Post 4: Popular Media Piece

Many Americans Believe They Don’t Need The Flu Vaccine

 Rae Ellen Bichell

http://www.npr.org/sections/health-shots/2015/11/27/456202280/many-americans-believe-they-dont-need-the-flu-vaccine

http://americanpreppersnetwork.com/2012/12/information-about-vaccinations.html

Of the 3000 adults surveyed in a recent NPR survey, 62% of people said they had been vaccinated or plan to get the vaccination for the flu. However for the other quarter of Americans, a series of reasons were presented as to why they opt out of immunization. The most common reasons included that 48% of those people believed that the vaccination was not necessary for them, 16% were worried about side effects, and 14% were worried the vaccination could infect them with the flu., and 8% believed the vaccination would be ineffective.

The seasonal flu alone is responsible for approximately 200,000 hospitalizations in the United States annually, facing over 25,000 deaths each year. The CDC recommends that everyone who is older than 6 months old and has no obvious allergies to the vaccine to become vaccinated because it helps reduce the amount of flu that gets transmitted to other people. Even if one person does not become ill by means of the ill, this person is still susceptible to transmit the illness to someone else.

Shannon Stokley, a epidemiologist who works for the immunization services department of the CDC, elucidates many common misconceptions of people who do not want to get vaccinated: “The virus that is included in the vaccine is either killed or weakened, so you just cannot get the flu from the flu vaccine.”

A study found that flu vaccinations were associated with a 71% reduction in flu-related hospitalizations amongst adults (http://cid.oxfordjournals.org/content/early/2013/02/27/cid.cit124.full.pdf?keytype=ref&ijkey=Xp84ym72BYicJiV)

The Flu can also exacerbate heart disease and asthma- all the more reason to get vaccinated Stokley states. 

http://www.cdc.gov/vaccines/programs/vfc/index.html

This begs the question- should children’s health be in the hands of uninformed, at times potentially negligent parents in full totality? Is there anyway we can reduce the risk uninformed parents instead of further polarizing those who are pro and anti-vaccinations? A step that governmental health agencies or even health cooperations in the private sector could take towards reducing the dichotomy would be to hold workshops, provide pamphlets, websites, and other resources that can inform the general population about the low risks and high benefits of getting vaccinated.  I strongly believe that everyone should have the freedom to maintain autonomy of their own health/body- however when one's freedom and autonomy begins to impede on the health and safety of other individuals we must make the most well educated and well informed decisions possible. And as stated in the article, in the case of vaccinations, the current state of research favors the treatment; and that is the bottom line. Since making vaccinations mandatory seems unlikely to pass as legislation, the next pragmatic option is the assiduous advancement of these public campaigns either in the governmental or private sector in hopes of enhancing population education on the issue and subsequently increasing vaccination rates. 

Post 3: Primary Source

Lack of H5N1 Avian Influenza Transmission to Hospital Employees, Hanoi, 2004 

Nguyen, Liam- World Health Organization International Avian Influenza Investigation Team

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320447/

Background: 

Influenza type A virus is prevalent in birds, humans, etc. One subtype of influenza, H5N1, has infected chickens in several different continents and has spread to humans as well, with a very high mortality rate.

This highly pathogenic avian influenza has been present in sporadic outbreaks in poultry- often reported as “fowl plagues.”  The first fowl plague was reported in Italy in 1878. Due to the human influenza pandemics that happened in the mid twentieth century, more attention was paid to monitoring the virus in avian species by the 1970’s. It was reported that wild waterfowl harbor all of the influenza A virus sub types and these subtypes  (H5 and H7) were primarily responsible for the high mortality in poultry within the United States.  Although the avian influenza occurred all around the world by 1959, the outbreaks were geographically  confined in specific regions within each country, revealing that the diseases were endemic to specific regions. However, due to globalization, H5N1 influenza virus has spread across the globe significantly. One additional factor that may have contributed to the avian influenza outbreak is the increase of poultry production and dissemination by a factor of 436% since 1970. Because the demand for poultry has risen significantly, there has been a subsequent increase in intensive poultry production which often leads to over crowded facilities with poor health conditions for the animals and easier spread of disease due to closer contact. Furthermore, higher demands for poultry has also led to genetic modifications for breeding mechanisms (for greater production), leading to less genetic diversity and subsequent higher susceptibility for disease and infection. The infection from avian to human populations is deadly, but rare and often occurs when one comes into contact with diseased birds.

