Category: Flu

Introduction

The problem involves the policy surrounding flu vaccines in children under five years old and its effects in delay or refusal. Vaccine policy usually refers to a government’s health strategy to manage herd immunity for its people (Jester et al., 2020). It has an advisory committee which provides information to states and assists in making an evidence-based decision on immunization mechanisms. The program is typically targeted towards specific individuals at risk as per their health vulnerabilities. One such disadvantaged group is children under the age of five years (Jester et al., 2020). The program is useful for the young generation because it reduces the spread of flues. It also offers direct protection to unvaccinated and high-risk persons. Such measures aim to eradicate or maintain the elimination of infections that can be prevented by vaccines. Furthermore, it seeks to achieve and surpass immunization coverage levels, which is globally recommended among young children.

Lack of vaccination within the specified age group under evaluation can lead to fatalities since their bodies’ immunity will be unprepared to combat invasions. As a result, the hospitals will be flooded with inpatients suffering from illnesses that could have been easily prevented if the right precaution had been taken. Others may equally succumb to the diseases leading to the loss of potential active members of the society shortly. However, the policy is mostly flawed and necessitates an adjustment to solve the underlying challenges. Yearly, the Center for Disease Control (CDC) issues recommendations and guidelines for the program to reduce childhood morbidity and mortality (Rizzo et al., 2018). However, some parents are hesitant to accept the advice because of such reasons as religion, medical, philosophical, or socioeconomic claims. The current government directives are flexible to accommodate the reservations of such parents or guardians. The resulting problem is the widespread non-compliance, which hinders the effectiveness of the vaccination objectives.

Policy Goal Establishment

The primary challenge affecting the policy is non-compliance from some community members; hence the solution will be a rectification of the problem. The scheme aims to encourage people to bring children under their care to go through flu vaccination. In an ideal state, every individual within the age group should gain access to the program and benefit equally. The perfect scenario will accommodate everyone’s varied perspectives while ensuring that the objectives of the stratagem are met. If it succeeds, then the tensions associated with the process will be eliminated since people feel that their autonomy and liberty are infringed upon.

The ethical objections and debate on mandatory vaccination protocols create multiple and interrelated dilemmas that make implementation difficult. Such concerns include contrasting family and religious beliefs and other human rights questions (Olson et al., 2020). As such, if the goal was achieved, the individual disagreement or rebellion towards the policy will be limited hence greater acceptance. Thus, it will result in a dramatic decline in child morbidity and spending on treating otherwise preventable infections. It is the desired outcome because of the fundamental roles of vaccines. They are primarily practical because they boost immunity against that particular flu and its associated symptoms, including asymptomatic carriers. Moreover, they protect individuals who have not gone through the process because of the reduced risk of exposure. Therefore, there is improved health among children under the age of five years, allowing them to survive to adulthood.

Policy Alternatives

Several alternatives can be adopted by authorities to achieve the desired goal and address the concerns. The solution generation process is focused on the individual challenges experienced or primary triggers of recalcitrance. The new scheme should make the program free and accessible to everyone that merits the age requirements. It originates from the reported claims of discriminatory action against some minority groups. The government can create incentives for private industries to manufacture the desired serums at a relatively low cost. Such means include creating tax breaks to stimulate fresh manufacturing plants and improvement of existing firms. It can equally take part in active partnership with private companies to further minimize production cost, hence making the program affordable to everyone (Savulescu et al., 2021). The approach will ensure that there is limited discriminative access in both socioeconomic and ethnic aspects.

Moreover, to tackle resistance, the alternative should focus on addressing contention issues and building a society with informed consent. Some of the beliefs that oppose the program are born from ignorance and misconceptions among people. It originates from the action of some states which provide legal representatives with a Vaccine Information Statement (VIS) with data on the general benefits and risks. The strategy hopes to help the guardians make decisions based on a scientific perspective instead of belief systems. The other means include increasing public awareness and general knowledge on inoculation. However, if the immunization is not done, numerous detrimental outcomes can happen, including children’s death. The no-change option can be considered because it will maintain the current environment.

Conclusion

The main challenge facing immunization policy for children under five years is the objection by some guardians. At this age, the children are most vulnerable because of their weak immune system. It is thus imperative to design new schemes that can solve the situation to save young lives. Alternative approaches include increasing the affordability and improving access to the serum. Additionally, the general public should be considerably informed to minimize the tensions that arise from the ethical debates. The shots are beneficial and are an excellent means of protecting the young population against severe infections.

References

Jester, B. J., Uyeki, T. M., & Jernigan, D. B. (2020). Fifty years of influenza A(H3N2) following the pandemic of 1968.American Journal of Public Health, 110(5), 669−676. Web.

Olson, O., Berry, C., & Kumar, N. (2020). Addressing parental vaccine hesitancy towards childhood vaccines in the United States: A systematic literature review of communication interventions and strategies.Vaccines, 8(4), 590. Web.

Rizzo, C., Rezza, G., & Ricciardi, W. (2018). Strategies in recommending influenza vaccination in Europe and US. Human Vaccines & Immunotherapeutics, 14(3), 693−698. Web.

Savulescu, J., Giubilini, A., & Danchin, M. (2021). Global ethical considerations regarding mandatory vaccination in children.The Journal of Pediatrics, 1−22. Web.

Abstract

• Overall aims and specific objectives: To examine the management of health emergencies by the World Health Organization (WHO) as a UN agent to establish its inefficiency in coordinating international cooperation. The paper analyzes structural and administrative shortcomings that led to poor communication, messaging, coordination, and cooperation during the 2009 influenza A (H1N1) and the 2014 Ebola disease outbreak health emergencies.
• Method/procedure: The paper analyzes evidence presented in the existing literature on the 2009 H1N1 and 2014 Ebola outbreaks.
• Key findings: During the H1N1 crisis, the WHO made communication and messaging mistakes that led to pigs’ mass slaughter. Simultaneously, the WHO erroneously declared a pandemic costing countries millions of dollars invested into vaccines that were never used. During the Ebola outbreak, the WHO’s coordination failed between the Geneva and African secretariats, delaying interventions. Additionally, the WHO accepted misleading official reports from governments and NGOs, giving the disease time to get out of control.
• Main conclusions and recommendations: The WHO needs to undergo policy and human resource reforms.

Introduction

The World Health Organization (WHO) has been existing for several decades now, serving the world to coordinate health responses to outbreaks and pandemics. Nevertheless, the organization receives criticisms from time to time due to its mishandling of disease outbreaks and resource management. Civil society organizations, member states, and non-governmental organizations have questioned the WHO’s relevance. This report uses a simple structure to examine the lack of coordination, appropriate communication, and international cooperation in the WHO’s Ebola and H1N1 management.

When H1N1 influenza was reported to the WHO in 2009, the world was confident that it was ready for the first 21^st-century pandemic. The virus originated from a rural village in Mexico called La Gloria. In a few weeks, influenza spread across 200 locations in the world (Kamradt-Scott, 2018). Governments worldwide joined the WHO to prepare for the next pandemic following the bird flu reemergence, also known as H5N1. During and after the H1N1 flu, the WHO was criticized for mismanagement of the event. Following the criticisms, three investigations were conducted to establish the causes of the organization’s crisis in H1N1 management (Kamradt-Scott, 2018). Although the inquiry failed to establish inappropriate conduct, they recommended changes to the organization’s emergency response strategies.

H1N1 Management Errors

The WHO’s mistakes during H1N1 include labeling the flu as “swine flu,” removing influenza guidelines from their website and declaring the flu as a pandemic. The 20^th-century influenza pandemics were named after the places of origin, such as the 1968 Hong Kong flu, the 1957 Asian flu, and the 1918 Spanish flu, adversely affecting these regions’ economies (Kamradt-Scott, 2018). The WHO attempted to change the trend by naming the flu concerning the animal linked closely to influenza, preventing it from being called the ‘Mexican flu.’ Since the flu was linked to pigs, the WHO named it the swine flu, making its first big mistake in H1N1 management.

International media houses described influenza as swine flu during its first few weeks. In the following weeks, 20 percent of the WHO’s member states deviated from international norms to protect their citizens from pigs as a swine flu source (Kamradt-Scott, 2018). Although Egypt did not report infections, the government implemented a preventative measure that saw over 400,000 pigs culled countrywide (Kamradt-Scott, 2018). A few days later, Iraq slaughtered three zoo boars to eliminate the fear of contracting the flu from visitors. Around the same time, over 20 countries banned importing pork and its products and live pigs to prevent the flu’s introduction within their borders (Kamradt-Scott, 2018). The mass slaughter of pigs was a consequence of miscommunication from the WHO.

