Influenza 2018: a new strain is attacking

According to experts, flu 2018 will be marked by the emergence of new, more dangerous strains. Let's consider methods of their treatment and prevention, as well as possible complications.

The first flu epidemic was recorded in 1580, when people knew little about the nature of the disease and how to treat it. Another outbreak in 1918-1920, called the "Spanish flu", took thousands of lives because humanity was again not ready for a viral attack. And only in 1933 was the nature of the disease established, and the pathogen itself was called virus A. In 1940, the B group virus was isolated, and in 1947, the C type virus. But despite the knowledge gained, the disease mutates every year, affecting more and more new strains.

According to the International Classification of Diseases ICD-10, influenza falls into the following category:

Diseases of the respiratory system (J00-J99)

• J09-J18 Influenza and pneumonia.
  • J09 Influenza due to identified zoonotic or pandemic influenza virus.
  • J10 Influenza due to identified seasonal influenza virus.
  • J11 Influenza, virus not identified.

The virus is an RNA-containing orthomyxovirus. Its particle size is 80-120 nm, they are weakly resistant to chemical and physical factors. They are destroyed at room temperature in a few hours, but at a low temperature of -25°C they can survive for several years. Drying, heating, exposure to UV radiation, ozone, chlorine and other factors are destructive.

The source of infection is an infected person with latent or obvious forms of pathology. The main route of transmission is airborne. The maximum danger is observed in the first days after infection, when the virus is released into the environment with mucus particles during coughing or sneezing. If the pathology is uncomplicated, then the release of the pathogen stops a week after its onset. In complicated cases, that is, pneumonia, the virus remains in the body for 2-3 weeks or more.

The disease is especially dangerous in the cold season. According to medical statistics, an epidemic of virus A and its strains is observed every 2-3 years. The infection rate is 20-50% of the population. Type B is characterized by a slower spread and lasts 2-3 months, affecting 25% of the population.

[ 1 ]

World Flu 2018 is already on the doorstep

Every year, about 500 thousand people die in the world from different strains of influenza infection. According to scientists' forecasts, in the 2017-2018 season, the world flu will be struck by a mutation of three previously known strains: Hong Kong, Michigan and Brisbane. At the same time, many doctors are confident that it will not be possible to avoid an epidemic.

The degree of mutation is difficult to predict. For example, with minor, i.e. point changes, the viruses will not differ much from the previous ones. Michigan is a derivative of the pandemic strain California, this is the A virus, identified in 2015 and affecting the southern hemisphere of the planet.

Those most susceptible to infection and severe disease are people from the risk group: children under 3 years old, pregnant women, elderly people and patients with chronic diseases. According to experts, the winter epidemic will make itself known already in November and will proceed in protracted outbreaks until March.

Flu epidemic 2018

According to medical forecasts, the 2018 flu epidemic will begin before winter, that is, in November. The acute course of the disease will most likely occur in the winter months and the first half of spring. Such a long course of the most dangerous type of ARVI is associated with changes in the circulation of the virus and its properties.

Microscopic pathogenic structures have many varieties and infectious strains. Today, the following types of influenza infection are distinguished that can cause an epidemic:

• Influenza A strains are the most dangerous and are responsible for most epidemics and pandemics. They are highly infectious and are transmitted very quickly from sick to healthy people. Not only people are susceptible to infection, but also animals, which can also act as carriers of bacteria. And the type is characterized by a tendency to frequent mutations. At the same time, each subsequent virus is stronger and more resistant to existing drugs.
• H1N1 is a strain of swine flu that appeared in 2009 and affected the entire planet with great speed. Its symptoms are no different from other strains. It occurs with severe intoxication and muscle pain. It causes significant complications to the lungs.
• H5N1 is a bird flu that was also registered in 2009. The peculiarity of this strain is that in 70% of cases patients die. The high mortality rate is a serious danger, as the flu mutates towards increased contagiousness, which can cause a pandemic.
• Influenza B strains are the second most severe. This flu is less contagious, easier to bear and mutates less often. It causes epidemics and, very rarely, pandemics.
• Influenza C strains are significantly less dangerous than the previous two. The incidence is isolated and proceeds in an asymptomatic, mild form. It does not cause infections of epidemic proportions.

