Category: Influenza

INTRODUCTION

Influenza, also known as flu is an infectious disease caused by an influenza virus that attacks the respiratory system of humans. It is also transmissible by droplets spreading from one infected person to another by just sneezing, coughing or talking. There are four types of influenza viruses: influenza A, B, C, and D, but only influenza A and B viruses cause clinically essential human disease and seasonal epidemics. Influenza causes symptoms corresponding to, but further severe than, the common cold, such as sudden onset of fever, cough, runny or stuffy nose and feeling unwell. Most people recover within week without medical treatment1, but the flu can cause serious complications, including pneumonia. According to World Health Organisation (WHO), these annual epidemics cause 3 to 5 million cases of severe illness, and about 290 000 to 650 000 respiratory deaths around the globe. Vaccines are used to prevent oneself from the influenza virus and further treatment to cure the infection.

PATIENT CONDITION AND SYMPTOMS

Influenza is a rare case for adult. However, regular older individuals of age more than 65 years old are prone to suffer from influenza. Besides, children (infant) are also susceptible to influenza mainly below than 2 years old. Pregnant women (up to two weeks from childbirth) likely to get influenza including individuals with chronic health conditions such as heart, lung, kidney, liver and metabolic disease (diabetes mellitus) and reduced immunity because of HIV/AIDS, cancer (leukemia) or post medication such as chemotherapy or radiation treatment can be causes to encounter “the flu” including those who are extremely obese with Body Mass Index over 40.

The flu can appear in many kinds of symptoms across one’s body in different ways. Early symptoms usually appear 1 to 4 days after becoming infected. The general symptoms is bad fever with high body temperature over 38°C and chills. Some could have headaches which lead to confusion. Usually elderly having these sort of confusion and shortness of breath since the feverish sign may be absent in them. At the respiratory parts, individuals might have dry cough and sore throat. Rhinorrhea (runny nose) and nasal congestion sometimes present to someone who having influenza as well. In children, gastrointestinal symptoms may more likely to appear such as vomiting, diarrhoea, and nausea. Moreover, Myalgia (muscle pain) could occur, they would feel aches in their joints, which causes fatigue or tiredness of whole body in performing daily tasks. Other side symptoms including earache, reddened or watering eyes, hoarseness, chest pain and sneezing could present too.

VACCINES AND TREATMENTS

Vaccination is the most convincing way in inhibiting influenza. Immunity developed in one seasonal influenza is not really sufficient to provide protection in future years mainly because of waning immunity. The Centers for Disease Control and Prevention (CDC) highly suggests flu vaccination for everyone age 6 months or older annually. Vaccinations against influenza are advised particularly for everyone from the high risk group. There are specifically two types of vaccinations; the flu shot and the nasal spray flu vaccine. WHO suggests on the trivalent vaccine flu shot made from inactive influenza that aims the three most representative virus types in circulation (two subtypes of influenza A viruses and one influenza B virus). After 2013, Quadrivalent vaccines is developed and used which include a second influenza B virus in addition to the viruses in trivalent vaccines, and are predicted to produce wider defence against influenza B virus infections. These inactivated and recombinant influenza vaccines are in the form of injection. Nasal spray made from weakened influenza virus vaccine and suitable for children of age 2-17 years old.

There are three antiviral medications have been used to treat or prevent influenza infection for patients that are not from a high risk group. Oseltamivir, zanamivir, and peramivir from the neuraminidase inhibitors group and can be utilized for the treatment of influenza A and B. The adamantanes antiviral set; amantadine, and rimantadine which are effective against influenza A, but not influenza B. Lastly, newly approved in 2018 Cap-dependent endonuclease inhibitors like Baloxavir Marboxil also treats influenza virus A and B3.

RECENT DEVELOPMENTS

Towards the end of 2017, researchers from the National Institute Allergy and Infectious Diseases (NIAID) were discussing about challenges on influenza vaccine when its effectiveness reduced because of unsuited seasons and mutation in chicken eggs used to develop the vaccine. They suggested to develop a “universal” influenza vaccine, which would eliminate the annual shots required and durable defence against multiple influenza subtypes—pandemic and seasonal. Early 2018, NIAID reveals strategic plan for developing a universal influenza vaccine by focusing on key aspects of influenza research; enhancing the comprehension of the transmission, natural history and pathogenesis of influenza infection; precisely characterizing how protective influenza immunity happens and how to tailor vaccination responses to achieve it. In 2019, NIAID, part of the National Institute of Health (NIH) begins First-in-Human Trial of an innovative Universal Influenza Vaccine known as H1ssF_3928 which is designed to instruct the body to create protective immune responses against heterogenous influenza subtypes by focusing the immune system on a part of the virus.10 There are also other examples of recent research on vaccines like the onset of clinical trials for H7N9 Influenza Vaccine, Antibiotics weaken flu defenses in the lung, the reveal of NIH-Supported Study on a Novel Indicator of Influenza Immunity.

OPINION ON FUTURE OF INFLUENZA

In 10 years, I think that vaccines will be improved not just durable protection but one shot for a lifetime by keep developing newly microneedle skin patch that really helps those with needle phobia, especially children which can be used widely as flu vaccine. If that happens, influenza epidemics can be inhibit easily from spreading since the patch can be produced abundantly in short time rather than using needle injection and can be more effective if it is made from beneficial plant-based cure like Echinacea. When healthcare cost can be reduced, people can afford treatment in this highly living cost days. Moreover, it would be easier to supply it any regions across the world when it based on plant where we can undergo plantation . I am sure it is quite hard to eradicate the flu virus completely since they mutating continuously but we can use the problem as part of our solutions. If we are able to develop these patches with once for a lifetime vaccination, I predict that we can reduce numerous infected individuals and death. I would like to see the sample epidemics virus is used to grow our own tougher immune system with the patch. I wish Influenza will be part of undangerous diseases that we do not have to worry about alongside upcoming medical-invention technologies and mortality can be avoided in the future.

Influenza, commonly known as flu, is an infectious disease of the respiratory tracts caused by influenza viruses which can be potentially life threateneing (Australian Government, Department of Health, 2014). An influenza pandemic occurs where a new subtype of the influenza virus emerges to which most people are not immune, therefore causing illnesses and deaths to large numbers of people worldwide and resulting in social and economic disruptions (Australian Government, Department of Health, 2014; Kotalik, 2005). This essay will introduce key stakeholders in response to planning and implementing and discuss the ethical and legal concerns around key issues of responsibilities of an infected person, duty of authorities to treat, allocation of potentially scarce resources, emergency powers and coercive regulation. Finally, a summary of the assessment of these issues and recommendations to policy and legal changes will be provided.

A potential influenza pandemic poses a serious population risk and various stakeholders exist to effectively tackle this health issue. A pandemic will lead to an extremely high number of ill people over a large geographic area, all requiring care simultaneously (Kotalik, 2005). This will result in rapid strain on human and material resources of health care such as extended hospitalisation, diagnostic facilities, availability of drugs and well trained workers if they are to have a chance to survive (Kotalik, 2005). The World Health Organisation (2019) is an important stakeholder in response planning and implementation, for example, developing and updating pandemic influenza preparedness, risk management and increase vaccine supply. Moreover, The Australian Government, Department of Health is accountable for preparing and implementing procedures at a national level such as prevention, readiness to meet community health needs, reduce a pandemic impact and assist in rapid recovery of individuals, communities as well as services. The Australian Health Management Plan for Pandemic Influenza (AHMPPI) was developed to reduce the impact on the health of Australians and the health system (Australian Government, Department of Health, 2014). Furthermore, continuous and extensive consultations with stakeholders such as states and territories continue to provide crucial feedback to improve the development of the framework (Australian Government, Department of Health, 2014) to ensure the overall health of Australians. Various other health sector stakeholders also play a significant role in developing their own pandemic plans compliant with national measures and for incorporating pandemic influenza into their overall business plans (Australian Government, Department of Health, 2014).

There are numerous ethical and legal concerns around key issues such as the responsibilities of an infected person. If an individual gets sick, it is their responsibility to stay at home, avoid public places such as schools and work or wear a mask to avoid contact with others to prevent spreading of the disease (Australian Government, Department of Health, 2014). Furthermore, a healthcare professional’s duty to treat infectious patients, when it poses serious risks of infection and possibly death to themselves raises legal concerns as well as ethical debates (Selgelid, 2009). A common viewpoint is that facing such risks are part of the healthcare worker’s job, providing implicit consent related to the codes of conduct. Malm et al. (2008) discusses the grounds for a duty to treat which include: express consent, special training, reciprocity, implied consent, and professional oaths and codes which healthcare workers should abide by. Regardless of such duties, when confronted with pandemic influenza, these healthcare professionals also have potentially conflicting duties. For example, if a nurse becomes ill or dies as a result of treating a patient, she will not be able to fulfil duties to family members (Selgelid, 2009). The moral and legal obligations suggest that healthcare workers have a duty to treat, however, the limitations within the codes of conduct provide no clear guidance for workers to treat patients under those extreme circumstances (Malm et al., 2008).

Moreover, there are various ethical and legal concerns around allocation of scarce resources including inadequate supplies of vaccines, drugs, ventilators, beds and personal protective equipment (Selgelid, 2009). Verweij (2009) argues the main principles for priority setting such as utility and equality. There are strong moral reasons to save as many people as possible; however, limited medical resources should also be fair and equitable.

Within reason of social utility and consequentialist ethical theory, endorse the idea that one should maximise expected value- saving the most lives there are various reasons that healthcare workers should receive prioritisation. For instance, treating a health professional is not only beneficial for themselves, but will contribute to saving others, hence reducing overall mortality (Verweij, 2009; Selgelid, 2009). The favour prioritisation of health workers is depicted through Bailey et al. (2011)’s study which found that the biggest priority was given to heath care workers (89%) of participants and supported saving the most lives (39.9%). However, even if prioritisation is given to healthcare workers, the question then becomes how much priority should they receive? It might be counterproductive considering if they receive large amounts of medicines, they would not be able to treat patients due to little treatment remaining (Selgelid, 2009). On the other hand, egalitarian approaches suggest that some will give priority to treating the elderly, assuming they run a higher risk of severe disease and death than others; while others will give importance to children, considering they have not had the many life opportunities compared to the elderly (Verweij, 2009). For example, the AHMPPI provides priority to people at high risk of exposure to the virus, such as the elderly and infants to the virus and provide essential services, then to people most vulnerable to severe illness from infection (Selgelid, 2009). Therefore, even though decisions regarding scarce resources before and during a pandemic influenza needs to reflect best scientific evidence available, the decisions are also deeply ethical and public values need to be considered to ensure a fair and equitable distribution of such resources (Bailey et al.,2011).

