WHAT IS INFLUENZA AND HOW IS IT CAUSED?

Influenza, commonly known as the flu, is a highly contagious respiratory illness caused by influenza viruses. It affects millions of people worldwide every year, leading to significant morbidity, mortality, and economic burden. This essay explores the nature of influenza, its causative agents, the mechanisms of infection, modes of transmission, and the various types of influenza viruses.

Nature of Influenza

Influenza is an acute viral infection that primarily affects the respiratory system, including the nose, throat, and lungs. It is characterized by sudden onset of fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills, and fatigue. Influenza can lead to severe complications, especially in high-risk populations such as the elderly, young children, pregnant women, and individuals with chronic health conditions.

Types of Influenza Viruses

Influenza viruses belong to the family Orthomyxoviridae and are classified into four types: A, B, C, and D. Each type has distinct characteristics and impacts human health differently.

1. Influenza A: This type is the most virulent and is responsible for most influenza epidemics and pandemics. Influenza A viruses infect humans and various animals, including birds, pigs, and horses. They are further classified into subtypes based on two surface proteins: hemagglutinin (H) and neuraminidase (N). There are 18 hemagglutinin subtypes (H1 to H18) and 11 neuraminidase subtypes (N1 to N11). Common subtypes that have caused significant outbreaks in humans include H1N1, H3N2, and H5N1.
2. Influenza B: This type primarily affects humans and is less common than Influenza A. Influenza B viruses are not classified into subtypes but are divided into two lineages: B/Yamagata and B/Victoria. Although Influenza B can cause seasonal outbreaks, it is generally less severe than Influenza A.
3. Influenza C: This type infects humans and pigs and is associated with mild respiratory illness. Influenza C viruses are not a significant public health concern as they do not cause epidemics or pandemics.
4. Influenza D: This newly identified type primarily affects cattle and is not known to infect humans. It poses no threat to public health at present.

Structure of Influenza Viruses

Influenza viruses are enveloped viruses with a segmented, single-stranded RNA genome. The viral envelope is derived from the host cell membrane and contains the hemagglutinin and neuraminidase proteins, which play crucial roles in the virus’s ability to infect host cells and spread.

1. Hemagglutinin (HA): This glycoprotein is responsible for binding the virus to the host cell receptors, facilitating viral entry. The HA protein undergoes frequent mutations, resulting in antigenic drift, which allows the virus to evade the host immune response.
2. Neuraminidase (NA): This enzyme helps release newly formed viral particles from the host cell by cleaving sialic acid residues on the cell surface. The NA protein also undergoes mutations, contributing to the virus’s ability to evade the immune system.
3. RNA Segments: The influenza virus genome consists of eight RNA segments that encode various viral proteins, including polymerases, nucleoproteins, and non-structural proteins. The segmented nature of the genome allows for genetic reassortment, leading to the emergence of new viral strains with pandemic potential.

Mechanisms of Infection

The infection process of influenza viruses involves several steps, including attachment, entry, replication, assembly, and release.

1. Attachment and Entry: Influenza viruses initiate infection by attaching to sialic acid receptors on the surface of respiratory epithelial cells. The hemagglutinin protein mediates this binding. After attachment, the virus is internalized into the host cell through endocytosis. Within the endosome, the acidic environment triggers conformational changes in the hemagglutinin protein, facilitating the fusion of the viral envelope with the endosomal membrane and releasing the viral RNA into the host cell cytoplasm.
2. Replication: Once inside the host cell, the viral RNA segments are transported to the nucleus, where they serve as templates for the synthesis of viral mRNA and complementary RNA. The viral RNA-dependent RNA polymerase, composed of the PB1, PB2, and PA proteins, is responsible for replicating the viral genome. The newly synthesized viral RNA segments are then exported to the cytoplasm for protein synthesis.
3. Assembly: Viral proteins and RNA segments are assembled into new viral particles at the host cell membrane. The hemagglutinin and neuraminidase proteins are incorporated into the viral envelope, while the RNA segments and nucleoproteins form the viral core.
4. Release: Newly formed viral particles are released from the host cell through a process called budding. The neuraminidase enzyme cleaves sialic acid residues on the host cell surface, preventing the newly formed virions from reattaching to the same cell and facilitating their release to infect other cells.

Modes of Transmission

Influenza viruses are highly contagious and spread primarily through respiratory droplets when an infected person coughs, sneezes, talks, or breathes. The modes of transmission include:

1. Droplet Transmission: Large respiratory droplets containing the virus are expelled from the infected person and can directly enter the respiratory tract of a nearby susceptible individual. Droplet transmission typically occurs within a short range, usually less than six feet.
2. Airborne Transmission: Smaller respiratory droplets, known as aerosols, can remain suspended in the air for extended periods and travel longer distances. These aerosols can be inhaled by individuals who are farther away from the infected person, particularly in enclosed or poorly ventilated spaces.
3. Contact Transmission: Influenza viruses can also spread through contact with contaminated surfaces (fomites). When an infected person touches their face and then a surface, they can deposit the virus on that surface. A susceptible person can then touch the contaminated surface and transfer the virus to their respiratory tract by touching their face.
4. Zoonotic Transmission: Influenza A viruses can be transmitted from animals to humans, often through direct contact with infected animals or contaminated environments. This zoonotic transmission can lead to the emergence of new influenza strains with pandemic potential.

