Maxine Staszak

Influenza

Introduction

Influenza is an infectious disease in which new strains of the influenza virus are created through

constant mutations from one season to the next. It is responsible for the worst and deadliest outbreak of

infectious disease history-killing 3% of the world’s entire population (Short, Kedzierska, & van de Sandt,

2018). Belonging to the Orthomyxoviridae family (ortho, Greek for “straight, true, or aromatic ring”; myxo,

Greek for “mucus-referring to the virus's ability to attach to the mucoprotein on the cell surface”), a family of

single-stranded RNA viruses that makes up three main types: Influenzavirus A (Type A), Influenzavirus B

(Type B), and Influenzavirus C (Type C) (oed.com, 2019). Lethal and unpredictable, Influenza is a highly

contagious respiratory illness and more commonly known as the “flu” that spreads from direct contact through

the air particles or indirect contact with an infected surface. The flu is not the same as the common cold, even

though they are both a respiratory illness and have similar symptoms. The Influenza symptoms are more

intense and can lead to serious neurological, cardiac, respiratory, pregnancy, and musculoskeletal health

complications or even death. Approximately 5-20% of Americans experience flu-like symptoms of a high

fever, body aches, tiredness, and chills every year mostly around late fall, winter, and early spring (Duda and

Jelic, 2018).

Influenza Virus Severity and Spread

There are two different types of Influenzas (pandemic and epidemic) that Public Health officials

constantly monitor and collect surveillance on based on the severity of the infection and the ease of spread. A

Pandemic Influenza is when a new flu virus emerges every few decades or so, causing a serious global

outbreak that affects the entire population making everyone susceptible to infection, disease and death without

having any possible immunity. While the Epidemic Influenza or the seasonal flu is the most common

developing infection among humans that produce significant medical complications and are generally not fatal

except with the elderly, young children, or people with autoimmune diseases.
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Types

Type A Influenza infects humans as well as several kinds of animals, including birds, pigs, horses, and

rats. Additionally, wild birds can act as a natural host for the Influenza A virus causing the avian or bird flu, an

infection spread quickly to other animals and humans. People diagnosed with Influenza A infection show an

acute onset fever (102-104oF), severe body aches and pains, exhaustion, inflammation of the mucous

membranes lining the inner layer of the respiratory tract, and a painful migraine (CDC.gov, 2019). Since there

is a continuous emergence of new virus variants, eradication of the Type A Influenza cannot occur, and prior

flu vaccinations are unable to prevent infection from the new strain.

When comparing the three types of Influenza, found on the CDC.org website, Influenza Type A is

considered the most dangerous due to the cause of widespread global outbreaks and increased risk for disease.

Influenza Type B is similar to Influenza Type A in its severity but differs with classification, host range, and

its potential to cause epidemics. Additionally, both Type A and Type B are always changing and creating new

strains from one flu season to the next, but Influenza A mutates faster since Influenza Type B strain of genetic

makeup takes longer to modify (Ghebrehewet, MacPherson & Ho, 2016). The slower modification rate affects

Influenza Type B’s outbreaks by making them less frequent during the flu season and hinders the possibility of

a pandemic occurring due to the drastically reduced risk of the

infection spreading further. Lastly, Influenza Type C does not

present public health importance like Type A and B because it

is frequently less detected, less likely to mutate, and is known

to only causes mild respiratory infections. It is very rare, and

Type A can make animals and human sick while
Type B and Type C can only affect humans. (Duda
and Jelic, 2018). when transmitted it is known to only affect humans as shown

on the image to the left.

Influenza Virus Nomenclature:

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The World Health Organization (WHO) revised the

nomenclature for Influenza to make sure that each discovered

virus strain is given proper identification with relevant

information to ensure global understanding as well as allow

non-specialists with the details on how to detect, manage, and

inhibit further infection. Each Influenza name must consist of Break down of the process in naming a Type A
Influenza virus. This can be shortened to
Influenza A subtype H3N2 and then further
the antigenic type (A, B, C), the host of origin (avian), shortened to A H3N2 (cdc.gov, 2019).

geographical origin (Denver), strain number (15), and year of isolation (2009) (cdc.gov, 2019). When naming

Type A Influenzas, they are further classified by subtype which is determined by which versions of the

hemagglutinin (HA) and neuraminidase (NA) proteins appear on the surface layer of the virus as well as strain

destination. There are 18 different subtypes for the HA protein representing the number, H1-H18 and 11

different NA subtypes, N1-N11 (cdc.gov, 2019). The image to the right shows an example of how a Type A

Influenza nomenclature is put together.

Transmission

The transmission Influenza is both direct and indirect. It can be transferred between an infected person

to a susceptible individual by direct transmission such as touching, kissing, or direct projection. Hirve,

Newman, Paget, Azziz-Baumgartner, Fitzner, Bhat, et al., believed that Influenza spread mainly through

droplets made when infected people coughed, sneezed, talked and these droplets landed directly in the mouth

or noses of people nearby or inhaled into their lungs. They also concluded that individuals were less likely to

be infected by indirect transmissions like touching a contaminated surface or object (doorknobs, faucets,

phones, tables, and toys) with the flu and then placing their hands on their mouth, nose, or eyes. This could be

because when droplets are dispensed into the air, they can spread up to one meter, anyone in the vicinity can

breathe the droplets in, plus once out of the host the influenza virus can remain infectious for about a week at

human body temperatures with lower temperatures increasing the survival time. Whereas when transferred

through indirect transmission the infected surface can live for only a few hours. Overcrowded areas like
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schools, nursing homes, airports, and cities can enhance transmission by making the infection spread faster and

easier (Ikonen, et al., 2018).

