Hong Kong and Influenza

¶ … ordinal list of the causes of death in the US. It has been reported that the disease causes more havoc in developing countries. During a flu epidemic, up to 20% of Americans are infected by the virus. Of this figure, approximately 36 000 people might die of the infection. It is reported that over 200 000 of those infected are infected in various hospital facilities across the country. Indeed, few viruses have inflicted as much damage and endured as the influenza virus.

Respiratory ailments blamed on influenza are documented in records that trace the infection back to Greece and Rome of the ancient world. The word influenza when viewed from its original Greek form: influentia points to the popular belief that the epidemics that people suffered were a result of the influence of stars. Indeed, people including medical experts refer to the infection of influenza as flu, yet most of these are not (Specter, 2005. Orthomyxovirus which occurs in three forms is the cause of influenza.

The three are termed as A, B, and C. The virus strains referred to as B. and C. have the capacity to infect humans and make them fall sick. This strain is fairly rare and indeed less commonly serious when it happens. It is the type A virus that we are always worried about. Each of the viruses of influenza is home to hundreds of spikes that are microscopic and they rise from the surface of the virus. These spikes are usually made of a protein referred to as hemagglutinin.

These spikes latch and attach on cells that the virus intends to infect. The other spikes are commonly known as neuraminidase. This is the enzyme that gives the virus its fire power. The two proteins are the reason behind the naming of the flu virus I labeled as type N and type H. The type A influenza is known to be the most mutating virus and thus the most successful in causing damage. It can alter or swap any of its eight genes with the others of variant strains (Specter, 2005).

The Nature of Influenza Micro-Organism Its genome is encased in a capsid made of proteins. The one of influenza A contains neuraminidase (NA) and glycoproteins hemaglutinin (HA) which are antigenic. Hundreds of molecules are required from each of the protein capsids. These are the parts of the virus which noted as foreign material by the immune system of the host body.

Owing to the fact that there are many varying types of influenza A neuramidase and hemagglutinin proteins the immune system of the human species is often compromised because of the challenge of eliciting an appropriate immune response. Apart from the human body, other organisms are known to host the virus and act as a reservoir for the influenza virus. Indeed, influenza outbreaks have been noted among poultry, pigs, camels, seals and horses.

Details of the origin, strain number, isolation year and NA/HA proteins are normally included when a strain is named (Clancy, 2008). The influenza A genome has eight genes which encode 11 different types of proteins and has the NA/HA genes. The proteins contain 3 RNA polymerases that work together in a complex formula that is needed by reproduce its RNA genome. It is worth noting that the polymerases have been observed to contain a high error rate because of the fact that they do not have proofreading ability.

This causes a high rate of mutation in the viral genomes that have been replicated. The end result is a high rate of evolution for the viruses. The genome of influenza also encodes extra structural proteins required to constitute the capsid, the NS1, NS2 proteins whose purpose is still under research and nucleoprotein. Other proteins that are encoded by the genone include M1 AND M2.

These are needed for export of nuclear and a range of other functions, and NA/HA which influence the attachment and release of the virus on host cells (Clancy, 2008). Owing to the segmented patterns of the genome of influenza where the sequence of coding is located within individual RNA strands, there is ready shuffling of the genomes within the cells of the host with a variety of flu viruses.

Furthermore, owing to the fact that there are at least 16 varying hemagglutinin sub types and a total of nine neuraminidase categories, it is possible to have many combinations of capsid proteins. Out of these sub types, 3 of them, i.e. H1 to H3, and two neuraminidase subtypes, i.e. N1 and N2 have led to epidemics that have sustained for years among the human population.

All influenza A is known to find home in the bodies of birds and these act as the reservoir from which the subtypes of HA infiltrate the human body (Clancy, 2008). Mode of Transmission It is believed that the infection spreads through airborne means in which very small nuclei in droplets are inhaled but there is little evidence to support such hypothesis.

It has been argued theoretically that minute nuclei droplets that contain the virus leave from the respiratory tract of those infected and due to their small size and lightness hang around in the sir for a long time. Once they are inhaled by a fresh victim, the virus enters the respiratory tract of the host and attaches itself to the specific receptor cells or antigens on epithelial cells surface which form the lining of the trachea and the pharynx.

These in turn replicate to constitute a large mass of new particles of virus which spread out to attach other body cells or even leave to infect fresh victims. The transmission for type A influenza has been shown to spread faster. It has also been shown that the virus spreads faster in enclosures such as residential places, hospitals and nursing homes. This tendency has led to the speculation that the virus is spread during the prodromal stage before its symptoms show in the victim (Gould, 2011).