A photo of avian influenza in chicken stomach cells

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3320447/

Primary Source Synopsis and Analysis: 

In this article, a cross sectional survey was administered amongst employees in a hospital in Vietnam  who were exposed to H5N1 patients to see if human to human transmission of influenza type A occurred. Because of the host barriers to infection (different cell receptors) avian to human transmission of influenza is rare, as it requires either a genetic mutation or genetic reassortment with a human influenza strain. However the study of household and social contacts of Hong Kong H5N1 patients revealed that human to human transmission of H5N1 viruses of purely avian origin is possible. The main concern is that if this highly pathogenic influenza virus has the ability to transmit from person to person it could cause a potential influenza pandemic. However, research is showing that although human to human transmission is possible, it is not sustainable, but over time with genetic alterations, the potential for the H5N1 to act differently exists.

From December 27, 2003, to January 19, 2004 four children from the age of four to twelve were confirmed to have H5N1 infection and there was one case of probable infection, who were admitted to the National Pediatric Hospital in Hanoi, Vietnam. Employees who came in contact and had possible exposure to the patients with (or with potential infection) H5N1 were surveyed and tested for signs of potential infection. Of the 83 surveyed hospital employees none tested positive for antibodies to influenza A H5N1. There are a number of potential reasons why none of the employees tested positive for the disease. These include the “lack of infectivity of the patients at the time of admission, the effective use of personal protective equipment (PPE) and infection control, low sensitivity of the antibody detection method, lack of susceptibility of HCWs, or a lack of transmissibility of this particular H5N1 strain."

A Vietnamese nurse with a patient infected with H5N1 in the National Pediatric Hospital in Hanoi

http://english.vietnamnet.vn/fms/society/98281/another-a-h1n1-death-confirmed-in-vietnam.html

Although the risk for the human to human transmission of the avian H5N1 virus is low, I believe that the fatal cases of recent H5N1 cases reveal the vital importance of hospital staff taking serious protective measures to ensure the spread of disease is limited and safety and health of other patients and health care workers. Effective use of personal protective equipment can include proper usage of face masks, gloves, and body suits in potentially infectious scenarios or encounters. This represents a very vital preventative measure health care employees and physicians must prioritize when dealing with patients with all transmissible infections- but especially so in the case of the avian influenza, whose nature of transmission is not fully understood at this time.   

The article ends with stating that the risk of human to human transmission of the H5N1 virus could increase in the future so every H5N1 case should be monitored and managed by health care workers and physicians to ensure that the spread is controlled as much as possible. A potential study that can be done is whether exposure to the avian influenza will impact  the susceptibility of any of the 83 health care employees in the face of future influenza type A or B exposures in the future. This cross sectional survey can be done over a period of several years by monitoring the infection rates of health care workers who were exposed to the H5N1 versus health care employees who had no exposure to H5N1. Infection rates can then be compared to determine if there is any potential association exposure to H5N1 and ones susceptibility to future cases of influenza. 

Post Two: Transmission & Treatment

Influenza is a lower respiratory illness and the several types include types A, B, and C. Their differences are a result of varying nucleoprotein antigens. Although no one is truly immune to catching the flu, certain groups of people such as infants, elderly, pregnant women, and people who are traveling abroad are at increased risk for catching the flu due to varying factors such as weaker immune systems or greater contact and exposure to pathogens (due to exposure in more crowded places such as elementary schools, nursing homes, and airplanes).  However, the influenza endemic also occurs amongst birds, seals, horses, and pigs.

The incubation period for the virus is approximately 2 days, however the disease can remain in the host and symptoms may never emerge. During this period, the host can pass along the virus to another susceptible host via sneezing, coughing, or coming into contact with another infected surface. The infected droplet is inhaled by the host (either orally or through the nasal passage) and then carried to the lungs. Then the hemmagglutinn of the influenza attaches to cell receptors on the ciliated epithelium- in a lock and key mechanism- and then viruses enters into the cell. Then we see the host cell begins to produce more of the viral nucleoproteins and eventually the cell gets destroyed and the virus is released as it matures. Secondary infections can be spread to ears, sinuses, and lungs. Symptoms of influenza include fever, fatigue, headache, and muscle soreness. 

                     http://oregonstate.edu/instruct/bb450/fall14/lecture/carbohydratesnotes.html

Due to antigenic shifts, and the accumulation of subtle changes in the influenza gene virus, different strains of the virus can occur as a result of a  new hemmagglutinn that allows the viral cell to trickle past the immune system unrecognized. These changes in viral strains are one of the primary factors that cause influenza to reemerge as an epidemic in human populations all throughout the world. 

