Introduction: Influenza is an infectious disease caused by influenza viruses. The symptoms range from asymptomatic to mild to severe. Managing a disease outbreak requires sound knowledge of the disease epidemiology and transmission patterns. This essay delves into these aspects and the impact on the community, reporting protocols, and prevention strategies of influenza disease.
Influenza is a viral infection caused by the influenza viruses. Records indicate that flu has existed for at least 1500 years. One of the deadliest flu pandemics is the Hong Kong flu. This flu pandemic outbreak occurred in 1968 and 1969 and claimed approximately between one and four million lives globally. According to CDC (2019), an H3N2 variant of the influenza A virus was responsible for the pandemic. Records indicate that the first outbreak case was established on 13th July 1968 in British Hong Kong. Considerable evidence suggests that the outbreak began in mainland China and then spread to Hong Kong. The first indication of the spread of the virus outside Honk Kong was in the second week of August in the same year when an influenza-like illness was reported in multiple populations in Singapore. The outbreak became obvious in Malaysia and the Philippines around the same time. Before the end of August, the outbreak was apparent in the Republic of Vietnam.
According to the CDC (2019), the first cases in the United Kingdom were established in early August. In September 1968, more outbreaks were experienced in schools in the UK. The outbreak reached Thailand, Europe, northern Australia, and India in that month. Also, an influenza outbreak erupted among participants of the Eighth International Congresses on Tropical Medicine and Malaria in Tehran, which led to the rapid spread of the virus in Iran. In October, the outbreak hit Japan, especially in school settings. In December 1968, the outbreak was apparent in the United States. The outbreak reached the Union of Soviets Socialist Republics (USSR) in mid-December. Records indicate that the outbreak was apparent in Africa and South America by 1969.
Epidemiology and Risk Factors of Influenza Virus
The rate of clinical attack for H3N2 varied. Jester, Uyeki, and Jernigan (2020) established the overall attack rate determined by the public health authorities was 43% in the United States. A study determining the disease attack rate among prisoners at Georgia State Prison reported a 40% attack rate. On the contrary, only 10% of inhabitants in a California retirement community were symptomatic. Jester et al. (2020) attribute the low rate of infection among the older age group to acquired immunity from previous pandemics. Serological studies that confirmed the existence of a high percentage of antibody virus before the pandemic in adults aged 65 years and older support these findings.
In contrast to the previous influenza pandemics where the index cases were predominantly in school children, the 1968 Hong Kong flu pandemic index cases were equally distributed among school-going children and adults. The highest clinical attack rate was experienced among those aged 10 to 14 years old, at 40% (Jester et al., 2020). Disease complications and worsening of underlying chronic illnesses such as congestive heart failure, diabetes, and chronic obstructive pulmonary disease (COPD) significantly contributed to high mortality rates in adults aged 65 years and above. The pandemic claimed approximately 100000 lives in the United States (Jester et al., 2020). Records also state that a large proportion of people younger than 65 years old lost their lives due to the 1968 flu pandemic (Jester et al., 2020).
The risk factors associated with the spread of 1968 flu pandemic varied depending on the age and health of the exposed persons. According to the CDC (2021), persons over the age of 65 with chronic diseases and children under two had a higher risk of developing complications due to influenza infection. Furthermore, older adults with metabolic diseases like diabetes and cardiovascular illnesses were at an increased risk of mortality and morbidity from influenza virus infection. Researchers show that pregnancy’s second and third trimesters placed an individual at higher risk of influenza health complications than the first trimester. The most common complications due to influenza virus infection included amplifying underlying respiratory diseases, secondary bacterial pneumonia, bronchitis, otitis media, and laryngotracheobronchitis. Other risk factors include, transverse myelitis, pericarditis, and primary pneumonia. Critically, some geographic regions such as West and Central Africa were at higher risk for influenza mortality and morbidity due to inadequate pandemic preparedness.
Route of transmission
Since the influenza virus affects the upper respiratory tract and presents with flu-like symptoms, respiratory secretions from the infected persons with significant viral loads can lead to disease transmission. Sneezing or coughing can expel large droplets of respiratory secretions loaded with the influenza virus, which might facilitate transmission if the secretion comes into contact with another person (Moghadami, 2017). Usually, the large droplets of respiratory secretions are transported through short distances like within six feet and land on surfaces, increasing the risk for disease transmission. Moreover, the influenza virus can also be transmitted through the aerosol transmission of tiny secretion droplets with a high viral load. Shedding of the virus lasts from 24 to 48 hours in adults without underlying medical conditions and stops after a week. However, adults over 65 years, immunocompromised individuals, and young children experience longer shedding hours (Moghadami, 2017). Influenza can be transmitted through indirect and direct contact, such as direct contact with contaminated surfaces and touching the mouth, nose, or eyes or direct contact with respiratory secretions from an infected person.