Finally, emergency powers and coercive regulation such as isolation and quarantine also raise extremely important ethical issues. Social isolation can be central to the protection of public health, although it clashes with basic human rights and freedom. Closing schools will aim to reduce spread of influenza as children are at a greater risk of transmission and more vulnerable to most respiratory viral infections than adults. Although, implementing this would have many consequences. Additionally, closing workplaces would result in direct and indirect business losses and question the rights of that (Australian Government, Department of Health, 2014). It should be used as a last resort (Selgelid, 2009). It is essential that those subjected to isolation and quarantine and ensure they are as comfortable as possible and be given basic necessities to promote fairness and furthermore, a system of compensation would assist in the formation of trust in the public health system. On the other hand, such measures should not be used, due to the discriminatory nature evident throughout history against the marginalised populations (Selgelid, 2009).

The assessment of these above issues are difficult to establish as developed nations employ implicit authorisation of western philosophical values of individual autonomy, and utilitarian liberal bases for public health interventions. This can be challenging for some people who come from different cultural traditions and do not share similar assumptions (Bennett and Carney, 2010). Based on above arguments, the potential limits on personal freedom are outweighed by the public good, however further research should be conducted. Countries such as the USA and Canada all have human rights agreements which provide procedural protections for citizens in regards to quarantine and detention, whereas Australia is yet to develop a Bill of rights at a national level (Bennett, 2009). Currently Commonwealth quarantine legislation and state as well as territory public health and emergency laws provide legal measures that rely on voluntary compliance rather than legal enforcement, wherever possible. Australian state and territory governments have started enacting human rights legislation, no there no comprehensive inclusion of human rights safeguards in the federal which raises issues about the mechanisms for ensuring procedural safeguards in the event of a pandemic. (Bennett, 2009). Hence, a nation legal framework needs to be developed that are based on the understandings of the role of law in responding to pandemics are necessarily informed by relational bonds between individual in society, and by the meanings of rights and responsibilities for public health laws when dealing with infectious disease (Bennett, 2009). The principal areas of legislation available to support pandemic actions are described in the following subsections. Governments should continue to improve policies and regulations that reflect cultural and ethical acceptability of pandemic planning that are more flexible (Bennett and Carney, 2010). In addition, during a pandemic influenza, laws should be implemented regarding healthcare workers willing to face dangers by higher pay (deserve) or given priority in the provision of influenza needs as discussed above. Also, affected healthcare professions and their families in the event of death should also receive financial compensation. This aligns with notions for reciprocity (Selgelid, 2009). Moreover, instead of forcing all healthcare workers to have a duty to treat in a pandemic emergency, laws and policies agreeing use of expressed consent for example, contract- based consent would be beneficial. As a result, more necessary workers acknowledge the duty to treat during a pandemic as it is more explicit and no blurry lines and becomes a compensated responsibility (Malm et al., 2008).

In conclusion, this essay discussed key stakeholders in response to planning and implementing, discuss the ethical and legal concerns around key issues of responsibilities of an infected person, duty of authorities to treat, allocation of potentially scarce resources, emergency powers and coercive regulation. Despite some concerns related to potential limits on personal freedom, they are outweighed by the public good. The issues regarding pandemic influenza planning are complicated and multifaceted, therefore further research needs to be done to ensure for an effective and ethical legal framework.

References

1. Australian Government, Department of Health (2014). Australian Health Management Plan for Pandemic Influenza. Commonwealth of Australia.
2. Kotalik, J. (2005). Preparing for an influenza pandemic: ethical issues. Bioethics, 19(4), 422- 431. doi: 10.1111/j.1467-8519.2005.00453.x
3. Malm, H., May, T., Francis, L.P., Omer, S.B., Salmon, D.A., & Hood, R. (2008). Ethics, Pandemics, and the duty to treat. American Journal of Bioethics, 8(8), 4-19. doi: 10.1080/15265160802317974.
4. Selgelid, M.J. (2009). Pandethics. Public Health 2009, 123(3), 255–259. doi: 10.1016/j.puhe.2008.12.005
5. Verweij, M. (2009). Moral principles for allocating scarce medical resources in an influenza pandemic. Bioethical Inquiry, 6(2), 159 -169. Doi: 10.1007/s11673-009-9161
6. Bailey, T., Haines, C., Rosychuk, R., Marrie, T., Yonge, O., Lake, R., Herman, B. and Ammann, M. (2011). Public engagement on ethical principles in allocating scarce resources during an influenza pandemic. Vaccine vol 29(17):3111-3117 DOI: 10.1016/j.vaccine.2011.02.032
7. Bennett, B. (2009). Legal rights during pandemics: federalism, rights and public health laws – a view from Australia. Public Health,123, 232-236. doi: 10.1016/j.puhe.2008
8. Bennett, B. and Carney, T. (2010). Law, ethics and pandemic preparedness: the importance of cross-jurisdictional and cross-cultural perspectives. Australian and New Zealand Journal of Public Health vol 34(2):106-112. Doi 10.1111/j.1753-6405.2010.00492.x

When the new species arrive in new environment, it will need to adapt that as human appear on the earth try to develop technology and system in order to overcome difficulties. In the past thousands of years, human already vanquished weather, fundamental living condition and becoming dominated the earth, however, there still has a stanch enemy that hasn’t be overcame which is disease. In the history, human faced various of disease. For example, cancer, flu, cough, anxiety, coronary artery diseases, these diseases can be classicised into chronic disease and epidemics. Chronic diseases would cause by environment or personal problem, but the epidemics could spread by bacteria or virus, so people try to figure out the solution or method to inhibit the infectious diseases, meanwhile, virus would evaluate and variate consistently as a competition between human and nature. In addition, some of contagious diseases is deathful and rest of them are not but still affect people’s daily life. Thus, the scientists and biologists spend their entire life for finding a suitable way in the cause of eliminate the virus till now even though some of epidemics have been treat but it accounted few of that. Recently, the most famous diseases are flu which is easily to infect to other one and with low dead rate but have strong effect to the life. This essay will discuss that the whole situation of influenza and prevention and solution.

Influenza could be the most common infectious disease among human being for thousands year and it cause several times of the world-class infectious epidemic in history such as 1918 flu pandemic or recent swine around 2009, creating the huge health problem for the world and crashing the economic development. Firstly, Cassidy (2020) reported that there has more than 310,000 cases presenting to hospital and health services nationwide in Australia last year, however this is one of the most successful vaccination years to date, but it broke out before the vaccination said by researchers. The flu shot development is depend on the situation in north of earth in order to guess predicable strains. Moreover, the death rate is around 1% which means flu cause 1500-3000 death per year and people with chronic diseases have a 40-fold increased risk of dying from flu (influenza specialist group 2020). Secondly, the disease usually has great deal of impact on non- governmental economic and government fiscal solvency for travel ban, shutting down the working place, subsidy or other solution to inhibit the disease infection. Besides, flu could be happened everywhere with human and although you can get the flu at any time, it is more likely to occur in the coldest month of the year (April to October). The flu season usually peaks in August, but so far this year, more flu cases have been diagnosed in the laboratory than usual-an appeal for flu-related symptoms from the direct service hotline (Flu trends in Australia 2019). According to Newall& Scuffam & Hodgkinson (2008 pp.6818–6823,) that for government the cost of influenza per year has been forecasted rough $800 million included direct cost from day lost due to the flu, nevertheless, direct costs command these prediction accounting around 68-70%. Specifically, direct costs contain the patient ’s out-of-pocket expenses, general practitioner costs, medical insurance and other health insurance company costs, laboratory and diagnostic costs, and hospitalisation costs. In addition, the lost-on grass roots are hyperbolic because people usually didn’t have sufficient balance and some of fundamental need would hard be satisfied. Absenteeism (absence from work due to illness) causes an annual loss of $ 7 billion in wages, while attendance (absence from work) results in a loss of productivity of $ 34 billion. This can have a devastating effect on the workplace, because the virus can spread quickly among colleagues and even family members (Lucas 2020). In brief, as above that can be known flu is about our life habit and can affect human dramatically.

There have several risk factors of influenza will be pointed below:

• Public area: according to WHO (2018) said that in terms of transmission, seasonal influenza can easily infect and spread rapidly in crowded areas (including schools and nursing homes). When an infected person coughs or sneezes, virus-containing droplets (infectious droplets) spread into the air and spread to one meter and infect people who breathe droplets nearby. The virus may also spread through contaminated hands.
• Pre-existing health problem and age: Adler et al. (2014) reported that in the United Kingdom (UK), 49% of children under five years old, 59% of children 5-14 years old, 35% of children 15-24 years old and 25% of children 25-44 years old are infected. Although many cases of influenza may be moderate, serious complications may occur, especially in children, elders and individuals with pre-existing health conditions. To help reduce the effects of flu, it is important to understand who is most likely to be infected. although the heavy burden of influenza, there is little quantitative information about risk factors, and this information may guide potential prevention strategies.
• Genetic changes: human influenza virus binds to sites of respiratory epithelia; avian influenza virus targets duck intestinal epithelium. This difference may be a natural barrier between species. Although, pig tracheal epithelium has two binding sites, so influenza infection in pigs may transfer genetic subtypes from birds to humans and other species, so tiny genetic mutations in the flu virus can cause the flu to spread quickly to many people because we do not have natural immunity against new subtypes. (Pruitt 2007, p.44-46).
• Weakened immune system: when people during pregnancy or with bad situation of their body might increase the risk to get the flu, according to Jamieson et al. (2009) reported that from April 15 to May 18, 2009, CDCs from 13 states reported 34 confirmed or probable H1N1 pandemic cases among pregnant women. 11 (32%) women were admitted to the hospital. The estimated admission rate of H1N1 influenza virus infection in pregnant women during the first month of the outbreak is higher than that of the general population (0.32 per 100,000 pregnant women, 95% CI 0.13-0.52 versus 0. 076, 95% CI 0 · 07-0 · 09). Between April 15 and June 16, 2009, the US Centres for Disease Control and Prevention reported 6 deaths from pregnant women. All patients had pneumonia and subsequently required acute respiratory distress syndrome with mechanical ventilation, so that, complications of pregnant women infected with the pandemic H1N1 virus may increase the risk.
• Obesity: obesity is all of the beginning of diseases; it could cause diversity of sick and to worsen body health condition. In early 2009, link between obesity and influenza was first discovered during the H1N1 pandemic. Data from many countries around the world indicate that obese patients account for a high proportion of influenza-related hospitalizations and deaths. Obese patients (BMI 30 kg / m²) or obese patients (BMI $ 40 kg / m²) appear to be at increased risk of admission and death in the influenza-related intensive care unit (ICU). In addition, compared with non-obese patients, the mechanical ventilation time, ICU and hospitalisation time of obese patients who were hospitalized and received ICU treatment in 2009 were both obese H1N1 infected patients. Since certain chronic medical diseases (including cardiovascular and metabolic diseases) that may put people at risk of influenza-associated complications are highly related with obesity, attempts to clarify the independent contribution of obesity to the severity of influenza viruses have been a challenge.

