go to the ER is great info for the media to impart. Wish they WOULD do more of it. Sounds like a great career for NURSES to try to move into....media preventative care :)

a_crftyldy · Dec 15, 2003

In microbiology last spring I had to do a presentation on the Influenza outbreak of 1918. It was interesting to discover that it originally came from an avian strain that subdivided into a human and swine variation. At some point, most likely in a human, the two strains infected a single individual simultaneously and mutated into the deadly virus that occured that year. It is thought and feared, that another virus like that can occur again. The following exerpt is out of my microbiology book and might help shed some light into this subject.

The Influenza Virus

Viruses in the genus Influenzavirus consist of eight separate RNA segments of differing lengths enclosed by an inner layer of protein and an outer lipid bilayer. Embedded in the lipid bilayer are numerous projections that characterize the virus. there are two types of projections: hemagglutinin (H) spikes and neuraminidase (N) spikes .

The H spikes, of which there are about 500 on each virus, allow the virus to recognize and attach to body cells before infecting them. Antibodies against the influenza virus are directed mainly at these spikes. The term hemagglutinin refers to the agglutination of red blood cells (hemagglutination) that occurs when the viruses are mixed with them. This reaction is important in serological tests, such as the hemagglutination inhibition test often used to identify influenza and some other viruses.

The N spikes, of which there are about 100 per virus, differ from the H spikes in appearance and function. Apparently they enzymatically help the virus separate from the infected cell as the virus exits after intracellular reproduction. N spikes also stimulate the formation of anitbodies, but these are less important in the body's resistance to the disease than those produced in response to the H spikes.

Viral strains are identified by variation in the H and N antigens. The different forms of the antigens are assigned numbers-- for example, H1, H2, H3, N1, and N2. Each number change represents a substantial alteration in the protein makeup of the spike. These changes are called antigenic shifts, and they are great enough to evade most of the immunity developed in the human population. This ability is responsible for the outbreaks, including the pandemics of 1918, 1957, and 1968. Incidentally, influenza viruses were not isolated before 1933, and the antigenic makeup of viruses causing outbreaks before this time depended on analysis of antibodies taken from persons who had been infected.

Antigenic shifts are probably caused by a major genetic recombination. Because influenza viral RNA occurs as eight segments, recombination is likely in infections caused by more than one strain. Recombination between the RNA of animal viral strains (found in swine, horses, and birds, for example) and the RNA of human strains might be involved. Swine, ducks, and chickens (especially swine, which can be infected by both human and fowl influenza strains) in Southern Chinese farming communities have come under suspicion as being the animals most likely to be involved in genetic shifts (and thus called "mixing vessels"). Wild ducks and other migratory birds then become symptomless carriers that spread the virus over large geographic areas.

Epidemiology of Influenza

Between episodes of such major antigenic shifts, there are minor annual variations in the antigenic makeup called antigenic drift. The virus might still be designated as H3N2, for example, but viral strains arise reflecting minor antigenic changes within the antigenic group. These strains are sometimes assigned names related to the locality in which they were first identified. They usually reflect an alteration of only a single amino acid in the protein makeup of the H or N spike. Such a minor, one-step mutation is probably a response to selective pressure by antibodies (usually IgA in the mucous membranes) that neutralizes all viruses except for the new mutations. Such mutations can be expected about once in each million multiplications of the virus. High mutation rates are characteristic of RNA viruses, which lack much of the "proofreading" ability of the DNA viruses.

The usual result of antigenic drift is that a vaccine effective against H3, for example, will be less effective against H3 isolates circulating 10 years after the event. There will have been enough drift in that time that the virus can largely evade the antibodies originally stimulated by the earlier strain.

Influenza viruses are also classified into major groups according to the antigens of their protein coats. These groups are A, B, and (rarely) C. The A-type viruses are responsible for the major pandemics. The B-type virus also circulates and mutates, but it is usually responsible for more geographically limited and milder infections.

Thus far, it has not been possible to make a vaccine for influenza that gives long-term immunity to the general population. Although it is not difficult to make a vaccine for a particular antigenic strain of virus, each new strain of circulating virus must be identified in time, usually about February, for the useful development and distribution of a new vaccine for later that year

source: Microbiology, An Introduction (seventh edition) by Tortora, Funke, and Case; published 2001 by Benjamin Cummings, an imprint of Addison Wesley Longman, Inc

Quailfeather · Dec 16, 2003

Wow, this thread has been valuable; if for no other reason, it has inspired me to actually do some research on the current flu outbreaks. Until now, I have just bemoaned the fact that it is crazy at work because of the higher patient volumes d/t the flu. I have to agree that the media has created some panic in folks, mainly because they are reporting morbidity and mortality and doing little to give reassuring information on what to do if you have the flu. Anyway, I went to the CDC website and spent a couple of hours reading everything that they had on the flu. Here are a few excerpts from a teleconference that was held on 12/11:

We don't have scientific evidence or epidemiologic evidence to suggest that this year's influenza outbreak is worse than it has been in in the past or that the strain is more virulent than strains that we've dealt with before. It's just simply too early in the course of the outbreak to say for sure how this will compare overall, but obviously the early start and the early widespread activity has given us a great deal of concern, and obviously, it's concerned a lot of people, and that's why there's been such an interest in getting the vaccination this year.

We know that the predominant virus this year is H3N2 strain. 75 percent of those are the Fujian strain, which is the strain that is not in the vaccine, but again, we're hopeful that vaccine will provide protection for this strain, given the laboratory evidence that we have and past experience when we've had slight mismatches between vaccine and circulating influenza strains of this type.

