Solomon Fallah Foa SANDY 9375 3rd Year Medicine

COLLEGE OF MEDICINE AND

ALLIED HEALTH SCIENCES

(UNIVERSITY OF SIERRA LEONE)

Virology Assignment

Essay on Human Outbreaks of

Influenza Viruses
Submitted to:
Submitted by:
Dr. Sulaiman Conteh
Solomon Fallah Foa SANDY (9375)
Lecturer Virology and Mycology
3rd Year Medicine,
Head of Department, Medical Microbiology
College of Medicine and Allied Health
College of Medicine and Allied Health Sciences
Sciences

10th December 2019

Solomon Fallah Foa SANDY 9375 3rd Year Medicine

INTRODUCTION.

Influenza viruses the causative agents of influenza are important human pathogens belonging to
the Orthomyxoviridae family. Influenza is an acute infectious disease of the respiratory tract that
occurs in sporadic, epidemic, and pandemic forms, with well-defined systemic symptoms which
is responsible for thousands of human deaths each year. Influenza viruses cause a wide range of
diseases in adults and children including Fever, myalgia, sore throat, and nonproductive cough in
adults and children with abdominal pain, vomiting, myositis, and croup occurring in children
with severe infection. Outbreaks of influenza viruses dates back as far as the 19th Century killing
millions of people.

MORPHOLOGY

Influenza viruses are composed of a segmented single stranded antisense RNA genome which
contains an RNA-dependent RNA polymerase enzyme, a helical nucleocapsid and an outer
lipoprotein envelope. Two different spikes of glycoproteins; Hemagglutinin and Neuraminidase
are found on the envelope which is made up of an inner membrane protein layer and an outer
lipid layer; these glycoproteins are responsible for the many antigenic variants of influenza
viruses. Hemagglutinin functions at the start of infection and it is responsible for binding to the
cell surface receptor to initiate infection of the cell, laboratory diagnosis (hemagglutination
inhibition test) because of its ability to agglutinate red blood cells and it is also targeted by
neutralizing antibody. Neuraminidase on the other hand acts at the end of infection, it is
responsible for releasing progeny viruses from the infected cells to the surrounding cells by
cleaving to neuraminic acid; and also facilitates the virus’ ability to access epithelial cells of the
respiratory tract by degrading the protective mucus layer in the respiratory tract.

Influenza viruses have a unique feature of Antigenic variation. Hemagglutinin and

Neuraminidase are responsible for the antigenic variations. Antigenic variations are as a result of
variations shown by the surface antigens; Hemagglutinin and Neuraminidase. There are four
types of influenza viruses; Which are type A, B, C, D of which Influenza A virus shows
maximum antigenic variations. Seasonal influenza outbreaks are mainly caused by type A and
type B influenza viruses. Influenza B virus is the only human virus for which there is no animal
source of new RNA segments. Antigenic variation never occurs in type C influenza virus and
Influenza A viruses are the only influenza viruses known to cause global epidemics of flu

10th December 2019

Solomon Fallah Foa SANDY 9375 3rd Year Medicine

disease. Influenza type C shows no antigenic variation. Influenza type D is not known to infect
or cause human infections but can affect and causes infections in other animals like cattle.

VIRIAL REPLICATION
The influenza virus attaches to the surface of the normal cell by binding to the hemagglutinin
receptor. After binding to the surface receptor, the virus invades the cell where the low pH within
the endosome helps the uncoating process to release the nucleocapsid, which travels to the
nucleus for transcription. In the nucleus, the viral genome is then transcribed to mRNAs by the
action of the virion RNA polymerase. Majority of the mRNAs produced move to the cytoplasm
where they are translated into viral proteins. The remaining viral mRNAs which remains in the
nucleus facilitates the formation of progeny virions by acting as the template for negative-strand
RNA genomes of the progeny virions. Assembling occurs in the cytoplasm and the matrix
protein mediates the interaction between the nucleocapsid and the envelope and virion is released
from the cell by budding outer cell membrane at the site where hemagglutinin and neuraminidase
are located.

HUMAN OUTBREAKS OF INFLUENZA VIRUSES

Human outbreaks of influenza viruses can be categorized into seasonal, pandemic and zoonotic
influenza based on its occurrence and means of transmission.