References

1. Adler, A, Eames, K, Funk, S, Edmunds, W 2014, Incidence and risk factors for influenza-like-illness in the UK: online surveillance using Flusurvey, BMC Infectious Diseases, viewed 10 May, < https://bmcinfectdis.biomedcentral.com/articles/10.1186/1471-2334-14-232 >
2. Cassidy, T 2020, Flu season which struck down 310,000 Australians ‘worst on record’ due to early outbreaks, ABC news, viewed May 9, < https://www.abc.net.au/news/2020-02-11/early-outbreaks-to-blame-for-worst-flu-season-on-record/11949320 >
3. Flu trends in Australia 2019, Healthdirect.gov.au, Healthdirect Australia,
4. viewed 9 May, < https://www.healthdirect.gov.au/flu-trends-in-australia >
5. Influenza specialist group, 2020, Influenza Fast Facts, ISG organization, viewed May 9, < http://www.isg.org.au/index.php/clinical-information/influenza-fast-facts-/ >
6. Jamieson, DJ, Honein, MA, Rasmussen, SA, Williams, JL, Swerdlow, DL, Biggerstaff, MS, Lindstrom, S, Louie, JK, Christ, CM, Bohm, SR, Fonseca, VP, Ritger, KA, Kuhles, DJ, Eggers, P, Bruce, H, Davidson, HA, Lutterloh, E, Harris, ML, Burke, C, Cocoros, N, Finelli, L, MacFarlane, KF, Shu, B & Olsen, SJ 2009, ‘H1N1 2009 influenza virus infection during pregnancy in the USA’, The Lancet, vol. 374, no. 9688, pp. 451–458, viewed 10 May, < https://www.sciencedirect.com/science/article/pii/S0140673609613040 >
7. Newall, A.T, Scuffham, P.A, 2008, Influenza-related disease: The cost to the Australian healthcare system. Vaccine, 26(52), pp.6818–6823, March 30 pp.6, < http://www.isg.org.au/assets/assets/isg-cost-influenza-report-30-2007.pdf >
8. Lucas, F ,2020, Flu costs Australian employers $7 billion in lost productivity, The Sector, February 27, < https://thesector.com.au/2019/02/27/flu-costs-australian-employers-7-billion-in-lost-productivity/ >
9. Pruitt, B 2007, Nursing, Vol37(10),p 44-46, viewed 10 May, < https://ovidsp-dc2-ovid-com.access.library.unisa.edu.au

Microbiology

Causing Agent — Influenza occurs due to infection of respiratory tract by Influenza virus, RNA viruses of orthomyxovirus genus. There are four types of influenza virus designated as A, B, C and D. Influenza A and B occurs commonly in humans. It is responsible for outbreak of respiratory illness, mostly in winters. It also increases the chances of hospitalization and death. Influenza A can be further classified as hemagglutinin (HA) and neuraminidase (NA), on the basis of two surface proteins. Influenza A(H1N1), A(H3N2), and influenza B- Yamagata, B- Victoria viruses cocirculate in humans worldwide. The distribution of these viruses varies every year, according to the time and geographical areas. Avian and swine influenza viruses rarely infects humans, and is associated with close exposure to infected animal populations. Type C infection has no impact on public health. It may either cause mild respiratory infection or no symptom at all. Type D virus primarily affects cattle, and it is not known to cause any illness in human beings.

In what parts of the world this disease is found?

Influenza is more common in east than in west, especially in Southeast Asia. It is also found in America and Australia. Influenza A(H3N2) spreads around the world more quickly than H1N1 and influenza B. H3N2 strain mutates rapidly changing the key protein. Thus, people get flu every year, and they need vaccination to protect themselves from illness.

Scientists gathered the information by analyzing DNA from 10,000 flu viruses over 12 years and mapped them together, so that they can see how each strain spread quickly and what it means for virus evolution. The map below shows the spread of H3N2 virus. Color indicates the region and the size of bubble indicates size of the population. Bigger is the size of bubble, more is the virus.

Note: Some blank areas in the map does not mean that people of that area are not infected by the virus, it’s only the lack of data.

• H3N2 virus is the most common form of flu virus. Bedford et al.
• H3N2 virus goes around East and Southeast Asia, and spreads to rest of the world. H3N2 virus mutates quickly and spread among people of all ages, especially adults who travel and spread it around the world.
• H1N1 does not spread as quickly as H3N2. Bedford et al.

It is more common in children than adults, that is why it does not spread quickly because children travel less as compared to adults.

Means of Infection

Influenza virus can be transmitted in humans by direct contact with infected individuals, by contact with virus contaminated objects or surface, and by aerosol transmission.

The effect on the human body system

Influenza seems like a regular cold with a runny nose, sneezing and sore throat. Flu comes sudden whereas cold comes slowly and it can be a nuisance but flue makes you feel much worse.

Influenza virus can be detected in body if all these following symptoms can be seen in humans : Fever over 100.4 F (38 degree C), cough, chest discomfort (dry cough can be severe), Fatigue and weakness, Nasal congestion, chills and sweats, body aches and pains (can be severe), Aching muscles, bedridden ( you may feel extremely exhausted), Headache (can be severe), sore throat, stuffy, runny nose. There are some risk factors that increases the risk of getting influenza are Age, living and working condition, weakened immune system chronic illness, Aspirin use under the age of 19, pregnancy, obesity. People living and working in facilities with many other residents, such as nursing homes or military barracks and people who are hospitalized are at the high risk of getting influenza.

Part of the body the disease affects

Influenza virus has an effect on the human body system as following: causing lungs infection, throat infection, ear infection and sinus infections. Influenza is a viral infection that mainly attacks respiratory system that includes nose, throat and lungs. High risk of serious complications can be seen in people with age group 65 or above, young children under age 5 and especially those under 12 months, pregnant women and women up to two weeks postpartum, indegenous people, those living with one or more chronic health conditions such as asthma, heart disease, kidney disease, liver disease and diabetes and those residing in nursing homes or other facilities and people with weak immune sustem and who are very obese, with a body mass index of 40 or higher.

Treatment

Preventions- flu virus change itself every year. Vaccines for viruses are created every year by the experts. To prevent flu virus every person should get vaccinated every year. The viruses in the Flu shot are either killed or weakened and cannot give you the flu.

Text Citation

1. Public Health Agency of Canada. (2018, October 19). Government of Canada. Retrieved from https://www.canada.ca/en/public-health/services/diseases/flu-influenza.html.
2. Potter, C. W. (2008, July 7). A history of influenza. Retrieved from https://sfamjournals.onlinelibrary.wiley.com/doi/full/10.1046/j.1365-2672.2001.01492.x.
3. https://wwwnc.cdc.gov/travel/yellowbook/2020/travel-related-infectious-diseases/influenza
4. https://www.medicinenet.com/influenza/article.htm
5. https://www.businessinsider.com/map-of-where-in-the-world-flu-comes-from-2015-6

INTRODUCTION

Influenza viruses are a virus that infects the respiratory tract of mammals and usually can cause fever, muscle pain, severe headache, sore throat, fatigue, coughing, and weakness. It is the Orthomyxoviridae family of enveloped viruses and a significant cause of respiratory infections worldwide (Bahadoran et al., 2016). It can be transmitted through the air by coughing or sneezing and also from infected birds through their droppings. Other transmissions are through saliva, nasal secretions, faeces, and blood of infected animals. Influenza viruses have four types which are A, B, C, and D. Influenza viruses have two proteins on it which help the infections to happen in mammals which are hemagglutinin (HA) and neuraminidase (NA). Hemagglutinin works as a mediator for the entry of the virus into the cell by membrane fusion activity and receptor binding while neuraminidase mediates the release of the virus by enzyme cleavage of the viral receptor (Bahadoran et al., 2016) .

DISCUSSION

Human influenza viruses that can cause seasonal epidemics of the disease are influenza A and B viruses. Other than that, influenza C viruses are generally can cause mild illness while influenza D viruses primarily affect cattle and not infect people. However, only influenza A viruses can cause flu pandemics (Centers for Disease Control and Prevention [CDC], 2019). This is because influenza A viruses can undergo evolutionary changes from one year to the next to evade immune protection of the host while maintaining their ability to function and interact with host cellular factors. Typically, there are two ways or mechanisms which influenza A viruses can change include antigenic drift and antigenic shift.

Antigenic drift or mutation is small changes in the virus structure or genome which can lead to changes in the surface proteins of the virus which are hemagglutinin and neuraminidase and will create new virus over a long time. This way take a long time to change enough for unrecognizable by antibodies of the immune system because minor changes of antigenic drift typically create viruses that are closely related to each other. As a result, these closely related viruses typically have identical antigenic properties that can be recognized by immune system antibodies (CDC, 2019). That is why, when a high case of virus infection happens in one year, the other years do typically not have a high case of infection than before. However, as minor variations occur over time or after a few years and result in antigenically different, immune system antibodies are no longer able to identify these new viruses, which can result in a person becoming vulnerable to influenza infection again as the virus has changed enough (CDC, 2019). Antigenic drift is the biggest explanation of why people may get the flu more than once, and the explanation of why the flu vaccine needs to be revised and changed regularly to keep up with evolving influenza viruses.