Impacts of influenza outbreaks on the community systems level
Influenza disease outbreaks disrupt school calendars, thus negatively affecting the students’ educational attainment. The influenza outbreaks led to massive closure of schools leading to disruption of learning across many regions globally. During the 1918-1919 influenza pandemic, many students failed to attend school due to the direct and indirect disease effects. The infected children had to temporarily stay out of schools due to influenza illness and recovery periods (Meyers & Thomasson, 2021). Besides, the fear of disease transmission saw some parents retaining their children at home due to fear of infection. Children in geographically high-risk areas are often affected disproportionately compared to their peers as these children experience more infections and severe forms of the disease. Prolonged school closures contribute to school dropout, especially among children who are 14 years and above as they enter the labor force searching for means of living, thus terminating their educational attainment. Reduced educational attainment leads to reduced scores limiting the student’s success later in life.
Influenza outbreaks affected the local government by creating conflicts between the authorities and the citizens, political effects, and intensifying discrimination. Contemporary studies reveal that pandemics can intensify existing conflicts within a region, especially with fragile leadership structures and the underlying threat of violence (Madhav et al., 2018). The pandemic control measures such as curfews amplify existing tensions within the local governments as the citizens receive these measures with increased suspicion, thus opposition leading to spark unrest and political tensions. These tensions could lead to riots and violence. Moreover, these conditions endanger the safety of the healthcare worker as locals resist intervention measures and attack healthcare facilities preventing effective medical intervention. Political tensions heightened during pandemics due to the increased suspicions of government motives, especially from the opposition, thus influencing the masses. Increased mortality and morbidity rates attributed to pandemics reduce the local authority’s capacity to manage the outbreak leading to leadership instability and increased absenteeism as individuals are affected by the influenza disease.
The effect of the influenza disease outbreak was not only felt by educational institutions and local governments but also by businesses. According to Madhav et al. (2018), pandemics create short and instant financial shocks leading to long–term effects on economic development. In the early stages of a disease outbreak, governments spend huge costs on disease management, including tracking infection cases, quarantine activities, and documentation involving many human and financial resources. Moreover, with the widespread disease outbreaks, states are forced to set up new facilities to adjust to the increased demand for medical care and medical equipment following increased infections due to the pandemic. Increased expenditures reduce the tax revenue exerting pressure on state fiscal reserves. This leads to budget shortfalls and reduced healthcare expenditures as the government cuts spending.
Hospitals face massive pressure during disease outbreaks due to the increased demand for health care interventions and more patients. Depletion of resources due to increased demand increases mortality and morbidity rates. Moreover, the influenza pandemic reduced access to medical health care as other patients missed routine care due to curfews, fear of transmission, and inability to travel due to reduced economic activities. Critically, the fear of infection may create an upsurge in hospitals as the “worried” and well individuals seek medical interventions, further overwhelming hospitals. The redistribution of funds to cover the costs of the pandemic reduced funding for other health care routine activities like immunization, increasing the mortality rates.
The health care system’s response to disease outbreaks relies on comprehensive laboratory data to present an accurate report. All disease testing locations must have a Clinical Laboratory Improvement Amendments (CLIA) certification (CDC, 2022). Moreover, the testing sites must be fully equipped with the state-required equipment for performing relevant tests and documenting all positive and negative results for reporting. The reporting protocol is initiated by presenting the gathered laboratory data to stated health departments, where the data will be sent to the relevant authorities or the CDC after removing the personal identities of individuals from the collected data. The public health authorities are required to route de-identified data daily to the CDC via the HL7 platform.
The prevention strategies for the influenza virus focus on curbing the disease’s spread. At the core of influenza, disease prevention is vaccination. Annual vaccinations against the disease reduce the risk of infection and the severity of the disease (Moghadami, 2017). Notably, the influenza virus has a high mutation rate, thus necessitating immunization to strengthen the body’s immunity function. Secondly, patients who are not responsive to vaccines should use antiviral chemoprophylaxis drugs such as zanamivir and oseltamivir to prevent influenza infection. These drugs are suitable for immunocompromised persons, those with chronic illnesses, and healthy people.
