Seasonal influenza is an acute viral infection caused by an influenza virus. There are 3 types of seasonal influenza viruses – A, B and C. Type A influenza viruses are further classified into subtypes according to the combinations of various virus surface proteins. Among many subtypes of influenza A viruses, influenza A(H1N1) and A(H3N2) subtypes are currently circulating among humans.

Influenza viruses circulate in all parts of the world. Type C influenza cases occur much less frequently than A and B. That is why only influenza A and B viruses are included in seasonal influenza vaccines.

Signs and symptoms

Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and runny nose. Cough can be severe and can last 2 or more weeks. Most people recover from fever and other symptoms within a week without requiring medical attention. But influenza can cause severe illness or death especially in people at high risk (see below). The time from infection to illness, known as the incubation period, is about 2 days.

Who is at risk?

Yearly influenza epidemics can seriously affect all populations, but the highest risk of complications occur among children younger than age 2 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 systems.

Transmission

Seasonal influenza spreads easily and can sweep through schools, nursing homes, businesses or towns. When an infected person coughs, infected droplets get into the air and another person can breathe them in and be exposed. The virus can also be spread by hands contaminated with influenza viruses. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.

Seasonal epidemics and disease burden

In temperate climates, seasonal epidemics occur mainly during winter while in tropical regions, influenza may occur throughout the year, causing outbreaks more irregularly.

Influenza occurs globally with an annual attack rate estimated at 5%–10% in adults and 20%–30% in children. Illnesses can result in hospitalization and death mainly among high-risk groups (the very young, elderly or chronically ill). Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 250 000 to 500 000 deaths.

In industrialized countries most deaths associated with influenza occur among people age 65 or older. Epidemics can result in high levels of worker/school absenteeism and productivity losses. Clinics and hospitals can be overwhelmed during peak illness periods.

The precise effects of seasonal influenza epidemics in developing countries are not known, but research estimates indicate that a large percent of child deaths associated with influenza occur in developing countries every year.

Prevention

The most effective way to prevent the disease and/or severe outcomes from the illness is vaccination. Safe and effective vaccines are available and have been used for more than 60 years. Among healthy adults, influenza vaccine can provide reasonable protection. However among the elderly, influenza vaccine may be less effective in preventing illness but may reduce severity of disease and incidence of complications and deaths.

Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with or care for high risk individuals.

WHO recommends annual vaccination for:

Influenza vaccination is most effective when circulating viruses are well-matched with vaccine viruses. Influenza viruses are constantly changing, and the WHO Global Influenza Surveillance and Response System (GISRS) – a partnership of National Influenza Centres around the world –monitors the influenza viruses circulating in humans.

For many years WHO has updated its recommendation on vaccine composition biannually that targets the 3 (trivalent) most representative virus types in circulation (two subtypes of influenza A viruses and one B virus). Starting with the 2013-2014 northern hemisphere influenza season, quadrivalent vaccine composition has been recommended with a second influenza B virus in addition to the viruses in the conventional trivalent vaccines. Quadrivalent influenza vaccines are expected to provide wider protection against influenza B virus infections.

The Centers for Disease Control and Prevention (CDC) urges immediate vaccination for anyone still unvaccinated this season and recommends prompt treatment with antiviral drugs for people at high risk of complications who develop flu.

So far this year, seasonal influenza A H3N2 viruses have been most common. There often are more severe flu illnesses, hospitalizations, and deaths during seasons when these viruses predominate. For example, H3N2 viruses were predominant during the 2012-2013, 2007-2008, and 2003-2004 seasons, the three seasons with the highest mortality levels in the past decade. All were characterized as “moderately severe.”

Increasing the risk of a severe flu season is the finding that roughly half of the H3N2 viruses analyzed are drift variants: viruses with antigenic or genetic changes that make them different from that season’s vaccine virus. This means the vaccine's ability to protect against those viruses may be reduced, although vaccinated people may have a milder illness if they do become infected. During the 2007-2008 flu season, the predominant H3N2 virus was a drift variant yet the vaccine had an overall efficacy of 37 percent and 42 percent against H3N2 viruses.

Depending on the formulation, flu vaccines protect against three or four different flu viruses. Even during a season when the vaccine is only partially protective against one flu virus, it can protect against the others.

“While the vaccine’s ability to protect against drifted H3N2 viruses this season may be reduced, we are still strongly recommending vaccination,” said Joseph Bresee, M.D., Chief of the Influenza Epidemiology and Prevention Branch at CDC. “Vaccination has been found to provide some protection against drifted viruses in past seasons. Also, vaccination will offer protection against other flu viruses that may become more common later in the season.”

Influenza viruses are constantly changing. The drifted H3N2 viruses were first detected in late March 2014, after World Health Organization (WHO) recommendations for the 2014-2015 Northern Hemisphere vaccine had been made in mid-February. At that time, a very small number of these viruses had been found among the thousands of specimens that had been collected and tested.

Treatment

Antiviral drugs for influenza are available in some countries and may reduce severe complications and deaths. Ideally they need to be administered early (within 48 hours of onset of symptoms) in the disease. There are 2 classes of such medicines:

Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. WHO monitors antiviral susceptibility among circulating influenza viruses to provide timely guidance for antiviral use in clinical management and potential chemoprophylaxis.

News Source: WHO & CDC

Dr. Shima Naghavi, Director of International Affairs