Category: Flu

Introduction

In 1918, the world saw the spread of one of the deadliest global pandemics in history known as the Spanish Influenza. The H1N1 virus was unique as it predominately affected young individuals. The origin of the virus remains unknown to this day, but many believe it to have originated in America, eventually spreading to Europe and Asia (Reid et al., 1999). Due to the lack of vaccinations and effective treatments, the number of flu cases skyrocketed, resulting in devastating public health consequences.

To address this, pandemic health and government officials had to take unprecedented measures and develop new means of containing the inter-community spread of the virus. Public authorities attempted to prevent the transmission of the influenza virus by enforcing quarantine, public education, and the creation of new regulations for public spaces.

Summary

The Spanish Influenza was a global pandemic lasting from 1918 up to 1920. It infected at least 500 million people, causing acute illness for 25-30% of the world’s population, resulting in an estimated 40 million deaths (Taubenberger, 2006). Sequencing the virus has been a challenging undertaking by several researchers during the 20th century. Eventually, the technology helped identify that the H1N1 influenza virus caused the Spanish Influenza with genes derived from avian-like and swine influenza virus strains. The specific 1918 H1N1 genome was unique, resulting in a mortality rate of 5-20% higher than usual for influenza, due to a higher proportion of complications of infection in the respiratory tract rather than other organ systems (Taubenberger, 2006).

The infected experienced typical flu symptoms of fatigue, fever, and chills, but as the disease became more deadly, victims began to die in a matter of days, if not hours, with observed cyanosis and fluid filling the lungs. An unusually young age group was most affected by the mortality rate, with many children and healthy young or middle-aged adults dying. Furthermore, waves of influenza activity exacerbated the public health problem, which resulted in three outbreaks in one year that is highly unusual (Taubenberger, 2006).

There are multiple hypotheses regarding the origin of the Spanish Influenza. Historians such as Alfred Crosby (2003) suggested the virus originated in Kansas, U.S.A. One of the first reported cases of the virus had been diagnosed on March 11, 1918, in Fort Riley, with unsanitary conditions leading to outbreaks in the city and later other military installments in the United States. Later, researchers suggested that the Kansas outbreak was much milder, but the study suggested the virus still had North American origins with reassortment occurring in 1915 (Worobey et al., 2019).

Another hypothesis suggests that the source was in China since the country was one of the least affected by the pandemic, supposedly due to the already acquired immunity. Historians argued that the spread occurred through either Chinese immigration to the United States, eventually shifting to Europe, or due to thousands of Chinese laborers behind the frontlines in Europe. However, this theory also seems to have been disapproved, suggesting the epidemic was circulating Europe months if not years before the pandemic began (Worobey et al., 2019).

A major troop camp and hospital for the U.K. in Étaples, France is also considered, if not the origin, then an epicenter of the outbreak. The overcrowded location was ideal for the spread of the virus, and more than 100,000 soldiers passed through the camp as well as having live poultry and pigs for provisions (Worobey et al., 2019). Historians believe that the virus was circulating in European armies, with Étaples serving as the epicenter of the further outbreak in Europe (Worobey et al., 2019).

In either of these scenarios, one of the critical factors of the outbreak was the ongoing World War I at the time, which created optimal conditions in war-torn cities and army installments for the spread of the virus. Furthermore, no matter if the virus originated in the U.S., Europe, or China, it was virally spread through the world most likely as a result of troop transportation and supply chains to the frontlines from virtually all regions of the globe (Erkoreka, 2009).

The first wave of the outbreak in the spring of 1918 was seasonal benign influenza, and only by spreading to the frontlines of WWI, it became a much viral and devastating disease by the fall of 1918, inextricably linked to the soldiers and their conditions. The combination of an international mix of populations in Western Europe, poor quality of life and infrastructure, destruction of war, and numerous other injuries and corpse decay were human factors that may have contributed to transmission. Ecological factors included climate and exposure to elements, as well as an agglomeration of humans contacting with animals, and each other contributed to the extremely high virulence of the Spanish Influenza (Erkoreka, 2009).

Government and Health Organizations Response

At the time, medicine in its present form was only beginning to develop, encouraged by World War I. There were no vaccines and lab tests, with governments and healthcare facilities relying on observations and autopsies to determine the disease and eventual cause of death (Barry, 2020). Meanwhile, government officials had to utilize non-pharmaceutical interventions to manage the disease and prevent transmission, such as imposing quarantine and limits on public gatherings. In general, cities experienced worse outbreaks than rural areas, and there were notable differences at times between infection and mortality rates in various cities (Strochlic & Champine, 2020).

The death rate of St. Louis (385 per 100,000) was half that of Philadelphia (807 per 100,000), one of the hardest-hit cities of North America. American cities responded with restrictions rapidly. New York City, having reacted earliest and with most stringent methods of virtually closing its borders, imposing mandatory quarantines, and regulating strict closures and controls for public gatherings, had one of the lowest mortality rates in the world (Strochlic & Champine, 2020).

Cities that implemented preventive measures early on had up to 50% lower mortality rates than those that did so later or not at all. Furthermore, statistics show that early relaxation of intervention measures could lead to secondary waves of outbreaks and relapses of a stabilizing city, as occurred in St. Louis that relaxed rules after two months (Strochlic & Champine, 2020).

The public health response implemented by New York City will be discussed in this paper as one of the most successful locales to mitigate the 1918 pandemic. NYC approached the epidemic by taking advantage of its robust public health infrastructure, which helped prevent the spread of contagion and increase disease surveillance capacities alongside a large-scale health education campaign (Aimone, 2010).

The city had some experience with epidemics such as tuberculosis in recent history at the time and suggested that public health infrastructure plays a critical role in shaping practices and policies during a health crisis. The city officials declared a modified maritime quarantine, almost a month before the first cases appeared in the city as well as partial land-based quarantine. For New York, one of the busiest seaports, this was significant (Aimone, 2010).

The city utilized its infrastructure by converting various gymnasia, armories, and other facilities into temporary hospitals for the duration of the epidemic. The surveillance capacity for new cases increased through stringent health inspections and physician reporting. The local health department increased its surveillance capacity by utilizing independent inspectors and nongovernmental organizations (Aimone, 2010).

New policies and regulations were explicitly developed for public places to ensure cleanliness. The city made sure to sterilize public infrastructure, such as water fountains. Meanwhiles, public places such as theaters remained open in order to reach a greater population with information about preventive methods. Still, they were forced to adhere to strict regulations and inspections to ensure sanitation (Aimone, 2010).

Other countries, such as Europe, Spain, and the U.K. often imposed similar measures. The rigidity and compliance with these regulations depended on the authority of local governments or health departments. Unfortunately, the measures had only mild effects due to lack of medical treatment and war-time censorship (Martini et al., 2019). These factors resulted in distrust for the government and actions it was implemented to control the pandemic (Martini et al., 2019).

Role of Influencing Factors

Socio-Cultural

Social factors played an important role regarding the transmission and response to the 1918 influenza pandemic. Similar to modern-day, social distancing was a persistent recommendation by governments around the world at the time. In combination with the strict measures described previously, health officials hoped it would reduce the spread of disease. Social and public health education was unusually prevalent in major cities such as New York, where posters and pamphlets were distributed. While schools remained open, children were educated about the disease and informed of safe health practices to prevent transmission.

Sanitary codes were put into place and enforced throughout American cities (Aimone, 2010). Fines were issued for citizens that did not follow social distancing guidelines and practiced dangerous behaviors such as spitting in public or coughing without covering their faces. Many wore handmade protective masks. New York also established 150 emergency districts that helped manage health service distribution and manage home care and case reporting. Business hours were regulated by the board of health timetables to prevent crowding in public transit and streets (Aimone, 2010).

Political

As discussed earlier, World War I was ongoing when the 1918 pandemic emerged. Governments strongly relied on both domestic economies turned towards war efforts as well as the well-being of their troops. Despite such prevalent death tolls of influenza, it is often overlooked in history in relation to that time. People had little to no understanding of disease and virus contagious. Meanwhile, governments in many places chose to hide or obstruct the fact that there was an ongoing pandemic in order not to upend the war effort (Martini et al., 2019). Governments imposed press censorship in most of the countries involved in WWI, such as Germany, the U.K., France, and the U.S.A.

In many locales, authorities refused to reveal epidemiological statistics and mortality rates, resulting in widespread mistrust of the government since populations were openly devastated by the disease. The 1918 flu pandemic has got its name, the “Spanish Influenza,” due to significant press coverage in Spain which was neutral in the war and did not instill censorship (Martini et al., 2019). Moreover, Spain arguably was taking the most aggressive actions in containing the pathogen (Martini et al., 2019).

Healthcare and Medical

People knew very little about influenza at the time, and many scientists accepted that the Pfeiffer’s bacillus bacteria were the cause. Germ theory by Robert Koch, based on the findings of the French biologist Louis Pasteur in the 1850s, made a connection that disease was caused by micro-organisms (Tognotti, 2003). However, this theory was highly controversial at the time and had no proof. Richard Pfeiffer identified the pathogenic influenza agent in a bacterium, Haemophilus influenza. Researchers attempted to test if the Pfeiffer’s bacillus was the cause of Spanish Influenza. Since they were unable to reject the theory, it remains unknown whether the bacterium had any role (Tognotti, 2003).

However, viruses, unlike bacteria, could not be seen through an optical microscope, although some research existed regarding their role in disease, yet nobody suspected it could be causing the flu. The modern genome classification of the remaining samples showed it was the H1N1 virus. Even so, antibiotics were not discovered until almost a decade later to treat infections accompanying the flu, and hospitals had limited treatment options (Kassraie, 2020).

Significance

In light of the ongoing COVID-19 pandemic, the Spanish Influenza has become a common reference point as the most recent historical pandemic of such global magnitude, drawing numerous parallels. Response by authorities tends to follow similar patterns to identify and prevent transmission. During the infamous bubonic plague in the Middle Ages, patients were put in isolation and encouraged to take precautions. However, there was a large lack of knowledge and awareness about the transmission that resulted in at least a third of the European population being wiped out and continuing pockets of outbreaks for close to 2 centuries (Hsieh et al., 2006).

As evident, during the Spanish Influenza pandemic, governments adopted similar measures with more improved recommendations and stricter enforcement that were based on knowledge of medical science at the time.

Nevertheless, there are eerie parallels between the current COVID-19 pandemic and the Spanish Influenza. In 2020, many of the same approaches help prevent the spread of the virus in a global pandemic (WHO, 2020). Similar to other pandemics, the COVID-19 outbreak sees identical measures. Once the virus began to show spread, areas affected by the virus, especially its origin and epicenter of Wuhan, China, were put into lockdown.

