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Facts about influenza

Flu

What is influenza (the “flu”)?

How the flu spreads.

Prevent the seasonal flu: get vaccinated.

Influenza ABCs.

Flu Pandemic

What is flu “pandemic”?

How are the seasonal flu and pandemic flu different?

What is the difference between an epidemic and a pandemic?

What are the effects of a flu pandemic?

What are the symptoms of a pandemic flu infection?

Will there be a vaccine available for pandemic flu?

How is the United States preparing for the next flu pandemic?

Avian Flu

What is the avian influenza (bird flu)?

How is the avian flu spread?

The current outbreak in birds.

Why the concern?

Is there a test for the bird flu?

Is there a bird flu vaccine yet?

Is there a drug to treat or prevent the flu?

Flu

What is influenza (the “flu”)?

The seasonal flu is a contagious respiratory illness caused by influenza viruses. It usually causes a mild to severe illness and, less commonly, can lead to death. The best way to prevent catching the flu is by getting a flu shot each fall.  The flu season in the U.S. usually lasts from December through March.  Every year in the United States, approximately 36,000 people die from seasonal flu-related complications.

The symptoms of flu include fever, headache, cough, sore throat, chills, and muscle aches.  Some people, such as the elderly, young children, and people with certain health conditions, are at high risk for serious flu complications.  These can include bacterial pneumonia, dehydration, or worsening of chronic conditions such as heart problems or diabetes.  Children can also have gastrointestinal symptoms, such as nausea, vomiting, and diarrhea, but these symptoms are uncommon in adults. Most people, however, recover from the seasonal flu within a two-week period.

What is the difference between an epidemic and a pandemic?

Epidemics and pandemics refer to the spread of infectious diseases among a population. An illness or health-related issue that is showing up in more cases than normally expected defines an “epidemic,”In the case of a “pandemic,” even more of the population is affected than in an epidemic, and it is more widespread around the world.

How the flu spreads.

Flu viruses spread from person to person in respiratory airborne droplets caused by coughing and sneezing. Sometimes people become infected by touching something (i.e., a door knob or other surface) contaminated with flu viruses and then touching their mouth or nose.

Prevent the seasonal flu — get vaccinated.

The single best way to prevent the seasonal flu is to get a flu vaccination each fall, between October and November. There are two types of vaccines:

  1. The “flu shot” — An inactivated vaccine (containing killed virus) that is given with a needle.
  2. The nasal-spray flu vaccine — A vaccine made with live, weakened flu viruses that do not cause the flu.

About two weeks after vaccination, antibodies develop that protect against influenza virus infection. Seasonal flu vaccines will not protect against influenza-like illnesses caused by other viruses or protect against other influenza strains not in the current vaccine, such as avian flu The reason for this is the decision on which strains of flu to include in that year’s vaccine is based on what was most common the previous flu season, so brand “new” strains are usually not in the vaccine.  You can learn more about seasonal flu by visiting the Centers for Disease Control and Prevention (CDC) website.

Influenza ABCs.

There are three main classes of influenza viruses: A, B, and C. Most human cases of flu illness are Type A or Type B, with A being more common. Influenza viruses also infect birds, pigs, horses, and other mammals — in fact some kinds of flu are mainly animal illnesses. In the past, where historical information is available, human pandemics have been Type A flu viruses. 

There are many subtypes of the Type A influenza viruses. They differ because of variations in certain proteins on the surface of the influenza A virus called H (hemagglutinin) and N (neuraminidase) proteins. There are 16 known H subtypes and nine known N subtypes of influenza A viruses. Many different combinations of H and N proteins, and therefore many different subtypes, are possible. The influenza virus commonly changes from year to year, developing new subtypes.

Flu Pandemic

What is flu “pandemic”?

A flu pandemic is a global outbreak of influenza, according to the CDC. A flu pandemic happens when a new influenza virus emerges. This is called “antigenic shift” — where a sudden change causes the virus to infect humans effectively. The virus becomes highly infectious and contagious in humans. No prior immunity would exist from exposure to seasonal influenza, and no vaccine would be available for wide distribution. It can spread easily from person to person, cause serious illness and death, and can sweep across the country and around the world in a very short time.

Three conditions must be met for a human pandemic to start:

  1. A new influenza subtype that can infect humans must emerge.
  2. It must cause illness in humans.
  3. It must spread easily between people and continue spreading among humans without interruption.