Next, antigenic shift or re-assortment is a major change of influenza A virus that can combine genome become new hemagglutinin and/or new hemagglutinin and neuraminidase proteins in influenza viruses and managed to infect the same cell (CDC, 2019). It drastically changes in virus structure or genome over a short time. This way usually may lead to pandemic infections. One way of shifting can happen is when the influenza virus from the animal population is able to infect humans which can lead to a pandemic of influenza A viruses. Pandemic influenza A viruses may also be Mproduced by reconfiguration between avian influenza viruses and human influenza viruses for the generation of new or novel viruses (Shao, W., Li, X., Goraya, M., Wang, S., & Chen, J.-L., 2017). This changes cannot be recognized by antibodies or memory cell because it has been totally modified as it has new strains and/or sub-types. This pandemic infections can cause the bad symptom of flu to humans as they do not have immunity against this new virus.

Some people might not get the flu even when the virus has successfully breached the physical barriers of that person. This is because they have a strong defence in their body that can protect them. Human bodies have three types of defence in their body which are physical defence, chemical defence, and cellular defence. Even though the virus can penetrate the physical defence, they may not successfully evade chemical and cellular defence for some people. Chemical defence of innate nonspecific immunity uses chemical mediators that have been detected in body fluid and tissue to help prevent microbial invaders. For example, interferons which are a class of cytokines are important in defence against viruses. It will inhibit viral replication and the development of mature viruses and hinder the spread of the virus. On the other hand, cellular defence such as leukocytes is primarily involved in the immune responses (Lumenlearning, n.d.). Subdivided leukocytes, such as lymphocytes, are very effective in releasing antibodies that bind to the virus and prevent it from infecting cells. Antibodies will bind to the surface protein of the virus called hemagglutinin (Lee et al., 2019).

Factors that viruses have failed to escape the person’s immune system are due to their diet, memory cells from the first infection they had, age and chronic illness. People who have a very high level of antioxidant precursors in their blood by drinking the juice, and eating fresh fruits and vegetables may protect them from getting sick with the flu (Taylor, 2011). Moreover, if the person has memory cells of the same strain that infect people on that year, they also may not get the flu. Furthermore, older adults have a higher risk of getting sick from the flu than young adults because their immune system was not as strong as young adults’ anymore. Ageing can gradually contribute to alterations in the immune system. As a result, specific symptoms that indicate the response of the immune system to these infections typically do not occur in older adults. Older adults, for instance, will not have a fever when they are sick with influenza. Some of their organs often experience some damage due to chronic illness or ageing. Thus, all these mechanisms for maintaining stability and work in the face of illness become less successful (Kernisan, 2018).

CONCLUSION

In conclusion, influenza viruses have four types which are A, B, C, and D but the only influenza A viruses can cause flu pandemics because it can change its structure or genome by antigenic drift or antigenic shift. The antigenic shift typically causes flu pandemics because influenza A viruses can change it structure in a very short time and produce a new virus that cannot be recognized by the antibodies or memory cells of the immune system. Whereas antigenic drift is a mutation of viruses that have little changes in their structures and take a long time to fully alter their structure to escape antibodies or memory cells, but antigenic drift can also be a factor why people can get flu more than once over time. Human bodies actually have protection against microbial invaders or pathogen. There are three types of defence in their body which are physical, chemical and cellular defence. That is why some people might not get the flu even though the virus has successfully breach physical defence. There are factors that have effectively prevented influenza viruses from penetrating the immune system, such as diet, memory cells from the last infection they had, and age. People who are young adults and have high antioxidant precursors usually have less risk to get the flu. Thus, it is very important to take flu vaccines to help strengthen the immune system against influenza viruses. Vaccines can function by activating an immune reaction to the virus so that human bodies are still secure when they encounter it.

REFERENCES

1. Bahadoran, A., Lee, S. H., Wang, S. M., Manikam, R., Rajarajeswaran, J., Raju, C. S., & Sekaran, S. D. (2016). Immune Responses to Influenza Virus and Its Correlation to Age and Inherited Factors. Frontiers in Microbiology, doi:10.3389/fmicb.2016.01841
2. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). (October 15, 2019). How the Flu Virus Can Change: “Drift” and “Shift”. Retrieved from https://www.cdc.gov/flu/about/viruses/change.htm
3. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). (November 18, 2019). Types of influenza viruses. Retrieved from https://www.cdc.gov/flu/about/viruses/types.htm
4. Juhye M Lee, Rachel Eguia, Seth J Zost, Saket Choudhary, Patrick C Wilson, Trevor Bedford, Terry Stevens-Ayers, Michael Boeckh, Aeron C Hurt, Seema S Lakdawala, Scott E Hensley, Jesse D Bloom. (2019). Mapping person-to-person variation in viral mutations that escape polyclonal serum targeting influenza hemagglutinin. Retrieved from https://elifesciences.org/articles/49324
5. Kimberly Hayes Taylor. (August 30, 2011). Cold and Flu. Why some people don’t get the flu, NBC News. Retrieved from http://www.nbcnews.com/id/44275043/ns/health-cold_and_flu/t/why-some-people-dont-get-flu/#.XrT2wXUza03
6. Leslie Kernisan. (February 9, 2018). Why the Flu is Often Missed in Older Adults (& What to Do About This). Retrieved from https://betterhealthwhileaging.net/avoiding-missed-flu-symptoms-diagnosis-in-aging/
7. Lumenlearning. (n.d.). Microbiology. Innate Nonspecific Host Defenses, Cellular Defenses. Retrieved from https://courses.lumenlearning.com/microbiology/chapter/cellular-defenses/
8. Lumenlearning. (n.d.). Microbiology. Innate Nonspecific Host Defenses, Chemical Defenses. Retrieved from https://courses.lumenlearning.com/microbiology/chapter/chemical-defenses/
9. Sabrina Richards. (August 27, 2019). Why does flu make some people sick, but not others?. Retrieved from https://www.fredhutch.org/en/news/center-news/2019/08/bloom-flu-single-mutation.html
10. Shao, W., Li, X., Goraya, M., Wang, S., & Chen, J.-L. (2017). Evolution of Influenza A Virus by Mutation and Re-Assortment. International Journal of Molecular Sciences, 18(8), 1650. doi:10.3390/ijms18081650
11. USMLE pass. (Feb 21, 2018). Reassortment, Phenotypic mixing, Recombination and Complementation. Retrieved from https://www.youtube.com/watch?v=NBNJKxvgwTc&feature=youtu.be

INTRODUCTION

Influenza continues to be a major public health concern.The World Health Organization (WHO) estimates that in a typical year, 10 to 20 percent of the world’s population is infected with influenza, resulting in 3,000,000 to 5,000,000 severe illnesses and 250,000 to 500,000 deaths (World Health Organization, 1999). In the United States, there are tens of thousands of deaths each year and the problem will increase due to the aging of the population and the susceptibility of the elderly. Influenza, generally referred to as ‘flu,’ is an contagious illness caused by an influenza virus. Some might heard about swine flu, bird flu, H1N1 or H3N2. The flu is a viral illnes that can range from mild to severe. The most frequent symptoms include: high fever, runny nose, sore throat, muscle and joint pain, fatigue, coughing and feeling exhausted. Influenza virus usually transmitted through coughing or sneezing. The droplets formed by coughing and sneezing that contain the influenza viruses can be spread through the air or just by touching surfaces that contaminated with the virus and then the person touch their faces, nose and eyes. This is how influenza virus will infect the individual person.

DISCUSSION

There are four types of flu viruses that can infect human which are type A,B,C and D. These viruses are divided into subtypes with some infecting humans and others infecting animals such as pigs and birds. These viruses are named after their editor protein spikes called hemagglutinin (H) and neuraminidase (N). Human influenza A and B viruses in the United States cause seasonal illness epidemics (known as the flu season), nearly every winter. Influenza A viruses are the only influenza viruses known to cause flu pandemics, that is to say, global flu outbreak epidemics. A pandemic can occur when a new and very different influenza A virus develops that both infects people and has the potential to effectively spread among people. Influenza type C infections typically cause mild influenza, and are not thought to cause epidemics of human flu. Influenza D viruses primarily affect cattle and are not known to infect or cause disease in humans.

Influenza viruses are constantly changing. They can change in one of two different ways; antigenic shift and antigenic drift. Antigenic drift results from continuous changes which modify the surface proteins of influenza viruses (H and N proteins) until the virus is eventually no longer recognized by the immune system. The changes associated with antigenic drift happen continually over time as the virus replicates. Because these antigens change, people can get influenza infections multiple times over their lifetime. The immune system of the body produces antibodies that recognize and bind to ‘antigenic sites’; areas located on the surface proteins of an influenza virus. Antibodies neutralize the flu viruses by binding to these antigenic sites, which stops them from causing further infection. Due to the constant changes of influenza viruses, antibodies produced by the immune system can not identify and bind to antigenic sites. This will lead to further infection.

Based on the theory about antigenic shift and antigenic drift, influenza strains are constantly mutating. Antigenic drift is referred to a small change of the influenza strains while a major change is called antigenic shift. Over years, these minor changes in the genes of influenza viruses result in a new strain that is not recognized by the immune system. In short, the antibodies created last year are unable to fight against this new version of virus. That is why some people can get sick from the flu even though they have had it before. According to scientists at Fred Hutchinson Cancer Research Center also find that a single mutation in the flu virus can sometimes give it the power to evade our antibody immunity to about 90%, but no others. This finding can help explain why individuals differ so greatly with respect to influenza virus susceptibility. There might be person-to-person variation in how influenza virus evolves to escape human immunity in order to fight against influenza virus or in another word, the same virus strain might have different effects on different people (Jesse, 2019).

But why some years people experience no disease even they get infected by the same strain virus with people that get flu in the same year? This can be explained by the lifestyle of people and their daily dietary intake which may cause variation in the function of the immune system among individuals. Theoretically, healthy immune system warriors need good and regular nourishment. Scientists have long recognized that malnourished people who usually live in poverty are more vulnerable to infectious diseases. For example, people that take enough micronutrient such as zinc, iron, copper, folic acid, and vitamins A, B6, C, and E will keep their immune system strong. So, this will decrease the tendency for these people to get disease like flu. As we know that nowadays, many people have awareness on consumption of dietary supplements such as vitamin C. So, what is the importance of taking vitamin C in our daily diet? According to Anitra C. Carr (2017), vitamin C is a powerful antioxidant having ability to contribute to immune defense by supporting various cellular functions of both the innate and adaptive immune system. Even though the role of vitamin C in lymphocytes is unclear but it had been shown that vitamin C can enhance the differentiation and proliferation of B- and T-cells due to its gene regulating effects. In short, vitamin C really helps improve our immune system and reduce the risk of getting flu.

