Influenza

Illnesses that are caused by bacteria or viruses that people spread amongst themselves via contact with bodily fluids, contaminated surfaces, blood products, animal bites or via the air are called communicable diseases (Wang et al., 2019). An example of a communicable disease is influenza (flu), a contagious disease caused by influenza viruses. The influenza causing viruses are responsible for annual seasonal outbreaks of the disease. According to the Centers for Disease Control and Prevention (CDC), annual vaccinations are the best way to avoid the flu. This paper analyzes influenza as a communicable disease by applying some epidemiology concepts.

Influenza is a contagious disease caused mainly by influenza A or B virus. It affects the respiratory system namely the throat, nose and lungs and in serious cases may affect other organs such as the heart, muscles and brain. The virus is transmitted from one person to another via contact with respiratory droplets when an infected individual expels the droplets by coughing or sneezing. Contaminated surfaces are also a potential source for the transmission of the disease. Since these droplets do not remain in the air nor travel long distances, close contact is required to acquire the disease. Some common symptoms include a runny nose, headaches, sore throat, fever, dry cough and body aches. The appearances of the symptoms may range from those similar to a common cold to relatively slight respiratory tract infections manifesting (Rello & Pop-Vicas, 2009). Recovery usually takes a few days; however, influenza may result in complications and even death particularly in high-risk individuals such as pregnant women or people with underlying health conditions. Influenza normally has high attack rates in young people with high mortality rates observed among older people. Moreover, morbidity and mortality rates are high in people with high-risk health conditions such as metabolic and cardiovascular diseases. Influenza occurs globally and leads to significant mortality and morbidity with seasonal, epidemic and pandemic patterns(Shrestha et al., 2015).Annual vaccination is the most crucial aspect in preventing influenza. New vaccines are developed annually to fight against new influenza virus variants. It is also estimated that influenza has led to around9 million to 45 million infections and the death of between 12,000 to 61,000 people every year since 2012 (CDC, 2020). Influenza is not a reportable disease according to the CDC.

Social Health Determinants

Social determinants of health may be defined as the conditions that people have grown up and lived in and the wider systems such as social and economic systems and policies that affect their environment and their day to day lives (Nagata et al., 2013). Research has suggested that these social determinants such as sex, social class, education, income, race and education may strongly influence numerous health outcomes including respiratory infections like influenza. Access to healthcare and vaccination are significant ways in preventing influenza. Nevertheless, due to inherent inequalities in the U.S., disadvantaged populations have been rendered more susceptible to infection through institutionalized or systematic barriers to receiving treatment or vaccination. Marginalized ethnic minorities and socio-economically underprivileged communities are more likely to have adequate access to healthcare, suffer from discriminatory policies and more prone to not trust government and health officials which in turn leads to an increased risk in influenza infections, hospitalization and death. People in economically destitute neighborhoods are more susceptible to developing comorbidities such as obesity, asthma and diabetes that could worsen or increase the risk of getting infected with the influenza virus and falling ill.

Another social health determinant that may influence the rate of influenza infection and transmission is school and workplace policies including school closures, free vaccinations and paid sick leaves. Early dismissal, school closures and keeping influenza-infected children home from school could be an effective mitigative measure. Vaccination is vital because, with herd immunity, both the individual and the people they come into contact with are protected. A study found that vaccinated health professionals were substantially less probable to get the virus as opposed to their non-vaccinated colleagues. It was reported that in 2015, 35% of the US civilian labor force did not enjoy paid sick leave and meagre-earning workers who depend more on their jobs for their livelihoods are significantly disadvantaged in observing outbreak readiness guidelines with instructions to stay home when ill from influenza(Cordoba & Aiello, 2016).

Epidemiological Triangle

The epidemiological triangle is made up of a host, environment and agent. This model helps visualize the communication of the agent, environment and host in managing and preventing contagious disease infection by disrupting this triangle. Any organism capable of carrying the disease is called a host. For influenza, humans are the host. Various factors called risk factors may influence an individual’s susceptibility, exposure or response to an agent. These include immunologic and nutritional status, genetic composition, psychological make-up, anatomic structure and presence of disease and medications (CDC, 2012). The weaker the person’s immune system, the more suitable they are as a host.

Environment refers to external factors that are crucial for disease and transmission and progression. They include climate, geology, biologic factors and socioeconomic factors such as sanitation, crowding, and access to healthcare services. Influenza viruses tend to be very resilient and versatile. Low humidity and temperature hasten droplet transmission and thus the seasonal occurrence of the virus. High precipitation especially in tropical climates leads to increased flu infection rates. Humans also tend to stay indoors during cold weather increasing human interactions and contact resulting to increased exposure to the virus carrying droplets. Some animals such as birds and swine have been known to be carriers of various strains of the flu. Humans exposed to these animals either due to livelihood or geography are likely to have higher infection rates. Exposure to other hosts is another environmental factor. Health care workers for example operate in highly exposed environments. The agent can be any infectious pathogen such as bacterium, a virus or a parasite and must be present for occurrence of the disease. The causative agent of the influenza virus is the influenza virus A, B and C present in droplets transmitted between people. Basic hygienic principles such as hand-washing and sneezing or coughing with the mouth covered can lower infection rates. Each state has laws and regulations concerned with the reporting of diseases. Influenza outbreaks may be reported to the CDC from organizations including state health departments, hospitals, universities or institutions going through an outbreak (CDC, 2017).