All people, except for those who had the essential professions, were ordered to stay at home. The sick, once tested and identified, were put into isolation (BBC, 2020). To enforce these measures, many countries have increased surveillance and law enforcement capacity. Public events are canceled to minimize person-to-person contact in public gatherings (BBC, 2020). Notably, many countries took these strong measures to prevent transmission too late, when community spread has already been initiated. This resulted in several new epicenters of disease arising and a tremendous peak in cases.

Conclusion

Evidently, approaches used by authorities largely remain the same as the Spanish Influenza, with the emphasis being put on modern medicine and vaccination research to prevent widespread infection and deaths. Public authorities, both in 1918 and today, attempt to prevent the transmission of the influenza virus by enforcing quarantine, public education, and the creation of new regulations for public spaces. Since the risk of influenza and future pandemics is expected, governments and health organizations should invest in effective influenza vaccines and medications as well as take a more competent approach in recognizing outbreaks and limiting their transmission (Hsieh et al., 2006).

One of the main lessons, according to historian John Barry, is that in a pandemic, one has to tell the truth in a public health setting, something that governments have failed to do in the current crisis (Barry, 2020). The COVID-19 outbreak is similar in many ways to the Spanish Influenza, and once the disease passes, there will be significant research and reviews on the ongoing situation. It is necessary to learn from historic, albeit devastating events such as these to develop new methods of response and management, particularly in a modern globalized world.

References

Aimone, F. (2010). The 1918 influenza epidemic in New York City: A review of the public health response. Public Health Reports (1974-), 125, 71-79. Web.

Barry, J. M. (2020). The single most important lesson from the 1918 influenza. The New York Times. Web.

BBC. (2020). Coronavirus: How are lockdowns and other measures being enforced?BBC News. Web.

Crosby, A. W. (2003). America’s forgotten pandemic: The influenza of 1918. Cambridge University Press.

Erkoreka, A. (2009). Origins of the Spanish Influenza pandemic (1918-1920) and its relation to the First World War. Journal of Molecular and Genetic Medicine, 3(2). Web.

Hsieh, Y. C., Wu, T. Z., Liu, D. P., Shao, P. L., Chang, L. Y., Lu, C. Y., … Huang, L. M. (2006). Influenza pandemics: Past, present and future. Journal of the Formosan Medical Association, 105(1), 1-6. Web.

Kassraie, A. (2020). Spanish Flu: How America fought a pandemic a century ago. AARP. Web.

Martini, M., Gazzaniga, V., Bragazzi, N. L., & Barberis, I. (2019). The Spanish Influenza Pandemic: A lesson from history 100 years after 1918. Journal of Preventive Medicine and Hygiene, 60(1), E64–E67. Web.

Reid, A., Fanning, T., Hultin, J., & Taubenberger, J. (1999). Origin and evolution of the 1918 “Spanish” Influenza virus hemagglutinin gene. Proceedings of the National Academy of Sciences of the United States of America, 96(4), 1651-1656. Web.

Strochlic, N., & Champine, R.D. (2020). How some cities ‘flattened the curve’ during the 1918 flu pandemic. National Geographic. Web.

Taunbenberger, J. K. (2006). The origin and virulence of the 1918 “Spanish” influenza virus. Proceedings of the American Philosophical Society, 150(1), 86-112. Web.

Tognotti, E. (2003). Scientific triumphalism and learning from facts: Bacteriology and the “Spanish flu” challenge of 1918. Social History of Medicine, 16(1), 97–110. Web.

World Health Organization. (2020). Report of the WHO-China joint mission on coronavirus disease 2019. Web.

Worobey, M., Cox, J., & Gill, D. (2019). The origins of the great pandemic. Evolution, Medicine, and Public Health, 2019(1), 18–25. Web.

The annual vaccination against influenza was proposed for healthcare workers in 1984. Later, the Society for Healthcare Epidemiology (SHEA) stated that unless the workers have contradictions to the vaccine, they are to receive it. Finally, in 2010, SHEA claimed that flu immunization was an obligatory condition for employment for the personnel involved in patient care (Thomas et al., 2010, p. 989). Despite its undeniable contribution to disease resistance, mandatory vaccination violates the human right to choose the appropriate treatment measures. In this paper, the unethical nature of compulsory immunization against influenza will be considered.

Overwhelmed with concern for the patients’ health, hospitals required their employees to get the flu shot annually. The vaccination was aimed to prevent virus transmission among the clinicians and patients, and secure a steady workflow. Nurses, physicians, assistants, or other medical workers delivering patient care might jeopardize the recovery process, let alone their health. Moreover, clinicians who become ill with influenza usually use more sick days (Nurse Journal, 2020, para. 4). The medical organizations proposed that vaccination be made obligatory for those working in healthcare to prevent these deplorable consequences of the virus from spreading.

The patient’s safety remains the highest priority for each medical institution. Specialists in the field state that health care workers have a moral obligation to protect their patients and themselves from influenza. The virus, “spread by droplets made when people with flu sneeze, cough, or talk, can land in the mouths or noses of people who are up to about 6 feet away” (CDC, Influenza Vaccination Information, 2020). About 35,000 deaths from influenza are registered annually, and its mortality rate equals rates of breast cancer (Holliman, 2015, para. 5). With this in mind, it is essential to remember that the workers who are at work while being ill might be a threat to the patients, as well as to their loved ones at home. According to Edmond (2019, para. 5), presenteeism – working while ill – is 47% for nurses and 63% for physicians. This point of view, therefore, undermines the notion of ethics.

However, mandatory vaccination against influenza remains a highly controversial and unethical issue. First, the flu shot might cause side effects such as a high risk of Guillain–Barré syndrome, paralysis, and convulsions (Nurse Journal, 2020, para. 6). The right to refuse medical treatment, in this case, is ruthlessly violated and may come with grave consequences for the receiver. Despite its controversial nature, in 2018-2019, the flu vaccination coverage was highest among physicians (96.7%), nurses (98.1%), pharmacists (91.5%), and nurse practitioners and physician assistants (91.0%) (CDC, Influenza Vaccination Information, 2020). The doctors forced to receive immunization are either subjected to threaten their health or become unemployed, which is far from ethical practice.

The mandate provokes the risk of unemployment for all the employees that refuse to be vaccinated. Currently, to avoid an administrative leave of one week, the clinicians who do not consent to be vaccinated should have an appropriate religious, philosophical, or other exemption. Then, if the demand remains when the leave is over, the employee will be forced to resign voluntarily. Even if an employee has an exemption, they are obliged to wear a mask.

Apart from the person’s right violation and unemployment, the vaccine is modestly effective. Over the recent influenza seasons back in 2004-2005, the flu immunization was proved to have 41% effectiveness. In contrast, many other vaccines in clinical practice exceed 90% (Edmond, 2019, para. 8). If the common immunization is intended to be for “the greater good” for everybody, both patients and medical workers, it contradicts itself by imposing a physical impact on one’s body.

The doctors and nurses have the right to decide for themselves how to treat their health. There are diverse alternatives for the influenza prevention measures they can choose from. Some of them are rather simple, effective, and, most importantly, available daily (Nurse Journal, 2020, para. 10). First, handwashing keeps one’s hands clean and, thus, keeps infections from spreading (CDC, Hand Hygiene, 2020). Second, in healthcare institutions, wearing a mask can prevent the spread of diseases, including flu. Third, it may be of use to keep patients sick with flu isolated from others. All the measures mentioned above contribute to the reduction of virus transmission while maintaining the workers’ health. It would be more effective to encourage, not impose, vaccination, and reduce presenteeism to lessen the transmission of viruses in the healthcare realm.

Any ethical practice implies a respectful attitude towards the people involved. Forcing the medical workers to the flu vaccination may cause irreparable damage to their health. Every person has the right to choose the treatment and, if necessary, refuse one. Although the need to reduce the risk of the virus spreading between the clinicians ill with flu and the patients is present, it should not cause any other harm. If the right violation has been committed, no one can be sure when the next episode comes. However, at the moment, the patient’s right to choose the appropriate treatment measures is ruthlessly violated with the mandate and causes unemployment for those who do not consent to be vaccinated. A practice can hardly be ethical if it provokes disrespect and harm for any human being.

References

Centers for Disease Control and Prevention (CDC). (2020) Influenza Vaccination Information for Health Care Workers. Web.

Centers for Disease Control and Prevention (CDC). (2020) Hand Hygiene is the #1way to prevent the spread of infections. Web.

Edmond, M. B. (2019) ‘Mandatory flu vaccine for healthcare workers: Not worthwhile’, Open Forum Infectious Disease, 6(4), pp: 1-5.

Holliman, K. (2015) ‘Mandatory flu vaccines work but can raise issues for workers’, ACP Hospitalist.

Thomas R. T. et al. (2010) ‘Revised SHEA Position Paper: Influenza Vaccination of Healthcare Personnel’, Infection Control & Hospital Epidemiology, 31(10), pp. 987-995.

Should Nurses Be Forced to Get Flu Shots? (2020) Nurse Journal.

Introduction

Community health nursing involves helping people and society to establish an environment that supports health through health promotion, prevention, and support (Diem and Moyer 2004 p.7). Avian influenza, which is normally spread by birds, is a fatal disease, as it kills infected people very quickly; besides, the treatment is quite expensive. In this case, proper community health nursing is highly recommended if an outbreak is reported to control further spreading, and modify care of more vulnerable people. To achieve good community health, the public should be educated about the flu, its causes, its transmission routes, and the control mechanism.

In the case of avian flu occurrence, it must be reported promptly to the authority in charge to put up measures of preventing further transmission, and care of infected persons. In addition, the government can reduce the cases of avian flu through surveillance, diagnosis, communication, and vaccination. Moreover, the community health nurse should also modify the care of persons with respiratory diseases, as they are a more vulnerable group.

An outbreak of avian flu results in disruption of travel affects the economy and can lead to diplomatic misunderstandings. Generally, there is no known treatment for avian flu; and worse enough, the flu has become resistant to the available vaccines. Due to this, quarantine and isolation are preferred as effective means to contain the spread of the outbreak.

Outbreak

Avian flu is caused by viruses found in birds the most dangerous strain being the H5N1 virus. This flu mostly occurs in the winter seasons, since the viruses can survive for extended periods in cold temperatures, but could still occur in any other season (Basavanthappa, 2008, p.669). The first occurrence of avian flu in humans was in China in 1997 where18 people were infected and six of them died. In the subsequent cases of the flu, the death rate is estimated to be 25% (American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons and Caroline, 2010, p 35 2). Moreover, since the first occurrence in 2002, H5N1 virus has continued to change its antigen and increase in its geographic prevalence (Heymann, Alcamo and Sfakianos, 2006, p.57).

Graphical representation

Avian flu has dominated the Asian continent with few occurrences in Africa and Europe. The first strain of human infection of bird flu was reported in Asia. In Africa, most outbreaks are reported in the northern part of the continent bordering the Asian continent i.e. Egypt. The movement of this flu since 2003 in different countries continues to rise due to increased market globalization and cross-border traveling. The graph below indicates the international trends of avian flu in three continents since 2003.