SEASONAL INFLUENZA
Influenza viruses circulate and cause diseases in humans annually and are therefore known as
Seasonal influenza. Seasonal influenza viruses can be transmitted from person to person through
sneezing, coughing or touching contaminated surfaces. They can cause mild to severe illness to
even death in high risk individual which includes Immunocompromised persons, pregnant
women, elderly, people with chronic underling medical conditions and children. Vaccines for
seasonal influenza are upgraded regularly and are reviewed biannually to grantee effectiveness as
the viruses evolve continuously. As a result of the viruses’ ability to evolve continuously People
can get infected multiple times in their life time. As mentioned earlier Seasonal influenza may be
caused by type A and type B influenza viruses.

10th December 2019

Solomon Fallah Foa SANDY 9375 3rd Year Medicine

Influenza type A subtypes A(H1N1) and A(H3N2) which were responsible for the 2009
influenza pandemic and type B subtype Victoria Lineage and Yamagata Lineage (named after
the areas where they were first identified) are responsible for current seasonal influenza. During
the period between 11 November 2019 to 24 November 2019, WHO’s Global Influenza
Surveillance and Response System (GISRS) laboratories tested more than 92883 for influenza
viruses, of which 5629 (71.1%) were typed as influenza A and 2285 (28.9%) as influenza B
making a total of 7914 positive Cases. Of the type A Viruses detected, 2682 (71.5%) were
influenza A(H3N2) and 1069 (28.5%) were influenza A(H1N1) and of the characterized B
viruses, 1014 (96.8%) belonged to the B-Victoria lineage and 34 (3.2%) to the B-Yamagata
lineage. During the period of January 1 to November 3, WHO ‘s Global Influenza Surveillance
and Response System processed a total of 169 samples from Sierra Leone of which 22 where
positive, consisting of 1 case of influenza A subtype A(H1N1), 18 cases of influenza A subtype
A(H3N2) and 3 influenza B cases, subtype of which was not determined.

PANDEMIC INFLUENZA
“The threat of pandemic influenza is ever-present.” said WHO Director-General Dr Tedros
Adhanom Ghebreyesus. “The on-going risk of a new influenza virus transmitting from animals
to humans and potentially causing a pandemic is real.
A pandemic influenza is a type of influenza virus that is infecting humans for the first time.
Hence there is no immunity against it. They affect large amount of people in the world when the
cause outbreaks outside the influenza seasons. Pandemic influenza viruses may cause large
number of severe cases or a large number of milder cases, the reasons for these variations is not
well understood. The number of people infected may be huge as there is no immunity to these
pandemic influenza viruses in the majority of the population. Only type A influenza viruses are
known to cause pandemic influenza, the recent of which is the strain of influenza type A virus
A(H1N1) which was responsible for the 2009 pandemic influenza outbreak and has since
become a seasonal influenza as discussed in the previous section. Pandemic influenza that has
affected a large number of people before includes the A(H1N1) first strain outbreak known
“Spanish Flu” in 1918-1919 affected more that 50 million people worldwide killing more than 20
million and the following outbreaks in 1957 (Asian Influenza – A (H2N2)) and the 1968 (Hong
Kong influenza – A(H3N2)) caused fewer death.

10th December 2019

Solomon Fallah Foa SANDY 9375 3rd Year Medicine

ZOONOTIC INFLUENZA
Animal influenza viruses are distinct from human seasonal influenza viruses and they do not
transmit easily. Occasionally, these animal influenza viruses known as Zoonotic influenza
viruses can infect humans either by direct or indirect contact with an infected animal and cause
diseases ranging from mild cases to death.
Avian influenza viruses the most popular of the zoonotic influenza was responsible for the
outbreak in poultry in Hong Kong, China in 1997 which is its natural host. After the outbreak,
human infections with the avian influenza were reported in China. Most swine influenza viruses
do not cause human infections but few cases of human infections with swine influenza viruses
have been reported.

Just like pigs and beds, Other animals such as dogs can be infected by influenza viruses.

References

1. Lavinson, 2016, Review of Medical Microbiology (14th Edition), pp 311-318, USA:

McGraw-Hill Education.
2. https://www.who.int/influenza/surveillance_monitoring/en/

3. http://www.who.int/entity/influenza/human_animal_interface/influenza_h7n
9/H7N9VirusNaming_16Apr13.pdf

10th December 2019