EPIDEMIOLOGY OF INFLUENZA 1

Epidemiology of Influenza

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Epidemiology of Influenza

Human beings are exposed to multiple healthcare issues that affect their health status

and overall wellbeing. While there are multiple categories of disease classification,

communicable diseases have become a significant health topic especially with the current

Covid-19 pandemic. Addressing these diseases has become one of the most important roles of

the healthcare systems across the globe. While there are many communicable diseases, an

important consideration is placed on influenza, a major public health problem associated with

respiratory failures and multiple hospitalizations (Baselga-Moreno et al. 2019). It affects

between 2% and 10% of the global population with El Ramahi and Freifeld (2019) estimating

that it causes between 250,000 to 500,000 deaths every year. Focusing on the issue of

influenza, the epidemiology paper describes the disease, social determinants, epidemiologic

triangle, role of community nurse, national agency addressing the issue, and its global

implications.

Communicable Disease – Influenza

Influenza is one of the most common respiratory infections that affect vast

populations across the globe. A description of this disease is based on the causes and

transmission, symptoms, complications treatment, reporting, and demographics.

Causes and Mode of Transmission

Influenza is a contagious respiratory infection that is caused by viruses infecting the

throat, nose, and lungs causing mild to severe symptoms and at times resulting to death of the

affected individual. According to Beselga-Moreno et al. (2019), influenza is one of the most

significant health issues at global level as it affects many people and results to the death of

many people. That illness is viral as the cause is a virus. According to the CDC (2019),

annual influenza illnesses are caused by two viruses; Influenza type A and B. these viruses
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are in constant genetic changes which has significant adverse effects on immunity and

prevention strategies. Like most of the other communicable disease, key risk factors for

influenza include age (being below 6 years or above 65 years), weakened immunity, obesity,

presence of chronic conditions, pregnancy, and diseases that suppress an individual’s

immunity (CDC, 2021). Like most of the other respiratory infections, influenza is spread

through respiratory droplets from an infected person to uninfected individual. Primarily, the

disease is spread through cough, talking, or sneezing which sends droplets with the virus to

the environment including the air and surfaces (American Lung Association, 2020). Inhaling

these droplets or touching the infected surfaces and touching the mouth, nose, or eyes.

Symptoms and Complications

The symptoms of a disease help in classifying and diagnosing the disease, a process

that is critical in developing a care plan. When infected by influenza, a person will exhibit

certain signs and symptoms but a person can spread the virus even without exhibiting the

symptoms. According to Puig-Barbera et al. (2019), some of the most significant symptoms

of influenza include fever, headaches, coughing, shortness of breath, the American Lung

Association (2020) also identify chills, joint pains, sore throat, fatigue, nasal congestion,

nausea and vomiting as among the symptoms associated with influenza infection. These

symptoms are in most cases universal or common among other respiratory and communicable

diseases including COPD, Covid-19, and tuberculosis.

Most people infected with influenza recover within a few days but a portion of the

infected population will develop complications as a result of influenza. According to the

CDC (2019), sinus and ear infections are among the moderate complications of this disease

while pneumonia is classified as a serious complication. Myocarditis, myositis, encephalitis,

and respiratory and kidney failure are other complications which are mostly triggered by
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influenza disease. For infections that occur in the respiratory tract, the CDC (2019) notes that

the disease can trigger extreme inflammatory response leading to sepsis.

Treatment

Influenza is a viral infection and treatments are based on lifestyle behaviors and the

use of antiviral medications. According to WHO (2018), patients with uncomplicated

seasonal influenza are managed with symptomatic treatments. However, if the situation

worsens or for complicated cases, patients are treated with antiviral drugs. Some of the

licensed influenza antiviral agents are classified as adamantine and neuraminidase. According

to El Ramahi and Freifeld (2019), the approved neuraminidase inhibitors include zanamivir,

peramivir, and oseltamivir which are administered intravenously, inhalation, or orally

respectively. Using these medications, healthcare providers can effectively treat the disease.

