Influenza, Third Edition

By Donald Emmeluth

Although influenza, commonly known as the flu, is a familiar disease to many people, its effects can be deadly. The virus holds the record for having the highest death rate in a two-year period of any disease (1918–1919), is highly potent, and is difficult to research because it is constantly mutating. Influenza, Third Edition examines symptoms and complications of the disease, as well as treatment, prevention, and the need for flu vaccines. 

Chapters include:

• Deadly World Traveler
• Viral Replication
• “I’ve Got the Flu, What Can I Do?”
• Influenza—Nature’s Frequent Flyer: Prevention
• Dealing with Complications
• What May the Future Bring?

• Language: English
• Publisher: Chelsea House
• Release date: Sep 1, 2019
• ISBN: 9781438194134

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Influenza, Third Edition

Copyright © 2019 by Infobase

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Contents

Foreword

Chapters

Deadly World Traveler

What Is a Virus?

Viral Replication

I've Got the Flu. What Can I Do?

Influenza Diagnosis

Influenza—Nature's Frequent Flyer: Prevention

Dealing with Influenza Complications

Avian Flu: Not Just for the Birds

What May the Future Bring? the Past and Future Concerns

The Future: Hopes and Dreams

Support Materials

Glossary

Further Resources

Bibliography

About the Author

About the Consulting Editor

Index

Foreword

The outbreak of Severe Acute Respiratory Syndrome (SARS) in the early part of the 21st century highlighted the significance of infectious disease outbreaks in the world today:  from a Chinese medical doctor who had become ill while treating patients with a clinically severe pulmonary syndrome in his home province, who then traveled to Hong Kong and stayed overnight in a hotel with international guests, the coronavirus that caused SARS spread around the world. The outbreaks that resulted, mostly in highly  industrialized countries, were typical of emerging infections in today’s globalized world.  Not only are these outbreaks serious risks to human health—often causing high mortality—they also have an effect on economies.  Fortunately the SARS outbreak was fully contained within six months – with a death toll just over 800.  But the SARS outbreaks also caused a severe shock to economies in Asia where travel, trade, and tourism came to a virtual standstill. 

Following the SARS outbreaks the International Health Regulations (IHR)—international law developed in the late 1960s to attempt to stop infectious disease at international borders—were revised.  Today the IHR provide requirements for a global response should infectious diseases cross national borders, and more importantly they require all countries to develop the public health capacity to help detect and stop infectious disease outbreaks where and when they occur. 

During the time of the revision of the IHR the related concept of global health security became an important political issue worldwide.  Its importance was highlighted by the 2013—2014 Ebola outbreaks in West Africa. Like SARS, Ebola virus infection spread across national borders to neighboring countries, and to highly industrialized countries far from the African continent.

The concept of global health security for persons living in industrialized countries with equitable access to health services is clear—it is about reducing their vulnerability to infectious disease threats that spread across national borders. 

But in many ways health security is like a chameleon that changes color depending on its environment. In addition to the collective health risk caused by the international spread of Ebola virus infection, health workers in West Africa, some infected with the Ebola virus, and Ebola-infected persons from communities they served, were forced to accept that their health care was not always effective, and not always accessible—that their own, individual health security was at risk. And many persons infected with the Ebola virus in West Africa died because their weak health systems collapsed, and care was not available to them, nor was it available to children and others who had nowhere to seek care for common infections such as malaria and other highly fatal tropical diseases.

The intertwining of collective and individual health security is a concept that must remain high on the political agenda as the IHR continue to serve as a global framework for collective health security, and as the world focuses its attention on universal health coverage, the key to realizing individual health security. At the same time the impact of deadly infectious disease outbreaks, and other outbreaks such as those caused by infections resistant to antimicrobial drugs, will remain a threat to collective and individual health security. This series of Deadly Diseases and Epidemics describes the past and present, and forecasts the future. It is important reading for anyone concerned about the spread of diseases in modern society.

David L.  Heymann, M.D.

Professor, Infectious Disease Epidemiology

London School of Hygiene and Tropical Medicine

Chapters

Deadly World Traveler

We live in a time of marvelous medical achievements. Scientists have identified and copied many of our genes and have inserted some of them into bacteria to produce, for example, the insulin that diabetics need. They have even genetically engineered bananas and potatoes so that one day we may be vaccinated while eating them. Viruses are being used as carriers of genetic information in gene therapy experiments.

In spite of these medical achievements, the Centers for Disease Control and Prevention (CDC) reports that every year more than 36,000 Americans die from influenza or as it is commonly known, the flu. In addition, more than 120,000 require hospitalization due to complications of the flu, and thousands more lose valuable time away from work or school. Everyone knows someone who has had the flu.

No one knows when or where influenza began. The Greek physician Hippocrates documented an outbreak of a flu-like disease about 412 B.C. in a region that is now part of Turkey. Two hundred years later, the historian Livy described a disease that struck the Roman army that might have been influenza.