According to the CDC, Influenza A (31 % of all cases) and B  (44%) viruses were most prevalent in Africa,  while in South America influenza A (32%) and influenza B (32%) were predominantly found, and in North America, 69% of influenza cases were identified as being influenza A viruses (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5939a3.htm). 

Although influenza is a very morbid disease and it is estimated to cause up to 40,000 deaths annually in the US alone (http://www.cdc.gov/flu/about/disease/us_flu-related_deaths.htm), along with other severe health complications, it is preventable.

  The first method of prevention is vaccination- a method that has an approximate 80-90% efficacy rate for sixth months, according to the CDC (http://www.cdc.gov/flu/about/qa/vaccineeffect.htm).

 In my opinion the next best method for preventing the influenza virus would be to monitor viral exposure by continually washing one's hands, avoiding crowded, confined places during flu season, and the continual sanitation of infectious fomites such as desk, counter tops, door knobs, etc.  

Treatment of the influenza virus includes oral antiviral medications such as Tamiflu and Rapivab that are effective against influenza type A and B. Other treatments recommended for treating the symptoms and severity of influenza A include Rimantadine and Amantadine.  

Disease management of influenza includes both managing the spread of disease and preventing its onset. The CDC recommends that all persons 6 months and older get an annual influenza vaccination (http://emedicine.medscape.com/article/219557-treatment). This would help minimize the spread of the influenza virus, and (hopefully) subsequently prevent the spread of the virus throughout the population.

                                   http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5838a2.htm

Influenza- Background & Basics

History of disease- The Influenza Pandemic occurred in several larger waves that began in 1918. The first Influenza Pandemic of 1918-1919 was also coined "The Spanish Flu" because it was thought to have spread from Spanish migrant workers who would travel from France to Spain in unsanitary working conditions (although nearly a century later, epidemiologists confirm that the influenza virus did not in fact originate in Spain). The influenza then rapidly spread through close contact in trenches, crowded barracks, trading routes and shipping lines.  The pandemic killed anywhere between 20-50 million people world wide (http://cid.oxfordjournals.org/content/47/5/668.full) Furthermore, the influenza pandemic infected 28% of all Americans, and killed nearly 675,000 people (https://virus.stanford.edu/uda/)

The next large outbreak was from 1957-1958 that impacted the United States in a series of smaller outbreaks. According to Flu.gov, infection rates were highest amongst school children, young adults, and pregnant women (http://www.flu.gov/pandemic/history).

The 1968-1969 pandemic presented the next largest outbreak that originated in Hong Kong. This outbreak accelerated treatment and antibiotics for treating secondary bacterial infections.

In 2009-2010 a flu virus emerged in the United States and around the world by the name of H1N1- other words known as swine flu. According to the CDC 74 countries were impacted by the virus- and within the United States 48 states were affected with an estimated 43-89 million cases of H1N1, with an estimated 8,870 and 18,300 H1N1 related deaths (http://www.flu.gov/pandemic/history/)

According to the CDC,  between 1976 and 2006, 10,000-40,000 people die each year  on average in the United States as a result of Influenza (http://www.cdc.gov/flu/about/disease/symptoms.htm).

Etiology-

The Influenza Flu is a infectious disease that has several different types: Influenza A, B or C (Influenza A belonging to the Orthomyxoviridae family). The flu is transmitted from person to person through droplets of infected hosts through coughing, sneezing, or even talking. The virus can be spread through the inhalation of droplets, or merely by touching a surface that is infected but the virus and then touching ones mouth or nose.

Clinical Symptoms- 

Symptoms of the flu can begin 1-4 days after the viruses has infected the body. This means that a healthy adult can spread the flu to others before symptoms even emerge- and are able to infect others from 5-7 days after the becoming ill. Children can spread the flu for longer than 7 days. (http://www.cdc.gov/flu/about/disease/spread.htm)

Symptoms include fever, cough, sore throat, runny or stuffy nose, muscle aches, headaches, and fatigue. Although most cases of individuals with the flu recover after the illness has run its course, some people can develop more severe complications such as pneumonia and bronchitis.

Detection Methods-

If obvious symptoms of coughing, fever, fatigue and muscle pain are not present, patients can either see a physician or get screen for a rapid influenza diagnostic tests (RIDTs), and obtain their results within 30 minutes to confirm a diagnosis. (http://www.cdc.gov/flu/professionals/diagnosis/rapidlab.htm)

http://www.cdc.gov/flu/