What is influenza?
Influenza (the flu) is a viral respiratory infection that spreads from person to person through coughing, sneezing, and contact with contaminated surfaces. The flu is caused by types A, B, or rarely C influenza virus. The most common cause is influenza A, the viral culprit behind flu pandemics and most epidemics. In colder climates, influenza is seasonal, occurring primarily in the winter. In warmer regions of the world, it may be present year-round. During each flu season, there are multiple strains of influenza present, but typically one or two strains predominate as that year's "seasonal flu."
Influenza A and B viruses change over time. Seasonal influenza strains can undergo a series of genetic changes so that people no longer have immunity from prior infections or vaccination. When a large number people are susceptible to the virus, it can cause an influenza epidemic. In addition to this, influenza A can undergo a major genetic change that can make a virus strain much more lethal and/or easier to transmit. Flu vaccines that are developed each year to prevent flu infection are based upon experts' opinions, working in conjunction with the World Health Organization, as to which strains are likely to circulate in the community and usually contain attenuated or inactivated virus targeting two influenza A strains and one influenza B strain.
The influenza virus causes illness in humans and in many animals, including birds, pigs (swine), dogs, and horses. Human influenza strains pass easily from person to person, but most strains of animal influenza only rarely infect humans. When they do, it is almost exclusively when there is significant close animal contact, such as a person that raises chickens or pigs, and the subsequent infection is only rarely transmitted from the infected person to another person.
The ongoing worry for the world's medical communities is that an influenza strain that is infecting animals such as birds or pigs will mutate sufficiently that it will cause serious illness and death in humans (who have no protective antibodies against it) and that it will become a strain that is transmitted easily from human to human.
Influenza A virus can be further sub-typed based on two unique protein antigens, H (haemagglutinin) and N (neuraminidase). The most common influenza A viruses currently infecting humans have the subtypes H1N1 and H3N2. If the influenza virus was compared to an address, then A would represent the state, and H and N designations, the city. Additional descriptors would be necessary to identify a particular street and house. For the influenza virus, this is a typically a combination of place where the virus was first observed, strain number, and year. For instance, the predominant strain during the 2003-2004 flu season was influenza A/Fujian/411/2002 (H3N2).
In most cases, the specific name of the influenza virus is only relevant to the medical community and those charged with influenza surveillance, but in recent years there has been news and focus on first avian (bird) flu and then H1N1 (swine) flu.
Avian (Bird) Flu
The avian flu, an influenza A, H5N1, virus was first described in Hong Kong in 1997. It caused an epidemic in birds in Southeast Asia in 2004, and since then it has caused illness and deaths in birds and in some people in parts of Asia. So far this strain of influenza has remained a bird-to-human infection.
H1N1 (Swine) Flu
The 2009 H1N1 flu virus was originally called "swine flu" but it is now known to be a combination of human, swine, and avian flu genes. First reported in Mexico and the U.S., it is a new influenza A, H1N1, virus. It became the predominant influenza A virus worldwide in 2009, causing influenza infections throughout the world, in what is known as a “pandemic”.
With the usual seasonal flu, the highest infection rates are seen in the very young, but more than 90% of influenza-related deaths and 60% of hospitalizations occur in those over 65 years old. In cases reported to European Centre for Disease Prevention and Control during the 2009 H1N1 pandemic, however, nearly 80% of those with severe respiratory infection from pandemic influenza who died were people under 65 years. The 2009 H1N1 flu virus is the latest, but not the most severe pandemic in history. For comparison, the most lethal pandemic in recent history, the 1918-1919 H1N1 influenza A pandemic, infected about one third of the world's population (an estimated 500 million people) and killed an estimated 20 to 50 million persons worldwide.
According to the Australian influenza report in 2011 there were 25,092 confirmed (laboratory test positive) cases of influenza reported to the National Notifiable Diseases Surveillance System (as at 16 October 2011). Estimating the actual numbers of flu cases is difficult, however, because many of those who get the flu do not seek medical treatment and, of those who do, only a small number are tested. Testing is more common in people who are hospitalized, but overall, laboratory-confirmed cases of influenza only represent a small percentage of those in a community who actually have the flu. In 2012, H3N2 Influenza infections began to increase again in the Northern Hemisphere, displacing the predominant H1N1 strain, illustrating the continual variation in global Influenza virus patterns over time. These patterns will continue to be monitored in Australia and worldwide.