Epidemiological indicators and epidemiology data Analysis

Epidemiological indicators include frequency of occurrence, distribution (time and place) and other deterministic factors. Avian flu has been reported to cause many deaths in many parts of the world including Asia, Africa, Europe, and America (Dudley, 2008). There are three types of viruses known to cause Avian influenza, namely; type A, B, and C. Type A virus is the only known type that infects birds and has other subtypes that have been identified to infect humans which include N5, N1, N2 and N8. These viruses are further classified as either low or high pathogenic; for instance, H5N1 is an example of a highly pathogenic virus. High pathogenic viruses cause severe diseases compared to low pathogenic viruses (Heymann, Alcamo, Sfakianos, 2006, p.57)

The first outbreak of H5N1 occurred in Hong Kong in 1997 and was later detected in 2002, thus necessitating the culling of a large number of chickens. However, this did not stop the occurrence of the flu in the subsequent years; for instance, in 2003, there were four deaths reported, caused by this virus. Since then, cases of H5N1 virus have been detected in Thailand, Vietnam, China, Indonesia, Japan to name but a few (Webber, 2009, p.259) Once these viruses enter the body of humans, they have the ability to mutate to stages that can be transferable from human to human, and whenever this stage is reached, a global epidemic is inevitable.

Some mode of transmission is human to human and contact with infected poultry and their products. Young children are at a higher risk of catching bird flu; this is attributed to kids playing with infected birds or on grounds infested viruses that cause avian flu (Basavanthappa, 2008, p.669). According to the American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons, and Caroline (2010, p. 35) the main and common symptoms of avian flu are “fever, sore throat, cough, and other respiratory diseases.” However, the symptoms vary from one person to another depending on what strain and subtype of virus caused the flu.

After analyzing the epidemiological data of avian flue, some risk factors were identified – rearing of mixed species, marketing of infected birds, and keeping of the birds in open fields. Besides identifying risks factors, analysis of epidemiology data assists in having improved interventions targets and the patterns of occurrence of avian flu. This data is used to trace the source of flock where it originated from, and once established, it is very important in the control of the flu. Moreover, regional analysis helps to identify the common strain of virus and patterns of occurrence in that region.

Effects on the community

Avian flu has serious consequences on the economy of a nation; for instance, the “ban of export of poultry products since 1997 has caused a loss of approximately U.S. $50 billion” (Dudley, 2008). Generally, the damage of one country’s economy could have a ripple effect on other nations since the world economy is interlinked. In addition, farmer lost their poultry through culling meant to control the outbreak. As a result, most farmers and employees lost their means of earning an income, creating unemployment.

During the outbreak of avian flu, there is controlled movement and traveling from or to those areas, affecting people’s schedules, as well as tourism. In addition, movement and transportation control also affect the economy as the transport and logistics industry suffers losses. Moreover, there are changes in poultry production due to government policies and biosecurity regulations.

The period also witnesses complete ban on people’s interaction in public places, schools being closed down and businesses. In addition, the cost of vaccines and treatment becomes very high and strains the families and the government as the demand is usually high. Generally, an outbreak of avian flu can cause diplomatic strains between nations because of the tighter travel regulations (through travel bans) and lack of cooperation in fighting the flu. For instance, countries would result in crossing borders or denying access to people from a nation with an outbreak, the result of which would be political tension.

Avian flu outbreak brings personal insecurity because of anxiety and stress in the community; for instance, farmers and farmworkers in poultry farming lose their jobs, and the fear of being infected is one of the causes. Detention of people suspected to be infected with avian flu and lack of vaccines are some causes of social unrest. These measures are always taken because the flu kills a lot of people who are infected; for example, it is estimated that half of the people infected die. In this case, there is a risk of tearing up the social knit as ill people fight for scarce medication.

Routes of transmission

One route of transmission is through direct infection through passing of virus from infected birds to human beings, with children reported to be more susceptible. Primarily, the migration of infected wild birds from place to place results in the transmission of the virus to domesticated birds and later to humans. These wild birds drop virus through saliva, droppings, or secretions, where domesticated birds pick up this virus from water sources, feeds, or soil.

The viruses are also transmitted from one farm to another through movement of tools or workers. Avian flu is transmitted to humans through inhaling infected droplets or direct contact with contaminated places. However, transmission can also occur in health facilities to health care workers and other patients treating infected people; thus to avoid this method of transmission, it is required that health care workers to have safety equipments and have isolated wards for avian flu patients.

Although improper handling and disposal of birds that died of avian flu also transmit the flu, up until now, there is no scientific evidence to prove that consumption of cooked poultry products can transmit avian flu.

Protocol of reporting an outbreak

If a case of avian flu is detected in the local health clinic, the matter should be reported to the health officer in charge of that health facility who should report immediately the case to the local health department. The cases should be reported to CDC (center for Disease Control and prevention) for evaluation of magnitude of the spread. The state government is then expected to relay the information to other countries through diplomats’ representatives. The information should also be relayed to the world for safety precautions and surveillance of visitors from a country with an avian flu outbreak.

Modification of care

People already suffering from respiratory diseases like asthma are more vulnerable during avian flu outbreaks. The care given to them should be modified to cater to the additional risks due to poor air quality. Clients with upper respiratory disease should be placed under antiviral therapy and supportive care. Supportive care with intravenous rehydration, mechanical ventilation, vasopressor therapy, and renal replacement therapy might be given to patients that are at a high risk of infection. The health care providers should provide frequent air changes per hour (6 to 12). N95 respirators can be reused in the care of TB patients, but they should not be reused after being worn by another patient.

Special health precautions should be undertaken by all the public but especially the persons with respiratory disease. These measures include wearing masks, washing of hands and vaccination. Immunization of older patients with chronic respiratory disease would very effective way of lowering the risks of infection. In addition, monitoring and surveillance of people will help the detection of any infections. Thus, people with respiratory diseases should be advised to avoid public areas and if they have to, they should wear protective masks.

Conclusion

Community health nursing helps in managing the spread of communicable diseases like avian flu. This flu is contagious and has fatal consequences if it is not detected early. It is caused by viruses and the most common is the H5N1 strain. Primarily, the virus found in birds’ intestines is transmitted to humans through contact with infected objects. The effects of avian flu on a community include loss of income, cause of stress and anxiety, and diplomatic misunderstandings.

Avian flu is a respiratory disease and people with other respiratory diseases are more vulnerable if they get affected. Therefore, for sake of public health quarantine, regulation of movement from areas with avian outbreaks can reduce the spread of the flu. In addition, an outbreak can tear apart the social setting of a community as they fight for scarce medication. Moreover, strains of avian flu tend to create resistance to vaccines and taking influenza shots cannot immunize someone from avian flu.

References

American Academy of Orthopaedic Surgeons, American Academy of Orthopaedic Surgeons and Caroline, N. (2010). Nancy Caroline’s emergency Care in the streets. Ontario: Jones & Bartlett Learning.

Basavanthappa. (2008). Community Health Nursing. Delhi: Jaypee Brothers Publishers.

Diem, E. & Moyer, A. (2004). Community Health nursing projects: making a difference. NY: Lippincott Williams & Wilkins publishers.

Dudley, J. (2008). Public health and epidemiological considerations for avian influenza risk mapping and risk assessment. Ecology and Society, vol. 13, No. 2, pp 21.

Heymann, D., Alcamo, E. & Sfakianos, J. (2006). Avian Flu. NY: Infobase Publishing. Web.

Webber, R. (2009). Communicable disease epidemiology and control: a global perspective. London: CABI.

Introduction

This article was recently published on a website concerning health-related issues and news. The article affirms a death caused by the deadly virus making people reconsider their health issues in terms of vaccination against the H1N1 virus.

Analysis

H1N1 virus or swine flu, as known commonly, has grown to be a threatening virus for people in the west. The death of Evan Frustalgio, a 13-year-old hockey player, has persuaded everyone situated in the vicinity as well as nationally, to be concerned actively regarding the virus. The virus has caused several deaths nudging people to reconsider their precautions and health safety issues (Mclean & Dale, 2009).

The Toronto Public Health officials announced to vaccinate people before the planned date due to high precautionary reasons. A reasonable number of doctor’s phone lines were transferred to answering machines stating about the abundance of H1N1 associated calls. The death that occurred was rare as stated by the chief medical officer of Ontario Dr. Arlene King, but inoculation against the deadly virus is necessary.

However, upon survey, numerous opinions were observed. Some said that they won’t let their child have a shot for immunization, no matter how serious the matter is. Some responded explaining the health of their children as the extreme priority. Some of them also confessed to being reluctant to force their children to get vaccinated. A woman declared her negligence towards the issue also. She stated that she is building her children’s immune system logically. She included that she won’t be hindering her children to participate in after-school activities just because of H1N1 issues (Mclean & Dale, 2009).

The death of Evan Frustalgio, although is a serious example of this lethal virus, yet strained officials and coaches of minor hockey teams and schools to take necessary precautions as well. As one of the coaches said, “This was a huge wake-up call for the hockey community.” coaches have ensured their vigilance over health issues also. The sharing of water bottles among players will be discouraged so as the handshakes exchanged after the game (Mclean & Dale, 2009).

The absentee rates at schools are observed critically for further investigation. Public health units are active in this matter also. The rate of absenteeism is higher than normal summing up to 10% due to the indications of influenza. Spokespersons for various school boards believe that it is moderately tough to analyze the rate of absenteeism as a result of illness or as a result of fear caused by illness. One of them also affirmed that student who is likely to have the symptoms of this disease is going to be confiscated until someone reaches for pick up. Teachers at schools are advised to educate children in this regard and insist upon cleanliness and tidiness (Mclean & Dale, 2009).

The virus has hit the state for the second time. People who are ignorant towards this issue should reconsider their attitude and seek medical awareness to get themselves and their children vaccinated. The virus is considered too severe since there are no such symptoms before fatal results. Dry cough and a sore throat is ambiguous symptom yet aware people handle them with appropriate measures before it gets too late.

References

Mclean, J., & Dale, D. (2009). H1N1 shots to be rolled out faster. Web.

Introduction

H1N1 is the source of numerous health care controversies. This is particularly the case of vaccination and vaccine allocation, since vaccine shortages may cause long-term effects on public health and increase the risks of H1N1 pandemics. It goes without saying that today’s legal mechanisms of vaccine allocation are far from perfect. Health care officials must be particularly creative in the development of vaccine allocation strategies. Declaring a Public Health emergency may aid health care organizations in achieving the highest penetration of influenza vaccines into the greatest number of high-risk persons. The Department of Health may also allow the existing private sector distribution methods to address the pandemic influenza vaccination needs of the community. Neither of the proposed solutions is entirely satisfactory. Yet, in the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency can give the Department of Health a strong advantage in its fight against the risks of H1N1 pandemics.