The WHO realized that the swine flu needed immediate rebranding to prevent further damage. The secretariat began renaming the flu Influenza A (H1N1) and sought other intergovernmental organizations’ help to lift the bans on pork products and pigs importation. Towards the end of April 2009, the WHO made press releases and advisories to remedy the situation, explaining that well-cooked pork products could not spread the flu. Although the WHO continually issued such messages jointly with the Food and Agriculture Organization (FAO) and the World Organization for Animal Health, several countries did not lift their bans (Kamradt-Scott, 2018).

The WHO failed to recognize how powerful its messages would be on member states and the world. The organization did not establish a scientific transmission of the flu between humans and pigs (Rathore, 2017). Nevertheless, it named influenza swine flu and caused damage to trade practices and animal malpractices.

The WHO made its second mistake when it removed pandemic guidelines from its site. With the uncertainties surrounding new diseases, many governments rely on the WHO website’s information to guide their responses and emergency committees. The measures included the development of vaccine manufacturing ability, creation of response committees, and antiviral stockpiling. The complete policies were posted on the website a few months before the outset of H1N1, and governments were yet to internalize them (Kamradt-Scott, 2018). Therefore, the removal of these guidelines left most countries unprepared to handle the pandemic.

The third mistake the WHO committed was prematurely declaring H1N1 influenza as a pandemic. A few weeks after the H1N1 flu was reported, Mexico reported around 84 deaths and 1300 infections (Rathore, 2017). In the following days, laboratories confirmed that nine countries reported illnesses, but the figure rose to 30 countries with 5000 infections by the middle of May 2009 (Kamradt-Scott, 2018). The International Health Regulations emergency committee established to support the WHO advised that the flu be escalated to Phase 5 (sustained community transmission) to signify that a pandemic was unavoidable (Kamradt-Scott, 2018).

However, the alert was immediately criticized since infections did not cause severe symptoms. The secretariat declined to provide the IHR emergency committee members’ names who advised on declaring a pandemic, leading to allegations of conflicts of interest.

Ebola Outbreak Management Errors

While transparency improved after the H1N1 emergency, the WHO failed its member states and the world in 2014 when Ebola was reported in West Africa. The organization made two critical errors: slow response due to reliance on ‘official reports’ and inadequate coordination. The Ebola virus disease (EVD) outbreak started in December 2013 in Guinea but was not reported to the WHO until March 2014, during which it spread to Sierra Leone and Liberia (Ostergard, 2020).

Although the WHO mobilized immediate response, it relied on official reports from NGOs and governments, providing insufficient data for resource allocation. In May 2014, Guinean data showed that Ebola was nearing its end, and its health minister supported the idea (Ostergard, 2020). However, an NGO called Medecins Sans Frontieres (MSF) disputed the claim while the WHO accepted it (Ostergard, 2020). Two weeks later, the outbreak got out of control, revealing poor judgment on the WHO’s side for accepting official reports without probing further.

The WHO’s response to the EVD outbreak involved insufficient coordination between the Geneva office and Africa’s regional offices. The regional secretariat approved a response plan in March 2014 that declared the outbreak as WHO Grade 2 Emergency, requiring a regional support team (Ostergard, 2020). However, the Geneva secretariat responded in May by sending 90 workers to Guinea, one to Sierra Leone, 20 to Liberia, and four to the Africa office (Wenham, 2017). These staff allocations revealed a disparity in how regional and Geneva offices treated the situation. The WHO regional secretariat also took three months to begin a coordination process in the region. The lack of proper coordination attributed to the spread of Ebola, which was severe enough to attract the UN secretariat and several countries around the world.

Conclusion

The WHO failed in managing the H1N1 pandemic and Ebola outbreak. Labeling H1N1 as Swine flu caused animal welfare issues as pigs were culled in various countries and created trade barriers as some countries banned pork products in some countries. When the secretariat declared the flu a pandemic and was criticized, it acted on the wrong media strategy of removing pandemic guidelines from its website; during the Ebola outbreak, the WHO trusted the affected governments’ reports, knowing that they lacked experience with Ebola outbreak. The outbreak went out of control and was contained through a global effort. As a UN agent, the WHO has shown much inefficiency in handling pandemics and outbreaks.

Recommendations

The WHO requires both policy and human changes to ensure a smooth response to health emergencies. Although funding is a big challenge for the organization, most of the mistakes described in this paper require policy and human resources. The WHO can formulate policies that create speed and eliminate unpredictability in emergency handling. The policies should support collective action, eliminate bureaucracy, and promote member states’ preparedness and readiness. The WHO may include a broader skillset among its staff and increase resource allocation to developing countries.

References

Kamradt-Scott, A. (2018). What went wrong? The World Health Organization from swine flu to Ebola. In A. Kruck, K. Oppermann, & A. Spencer (Eds.). Political mistakes and policy failures in international relations (pp. 193-215). Palgrave Macmillan.

Ostergard Jr, R. L. (2020). The West Africa Ebola outbreak (2014-2016): A health intelligence failure?Intelligence and National Security, 35(4), 477-492. Web.

Rathore, I. (2017). Swine flu (H1N1 Influenza A): A recent pandemic and future threat. Asian Journal of Nursing Education and Research, 7(2), 239-242. Web.

Wenham, C. (2017). What we have learnt about the World Health Organization from the Ebola outbreak. Philosophical Transactions of the Royal Society B: Biological Sciences, 372(1721). Web.

Introduction

The health problem considered in this paper is the epidemic of influenza, a small enveloped virus that is highly contagious. To date, the continuous spread of influenza viruses as well as the emergence of reassortant strains of animal origin pose a constant danger to people’s health. The researchers (1) state that clinical implications of influenza are associated with the involvement of lung tissue and pleura. It is possible to develop respiratory distress syndrome, in which patients need hospitalization and transfer to artificial lung ventilation within a day from the onset of symptoms. Some scholars (2) admit that the economic implications of an influenza pandemic require high annual costs, resulting in a decline in GDP. For some countries in South Asia and Africa, the decline in GDP as a result of the medical costs associated with influenza is equal to the level of the average economic growth rate of these states.

Treatments to be analyzed in this review are annual vaccinations that protect against three or four of the most common strains of the virus in a given area. The study will involve influenza vaccines of different compositions. These are four-component, three-component, and two-component vaccines that include an appropriate number of virus strains (3). The reason for performing this study is to evaluate the current evidence about the cost-effectiveness of influenza vaccination. The work aims to analyze data to find the economic effect of both medical expenses and indirect costs and comment on which vaccine is more cost-effective. It is possible to stipulate that the review follows a few objectives. Firstly, the aim is to find and synthesize the existing evidence to compare the cost-effectiveness of the trivalent versus quadrivalent influenza vaccine. Secondly, the review focuses on accumulating other relevant knowledge about the two vaccine types. The data focus on age group vaccination specifics, economic burden, reasons for limited use of influenza vaccines, safety and supply issues, health effects, and clinical outcome.

The various efforts performed by different countries in preparing and developing strategies to curb the influenza pandemic have been prioritized. According to Ortiz and Neuzil (4), influenza vaccines are hardly utilized in low and middle-income nations. The assessment of whether quadrivalent influenza vaccines are better than trivalent influenza vaccines has been done by evaluating the cost-effectiveness of the Quadrivalent Influenza vaccine (QIV) and Trivalent Influenza vaccine (TIV). There is a significant difference between the two types of influence vaccines. On the one hand, the scholars (5) admit that the TIV protects individuals from three influenza strains, including one B strain and two A strains. On the other hand, the name suggests that the QIV offers protection against two A and two B strains, making a total of four. That is why it seems reasonable to compare the effectiveness of these two approaches, and it is a task of this literature review.

The issue under analysis is not unique because many scholars focus on the topic. For example, the literature assessment (1) systematically evaluates the evidence of economic burden initiated on influenza in low and middle-income countries and shows financial consequences of influenza disease in the countries. It also examines why lower and middle-class countries underutilize influenza vaccines and the what vaccination costs they face. Still, it illustrates how the safety and availability of supply issues affect health results in regions that are more vulnerable to the disease. In addition, it provides different articles that cover numerous subjects on the disorders and can help conduct research. However, it is still reasonable to conduct a literature review to synthesize the existing knowledge on the cost-effectiveness of the TIV and QIV and conclude on which variant is better and why.

Methodology

The literature review methodology is used to undertake this study. The researchers (6) stipulate that this approach is suitable to locate and analyze international data on a specific issue to arrive at grounded conclusions. Thus, one can state that this methodology allows for summarizing and presenting an overview of the existing data. Consequently, it is reasonable to rely on the given approach to find and synthesize the data about the cost-effectiveness of the TIV and QIV.