Besides that, scientifically, stress can weaken our immune systems. In a stress condition, our innate immune system and cell mediated immune system will be affected. Stress can effect our brain undergoes a process that elevate Corticotrophin Releasing Hormone (CRH) . It will suppress immune system by reducing the function of NK cells and also T cell. So, our body prone to get infectious disease such as flu as the development of NK cells and T-cell are very important in order to fight microbes. Stress can also have indirect impact on the immune system by practising unhealthy lifestyle. It happens when a person drink alcohol and smoking as ways for them to relieve stress. This unhealthy behaviour will affect our immune system.

CONCLUSION

Human influenza or better known as the ‘flu’ is a common infectious disease that can easily transmit from one person to another by tiny little droplets of mucus through the air. There are 4 types of this virus which are type A, B, C and D but there are two main types of influenza (flu) virus that have been focused here; Types A and B. Our main concern on influenza virus features are the surface proteins hemagglutinin (H) and neuraminidase (N) because the changes of these antigenic structures can be related to antigenic shift and antigenic drift. These two ways of changing influenza viruses results in making a new strain of virus hence, make the virus unrecognized by our immune system. That is the reason why some people get infected by this flu virus many times. But, not all people can be infected by this virus as this also depends on their immune system activity. Good or bad lifestyle, dietary supplements and stress levels can be one of the factors that may affect the immune system conditions and thus, it will affect the strength of our immune system to fight against the invasive viruses. All in all, the best way to prevent the flu is to get yearly influenza vaccine.

REFERENCES

1. Anitra C. Carr & Silvia Maggini. (2017, November 3). Vitamin C and Immune Function. Retrieved March 25, 2020, from https://www.mdpi.com/2072-6643/9/11/1211.
2. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). (2019, July 10). Understanding Influenza Viruses. Retrieved March 22, 2020 from https://www.cdc.gov/flu/about/viruses/index.htm.
3. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). (2019, October 15). How the Flu Virus Can Change: “Drift” and “Shift”. Retrieved March 22, 2020 from https://www.cdc.gov/flu/about/viruses/change.htm.
4. Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). (2019, October 15). Antigenic Characterization. Retrieved March 23, 2020 from https://www.cdc.gov/flu/about/professionals/antigenic.htm.
5. Saul McLeod. (2010). Stress, Illness and the Immune System. Retrieved March 25, 2020, from https://www.simplypsychology.org/stress-immune.html.
6. Suzanne L. Epstein. (2003). Control of Influenza Virus Infection by Immunity to Conserved Viral Features. Retrieved March 21, 2020, from https://www.ncbi.nlm.nih.gov/books/NBK22159/.

Have you ever experienced a combination of these symptoms: sore throat, coughing, rhinorrhea, body aches and a fever? The answer for most people would be yes, this means that for some they have contracted the disease known as influenza or as most commonly put, ‘the flu.’ The aim of this essay is to discuss what influenza is and mode of spread. Also, to identify knowledge of infection control practices, risk assessments, health team involvement and cultural safety. The essay will discuss these points through a case study of an elderly patient by the name of Jimmy Holden who has contracted influenza. This paper will point out that older residents have an increased likelihood of individuals contracting influenza and other health risks.

The influenza virus is an acute respiratory illness that causes an infection in the respiration tract. (Paules & Subbarao, 2017) There are three types of influenza viruses; A, B, and C, these occur through local outbreaks or seasonal epidemics. Even though the influenza virus can sometimes present similar symptoms to a common cold like sore throat, rhinorrhoea, cough, fever, and muscle aches, (Bartok,2014) it also can cause a more severe illness or death. (Barnett, 2019) Just over 100 years ago an epidemic went on to contaminate a billion people and killed at least 50 million. (Barnett, 2019) In the early 21st century to now, influenza remains an extensive cause of mortality. (Barnett, 2019) Influenza viruses are believed to be spread between people through a couple of modes of transmission, (Cowling et al., 2014) although primary influenza or any human respiratory disease is mainly transmitted through droplet transmission (CHENG et al., 2015) that contain the infectious virus. The upper respiratory tract such as the nose, mouth, throat is the primary location of droplet formation. (CHENG et al., 2015) Droplets containing microorganisms are generated when a person is coughing and sneezing, (CHENG et al., 2015) this is why most lung infections result in droplet transmission by which the larger particles from the cough are transmitted and do not remain suspended in the air. (Seto, 2015) As discovered earlier Jimmy who is an elderly man has been diagnosed with influenza, so what does that mean for his wellbeing. According to a study by H. Keipp Talbot, when an elderly person becomes infected by influenza 67% of them become at least temporarily housebound, and 25% become temporarily bedbound. (Talbot, 2017) The study also found that even though the elderly have been exposed to many influenza viruses in the past, the occurrence of this illness and mortality due to influenza continues to surge with age. This is likely because of immune system deterioration with age as it becomes slightly less effective at protecting from diseases, with a higher number of already existing health conditions that are present in older adults. (Talbot, 2017)

With Mr Holden being diagnosed with influenza there are certain infection control precautions that his aged care facility will need to implement to reduce the risk of transmission of infectious agents. This is to ensure the safety of others and stop or minimize the influenza virus from spreading to other vulnerable residents. Some precautions need to be considered, these include the promotion and administration of the influenza vaccine and the following of standard contact and droplet precautions. (Blanco, Eisenberg, Stillwell & Foxman, 2016) As has been previously discussed as people grow older their immune system doesn’t function like it used to. This means that an elderly person could be more prone to catching infections, the best way of protecting them from serious infections is to be vaccinated against them. A study that observed elderly patients who received the influenza vaccine found that “Older adults receiving the influenza vaccine may have a lower risk of influenza (from 6% to 2.4%) … compared with those who do not receive a vaccination over the course of a single influenza season.” (Demicheli et al., 2018) Vaccination is also highly recommended for health care workers. (Blanco et al.,2016) With the additional use of standard contact, droplet precautions reduce influenza virus transmission amongst patients. (Blanco et al.,2016) Droplet precautions involve wearing surgical masks for staff, restricting access to visitors in the unit and in forcing hand hygiene before entering the room and after leaving the room. (Bal et al., 2015) An aged care facility residence is already allocated a single patient room with en suite, to further enforce precautions limiting resident movement outside the room to only when medically necessary is advised. It is also important to educate residents about respiratory hygiene and cough etiquette to reduces spread of droplet particles. (Department of Health and Human Services, 2014)

Aside from the infection risk, while in an aged care facility Mr Holden will also need to have other risk assessments performed by a nurse. The first risk assessment that should be performed is a Fall Risk Assessment. This is because Mr Holden is stated to be “unsteady when mobilising and uses a walking frame,” this puts Mr Holden at a risk for falling. Fall risk assessments have been determined as the best practice for preventing falls and injury obtained from falls in residential aged care. (Department for Health and Ageing, 2015) Risk assessments are used to identify residents who are most at risk for falling and to identify essential factors that contribute to their increased risk of falling. (Barker, Nitz, Low Choy & Haines, 2009) The second risk assessment that should be considered is a Pressure Injury Assessment. A pressure injury is defined as a: “Localised injury to the skin, and/or underlying tissue, usually over a bony prominence, as a result of pressure.” (Charalambous, Koulori, Vasilopoulos & Roupa, 2018) A person who is most at risk of developing a pressure injury are those who have: reduced mobility, are over the age of 65, have a low BMI, and have underlying medical conditions. (Charalambous et. al., 2018) By identifying these factors it is safe to say that Mr Holden is at risk of developing a pressure injury. Another assessment would be a fluid balance chart. The aim of an FBC is to keep an accurate record of a patient’s fluid input and output and to identify any deficits. (Scales & Pilsworth, 2008) Fluids in any patient are vital to their health, especially for Jimmy who needs to have an adequate amount of fluids due to having influenza. The last assessment is a pain assessment, by observing Jimmy’s condition such as decreased mobility and suffering symptoms of influenza such as aching joints, a pain assessment would be appropriate. This assessment will be used to diagnose the cause of his pain, understand the effect, recognize appropriate pain relief strategies and evaluate their success. (Briggs, 2010) With Jimmy also being an Aboriginal elder there are cultural safety aspects the need to be recognized. Cultural safety is defined as a nurse’s ability to deliver care in a way that the patient considers culturally safe. (Crisp, Douglas, Rebeiro & Waters 2017, p.35) Cultural aspects that need to be recognized with caring for Jimmy is indigenous patients value talk, health professionals taking time to speak with him personally or to the community will demonstrate respect and care, this allows Jimmy and his community to feel valued when information about his care is shared. (Jennings, Bond & Hill, 2018) It is also vital to avoid asking him questions about ceremonial business, bereavement, sexuality, fertility, domestic habits and other similar issues that may be considered sensitive. (Daly, Speedy & Jackson, 2014)

After reviewing Jimmy’s risk assessments and overall health it may be in his best interest to notify other health teams about his condition for an assessment of their own. Due to Jimmy’s risk of falling he may need to be referred to a physiotherapist to not only treat an injury from a fall but to also help prevent one from happening. A physiotherapist may prescribe a fall prevention intervention such as exercise. Exercise is shown to improve impaired muscle strength and poor postural control and decrease the risk of falling. (Sherrington & Tiedemann, 2015) If Jimmy is experiencing a high level of pain a Doctor may also need to be consulted to discuss and provide an intervention for the pain. Jimmy’s Doctor should consider his pain perception and establish a wide range of treatments that co-exist in the presence of multiple health problems. (Kruschinski et al., 2016)

Health professionals who understand how influenza spreads and the precaution that musted be followed will decrease the likelihood of elderly residence contracting or spreading the disease which could be fatal due to a low immune system. Knowing which risk assessments would be appropriate for a patient and interdisciplinary team involvement also result in improved patient care. Understand the importance of these skills such as professional client-centred nursing care, infection control practices and specifically cultural safety are important knowledge that will ensure a patient is always given the best care available and ultimately increase their wellbeing and satisfaction with the care of given by a nurse.