Recorded history is unclear as to when the next outbreak of influenza took place. Some evidence suggests that in the late Middle Ages influenza was spread by the Crusaders. Indeed, the name influenza was first used about this time. People thought that the disease was caused by some catastrophic or cosmic influences. Epidemics of disease in Italy in 1357 and 1387 were soon being described as influenza.

During the 1500s, three major outbreaks of influenza occurred in Europe. The outbreak of 1580 probably qualified as a worldwide epidemic or pandemic. In the 1620s there were reports of influenza in both Virginia and New England, and the first recorded epidemic of influenza in North America occurred in 1647. Historical reports suggest that influenza was present from South Carolina to New England during most of the 1700s. The epidemic of 1759 was particularly devastating to the elderly population. In 1790, President George Washington was struck by influenza, and his own doctor predicted Washington's death. But Washington's fever broke, and he survived. A few months later, Thomas Jefferson and James Madison developed the disease, and Jefferson was said to have suffered with terrible headaches for more than a month. Fortunately, all the leaders of the new nation survived.

This epidemic in the United States was relatively minor compared to the pandemic that had swept through Europe in the early 1780s. Historical records show that two-thirds of the population of Rome and three-fourths of the population of Britain were afflicted with the disease. But so far, no one had any idea of the cause.

During the 1800s, science and technology combined to find answers to many medical questions. Although the causes of many diseases were discovered, the cause of influenza remained unknown. Some physicians believed that a virus could be the cause, especially since our knowledge of viruses was growing at the end of the 1800s. In 1898, two investigators named Friedrich Loeffler and P. Frosch were studying an animal skin disease known as foot-and-mouth disease. They were surprised that the agent of the disease was smaller than bacteria because it was able to pass through filters designed to trap the smallest bacteria. The following year, in 1899, a Dutch microbiologist, Martinus Beijerinck, was trying to find the cause of tobacco mosaic disease, a disease that afflicts tobacco plants. He called the agent he found in the sick plants a contagium vivum fluidum or contagious living fluid, a name that reflected his uncertainty about the true nature of a virus. This agent ultimately did turn out to be a virus.

Beijerinck recognized that he was dealing with a different form of microbe (minute life form), and he predicted that a similar agent might cause other plant diseases. His insights became the building blocks for the field of virology. In 1900, Walter Reed discovered that a virus caused yellow fever in humans. An understanding of the viral basis of many diseases was now becoming clearer. However, it would be another 33 years before scientists saw the influenza virus by using an electron microscope.

As the twentieth century began, the United States was actively pursuing a policy of expansion and becoming more involved in the events in the rest of the world. Economically and politically, the United States was increasing its influence throughout the world. Unfortunately, that expansion would also bring involvement in the Great Influenza Pandemic as travelers spread the virus across the globe.

Influenza arrived on the sunny northern coast of Spain in February 1918. Although the weather was warm, an increasing number of people were sweating not from the heat but from the high fevers associated with the disease. In spite of all the efforts by health officials, the disease spread. Beautiful San Sebastian, Spain, an attractive city and popular tourist destination, was where the first wave of influenza struck. The great pandemic to follow would be known as the Spanish Flu. Two months later, it seemed that all of Spain was affected. Historians have suggested that 8 million people, including the king, were ill, although only a few hundred died. Government offices were forced to close, and vehicular traffic came to a standstill. The troops called it the three-day fever, although the aftereffects lasted at least a week. The Spanish Flu spread throughout Europe, Asia, and the United States. Millions of people in all walks of life were affected.

During the second half of the 20th century, Asian Flu killed more than 700,000 people around the world. The epidemic was so severe that colleges set up temporary infirmaries to house the patients, such as this one in the ballroom at the University of Massachusetts.

Source: Wikimedia Commons.

In 1957, a new strain of influenza virus was isolated in Beijing, China. Some suggested that the disease had started in Russia. In early April, the virus reached Hong Kong after infecting large numbers of people in Singapore and Japan. The pandemic involved 22 million cases and became known as the Asian Flu. Then, in 1968–1969, a new Hong Kong Flu claimed 700,000 lives globally. About 34,000 people died in the United States.

In 1976, a new influenza virus was identified in an army recruit at Fort Dix, New Jersey. It was known as the swine flu, and it was feared that this flu was related to the influenza strain of 1918–1919. The government began a massive influenza immunization program. Luckily, the swine flu epidemic never materialized.

Then in 1997, another Hong Kong Flu emerged. Eighteen people became ill, and six died. This flu was unique because it seemed to be carried by chickens and moved directly from chickens to people. To stop the outbreak, more than a million chickens were slaughtered in Hong Kong. Although this seems cruel, it was the smart way to stop a pandemic and was necessary from a public health point of view. When and where will this deadly traveler strike in the twenty-first century? Answers to the questions of where and when this deadly traveler will go have been serious concerns to scientists and the lay public. Given the worldwide access of people and viruses to airline transportation, the spread of new flu viruses has the capability to be swift and far reaching. The spread of influenza viruses does not always follow the conventional wisdom in areas of the world that do not have the traditional seasonal bouts