The specific and detailed PICO question guides the whole research process. It is as follows: In patients from low- and middle-income countries (P), is quadrivalent influenza vaccine (I) or trivalent influence vaccine (C) is more cost-effective (O)? The proposed question should make it clear that the given literature review focuses on comparing TIV versus QIV. In other words, the primary task is to determine which strategy is more cost-effective.

The literature review dealt with the articles retrieved from Google Scholar. This resource was used to find additional credible and reliable studies. The rationale behind this statement is that Google Scholar provides access to many databases, including SciELO, NCBI, and others, and scholarly journals to locate relevant literature. The given work focuses on those articles that were written in English and between 2017-2021. Consequently, a convenience sampling technique was used to provide the paper with reports.

The searching strategy consisted of a few keywords, including trivalent influenza vaccine AND/OR quadrivalent influenza vaccine AND cost-effectiveness. As is evident, the Boolean operators AND were used to ensure that all the three key terms are present in the papers under analysis. Simultaneously, the OR operator denotes that any of the two key terms could be present in articles. The inclusion criteria were English language and the publication date between 2017-2021. There was an exception to this criterion because there were included three studies that were published before 2017, and they were considered because they offered valuable information. Simultaneously, a study was excluded from the literature review if reading its abstract revealed that it contained irrelevant content. Furthermore, a study was not included in the review if no full text was available. Finally, the articles were excluded if they only contained data about vaccination in high-income states. Thus, the literature review’s author is responsible for ensuring that appropriate studies are included in the analysis.

The interventions selected for the study consist in monitoring epidemiological data on the prevalence of the disease (disease burden) prior to vaccination. An intervention was also performed to determine the immunogenicity of the vaccines intended for use and to monitor the outcomes of vaccination. The comparator will be conducted on the basis of comparing the costs of vaccinations and treatment, payment of sick leave, and other manipulations with influenza patients. Monetary indicators of investments in vaccinations and treatment of patients will be compared.

Results

The selected search strategy resulted in the fact that 74 articles were initially obtained. The inclusion and exclusion criteria application resulted in the fact that 12 articles remained. The articles that were published earlier than 2017 were found by the references of the already selected papers. All the other studies were removed as per one of the stipulated exclusion criteria. In particular, the PRISMA chart below provides a detailed explanation of how the literature review has come to the specified number of articles. The chart is followed by the obtained results from individual themes that were mentioned in the Introduction section.

Table 1 lists all the articles that were included in the review, and their main findings.

Table 1: Literature Findings

Cost-effectiveness. In the beginning, it is worth admitting that QIV is a promising intervention to reduce an economic burden on healthcare systems. According to Lee, Bartsch, and Willig (7), this phenomenon contributes to better protection and cost savings at the same time. In particular, the researchers admit that relying on QIV instead of TIV can imply $3.1 billion in cost savings for society and approximately $290 million for third-party payers. Lee, Bartsch, and Willig (7) stipulate that this state of affairs is present irrespective of the fact that the cost of a single QIV dose is significantly higher than that of a TIV one. This information contributes to the fact that more and more countries and healthcare establishments consider implementing QIV.

In addition to that, other articles provide more specific results of comparing the cost-effectiveness of TIV and QIV. For example, the researchers (8) consider how these two vaccines are implemented in Brazil. These scholars (8) compared the cost-effectiveness of two vaccines under different conditions and identified that QIV could contribute to the savings of R$19,257 to R$22,768 using a lifetime horizon. The given study utilized a comprehensive and appropriate methodology and identified that QIV could contribute to better economic outcomes for patients.

The cost-effectiveness of QIV fluctuates among different countries because of differences in the study of disease transmission, co-morbidities, and unit costs. One can mention that the burden of influenza B decides the success of QIV or TIV among the targeted population and the country’s willingness to undergo the strains associated with the immunization (3). De Boer et al. (3), using an energetic modeling study authorized by the World Health Organization, recommends that QIV may be more financially savvy than TIV in the specified countries under certain conditions.

Quadrivalent Influenza vaccines provide a better health benefit, according to Hendriks et al. (12). If high attack rates were assumed, QIV would be cost-effective (3). Substituting QIV for TIV would mean an extra expense of 25–29% spending increment for occasional flu, resulting in an increase in the annual cost of immunization, leading to a rise in the National budget (13). The high costs associated with Quadrivalent Influenza vaccines might lead low and middle-income countries to select the Trivalent Influenza vaccines due to the low immunization costs. Low-income countries will prioritize the affordability of the vaccines, not their effectiveness (4). The QIV prices are significantly more than the prices of Trivalent Influenza vaccines (12). When the TIV doses are increased, the health gain is close to that associated with QIV; therefore, these low and middle-income countries choose to stick to the Trivalent Influenza vaccines as a better and cost-reducing option.

However, these countries need to decide if the health gain out-gauges the extra cost accrued from the utilization of QIV. Inoculating a bigger group of people with TIV has superior cash esteem regarding the effects on the wellbeing outcome. Still, QIV leads to a significant decrease in influenza prevalence, hospitalizations, and death (12). The production of seasonal Trivalent Influenza vaccines routinely uses a lot of time. Effectively finishing each vaccine production yearly, the vaccination process involves ideal and consistent correspondence between the WHO, manufacturers, and administrative units. Still, the introduction of QIV adds additional production risks and market delays (14). Newall et al. (14) discovered that immunization programs considered economically efficient are not implemented in developing countries. The cost-effective intervention is not always prioritized for financial backing due to insufficient financial resources (14). Decision-makers in these countries might prioritize other inoculation programs for the same budget increment, keep a level immunization financial plan, and opt for the cheap TIV instead of acquiring costly QIV influenza vaccinations.

Age group vaccination reviews. All age groups, children, adults, and the elderly, are infected by the influenza virus. However, the elderly are more susceptible to the risks associated with influenza disease; thus, influenza vaccination is highly advocated for them. However, the injection has been suggested for guardians and health workers since they often contact the infections. According to de Francisco (Shapovalova), Donadel, Jit, and Hutubessy (10), people of all ages with other medical conditions are in more danger of flu-related entanglements than the rest of the population. TIV is the recommended vaccine used in individuals with high risk. The use of high TIV doses has been proved to be effective and safe with no adverse effects. These vaccines, both the QIVs and TIVs, are considered safe for children and adults.

Children are susceptible to influenza infections; thus, a recommendation of influenza vaccination was implemented targeting an age group of 7 to 24 months. Neuzil et al. (13) states that for children above six months, TIVs are the recommended and authorized injections. However, QIV has been observed to contain the Yamagata and Victoria lineages of the B virus, which shows a more outstanding antibody defense against the immunogenicity and additional B strain than TVs (4). However, the health systems in low and middle-income countries lack proper structures for healthcare to administer and disseminate these vaccinations.

Economic burden. The scope of the burden of influenza varies with age and the health of the patient. For instance, in an investigation in South Africa, which is renowned for possessing the most extensive human immunodeficiency infection (HIV) pervasiveness, it was assessed that individuals who are HIV positive are more subjected to influenza-associated lower respiratory infections compared to HIV-uninfected people (12). Hendriks et al. (2018) suggest that HIV-infected people have a risk 4-8 of contracting the flu compared to HIV uninfected. The differences between financial constraints, socio-economic factors, health care financial plans, and the formulated budgetary plans do not allow the Cost-effectiveness outcomes to have the same effects between different countries (15). The complications related to influenza disease are higher in children and the elderly.

Those living in closed communities such as Refugee camps, small settlements, and plantations are more susceptible to these infections because proximity increases transmission rates. The economic factor is estimated by the assessment of the sickness funds (12). Seasonal Influenza immunization continues to pose a crisis in the U.S due to factors such as inadequate immunization vaccines (15). The cost-efficiency of Influenza vaccination varies between states due to the difference in influenza epidemiology, HIV prevalence, and unit cost (3). The author suggests that to assess whether Quadrivalent Influenza Vaccines are better and more cost-efficient than Trivalent Influenza vaccines depends on the budgetary impact, countries’ willingness to pay the threshold and influenza’s burden on the said country.

People with specific underlying health conditions comprise the elderly and young, who are considered to be at higher risk of developing multifaceted complications. In addition, influenza poses a critical financial weight that is accrued from medical productivity losses and costs. In low-and middle-income nations, expenditures stemming from influenza may have a huge financial impact that has been surveyed at 3–7% of (GDP) per capita, diverged from simply 0.05–0.14% of GDP per capita in revenue generation of the nations (12). The previously done economic analysis on influenza immunization had focused on high-income countries overlooking the monetary effects of influenza vaccination in Low and middle-revenue nations. According to the researchers (12), the economic burden of the infection covers the instant expenses to the health services, people and the unintended budgets felt in the output losses, which affect the broader economy. The scientists claim (12) that the direct costs in middle and low-income countries Compared to high-income economies are lower and productivity losses higher. Thus, due to different socio-economic factors, co-morbidities, budget impacts, infrastructure, and health care plans, the economic cost value of the Trivalent influenza vaccines and Quadrivalent influenza vaccines vary.

