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Introduction

The recent spread of bird flu across Asia and parts of Europe and the Middle East, as well as the occasional infections of humans with a disconcertingly high number of deaths, have caused worldwide concern about a potential new global epidemic of influenza. 1 x World Health Organization. Avian influenza: assessing the pandemic threat. (www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/) (2005) Are the ongoing outbreaks of avian flu indeed heralding the next pandemic? Although it is difficult to answer this question, there is broad consensus that the emergence of a new worldwide outbreak of influenza is just a matter of time. Literally for ages influenza has been with mankind, and it would be naive to think that as of the 21st century there will be no further influenza pandemics. However, now for the first time, we may have the opportunity to follow the emergence of a potential new influenza pandemic and to prepare ourselves, so that we may ameliorate the burden of the outbreak or perhaps even avert it altogether at the start.

Influenza, or simply “flu”, is caused by a virus. It occurs not only in occasional major pandemic outbreaks, but also in epidemics of variable severity almost every winter.2, 3, and 4 x KD Patterson. Pandemic and epidemic influenza, 1830–1848. Soc Sci Med 21 (1985) (571 - 580) x Y Ghendon. Introduction to pandemic influenza through history. Eur J Epidemiol 10 (1994) (451 - 453) Crossref. x WI Beveridge. The chronicle of influenza epidemics. Hist Phil Life Sci 13 (1991) (223 - 234) The term “influenza” has been derived from the Italian influentia in the mid-1300s, indicating that, at the time, the illness was believed to result from astrological influences. Yet, the aetiology of the disease and the explanation for its peculiar behaviour remained elusive. At the turn of the 19th century, influenza was thought to be due to a bacterial infection with Haemophilus influenzae. It was not until 1931 that Richard Shope showed that swine influenza could be transmitted with filtered mucus, indicating that the causative agent was a virus. 5 x RE Shope. Swine influenza. III. Filtration experiments and etiology. J Exp Med 54 (1931) (373 - 380) A few years later, Smith and co-workers isolated the influenza virus from humans with respiratory illness. 6 x W Smith, C Andrewes, P Laidlaw. A virus obtained from influenza patients. Lancet 2 (1933) (66 - 68) Crossref.

The burden of influenza for the society, not only from a clinical but also from an economic perspective, is often underestimated. 7 x KG Nicholson, JM Wood, M Zambon. Influenza. Lancet 362 (2003) (1733 - 1745) Crossref. This relates particularly to the recurring annual winter epidemics. Fortunately, since the virus was first discovered, efficient means to contain the infection have been developed. Vaccination is the cornerstone of influenza prevention and control (see Chapter 8). Accordingly, the World Health Organization (WHO) has issued guidelines for the implementation of influenza vaccination programmes in individual countries. 8, x World Health Organization. Influenza vaccines. Wkly Epidemiol Rec 75 (2000) (281 - 288) (www.who.int/docstore/wer/pdf/2000/wer7535.pdf) 9 x World Health Organization. Influenza vaccines. Wkly Epidemiol Rec 77 (2002) (230 - 239) (www.who.int/docstore/wer/pdf/2002/wer7728.pdf) As a result, many thousands of lives are saved worldwide each year. Yet, in many places, implementation of vaccination programmes remains woefully deficient. 10, x The Macroepidemiology of Influenza Vaccination (MIV) Study Group. The macroepidemiology of influenza vaccination in 56 countries, 1997–2003. Vaccine 23 (2005) (5133 - 5143) 11 x A Palache. Influenza vaccines. A reappraisal of their use. Drugs 54 (1997) (841 - 856) Crossref. This implies that significant numbers of people at risk of the complications of influenza remain vulnerable to infection and possibly death. Health-care workers are in a key position to promote vaccination coverage and thus to ameliorate the yearly burden of influenza. At the same time, an increased annual vaccine uptake significantly contributes to an improved preparedness for coming pandemic outbreaks of influenza.