References

1. Bal, A., Schuffenecker, I., Casalegno, J., Josset, L., Valette, M., & Armand, N. et al. (2015). Enterovirus D68 nosocomial outbreak in elderly people, France, 2014. Clinical Microbiology And Infection, 21(8), e61 e62.http://dx.doi.org/10.1016/j.cmi.2015.05.008
2. Barker, A., Nitz, J., Low Choy, N., & Haines, T. (2009). Measuring Fall Risk and Predicting Who Will Fall: Clinimetric Properties of Four Fall Risk Assessment Tools for Residential Aged Care. The Journals Of Gerontology Series A: Biological Sciences And Medical Sciences, 64A(8), 916-924. http://dx.doi.org/10.1093/gerona/glp041
3. Barnett, R. (2019). Influenza. The Lancet, 393(10170), 396. http://dx.doi.org/10.1016/s0140-6736(19)30148-5
4. Bartok, V. (2014). The common cold: Treatment algorithms: Relief is available for common cold symptoms. Pharmacy Times, 80(11), 66.
5. Blanco, N., Eisenberg, M., Stillwell, T., & Foxman, B. (2016). What Transmission Precautions Best Control Influenza Spread in a Hospital?. American Journal Of Epidemiology, 183(11), 1045-1054.http://dx.doi.org /10.1093/aje/kwv293
6. Briggs, E. (2010). Assessment and expression of pain. Nursing Standard (Royal College of Nursing (Great Britain) : 1987), 25(2), 35-38.http://dx.doi.org/10.7748/ns2010.09.25.2.35.c7986
7. Charalambous, C., Koulori, A., Vasilopoulos, A., & Roupa, Z. (2018). Evaluation of the Validity and Reliability of the Waterlow Pressure Ulcer Risk Assessment Scale. Medical Archives, 72(2), 141. http://dx.doi.org/10.5455/medarh.2018.72.141-144
8. CHENG, Y., WANG, C., YOU, S., HSIEH, N., CHEN, W., CHIO, C., & LIAO, C. (2016). Assessing coughing-induced influenza droplet transmission and implications for infection risk control. Epidemiology and Infection, 144(2), 333-345. http://dx.doi.org /10.1017/S0950268815001739
9. Cowling, B., Ip, D., Fang, V., Suntarattiwong, P., Olsen, S., & Levy, J. et al. (2014). Modes of Transmission of Influenza B Virus in Households. Plos ONE, 9(9), e108850. http://dx.doi.org /10.1371/journal.pone.0108850
10. Crisp, J., Douglas, C., Rebeiro, G. & Waters, D, (2017). Potter & Perry’s Fundamentals of Nursing – Australian Version (5th ed.). Chatswood, NSW. Mosby
11. Daly, J., Speedy, S., & Jackson, D. (2014). Contexts of Nursing (4th ed., p. 343). Victoria Avenue.
12. Department of Health and Human Services, Tasmania Government. (2014). Transmission Based Precautions: A guide for healthcare workers. Retrieved from https://www.dhhs.tas.gov.au/__data/assets/pdf_file/0007/75715/Transmission_Based_Precautions_Guide_V2_2014.pdf
13. Department for Health and Ageing, Government of South Australia. (2015). When and how to do fall risk screening, assessment, care planning and discharge planning. Retrieved from https://www.sahealth.sa.gov.au/wps/wcm/connect/2d841f804b7bda65b903f97c1f47d846/15093.7+-+Tool+2%28v3%29WebS.pdf?MOD=AJPERES&CACHEID=ROOTWORKSPACE-2d841f804b7bda65b903f97c1f47d846-mN5MMkm
14. Demicheli, V., Jefferson, T., Di Pietrantonj, C., Ferroni, E., Thorning, S., Thomas, R., & Rivetti, A. (2018). Vaccines for preventing influenza in the elderly. Cochrane Database Of Systematic Reviews.http://dx.doi.org /10.1002/14651858.cd004876.pub4
15. Jennings, W., Bond, C., & Hill, P. (2018). The power of talk and power in the talk: a systematic review of Indigenous narratives of culturally safe healthcare communication. Australian Journal Of Primary Health, 24(2), 109.http://dx.doi.org/10.1071/py17082
16. Kruschinski, C., Wiese, B., Dierks, M., Hummers-Pradier, E., Schneider, N., & Junius-Walker, U. (2016). A geriatric assessment in general practice: prevalence, location, impact and doctor-patient perceptions of pain. BMC Family Practice, 17(1).http://dx.doi.org/10.1186/s12875-016-0409-z
17. Paules, C., & Subbarao, K. (2017). Influenza. The Lancet, 390(10095), 697-708. http://dx.doi.org/10.1016/S0140-6736(17)30129-0
18. Scales, K., & Pilsworth, J. (2009). The importance of fluid balance in clinical practice. Nursing Standard, 22(47), 50-57. http://dx.doi.org/10.7748/ns2008.07.22.47.50.c6634
19. Seto, W. (2015). Airborne transmission and precautions: facts and myths. Journal Of Hospital Infection, 89(4), 225-228.https://doi.org/10.1016/j.jhin.2014.11.005
20. Sherrington, C., & Tiedemann, A. (2015). Physiotherapy in the prevention of falls in older people. Journal Of Physiotherapy, 61(2), 54-60.https://doi.org/10.1016/j.jphys.2015.02.011
21. Talbot, H. (2017). Influenza in Older Adults. Infectious Disease Clinics Of North America, 31(4), 757-766. https://doi.org/10.1016/j.idc.2017.07.00

Introduction

The task requires a detailed investigation to find out the data provided which include the reference number of state and territories, date of onset, notification date which is relevant to the health authority, age, sex and the postcode of residence. The feature and the extensiveness of the data are accumulated in the National Notifiable Diseases Surveillance System which are been influenced with many factors. The Notifications may be from the hospitals and laboratories. Adding, device of the notifications is between the state and territories are noticeable with different mechanisms. Health care provide the number of cases that subject the health authorities for many diseases and may fluctuate among diseases.

The purpose of this task is to make predictions of the future trends which regards to the number of flu cases in Australia for rest of the 2019. A set of flu data with a polynomial value of 3 or more with more suitable parameters and assumptions to develop a model and the implications of my model. All the models which I made will be compared to their accuracy and plausibility.

Observation and assumptions

The primary observation of the task is to see that influenza season can be very different from one year to another, viruses of influenza changes, and different strains which can circulate in the population. It was expected that the number of people imposed with the flu has been changed. The frames which is useful for real-life applications with realistic outcome. With the observation, the following assumptions are determined.

1. People who have been vaccinated then there will less likely to get the diseases like flu in their community. This is valid assumption, because of efficiency of vaccines.
2. A number of people who get the flu in 2015, 2016, 2017 and 2018 is more but in 2019 its decreasing.
3. As compared to last 3 years in 2019 impact of influenza on people is fewer. In 2018, less than or 11% of the beds were available in FLuCAN hospitals were occupied by the patient with a confirmed influenza.
4. Getting a flu shot and the influenza vaccination each year is one of the best to prevent the flu.

Mathematical concepts and the procedures

Online programming DESMOS has been used to determine the unknown parameters because this is an efficient way to visually to see how the parameters will transform an equation. A variety of cubic functions will be used to solve the problem and to make predictions of future trends with regards to a number of flu cases in Australia for the rest of 2019.

The polynomial function can also be written as:

P(x) = anxn+an-1xn-1+…+a1x+a0

Where n is a natural number or zero and the≠0

• Number 0 is called the zero polynomial
• Degree of polynomial is the index n of the leading term
• A monic polynomial is a polynomial in which the leading term has coefficient of 1
• The constant term is the term of index 0

The given polynomial function from a power of 3 and more.

Functions with power 3 y= ax3+bx2+cx+d

Functions with power 4 Y= ax4+bx3+cx2+dx+e

Functions with power 5 Y= ax5+bx4+cx3+dx2+ex+f

Functions with power 6 Y= ax6+bx5+cx4+dx3+ex2+fx+g

Determining the mathematical models:

A set of data has been collected from different years for different genders and ages to make a prediction of flu cases in the rest of 2019 in Australia.

TABLE 1 (RAW DATA)

These are the results that were gathered. The settings are described in “Formulate”. A number of notifications of influenza were recorded from 2008 to 2018 in Australia to get an overall judgment. This will give me data to work with, in order to compare the number of influenzas in different months and years and to differentiate which one worked the most efficiently.

TABLE 2 (Graph of Influenza from 2010-2018)

I have taken a decision to eliminate those few in order to get an even more accurate average of the scenarios which could take place in real-life situations. If you see the averages of influenza in different years average increase in every year but the government isn’t taking any actions towards the influenza flu if it gets going this will definitely caused many problems.

Figure 1.0 Number of people inflicted with flu by age group in 2019

Number of people Age group

4524 00-04

4084 05-09

1965 10-14

2116 15-19

2349 20-24

2476 25-29

2752 30-34

2684 35-39

2284 40-44

2334 45-49

2270 50-54

2358 55-59

2300 60-64

1940 65-69

1717 70-74

1464 75-79

1278 80-84

1839 85+

This figure shows the number of people get inflicted with influenza in different era groups in 2019. In this graph it shows that younger people are more endangering to get influenza as compared to older people. If the young generation will get the vaccination then this flu on the youth will definitely decrease.

Median: 2292

Mode: 2270

Mean: 2172.39

Average: 2374.11

Figure 2.0

This figure shows that most of the people who got inflicted with the flu is in September and about 40000 people were get inflicted with influenza. As in figure 2.0 state the y-intercept of the graph and in the area that the more people in September got the flu. The y-intercept is equal to 11778 which mean that most person get were inflicted in September in 2015. The R2 value is not close to 1 and that’s because of increasing the number of people inflicted with influenza after June until September which the gravity is positive and decreasing the number of people inflicted with influenza from September to November which the gravity is negative.

Figure 3.0

This figure shows the number of people inflicted with flu each month in 2016. Most of the people were inflicted with flu in August which is nearly about 30000 and the y-intercept of the function happens there. The y-intercept is 11723 and it’s in the first quartile which both x and y values are positive. If you compare year 2015 and 2016 then you will see that a smaller number of people got inflicted with influenza in 2016 than 2015. If you see R2 value is closer to 1 in the number of people inflicted with flu in 2016 than the number of people inflicted with in 2015.

This has been predicted that a number of people inflicted in 2016 was less than the number in 2015.

Figure 4.0

This figure shows the number of people who got inflicted in each month in 2017. Most of the people who were inflicted with influenza between august and September about 1 lakh people and the y-intercept of the function happens here. If you see R2 value is not equal to 1, if it is then this graph is not correct. This has been predicted that number of people been affected in 2017 is much more than in 2014, 2015 and 2018

Figure 5.0

In figure 4.0 and 5.0 shows the number of flus cased in each month in 2017 and 2018. As in figure 4.0, there were more people who got inflicted with flu in year 2017 than the recent years. The y-intercept on the graph of 2017 is at a higher point than the y-intercept on the graph of year 2018 and as compared to both year there were more people who has been got inflicted with influenza in 2017. The R2 value on the graph in 2018 is closer to 1 than the R2 value on the graph in 2017 it means that the number of flu cases in each month in 2018 than the graph of the number of flu cases in each month in year 2017.

