Evaluating and establishing industry standards for flu vaccines for hospitalized children could help prevent additional hospitalizations and complications from influenza, according to a study published in a recent issue of Pediatrics.
A research team led by Danielle M. Zerr, MD, MPH, medical director of infection control at Seattle Children’s Hospital and associate professor of Pediatrics at the University of Washington School of Medicine (UWSOM), monitored the number of times children with influenza had been hospitalized, and summarized their findings in an article entitled "Hospital-Based Influenza Vaccination of Children: An Opportunity to Prevent Subsequent Hospitalization."
It was found that 23% of the children admitted to hospital with influenza had a previous hospitalization during the most recent flu season. This suggests that providing in-hospital vaccinations when the children were at highest risk for influenza could reduce the rates of childrens’ influenza during the flu season.
Approximately 14,000 children were hospitalized with influenza—and 170,000 were hospitalized with influenza or a respiratory illness—during a 5-year period (2001–2006) when discharge data provided by the Pediatric Health Information System (PHIS) database was analyzed. The data was checked to see how many children had a previous hospitalization during the most recent flu season.
Researchers found approximately 16% of those hospitalized with influenza and 23% of those hospitalized with influenza and another underlying condition had previous hospital admissions during the vaccination season.
"This information will help pediatricians recognize hospitalization as an important opportunity to vaccinate the highest-risk children, and may hopefully prompt the development of hospital-based flu vaccine programs," said Zerr.
The study looked at five years of hospital discharge data from the Pediatric Health Information System (PHIS) database from 2001 through 2006 to determine how many children hospitalized with influenza or respiratory illness had a previous hospitalization during the most recent flu-vaccine season. PHIS is an administrative database developed by the Child Health Corporation of America (CHCA), used by 42 free-standing pediatric hospitals. Subjects included newborns through age 18. A previous hospitalization during flu vaccination season was considered if it occurred in the two weeks to six months prior to the influenza admission and between September 1 and March 1. Approximately 14,000 cases of children hospitalized with influenza and 170,000 hospitalized with influenza or a respiratory illness were reviewed.
Source: Pediatrics, February, 2008
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A Very Concerning Sub-Microscopic Infectious Agent
Influenza is the virus responsible for the disease that has its name. This virus can be deadly, as it did create the last pandemic in the United States less than 100 years ago. When this occurred, the United States experienced about a half a million deaths due to what is now known as the Great Influenza Epidemic. Some of these viruses are more dangerous than others.
The Influenza pandemic that occurred before the 1918 Spanish Flu happened about thirty years before this one. Influenza epidemics normally occur about every 9 months or so, it has been reported
The disease of Influenza is caused by this virus penetrating a host, which could be a human or an animal. Once infected, the virus replicates within the cell of the host in the cell’s cytoplasm. To survive, the influenza virus targets an enzyme called polymerase that directs the content of this cell to produce proteins the virus needs to survive.
Virus is a Latin word, meaning ‘poison’. And the virus is more of a very well organized molecular parasite than an actual life form, such as bacteria. The virus cannot grow or reproduce without a host cell. That means it needs you, the host, to exist and thrive. And the virus has the potential to destroy you in the process in order to exist.
With the 1918 pandemic, it is believed that it was called the Spanish Flu because the first human case was identified in Spain. The pandemic ended up killing more than those that died during WWI.
Understandably there was panic among people worldwide, as the influenza virus itself was not identified until the year 1933, so the mystery was rather frightening of what was happening at that time.
Those who survived have allowed others to obtain antibodies from them to develop other antibodies for future viral outbreaks that may occur with this type of virus.
This last influenza pandemic also allowed others to obtain this virus from those who died as a result to create effective treatments and vaccines for viral outbreaks that may happen in the future as well. Over a half a million people in the U.S. died as the result of the Spanish Flu- and those that did die was due often to a bacterial pneumonia that followed the viral invasion and the damage this virus caused.
Specifically, the bacteria that killed those due to this flu were called strept. pneumo. On average, it took about 9 days for one to die after being infected. The Spanish Flu caused an unusually severe immune response in the human host which made it very deadly due to overkill of the cells of this host. The influenza virus has this ability on occasion, which makes it very deadly to its host.
The influenza viruses are of what are called orthomyxoviruses, which is a group or family of RNA viruses that are categorized into A, B, and C. The Influenza A virus is the one that historically has caused pandemics that have developed- such as the Spanish Flu Pandemic.
Other influenza pandemics primarily have occurred in countries in Asia.
With influenza, it is understood that the disease influenza is a disease caused by a RNA virus that can now infect and kill both mammals and birds. In fact, at least one particular virus can mutate to where it can be shared between the two life forms and multiply within each one of them with ease.
Unlike coryza, influenza expresses symptoms more severely, and usually lasts two weeks until one recovers who has the flu. Influenza, however, poses a danger to some with compromised immune systems, such as the chronically ill, so the risk is greater in such populations, along with women who may be pregnant during the flu season, residents of nursing homes or chronic care facilities. If untreated with such patient populations, influenza can create complications such as bacterial pneumonia or encephalitis.
Health care personnel are encouraged to get a flu vaccine. However this vaccine, as will be described in a moment, offers no guarantee that the one immunized by this vaccine will not acquire the flu. 80 percent of flu cases in the U.S. are type A influenza virus. Nearly 40,000 people in the U.S. die each year, and 200,000 are hospitalized in the U.S. due to the influenza virus.
