Influenza Epidemiology

According to the Centers for Disease Control and Prevention (CDC) (n.d), influenza, differently known as the flu, is an extremely contagious viral infection that affects the throat, nose and lungs. The disease largely emerges during the late fall, winter as well as early spring (Lopman, Armstrong, Atchison, & Gray, 2009).  The severe infection affects between five and twenty percent of the U.S. population per year (Centers for Disease Control and Prevention, n. d). Every year, around two hundred thousand persons are hospitalized; moreover, between three thousand and fifty thousand deaths result from flu- related complications (CDC, n. d).

Common signs of the infection include high fever, body/ muscle aches, chills, headache and tiredness (Lopman et al., 2009). A sore throat and / or cough accompanied with a runny or stuffy nose are also symptoms of the disease. Owing to the severity of the condition, affected persons might be forced to abandon their routine chores. Victims of the infection also run the risk of developing pneumonia (Lopman et al., 2009). The best approach to prevention is vaccination every twelve months. Based on the recommendations of the Centers for Disease Control and Prevention (CDC), each person above the age of six months should receive a vaccine each year to guard against the infection.  

Statement of the Problem

The highly contagious disease is also airborne; it is an aspect that makes it a serious health threat (Jansen et al., 2008). Lafferty (2009) observed that the disease is seasonal and manifests itself as an acute febrile illness having a variable degree of systematic signs that range from respiratory failure to mild fatigue and death. The loss of workdays, suffering, and mortality are some of the most adverse effects of the disease. Despite the seasonal influenza strains occurring in circles constitute a health concern periodical outbreaks have proved lethal (Lafferty, 2009). For instance, in 1918, the Spanish flu led to massive deaths estimated to be between twenty and fifty million individuals. Over half a million deaths were in the United States (CDC, n.d).

Apart from affecting human beings, influenza also targets many animal species. According to Lafferty (2009), although some strains are specific, new ones can spread from animals to people. For instance, avian influenza is a zoonotic human infection that previously affected only birds. Swine influenza is a kind of the flu that initially affected pigs. The influenza pandemic of 2009 captured a recombinant type of the infection which was a composition of human gene, swine and avian segments (Jansen et al., 2008). According to Jansen et al. (2008), influenza signs and symptoms overlap with those of different viral respiratory tract infections. Viruses such as adenoviruses, enteroviruses, human parainfluenza viruses and paramyxoviruses lead to similar signs.  Probably, moderate flavivirus infections also mimic the grippe.

Without a doubt, influenza poses critical health concerns. Despite many efforts to contain the disease, every time it breaks out and causes deaths. Being lethal and highly contagious, the disease put people at risk. The question arises as to whether any strategies to manage this disease will be developed in future.

Significance of the Problem to Nursing

From the above sections, it is apparent that influenza is a health concern that bothers healthcare practitioners and society in general . Primarily, the healthcare profession which extends to nursing focuses on the extension of care and improving life. As a result, influenza is a major issue for the nursing fraternity. A good understanding of the disease would not only increase social well-being, but would also  contribute to improvement of care delivery in the fight against other viral infections such as Ebola. Thus, it is supposed that the understanding of influenza is significant for nursing.

Aim/ Purpose

The aim of the current paper is to explore the influenza infection to facilitate the understanding of various aspects about the disease such as its risk factors, spread, prognosis and control, legal and ethical implications, in addition to nursing implications. To achieve the goal, the paper relies on available epidemiologic data from secondary sources.

Epidemiologic Data in Terms of Person

According to the Centers for Disease Control and Prevention (2015), individuals of different ages run the risk of contracting the disease. In particular, the CDCP affirms that children under the age of five are at higher risk of getting infection. However, children aged under two have enhanced chances of being infected. Besides, the Centers for Disease Control and Prevention (2015) highlight that persons aged sixty-five years and above have increased chances of contracting influenza. However, the pandemic of 1918 claimed many lives of people between the ages of fifteen and thirty-five years (Lowen, Mubareka, Steel, & Palese, 2007). During the pandemic of 2009-10, people aged under sixty-five years felt the symptoms more severely, however a lot of children and young adults died from related complications (Chao, Halloran, & Longini, 2010). From the above statistics, it becomes unclear what age is at risk for infection. However, common knowledge indicates that children under the age of five and elderly persons aged over sixty-five years suffer from weakened immune system (Chao et al., 2010). Hence, these groups are likely to be at higher risk of being infected by influenza.