H1N1 Flu: A Brief Background

H1N1 has become a distinctive feature of the global health reality. H1N1 no longer frightens anyone, although its effects on public health are profound and multifaceted. Also called “swine flu”, H1N1 is a relatively new type of influenza, first detected in 2009 in the United States (Ohio Health). The virus spreads like other types of influenza, from person to person (Ohio Health). Severe illness is uncommon, although possible (Ohio Health). That individuals with H1N1 can infect others up to 7 days after getting sick is the most threatening factor of the disease (Ohio Health). Statistically, younger individuals are more susceptible to the risks of H1N1 than older populations (Louie et al 1896). 40% of all H1N1 cases occur in adolescents (Louie et al 1986). Almost all individuals younger than 50 years are at risk for H1N1 (Louie et al 1896). The main risk factors for H1N1 complications include immunosuppression, lung disease, and pregnancy (Louie et al 1986). These high-risk populations demand particular medical attention. Vaccination can give them a chance to avoid the infection or at least reduce the risks of H1N1 complications. H1N1 vaccines must target pregnant women, individuals with lung disease and immunosuppression, as well as those younger than 18 years old.

H1N1: Devising a vaccination strategy

Today’s mechanisms of vaccine allocation are imperfect. At times of emergency and vaccine shortages, all health care policies and department decisions must aim at (1) assessing the local supply of vaccine; (2) assessing the number of high-risk members of the community and assessing the demand for vaccines; and (3) “ensuring that to the greatest extent, the limited local supply of vaccine is used exclusively by those at highest risk within the local jurisdiction” (Iton 350). This is possible by either declaring a Public Health emergency or giving health care providers a carte blanche in dealing with the risks of influenza epidemics. Both strategies have serious advantages and visible drawbacks.

Declaring a Public Health emergency can give the Department of Health a serious advantage in dealing with vaccine shortages and the risks of influenza pandemics. First, it is under conditions of emergency that the Department of Health can quickly assess the state of vaccine supply through public and private entities. The fact is that, under normal conditions, private and public suppliers and health care institutions may be reluctant to release information regarding vaccine supply (Iton 353). Trade secret concerns, business competition, and the fear of legal liability for holding inadequate supplies of influenza vaccine can explain health care facilities’ reluctance to publicize these data (Iton 353). In conditions of a Public Health emergency, the Health Commissioner can obligate influenza vaccine providers to respond to official vaccine supply inquiries. The Health Commissioner can also issue an administrative subpoena, to obtain legitimate access to vaccine shipping information and validate inventory information concerning vaccine supplies (Iton 353). Second, a Public Health emergency can let the Health Commissioner audit and monitor the process of vaccine allocation, to ensure that limited supplies target high-priority populations. The Health Commissioner will be able to demand that limited supplies of vaccine be commandeered from private and public providers and penetrate into high priority populations (Iton 354). Under normal public health conditions none of these actions is possible. Only a Public Health emergency can legitimize the health commissioner’s authority to commandeer vaccine supplies from private health care entities and providers (Iton 354).

Notwithstanding the benefits of a Public Emergency, the mere word “emergency” can generate panic and anxiety among state residents. Panic and anxiety are extremely undesirable, given the effects they may cause on public health and wellbeing. Alternatively, the Health Commissioner can allow the existing private sector companies and providers to address the pandemic influenza vaccination needs. As always, the need for engaging private health care players in vaccination planning and pandemic response efforts is critical (Smith & Strikas 305). The U.S. Department of Health and Human Services has developed a number of strategies to facilitate collaboration and partnerships between local private and public vaccine providers (Smith & Strikas 305). Private entities may add to the vaccine supply from public providers. However, under normal conditions, such partnerships can do little to deal with the problem of vaccination shortage. This is because the 1938 Food, Drug, and Cosmetic Act prohibits any movement and reallocation of drugs between hospitals and providers, unless initiated for emergency reasons (Hodge & O’Connell 345). Therefore, private sector organizations alone cannot enhance the supply of influenza vaccines and their allocation among high-risk populations.

Objectively, neither of the two alternatives is entirely satisfactory. Panic about the state of emergency is highly undesirable. Yet, under normal conditions, private and public entities may refuse to disclose information regarding vaccine supplies. Moreover, the movement and reallocation of drugs and vaccines under normal public health conditions are strictly prohibited. Another problem is that neither of the two solutions increases public awareness of influenza and informs the public about the importance of H1N1 vaccination. In the meantime, whether or not the public accepts and adheres to public health measures recommended by the Department of Health directly depends upon the way the general population perceives the risks of getting infected (Seale et al 104). Low awareness means low anxiety about the risks of influenza; the latter, in turn, predicts little to no change in behaviors against the background of the influenza pandemic (Seale et al 104). Public awareness of influenza risks is what the Department of Health needs, to expand vaccination coverage and ensure that the risks of infection in high-priority populations are minimized. Partnerships created during vaccine shortage seasons can benefit public health before and after influenza pandemics (Smith & Strikas 305). As the pandemic is getting closer and the shortage of vaccines threatens lives and wellbeing of all community members, only declaring a Public Health emergency can give the Health Commissioner a strong advantage in allocating scarce vaccination resources among all populations at risk for influenza.

In the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency is the best way to deal with vaccine shortages. The state is running of time, and there is no other chance to deal with broad policy challenges affecting the vaccine market. Everything should be done here and now. Only a Public Health emergency can give the Health Commissioner the right to assess the supply of vaccines and reallocate available vaccine supplies in ways that target at-risk populations. These emergency efforts must be coupled with broad public awareness campaigns, to communicate the meaning and relevance of the emergency and increase the population’s vaccination coverage. Under normal conditions, the Department of Health must develop and sustain effective partnerships with private healthcare entities. These partnerships will eventually help to raise public awareness of influenza risks and guarantee that all health care providers, irrespective of their form, have sufficient vaccine supplies in case of an emergency.

Conclusion

In the absence of viable legal mechanisms of vaccine allocation, declaring a Public Health emergency can give the Department of Health a strong advantage in its fight against the risks of H1N1 pandemics. It is under conditions of emergency that the Department of Health can quickly assess the state of vaccine supply through public and private entities. Only a Public Health emergency can legitimize the health commissioner’s authority to commandeer vaccine supplies from private health care entities and providers. Certainly, this alternative is not entirely satisfactory. The public lacks awareness of H1N1 risks. A Public Health emergency coupled with broad public awareness campaigns can give the Health Commissioner the right to assess the supply of vaccines and reallocate available vaccine supplies in ways that target at-risk populations.

Works Cited

Hodge, James G. & Jessica P. O’Connell. “The Legal Environment Underlying Influenza Vaccine Allocation and Distribution Strategies.” Journal of Public Health Management and Practice, 12.4 (2006): 340-48. Print.

Iton, Anthony B. “Rationing Influenza Vaccine: Legal Strategies and Considerations for Local Health Officials.” Journal of Public Health Management and Practice, 12.4 (2006): 349-55. Print.

Louie, Janice K. et al. “Factors Associated With Death or Hospitalization Due to Pandemic 2009 Influenza A(H1N1) Infection in California.” Journal of American Medical Association, 302.17 (2009): 1896-1902. Print.

Ohio Health. “General H1N1 Information.” Ohio Health, 2011. Web.

Seale, Holly, Anita A. Heywood, Mary-Louise McLaws, Kirsten F. Ward, Chris P. Lowbridge, Debbie Van and C. Raina MacIntyre. “Why Do I Need It? I Am Not at Risk! Public Perceptions Towards the Pandemic (H1N1) 2009 Vaccine.” BMC Infectious Diseases, 10 (2010): 99-107. Print.

Smith, Nicole & Raymond A. Strikas. “Approaches for Improving Influenza Prevention and Control.” Journal of Public Health Management and Practice, 12.4 (2006): 303-7. Print.

Abstract

The world has experienced three H1N1 Influenza virus pandemics since last century. The effects of these pandemics on human beings have varied in magnitude. The 1918 pandemic was the most devastating compared to later ones. The catastrophic potential of these pandemics has drawn a lot of attention in the quest of understanding their viral agents and Influenza infections they cause. The highly contagious flu infections they cause have been studied in various aspects using various scientific techniques. Due to the highly unstable and unpredictable nature of the viral agents , a lot of efforts have been concentrated on understanding the pattern of infections and illnesses of these viruses on the general human population. As most scientific investigations have shown, understanding the social and behavioral aspects of pandemic viruses such as H1N1 is crucial in formulating control and prevention strategies for future outbreaks.

Definitions and Description

H1N1 refers to a strain of non-seasonal Influenza Type A virus which was first detected in Mexico in April 2009. Upon its medical discovery, the viral infection quickly spread to other continents in the world warranting its classification by the WHO as a pandemic. Initially referred to as “Swine flu” among a host of other names by various countries ,the WHO proposed name, Pandemic Influenza A /H1N1 2009 was later adopted to differentiate it from the 1918 H1N1 strain that killed millions of people.

H1N1 bears structure akin to most viruses. It is spherical with a diameter of 80-120 nm (Dandagi & Byahathi, 2011). It is composed of RNA enveloped by a lipid. The enveloping lipid is characterized by surface proteins namely Hemagglutinins (HA) and Neuraminidase (NA) that are responsible for virulence properties (Mpolya et al., 2009). The Influenza virus causes highly contagious diseases in pigs that are rarely transmitted to human beings. Besides pigs other hosts include human beings, birds (Chicken and ducks), pigs and horses (Mpolya et al.,2009). The Influenza virus is classified as A, B and C. Human beings are mostly susceptible to the “A” strain that causes seasonal flu common in winter and autumn.

The development of the 2009 H1N1 subtype of Influenza A is attributed to reassortment of different genes of influenza viruses found in swine, avian species and human hosts (Dandagi & Byahathi, 2011).It genome has been pointed out to be a combination from four Influenza viruses namely: N. America Swine Influenza, Asia/Europe swine Influenza, human Influenza and avian Influenza (non-H5) (Narain, Kumar & Bhatia 2009, e1). The reassortment is believed to occur by antigenic drift whereby mutations in the surface proteins produce a novel subtype (Mpolya et al., 2009 ).

Transmission of H1N1 influenza occurs through inhalation of infected respiratory droplets of after sneezing and coughing and from formites on infected surfaces (Mpolya et al., 2009, p.29).This means close contact is an important facilitating factor of the infection

Owing to previous Influenza pandemics most government in the developed world were well prepared to closely monitor the 2009 H1NI pandemic. The surveillance was in terms of monitoring the communicability of the virus which was measured by attack rates, the virulence or severity measured by case fatality rates and governmental response which was measured by the surge capacity of the health or medical services (Narain, Kumar & Bhatia 2009, e1).Most governments set up monitoring centers that collaborated and exchanged data with other nations. Unlike previous pandemics, a lot of scholarly effort was noticeably with many publications on the H1N1 coming out. The private media was also used to channel out awareness messages to the public.