Moreover, practicing good health habits like hand washing reduces the risk of transmission. Since influenza disease is a seasonal flu-like infection, practicing regular handwashing, cleaning surfaces, and covering the mouth and nose while coughing and sneezing can curb the spread of germs causing influenza disease (CDC,2021). Moreover, individuals should avoid close contact with sick persons to reduce the risk of transmission. Staying home or in quarantine while sick also minimizes contact leading to a reduced risk of influenza transmission. Critically, proper handwashing using water and soap limits the transmission of the virus. Alternatively, one can alcohol-based hand sanitizers in place of water and soap to rid germs off the hand.
In conclusion, respiratory virus has the most common outbreaks as evidenced by the previous three flu pandemics. The influenza outbreaks create enormous burdens on the health care system and negatively impact other systems in the community. Understanding the disease epidemiology, transmission patterns, and risk factors facilitate effective disease management to reduce the burden on education systems, businesses, local government, and hospitals. Additionally, owing to the fast rate of transmission of the viruses, governments should collaborate with healthcare systems to ensure adequate resources in place for disaster and pandemic management.
Francis, M. E., King, M. L., & Kelvin, A. A. (2019). Back to the future for influenza preimmunity—Looking back at influenza virus history to infer the outcome of future infections. Viruses, 11(2), 122.
Madhav, N., Oppenheim, B., Gallivan, M., Mulembakani, P., Rubin, E., & Wolfe, N. (2018). Pandemics: risks, impacts, and mitigation.
Mallory R. and Dillaha J. (2022). Outbreak Response/Epidemiology Influenza Weekly Report Arkansas 2021-2022. Arkansas Department of Health. Retrieved from https://www.healthy.arkansas.gov/images/uploads/pdf/Weekly_Influenza_Report_Week_Ending_Saturday_May_14,_2022.pdf
Moghadami, M. (2017). A narrative review of influenza: a seasonal and pandemic disease. Iranian journal of medical sciences, 42(1), 2.
Centers for Disease Control and Prevention. (2019). 1968 pandemic (H3N2 virus). Retrieved from https://www.cdc.gov/flu/pandemic-resources/1968-pandemic.html
Centers for Disease Control and Prevention. (2021, 18th August). Pinkbook: Influenza. Centers for Disease Control and Prevention. Retrieved 10th May, 2022, from https://www.cdc.gov/vaccines/pubs/pinkbook/flu.html#:~:text=Influenza%20is%20an%20infectious%20viral,of%20influenza%20was%20in%201580
Centers for Disease Control and Prevention. (2021, 26th August). Healthy habits to help protect against flu. Centers for Disease Control and Prevention. Retrieved 11th May, 2022, from https://www.cdc.gov/flu/prevent/actions-prevent-flu.htm
Centers for Disease Control and Prevention. (2022, 4th April). How to report COVID-19 Laboratory Data. Centers for Disease Control and Prevention. Retrieved 11th May, 2022, from https://www.cdc.gov/coronavirus/2019-ncov/lab/reporting-lab-data.html
- Interview three families from different cultures. One family should be from your own culture. Compare the differences in health traditions between these cultures.
- MN576 Written Assignment: Vulnerable Female Populations Impacting Culturally Competent Delivery Of Women’s Health Care
- Creating Culturally Competent Health Care Organizations
- Culturally Competent Nursing
- Development Of Health Care In The Chinese And Guatemalan Heritage And Their Similarity Between Both Cultures Regarding Health Care.
- Choose a country other than the United States and research its health care system. Provide an overview of your selected country’s health care system and ANSWER all the questions below:
- Preparation For This Assessment, You May Choose One Of The Following Three Options For A Performance Dashboard To Use As The Basis For Your Benchmark Evaluation. Option 1: Dashboard And Health Care Benchmark Evaluation Simulation If You Decide To Use One
- Annotated bibliography using sources pertaining to Professionalism in Nursing
- write an annotated bibliography
- HCS 465 Week 1 Literature Review in Research: An Annotated Bibliography
- Annotated Bibliography: Workplace Laws
- Annotated Bibliography: Electronic Health Records
- Devry NR500 week 5 EBP Searchable Clinical Questions with Annotated Bibliography
- Annotated Bibliography of websites related to Health and Wellness
- Annotated Bibliography: Academic Honesty
- The Annotated Bibliography and Outline of the Teachings of Islam