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Harry Ta

Influenza Descriptive Epidemiological Paper

California State University, Long Beach

Professor Garrido-Ortega
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There are many diseases that inflict the United States such as human immunodeficiency

virus (HIV), sexual transmitted illnesses, heart disease, cancer, and strokes. One of the most

common and known diseases in the United States is influenza (flu). Due to the agent of

influenzas special characteristics and properties, and the seasonal epidemic, there is a strong

need to be vigilant about influenza and its impact on the population.

On a yearly average, between five percent and twenty percent of the United States

population contract the flu (American Lung Association). The large range of the American

population getting influenza is most likely due to the effectiveness of the vaccine released in the

flu season and the new mutation or strain of the influenza virus in the flu season. The American

Lung Associated (ALA, n.d.) also reported that each year between 3,000 and 49,000 Americans

die from the flu and its complications.

In the United States, because of the vaccines released every year for the influenza virus

and technology for treatment of influenza, it is difficult to believe that people die from the flu.

The Centers for Disease Control and Prevention (CDC, 2015) estimated that about 3,697 die

every year due to influenza or 1.2 deaths per 100,000 population. However, the CDC (2015) also

reported that the exact number of deaths from the seasonal flu each year is unknown. There are a

few explanations for the unknown number of deaths from seasonal flu and the large range of

deaths provided by other organizations such as the American Lung Association. One reason is

that states are not required to report individual seasonal flu cases or deaths of people older than

18 years of age to the CDC (CDC, 2015). Another reason is that seasonal influenza is

infrequently listed on death certificates of people who die from flu-related complications (CDC,

2015). Many deaths from influenza most likely have been mistaken for death of one of the flus

complication such as high fever.

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The agent that causes influenza is a virus. There are three different types of influenza

viruses: A, B, and C. Influenza type A is the most severe out of the three and is divided into

subtypes based on two proteins on the surface of the virus (CDC, 2015; ALA, n.d.). Influenza

type B virus is less severe than type A virus, and is divided into lineages and strains rather than

subtypes like the Influenza type A virus (CDC, 2015). Vaccines for the type A and B virus are

produced each year for the flu season. Influenza type C virus infects a small amount of people

and is associated with mild cases of illness, thus, the seasonal flu vaccine does not protect against

the type C virus (CDC, 2015; ALA, n.d.). What makes the virus troubling is the fact that the

strain changes and mutates every year, thus, having the same result with a new vaccine for the

new strain is not likely.

When one unfortunately contracts the flu, there will be many different signs and

symptoms. A sick person will experience high fever, aching muscles, headaches, coughing,

fatigue, sore throat, and nasal congestion (MayoClinic, 2015). An article from the World Health

Organization states that most people recover from fever and other symptoms with a week

without requiring medical attention (WHO, 2014). Symptoms will last longer and can cause

serious illness and death for some people at high risk. These high risk individuals include

pregnant women, children two years of age or younger, adults aged 65 years or older, people

with medical conditions or weakened immune systems (WHO, 2014).

The reason that children ages two and younger are at a higher risk for severe illness and

death from influenza is because childrens and infants immune system has not fully develop and

weak, therefore, will have difficulty fighting the influenza virus infection. The reason is similar

for the elderly population that seniors have a weak immune system, but the immune system is

weak because of wear-and-tear of the body. People with medical conditions such as heart
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disease, diabetes, cancer and HIV will also be more susceptible to serious symptoms and death

due to weakened immune systems from dealing with existing medical problems prior to

contracting influenza. Also, women in general have higher rates of influenza infection than men

(C. Sloan et al., 2015).

Host factors are not the only factors that contribute to the vulnerability of the influenza

virus. There are also environmental and socioeconomic factors. A study that was done in

Tennessee by Sloan et al. (2015) reported that urban areas have higher rates of hospitalization

due to influenza than in rural areas. The population density of urban areas is much higher than in

rural areas, therefore, there would be more chance for contact and spread of the flu. Sloan et al.

(2015) also reported that families with a low socioeconomic status are more likely to stay in

crowded households and not go to hospitals for care. People with low income tend to live in

small households with many family members, thus, increasing contact and spread of the flu.

Also, people with low income are less likely to go to the hospital due to less resources to pay for

medical bills.

There are multiple ways of the virus entering a persons body. There is direct and indirect

contact, and airborne transmission. The World Health Organization (WHO, 2014) claims that

when an infected person coughs, infected droplets get into the air and another person can

breathe them in and be exposed. In addition, touching infected objects and infected person can

also spread the influenza virus. When a person have ingested the influenza virus and causes the

infection of the nose, throat, and lungs, then that person has the flu (U.S. Food and Drug

Administration, n.d.). A person that has been infected with the influenza virus, but does not show

any signs of symptoms, can still spread the flu (ALA, n.d.).
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With the several ways of the influenza virus entering and infecting a persons body, there

are also several ways to prevent the modes of transmission and many ways to treat the flu. To

prevent the disease from entering and infecting the body is to thoroughly wash hands, cover

mouth and nose when sneezing or coughing, avoiding large crowds during flu season to reduce

risk of contracting the influenza virus or spreading the virus (MayoClinic, 2015; WHO, 2014).