Pathology Influenza virus replicates within the epithelial cells along the stretch of the respiratory spread. The virus can be recovered from both upper and lower respiratory tracts of those infected. It is not sufficient to make histotologic diagnosis since histologic changes are not specific. Proper diagnosis requires specific tests such as isolation of the virus, RT-PCR tests, serologic analysis autopsy or biopsy tissue section which should be confirmed by immunohistochemical and in situ hybridization techniques.

Influenza infections that are non fatal commonly involve the upper part of the respiratory tract and the trachea. The fatal incidences of influenza have shown evidence of pneumonia. This review is focused on the lower respiratory tract pathology (Taubenberger and Morens, 2008). Infection Cycle There must be several steps to facilitate infections to occur. Such stages are commonly referred to as the infection cycle. Each of the stages must happen if the infection is to occur.

The control of infection is based on the reality that transmission of infectious diseases will be forestalled when any level in the cycle is interrupted or broken (Lindh et al., 2013). The steps include 1. The agent of infection These are microorganism that can be lumped into five categories, i.e. rickettsia, fungi, parasites, bacteria and viruses. An agent must be present for an infection to occur.

When an infectious disease is identified, on the basis of the organism that causes the disease, the infection of that disease could be stopped by use of an anti infective medicine or other infection control strategy (Lindh et al., 2013). 2. Reservoir The main reservoir of human influenza A virus. The reservoir of influenza A virus among the avian group is the wild birds group. There is suspicion that some animals act as reservoirs to some new human infection subtypes.

The influenza A virus is commonly isolated in such animals as horses and pigs. It has also been noted that swine have special receptors for human and avian influenza virus. There seems to be a chance that there will be a re-assortment with antigenic characteristics that will infect humans even as the human immune system remains naive (Public Health Agency of Canada, 2011). 3. Portal of Exit When the agent migrates from the reservoir, there is a high chance that an infection will occur.

They include secretions and excretions, respiratory tract, gastrointestinal tract and mucous membranes (Basarkar, S., 2016). 1. Means of transmission Transmission can occur through aerosols and droplets via the respiratory tract. It may also occur through contact with infected surfaces. Transmission has also been noted to occur rapidly through encloses spaces of human habitation and activity. Transmission from generous donors of the virus can take place and evolve into actual infection within 8 hours through surfaces made of stainless steel and for a couple of minutes via tissue paper (Public Health Agency of Canada, 2011). 2.

Postal of entry The ocular surface is a potential virus infection site for the respiratory tract and a replication venue. Nevertheless, properties governing influenza virus ocular tropism, virus spread mechanisms for evolution from ocular to respiratory tissue, the possible differences in respiratory disease acquired from various infection channels are still not understood sufficiently (Belser et al., 2012) (Basarkar, S., 2016). 3. Susceptible host 4. Everyone is susceptible. The difference is the type, level of exposure and the health status of the subject.

People, who have never been ill, may catch the infection because they have not generated requisite antibodies to shield them. Audit Analysis The control audits for infection were done at 70 RCHEs in HKEC between December of 2013 and May 2014. Nurses from CGAT did the surprise audit on-site twice a week. They adopted convenient sampling by selecting randomly frontline RCHE staff members to include in the audit.

HKEC CCGAT was the developer of the audit tool to assess the level of compliance by staff working in RCHEs in six pertinent sections, i.e. hand hygiene, environmental precaution, care of influenza infected residents and staff uniform cleanliness and personalized feeding utensils. The CCGAT nurses would assess through observing or ask the RCHE staff members. There was feedback and coaching education provided to the RCHE staff members following the assessment so as to improve their performance.

The study also sought to compare the admission rates and outbreaks of influenza occurring over the past 3 years during the winter surge season (Cheng et al., 20.15). The results indicated that there were 723 audits conducted averaging 11 audits in each of the homes. The mean rate of compliance was 84.7 % among the six areas of assessment. Hand hygiene scored the lowest in compliance rate at 67%. Generally the compliance rate ranged between 85% and 92% for the other areas of assessment.

Following the introduction of the enhanced program, there was marked improvement in compliance compared to last year. The number of those infected with influenza dropped by an 83% margin. The number of residents and staff who were infected reduced by 46% and 67% respectively. Among resident hospital management, the number reduced by an impressive 90 % (Cheng et al., 20.15).

Surveillance of Influenza Infection The Center for health protection of the Department of health has put in place several systems for surveillance in the city of Hong Kong aimed at monitoring activity of communicable disease at both public and private healthcare points. With different partners giving their input, CHP is poised to have a better impression of the state of communicable diseases. One of the surveillance systems dedicated to the monitoring is the Sentinel surveillance based at CMP clinics.