Despite believes that gender is a factor, no significant differences exist (Jansen et al., 2008). In addition, race, ethnicity, and culture do not have an influence given that Asia, North America, Africa and other parts are affected by the pandemics. However, chances of infection spread seem to be higher in Asia (Jansen et al., 2008). The discrepancy might be explained by geographic variations (Lafferty, 2009). Income level is also a factor; thus, individuals from poor countries are at increased risk of contracting the disease compared to those who have a good socioeconomic status (Chao et al., 2010).

In summary, the understanding of the role of age, gender, race, ethnicity,culture and income level would help in controlling the infection. However, based on the research, age and income level are some of the factors which determine the risk level  of the disease.

Epidemiologic Data in Terms of Place

The role of place in the emergence of influenza is critical. By June 2013, the World Health Organization (WHO) has reported six hundred thirty cases of avian influenza (CDC, 2015). At the time, three hundred seventy-five people has lost their lives. Owing to discrepancies in reporting, the accuracy of the data cannot be ascertained. However, many cases were reported in Eastern Asia, Eastern Europe and North Africa. Cases of underreporting relate to China, although such trends are bound to change with the lapse of time. Vietnam, China, Cambodia, Bangladesh and Egypt were also casualties of the recent pandemic.

Influenza and related deaths are commonly reported in the United States. Referencing the 2011-2012 season, twenty-six influence-related deaths were reported (CDC, 2015). In the subsequent season, H3N2 caused widespread mortality concerns in the country. By the turn of 2013, eighty-seven flu-related deaths were documented across the United States (CDC, 2015).

Tracking the epidemic of 1918, it becomes evident that influenza varies in its distribution based on the demographics of a particular area. Statistics demonstrate that there were up to three thousand deaths per one hundred thousand people across the United States (Jansen et al., 2008).  During the 1918 pandemic, roughly six hundred thousand deaths were reported in the U.S.; moreover, a large number of people died in October (Jansen et al., 2008). Across the globe, over thirty million deaths occurred as a result of influenza. An estimate indicated that most of the casualties were between the ages of fifteen and thirty-five years (Jansen et al., 2008). The next considerable epidemic occurred in 1957, when H2N2 influenza (Asian flu) led to almost seventy thousand deaths in the United States. Globally, over one million people lost their lives following the outbreak of the disease (Jansen et al., 2008). Eleven years later, another pandemic, the Hong Kong flu, caused by H3N2, led to approximately thirty-five thousand deaths across the U.S. (Jansen et al., 2008). Worldwide, over seven hundred thousand people died because of the infection.

In summary, a place seems to be a factor in the emergence and spread of the disease. More cases are reported in such areas as Eastern Asia, Eastern Europe and North Africa due to overpopulation. The United States is also the country where influenza is rather widespread disease.  

Epidemiologic Data in Terms of Time

In the 2009-10 season, a new influenza outbreak occurred as a result of H1N1 (“swine flu”) (Lopman et al., 2009). According to Lopman et al. (2009), the first wave of the epidemic happed in the U.S. during spring time. The second but larger wave rose in the fall and winter before peaking in October. However, the rate fell significantly only in January. Few cases were also reported during the spring and summer of 2010 (Chao et al., 2010). The effect of the influenza of 2009-10 differed from typical cases in a number of ways. In particular, the disease was more lethal among people aged under sixty-five years compared to non-pandemic influenza durations. Young adults and children became victims of mortality (Chao et al., 2010). In addition, the rates of hospitalizations were higher among persons at the two age categories.  Between April and August 2009, the death rate related to the influenza outbreak stood at 477 (Chao et al., 2010). Thirty-six children aged under eighteen years died because of the disease (Chao et al., 2010). However, two thirds of the children who died suffered from high-risk medical conditions. Cases of the excessively pathogenic H5N1 influenza were found in birds and humans across the United States. Commonly called "bird flu", the H7N2 type was reported in Virginia during the year 2002. In the following year, the disease spread to New York as well (Chao et al., 2010).

In summary, it emerges that time is also an important factor in the emergency and spread of the influenza. In particular, the virus takes a cyclical path as it is experienced in different times across America. Similarly, the effect of the pandemic differs based on the time of occurrence.

Environment

The environment is a factor in the development of the influenza pandemic. According to Neighbours and Vaughn (2013), air pollution affects health adversely. In particular, respiratory health suffers in the polluted environment. Apart from increasing mortality and morbidity due to chronic illnesses such as COPD and asthma, air pollution also increases the vulnerability to viral respiratory infections. Neighbours and Vaughn (2013) acknowledge that a number of studies have carried out to assess the susceptibility to influenza. Citing a number of studies, Neighbours and Vaughn (2013) conclude that residents of highly polluted environments were at an elevated risk of contracting influenza. A high level of incidence affected both clinical conditions and individuals with anti-influenza antibodies.  Neighbours and Vaughn (2013) cite another ecological study which has found that the acute effects of pollution from formaldehyde, sulfur dioxide and nitric oxides precipitate the emergence and spread of various strains of influenza. However, a high concentration of oxidants havea negative association with influenza. Whereas, formaldehyde and nitric oxides has delayed effects, sulfur dioxide has almost an instantaneous effect because its consequences are witnessed as soon possible.