Reasons for limited vaccine use. WHO’s routine immunization services do not reach the Low and middle-income countries due to poor infrastructure to reach the people in these communities and administer the immunizations. Ortiz and Neuzil (4) mention that the systems used to evaluate, assess, regulate and administer these vaccines are weak thus cannot support the set immunization program for adults and children. Neuzil et al. (13) say that the lack of clarity on the importance of prioritizing the immunization, insufficient evidence on the economic burden it poses, and the poor data on the vaccine’s efficacy has led to its underused in these low and middle-income states. Gupta et al. (11) state that to increase the efficiency of the vaccine being administered, it is vital to understand the epidemiology of this disease is crucial. According to Ortiz & Neuzil (4), effective surveillance needs to be put in place to establish the disease burden and overall risk in the targeted groups such as children, older people, and pregnant women.

The already available national data showing the stain, disease burden, and timing can effectively help reduce the constraints that have made Some Low and middle-income countries prefer to administer the periodic Influenza vaccine in their vaccination package. They are also considering whether this program should involve Trivalent Influenza vaccines or Quadrivalent Influenza vaccines (9). However, identifying target populations, patients with chronic conditions, and the effective vaccination strategies that will target specific endangered clusters of individuals in the low and Middle-Income countries can be challenging. According to de Boer et al. (9), for the Low and middle-income countries to consider the practice of the influenza vaccines, data on health outcomes, such as severe illness and mortality, are needed. The lack of a sound vaccination dissemination system that regularly monitors the infections, the poor infrastructure, and the financial constraints also cause the limited use of influenza vaccines.

Safety and supply issues. The routine seasonal production of Trivalent Influenza vaccines takes a considerable amount of time. To effectively finish each progression in the flu immunization producing cycle, timely and regular correspondence between the WHO, manufacturer, and administrative authority has required the introduction of Quadrivalent Influenza vaccines would mean additional market delays and production risks (14). Vaccine creation begins one year before the set date of the agreement in the Northern and Southern hemispheres (12). The vaccine production steps are time-critical and require an exceptional manufacturing environment. Thus, replacing the trivalent Influenza vaccines in the market comes with production risks and untimely market delays. This change could pose a lot of practical difficulties in the market. Safety policies of influenza vaccines need to be well understood to reduce the adverse effect of a reaction (15). The vaccine’s safety is highly critical in creating public confidence in the vaccination programs. The flu shots are advocated for children, adults with other medical issues, and older persons who are highly susceptible to infections. These vaccines are required to meet the required health standards and guidelines since they are provided to healthy individuals such as children.

The WHO monitors these vaccines before they are issued by different states. The management on the economic assessment of influenza vaccination, set up by WHO, defines heretical concepts and the best methodological practices that facilitate efficient guidance on influenza vaccination evaluation in Low and middle-income nations (15). This guideline includes an economic assessment of the Influenza vaccine in terms of the estimates of adverse events that may occur after immunization (12). In low-income areas, trivalent influenza vaccines are better since they are affordable, practical, and logistically feasible (12). During clinical trials, the recognition of potentially severe adverse reactions should be considered. These potential risks can cause drastic deviations in the invention course, specifically if the responses are deadly and put lives at risk (15). The safety of these vaccines is crucial because it’s administered to many healthy persons; thus, the WHO should ensure the manufactured vaccines meet the required standards. The decision to replace the Trivalent Influenza vaccines with QIV depends on the transition on the country’s burden and the resources available for the transitions in the manufacturing process.

Health effects and clinical outcome. Influenza causes premature death, and individuals who are HIV positive have a higher mortality rate if infected by influenza than the Non-HIV infected individuals (1). Vaccination reduces clinical visits, hospitalizations, and mortality rates. According to the research done by Neuzil et al. (13) and de Boer et al. (9), the advantage of TIV over QIV was assessed to be a 13.1% decrease of suggestive flu and an 18.0% decrease of flu-associated death. Introducing Quadrivalent Influenza vaccines would reduce influenza cases, which will lead to fewer deaths. In Agincourt SA, when the QIV vaccine was used over TIV, the outcomes gave an estimation of a 13.1% decrease of suggestive flu and an 18.0% decrease of flu-related mortality (1). From the data collected in the two influenza seasons by Gupta et al. (11), those vaccinated with QIV, 21364 of 53627 (5.3%) and 6365 of 133147 (6.5%) were hospitalized distinguished to 7873 of 111297 (8.4%) and 4423 of 43222 (8.3%) of those immunized with TIV S2 and S1, separately.

Seasons with moderately high flu B action, Quadrivalent Influenza Vaccine results appeared to be more compelling than Trivalent Influenza vaccines (11). In South Africa, for example, the cost-efficiency of TIV was as shown from the studies by de Boer et al. (2018), is estimated depending on the assumed attack rate. A review conducted in Australia, Vietnam, and South Africa, by de Boer et al. (3), introducing 6% of TIV vaccination while assuming a SAR of 5%, showed the decrease in the predominance of the seasonal flu locally by 48.4–50.2%. These reductions included hospitalizations, death, and clinical visits and were the same across all age groups. Additional doses of TIV administered to large groups share a close to the higher outcome linked with QIVs.

Vaccination cost. The cost incurred can determine the charges of the Influenza vaccine depending on the form of vaccination being directed. The Quadrivalent inactivated vaccine [QIV]) and trivalent inactivated vaccines (TIV) differ in prices, and most low and middle-income countries prefer the Trivalent Influenza vaccines due to their low costs (13). The direct service delivery cost associated with the cost of the cost related to doctor’s expenses and visits, vaccination of the vaccines in health care faculties can also lead to an increment in the vaccine cost when related to the vaccines administered in non-medical administrations such as pharmacies. However, inoculation can be done and managed by lower-wage staff like qualified medical caretakers to decrease medical expenses.

Proof on the expense adequacy of QIV shows that supplanting TIV with QIV would be a significant move economically and beneficial in public health. However, low and middle-class countries have low resources, and their budget can hardly support the transition (12). De Francisco (Shapovalova), Donadel, Jit, and Hutubessy (10) add that the potential additional benefits derived from Quadrivalent Influenza vaccines are therefore not recognized in these countries because they cannot afford the costs.

Yearly, the expense associated with vaccination, including direct clinical consideration and lost profit, has been assessed at $26.7 billion (12). The cost of TIV is lower compared to QIV, thus is preferred in numerous Low and middle-income nations. From the research reports made by de Boer et al. (3), it’s observed that the practice of an extra quantity of TIV prescriptions in low and middle-class countries results in a very close to or higher number of avoided cases of influenza infections than what is achieved through QIV. To determine which vaccine is more effective at a lower cost affordable, some factors such as illness and the practical realities of product availability to be used for immunization systems are considered. Influenza-related costs are grouped into healthcare and non-medical care costs.

The medical services cost constitutes GDP costs, medication expenses, and others. In contrast, non-medical care expenses incorporate expenses incurred from time and profitability losses resulting from work loss (1). The Quadrivalent Influenza vaccine prices are higher than Trivalent influenza vaccines from the study reports across the countries. From the indication on the affordability of QIV, deciding on the selection of this vaccine would be a significant choice, especially in enhancing public health. However, in low and middle-income countries with a fixed budget and inadequate resources, this move would cause many financial constraints; that’s why most of these countries consider TIV to be the most attractive option.

Discussion

Each of the articles contained data confirming the economic advantages of these vaccination types. The points extracted from the search were related to the cost of cases, the number of cases, and the intensity of symptoms. The results showed that the findings of specially planned studies to assess the economic effectiveness of influenza vaccination demonstrated the profitability of vaccination prevention. At the same time, it was shown that the economic effect of vaccination increases in proportion to the increase in the incidence of influenza.

Sufficient evidence has proved that the application of QIV instead of TIV can lead to significant economic benefits for entire societies and healthcare systems. It is worth admitting that the literature review deals with figures in different currencies, including American dollars and Brazilian real. There is no necessity to convert any of these currencies to find a common denominator. Since the focus of the literature review is to deal with the cost-effectiveness of two vaccination options, it can only be sufficient to compare the figures. Since many articles reveal that QIV is associated with lower expenses when compared to TIV costs, it is possible to confirm the cost-effectiveness of this intervention.

At the same time, the initial hypothesis was confirmed that the influenza epidemic has the most significant economic consequences for developing countries. In comparison with the studies conducted by European scientists, the results obtained by African and Asian researchers differ. Despite the reduced prevalence of vaccination, in these countries, it has the greatest economic efficiency due to the low GDP of the state.