The most important preventive way to control the problem or spread of the influenza virus is to

get vaccinated each year. Getting vaccinated is especially important for high risk individuals and

people who live or in constant contact with high risk individuals. Although, vaccines are limited

to the effectiveness of the drug and the potency of the new strain of the influenza virus for that

season. When a person has the flu the most common treatment is to get adequate amount of sleep

and to stay hydrated (MayoClinic, 2015; ALA, n.d.). However, when that treatment is not

improving symptoms and the illness is serious, taking antiviral drugs is necessary. Antiviral

drugs is most important for people that are high risk individuals such as children ages two and

younger, pregnant women, and adults 65 years and older.

Knowing when the flu season starts is an important piece of information to prevent

getting the flu. The flu season is a flu epidemic that starts around October and ends by April with

the infection peaking between December and March every year (CDC, 2014). What makes each

flu season unique is that the influenza virus will always be a different strain from previous flu

seasons. The reason for the influenza virus changing each year is due to mutations from moving

between animals to humans or simply the virus changing over time (Flu.gov, 2014). These quick

changes happens too quick for humans immune system to recognize the virus, thus a new

vaccine is needed every year (Flu.gov, 2014).

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There are a couple of hypotheses on the reason why the flu season happens in the winter.

One hypothesis is that in colder temperatures the flu virus envelope hardens to a gel that protects

the virus as it passes from person to person. But, at warmer temperatures the gel melts and

envelope is unable to protect the virus and loses its virulence (National Institute of Health, 2008).

Other hypotheses are that people spend more time indoors during winter which can increase

contact with others that might have the flu virus and that staying indoors mean less vitamin D

and melatonin for our immune system (H. Foster, 2014).

Not much is known and not much information is provided about the reason that the flu

epidemic season starts around winter in the United States. There are only hypotheses for the flu

to be more active in the winter than in the summer. Another gap in the knowledge of influenza is

the mutation of the influenza strain each year. The lack of knowledge to determine what the new

strain of influenza is each year can be troubling.

Thoughts that epidemiologists and researchers should do to fill in these gaps in

knowledge about influenza is to compare and contrast flu seasons in the United States with flu

seasons in other countries, and compare and contrast the influenza virus in different animals

throughout many years. Examining the similarities and differences with countries that have flu

seasons in the winter, and countries that have flu seasons in the summer can help determine the

reasons for the flu season to be in the winter in the United States. With this knowledge,

epidemiologists and researchers can hopefully find more preventive measures for the flu. Also,

examining the similarities and differences in the influenza virus in different animals for many

years can help determine whether the new strain is similar to a previous strain. Therefore;

creating a new vaccine for the new flu season should be more quick and efficient than previous

flu seasons.
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References

Foster, H. (2014). The Reason for the Season: Why flu strikes in winter. Retrieved April 11,

2016, from http://sitn.hms.harvard.edu/flash/2014/the-reason-for-the-season-why-flu-

strikes-in-winter/

How the Flu Virus Changes. (2014). Retrieved April 11, 2016, from

http://www.flu.gov/about_the_flu/virus_changes/

Influenza. (n.d.). Retrieved April 11, 2016, from http://www.lung.org/lung-health-and-

diseases/lung-disease-lookup/influenza/

Influenza (Flu). (n.d.). Retrieved April 11, 2016, from http://www.nfid.org/idinfo/influenza

Influenza (Seasonal). (2014, March). Retrieved April 11, 2016, from

http://www.who.int/mediacentre/factsheets/fs211/en/

Influenza (flu). (2015, September 29). Retrieved April 11, 2016, from

http://www.mayoclinic.org/diseases-conditions/flu/basics/definition/con-20035101

NIH Scientists Offer Explanation for Winter Flu Season, March 2, 2008 News Release - National

Institutes of Health (NIH). (2008, March 2). Retrieved April 11, 2016, from

http://www.nih.gov/news-events/news-releases/nih-scientists-offer-explanation-winter-

flu-season

Seasonal Influenza: Flu Basics. (2015). Retrieved April 11, 2016, from

http://www.cdc.gov/flu/about/disease/index.htm
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Sloan, C., Chandrasekhar, R., Mitchel, E. F., Schaffner, W., & Lindegren, M. L. (2015,

September). Socioeconomic Disparities and Influenza Hospitalizations,

Tennessee, USA - Volume 21, Number 9-September 2015 - Emerging Infectious Disease journal

- CDC. Retrieved April 11, 2016, from http://wwwnc.cdc.gov/eid/article/21/9/14-

1861_article

The Flu Season. (2014). Retrieved April 11, 2016, from

http://www.cdc.gov/flu/about/season/flu-season.htm

U.S. Food and Drug Administration. (n.d.). Retrieved April 11, 2016, from

http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/UCM1102

88

Weekly U.S. Influenza Surveillance Report. (2016, April 08). Retrieved April 11, 2016, from

http://www.cdc.gov/flu/weekly/
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APPENDIX A

http://www.cdc.gov/flu/weekly/
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APPENDIX B

http://www.cdc.gov/flu/weekly/
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APPENDIX C

Age-standardized incidence of influenza hospitalizations by census tract socioeconomic

variables, Middle Tennessee, USA, October 2007April 2014.

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http://wwwnc.cdc.gov/eid/article/21/9/14-1861_article

APPENDIX D
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Peak Month of Flu Activity 1982-83 through 2013-2014

http://www.cdc.gov/flu/about/season/flu-season.htm

APPENDIX E

http://www.cdc.gov/flu/weekly/
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