However, it can be presented through influenza vaccines which have been in development for

decades.

Demographics of Interest

Influenza has been identified as a significant communicable disease. According to the

Global Influenza Hospital Surveillance Network report of 2016-2017 on influenza, there was

an increase in cases of influenza with a passivity of 70.3% for influenza A and 29.7% for

influenza B (Baselga-Moreno et al. 2019). Globally, influenza is estimated to cause between

250,000 and 500,000 deaths per year (El Ramahi & Freifeld, 2019). In the United States, the

disease affects many people with some dying from the infection and associated

complications. The 2019-2020 season was marked by 38 million influenza infections,

400,000 hospitalization, and 22,000 deaths from the disease (CDC, 2020a). The burden of the

disease is higher in children below the age of 4 years and adults aged between 18 years and

49 years.
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Disease Reporting

Like most of the other communicable diseases, influenza is a reportable disease. All

clinical and public health laboratories must report the total number of specimens tested for

influenza and the positive cases along with a brief description of the demographics including

the age of the person (CDC, 2020b). The reports are made to the Influenza Divisions of the

CDC which uses the weekly data to create weekly influenza surveillance reports. These

reports are fundamental in the preventive and management strategies and analysis of the

effectiveness of these measures.

Social Determinants of Health

Health and health outcomes are influenced by multiple factors and as described in

Healthy People 2020, the social determinants of health (SDOH) are factors within an

individual’s environment or being that influence health behaviors and decisions. Several

SDOHs have direct and indirect influence in the spread of communicable diseases including

influenza. According to ODPHP (2021), these SDOHs may include access to healthcare,

personal health practices, education, economic status, availability of resources, and social and

physical environment. In the spread of influenza, poverty, a major factor that increase human

congestion increases the risk of spreading influenza as people are overcrowded in specific

areas and at times in places with poor ventilation which increase the spread of the virus.

Knowledge deficit on preventive measures for this disease also increase the risk and spread.

As evidenced by Tuohetamu et al. (2017), lack of knowledge and poor attitudes towards

primary care measures increase the spread and risk of influenza. Personal health practices

may also impact an individual’s health and determine the risk of influenza. As pointed out by

Tuohetamu et al. (2017), poor personal health practices such as poor hand hygiene may

increase the risk of propagating and spreading the virus that causes influenza.
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Influenza Epidemiologic Triangle

To understand infectious diseases like influenza, public health officials must ask

questions related to the agent that causes the disease, the host, and where the transmission

occurred. The agent is the microbe that causes the disease and for influenza, the responsible

pathogen is influenza type A and influenza type B virus. The host of this microbe is human

beings and as described by the CDC (2019), influenza virus can affect any person at any age.

However, susceptibility including weakened immunity, age, and risk hygiene behaviors as

well as contagiousness of the host expedites the infection. The environment is the setting in

which increase the risk of influenza infection. According to Spicknall et al. (2010), surface

area to volume ration which define congestion/crowding, host density, and type of host

present are environmental factors that influence the virus’ transmission. The Figure outlines

key components of the triangle and the associated characteristics that define the agent, host,

and the environment in which influenza is transmitted.

Role of Community Nurse

In the prevention and treatment of communicable diseases, community nurses are an

important resource as they work collaboratively with the community and infectious disease

specialists to address these diseases. The initial role of this group of professionals is
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conducting patient assessments which help identify important patient information about a

specific healthcare issue and the underlying risk factors which form the basis for

interventions. Once data on the patient is collected, the CDC (2020b) indicates that these

healthcare providers must report the number of tests for influenza and the positive cases to

the CDC Influenza Division. The data provided to the CDC Influenza Division is used to

generate weekly reports of the disease which inform new and effective interventions to

prevent and treat the disease. Also as has been pointed out by Tuohetamu et al. (2017),

knowledge deficit is one of the significant risk factors for influenza and other communicable

diseases. Therefore, community health nurses have a responsibility to the community in

creating awareness on the disease. Primarily, they are involved in educating the community

on influenza preventive measures that are effective and ways to manage the spread from one

person to another. Influenza, like most other communicable diseases is easily preventable and

community health nurses play a central place in preventing these infections.