Mutation

The two ways that Influenza mutates is called antigenic

shift and antigenic drift. Type A viruses undergo both antigenic

drift and shift while Influenza Type B viruses change only by

antigenic drift. Antigenic drift is a slow, ongoing change that

appears when the virus makes a slight difference when copying the

HA and NA proteins (Sandbulte, Spickler, Zaabel & Roth, 2015).

Although the mistake may be small, it can cause a significant

impact on the body's immune system ability to recognize the virus

and defend the altered proteins thus stripping the body from any
immunity built. This drift is the reason why people can repeatedly
The 2009 H1N1 swine flu spread around the globe
faster than any virus in history due to the mutation
A and mutation B shown in the image above as well
as air travel. (Sandbulte, Spickler, Zaabel, & Roth,
2015).

be infected by the flu and why flu vaccinations must be administrated at least every year to combat the current

circulating strain of the virus.

On the other hand, an antigenic shift is a sudden, substantial change in the influenza A virus which

produces a new arrangement of HA and NA proteins. When the shift occurs, most people have little to no

protection against the new infection since the new influenza subtypes are either completely different from the

current strain, haven’t been seen in a very long time, or entirely new. During this time the new virus spreads

rapidly and is transmitted easily from one person to the next often creating a pandemic. There are two possible

mutation outcomes. Sandbulte, Spickler, Zaabel & Roth, explain that the first mutation virus shift takes place

when the natural host (a person or animal) is infected by two different subtypes of influenza viruses circulating

at the same time, for instance, the human subtype can infect humans and/or pigs while the duck subtype can
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infect ducks and/or pigs. When the pig becomes infected concurrently with both the human and duck influenza

subtypes, the strands of both viruses are reasserted inside the same infected pig cell. The researchers

rationalize that the new subtype becomes highly contagious and dangerous because it gained the capability to

use the new duck HA protein to block the body’s immune response so that the antibodies are unable to defend

against the new virus subtype foreign attack. Another possible mutation that can develop is the avian strain

evolving so that the avian virus can directly transmit from birds to humans without needing another species to

rearrange the genetic material of influenza strains. An example of the antigenic shift was the production of the

2009 H1N1 swine flu as shown on the figure to the above.

Importance to Public Health

The ‘Great Influenza’ pandemic of 1918 also known as the

Spanish flu remains the worst outbreak and deadliest of infectious

disease history; caused by a strain of H1N1, killing more than 400,000

people in the United States, infected one-third of the world’s

population, and up to 50 million possible deaths worldwide (McAuley,

Kedzierska, Brown & Shanks, 2015). Records found that nearly half of
the reported deaths were among the young healthy individuals. Short,
Kedzierska & van de Sandt, in a scholarly article, released a warning
All the factors that Short, Kedzierska &
van de Sandt cross-referenced with the
influences that impacted the Spanish flu
to figure out what we need in order to
be prepared for the next influenza virus
pandemic.

that even though we are better prepared than 100 years ago, doesn’t mean we are even close to being ready

for the new challenges that will impact the next influenza virus pandemic. They researched the factors

behind the Spanish flu and incorporated it with the new problems that could affect the severity of a future

outbreak like population demographic changes, antibiotic resistance, climate change, as well a virus-related,

host, and external factors. More examples and important current factors that they took into account is shown

in the image above.

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References

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https://www.cdc.gov/flu/avianflu/h7n9-virus.htm [Accessed 25 Feb. 2019].

Cdc.gov. (2019). Types of Influenza Viruses | CDC. [online] Available at:

https://www.cdc.gov/flu/about/viruses/types.htm [Accessed 25 Feb. 2019].

Dash, M., & Kumari, P. (2017). Influenza: An overview. Indian Journal of Microbiology Research, 4(3),

234-238.

Duda, RN, K. and Jelic, MD, S. (2018). Overview of Influenza A and B. [online] Verywell Health.

Available at: https://www.verywellhealth.com/what-is-influenza-a-

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Ghebrehewet, S., MacPherson, P., & Ho, A. (2016). Influenza. Retrieved from

https://www.bmj.com/content/355/bmj.i6258

Hermann Ph.D., C. (2019). Influenza Virus (Flu). Retrieved from

https://www.bcm.edu/departments/molecular-virology-and-microbiology/emerging-infections-

and-biodefense/influenza-virus-flu

Hirve, S., Newman, L. P., Paget, J., Azziz-Baumgartner, E., Fitzner, J., Bhat, N., ... & Zhang, W. (2016).

Influenza seasonality in the tropics and subtropics–when to vaccinate?. PloS one, 11(4),

e0153003.
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Ikonen, N., Savolainen-Kopra, C., Enstone, J. E., Kulmala, I., Pasanen, P., Salmela, A., ... & Ruutu, P.

(2018). Deposition of respiratory virus pathogens on frequently touched surfaces at airports.

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McAuley, J., Kedzierska, K., Brown, L., & Shanks, G. (2015). Host Immunological Factors Enhancing

Mortality of Young Adults during the 1918 Influenza Pandemic. Frontiers In Immunology,

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Influenza Pandemic. Retrieved from

https://www.frontiersin.org/articles/10.3389/fcimb.2018.00343/full
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