Seasonal Influenza and Pandemics

Influenza exhibits a seasonal pattern, with peaks typically occurring during the winter months in temperate regions. This seasonality is influenced by factors such as temperature, humidity, and human behavior (e.g., spending more time indoors during colder months). Seasonal influenza outbreaks cause significant morbidity and mortality each year, particularly among high-risk populations.

Pandemic influenza, on the other hand, occurs when a new influenza A virus subtype emerges with the ability to infect humans, spread efficiently, and cause severe disease. Pandemics are characterized by widespread, global outbreaks and can have devastating public health and economic impacts. Notable influenza pandemics in history include:

1. Spanish Flu (H1N1), 1918-1919: The deadliest influenza pandemic in history, causing an estimated 50 million deaths worldwide. The Spanish Flu disproportionately affected young adults and had a high mortality rate.
2. Asian Flu (H2N2), 1957-1958: Originating in East Asia, this pandemic caused an estimated 1-2 million deaths globally. The virus spread rapidly, facilitated by increased global travel and trade.
3. Hong Kong Flu (H3N2), 1968-1969: This pandemic resulted in an estimated 1 million deaths worldwide. The H3N2 virus continues to circulate as a seasonal influenza strain.
4. H1N1 Pandemic, 2009-2010: Also known as the swine flu, this pandemic emerged from a reassortment of influenza viruses in pigs. It caused an estimated 151,700-575,400 deaths globally. The 2009 H1N1 virus has since become a seasonal influenza strain.

Influenza Vaccination and Prevention

Vaccination is the most effective way to prevent influenza and its complications. Seasonal influenza vaccines are updated annually to match the circulating strains, as influenza viruses undergo frequent antigenic changes through antigenic drift. The two main types of influenza vaccines are:

1. Inactivated Influenza Vaccine (IIV): This vaccine contains killed virus particles and is administered via injection. It is suitable for most people, including those with weakened immune systems.
2. Live Attenuated Influenza Vaccine (LAIV): This vaccine contains live but weakened virus particles and is administered via nasal spray. It is recommended for healthy individuals aged 2-49 years who are not pregnant.

The World Health Organization (WHO) and other public health agencies monitor influenza activity worldwide and recommend vaccine formulations each year based on the most prevalent and anticipated strains. Vaccination not only protects individuals from influenza but also contributes to herd immunity, reducing the overall spread of the virus in the community.

In addition to vaccination, other preventive measures include:

1. Hand Hygiene: Regular handwashing with soap and water or using hand sanitizer can reduce the risk of infection by removing the virus from hands.
2. Respiratory Etiquette: Covering the mouth and nose with a tissue or elbow when coughing or sneezing can prevent the spread of respiratory droplets.
3. Avoiding Close Contact: Staying away from individuals who are sick and avoiding crowded places can reduce the risk of exposure to the virus.
4. Cleaning and Disinfecting: Regularly cleaning and disinfecting frequently touched surfaces can reduce the risk of contact transmission.

Treatment of Influenza

While vaccination is the primary preventive measure, antiviral medications can be used to treat influenza and reduce the severity and duration of the illness. The most commonly used antiviral drugs include:

1. Oseltamivir (Tamiflu): This neuraminidase inhibitor is effective against both influenza A and B viruses. It can reduce the duration of symptoms if taken within 48 hours of symptom onset.
2. Zanamivir (Relenza): Another neuraminidase inhibitor, zanamivir is administered via inhalation and is effective against influenza A and B viruses. It is used similarly to oseltamivir.
3. Peramivir (Rapivab): This neuraminidase inhibitor is administered intravenously and is used for the treatment of acute uncomplicated influenza.
4. Baloxavir Marboxil (Xofluza): This antiviral drug inhibits the cap-dependent endonuclease enzyme, which is essential for viral replication. It is effective against both influenza A and B viruses and is administered as a single dose.

In addition to antiviral medications, supportive care, including rest, hydration, and over-the-counter medications to relieve symptoms, can help individuals recover from influenza.

Conclusion

Influenza is a highly contagious respiratory illness caused by influenza viruses, with significant impacts on public health and society. The viruses’ ability to mutate and evade the immune system poses ongoing challenges for prevention and control. Understanding the nature of influenza, its causative agents, modes of transmission, and the importance of vaccination and other preventive measures is essential for mitigating the impact of this disease. As research and public health efforts continue, improving influenza surveillance, vaccine development, and global cooperation will be crucial in managing both seasonal and pandemic influenza in the future.