Most scientific studies have examined the social and behavioral epidemiological aspects of H1N1 Influenza from various parameters of the affected population such as the age group, climatic area, socioeconomic impact, associated risk factors, seroprevalence, hospitalization rates, time course of the pandemic, case fatality rate (CFR), behavioral response, and international management efforts. The objectives of such studies have been to explain the causal relations and the significance of each determinant and possible prediction of future similar pandemics. Many epidemiological models and analytic tools from diverse disciplines have been employed to this end. The results based on these factors have been critical in drafting and executing mitigation responses.

Epidemiology profile

Distribution and burden of the disease

By the time the WHO declared H1N1 pandemic over in 10 August 2010, almost all countries had confirmed cases of pandemic H1N1 2009 virus (WHO committee on Clinical Aspects of pandemic H1N1, 2010). According to the WHO committee on clinical aspects of pandemic H1N1, from the start of the H1N1 flu pandemic up to mid February 2010, an estimated 59 million Influenza –like illnesses (ILI), 265,000 hospitalization and 12500 deaths were reported in the United States alone. Data from this committee also shows that Overall fatality rate was less than 0.5% and In the US and UK the case fatality rate for symptomatic illness was estimated to be 0.048% and 0.026% respectively.

In the Western Pacific Region, the WHO reports that from April 2009 to July 2010, over 250,000 cases and 1800 fatalities were due to the Pandemic H1N1 2009 virus (McCallum & Partridge, 2010). By NEJMra1000449age groups, 8.6%, 41.9%, 48.3% and 1.2% of cases were in the <5 yrs, 5-14 yrs, 15-64 yrs and 64+ years group respectively while the overall crude fatality ration was 0.5% (McCallum & Partridge,2010). An assessment carried out from May 1 to Aug 24, 2009 by Department of Health and Human Services of the United States on the 2009 H1N1 Influenza outbreak in some southern hemisphere countries (Argentina, Australia, Chile, New Zealand and Uruguay) also revealed H1N1 to be predominant in school-aged children and adults under 65 years of age. The assessment also revealed that pregnant women and individuals with underlying chronic diseases were at an increased risk of severe forms of the H1N1 2009 flu.

Economic costs

The economic effects of the pandemic H1N1 2009 virus varied from country to country. This was as a result of measures taken by authorities to contain the spread of the pandemic within their locality. Some countries experienced significant workers absenteeism especially when close proximity of persons in public and work places were restricted. This might have negatively affected morale and thence productivity. Tourism also suffered in some countries after travel bans were effected perhaps influenced by the novel flu pandemic that was underway. According to a 2009 assessment report by the US Department of Health and Human Services (HHS), Low tourist arrivals were reported in Australia and Argentina during the peak periods of the epidemic. In Chile, Uruguay and Japan, many schools were closed during the height of the pandemic. Many retail businesses in the affected countries may also have suffered as locals shunned public and overcrowded place they perceived as dangerous. Most governments were also forced to divert funds to combat the pandemic through provision of medical facilities, medical personnel, and awareness and surveillance initiatives.

Intervention practices and their effects

Broadly, intervention for pandemic H1N1 may be pharmaceutical or non-pharmaceutical based. Non pharmaceutical intervention (NPI) may involve isolation and social distances whereby caregivers of the H1N1 victims and their patients are isolated until they do not show any symptoms related to the flu. Social distancing may also involve closure of school and prohibiting mass assembly in public places as was the case in the United States and Japan where large number of schools were closed in the wake of the H1N1 2009 pandemic. Public and health care workers education has also been identified as a crucial part of any campaign against an influenza virus pandemic (Balinska and Rizzo, 2009)

Perhaps the most stressed intervention practice stressed by health authorities is that people should observe high standards of personal hygiene accompanied by a behavioral change. In creating awareness of the pandemic the populace is always reminded to thoroughly wash hands with soap and running water after sneezing. They are also advised to cover their mouth and nose with a tissue to be disposed immediately in a waste container. Face masks are also encouraged when in public. Touching of the nose, mouth and eyes is also discouraged as formites in the places are perfect entry routes for the flu viruses. Healthy people are also discouraged from getting in contact with persons with influenza illness as they will be exposed to droplets from sneezing and coughing of the victims. Those with Influenza like illness are also advised to stay away from public places and healthy persons. This is because the virus is still transmissible even in recovering victims and this may extend to even week from the onset of the illness (Mpolya et al., 2009). Some countries have also been known to issue travel advisory to affected countries. People are generally advised to seek medical care when they develop Influenza-like symptoms that among others include fever, cough, sore throat, runny nose, nasal obstruction, fatigue, joint or muscle pain, headache and nausea (Mpolya et al., 2009 ).

Pharmacological intervention of pandemic H1N1 virus has involved vaccination and use of antiviral drugs. However novel influenza viruses are known to have developed resistance to some of these drugs. A case in point is the drug Oseltamivir/Tamilfu and Adamantanes drugs such as Amantadine and Rimantadine which the pandemic H1N1 viruses have become resistant to (Mpolya et al., 2009 ). Vaccination offers the best prevention against influenza although most vaccines have considerable development time. In this respect Balinska and Rizzo (2009) have found out that NPIs offer the most significant mitigation results in the absence of a vaccine during an influenza pandemic. The 2009 H1N1 pandemic was tackled at international level. This involved coordinated researches and collaboration by all affected nations with the view of exchanging crucial epidemiological, clinical and genomic data for developing population-specific vaccines and formulating management policies (Mpolya et al., 2009).

Social-ecological, behavioral risks and resiliency factors

The social-ecological aspect of the H1N1 can be viewed from a standpoint of how the environment influences the development of H1N1 viruses. Maliszewski and Wei (2011) hypothesized and confirmed that public transportation usage, agricultural land proportions and population proximity are significant parameters for the social ecological profile of H1N1 viruses. According to their study, public transportation networks place masses at close proximity to the pathogenic viruses increasing the chances of contracting it. Owing to their zoonotic nature most influenza viruses, they suggest that close association of animal farming communities with their animals may easily expose human being to infections in the case of a novel influenza virus capable of human infection. In their study they found a positive correlation between influenza illness hospitalization and the proportion of agricultural land in the sample community. With regard to geographical proximity of populations, they found, although marginally significant, a positive correlation between communities at close proximity and hospitalization rates of pandemic H1N1 2009. This was a rare study of its kind but altogether shows that more effort be channeled into studying social ecological factors of pandemics for purposes of future preparedness.

Public awareness has been applied in many countries in times of Influenza campaigns. Although health authorities always react swiftly by increasing awareness of an infection during pandemics some behaviors increase risk of contracting the infection. A study in Malaysia at the height of the H1N1 2009 pandemic concluded that observing precautionary behavior by the masses under a pandemic attack is an important step in curbing further spread of the pandemic and enhancing psychological appreciation for future outbreaks (Sam & Wong 2011, 23).

At a personal level, the behavioral aspect of influenza A H1N1 can be categorized in terms of fear of contracting the illness, risk avoidance and health protective behavior (Wong & Sam 2011, 24). For Influenza H1N1,risky behavior include: not wearing face masks in public, going to crowded places, using public transport, visiting victims’ hospitals, travelling to infested places have been cited to greatly increase the chances of contracting infection. Most importantly, coughing and sneezing without covering the mouth and nose greatly exposes danger to those in the surroundings. This is due to the fact that the droplets from coughing are believed to be the major carrier of the viruses. Other factors are not washing of hands upon sneezing and/or coughing and adopting a poor lifestyle (poor diet and little/no physical exercise).

The global spread of the Influenza H1N1 virus in a matter of days points to its resilience nature. Unlike the seasonal flu a novel influenza virus is not affected by seasons or other environmental dynamics. The most noticeable feature of most influenza pandemics is that they occur in two waves before subsiding. The 1918 H1N1 pandemic was devastating in its second wave leaving millions of deaths in its trail. Their however is little literature with regard to this behavior. The novelty and perhaps resilience of influenza virus has been explained in terms of reassortment of the virus genes from various sources via antigenic shift whereby significant changes take place in the surface proteins namely: HA and NA proteins resulting in more virulent subtypes (Mpolya et al 2010 ,26). The 2009 H1N1 pandemic affected mostly young people and most elderly persons over 65 yrs of age were spared. This has been attributed to previous exposure to influenza viruses that conferred to them protective immunity. The short incubation period of the pandemic H1N1 2009 virus may explain its short lived illness.This may be explained as perhaps the infected body producing heavy immunity that effectively overwhelms the virus at shedding period.

Models for studying causal relationships of the epidemiology of Influenza H1N1 viruses

In causal relationships, the cause and the effect of a phenomenon are studied for any relationship between them. In epidemiological studies the cause may refer to exposure while the effect may constitute a disease. In such studies the main objective is to determine and analyze the determinants of a disease which is a key to setting up prevention and control measures (“Epidemiological modeling and risk analysis”, Chap 9). The determinants may include lifestyle, characteristics, incubation period, host factors (age, sex, breed, race, immune status) and environmental determinants such as climate, season, housing, nutrition and management (“Epidemiological modeling and risk analysis”, Chap 9). After drawing up a list of the possible determines/variable they are then subjected to thorough testing using various analytic tools such as the widely used multivariate analytic techniques of regression analysis. There are many attempts to explain causal relationship, which by and large, is still a much debated topic in many disciplines. In this section a number of classical and modern ones will be briefly discussed.

Some of the causality models of epidemiology include: the host-agent-environmental model, person place and time model, exposure-outcome mode, cause effect model, observational-experimental model and mathematical and statistical model. In this paper ,due to brevity requirement, only the host-agent-environmental model and the cause-effect model of infectious diseases will be discussed.

The cause-effect model is based on the premise of the interaction of an agent and disease. According to this model, a disease cannot develop in the absence of exposure to an agent (Vineis & Kriebel, 2006 ). In this model there can be a clearly defined one agent-one disease such as in small pox. This is referred to as the Pasteur and Koch Postulate. This is a rare occurrence. Conversely, a clearly defined cause /agent (e.g. bacteria, parasite or virus) may result in a myriad of symptoms such that the end disease is not clearly defined. This is common with some chronic diseases. The cause/agent has also been explained in terms of the Rothman’s pie hypothesis whereby the cause is said to be made up of a number of components, each with unique significance that are necessary to initiate and produce a disease (Vineis & Kriebel, 2006,p.1).

The epidemiological triangle is a modern tool used together with other biological disciplines; mainly biostatistics to investigate causal relationship of a disease.It is an important tool in formulating prevention and control strategies of infectious diseases. It based on the interaction of the host, agent and environment of a disease. The epidemiological triangle can be used to draw a model of causative interactions of the H1N1 Influenza virus (see fig.1). The basis for establishing casual inference for the two models is based on the Bradford Hill criterion. The parameters for this criterion are strength of association, of association, consistency, specificity, temporal relationship, Biological gradient, plausibility, coherence, experiment and analogy.