The mentioned studies have employed a time-series approach in evaluation of the effect the environment has on the emergence of influenza, in addition to its spread (Neighbours & Vaughn, 2013). Adjusting for temperature and seasonal factors, a significant relationship was established between sulfur dioxide and influenza incidences. However, a lag of two weeks in exposure existed. Increases in ozone, nitrogen dioxide and particulate matter in the environment also had a correlation with the rising incidence of influenza and hospitalizations resulting from such illness.

The exhaust from burning diesel is also considered to be an environmental risk factor. Diesel exhaust is a combination of particulate matter and gases from both organic and inorganic compounds. The volume of such waste is high in urban areas compared to rural areas. According to the review of the literature conducted by Neighbours and Vaughn (2013), the exhaust aggravates or contributes to the emergence of pulmonary inflammation. Citing the only study that focused on diesel exhaust and influenza among human beings, Neighbours and Vaughn (2013) found that exposure to the fumes led to a significant rise in IFN-y response among study subjects.  In addition, the study indicated that viral RNA levels were higher among persons exposed to diesel fumes compared to those who do not come under influence of such conditions. Allergic persons were at an elevated risk compared to non-allergic subjects. In addition, exposure to the substance exacerbated the level of the disease for individuals already infected. In particular, individuals in the environment polluted by diesel fumes were at risk of contracting H3N2 influenza virus.

Ozone is classified as one of the leading oxidant pollutants found in ambient air. Being the main component of smog, exposure to the substance is associated with a number of negative health outcomes. Being exposed to ozone after contracting the influenza virus, a person has higher chances to survive and avoid death. The authors (Neighbours and Vaughn (2013) alleged that ozone works by lowering lung infection by the virus.

Healthy People 2020

Healthy People initiative borders on the provision of science-based ten-year objectives targeted at improving the health of American people. For the last thirty years, Healthy People has founded benchmarks and assessed progress to ensure goals have been met (The Centers for Disease Control and Prevention, 2011). The organization encourages collaborations among communities and various sectors, empowers people to make informed health choices and measures the effects of prevention initiatives. Healthy People 2020 continues with group activities. In 2010, the Healthy People group has launched its agenda for the subsequent ten years which are largely known today as Healthy People 2020 (The Centers for Disease Control and Prevention, 2011). The 2020 framework is a reflection of an ambitious plan to enhance healthcare in the United States. The objectives are based on input from many players spread across individuals and organizations.

With a vision to facilitate the presence of the society whose people lead healthy lives and a mission to have a healthy population by 2020, the initiative is based on the following goals, as enumerated by the Centers for Disease Control and Prevention (2011).

• Classify countrywide health improvement priority areas.
• Improve public understanding and awareness of health, illnesses, and disability determinants as well as existing opportunities for progress.
• Identify quantifiable objectives and goals that apply at all levels (national, state, and local).
• Engage critical sectors to initiate measures that strengthen policies and enhance practices driven by best practices such as evidence and knowledge.
• Publicize critical research, collect and evaluate data to serve various needs.

Overarching goals from the above, it is discerned that Healthy People 2020 has the following aims:

• To achieve high-quality and long lives devoid of preventable diseases, injury, disability, and premature deaths.
• To support the achievement of equity in health, to save every person from discrepancies, and improve the health of every citizen. 
• To create a physical and social environment that enhances good health for each individual.
• To improve healthy development, the quality of life, and healthy behavior at all stages of life.

Given that influenza is a fatal health concern, many of the Healthy People 2020 goals are applicable and useful. In particular, all the overarching objectives are relevant. For instance, the need to attain high quality of life requires the elimination of any possibilities that expose persons to ill-health such as influenza infections. Consequently, the objective aligns with the significance of containing the viral disease. Regarding elimination of inequalities, there is a need to ensure that every person receives care so that his/ her exposure to the infection is minimum. Thus, the role of the environment in the emergence of the disease is explained in the paper. As such, the third objective of creating a healthy environment aligns perfectly with the objective of eliminating the chances of encountering the infection.