Clinical trials to measure vaccine efficacies are being conducted, and efforts to develop an influenza vaccine that is more effective and durable in preventing Influenza disease are underway. In low and middle-income societies, vaccination programs and health care systems are weak. The vaccine deliveries are affected by the poor infrastructure. High-income countries can afford to substitute seasonal trivalent influenza vaccines with quadrivalent vaccines due to resource availability. The Quadrivalent vaccines have an additional health benefit; they are preferred more in the countries that can afford their costs (4). However, in countries of lower income, the National budgetary plans and considerations lead to the preference of TIVs due to their low cost. Therefore, determining the most effective vaccine requires the efforts of countries to have knowledge on the benefits and disadvantages of both TIVs and QIVs (10). Influenza A strain causes severe influenza morbidity and mortality rates, according to Newall et al. (14). Thus, QIVs would be the most financially effective vaccine but, the overall budgetary impact of QIV is higher than that of TIVs.

Due to the lack of funding and financial constraints, high cost-effective vaccines are not prioritized in these countries. When considering suitable vaccines to use in low and middle-income regions, individuals mandated to make decisions feel the context-specific limitations, such as human limitations and available health facilities. The indirect patient efficiency and direct transportation costs incurred during the vaccine dissemination should be considered while assessing the expense of an inoculation procedure and strategy (13). The Inclusion of productivity costs, dictated by lost time opportunity to patients or guardians, add to the expenses inferable to the program, which will help countries in their cost-effectiveness estimation.

Counting transportation costs paid by people to go for inoculation in clinics will likewise add to the community expenses of the flu immunization strategies (4). However, the individual cost in most cases is insignificant thus does not need to be included in the cost-effectiveness estimation strategies. TIV and QIV’s economic value depends on many factors such as influenza epidemiology, vaccine price, and budgetary impact. Assessing these factors will help a country decide on the best vaccination program beneficial both health-wise and helps save the cost.

The strengths of my review are a wide selection of geographical areas used in the study. The economic effects of vaccination were considered not only in Europe but also in developing countries. The weaknesses of the study are the use of data only for large states. This is due to the insufficient number of observations conducted on the economic effects of vaccination in small Asian and African countries.

Policy implications of this study substantiate the costs associated with immunization of people of working age. The data obtained also take into account the specifics of economic processes and the level of medical development of the countries represented in the study. Reasons for further research are to keep investigating the issue not only using an empirical method but also using situation modeling. In addition, further studies can be carried out using the methodology for calculating the economic profitability of vaccination at different levels of seasonal influenza incidence.

Conclusion

The given paper has conducted a literature review and compared the cost-effectiveness of trivalent and quadrivalent influenza vaccination options. The appropriate methodology allowed for collecting and synthesizing the relevant evidence. In turn, this fact contributed to finding the evidence to comment on the leading research objective and describe a few related topics. According to the collected and synthesized data, quadrivalent influenza vaccination is more cost-effective because it implies financial savings. Researchers from different middle-income countries demonstrated that the intervention under consideration implied savings for societies and healthcare systems, in general, and individuals, in particular. These findings indicate that various countries should consider implementing quadrivalent influenza vaccines irrespective of the fact that a single dose of this medicine is higher than that of a trivalent one. The difference arises because quadrivalent vaccines are more efficient, which simultaneously implies economic benefits.

References

Arefin, M, Masaki, T, Kabir, K, Tanimoto, J. Interplay between cost and effectiveness in influenza vaccine uptake: a vaccination game approach. Proc. R. Soc. A: Math. Phys. Eng. Sci. 2019;475(2232):20190608.

Dabestani, NM, Leidner, AJ, Seiber, EE, Kim, H, Graitcer, SB, Foppa, IM, et al. A review of the cost-effectiveness of adult influenza vaccination and other preventive services. Prev. Med. 2019;126:105734.

de Boer, P, Kelso, J, Halder, N, Nguyen, T, Moyes, J, Cohen, C, et al. The cost-effectiveness of trivalent and quadrivalent influenza vaccination in communities in South Africa, Vietnam, and Australia. Vaccine 2018;36(7):997-1007.

Ortiz, JR, Neuzil KM. Influenza immunization in low- and middle-income countries: preparing for next-generation influenza vaccines. J. Infect. Dis. 2019;219(Supplement 1):S97-S106.

Coleman, BL, Snaderson, R, Haag, MDM, McGovern, I. Effectiveness of the MF59-adjuvanted trivalent or quadrivalent seasonal influenza vaccine among adults 65 years of age or older, a systematic review and meta-analysis. Influenza Other Respir Viruses 2021;15(6):813-823.

Munn, Z, Peters, MDJ, Stern, C, Tufanaru, C, McArthur, A, Aromataris, E. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med. Res. Methodol. 2018;18(143):1-7.

Lee, BY, Bartsch, SM, Willig, AM. The economic value of a quadrivalent versus trivalent influenza vaccine. Vaccine 2012;30(52):7443-7446.

Van Bellinghen, LA, Marijam, A, de Araujo, GTB, Gomez, J, Van Vlaenderen, I. Cost-utility of quadrivalent versus trivalent influenza vaccine in Brazil – comparison of outcomes from different static model types. Braz J Infect Dis 2018;22(1):1-10.

de Boer, P, van Maanen, B, Damm, O, Ultsch, B, Dolk, F, Crépey, P, et al. A systematic review of the health economic consequences of quadrivalent influenza vaccination. Expert Rev. Pharmacoeconomics Outcomes Res. 2017;17(3);249-265.

de Francisco (Shapovalova), N, Donadel, M, Jit, M, Hutubessy, R. A systematic review of the social and economic burden of influenza in low- and middle-income countries. Vaccine 2015;33(48):6537-6544.

Gupta, V, Dawood, F, Muangchana, C, Lan, P, Xeuatvongsa, A, Sovann, L, et al. Influenza vaccination guidelines and vaccine sales in southeast Asia: 2008–2011. PLoS ONE 2012;7(12):e52842.

Hendriks, J, Hutubessy, R, Grohmann, G, Torelli, G, Friede, M, Kieny, M. Quadrivalent influenza vaccines in low and middle income countries: cost-effectiveness, affordability and availability. Vaccine 2018;36(28):3993-3997.

Neuzil, K, Bresee, J, de la Hoz, F, Johansen, K, Karron, R, Krishnan, A, et al. Data and product needs for influenza immunization programs in low- and middle-income countries: rationale and main conclusions of the WHO preferred product characteristics for next-generation influenza vaccines. Vaccine 2017;35(43):5734-5737.

Newall, A, Chaiyakunapruk, N, Lambach, P, Hutubessy, R. WHO guide on the economic evaluation of influenza vaccination. Influenza Other Respir Virusess 2017;12(2):211-219.

Wiley, S. Seasonal influenza vaccine guidelines, 2018-2019.Nursing 2018;48(11):11-13.

The article reviewed in this essay concerns a virtual exercise that involved medical workers and first responders. The effort simulated an influenza pandemic, which had led to the declaration of a state of emergency and an overwhelming surge of patients at hospitals. As such, the hospital featured in the exercise activated its emergency response plan, which involved the performance of triage (Beedasy & Ramloll, 2010). The participants were first responders and hospital workers tasked with performing the activity to help sort the patients. The novelty of the exercise was in that it was performed entirely virtually and online, without requiring participants to physically attend or endangering people. The hospital’s reception areas were simulated using software specifically designed for the purpose, and the participants demonstrated their abilities there.

The primary point of the article is that modern technology enables new training modes that are comparable in effectiveness to traditional physical training while taking a fraction of the time and effort to complete. They do not require the usage of physical resources, which enables larger-scale simulations than those possible in the real world. At the same time, the authors allege that these methods do not necessarily result in lower-quality training than what physical experiences would provide. While practical knowledge is essential to many aspects of medical treatment, triage relies more on the understanding of procedures and symptoms, especially in emergency workers. To that end, the authors test the methods developed by reviewing the participants’ knowledge of relevant topics before and after the training. The expectation was that their understanding would be improved considerably, establishing the training’s effectiveness and competitiveness with traditional approaches.

Overall, the participants’ responses to the exercise were positive, with most rating it highly. The only participant to view the exercise negatively commented that they had to leave to attend to a real patient during the drill, so this score is not necessarily valid. The trainees remarked that their knowledge of how triage is implemented had been improved considerably by the exercise. Additionally, they claimed that the training was an opportunity for members of different organizations to cooperate, which were usually difficult to obtain due to the commitments required. However, there were also issues in the exercise, notably one involving computer usage. Some participants lacked the competencies required to operate the simulation, while others’ computers were not powerful enough to run it smoothly. Still, the simulation represented a real scenario with considerable accuracy, including some unforeseen situations that may take place.