Such populations of those recommended to receive the flu vaccination are those believed to need the protection the vaccine may offer the most. This is of concern, as Influenza can progress rapidly into the more serious illness of pneumonia.
Symptoms of influenza usually start to express themselves symptomatically about two days or so after being infected with the virus. Over 10 percent of the population is infected with this virus every year- resulting in about 200,000 hospitalizations and nearly 40,000 deaths.
This season’s first influenza case was identified in Delaware in November of 2008, and it was a type B influenza strain.
The flu vaccination is trivalent- meaning it contains three viral strains of suspected viruses for flu outbreaks during a particular winter season, as determined by the World Health Organization, as well as the Centers for Disease Control, and other organizations.
Yet one should keep in mind that these three strains of influenza may not even exist in a particular flu season. The vaccination is a guess, at best, yet is certainly better than the absence of a flu vaccination.
Unfortunately, the influenza vaccine administered last flu season was largely ineffective due to unsuspected strains of the virus infecting others, although about 140 million injections of this vaccine were administered, and this proved to be pointless for preventative medicine.
After giving the vaccination dose to one, it takes about 10 days for that person to build up the immunity for the disease of influenza. The months of October to December are recommended to receive this vaccine. And the vaccine is about 50 percent effective in offering protection from influenza, according to others, if one calculates the previous flu seasons with flu vaccinations.
Vaccines are a catalyst for antibody production in humans, which protect them against the virus, if it happens to present itself within them.
Influenza vaccines can be given by injection or nasally.
Anti-virals, on the other hand, decrease greatly the ability for viruses to reproduce once established in a human. That seems like it should be a focus during viral seasons instead of any vaccination that exist today regarding the disease of influenza.
The flu season that is now occurring was supplied with 150 million vaccines in the United States. However, some studies have shown that this vaccine is rather ineffective based on incidences of the acquisition of the influenza virus by others anyway.
The influenza season peaks between the months of January and March. The vaccine for this influenza season is manufactured by 6 different companies.
Yet the strains chosen contain what are speculated influenza viruses, so this does not eliminate the chance of a new and dominant influenza viral strain that possibly could cause a pandemic regardless if one is vaccinated for influenza. Also, it takes manufacturers about 6 months to make and formulate the influenza vaccination.
There is a vaccine for this illness that is produced every year according to which type of virus types that may be prevalent during a particular flu season. If influenza occurs in a human host, the results may be the patient acquiring pneumonia or meningitis is possible, as well as their ability to transmit such a virus to another.
The presence of influenza can be widespread in certain states, yet not others. The vaccination is recommended to be administered to those who are at high risk, such as the chronically ill.
Also, it is recommended that those under 18 years of age get the vaccine, as well as those people over the age of 50. Furthermore, those people who regularly take aspirin should receive the vaccine, as the influenza disease can become a catalyst for what is called Reye’s Syndrome.
Pregnant women should receive the vaccine as well- as there are many vaccines available to hopefully prevent this potentially dangerous viral disease in this form.
However, the Avian influenza presented itself in China in 1997. Called the H5N1 virus subtype, it has the potential to be the next flu pandemic. The virus responsible for the 1918 pandemic was an avian influenza, which was called the H1N1.
This virus, unlike the human influenza virus, has a longer incubation period- about 5 days. Also, H5N1 has the ability to mutate more rapidly, as well as replicate at a similar speed. Avian influenza viruses are highly pathogenic. No one fully understands the influenza virus and its rapid ability to mutate.
This is because this particularly malicious virus is the result of two separate influenza viruses acquiring the same host at the same time. As a result of mutual sharing of genetic material between the two viruses, novel attributes are allowed to develop and create a H5N1 that obviously prove to be rather deadly.
For an influenza pandemic to occur, which means a global disease existence and presence, the virus must emerge from another species to humans without a strong immune system- as well as the ability to make more humans ill than normal due to the constant mutation of the influenza virus.
Also, the virus must be highly contagious for a pandemic to occur. This particular virus that has been identified is just that.
The H5N1 Avian influenza virus seems to have become progressively more pathogenic in the past decade, according to others. The letters H and N, by the way, stand for the antigens HA and NA-and are the letters of proteins that protrude from the viral shell.
It is these proteins that mutate so often with the influenza virus, and which is why we continue to be infected with this virus.
With the Avian Influenza existing with the H5N1 strain, millions of birds have been slaughtered due to the danger and unpredictability of this strain.
The first recorded incidence of human-to-human transmission of the H5N1 virus was believed to be in Thailand in 2004.
There have been outbreaks of Avian flu in about 15 countries in the world so far- with Indonesia being the worst. Migratory birds spread this influenza virus between continents.
The pathogenic strength of the H5N1 strain varies due to constant re-assortment or switching of genetic material between the viruses- essentially creating hybrid modifications of what it was before this occurs due to this re-assortment that makes this virus much more virulent.
So far, about 400 people worldwide have been infected with this strain- and about half have died from the infection. This is believed to be greater than 50 percent of all those infected with the H5N1 virus. Vaccinations are being developed and reformulated constantly at this time due to the pandemic threat of the H5N1 Influenza virus.
Dan Abshear
• http://www.hhs.gov/pandemicflu/plan/appendixh.html
• http://www.cdc.org/flu/weekly