Laws

Nosocomial influenza outbreaks related to unvaccinated health care workers, cause patient complications, death, and worker absenteeism due to the illness, as well as big economic costs not only to victims but also to the entire health care system (The Centers for Disease Control and Prevention, 2015). Since 1981, the Advisory Committee on Immunization Practices (ACIP) began advocating for all Health Care Employers (HCP) to receive influenza vaccinations annually (The Centers for Disease Control and Prevention, 2015). Health care employers rely on a number of strategies to encourage care professionals to voluntarily undergo the vaccination. Other measures include: promoting and sponsoring educational campaigns, allowing the application of declination statements, increasing access to recurrent influenza vaccines, and combining various approaches. Despite the adoption of such efforts, vaccination uptake among HCPs did not improve (The Centers for Disease Control and Prevention, 2015). Consequently, at the beginning of 2004, local health departments and health care centers began demanding that HCP undergo influenza vaccination to qualify for employment (CDC, 2015). Presently, many care facilities adopt such measures. In addition, several states have passed laws directing HCEs to implement vaccination initiatives. The enactments vary although they incorporate six attributes regarding compulsory HCP influenza vaccination. Four from twenty states adopt a broad definition of HCP (CDC, 2015). Sixteen from twenty laws demand that employers provide, arrange, ensure, and require or provide influenza vaccinations to HCPs. Thus, the law on HCP is the one that regulates matters bordering on the influenza virus.

Ethics

Ethics play a significant role in decision-making and acting across various fields. The nursing and medical fields are not that different. Ethics fall into two broad dispositions: teleological and deontological (Robichaux & Sauerland, 2012). Based on the deontological school, the duty to do what is right is a determining principle while the teleological school of thought takes a consequential outlook (Robichaux & Sauerland, 2012). As such, the latter ethical framework views actions or decisions in terms of outcomes. Those actions that lead to the best results or the greatest good are often seen as ethical. Since influenza is a highly contagious and fatal infection, ethical requirements would require that all efforts target to protect people regardless of their status. For the deontological school, it would be ethical to protect people or extend them care as it is the duty of medical fraternity. Relying on the teleological disposition, preventing influenza would be desirable because it would generate the greatest good to the society.

Hindrance or Promotion of Current Health Care

From the previous sections, it emerged that the current healthcare system is structured around the need to extend care for all. Thus, from the outlook it seems that preventing influenza, a dreaded ailment, is one of the goals pursued . By enacting laws on HCEs, it is clear that the U.S.A. is making major steps towards controlling the sickness. However, focusing on nurses or health workers only is insufficient. Ideally, each individual should be vaccinated.  However, the system may hinder the fight against the infection because of structural inadequacies. Besides, it was mentioned that not all states have such laws. Accordingly, such states impede the system in its bid to control influenza.

Nursing Implications

Attempts to control influenza must focus on prevention rather than treatement. Owing to the significance of prevention, the United States spends time on vaccine development and administration. The vaccine shields individuals from possible contraction of the disease. It contains antigens of the strains, and comes effective from ten to fourteen days after its injection. Antiviral agents, useful in the prevention can also be used to control given cases of influenza. First of all, advancing care to all at-risk populations is a primary responsibility of healthcare professionals. Secondly, advocating preventive measures is also significant since the disease is highly contagious and lethal. Additionally, the final implication is that nurses need to embrace further research to understand the infection better.

DNP’s Role and Responsibility

DNPs focus on practice competency as opposed to academic or research attributes. Thus, DNPs rely on evidence-based care when practicing or administering care. They play roles such as improving care systems besides assessing community, group and patient outcomes. Infection control is among the primary responsibilities that nurses do within communities and healthcare settings. The Doctor of Nursing Practice with education, experience and specialized training is an important person in the fight against viral infections such as influenza. Nurses entrusted with the responsibility of controlling infections must identify, prevent, and manage a multiplicity of diseases and infections based on evidence-based care. In this regard, relying on past outcomes or experience is critical when handling cases involving influenza.

Future Needs

In the future, conducting further research to inform nursing practice must be advocated. The need for such advocacy lies in the role that nurses play in controlling infections off this nature. The nursing profession would benefit from using evidence-based research in controlling influenza and related infections. Owing to the experience gained from practice, nurses can also prevail upon policy makers to adjust laws so that the fight against similar pandemics is enhanced. In the future, nurses would also contribute by helping in the identification of at-risk populations, and advocating the use of preventive measures to control the illness.

Conclusion

Viral diseases are known for their complicated nature. Such infections are often difficult to treat, what is an aspect that strengthens the role of nurses. However, the care delivery profession plays a primary role in securing societies through their expertise and knowledge. Consequently, medical fraternity needs to conduct regular research to understand the illness in order to get the most appropriate responses. In particular, relying on evidence-based research would be of significant help.

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