InfluenzaEssential Information

Influenza

OriginsInfluenza (also called the “flu” or “seasonal influenza”) is a highly contagious acute viral infection caused by influenza viruses. Influenza viruses are part of the orthomyxoviridae family of viruses. While influenza viruses can be classified generically as belonging to a certain family (influenza type A, B or C), within a species unique serotypes are identified with letter/number combinations, such as H1N1, H3N2, etc, which is often how they are referred to in the media.

Influenza viruses have two large glycoproteins on the outside of the virus. The antibody response to these glycoproteins is used to classify Influenza viruses into subtypes (in the format HxNy). There are 16 H and 9 N subtypes known, but only a few (H1, H2, H3, N1, and N2) are generally found in people. The combination of the H and N subtypes identifies a serotype.

Within a serotype there can be a number of unique strains, so as an example, H1N1 identifies a specific type of Influenza, but not all strains of H1N1 are the same even though they may be part of the same serotype. Since influenza viruses can change (mutate) rapidly, serotyping allows scientists to compare strains and as strains mutate, to identify which strains they mutated from originally.

In some cases, strains appear that are not particularly virulent, but later generations may mutate into a highly virulent form.

Each year, influenza illness can be caused by a number of different strains, but generally one strain dominates and causes the majority of the illness, as in the 2009 pandemic year, when H1N1 dominated. Influenza vaccines are changed each year to reflect the strains found to be causing illness. Because the influenza risk is present every year, it is especially important to have plans in place for dealing with its consequences.

Symptoms of human influenza illness include: • Sudden onset fever/high fever• Headache• Cough• Muscle and joint pain, body aches, and fatigue• Stuffy/runny nose• Sore throat• Watery eyes• Chills• Vomiting and diarrhea can also occur,

but are less common

While not everyone has all these symptoms, these are the most commonly reported symptoms. Severe illness, such as pneumonia and respiratory failure (which can be fatal) and worsening of existing chronic health conditions, such as congestive heart failure, asthma, or diabetes, have been reported with influenza as well.

The symptoms likely to present early in the illness are often seen in patients with more commonly occurring diseases, such as the common cold, and other coronaviruses, that generate similar symptoms. Diagnosis and treatment should only be performed by a trained physician who can rule out other potential diseases.

Diagnosis Method of Transmission/ContagiousnessOne of the main concerns with influenza is that it is highly contagious. People already infected with influenza can transmit the disease to others starting one to four days before the infected person shows symptoms and continuing for approximately 7 days after they show symptoms or until symptoms resolve.

Influenza viruses are found in the mucous membranes of infected people. Influenza viruses are spread through droplets that carry the virus as a result of a cough or sneeze. A single sneeze can release 40,000 droplets, which can travel through the air and be inhaled or swallowed by others at distances of up to 2 meters (6 feet). The virus can live on surfaces for up to several days.

Droplets can also settle on surfaces and objects, where people can pick the virus up on their hands and by touching their mouth, nose, or eyes, become infected. Influenza is not believed to be transmitted by food if the food is handled and prepared properly.

Influenza is spread by:• Direct contact: Having direct contact with a person who is infected.

• Indirect contact: Touching surfaces or objects that are contaminated with

influenza and then touching eyes, nose, or mouth.

PreventionVaccinationThe best way to prevent influenza infections is by getting vaccinated each year. The CDC recommends that anyone 6 months and older should get vaccinated annually and that all Healthcare workers be vaccinated. The strains in the vaccine are changed annually to reflect the change in strains that are circulating that year.

Hand HygieneFrequent hand washing with soap and water or use of alcohol hand gel can prevent the transmission of influenza. Hand hygiene should be performed after sneezing or coughing. Avoid touching your face, mouth, eyes, and nose.

Respiratory HygieneAnytime you or others cough or sneeze, cover your mouth with a tissue or use your elbow. Dispose of the tissue once used. Wash your hands or use alcohol hand gel after sneezing or coughing.

Reduce ContactAvoid or minimize contact with sick people. People who are already sick should stay home for at least 24 hours after their fever subsides. Surface DisinfectionThe influenza virus can live for up to several days on environmental surfaces. Commonly touched surfaces (door handles, light switches, elevator buttons, keyboards, phone, etc.) should be disinfected regularly or when visible soiled. During influenza season, the cleaning frequency of these surfaces should be increased based on the severity of influenza for that year.

Good Health PracticesPracticing good health is also helpful in preventing the development of illness. The strength of a person’s immune system is often related to their overall health. Get plenty of sleep, eat healthy, be physically active, manage stress, and drink plenty of fluids to keep your immune system strong.

Protocol for Sick Staff MembersStaff members who lose pay for staying home when sick may be tempted to come to work sick, creating risk for other staff and customers. Facility policy should address how to resolve this issue.

Healthcare Specific RecommendationsVaccination of Healthcare WorkersAnnual vaccination is the most important measure to prevent seasonal influenza. Achieving high vaccination rates of staff and patients is a critical step in preventing healthcare transmission of influenza between staff and patients or visitors.

Minimize ExposureA range of administrative policies and practices can be used to minimize transmission exposure before arrival, upon arrival, and while at a healthcare facility.

This includes triage and screening of symptomatic patients and visitors and the use of respiratory hygiene and cough etiquette. Posting signs around waiting rooms and patient areas can help create awareness and remind people of prevention strategies.

Monitor and Manage Infected Healthcare Personnel Staff who develop illness symptoms should be instructed not to report to work or if at work, to stop patient care activities and don a face mask while contagious.

Staff with a fever should stay home for at least 24 hours after their fever subsides.

Adherence to Standard Precautions During contact with a patient or during patient care activities, all staff should adhere to standard precautions including:

• Hand hygiene - perform hand hygiene frequently, including before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of personal protective equipment, including gloves.

• Gloves - Wear gloves for any contact with potentially infectious person / material. Remove gloves after contact, followed by hand hygiene.

• Gowns - Wear gowns for any patient-care activity when contact with blood, body fluids, secretions(including respiratory), or excretions is anticipated.

• Visitor Access and Movement - Limit visitors for patients in isolation for influenza to persons who are necessary for the patient’s emotional well-being and care. Discourage visitors who are ill, or symptomatic.

Adherence to Droplet Precautions Droplet precautions should be implemented for patients with suspected or confirmed influenza for 7 days after illness onset or until 24 hours after the resolution of fever and respiratory symptoms, whichever is longer, while a patient is in a healthcare facility.

Much of the Information used in the development of this brochure was taken from the sites listed below.

The World Health Organization site on influenza http://www.who.int/influenza/surveillance_monitoring/updates/en

Centers for Disease Control and Prevention site in influenza http://www.cdc.gov/flu

US Government website on seasonal influenza www.flu.gov

Google weekly flu trends www.google.com/flutrends

General information on flu and trends http://www.fluwikie.com

References and useful websites

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