H1N1 (Swine Flu)
The H1N1 influenza virus (also called the swine flu) has met all three criteria according to the WHO. To date, swine flu virus outbreaks have been detected in more than 120 countries around the world, all 50 states in the U.S., plus Washington, D.C., Puerto Rico, U.S. Virgin Islands, and Quam.

Avian Influenza
The H5N1 influenza virus (also called avian or bird flu) is currently spreading through wild birds and poultry in Asia, Europe, the Middle East, and Africa.  So far, it has met the first two criteria of a human pandemic — it’s a new virus that can infect humans, and it has caused rare cases of serious illness and death. However, to date, it has not met the third criteria. It has not been easily transmitted from human to human.

How are the seasonal flu and pandemic flu different?

Seasonal Flu

Pandemic Flu

Outbreaks follow predictable seasonal patterns; occur annually, usually in winter, in the northern hemisphere.

Occurs rarely (only three times in the 20th century, with the last one in 1968)

Usually some immunity built up from previous exposure

No previous exposure; little or no pre-existing immunity

Healthy adults usually not at risk for serious complications; the very young, the elderly and those with certain underlying health conditions at increased risk for serious complications

Healthy people also at increased risk for serious complications

Health care systems can usually meet public and patient needs

Health care systems may be overwhelmed

Vaccine developed based on known flu strains and available for annual flu season

Vaccine probably would not be available in the early stages of a pandemic

Adequate supplies of antivirals are usually available

Effective antivirals may be in limited supply

Average U.S. deaths approximately 36,000/yr

Number of deaths could be much higher

Symptoms: fever, cough, runny nose, muscle pain; deaths often caused by complications, such as pneumonia

Symptoms may be more severe and complications more frequent; to date, rare human deaths caused by viral damage to lungs

Generally causes modest impact on society (i.e., some school closing, encouragement of people who are sick to stay home)

May cause major impact on society (i.e., widespread restrictions on travel, closings of schools and businesses, cancellation of large public gatherings)

No major impact on domestic and world economy

Potential for major impact on domestic and world economy

For additional information on seasonal flu, visit the CDC website.

For additional information on pandemic flu, visit www.pandemicflu.gov.

What are the effects of a flu pandemic?

A flu pandemic will have a significant impact on society. A pandemic could result in a large number of people falling ill, including children and young adults, with many deaths. A pandemic could also require restrictions on travel, alterations to normal business operations, and dismissal of students from school to help slow the spread of infection.

The United States was overwhelmed by the 1918–1919 flu pandemic, which caused the deaths of at least 675,000 Americans. If a pandemic of similar severity occurred today, 90 million Americans could become ill, and approximately two million Americans could die. In addition to the impact on human health, a flu pandemic presents a major threat to the world economy.

What are the symptoms of a pandemic flu infection?

The symptoms of a pandemic flu infection will likely be similar to those of seasonal flu, but they may last longer and be more severe.

Will there be a vaccine available for pandemic flu?

A vaccine for pandemic flu may not be available for 4–6 months after a pandemic starts, and even then, it may be available only in limited amounts.

How is the United States preparing for the next flu pandemic?

The United States is working with other nations and the World Health Organization (WHO) to strengthen systems to detect and contain outbreaks of viruses that may cause a pandemic. WHO uses a series of six phases of pandemic alert to inform the world of the seriousness of the threat and of the need for progressively more intense preparedness. The WHO raised the swine flu alert to its highest level – Phase 6 – saying the H1N1 virus has spread to enough countries to be considered a global pandemic. Increasing the alert to Phase 6 does not mean that the disease is deadlier or more dangerous than before, just that it has spread to more countries. For detail descriptions of the alert phases, please view the current WHO phase.

World Health Organization Pandemic Alert Phases

Inter-pandemic phase

Low risk of human cases

1

New virus in animals, no human cases

Higher risk of human cases

2

Pandemic alert

No or very limited human-to-human transmission

3

New virus causes human cases

Evidence of increases in human-to-human transmission

4

Evidence of significant human-to-human transmission 5

Pandemic

Efficient and sustained human-to-human transmission

6
  • The United States is improving vaccine technology in order to produce vaccines quickly and in large quantities.
  • Preparedness information and checklists have been developed for different sectors of the economy and for individuals, families, and communities to help reduce the effects of a pandemic.
  • The government is providing funding, advice, and other support to states to assist with pandemic preparation.
  • The government is providing up-to-date information through www.pandemicflu.gov.
  • The United States is stockpiling antiviral medicines, such as oseltamivir brand name Tamiflu, to treat  certain high risk people who may get sick with pandemic flu.