The information in the article highlights how training can be performed using different media and how these modes create variation in the results. Online training can help people internalize knowledge with minimized time and effort commitment, though it requires additional competencies and a capable enough device. Both of these issues have become less prevalent recently as adoption of the Internet and computing technology rises, increasing the viability of the approach considerably. The additional advantages of online training, such as the ability for different organizations to cooperate more easily, should also be considered. With that said, traditional physical training should not be disregarded, either, especially where it concerns the medical profession. A number of skills can only be learned through direct hands-on practice and cannot be substituted with knowledge. Different training approaches should be used in tandem to maximize efficiency and instruct workers in all of the skills that they require.

References

Beedasy, J., & Ramloll, R. (2010). Lessons learned from a pandemic influenza triage exercise in a 3D interactive multiuser virtual learning environment—Play2Train. Journal of Emergency Management, 8(4), 53-59.

Overview

Influenza is a viral infection affecting the upper respiratory tract. It is more common in winter. It results in symptoms such as sore throat, cough, headache, fever, malaise, fatigue, and other non-specific signs. It has long been defined as a significant cause of morbidity and mortality both in adults and recently in children (Izurieta et al. 2000, p.232: Neuzil et al. 2000, p.322). It is estimated that in the United States alone, 20,000 deaths each year are because of influenza epidemics (CDC 1999, p.1). The spread of influenza, an orthomyxovirus, is via aerosols from infected organisms to susceptible hosts. Kilbourne explains that the continuous spread of the virus leads to the production of new viral strains and re-infection, which is the challenge in the development of an effective vaccine (1987, p.334).

The diagram below shows the configuration of the influenza virus.

Types of Influenza

Scientists classify influenza into three types A, B, and C depending on their nucleoproteins and matrix proteins. However, only type A and B are known to cause diseases in man. Type B has man as the sole reservoir with Type A existing in other hosts known as natural reservoirs like pigs and other mammals (Webster et al. 1993, p.180). The orthomyxovirus has two of the eight segments in its negative single-stranded genome coding for surface glycoproteins (Lamb 1989, p.66: Varghese et al. 1997, p.1108). These glycoproteins are the Hemagglutinin (HA) and Neuraminidase (NA). Hemagglutinin binds to the terminal sialic acid while neuraminidase cleaves the sialic acid. When viewed from outside the virus, the neuraminidases appear like spikes protruding from the viral envelope.

The control of influenza has elicited major developments in drugs and vaccines. Various drugs developed so far have different targets both in the virus and in its replication cycle. One such target is the Neuraminidase, which is an exoglycosidase. It breaks down the hemagglutinin receptor by cleavage of the terminal sialic acid from the adjacent sugar molecule (Gottschalk 1957, p.645: Klenk et al 1955, p.236). This activity of NA is important in the replication cycle of the influenza virus and mainly in the escape of the virus from the envelope. The effect of neuraminidase inhibitors, as will be discussed, is due to their inhibition of the escape of the virus through the envelope and therefore the exit from infected people (Moscona 2005, p.1370)

Drugs that inhibit the activity of NA cause the immobilization of the virus by the upper respiratory tract mucosal secretions (Barnett et al 1997, p.231). Studies have however demonstrated that in vivo replication is not affected by the deficiency of neuraminidase (Liu, & Air 1993, p.784) and the replication occurs at a slower rate (Liu et al 1995, p.243). Examples of Neuraminidase inhibitors include inhaled Zanamivir, inhaled laninamivir, parenteral peramivir, and oral Oseltamivir (Tamiflu) (Sugaya, & Oshasi 2010, p. 132) with other neuraminidase inhibitors being tried for efficacy (Hayden 2009, p.10). This case study looks at Tamiflu (Oseltamivir), its discovery, development, efficacy, safety, and adverse effects in the control of influenza virus infection.

Major and Minor Objectives

The major objective of this case study is to assess the efficacy, safety, adverse effects, and drug resistance of Tamiflu (Oseltamivir) based on the available scientific findings. The specific minor objectives include assessing the efficacy of Tamiflu besides evaluating the documented side effects of Tamiflu, and finally to assess the safety record of Tamiflu. The key issue that this case study will focus on is the development of drug-resistant viral strains. These will be looked at in different sections with appropriate support from existing trials and research conclusions.

Key Issues

Tamiflu (Oseltamivir phosphate), as used in the treatment and prevention of influenza infection, was patented in February 1995 and launched in November 1999. Patented in April 1990 and launched in July 1999 (Kim et al 1997, p.89), its competitor, Zanamivir (Relenza) has found a lot of use in the southern hemisphere. Gilead Science designed Oseltamivir with resemblance to sialic acid bound to NA. Tamiflu is developed from Chinese star anise where shikimic acid is involved in the chemical synthesis of the final drug (Rohloff et al 1998, p.4550: Federspiel et al 1999, p. 270). Its use was marked in the recent H1N1 swine flu infection of 2009. Its development followed other drugs using a sialic acid template (Johnson, & Li 2007, p.108).

Many methods have been developed in the synthesis of Oseltamivir since the development of the prototype (Kipassa et al 2008, p. 815: Fukuta, et al 2006, p.6313.). These have different starting materials, as well as the techniques. The initial drug development utilized shikimic acid as the starting material (Rohloff et al 1998, p.4550) because it closely resembled the targeted site. It is cheap and readily available. Some different starting materials were later tried including the ginkgo leaves. However, the material of choice in the development resulted from the genetic engineering of some bacterial strains of E.coli (U.S. Department of Health and Human Services 2005). This provides the major starting material. To synthesize the final product, Roche, the company of origin of Tamiflu, uses this material.

Two approaches in the synthesis have been defined (Abrecht et al 2004, p.623) with the first making use of Diels Alder. Corey et al successfully used this type of approach in a shorter synthesis process, which yielded approximately 30% over 12 steps (Yeung, Hong & Corey 2006, p.6311). To synthesize oseltamivir, Zutter et al (2008, p.4902) also utilized the second type of approach.

Trost and Zhang later published what was the shortest method in their time of synthesizing oseltamivir (2008, p.3759). This involved the utilization of lactone. There were only eight steps in this method with an overall production yield of 30%. A year later, an eight-step synthesis with a 47% yield was published. This utilized a different starting material (Nie et al 2009, p.3970). Different studies have been conducted looking at the effectiveness of Tamiflu. Some are clinical tries. In one double-blinded, placebo-controlled study, a 74-82% efficacy was observed (Hayden et al 1999, p.1336). This was highly dependent on its use in the subjects under study.

The target of the drug is the Neuraminidase, which it inhibits, resulting in the inability of the virus to exit the host cell thus leading to the subsequent death of the host. In the end, the virus is not able to infect the neighboring cells. Thus, the progression of the infection is controlled. Older antiviral drugs, which inhibit M2, are only active against one of the virus types as compared to neuraminidase inhibitors that are effective on both type A and B. Tamiflu is used in the prevention and treatment of influenza in children older than a year and in adults. The use in children is a major breakthrough in the prevention of influenza since school-going children have been identified as the main source of introduction in homesteads (Longini 1982, p.373). Influenza is also known to exacerbate some chronic conditions such as asthma even mimicking some common illnesses causing delays in treatment and wrong diagnosis (Pattemore 1992, p.332).

Significant issues relating to the use of Tamiflu include the side effects and the proposed development of resistant viral strains. There is a growing concern about the introduction of new antiviral drugs due to the development of drug-resistant viruses (Gubareva et al 2000, p.831). Tamiflu has not been spared. This study focuses on the major issue in light of the importance of the effective control of the influenza virus.

Background Brief

Tamiflu is a neuraminidase inhibitor used in the treatment of influenza. It is indicated that the symptoms have not been present for more than two days. It has also been used in the prophylaxis of children older than a year. The chemical structure is given as.

Mode of Action

The mode of action of Tamiflu involves the inhibition of the neuraminidase on the influenza virus preventing its replication by stopping its exit from infected cells. NA is important in influenza virus replication. Thus, inhibition causes slowing down of the infection (Zambon & Hayden 2001, p.153). Cells neighboring those infected are protected through the action of Tamiflu. Thus, the infection is halted.

Selectivity

Amantadine and Rimantidine, which were the drugs used in influenza treatment, were only active in influenza type A. The development of Tamiflu, which is active on both influenza A and B means it is more appropriate for treatment. The drug also has 100-fold less activity against the sialidase in the human lysosome meaning it is more specific to the virus (Woods et al 1993, p.1477). This also means that the side effect profile is not as significant as with the non-specific drugs (Srange et al 1991, p.704: Monto et al 1995, p.2225).

Indications and Usage

The indications for the use of Tamiflu include treatment of influenza in patients with symptoms for not more than 48 hours. In fact, the diagram below confirms this following the evident 32-hr reduction of the length of time that flu lasts in an adult who has been subjected to Tamiflu medication in relation to placebo.