Conclusion and Recommendation

There is always a likelihood of an eruption of an influenza pandemic owing to the unstable nature of influenza viruses. New genetic makeup from a combination of different strains can present a novel strain whose effects can be catastrophic both socially and economically as has been experienced from the H1N1 subtype. Data from the influenza epidemics of 1918, 1958/68, 1976 and more recently 2009 indicate that Influenza viruses have high transmissibility and have the potential to cover a large geographical expanse in a short period of time. This means that time is critical factor in combating a new influenza outbreak. In this regard, governments should always have appropriate response strategies to handle any sudden outbreaks.

This can be achieved by perfecting Predictive models of epidemiology. As was the case during the 2009 H1N1 Influenza pandemic, the role of international collaboration cannot be downplayed. Developed nations need extend resources (personnel, finances, facilities, technology etc) to less developed/developing nation so as to strengthen their capacity to combat such pandemics. Otherwise, their localized efforts are bound to greatly fail. As most research have shown, public awareness and behavioral change at a personal level change have significant mitigating effects during the initial periods of an influenza outbreak when vaccines are unavailable. Therefore, public education strategies should put more emphasis on social measures such as personal hygiene and behavioral change. This form of awareness should persist even after the end of a pandemic. This can be achieved by incorporating pandemic education in mainstream education curriculum.

Understanding every aspect of a pandemic such as H1NI is crucial for future preparedness. Epidemiological studies and research should focus on the crucial areas such as host, environment and agent factors for purposes of setting up appropriate countermeasures.

References

Balinska, M., & Rizzo, C. (2009). Behavioral responses to Influenza pandemics.PLos Current,.1. Web.

Dandagi, G.L., Byahatti, S.M. (2011). An insight into the swine-influenza A (H1N1) virus infection on humans. Lung India, 28, 34-8. Web.

Department of Health and Human Services (US) (HHS). (2009). August 26).Assessment of the 2009 Influenza A (H1N1) outbreak on selected countries in the southern hemisphere 2009 (Argentina, Australia, Chile, N. Zealand and Uruguay. Web.

“Epidemiological modeling and risk analysis” (n.d). Tuskegee University College of Veterinary medicine nursing and allied health. Web.

Maliszewski, P.J & Wei, R. (2011). Ecological factors associated with pandemic Influenza A (H1N1) rates in California (USA): A Geospatial analysis [Working Paper]. Web.

McCallum, L & Partridge, J. (2001). Epidemiological characteristics of the Influenza A (H1N1) 2009 pandemic in the western pacific region. Western Pacific Surveillance and Response Journal. 2010, 1(1). Web.

Mpolya, E.A, Furuse,Y., Nakiwa,N., Suzuki. A., Kamigaki, T., & Oshitani, H. (2009). Pandemic (H1N1)2009 virus viewed from an epidemiological triangle model. Journal of Disaster Research 4 (5)5. Web.

Narain, J.R, Kumar, R., Bhatia, R. (2009). Pandemic (H1N1) 2009: Epidemiological ,clinical and prevention aspects. National medical journal of India ,22(5), Web.

Vines, P., & Kriebel, D. (2006). Causal models in epidemiology: past inheritance and genetic future. Environmental health: A global access science source 2006. Web.

WHO committee on clinical aspects of pandemic H1N1. (2010).Clinical aspects of pandemic 2009 Influenza A (H1N1) virus infection.New England Journal of Medicine: 362, 1708-1719.

Wong, L.P., & Sam, I.(2011). Behavioral responses to the influenza A (H1N1) Outbreak in Malaysia. Journal of Behavioural Medicine, 34, 23-31. Web.

Introduction

According to the World Health Organization (2008), influenza is a respiratory viral infection. It mainly affects the nose, throat, bronchi and occasionally, lungs. The infection may last for an average of one week and is normally characterized by sudden onset of high fever, aching muscles, headache and severe malaise, non-productive cough, sore throat and rhinitis. The mode of transmission is through droplets and small particles from one person to another. This type of infection normally spreads rapidly in seasonal epidemics.

Pandemic influenza is caused by influenza A which in the past century have gone major genetic changes in their H-component, causing global pandemics and adverse consequences in terms of disease and deaths. The “Spanish flu” is one of the most infamous pandemics that affected large parts of the world population and was thought to have killed at least 40 million people in 1918-1919. Others include the 1957 Asian influenza and the 1968 Hong Kong influenza.

Diagnosis is mainly by laboratory examinations and, to some extent, respiratory symptoms that may also be due to differential diagnosis. Rapid diagnostic tests have been developed and are able to detect influenza viruses within 30 minutes. Vaccination is the major prevention measure, and it is recommended that people who are at high risk should be vaccinated. These are the elderly and persons of any age who are considered at high risk. The main aim of vaccination is to reduce morbidity by 60% in the elderly and by 70-90% in healthy adults.

Antiviral agents such as amantadine, rimantadine and neuraminidase inhibitors (zanamivir and oseltamivir) are effective and efficient.

Australian Public Health Policy on Influenza Pandemic

In order to understand the current public health policy on influenza pandemic in Australia, this paper will review the National Action Plan for Influenza Pandemic (2009). This is a publication on policies and guidelines on how the pandemic should be addressed, right from surveillance to management of active cases. The main objective of the National Action Plan for Human Influenza Pandemic is to protect Australia against the threat of an influenza pandemic and to support the Australian community should one occur. There are four partners to ensure that this objective is achieved; the commonwealth, state, territory and local government (Commonwealth of Australia, 2009).

There is various Australian legislation that was put into place with the purposes of protecting Australia and its citizens from health threats which may be internal or external. To begin with, there is the international health regulation of 2005 which is a legally binding public health treaty which is under the World Health Organization. These regulations basically are put in place to prevent control and provide PH responses to the international spread of disease. They also help in the monitoring and surveillance of diseases. Within Australia, there are the quarantine Act 1908, air navigation Act 1920, Customs Act 1901, Privacy Act 1988 and National Health Security Act 2007 (Commonwealth of Australia, 2009). The quarantine Act of 1908 deals with both external and internal quarantine arrangements within Australia. The main aim is to protect the public from getting infected with quarantinable diseases. The Air Navigation Act of 1920, on the other hand, allows the government to vary, suspend or cancel an approved timetable of an airline on the basis of health concerns. The Customs act of 1901 established the Customs and Border Protection that monitors the movement of people and goods across the Australian border. It supports the influenza pandemic preparedness and planning. The Privacy Act of 1988 allows for free flow of information even in emergency and or disaster situations such as the influenza pandemic. Finally, the National Health Security Act of 2007 allows for a free exchange of information between jurisdictions and with the WHO with the purpose of monitoring and surveillance and responses to international public health emergencies. In 2008, the National Health Security Agreement was put into place with the objective of surveillance and decision-making structure to help in organizing a national response to public health emergencies such as the influenza pandemic. From these Acts, it is evident that they are capable of monitoring and surveillance of influenza pandemic. The commonwealth, state and territory have human infection health responsibilities with regard to control and prevention of influenza pandemic. These include surveillance, monitoring and reporting, which include clinical and laboratory surveillance activities; infection control and clinical care guidelines for health workers and the public to minimize transmission of the influenza virus; quarantine of humans suspected of being infected or contaminated; border measures which include preventing of access of any animal or human infected with virus from or to countries having outbreaks of the influenza virus.; the National Influenza Pandemic communications guidelines that have made smooth, free flow of information about influenza and easy coordination of surveillance and monitoring services across the country; There are measures that have been put into place to ensure that the risk of transmission is reduced. These are done at the community level, and the national level; the use of vaccines and antivirals are currently being advocated for in Australia. With the development of the National Medical Stockpile by the commonwealth government in 2002, there has been stocking of equipment, medications, and other supplies for purposes of health emergencies. Another co-function of primary health care is public awareness and education. This has been well developed in Australia with three major components: public education, public information, and effective media engagement. These have been put into place to primarily inform the public prior to an influenza pandemic. Awareness and health education and is a powerful tool to equip the public with relevant and accurate information. From all the information given above, it is clear that Australia has put enough measures that are concrete and capable of combating the influenza pandemic. It will therefore be right to conclude that Australia is ready to face an influenza pandemic (Commonwealth of Australia, 2009).

Current Western Treatment of Flu

Tamiflu is the drug of choice in the treatment and prophylaxis of influenza. The drug must be taken within 48 hours of appearing symptoms. The normal adult dose is 75mg BD for five days, while the weighted adjusted dose is used in children one year of age or older. The doses, even in children, are twice daily. Prophylaxis doses are as follows; adults and teenagers above 13 years get 75mg BD for ten days, children between 1 year and 12 years get weighted calculated dose. This drug is contraindicated in children under a year.

Another vaccine used against influenza is the Emerflu. It is sold as a suspension for injection and is made of attenuated flu virus strain called ‘A/Vietnam/1194/2004 NIBRG-14’ (H5N1). Emerflu is expected to work as a ‘mock-up’ vaccine. This is a special type of vaccine that is designed to help with the management of a pandemic.

Complementary and Alternative Treatment of Flu

Traditional Chinese Medicine: clinical trials and studies have shown that TCM is effective in the treatment of influenza. In a review of clinical studies, Chen et al. (2006), with the objective of assessing the therapeutic effect of TCM in treating uncomplicated influenza, showed that most of the reviewed studies showed that TCM as a whole seemed to be comparatively or more effective compared to different chemical drugs. In another study titled ‘Antiviral effect of Gingyo-san, a traditional Chinese herbal medicine, on influenza A2 virus infection in mice’ by Kobayashi et al. (1999) revealed that Gingyo-san has an antiviral agent in mice infected with a lethal amount of mouse-adopted strain of influenza A2 virus. The researchers then concluded that the herb might be effective in human beings, and therefore more studies need to be done using human beings. In yet another similar study by Kaneko and Nakanishi (2004) to prove the mysterious efficacy of ginseng showed that ginseng has preventive effects of medial ginseng on common cold symptoms complex and flu. A study was carried out by Lau et al. (n.d) to investigate the efficacy of a herbal formula in the prevention of severe acute respiratory syndrome (SARS) transmission among health care workers. The results showed that health care workers who used the herbal supplements improved from influenza-like symptoms and quality of life measurements. The study concluded that TCM supplements have the ability to prevent the spread of SARS. Wang et al. (2006) carried out another study to evaluate anti-influenza agents from plants and traditional Chinese medicine, which included a variety of polyphenols, flavonoids, saponins, glucosides and alkaloids. This study showed that TCM has potential in the therapy of influenza and its symptoms.