The update done weekly highlights the provided data by CMPs taking part in the sentinel program. Such update is meant to inform members of the public of the trends unfolding across the community based on insights and inference from the data collected. It doesn't represent the situation at any particular geographical location or clinic. It applies the methodology outlined below • Sentinel CMPs at appointed clinics take note of the total consultations and those who fulfill the case definitions of the conditions of disease in focus.

CHP receives records every week • The disease conditions in Sentinel CMPs surveillance include illnesses that manifest like influenza (ILI) and diarrhea disease of acute nature (ADD) • CHP collates data they collect from all sentinel surveillance clinics on weekly basis. The weekly rate of consultation is derived by dividing the total cases reported by the sum of the total number of consultations over the week (Centre for Health Protection, 2017). Infection prevention and control measures The primary method used in the prevention of influenza is vaccination.

It is generated through a complex method of growing viruses in many millions of chicken eggs that have been fertilized. Te vaccine for influenza is administered every year to provide protection against specific influenza strains which are expected to prevail in that year. From experience, it has been demonstrated that the production of influenza vaccine takes at least six months to produce following the identification of a virus strain. It has been difficult to produce vaccines for certain influenza strains en mass.

After vaccinating for the annual influenza season, the body takes approximately two weeks to produce antibodies needed for protection. According to the recommendations by CDC, October through November is the best time to conduct vaccinations. Vaccinations done in December or January in some years can still help (Crosse, 2005). Cough etiquette and respiratory hygiene programs should be implemented at first contact point with a person potentially infected people to forestall transmission of respiratory tract infections such as influenza in healthcare centers.

These programs include • Visual alerts postings and giving instructions to patients and those who accompany them to alert health personnel if the patients show any signs of respiratory tract infections. • Providing tissue to patients infected with influenza to cover their mouths when sneezing and coughing • Making sure that hand washing supplies are provided at all times • Giving masks to those who are coughing • Encouraging those who are coughing to sit at a three-fit distance from others (Smith, 2007).

HCP vaccination should be incorporated in the multifaceted influenza [prevention program which focuses on all areas of influenza prevention. The vaccination expectation should be communicated fully to all HCP. Enough resources should be provided to support HCP vaccination programs. All practices aimed at reducing and preventing infection should be encouraged and implemented in an effort to cut down the chances of infections in healthcare environments. Such practice has been shown to successfully reduce influenza spread (National Vaccine Advisory Committee, 2013).

There have been a number of dental and medical procedures that have been shown to produce aerosols and been linked to the increased pathogenic transmissions. The risks liked to the generation of aerosols in such medical procedures are not yet clearly pointed out. The way AGP aerobiology is understood may be altered with further research in the area. The following list constitutes aerosol generating procedures that have been associated with increased risk of pathogenic infections among patients with acute infections.

• Intubation and similar procedures • Cardiopulmonary resuscitation • Postmortem and surgery when using high speed devices • Broncoscopy WHO specified but controversial procedures include bi-level positive airway pressure, nebulisation, non-invasive pressure ventilation and oscillating ventilation (Influenza, P., 2007). There may be need for a protective environment for a number of neutropenic patients there may also be a need for ultra clean unidirectional air supply in some units such as ICU and haematology owing to immunosuppression levels for patients.

In order to reduce airborne particles there must be air circulation into the room coming at a velocity of a minimum 0.25m/sec through HEPA filters. If particles exceeding 0.3microns are sieved out it is possible to classify the air entering the room and devoid of bacterial contamination. The waste produced in hospitals is a likely source of many pathogens. It should be handled with the ultimate care too. There should be a dedicated person in charge of managing the waste in a way that reduces infection risk.

The management of waste should be done in coordination with the infection control teams (World Health Organization, 2004). Droplet isolation precautionary measures when taking care of patients with or suspected of having contracted influenza until 24 hours when after healing with no fever management mediations. • In all routine care for patients when entering their rooms, use a surgical procedure or mask. Make sure you remove the mask and engage hand hygiene when leaving such a room.

• Use a fresh gown when you expect to soil clothes with blood or body fluids. Remove the gown and clean hands when leaving the room • If the patient must leave the room, they must wear a surgical mask • Only those who must should enter the room (Grohskopf et al., 2015). Factors influencing Control of infection and Prevention Measures in Hong Kong H5NI and HPAI were first detected by the People's Republic of China in 1996. The country also was the first to experience disease outbreak in 2004.

There has been a gradual reduction of outbreaks over.