Community Health Nurse Roles

One of the main responsibilities of a community health nurse is investigating and reporting instances and rates of contagious diseases (Maurer & Smith, 2012). By doing so, a community health nurse collects information for the purpose of developing a populace that is more prepared and informed thus avoiding a severe epidemic. The information gathered enables accurate risk evaluation and allows for tracking of interventions. The effectiveness of a vaccine is dependent on this data and without it, scientists tasked with producing a vaccine would have no reference data to go by. Additionally, nurses besides providing medical care can organize community workshops and create campaigns to educate people on how to identify the symptoms of influenza, the risks of influenza and the advantages of being vaccinated against it. It is also in their mandate to push for beneficial school reforms, charitable funding and direct public interaction in addressing influenza.

By understanding the epidemiologic triangle, a nurse can employ nursing procedure to lessen the impact and frequency of flu cases in their jurisdiction. The evaluation phase is used to collect and assess information concerning the disease and to identify accessible assets and community needs. After the collected information is analyzed and interpreted, the nurse is able to participate in influenza case findings and trend monitoring. The diagnostic stage is where the data is translated and used to plan for interventions and care execution. By handing out questionnaires or doing home visits, a nurse is able to recognize and establish strategies to conquer obstacles to vaccination including cost and access to medical care. Demographic data is crucial in designing and implementing community-based health initiatives to develop recommended health practices. Demographic data also aids in designing future influenza vaccination initiatives. For example, from this data, the World Health Organization (WHO), provides vaccine manufacturing companies with the necessary information on the rates of prevalence and incidence which helps determine the vaccine compositions and the strains to be targeted.

National Communicable Disease Organizations

Numerous public health institutions have dedicated their efforts in addressing communicable diseases such as influenza. The CDC have a program, The Influenza Division International Program, which works in tandem with a broad spectrum of international partners such as WHO and others in a bid to address pandemic influenza and in preventing and managing seasonal influenza (CDC, 2020). Their goal is to prevent and control influenza infections globally, share influenza-related risks and limit the impact of seasonal, pandemic and novel influenza viruses by developing and maintaining influenza surveillance and lab capacity, developing local and global influenza related policies, funding targeted projects and building an influenza evidence base for future inoculation program expansion. The CDC can improve patient treatment by identifying variables related to pathogenesis. Due to the resilient and destructive nature of the virus, public health organizations need to be observant, push for the advancement of new vaccines, and train healthcare workers, individuals and communities on influenza. By applying the epidemiologic triangle, the CDC can identify new strains of the virus, monitor the infections as the disease spreads globally and locally and combine efforts with other organizations focusing on measures to interrupt the chain of transmission.

The National Institute of Allergy and Infectious Diseases(NIAID) is also another organization focusing on communicable diseases. NIAID directs and aids research aimed at discovering new and better methods to diagnose, manage and prevent influenza infections. They are currently working on a flu vaccine that provides protection against several influenza strains including those responsible for seasonal outbreaks and those with potential global pandemic implications.

Global Implications

A pandemic is a potentially serious hazard to health security on a global level especially with gaps in available resources and capacity. In such an event, large multitudes of people may try to cross international lines in order to get treatment or to avoid chaotic scenarios. Therefore, pandemic preparation in a single country may not be effective and should be handled on a global level not a national one. Effective preparation in case of an influenza pandemic may mitigate its effects. Several countries already have preparedness plans in case of an influenza pandemic. Nonetheless, the preparedness level among countries varies. Developing countries experience difficult and unique challenges in their pandemic preparation plans. Influenza-related mortality rates can be significantly higher in developing countries in comparison to first world countries. This is because of factors such as availability of medical interventions including antiviral agents and vaccines which is lower in developing countries. In developing countries, the health infrastructure is often inadequate to deal with pandemic level infections. On such a magnitude, the global effect will be massive hence the need for every country to be prepared for such an occurrence.

For example, avian flu continues to cause worldwide outbreaks among poultry and other birds. It was first reported in Asia and has since spread the Middle East, Africa and parts of Europe. The human subtype infections are on the rise too. Such outbreaks have highlighted serious concerns if an influenza pandemic was to ensue. Another key aspect that may influence the mortality rate in such a pandemic in developing countries is the HIV/AIDS prevalence rate. Influenza-related deaths are substantially higher in HIV infected people in influenza seasons (Lin & Nichol, 2001). In developing nations, the availability of pharmaceutical interventions is inadequate and therefore other intervention measures to mitigate the infection and transmission of influenza could suffice. These include encouraging personal hygiene, social distancing, household quarantine and school closures (Ferguson et al., 2006). Most health programs in such countries depend on donor funding. Influenza had little financial support before the avian influenza outbreak. Now, more donor support is available for these types of influenza.

Some parts of the world have reported endemic influenza. More than 80% of Asia’s population resides in tropical regions allowing for continuous endemic influenza strain transmission and further likelihood of new strains developing. Monitoring for creating new vaccines should focus on regions in Asia where community dynamics and the size of the population can hasten the transmission of endemic flu strains(WHO, 2015).

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