Acupressure and Massage: this has been shown to be having therapeutic effects in people suffering from the influenza virus. In order to demonstrate this, two studies to evaluate the use of acupressure and massage will be discussed. In a study carried out by Nguyen et al. (1995) titled ‘CHROMASSI: a therapy advice system based on chrono-massage and acupressure using the method of ZiWuLiuZhu. In the study, it was noted that CHROMASSI is able to advise on ways to treat over 153 diseases, including common cold and influenza. In another multi-treatment study done by Ketiladze et al. (1987) where the authors reviewed outcomes of immunological examinations of patients with influenza given adapromine and virazole drugs, as well as reflex therapy, increased host resistance. The study showed that patients with influenza who were administered reflex therapy, among other therapeutic measures, had a high level of IgM as compared to the control group. The final results showed that patients treated with both antiviral drugs and reflex therapy demonstrated a rapid disappearance of influenza antigen from the respiratory mucosa smears than in the control subjects.

Vitamins have been known to boost body immunity. Vitamins that are important to the treatment and prevention of influenza are vitamin C, D, niacin and thiamine. A study by Canell et al. (2006) showed that these vitamins have antiviral properties, and there their supplementation during and or before infection with influenza prevents infection or reduces influenza viral load.

According to Wei et al. (2009), some of the most common Traditional Chinese Medicine (TCM) includes Woad root (Ban Lan Gen), which is a popular herb for the treatment of flu and cold; Woad Leaf (Dan Qing Ye), which is an antiviral; Forsythia Fruit (Lian Qiao), clinical trials has shown that it has antiviral and antibacterial properties and effectively treats Upper and Lower respiratory infections; Honeysuckle Flower (Jin Yin Hua) which has been proved to be effective in deactivating influenza virus strain PR8; Baical Skullcap Root (Huang Qin) which is an antiviral and one of the most effective herbs against influenza and other Upper respiratory tract infections. These are just, but some of the TCM herbs that have been scientifically studied and therefore their safety and use have been tested in humans they have been declared safe for human use. More studies need to be done so that more of these herbs can be approved for human use, as studies that have already been done show that TCM is very effective in treating influenza and that they can treat more than one illness. They have no known side effects and can be used safely together with other western medicines without any interactions.

Complementary and alternative medicine still remains the better option in the treatment and management of many diseases, including influenza. Acupuncture, acupressure, TCM, and vitamin supplements have very few side effects, if not none, and treat more than one disease at any given time. Therefore, more studies need to be done on the use of CAM in the treatment and management of influenza.

References

1. Cannell, J. J., et al. (2006). Epidemic influenza and vitamins. Epidemiology and Infection, 134(6):1129-40.
2. Chen, X. Y., et al (2006).Chinese medicinal herbs for influenza. J Altern Complement Med, 2(2):171-80.
3. Kaneko, H., & Nakanishi, K. (2004). Proof of the mysterious efficacy of ginseng: basic and clinical trials: clinical effects of medical ginseng, korean red ginseng: specifically, its anti-stress action for prevention of disease. J Pharmacol Sci, 95(2):158-62. Web.
4. Ketiladze, E. S., (1987). Interferon and other immunological indices of influenza patients undergoing different methods of treatment. Vopr Virusol, 32(1):35-9. Web.
5. Kobayashi, M., et al (1999). Antiviral effect of gingyo-san, a traditional Chinese herbal medicine, on influenza A2 virus infection in mice. Am J Chin Med, 27(1):53-62. Web.
6. Lau, J. T., et al (2005). The use of an herbal formula by hospital care workers during the severe acute respiratory syndrome epidemic in Hong Kong to prevent severe acute respiratory syndrome transmission, relieve influenza-related symptoms, and improve quality of life: a prospective cohort study. J Altern Complement Med, 11(1):49-55. Web.
7. Commonwealth of Australia (2009). National Action Plan for Human influenza Pandemic. Australia: department of the Prime Minister and Cabinet.
8. Nguyen, H. P., et al (1995). CHROMASSI: a therapy advice system based on chrono- massage and acupression using the method of ZiWuLiuZhu. Medinfo, 8 Pt 2:998. Web.
9. Wang, X., Jia, W., Zhao, A., & Wang, X. (2006). Anti-influenza agents from plants and traditional Chinese medicine. Phytother Res, 20(5):335-41. Web.
10. Wei, L., et al (2009). Defeating cold and flu with Chinese medicine. Web.
11. WHO, (2008). Influenza. Web.

Introduction: The swine influenza A virus (H1N1) has in the recent days infected humans in USA, Mexico, European countries and some Far East countries. (Cannell et al, 2006).

Causes: The swine influenza virus can be spread from pigs to humans and humans to humans. Pig to human infection is most likely to occur when close contact with infected pigs occurs such as in pig barns. The virus is spread through coughing and sneezing.

Clinical Manifestation: The swine flu virus infection manifests with sudden and elevated fever, cough, sore throat, respiratory illnesses such as nasal congestion and rhinorrhea. Other symptoms include nausea, severe vomiting and diarrhea, anorexia headache, chills, fatigue, myalgia and dyspnea (WHO, 2008).

Treatment, Management and Prevention: This virus is very sensitive to antiviral agents such as Oseltamivir (Tamiflu) and Zanamivir (Relenza). Prevention may include early detection so that its spread is controlled, killing and avoiding of infected pigs, quarantining of infected persons until they are declared safe to mingle with others, and use of face masks to prevent inhalation of the virus from the air. Hand washing and personal hygiene is also very important (Commonwealth of Australia 2009).

Epidemiology of Swine Flu Virus: The recent swine flu virus was first detected in Mexico in March, 2009 where it caused 159 deaths and 2,498 illnesses. The virus was also reported in United States, Canada, Britain, Spain, and New Zealand and Israel.

Outbreak effects on my Community: Swine flu virus infection can have varied impacts in the community in terms of health, socioeconomic and psychological effects. Initially, the monitoring and surveillance of this infection needs huge amounts of money to be effectively and efficiently carried out.

Secondly, the infection has severe consequences on human health ranging from mild symptoms to severe complications that may lead to death. The infected persons don’t go to work hence a reduction in productivity and loss of work time. Finally, there is also a lot of stress and psychological disturbances associated with the infection such anxiety and fear of being infected.

Protocol for Reporting Disease outbreak (SARS)

As a community health nurse, the outbreak will be reported first to the nursing officer in-charge of the local health clinic, the nursing officer will then report to the local health department in my county. This will be done within 24 hours of diagnosis.

Care Modification

The first step in care modification is assessment of the nature of the poor air quality index and the possible risk factors and adverse effects and putting into place measures to counteract and prevent the occurrence of these adverse effects. The first action I will take will be to ensure that all people within the community who are suffering from asthma and other respiratory diseases get face masks and other protective gear that are able to prevent complications associated with the change in air quality. There will also be increased surveillance and monitoring of the patients more so on the respiratory system to detect any deviations from normal and taking necessary measures, they will also be admitted into health facilities and put on oxygen when necessary to prevent the occurrence of oxygen insufficiency. This will include respiratory rate, dyspnea, use of accessory muscles, chest movements, difficulties in and breathing. Patient education will be initiated to ensure that they are aware of symptoms associated with poor air quality and how the patients can modify their activity in relation to air quality index with the aim of preventing adverse effects. This will include strongly advising the patients’ that poor air quality is harmful to them and that they are at a high risk of developing adverse effects and complications if they are exposed. They will therefore be kept indoors so that they avoid heavy outdoor exertion. Preventing those with asthma and other respiratory tract infections from being exposed to the poor air conditions is the best way of preventing adverse effects associated with poor air conditions. Improved care modification will also include adherence to evidence based treatment and practice guidelines for patient care so that they are protected from allergens and other precipitating factors that may initiate or complicate their conditions; asthma and other respiratory diseases.

References

1. Cannell , J. J., et al. (2006). Epidemic influenza and vitamins. Epidemiology and Infection, 134(6):1129-40.
2. Commonwealth of Australia (2009). National Action Plan for Human influenza Pandemic. Australia: department of the Prime Minister and Cabinet.
3. WHO, (2008). Influenza.

Vaccination is one of the best ways to avoid the infection and to stay healthy and, in many cases, alive. The problem of influenza made people think about the protection from this virus which brings deaths to people and is very dangerous if not to endeavor to avoid it. One of the main ways to protect people from the influenza virus is vaccination. This way of protection is legal and is practiced all over the world, but not all people know how these vaccines are produced and that they may not only protect people from influenza but also provide harmful effects, one of which causes maybe even death.

The mentioned negative effect of the influenza vaccine is provoked by the special technology, according to which the flu vaccines are made. Cells are the main components of the flu vaccine, and there are a lot of types of such cells, according to which different types of vaccines are created. One of the main ways to create the flu vaccine in the United States of America remains the production of the vaccine from the embryonated chicken eggs (Liu, et al, 2009). This technology is rather effective, but the increase of the cases of flu epidemics requires the increase of the vaccine production what is rather difficult to do taking into consideration the limitation of the raw materials. This makes scientists and vaccine manufacturers search for alternative ways of vaccine production.

The Madin Darby Canine Kidney (MDCK) is one of the alternative cell lines which were discovered in 1958. MDCK (CCL 34), Vero, MRC-5, WI-38, and FRhL-2 cells are the types of cells that are used for vaccine production in the United States now. The article by Liu et al introduces the examples of materials and processes of the new innovative technology for the flu vaccine creation. The viruses which are aimed to be contested in the experiment are A/Sydney/05/97, A/Beijing/262/95, B/Harbin/7/94, A/Panama/2007/99, A/New Caledonia/20/99, B/Jilin/20/2003, A/Hiroshima/52/05, B/Malaysia/2506/04, A/Vietnam/1203/2004, A/Teax/36/91, B/Hong Kong/220/01 and B/Victoria/504/2000 (Liu, et al, 2009). The current study showed that MDCK cells are the most appropriate raw material for live attenuated influenza vaccine production and maybe a good alternative to the embryonated chicken eggs.

The experiments and investigations which were reflected in the article “Use of MDCK cells for production of live attenuated influenza vaccine” by Liu et al is a good start for the researchers in vaccine manufacturing and the investigation of the other ways and technologies. The first step is the most difficult, as the understanding of the problem and its further decision is much easier to provide.

The cell production of the influenza vaccines is rather effective, but there are still some cases when everything goes wrong and this vaccine becomes the cause of health problems and even death. There is the opinion that the reason for such cases is that the vaccines are produced from cells, the others insist that the vaccine is not the cause of the problems. To consider these opinions it is better to dwell upon the real situation where real people were involved and these people became the victims of the vaccination from influenza.

The question of whether the influenza vaccination is safe appeared after some cases appeared when people had either great problems with health or died after influenza vaccination. Government and medical institutions began to check the information and provide some investigations to prove that the causes of the problems were not caused by vaccines, but people, when frightened, are difficult to be persuaded.

The described situation took place in Israel when four people died after the influenza vaccination in October 2006. After the cases emerged, the vaccination campaign was stopped till the ascertainment of the facts. The investigations and tests showed that the vaccine could not be the reason for the death and the results of these investigations were introduced, according to which, the death rates from the influenza vaccine within 7 days ranged from 0.01 to 0.02, and 0.09 – 0.1 at 30 days. The investigations showed that the possibility of the deaths, caused by vaccination, was very low and the immunization of the Israel population continued, but still the possibility was, that is why the further vaccination was reduced as people refused to be vaccinated (Kokia, 2007).