Key Messages

  • The impact of influenza is often underestimated – annual epidemics are deadly and costly events, and pandemic outbreaks may be devastating.
  • Deaths can be prevented and cost savings made by implementation of appropriate vaccination measures.
  • Many people who need vaccination do not get it.
  • Health-care workers play a pivotal role in reducing morbidity and mortality from influenza by vaccinating people at risk of its complications.
  • An increased annual influenza vaccine uptake will not only ameliorate the burden of influenza epidemics but also contribute to an improved pandemic preparedness.

References

Label Authors Title Source Year
1

References in context

  • The recent spread of bird flu across Asia and parts of Europe and the Middle East, as well as the occasional infections of humans with a disconcertingly high number of deaths, have caused worldwide concern about a potential new global epidemic of influenza.1 Are the ongoing outbreaks of avian flu indeed heralding the next pandemic?
    Go to context

  • Influenza pandemics are the result of so-called antigenic shift of the virus (see Chapter 3).13 This means that a virus with a new HA (and NA) is introduced into the human population.
    Go to context

World Health Organization. Avian influenza: assessing the pandemic threat. (www.who.int/csr/disease/influenza/WHO_CDS_2005_29/en/) (2005) 2005
2

References in context

  • It occurs not only in occasional major pandemic outbreaks, but also in epidemics of variable severity almost every winter.2–4 The term “influenza” has been derived from the Italian influentia in the mid-1300s, indicating that, at the time, the illness was believed to result from astrological influences.
    Go to context

KD Patterson. Pandemic and epidemic influenza, 1830–1848. Soc Sci Med 21 (1985) (571 - 580) 1985
3

References in context

  • It occurs not only in occasional major pandemic outbreaks, but also in epidemics of variable severity almost every winter.2–4 The term “influenza” has been derived from the Italian influentia in the mid-1300s, indicating that, at the time, the illness was believed to result from astrological influences.
    Go to context

  • Since everyone will be immunologically naive to that new virus subtype, the infection may spread rapidly and cause high morbidity and mortality among the entire population, including young healthy people.3,14 Three major influenza pandemics struck the globe in the 20th century.3,4 The Spanish flu (caused by an H1N1 influenza A virus) occurred in 1918–19, after the First World War, and resulted in the death of an estimated 50 million people,14 more than the death toll of the war itself (Figure 2).
    Go to context

  • Since everyone will be immunologically naive to that new virus subtype, the infection may spread rapidly and cause high morbidity and mortality among the entire population, including young healthy people.3,14 Three major influenza pandemics struck the globe in the 20th century.3,4 The Spanish flu (caused by an H1N1 influenza A virus) occurred in 1918–19, after the First World War, and resulted in the death of an estimated 50 million people,14 more than the death toll of the war itself (Figure 2).
    Go to context

Y Ghendon. Introduction to pandemic influenza through history. Crossref. Eur J Epidemiol 10 (1994) (451 - 453) 1994
4

References in context

  • It occurs not only in occasional major pandemic outbreaks, but also in epidemics of variable severity almost every winter.2–4 The term “influenza” has been derived from the Italian influentia in the mid-1300s, indicating that, at the time, the illness was believed to result from astrological influences.
    Go to context

  • Since everyone will be immunologically naive to that new virus subtype, the infection may spread rapidly and cause high morbidity and mortality among the entire population, including young healthy people.3,14 Three major influenza pandemics struck the globe in the 20th century.3,4 The Spanish flu (caused by an H1N1 influenza A virus) occurred in 1918–19, after the First World War, and resulted in the death of an estimated 50 million people,14 more than the death toll of the war itself (Figure 2).
    Go to context

WI Beveridge. The chronicle of influenza epidemics. Hist Phil Life Sci 13 (1991) (223 - 234) 1991
5

References in context

  • Influenza, or simply “flu”, is caused by a virus.
    Go to context

RE Shope. Swine influenza. III. Filtration experiments and etiology. J Exp Med 54 (1931) (373 - 380) 1931
6

References in context

  • Influenza, or simply “flu”, is caused by a virus.
    Go to context

W Smith, C Andrewes, P Laidlaw. A virus obtained from influenza patients. Crossref. Lancet 2 (1933) (66 - 68) 1933
7