Table 3: Flu cases in QLD from 2011 to 2018

Average of flu cases in QLD from year 2011 to 2018

TABLE 3

Influenza notifications from 2010-2018 in different states and territories

Table 3 shows that the number of flu cases from 2010 to 2018 from the different territories and states

Prediction of future trends with regards to the number of flu cases in Australia for the rest of 2019

For calculating a number of flu cases from May to December in 2019, we have to sub the no of months into the equation to find the f(x).

May 6649.325

June 12582.716

July 18136.843

August 22047.212

September 23049.329

October 19878.7

November 11270.831

December 9587.411

May -210.749(5)3+ 3603.85(5)2 – 14530.8(5)+ 15550.7

June -210.749(6)3+ 3603.85(6)2 – 14530.8(6)+ 15550.7

July -210.749(7)3+ 3603.85(7)2 – 14530.8(7)+ 15550.7

August -210.749(8)3+ 3603.85(8)2 – 14530.8(8)+ 15550.7

September -210.749(9)3+ 3603.85(9)2 – 14530.8(9)+ 15550.7

October -210.749(10)3+ 3603.85(10)2 – 14530.8(10)+ 15550.7

November -210.749(11)3+ 3603.85(11)2 – 14530.8(11)+ 15550.7

December -210.749(12)3+ 3603.85(12)2 – 14530.8(12)+ 15550.7

The data gathered shows that the flu cases in Australia will increase for the rest of 2019 and for the rest of 2019 more people will inflict with flu.

Evaluation

A major factor behind this task is to see how realistic the models are and if they can be used dependably to interpose the values that are plausible. This allows the validity of the model to be verified. Data from different states and territories make a pattern that the number of flu cases in every state is different. The figures of 2014, 2015, 2016, 2017, 2018 and 2019 undoubtedly show that the fu cases is decreasing from 2014 to 2016 and from 217 to 2018 it increases again. The data also shows that people who got inflicted with flu in 2019 is even higher than the people in 2017 and 2018 from January to April. And for the rest of 2019, its predicted that the number of people with flu will increase.

Conclusion

Using the function to model the polynomial to make a prediction of the future trends with regards of the number of flu cases in Australia for rest of 2019. By using all the given functions, models were obtained by fitting the function in them. The validity of each model was to test the correlation coefficient, remaining analysis and the real-world application. All models had drawbacks. The polynomial models from the given data has the potential to produce a reasonable and better model to make it more realistic values for the variables.

Influenza has become an annual epidemic, increasing in volatility, which can greatly affect the fragile and vulnerable, particularly the elderly. Within healthcare settings, such as aged-care facilities, outbreaks can be greatly detrimental to the health and wellbeing of the residents, impacting greatly on their ability to partake in their activities of daily living (ADL). This essay will discuss influenza, infection control precautions, assessment and nursing care as well as a further interdisciplinary approach to the case study. Influenza has the potential to have a profound impact on a patient’s health and wellbeing if the appropriate precautions, assessments and continuous care is not provided to them.

Annually, multiple strains of influenza arise and spread throughout the population, leading to a yearly epidemic and a greater health risk for the vulnerable. Influenza is a complex virus in the way that it has the unique ability to undergo frequent antigenic variations. These minor changes in the structure of surface glycoproteins, hemagglutinin and neuraminidase facilitate for these yearly epidemics and the potential for multiple active strains (Pop-Vicas & Graventrein, 2011). In 2018, more than 90% of all influenza-related deaths were in people aged 65 years and older (Sheridan, Patel, Macartney & Cheng, 2018). This can be attributed to the clear decline in immune competence associated with increasing age. The elderly population’s risk is increased again if they live in nursing homes. This is due to the increased exposure risk through close living quarters, shared caregivers as well as frailty and nutritional deficiencies (Pop-Vicas & Graventrein, 2011). Influenza is transmitted primarily through airborne droplets and spread occurs in healthcare settings during aerosol-generating procedures such as changing sheets and close proximity to residents. Furthermore, the virus may be spread though droplets produced by coughing, sneezing and talking making residents extremely vulnerable to an influenza outbreak and widespread illness (Pop-Vicas & Graventrein, 2011). In the absence of treatment, viral shedding, which starts prior to the onset of symptoms, continues for approximately five days in healthy adults and can last significantly longer in the elderly (Pop-Vicas & Graventrein, 2011). Whilst vaccines offer some protection against the influenza through active immunity, poor vaccine responses in the elderly decrease the ability to control the virus (Pop-Vicas & Graventrein, 2011). This combination of easy infection and transmission, place the elderly residents of aged care facilities at a significant risk of contracting the virus. Therefore, it is important to have adequate infection control precautions to limit the likelihood of spread and help improve patient health and wellbeing.

To decrease the risk of an influenza outbreak in a care facility, appropriate infection control precautions must be undertaken by staff, residents and all visitors who enter the facility. Whilst it is impractical to completely prevent influenza, it is vital to recognise the importance of infection control precautions. Nursing home residents experience a major decline in physical functions following an influenza-like illness and has been associated with greater negative outcomes in older adults. Influenza immunizations may prevent hospitalizations and associated functional decline in the elderly (McElhaney, Andrew & McNeil, 2017). Currently, Australian recommendations determine an annual influenza immunization for all persons regardless of age, as vaccinations improve influenza immunogenicity and efficacy, specifically in older adults (Whitaker, von Itzein & Poland, 2018). Through wide-spread vaccination use, herd immunity has resulted in lower infection rates so healthcare facilities may have policies to reflect mandatory vaccination campaigns further limiting the risk of falling ill (Lang, Mendes, Socquet, Assir, Govind & Aspinall, 2012). Hoi (2019), also explained how continually using disinfectants on public surfaces including door handles and handrails, reduces the exposure to virus and limits continual spread from person to person. Furthermore, appropriate personal protective equipment (PPE) must be worn by all staff when coming into close contact with potentially ill residents. PPE includes physical measures to reduce influenza transmission through gloves, masks and continuous hand hygiene. This is further required when residents are allocated droplet precautions which are posted outside their rooms. Rainwater-Lovett, Chun and Lessler (2013), explain that social distancing, quarantining or cohorting and visitor and staff restrictions further control and limit the spread of the virus. Current data remains unclear as to whether visitor restrictions do contribute to a clear decline in influenza cases however, cases of influenza in residential care facilities are primarily driven by the burden of influenza’s emergence within the community (Bischoff, Petraglia McLouth, Bischoff & Palavecino, 2019). The elderly have a weakened immune system which allows the virus to manifest and endure, thus it is imperative it provide adequate assessments and nursing care to ensure that influenza is contained and a resident’s health is upheld.

Mr Holden would require further clinical assessments to ensure his health and wellbeing is adequately maintained. These assessments include pressure injury, fluid balance, nutritional and falls risk assessments. Pressure injury assessment is imperative to ensure adequate skin integrity and to significantly lower the risk of developing a pressure injury. As Mr Holden has unsteady mobility he is at greater risk of developing a pressure injury due to a lack of movement. Through increased friction between skin, clothing or other materials pressure injuries can occur which has the potential to further impact on Mr Holden’s ability to mobilise (Campbell, Coyer & Osboune, 2014). Furthermore, fluid balance charts and nutritional assessments should be undertaken and kept continuously. Prolonged dehydration in the elderly can result in serious health and cognitive issues and will further exacerbate existing symptoms of influenza, again limiting quality of life and prolonging the impact of the virus (Miller, 2017). The elderly are vulnerable to malnutrition and interventions play an important role in the prevention of degenerative conditions (Agarwalla, Saika & Baruah, 2015). An adequate nutritional assessment would further decrease the impact on the virus. Additionally, a falls risk assessment should be undertaken especially considering Mr Holden’s limited and unsteady mobility. It is suggested that due to a multitude of factors affecting gait and balance, multiple assessment tools should be utilised to maximize the advantages of predicting the occurrence of falls (Park, 2018). Furthermore, it is crucial to recognise the importance of the cultural aspects of care and becoming culturally competent. As Mr Holden identifies as an Aboriginal Elder, his cultural identity must be recognised in order to provide care that is culturally sensitive. Daly, Speedy and Jackson (2017), explain that in order to provide culturally safe care, nurses must be aware of themselves and their clients. In regards to the case study, healthcare workers must be aware of Mr Holden’s cultural beliefs including the distrust created by historical and contemporary factors which can impede on his ongoing health. Workers must also understand that Mr Holden is an Elder whom is regarded as a respected individual and role model within the community and this must reflect on the way care is provided and the relationship he has with his family and community (Waterworth, Pesuc, Brahaam, Dimmock & Rosenberg, 2015). Additionally, staff will work with other healthcare professionals to ensure Mr Holden’s health and wellbeing is adequately maintained into his future.

Additional healthcare professionals will be required to uphold Mr Holden’s health and wellbeing. Lancaster, Kolakowsy-Haner, Kovacich and Greer-Williams (2015), explain that the coordination of various treatments and interventions provided is crucial in preventing errors and fragmented care. For this case study nurses will work in conjunction with physiotherapists and psychologists to ensure that Mr Holden has exceptional ongoing care. Physiotherapists can help maintain functional independence in daily life and encourage patients partake in tasks to improve the efficacy to perform ADLs (Pihl, Cider, Stromberg, Fridlung & Matensson, 2011). A psychologist has the potential to improve and maintain Mr Holden’s mental health in the short and long term. This offers the potential to discuss the short-term impact influenza has on his ADLs as well as his approach to cultural disparities, his cultural identity and to discuss his beliefs on the social connections to family that is intensified by his cultural obligations (Waterworth et al., 2015). These professionals will be used to enhance and maintain Mr Holden’s health and wellbeing as well as overall quality of life during and after his experience with influenza.

Influenza is an infectious virus that results in yearly outbreaks and high rates of morbidity and mortality in the elderly. It is crucial to adhere to appropriate infection control precautions in order to contain and limit the spread of the virus. It is also important to use appropriate assessment on an impacted resident to ensure well-maintained health and wellbeing. These assessments may include pressure injury, fluid balance, nutrition and falls risk assessments which will be used in conjunction with culturally safe care to ensure the resident is comfortable presently and into the future. Lastly, an interdisciplinary approach is used to ensure that the resident has exceptional care provided to them both during this virus and into the future.

