Influenza (Flu) viruses - a continuous threat to the public1
Influenza (Flu) viruses -
a continuous threat to the public1
Influenza – an important paediatric illness
Children are the
biggest carriers of Influenza infection
Seasonal influenza is characterized by a sudden onset of high fever, cough, headache, muscle and joint pains, feeling of being unwell, sore throat and runny nose. Being a virus, most people recover from the illness within a week without requiring formal medical therapy, barring symptomatic medications. But influenza as an illness itself can be extremely debilitating even in otherwise healthy humans and can cause severe illness or death especially in people at high risk1. People at highest risk of influenza related complications are - children younger than age 5 years, adults aged 65 years or older, pregnant women, and people of any age with certain medical conditions, such as chronic heart, lung, kidney, liver, blood or metabolic diseases (such as diabetes), or weakened immune systems1.
Seasonal influenza spreads easily via the air-borne route from person to person1 through sneezing, coughing, or through touching contaminated surfaces2. In the Indian scenario, where overcrowding, poor sanitation and lack of awareness and misconceptions about the disease are so much prevalent, the circumstances are overwhelmingly in favour of enhanced disease burden3.
Regardless of their annual seasonal character, influenza epidemics are unpredictable4. It is difficult to predict when a certain epidemic will start, how long it will last, and how harmful it will be.5 The severity of an epidemic in any given year depends on factors- immunity level of the population, type of the newly-evolved influenza virus and its harm-causing potential or virulence.5 Due to the ever-evolving characteristic of seasonal influenza viruses, there is a high probability that people can get infected with influenza multiple times in the same season and again throughout their lives2.
The situation is even worse in India, as we witness two peaks in Influenza cases, one in winter and other just after the monsoon season3.
Dr. Siddharth Kamat, a community-based pediatrician, maintains, “Influenza has gradually been recognized as an important illness in paediatric population. In fact influenza-infected children are one of the biggest carriers of infection. It is difficult to expect the under-5-year-old children to conscientiously practice good hand hygiene. They carry infection via both direct and/or indirect modes of transmission - hands and/or fomites.5 Children in group-settings like day-care centres and schools are important transmitters of influenza in the community4. Studies have shown that the influenza virus could be detected in over 50% of the fomites tested in day-care centers and homes during the influenza season5.”
The impact of paediatric influenza goes beyond just the clinical illness it causes to the child. The related socioeconomic burden includes direct costs like medication, doctor visits, and hospitalisations from the associated complications like pneumonias, and indirect costs including absence from school or day-care and missed workdays, either because of hospitalization or home care of a sick child or secondary illness of the parents5 and/or the grandparents who are at high risk, and finally the emotional trauma related to the severe illness.
What further adds to influenza burden amongst children are influenza-related co-morbidities. Acute lower respiratory infections (ALRI) such as pneumonia and bronchitis are a leading cause of morbidity and mortality in young children6. Studies have suggested that Influenza-associated ALRI is the second most common infection identified in children and contributes substantially to the burden of hospitalization and mortality in young children6.
Dr. Kamat, further added, “In my day to day practice, what I have observed is the universal occurrence of the illness across all socio-economic strata of the society and uniformly prevalent devastation the disease leaves behind. Not only does the acute phase of the illness last for almost a week, the recuperation in terms of actually getting back to routine daily activity, compensation in terms of nutrition lost in the illness period and recovery of the school/study period lost takes twice as long.”
“In this scenario what becomes very important is annual influenza vaccination to match the prevailing strains as followed by WHO recommended Infection, Prevention and Control (IPC) measures for the safety of patients, healthcare workers and the environment.7 Recommendations include - respiratory hygiene, i.e., covering the mouth and nose during coughing or sneezing with a medical mask, tissue, or a sleeve or flexed elbow, followed by hand hygiene; use of personal protective equipments like medical masks, gloves, long sleeved gowns and eye protection while providing care to patients; isolating the patients; vaccination of all people in the community at high risk including young children, the elderly and people suffering chronic medical illnesses on a priority basis, which can always be extended to include the entire family.” concluded Dr. Kamat.
References:
1. Influenza (Seasonal), Fact sheet Nಱ1, March 2014, http://www.who.int/mediacentre/factsheets/fs211/en/ , accessed on August 1, 2014
2. Influenza virus infections in humans (February 2014) http://www.who.int/influenza/human_animal_interface/virology_laboratories_and_vaccines/influenza_virus_infections_humans_feb14.pdf?ua=1, accessed August 1, 2014
3. Flu and pulmonary fibrosis, Sharma BB, Singh V, Lung India, 2013, April - June: 95-96, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3669566/?report=reader, accessed on August 1, 2014
4. WHO Position Paper, Weekly epidemiological record, 23 November 2012, 87th year, No. 47, 2012, 87, 461–476, http://www.who.int/wer
5. Burden of Influenza in Children by HeliSilvennoinen, From the Department of Pediatrics, University of Turku, Turku, Finland, ISBN 978-951-29-5209-0 (PRINT), ISBN 978-951-29-5210-6 (PDF), ISSN 0355-9483, PainosalamaOy – Turku, Finland 2012
6. Nair H et al; Global burden of respiratory infections due to seasonal influenza in young children: a systematic review and meta-analysis;www.thelancet.com, Vol 378, December 3, 2011
7. Broor S et al. Dynamic Patterns of Circulating Seasonal and Pandemic A(H1N1)pdm09 Influenza Viruses From 2007–2010 in and around Delhi, India. 2012;7(1): 1-9
8. WHO Guidelines 2014 - Infection prevention and control of epidemic- and pandemic-prone acute respiratory infections; http://apps.who.int/iris/bitstream/10665/112656/1/9789241507134_eng.pdf, accessed on August 5, 2014
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