This follows because the efficacy in patients beginning therapy after 48 hours of disease onset has not been established. The drug can also be used in prophylaxis in children who are one year or older. According to the manufacturer, the dosages vary with age, and a dosage of 75mg twice daily for five days is adequate in adults (Roche 2011: Centers for Disease Control and Prevention 1999, p.263). The dosage in children is dependent on their weight.

Side Effects

Limited studies exist, which define the side effects of neuraminidase inhibitors as most of them focus on the reduction of symptoms (Jefferson et al 2009, p.5106: Jefferson et al 2011, Para. 4: Shun-Shin 2009, p.3172). The most frequent side effects are queasiness and barfing. These effects are mild (moderate severity), and maybe reduced if taken with food (Roche 2011: Hayden et al 1999, p.1245). Other serious side effects such as hypersensitivity reactions and neuropsychiatric events have been defined. In clinical randomized controls, bronchitis, insomnia, and vertigo have all been described. The side effects however are dependent on various factors such as the patient’s age, the condition before treatment, and the dosage. Other rare side effects include diarrhea, mild abdominal pain that lasts for some time after drug administration, fatigue, dizziness, headache, and cough. Some studies have demonstrated some of these effects to be as a result of the influenza infection and not necessarily due to the drug administration (Vogel 2002, p.162: Kawai et al 2003, p.427: Mitamura et al 2002, p.950: Machado 2004, p.113: Yamaura 2003, p.890).

Resistance

The development of resistance to Tamiflu has not been significantly demonstrated due to the limited materials necessary in the investigation. In the treatment, the development of resistance has been shown to be less frequent with the use of the drug. More research is necessary to establish the extent of the development of new and resistant influenza virus strains.

Major Issue

The main issue that develops with the use of Tamiflu as indicated above is the development of resistance. Though mild compared to previous antiviral drugs, it continues to pose a challenge in the treatment of influenza virus infection. Observations were made of the development of the strains of influenza viruses that were resistant to Amantadine and Rimantadine with their virulence not decreasing. Resistance is due to the mutation in neuraminidase and haemagglutinin (Zambon 2001, p.150). In a clinical trial of Oseltamivir treatment in children, 18% of them had mutants of neuraminidase isolated that were resistant to Oseltamivir (Kiso et al 2004, p.733). An Oseltamivir-resistant strain of H5N1 was reported in a Vietnamese girl. Nevertheless, she later recovered after the dose was doubled (Mai Le et al 2005, p.1108). In some significant studies, some immune-competent patients were treated with Oseltamivir to determine the resistance rate. Resistance was found to develop in 1-2% of adults (Covington et al 2000, p.326: Gubareva et al 2001, p.527), and about 6% of treated children.

Some findings have shown that resistance is higher in children than in adults. This might be explained by the possibility of children shedding the virus for a longer time compared to adults. It has also been suggested that the reason for this is due to the delay in immune response in children with the initial response being sub-optimal (Moscona 2005, p.1371). In animal studies, the development of resistant viral strains has produced new strains, but these are not as infectious as the wild strains (Mendel, & Sdwell 1998, p.67). They have also been shown to be more pathogenic (Yen et al 2005, p.4068) with no reported transmission of neuraminidase-resistant strains. However, the transmission of viable Oseltamivir-resistant strains was observed in animals (Herlocher et al 2004, p.1628: Yen et al 2005, p.4069). It is therefore important to investigate further its resistance to Tamiflu to assess and prevent further resistance besides developing guidelines associated with its use.

Tamiflu, as shown above by the mode of action, reduces viremia and the duration of illness in patients with influenza. The effect of this is marked with the reduction of symptoms. The interval of disease is shortened by “one to two days” (World Health Organization 2011). It is, therefore, true to conclude that Tamiflu is effective in the treatment of influenza. While looking at the political issues related to the drug, an important consideration is that the drug is recommended for the treatment of patients with serious influenza infections. It has also been given as the drug of choice in severe influenza infections in major health institutions around the world. It is the drug of choice in the widespread epidemics of influenza.

Media’s response to the development, effectiveness, and use of Tamiflu was marked during previous outbreaks of H1N1 where many people were infected with some being treated successfully with the drug. The media described its discovery as a relief and of great importance in taming the epidemic. In the recent epidemics, the New Zealand Times gave clients an article on Tamiflu with definitions and government policies on its usage. The government also provided it over the counter to patients who openly came with the symptoms of influenza.

More research and studies are needed to provide adequate evidence to the use of Tamiflu in influenza treatment. Some of them include the comparison of Zanamivir and Oseltamivir to see their relative side effects and efficacy. More studies are also needed to find out the cost-effectiveness of the drug in clinical practice, and so is further research on the development of resistance in practice. A more focused trial is needed on the efficacy of the drug on resistant strains, especially in children.

Prior to the H1N1 outbreak of 2009, the USA had a large stock of Tamiflu since it was the only oral neuraminidase inhibitor available. Various institutions such as the US Department of Health and Human Service (HHS), The Advisory Committee on Immunization Practice (ACIP), the Australian Therapeutic Goods Administration, and European Medicines Agency (EMA) heralded the development of the drug by saying that it would reduce hospitalizations (HHS 2005, Para. 6: Harper et al 2004, p.56: Roche 2011, Para. 9: EMA 2011, Para. 2). However, the Food Drug Administration (FDA) found that the results of a clinical trial by Kaiser and colleagues did not reduce the complications. They demanded that a statement be made on the drug’s label claiming that this was wrong (Roche 2011, p. 9). Legal claims were made against Roche, the manufacturer of Tamiflu, with the suspicion of making claims contrary to studies. FDA did not approve the use of Tamiflu in the prevention and treatment of influenza based on its findings.

From the above-raised issues, it is clear that, before a product is accepted to be effective, a critical analysis is necessary and this should be carried out by an independent organization with no bias or stake such as a Cochrane review. The use of published reports should be substituted with clinical trials especially where new drugs are involved. The industry has responded with the development of new regulations and a fresh review of the existing studies so that more significance is given to clinical trials. In 2010, Cochrane began a review update using the existing clinical trials instead of the published papers (Harper et al 2004, p.37). This is bound to bring a change in the acceptance of new studies.

Conclusion

In conclusion, the control of influenza viral infection outbreaks is critical in the survival of the human race. Various drugs have been studied with Tamiflu (Oseltamivir) drawing headlines since its discovery and development. The efficacy action, selectivity, and side effects have been looked at with special attention going to the development of resistance to the drug. This has been shown after several reviews to be less significant to the resistance developed by previous antiviral drugs. Therefore, the drug remains effective. In the development and marketing of the drug, legal issues were raised concerning the study methods used to ascertain effectiveness. Despite the drug being recommended by several international bodies, FDA found some inconsistencies in the information given by the manufacturer and studies done. This has led to the review of the methods used to determine drug efficacy.

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Equine influenza is a respiratory disease that is highly contagious to horses and other animals in the horse family. It is caused by numerous influenza subtypes, a virus comparable to but distinct from influenza viruses seen in other animals. Contact with sick horses and infected clothing, equipment, brushes, gear, and so on transmits the virus swiftly. When the illness strikes horses, it is known to cause considerable losses. Horses may not display the corresponding signs when affected by the disease. However, it is possible to prevent the spread of the virus by vaccinating the horses, treating the sick horses, and using any other preventive measure. The essay will discuss the effects, ways of transmission, and how to treat and prevent equine influenza.

Horses are affected by two varieties of influenza viruses that steadily circulate and produce seasonal flu waves, influenza A and influenza B with two varieties of influenza viruses that steadily circulate and produce seasonal flu waves, influenza A and influenza B. Influenza stresses the letters H and N are used to categorize viruses. Letters H and N stand for hemagglutinin and neuraminidase, correspondingly. These are both proteins on the worm’s external that help in the virus’s raid of cells (Oladunni et al., 1657). Occasionally the bacteria exchange genetic data, acquiring original traits that human immune mechanisms have never seen before.

Equine fever is a viral infectious respiratory illness that spreads quickly among horses and has a short incubation period (1-3 days). It is transmitted by diseased horses coughing, filthy buckets, brushes, gear, and so on. Coughing horses volatilize the organism, which may spread the virus up to 150 feet and infect an entire barn in a matter of minutes (Blanco-Lobo et al., 933). Infectious horses may shed influenza for 14 days after being infected.

Finally, many horses are symptomless virus shedders, which means they are resistant and will not become sick; however, the virus may still multiply and transfer to other horses.

Because equine influenza respiratory indicators are comparable to other respiratory disorders, they cannot solely identify illness on clinical signs. The testing window is limited; the findings may be harmful if samples are analyzed very late in the disease’s progression. Diagnostic testing facilities isolate viruses mostly from nose swab samples acquired from ill horses shortly after infection. Serum sample testing can also be used to make a diagnosis.