References

1. Agarwalla, A., Saika A. M., & Baruah, R. (2015). Assessment of nutritional status of the elderly and its correlates. Journal of Family and Community Medicine, 22(1), 39-43. https://dx.doi.org/10.4103/2230-8229.149588
2. Bischoff, W., Petraglia, M., McLouth, C., Viviano, J., Bischoff, T., & Palavecino, E. (2019). Intermittent occurrence of health care – onset influenza cases in a tertiary care facility during the 2017-2018 flu season. American Journal of Infection Control, 1, 1-4. https://dx.doi.org/10.1016/j.ajic.2019.06.020
3. Campbell, J. L., Coyer, F. M., & Osborne, S. R. (2014). Incontinence-associate dermatitis: a cross-sectional prevalence study in the Australian acute care hospital setting.International Wound Journal, 13 (3), 14. https://dx.doi.org./10.111/iwj.12322
4. Daly, J., Speedy, S., & Jackson, D. (2017) Contexts of Nursing (5). Chatswood, Australia: Elsevier
5. Hoi, H. T. (2019). Some effective ways to prevent common influenzas. Indian Journal of Physiotherapy and Occupational Therapy, 13 (3), 191-195. https://dx.doi.org/10.5958/0973-5674.2019.00117.5
6. Lancaster, G., Kolakowsky-Haner, S., Kovacich, J. & Greer-Williams, N. (2015). Interdisciplinary communication and collaboration among physicians, nurses and unlicensed assistive personnel. Journal of Nursing Scholarship, 47(3), 1-2. https://dx.doi.org/10.111/jnu.12130
7. Lang, P. O., Mendes, A., Socquet, J., Assir, N., Govind, S., & Aspinall, R. (2012). Effectiveness of influenza vaccine in aging and older adults: comprehensive analysis of the evidence. Clinical Interventions in Aging, 7, 55-64. https://dx.doi.org/10.2147/CIA.S25215
8. McElhaney, J. E., Andrew, M. K., & McNeil, S. A. (2017). Estimating influenza vaccine effectiveness: Evolution of methods to better understand effects of confounding in older adults. Elsevier, 35, 6269-6274. https://dx.doi.org/10.1016/j.vaccine.2017.09.084
9. Miller, C. G. (2017). Dehydration in nursing home residents: a meta-analysis of causes of dehydration, implications, and those most at risk. Honours College, 1. Retrieved from: https://digitalcommons.acu.edu/honors.
10. Park, S. (2018). Tools for assessing fall risk in the elderly: a systematic review and met-analysis. Aging Clinical and Experimental Research, 30 (1), 1-16. https://dx.doi.og/10.1007/s40520-017-0749-0
11. Pihl, E., Cider, A., Stromberg, A., Fridlund, B. & Martensson, J. (2011). Exercise in elderly patients with chronic heart failure in primary care: effects on physical capacity and health-related quality of life. European Jounral of Cardiovascular Nursing, 10 (3), 150-158. https://dx.doi.org/10.1016/j.ejcnurse.2011.03.002
12. Pop-Vicas, A., & Graventein, S. (2011). Influenza in the elderly – a mini-review. Gerontology, 57, 397-404. https://dx.doi.org/10.1159/000319033
13. Rainwater-Lovett, K., Chun, K., & Lessler, J. (2013). Influenza outbreak control practices and the effectiveness of interventions in long-term care facilities: a systematic review. Influenza and Other Respiratory Viruses, 8, 74-82. https://dx.doi.org/10.1111/irv.12203
14. Sheridan, S. L., Patel, C., Macartney, K., & Cheng, A. C. (2018). New enhanced influenza vaccines for older Australians: what promise do they hold? MJA, 209 (3), 110-113. https://dx.doi.org/10.5684/mja18.00334
15. Waterworth, P., Pescud, M., Braham, R., Dimmock J., & Rosenberg, M. (2015). Factors influencing the health behaviour of indigenous Australians: perspectives from support people. PLoS One, 10 (11), 1-17. https://dx.doi.org/10.1371/journal.pone.0142323
16. Whitaker, J. A., von Itzein, M. S., & Poland, G. A. (2018). Strategies to maximise influenza vaccine impact in older adults. Elsevier, 36, 5940-5948. https://dx.doi.org/10.1016/j.vaccine.2018.08.040

Pandemics are worldwide outbreaks of disease that greatly effect a population socially, economically and politically (Gallivan et al. 2017). They are different to epidemics in the way that pandemics impact globally, while epidemics are often contained inside one community.

The most devasting pandemic is the influenza virus. Also known as the flu, this virus is constantly spreading throughout the world, but as each person grows more immune to it, the effects of the flu are generally mild and non-life threatening.

However, every 20-40 years the influenza virus mutates and can cause deadlier infections in humans. This is called antigenic shift, and one way of this occurring is when a virus exclusive to animals is now able to also infect humans. When this occurs, most people have no immunity to the mutated influenza and become sick very easily.

History

Pandemics can spread many ways through touch, air or bodily fluids. During the stone age, humans lived in small communities and moved around often, so contracting and passing on viruses was difficult. As humanity modernised, the spread of bacteria and viruses was much easier. Transportation such as trains, boats and planes made transferring a disease from one community to another simple. This is only becoming easier as new technologies occur and transportation is upgraded, turning epidemics into pandemics.

The most famous example of a pandemic was the Black Death, occurring in Eurasia with its peak during 1347-1351. By 1400, 34 million Europeans had died. This plague was caused by the bacillus Yersina pestis and infected people by travelling through the air, or from the bite of an infected flea or rat. Ships harboured many rats and fleas, and so the plague was spread rapidly through transportation.

In more recent times, the 2009 influenza pandemic (known as Swine Flu) greatly impacted the world. Caused by the H1N1 virus, it has been estimated to of killed between 123,000 to 203,000 people worldwide (Flemming et al. 2013), 10 times the amount of the World Health Organisation’s (WHO) confirmed deaths. The H1N1 virus isn’t new, it also caused another massive pandemic; The Spanish Flu (1918-1920). This hugely devastating pandemic caused 50 million deaths worldwide, with 15,000 deaths in Australia alone.

Preparedness

It wasn’t until recently that countries began creating pandemic preparedness plans to outline how they’d cope with a new outbreak. The first unofficial plan was from Hong Kong in 1997, after an avian influenza outbreak (Itzwerth et al. 2017 p. 112).

Generally, countries’ plans outline how they’d deal with the high mortality rate and infection, as well as how they’d ensure essential services (such as water, power, transport and communication) were kept up and running. The WHO “checklist for influenza pandemic preparedness planning” outlines 7 main points for countries’ to include in their own preparedness plans. One of these points is “Implementation, testing and revision of the national plan” (WHO 2005), which suggests every country must kept up to date with their plans.

The Australian National Action Plan for Human Influenza Pandemic outlines the ways in which Australia would deal with another pandemic, particularly an influenza. The plan “outlines the responsibilities, authorities and mechanisms to prevent and manage a human influenza pandemic and its consequences in Australia” (Australian Government 2009). It focuses on prevention and preparedness, response, and recovery. It not only describes how Australia would cope with a pandemic, but also how Australia would prevent one from ever happening in the first place.

In most preparedness plans from differing countries, the level of preparation is designed for ‘worst case’ scenarios, ignited by fears of what happened with the Spanish flu. This was true in Australia and was what occurred when swine flu arrived into the country. However, after observing the impact on Australian citizens, the plan was modified. It was found that Aboriginal and Torres Strait Islander people, pregnant people, and those with another serious medical condition had the highest rates of morbidity for swine flu. Instead of focusing on limiting the spread of disease across the whole population, attention was drawn to specific groups of people who were vulnerable to the pandemic.

Response

When pandemics impact Australia, there is a set outline for how to deal and manage public health. The framework set out by the Australian Health Management Plan for Pandemic Influenza [AHMPPI] is utilised. There are six identified pandemic response phases: 1) alert; 2) delay; 3) contain; 4) sustain; 5) control; 6) recover.

The Delay phase has a focus on boarder control and identification of the virus. It aims to slow down the transmission rate to Australia. After this, the Contain phase commences, intending to stop the transmission within communities. During the 2009 swine flu pandemic, a new Protect phase was implemented with the goal of assisting and defending those who were of high risk to the virus.

Public crisis management is also a huge part of pandemic plans. During the swine flu pandemic, the media influence and coverage created fear and anxiety in the public. Many people went to their general practitioners and the emergency ward at hospitals due to the panic of being infected. Most of these people were not unwell or didn’t have the H1N1 virus. This caused extra strain on the health care system, which was already trying to help many infected people. However, toward the end of the pandemic, the media portrayed swine flu as not such a serious concern. This caused the public to become too relaxed with the virus, and thus forgo prevention methods such as wearing masks, washing hands, and regularly using hand sanitiser.

Opinions

In today’s climate there are many differing opinions on pandemics and diseases, namely relating to vaccines. Humanities pharmaceutical advancement allowed many lethal diseases to become preventable by ways of vaccination. Because of this, diseases like polio, measles and rubella are very rare nowadays.

However, scientists are finding more and more people are against vaccination. In a 2014 study by WHO’s Strategic Advisory Group of Experts (SAGE), they found the main reasons for vaccine uncertainty was safety concerns, religious beliefs, doubt in health authorities, and a disbelief of any benefit from vaccines (WHO 2017).

Anthropologist Heidi Larson predicts that “the next major outbreak [of a pandemic] …will not be due to a lack of preventive technologies. Instead, emotional contagion…could erode trust in vaccines so much as to render them moot” (Larson, H 2018). She continues on to say “The deluge of conflicting information, misinformation and manipulated information on social media should be recognized as a global public-health threat” (Larson, H 2018).

Conclusion

Pandemics are a devasting display of the power of viruses and bacteria, showcasing nature at it’s most poisonous. The science of these outbreaks is incredibly interesting to study and learn from.

Throughout humanity, pandemics and epidemics have caused a great impact, leaving our society with deep scars. Significant advances have been made in pandemic reduction, due to humanities’ advancements in pharmaceutical products and hygiene.

Humans have come together to formulate plans and strategies to cope with new pandemics, learning from the past and studying to prepare for the future. However, there is still a great deal unknown about pandemics, as future matters will most likely not mimic those of the past.