Avian Flu

What is the avian influenza (bird flu)?

There are many types of avian influenza viruses that occur naturally in wild birds — such as ducks, swans, and geese — in all regions of the world. Waterfowl have probably carried these viruses for centuries. The virus is carried in the bird’s respiratory and digestive systems. These viruses are highly contagious between birds. Some strains do not make the birds sick, but other strains can kill them.

How is the avian flu spread?

These viruses are spread as wild birds, following their normal migration routes, come in contact with other wild birds or domestic poultry.  The virus is spread through saliva, nasal secretions, and feces of infected birds.  As the influenza viruses are spread to susceptible birds, they cause two forms of the disease.  The “low pathogenic” form may go undetected, causing only mild symptoms (such as ruffled feathers or a reduction in egg production). The “highly pathogenic” form can spread rapidly through flocks of poultry. This form can have a high mortality rate that can reach 90–100 percent, often within 48 hours. Domesticated birds can become infected with the avian influenza virus when they come in direct contact with another infected bird, contaminated surfaces (dirt, equipment, or cages), or material (water or feed).

The current outbreak in birds.

The current outbreak of the avian influenza virus is a Type A flu virus of the subtype H5N1 and has been identified in birds in certain countries in Asia, Europe, the Middle East, and Africa.  More than 200 million birds have died or been culled (selected for slaughter) in order to contain the spread in the bird population. Worldwide public health professionals and scientists are closely monitoring the situation.

Why the concern?

The avian influenza A (H5N1) strains have raised concerns because they continue to evolve, are very contagious in birds, and have been transmitted, in limited circumstances, to other animals and humans.  Therefore, public health officials are closely monitoring the spread of the virus.

In the 20th century, there have been three flu pandemics which were all caused by Type A influenza viruses:  1) the 1918-19 “Spanish flu” [A (H1N1)], which caused the highest number of known influenza deaths; 2) the 1957-58 “Asian flu” [A (H2N2)]; and 3) the 1968-69 “Hong Kong flu” [A (H3N2)]. There was a significant increase in human mortality as a result of these pandemics.

While the avian influenza A (H5N1) usually does not affect humans, more than 400 human cases have been reported between January 2003–2009, mostly in Asia. More than half of those affected have died.* WHO maintains situation updates and reports on human cases of the avian flu.

Most of these human cases have occurred from direct or close contact with infected poultry or contaminated surfaces. In very rare cases, the avian flu virus has spread from one person with the avian flu to another person, but transmission has been limited, inefficient, and unsustained. Scientists are also investigating why a majority of the cases and deaths occur in younger, healthy groups.  As stated previously, this characteristic differs from the seasonal flu.

Is there a test for the bird flu?

In 2009, the FDA approved a new, more rapid test for detection of avian flu. The test, called AVantage A/H5N1 Flu test detects influenza A/H5N1 in nose or throat swabs collected from patients who have flu-like symptoms. The test identifies in less than 40 minutes a specific protein (NS1) that indicates the presence of influenza A/H5N1 virus subtype. Previous tests cleared by the FDA to detect the influenza A virus could take up to three or four hours to produce results.  

Is there a bird flu vaccine yet?

In 2007, the FDA approved the first avian flu vaccine. The manufacturer has stated that the vaccine won't be available to the public commercially, meaning it can't be obtained from a doctor's office. It has been purchased by the federal government for inclusion within the country's National Stockpile, for distribution by the Department of Health and Human Services in case it is ever needed.

Is there a drug to treat or prevent the flu?

Antivirals drugs that may help prevent or treat viral infection. There are several drugs that have been used to prevent or treat seasonal flu. Their effectiveness in avian flu is not yet known. There is not a sufficient supply of antiviral drugs to prevent flu in the whole population, and, for treatment, they likely work best if given within the first 48 hours of a flu infection. In the event of widespread seasonal flu or a flu pandemic, government public health agencies would likely issue guidelines on who should receive antiviral drugs and may play a role in their distribution. It is unlikely that these drugs would substantially modify the course or effectively contain the spread of an established influenza pandemic, whereas they may help an individual person.

* WHO only reports laboratory-confirmed cases.

Information gathered from WHO and www.pandemicflu.gov.

Important information about links to other sites