In addition, it's important to remember that for healthy people, for the vast majority of us, influenza is an annoying illness, it's certainly not fun, but it's something that we will recover from with common sense self care. It's not necessary to go to the emergency room or to visit a physician simply because you have the flu. The treatment is good old-fashioned rest, fluids and the over-the-counter medications that we typically use to treat symptoms.

It would be nice if the news could report some of this information, instead of focusing on the shortage of vaccine and recent deaths. I am certainly not saying that the deaths are not newsworthy, I just feel that these tragic occurances should be balanced with helpful information that gives the public some optimism, rather than a doomsday scenario. The people that are presenting to our ER are terrified! And most of them are in their 20's and 30's, rather than the very young and the elderly who are more likely to need medical attention when the flu strikes. I agree that nurses would be good candidates to educate the public through the media. Every news broadcast ought to have a nurse anchor!

If anyone is interested in reading transcript of the entire teleconference, the link is:

http://www.cdc.gov/od/oc/media/transcripts/t031211.htm

a_crftyldy · Dec 16, 2003

The vast majority of the people who died in the great flu outbreak of 1918 where healthy young adults in their 20's, 30's, and 40's, which is another thing that made that flu so unusual. Most victims of the flu are the very young, and the very old as well as any who is already immunocompromised. Also, most people who die of the flu don't exactly die from the virus itself but rather complications that set in, such as pneumonia. Plus, you have to remember that we had SARS running rampant not too long ago, on top of all the terror threats and anthrax scares (which produces flu-like symptoms in its prodrome stage), it's no wonder some people are terrified. And let's face it, there will always be people out there who will make mountains out of molehills.

Q. · Dec 16, 2003

Originally posted by SharonMH31
Without a doubt, influenza is very serious. I always hated working in acute care this time of year whether it was adult med-surg or peds because the beds would be filled with people trying to breathe.

BUT there is no doubt the media is hyping it. Aside from the news reports and the national media, the local media here in Atlanta runs the story in the morning, noon and evening. We are shown a picture of a man getting what is supposedly the last flu vaccine in the entire city of Atlanta(never mind that we just got in a shipment of a 1000 doses that same morning) and we are shown pictures of anxious parents with captions like "desperate mother" as they detail their attempts to get their children vaccinated. This is all followed up with reports on the number of people who are dying from the flu, especialy children. That type of reporting creates a sense of panic in people who believe that their own illness and subsequent demise from the common flu is imminent. In fact, every time one of those stories runs, the employee health clinic where I work is inundated with desperate and scared people who are frightened out of their minds about what they are seeing.

There's no balance. The truth is that the flu kills thousands every year and while this year may be worse, the same people who are most at risk this year are the same ones who were most at risk last year. That doesn't mean that it isn't serious, but there should be some perspective and common sense about it.

EXCELLENT post!!

CarVsTree · Dec 17, 2003

The U.S. death toll surged fourfold from 16,263 in 1976-77 to 64,684 in 1998-99, the Centers for Disease Control and Prevention reported. Flu deaths now average about 36,000 a year, up from 20,000 in previous estimates, the CDC said.
Colorado already has had more influenza cases in the first 1 1/2 months of this season than in the previous two seasons combined. "We do not have any information yet on the type of flu we're seeing," Parmenter said.
Influenza viruses get their names from the cities or countries of origin. Certain A strains, those that are further characterized as H3N2, are most likely to cause severe cases of flu. Both A-Panama and A-Fujian are H3N2 flu viruses.

It's NOT Nothing! Bet it wouldn't be nothing if it was your kid.

WV_heart_RN · Dec 17, 2003

I agree with everybody else. That post was sooo rude and uncaring. IF they were asking a legitimate question they could have worded it differently to say the least. My five year old and I both are recovering from the flu plus complications. I had him in the emergency room twice and the doctor's office twice. I asked the doc if I was overreacting and she said,"NO, bring him back anytime you think he is getting worse." Yesterday, after another visit to the doc's office we found out we both have severe bronchitis.

We have been ill for going on two weeks now. fever, coughing that feels like a lung is coming up, and body aches I would n't wish on anybody!!! AND I HAD THE FLU SHOT!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

That is why the media is constantly commenting on the flu. It is very bad and very difficult to get over too!

jeanrnurse · Dec 23, 2003

Interesting disucssion. Although I, like many people, have tended to think that the flu is not a huge deal for most healthy people, (and since I have never gotten the flu OR had a shot, until this year)--this year does seem to be hitting children very hard.

To put things into perspective, 17-30,000 people die from it worldwide, while only 800 people died from SARS last year.

Look at the media hype from THAT! Maybe flu doen't get ENOUGH hype, and a lot of us should respect it more.

Snce I'm a former ICU nurse, I guess I didn't think anything was a big deal unless someone had their brains oozing out their ears!

ktwlpn, LPN · Dec 27, 2003

Originally posted by Jean Roberson
Interesting disucssion. Although I, like many people, have tended to think that the flu is not a huge deal for most healthy people, (and since I have never gotten the flu OR had a shot, until this year)--this year does seem to be hitting children very hard.
To put things into perspective, 17-30,000 people die from it worldwide, while only 800 people died from SARS last year.
Look at the media hype from THAT! Maybe flu doen't get ENOUGH hype, and a lot of us should respect it more.
Snce I'm a former ICU nurse, I guess I didn't think anything was a big deal unless someone had their brains oozing out their ears!

I know it has kicked my orifice....After missing a week with the sx of flu I went back to work for 2 days and went into bronchitis and a week later I still feel like poop on a waffle...