Mentioned examples are not so numerous, but they still exist. Knowing about such cases, people begin to question the properties of the vaccines and refuse vaccination that can lead to epidemics, where even people, who were vaccinated, can die from flu complications. The distrust in medicine is the other reason why people refuse immunization and the growing rate of deaths in the country support people’s idea, as they are not informed whether the vaccination was implemented on those people or not.

The article by Benedict Carton (2003) introduces the examples when people were infected by the other types of viruses, which is why the influenza vaccination was not effective. It is a proven fact that there are a lot of types of vaccines and that every year newer and newer vaccines should be developed in order to reduce the risk of infection to a minimum. The vaccine which kills this or that type of virus can easily create some health problems in the combination with the other type of flu virus as the vaccinations are created from the cells, and it is never possible to predict the further consequences in the genetics, that is why some people believe that flu vaccines can lead to death (Armstrong, et al, 2004). Kathleen M. Neuzil and Rick A. Bright (2009) in their article insist that vaccine from influenza does to give 100% guarantee to avoid the facts of being infected, but they give strong immune support and the consequences of the infection are much better to bear than without vaccination (Neuzil & Bright, 2009).

Fireman, B, et al (2009) in their article provided the investigation, according to which older people, even after the vaccine, had a higher rate of deaths during the period of the epidemics. The arguments were given that vaccines did not only fail to protect people but also were the reasons for their deaths. The investigations showed that the vaccine was not to the point. Old people had a lot of other health problems and such as heart, diabetes, and other problems which come to people with the age. The authors of the article managed to prove that the increased rate of deaths of old people during the flu epidemics is not connected with the vaccination. Moreover, vaccination is not the reason for the health problems.

It is important to mention that there is not so much information about the causes of deaths, where the flu vaccines were the reasons for the health problems and death, and even if the suspicions were about the cases, the medical institutions provided a lot of investigations and researches and proved that vaccine was not the reason. The actions of the health department are easy to understand, as even if there could be at least 30-40% of the possibility that the deaths were provoked by the vaccines, people would refuse to be vaccinated and the possibility of the epidemic could emerge. The Health Department is responsible for the vaccines which are promoted to the markets and they are carefully checked before entering the sales, so the cases of death reactions to the vaccine are so rare that they even cannot be distinguished.

There are a lot of cases when vaccines provoked health problems, but they are not really the causes as people could have had the health problems before and the vaccines just opened the doors to the disease, which had absolutely alien reasons. So, in conclusion, it may be said that the new technologies, where vaccines are created on the basis of cells, are much more productive than those which are created out of egg embryos as the time limits are different. Cell vaccine production is faster what is very important in the cases when the virus has already started its work and the faster the vaccine will be created the faster it will be able to give its results. On the other hand, the cell-produced vaccines may come into the contest with the organism and the consequences may be unpredictable.

Reference List

Armstrong, B. G., et al. (2004). “Effect of influenza vaccination on excess deaths occurring during periods of high circulation of influenza: cohort study in elderly people.” BMJ. Vol. 329, no. 7467.

Carton, B. (2003). “The Forgotten Compass of Death: Apocalypse Then and Now in the Social History of South Africa.” Journal of Social History. Vol. 37, no. 1.

Fireman, B, et al. (2009). “Influenza Vaccination and Mortality: Differentiating Vaccine Effects From Bias.” American Journal of Epidemiology. Vol.170, no. 5, pp. 650-656.

Kokia, E. S., et al. (2007). “Deaths following influenza vaccination—background mortality or causal connection?” Vaccine. Vol. 25, no. 51, pp. 8557-8561.

Liu J, et al. (2009). Use of MDCK cells for production of live attenuated influenza vaccine. Vaccine.

Neuzil, k. M. & Bright, R. A. (2009) “Influenza Vaccine Manufacture: Keeping Up with Change.” The Journal of Infectious Diseases. Vol. 200, no. 6, pp. 835-837.

The US and the Northern countries are getting ready for a second wave of the H1N1 (Swine Flu) infections that could affect many people and lead to many more being hospitalized, thousands dead and closure of businesses and schools. This is according to a report by Rob Stein (2009) in the Washington Post that the flu virus is very notorious and any efforts to make firm predictions are impossible. Swine flu affects the respiratory system, and it infects pigs. The causal agent is influenza type A and seems to spread widely in winter and autumn but can flow all year round. It occurs mostly in humans who have had close contact with pigs, and cases, where humans pass the disease to others, have also been documented. Swine flu has been reported to be associated with Severe Respiratory Syndrome (SARS), a bird’s flu that has caused many deaths in South East Asia in recent. It is a different strain of the influenza virus from that of swine flu. Swine flu is a type of H1N1 strain while the bird’s flu strain is H5N1 (Mancilla, 2009). H5N1 can lead to being a virulent disease because it can transform rapidly but to date, it has been more of a bird’s disease than a human disease. H1N5 is transmitted from birds to humans who work closely with them. However, the flu has since gained the ability to be passed from humans to humans (Mancilla, 2009).

The death toll from influenza varies with different strains and the times the strains appeared. The Spanish flu infected 40% of the global population and killed more than 50 million people in 1918 (Fischer &Irving, 1933). The young adults were the most affected group. It is caused by a strain of flu in the form of HN1. In 1957, 2 million people were killed by the Asian flu of the human form of H2N2 of the flu strain which was combined with a mutated train of ducks (WHO Guidance, 1957). The most vulnerable age group at that time was elderly. An outbreak that was initially detected in Hong Kong in 1968 killed approximately 1,000,000 people worldwide (Pappas, et al, 1970). The strain which was known as H3N2 mostly affected people over 65 years of age (Pappas, et al, 1970). The WHO has warned that the Swine flu could generate a global virulent disease.

However, it is too early to correctly judge the death toll from the swine flu with certainty. The flu epidemic is being experienced in the world at a higher rate since 1968, rated at 3 on 6 point scale (Rob, 2009). Up to now, the H1N1 virus has spread to over 168 countries with over 162, 000 cases confirmed (Public Services International 2009), and 1,154 deaths with 436 of these deaths occurring in the US (Rob, 2009). The potential pandemic impact of swine flu is not known but researchers and health experts predict that it could cause loss of lives to millions globally (Mancilla, 2009).

The signs and symptoms of an infection from swine flu are similar to those of common seasonal flu and include headaches fever, sore throat, chills, diarrhea, cough, fatigue, and body aches (Romelia, 1992). Severe illnesses like pneumonia and respiratory diseases are associated with the flu (Spink, 1996), and deaths reported from H1N1 were associated with such diseases (WHO, 2009.

The treatment of influenza is normally through antibiotics. For instance, H1N1 is treated using Tamiflu and Relenza (Rupert, 2009), which have been known to be effective when used to treat the confirmed cases that have so far occurred. The use of antibiotics to treat viral diseases is however ineffective since antibiotics always target apart on the pathogen that is not similar to the host cells, like the cell wall in bacteria. The biochemistry and the cellular makeup of viruses are similar to that of the human host cell (Berkow, 1997). Therefore, if the antibiotics are toxic to viruses, they might also harm the human host cell. Antibiotics are also known to have several side effects like nausea, diarrhea, vomiting, itchiness, fatigue, and those that are the sedative cause, someone, to sleep. This problem is usually caused by the overuse of antibiotics when people use them for the wrong reasons. The use of antiseptic soaps, detergents, and protective lotions has no known benefits (Webbe, 1999). However, the continued use of antibiotics exposes the disease-causing agents to them, develops a resistance to them hence when one is infected by a disease caused by that particular pathogen, the drugs become ineffective since they cannot be killed by them (Blobel, 1992). Antibiotics of the class Beta lactams have a lactam that is strongly reducing and they use this to attack the cell wall of the bacteria. Bacteria develop a group of enzymes called beta-lactamases that destroy the beta-lactam ring of the antibiotic such that it is no longer effective against the bacteria. Antibiotic-resistant strains emerge due to the overuse of antibiotics (Spectre, 1997). This causes another problem; the emergence of more virulent viruses that become hard to treat. A good example is an H1N1 virus that is known to mutate rapidly. This is usually to evade the toxicity of the antibiotics used for the treatment. The vaccines being produced against H1N1 for instance may prove useless since flu viruses mutate rapidly and within a very short period (Berkow, 1997). Swine flu is already showing signs to change and the antiviral drug Tamiflu is becoming ineffective in some people. The WHO (2009) reported that H1H1 influenza viruses were detected to be resistant to Tamiflu in Hong Kong, Denmark, Canada, and Japan. This is what makes the treatment of viral diseases like influenza hard to treat because of the rapid mutations they undergo.

Reference List

Berkow, RE, ed 1997, The Merck Manual of Medical Information, Home ed; USA, Warehouse Station, Pgs 864-5

Blobel, H and Schliesser, eds 1992, Handbook of Bacterial Infections in Animals, V.E. B. Gustav, Fischer, Jena, Pgs 231-35

Fischer and Irving 1933, The Pandemic of the Influenza Virus and its effects. Econometrica 1: 337–357.

Mancilla 2009, The Swine Flu (H1N1) Pandemic, The Washington Post.

Marie, 2009. The Vaccine for the Swine Flu (H1N1), The Los Angeles Times Blog.

Pappas, G, Papadimitriou, P, Acridities, N, Christie, L and Tisanes, EV 1970, The new global map of human H3N2. Lancet Infect Dis.91-9

Public Services International 2009, The worldwide trends of swine flu, World Health Journal, Vol 23 (4) Pp 123-126

Rob, S 2009, “Northern hemisphere braces for a second attack of swine flu as we enter the winter.” The Washington Post. Web.

Romelia, SD1992, “Signs and Symptoms of a common Influenza infection”, Journal of Economic History, vol 52, num 4, pages 757-784

Rupert, T 2009, “Influenza Pandemic Threat Underplayed?” in Diseases/Viruses. Web.

Shurden, WB1993.”The Baptist identity: four fragile freedoms”; Smyth & Helwys Pub. Pgs 119. ISBN188083720X, 9781880837207.

Spectre, S Dr 1997, “The Failure of Antibiotocs, the Old bugs don’t work”, Health Publications, 232 pages. ISBN-10: 0842431812.

Spink, WW 1996, The nature of Influenza, University of Minnesota Press, Minneapolis Pgs 14-23.

Webber, C 1999, Antibiotics: Criteria for use and the Side effects, Threodor Publishing, Inc., SBN0879278200.

WHO 2009, Vaccine and retaviral report on H1N1 strain of influenza, World Health organization, Geneva.

WHO Guidance 1957, The H2N2 Epidemic, Geneva, World Health Organization.