Equine influenza is a worm with severe penalties, but with proper immunization and biosecurity, supervisors may affect the outcome of infections. Shareholders, riders, handlers, and coaches can lessen the risk of sickness by succeeding the American Association of Equine Practitioners’ immunization recommendations (AAEP). Sticking to proper biosecurity follows, collaborating closely with the vets, and existence proactively (getting temperatures, separating horses) if they detect potential signs of illness. Working with your vet to ensure that horse(s) is on a suitable immunization regimen is critical.

Though vaccination is not a panacea, it is among the most effective existing defense against this condition. If an immunized horse becomes sick, the situation is milder, and vaccinated animals shed influenza for shorter times. A rise in events, along with an increase in horse movement, leads to epidemics of infectious illnesses such as equine influenza (Sacket al., 1185). Effective biosecurity strategies, methods to decrease pathogen spreading, and understanding of sickness symptoms are necessary safety precautions.

Finally, Equine influenza may infect both horses and humans. It is easily spread through direct contact with sick horses and can swiftly infect a significant number of horses in a single grazing area. Familiarize oneself with the approved indications of equine influenza and keep an eye out for them over the winter season. If you believe that you have the flu, have your veterinarian take suitable samples and submit them to a specialist laboratory for examination. Adequate measures and improved knowledge will help to keep this highly contagious respiratory ailment at bay.

Works Cited

Blanco-Lobo, Pilar, et al. “A bivalent live-attenuated vaccine for the prevention of equine influenza virus.” Viruses, vol. 11, no. 10, 2019, p. 933.

Oladunni, Fatai S., et al. “Equine Influenza Virus and Vaccines.” Viruses, vol. 13, no. 8, 2021, p. 1657.

Sack, Alexandra, et al. “Equine Influenza virus—a neglected, reemergent disease threat.” Emerging infectious diseases vol.25, no. 6, 2019, p. 1185.

Influenza, including the A/H3 variant viruses, joins the ranks of common contagious conditions causing seasonal disease. In the general population, the prevalence does not increase with age; patients with flu-like symptoms aged 18-59, 60-74, and 75+ get the type A influenza diagnosis in 12.2%, 6.6%, and 5.4% of cases, respectively, and all influenza infections affect up to 20% of the total population. In hospitalized pediatric patients, A/H3 is the second most diagnosed strain after A/H1; influenza-related hospitalizations peak every August to September, and all infections affect 5-20% of children, with life-threatening complications being more widespread in those younger than 5.For epidemiological trends, categorized into HA and NA lineages, influenza A viruses undergo genetic changes in both children and adults, including antigenic shifts, can co-circulate with type B infections, have season-specific peaks, and spread through inhaling the infected individuals’ respiratory droplets.

In pediatric patients, common risk factors for influenza and complications are the preschool age (<5), unsafe living or health conditions conducive to immune weakening or increases in viral load (HIV/AIDS, obesity, etc.), and chronic illnesses.For pathophysiological mechanisms, influenza viruses, including those in the A/H3 strain, engage in replication in the respiratory epithelium, which causes the infection of immune cells and viral protein synthesis and could lead to lung compromise/inflammation.Children’s signs/symptoms typical for seasonal flu viruses pertain to general well-being (fever reaching up to 105°F, fatigue, or chills), the gastrointestinal system (nausea, emesis, or diarrhea), and the respiratory system (cough, rhinorrhea, nasal congestion, or pharyngitis). Type A strains differ from type C strains in symptoms’ severity.

Influenza, including the A/H3 strain infections, is preventable through flu vaccines with annual revaccination, self-isolation, hand hygiene, and practices for respiratory protection, but the influenza virus’s changes pose barriers to prompt vaccine development. Concerning diagnostic workup, symptom evaluation, molecular RP panel tests, rapid influenza diagnostic tests or antigen tests, and polymerase-chain reaction-based approaches to testing are available.For treatment/management, suspected and confirmed influenza cases involve antiviral drug use, including neuraminidase inhibitors effective against both type A and type B viruses, adamantine antiviral drugs active only against type influenza, or analgesic and antipyretic drugs against fever.For care standards, antiviral treatment is recommended in uncomplicated influenza cases, including the specified strain, with oseltamivir (oral suspension/tablets) and peramivir (IV antiviral) as the safest options for children younger than 7.Pre-existing disorders should also be considered to provide the appropriate plans of care.

The patient’s clinical presentation is predominantly typical and incorporates various common signs of influenza. Specifically, fever, nasal congestion, rhinorrhea, sore throat, and abdominal pain present in the child’s case represent the condition’s most widespread manifestations.At the same time, relatively rare atypical features, such as seizure-like symptoms, was denied. The features that slightly differ from the typical clinical picture are mild radiographic abnormalities and the patient’s productive cough; dry cough is much more common in the specified condition.Therefore, despite the condition’s seriousness, which finds reflected in the fever’s duration and the highest documented body temperature, the clinical manifestations are not severely atypical.

Regarding the topic’s importance to clinicians, studying the various manifestations of influenza in pediatric patients is crucially important to provide faster and more effective responses to infections complications, including the atypical signs. Infants and preschool children with influenza might develop a plethora of symptoms, for instance, new-onset neurological symptoms, seizure-like episodes, mental status alterations, and chronic disease exacerbations.Since influenza-related deaths in pediatric populations are not extremely rare, clinicians’ preparedness for assessing and reacting to complicated influenza cases is a priority to protect public health.

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The 1918 flu pandemic is considered the biggest pandemic in the history of humankind. This disease, which has claimed many people’s lives, also has the name Spaniard and H1N1 in science. H1N1 is the same virus as the usual seasonal flu, but younger people are exposed to the disease. In addition, H1N1 is a new type of influenza; accordingly, people have had little immunity to this virus. It was because the news about the pandemic began in Spain. This paper discusses the causes of the 1918 influenza pandemic, how humans contributed to its spread, and the responses to it.

The main reason for the global spread of the pandemic was the world war that was taking place at that time. The war is accompanied by a large number of people who physically interact closely with each other. People who died during the war remained unburied and it leads to releasing toxic substances from the dead organism. In addition, the dead bodies served as food for the animals and were eaten where the remains were scattered. Consequently, this phenomenon led to unsanitary conditions and the accumulation of microbes and bacteria, which served as a hotbed for a pandemic. When the military camps were very close to each other and there was a livestock nearby, there were no reasons or obstacles for the flu to arise and then spread rapidly. This phenomenon has provided a pandemic with favorable conditions for the emergence and rapid spread (Short et al., 2018). Since people were going through a war at that time, the cause of the epidemic may well be considered dead and rotting corpses of people. If there were fewer interactions, then there might not have been a pandemic, or there would have been significantly fewer victims (Short et al., 2018). Since the war was going on worldwide, corpses were everywhere, and there was no concrete hearth. Accordingly, a pandemic could occur in many places at the same time.

Usually, when seasonal flu occurs in a specific group of the population of a particular area, elderly and very young people are exposed to death. However, during the 1918 pandemic, adults also had a high mortality rate. The reason for this is, again, the immune system of humanity. In addition to everything, people fought and were far from favorable life conditions (Short et al., 2018). For this reason, their immune system is also in danger. The fatal mistake of humanity, which led to the global spread of the disease, was that the authorities kept confidential the already spreading pandemic. This decision was taken at the expense of the First World War going on at that time so that residents and armies would not start panicking and rebelling.

Many problems have accompanied humanity’s response to the horrific spread of the Spanish flu. At that time, people were unprepared for this pandemic and could not foresee it since they were busy with the war. However, the Spanish flu claimed five times more lives than the war. Still, people tried to prevent such a catastrophe somehow. Of course, the first measures were sanitary. Moreover, many countries have introduced sanitary measures and restricted the access of some vehicles. However, this did not help much, as people took the measurements late. Another reason for this phenomenon may still be the disobedience of citizens to keep a distance and other quarantine measures (Short et al., 2018). Australia, in turn, closed its borders before detecting recorded people. Thus, she could resist a formidable disease by limiting her people from interacting with the outside world.

In conclusion, the reason for the frightening pandemic was the war, because of which the corpses lay in open lands and were not buried. In addition, the immunity of many soldiers and other residents has noticeably weakened. Closely interacting with each other, people caused the spread of the flu, and the late announcement of a pandemic also facilitated the distance. The main measures taken by humanity were primarily quarantining measures.

Reference

Short, K. R., Kedzierska, K., & Van de Sandt, C. E. (2018). Back to the future: lessons learned from the 1918 influenza pandemic. Frontiers in cellular and infection microbiology, 8, 343, Web.