With access to influenza data from a community or target population, community

health nurses can effectively design preventive and treatment plans that are tailored to

addressing the community needs and concerns related to the disease. Demographic data is

critical in guiding healthcare providers on the most important issues related to the disease that

they should focus their interventions on. Using the approved medications for influenza as

described by El Ramahi and Freifeld (2019), healthcare providers can initiate appropriate

treatments for critical or serious cases while providing guidelines to moderate cases and at

risk population. Identifying environmental and host factors that increase the risk of influenza

is part of the community health nurses’ role and using such information may help enhance

preventive strategies.
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National Agency that Address TB

TB is not a local issue but rather a national health issue that require the input of

national agencies and organizations as well as community organizations and resources to

prevent and manage. There are therefore multiple agencies that are tailored to addressing the

issue of influenza with one significant one being the Centers for Disease Control and

Prevention Influenza Division. The primary goal of the influenza division in the CDC is to

improve the control and prevention of novel and seasonal influenza and improve

preparedness and response to influenza globally (CDC, 2020c). The agency works

collaboratively with local, domestic, and global partners to monitor and assess the virus and

improve vaccination efforts, build surveillance and response capacity, and apply research to

enhance control and prevention policies and programs.

Another important agency that is focused on the prevention of influenza is the World

Health Organization which is a global organization that is focused on creating and promoting

global influenza strategies that provide a framework of influenza prevention and treatment.

The World Health Organization also provides critical information on global influenza

prevalence, risk factors, and prevention strategies that inform national interventions for the

prevention and treatment of this disease. The U.S. Department of Health and Human Services

(HHS) is a Federal agency that is dedicated to developing and enforcing pandemic response

activities. The goal of this agency is to enhance the health and wellbeing of all American

citizens through the provision of effective healthcare services and fostering advances in

science that seek to enhance healthcare (HHS, 2021). These agencies are central in the fight

against communicable diseases and mainly influenza. In achieving their objectives, they

focus on collaborative effort with local agencies and organizations.

Global Implications of Influenza

Influenza is a significant national and global health issue that affects multiple people

across the globe. According to WHO global influenza strategy of 2019-2030, there are

approximately a billion cases of influenza in a year (Chadwick, 2019). Of these cases, 3 to

million cases are severe. WHO also reports that global influenza-related respiratory deaths

stand at between 290,000 and 650,000 cases (Chadwick, 2019). The disease is also

responsible for multiple complications with Lafond et al. (2021) indicating that influenza-

associated lower respiratory tract infections and hospitalizations as key implications of the

disease. The associated costs are not localized as they have expanded impact on national and

global economy and health status.

Conclusion

Influenza is one of the most significant health issues in the United States and across

the globe. As demonstrated, this is a communicable disease that affects many people and

which results to thousands of deaths. Addressing it is therefore critical in improving health

outcomes and health status of a community. Healthcare providers must therefore have an

understanding of the cause, agent, and host as well as the role of the environment in

influencing the transmission of this disease. As demonstrated, the disease is caused by

influenza virus with the primary host being human beings and environmental factors

propagating the agent. By targeting these aspects of the disease, community health nurses can

effectively prevent the disease by educating the population on preventive strategies and

measures that are effective. The nurse is also responsible for reporting the cases which help

support the creation of weekly reports that are fundamental in guiding preventive and

treatment plans. With the input of national agencies such as the CDC and WHO, local
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organizations and community health nurses can effectively manage the disease and enhance

preventive measures within their scope of practice.

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