Influenza (Seasonal)
Key facts
- Seasonal influenza is an acute viral infection that spreads easily from person to person.
- Seasonal influenza viruses circulate worldwide and can affect anybody in any age group.
- Seasonal influenza viruses cause annual epidemics that peak during winter in temperate regions.
- Seasonal influenza is a serious public health problem that causes severe illness and death in high risk populations.
- An influenza epidemic can take an economic toll through lost workforce productivity and strain health services.
- Influenza vaccination is the most effective way to prevent infection.
- Antiviral drugs are available for treatment, however influenza viruses can develop resistance to the drugs.
Overview
Seasonal influenza is an acute viral infection caused by an influenza virus.
There are 3 types of seasonal influenza viruses – A, B and C. Type A influenza viruses are further classified into subtypes according to the combinations of various virus surface proteins. Among many subtypes of influenza A viruses, influenza A(H1N1) and A(H3N2) subtypes are currently circulating among humans.
Influenza viruses circulate in all parts of the world. Type C influenza cases occur much less frequently than A and B. That is why only influenza A and B viruses are included in seasonal influenza vaccines.
Signs and symptoms
Seasonal influenza is characterized by a sudden onset of high fever, cough (usually dry), headache, muscle and joint pain, severe malaise (feeling unwell), sore throat and runny nose. Cough can be severe and can last 2 or more weeks. Most people recover from fever and other symptoms within a week without requiring medical attention. But influenza can cause severe illness or death especially in people at high risk (see below). The time from infection to illness, known as the incubation period, is about 2 days.
Who is at risk?
Yearly influenza epidemics can seriously affect all populations, but the highest risk of complications occur among children younger than age 2 years, adults aged 65 years or older, pregnant women, and people of any age with certain medical conditions, such as chronic heart, lung, kidney, liver, blood or metabolic diseases (such as diabetes), or weakened immune systems.
Transmission
Seasonal influenza spreads easily and can sweep through schools, nursing homes, businesses or towns. When an infected person coughs, infected droplets get into the air and another person can breathe them in and be exposed. The virus can also be spread by hands contaminated with influenza viruses. To prevent transmission, people should cover their mouth and nose with a tissue when coughing, and wash their hands regularly.
Seasonal epidemics and disease burden
In temperate climates, seasonal epidemics occur mainly during winter while in tropical regions, influenza may occur throughout the year, causing outbreaks more irregularly.
Influenza occurs globally with an annual attack rate estimated at 5%–10% in adults and 20%–30% in children. Illnesses can result in hospitalization and death mainly among high-risk groups (the very young, elderly or chronically ill). Worldwide, these annual epidemics are estimated to result in about 3 to 5 million cases of severe illness, and about 250 000 to 500 000 deaths.
In industrialized countries most deaths associated with influenza occur among people age 65 or older. Epidemics can result in high levels of worker/school absenteeism and productivity losses. Clinics and hospitals can be overwhelmed during peak illness periods.
The precise effects of seasonal influenza epidemics in developing countries are not known, but research estimates indicate that a large percent of child deaths associated with influenza occur in developing countries every year.
Prevention
The most effective way to prevent the disease and/or severe outcomes from the illness is vaccination. Safe and effective vaccines are available and have been used for more than 60 years. Among healthy adults, influenza vaccine can provide reasonable protection. However among the elderly, influenza vaccine may be less effective in preventing illness but may reduce severity of disease and incidence of complications and deaths.
Vaccination is especially important for people at higher risk of serious influenza complications, and for people who live with or care for high risk individuals.
WHO recommends annual vaccination for:
- pregnant women at any stage of pregnancy
- children aged 6 months to 5 years
- elderly individuals (≥65 years of age)
- individuals with chronic medical conditions
- health-care workers.
Influenza vaccination is most effective when circulating viruses are well-matched with vaccine viruses. Influenza viruses are constantly changing, and the WHO Global Influenza Surveillance and Response System (GISRS) – a partnership of National Influenza Centres around the world –monitors the influenza viruses circulating in humans.
For many years WHO has updated its recommendation on vaccine composition biannually that targets the 3 (trivalent) most representative virus types in circulation (two subtypes of influenza A viruses and one B virus). Starting with the 2013-2014 northern hemisphere influenza season, quadrivalent vaccine composition has been recommended with a second influenza B virus in addition to the viruses in the conventional trivalent vaccines. Quadrivalent influenza vaccines are expected to provide wider protection against influenza B virus infections.
Treatment
Antiviral drugs for influenza are available in some countries and may reduce severe complications and deaths. Ideally they need to be administered early (within 48 hours of onset of symptoms) in the disease. There are 2 classes of such medicines:
- adamantanes1(amantadine and rimantadine); and
- inhibitors of influenza neuraminidase (oseltamivir and zanamivir; as well as peramivir and laninamivir licensed in several countries).
Some influenza viruses develop resistance to the antiviral medicines, limiting the effectiveness of treatment. WHO monitors antiviral susceptibility among circulating influenza viruses to provide timely guidance for antiviral use in clinical management and potential chemoprophylaxis.
WHO response
WHO, with its partners, monitors influenza globally, recommends seasonal influenza vaccine compositions twice a year for the Northern and Southern hemispheres, and supports Member States efforts to develop prevention and control strategies.
WHO works to strengthen national and regional influenza diagnostic capacities including antiviral susceptibility monitoring, disease surveillance, outbreak responses, and increase vaccine coverage among high-risk groups.
1Currently, WHO recommends neuraminidase inhibitors as the first-line treatment for people requiring antiviral therapy, as the currently circulating influenza viruses are resistant to the adamantanes.