References in context

  • The burden of influenza for the society, not only from a clinical but also from an economic perspective, is often underestimated.7 This relates particularly to the recurring annual winter epidemics.
    Go to context

  • Each year, influenza results in 3–5 million cases of severe illness and kills between 0.25 and 0.5 million people worldwide.7,29 The WHO estimates that there are currently 1 billion people worldwide who are at high risk of suffering or dying from influenza and its complications.29 Furthermore, as the elderly population increases, future influenza epidemics will be associated with ever-increasing hospitalization rates and excess mortality unless adequate prophylactic measures are taken.
    Go to context

  • Each year, influenza results in 3–5 million cases of severe illness and kills between 0.25 and 0.5 million people worldwide.7,29 The WHO estimates that there are currently 1 billion people worldwide who are at high risk of suffering or dying from influenza and its complications.29 Furthermore, as the elderly population increases, future influenza epidemics will be associated with ever-increasing hospitalization rates and excess mortality unless adequate prophylactic measures are taken.
    Go to context

  • As indicated above, the three major pandemic outbreaks of influenza in the 20th century have caused many millions of deaths, and future pandemics are also expected to have a devastating impact on society.32 Yet, it has been estimated that the cumulative mortality of annual influenza epidemics in the last century exceeded that of the three major pandemic outbreaks.7,33 This underscores the fact that not only influenza pandemics but also the recurrent annual outbreaks of flu remain a major health threat worldwide.
    Go to context

KG Nicholson, JM Wood, M Zambon. Influenza. Crossref. Lancet 362 (2003) (1733 - 1745) 2003
8

References in context

  • Accordingly, the World Health Organization (WHO) has issued guidelines for the implementation of influenza vaccination programmes in individual countries.8,9 As a result, many thousands of lives are saved worldwide each year.
    Go to context

  • The WHO recommends annual vaccination of people in at-risk groups.8,9 The primary target groups for annual vaccination include the elderly, nursing-home residents, patients with chronic respiratory or cardiovascular disease, diabetes or renal dysfunction, as well as immunocompromised individuals.
    Go to context

World Health Organization. Influenza vaccines. Wkly Epidemiol Rec 75 (2000) (281 - 288) (www.who.int/docstore/wer/pdf/2000/wer7535.pdf) 2000
9

References in context

  • Accordingly, the World Health Organization (WHO) has issued guidelines for the implementation of influenza vaccination programmes in individual countries.8,9 As a result, many thousands of lives are saved worldwide each year.
    Go to context

  • The WHO recommends annual vaccination of people in at-risk groups.8,9 The primary target groups for annual vaccination include the elderly, nursing-home residents, patients with chronic respiratory or cardiovascular disease, diabetes or renal dysfunction, as well as immunocompromised individuals.
    Go to context


  • Go to context

World Health Organization. Influenza vaccines. Wkly Epidemiol Rec 77 (2002) (230 - 239) (www.who.int/docstore/wer/pdf/2002/wer7728.pdf) 2002
10

References in context

  • Yet, in many places, implementation of vaccination programmes remains woefully deficient.10,11 This implies that significant numbers of people at risk of the complications of influenza remain vulnerable to infection and possibly death.
    Go to context

  • However, despite the established effectiveness of immunization, the national and international response to influenza prevention measures is often inadequate (see Chapter 8).
    Go to context

The Macroepidemiology of Influenza Vaccination (MIV) Study Group. The macroepidemiology of influenza vaccination in 56 countries, 1997–2003. Vaccine 23 (2005) (5133 - 5143) 2005
11

References in context

  • Yet, in many places, implementation of vaccination programmes remains woefully deficient.10,11 This implies that significant numbers of people at risk of the complications of influenza remain vulnerable to infection and possibly death.
    Go to context

  • However, despite the established effectiveness of immunization, the national and international response to influenza prevention measures is often inadequate (see Chapter 8).
    Go to context

A Palache. Influenza vaccines. A reappraisal of their use. Crossref. Drugs 54 (1997) (841 - 856) 1997

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