There is a certain classification of influenza based on the characteristics of its course:

1. Seasonal – occurs annually, usually in the cold season. Affects about 15-20% of the entire population of the planet. Easily transmitted by airborne droplets and contact. Symptoms appear 3-5 days after infection. Patients suffer from severe headaches and body aches, severe cough and fever. With complex treatment, it subsides within a week. It has several forms of severity:
   • Mild – body temperature is not higher than 38°C, signs of intoxication are absent or weakly expressed.
   • Moderate severity – elevated body temperature with signs of intoxication and changes in the back of the throat, nasal congestion, cough.
   • Severe – high body temperature of 39-40°C and intoxication. Nosebleeds, vomiting, convulsions and hallucinations are possible.
   • Hypertoxic - temperature above 40°C, signs of intoxication are clearly expressed. CNS toxicosis, infectious toxic shock, respiratory failure are observed.
   • Lightning – dangerous due to the risk of death, especially for patients with a weakened immune system and chronic diseases. Accompanied by respiratory failure, bleeding, pulmonary and cerebral edema.
2. Atypical flu – has a rapid and acute onset, which is what distinguishes it from seasonal infection. It occurs with complications. Its peculiarity is that you can get infected in any season, since the virus is constantly present in the air.
3. Highly pathogenic – the disease is associated with the action of a specific strain.
4. Rotavirus is an intestinal flu that is not inferior in its seriousness and danger. Its first symptoms are various gastrointestinal disorders: diarrhea, flatulence, foamy stool. There is also an elevated body temperature and cough. Infection occurs by airborne droplets, and the first symptoms make themselves known after 10-12 hours. Treatment is aimed at increasing the protective properties of the immune system.

Flu 2018 in Russia

The World Health Organization has warned that the 2018 flu in Russia will begin with an attack of three of these strains:

• Brisbane
• H3N2- Hong Kong
• H1N1- Michigan

Thanks to this forecast, the Ministry of Health is already developing vaccines to combat the upcoming epidemiological season. In the fall, the Michigan virus will begin to circulate in Russia, which, according to forecasts, will correspond to the swine flu of 2009. It was recorded back in January-March 2017. During this period, the disease took the lives of more than 100 people. Moreover, the main reason for its appearance was abnormally warm weather conditions.

How the new Michigan strain will manifest itself is still anyone's guess. Therefore, it is extremely important to think about vaccination and preventive measures. At the same time, according to the Russian Ministry of Health, vaccination is possible throughout the epidemiological season. Antigens of pathogens will be included in the vaccine. The vaccination campaign should cover 70 to 90% of the population. Particular attention will be paid to risk groups.

[ 2 ]

Flu 2018 in Ukraine

A new cold season is approaching Ukraine. Experts point to an increase in the number of infections compared to the last epidemic season. Flu 2018 in Ukraine, as in its northeastern neighbors, will be marked by the functioning of three previously known, but mutated strains:

1. Michigan H1N1 is a new strain of California or swine flu. It will be active in December-January, affecting the working population aged 25-49.
2. Hong Kong H3N2 – most dangerous for people over 50 and children under 6. Expected mid-January.
3. Brisbane virus type B is a "family" virus with a mild course. It is predicted for February-March.

The strain type A/Michigan/45/2015, similar to A(H1N1) pdm09 will replace the California strain, which is known as swine pandemic flu. It contains the virus that functioned in the world in 2015. When analyzing the incidence in the next season, the development of large epidemics is not predicted.

According to the conducted studies, the incidence rate has its own characteristics. Thus, the weakest immunity is among residents of the Dnipro, Kherson, Kharkiv and Kyiv regions. Virologists and immunologists explain such statistics by increased crowding. Residents of the western regions of the country have the strongest immunity.

The first symptoms will be similar to those of previous years. In addition to preventive measures, vaccination is recommended to prevent infection. Today, vaccines from 5 manufacturers are registered in Ukraine. Influenza vaccines are updated annually, undergoing a procedure for changing the strain composition. The most popular are: "Vaxigrip" France, "Luarix" Belgium, "Influvac" Holland, there are also Chinese and South Korean vaccines.

Flu 2017-2018: High-Risk Groups

Like any disease, acute viral infections have special risk groups that are most susceptible to infection. According to the World Health Organization, the 2017-2018 flu is most dangerous for the following categories of the population:

1. People at risk of developing severe disease with risk of death and requiring hospitalization:
   • Pregnant women are the highest priority group for vaccination. Vaccination is carried out at any stage of gestation to prevent the risk of developing severe complications in the mother and fetus.
   • Children – prophylactic vaccination is indicated only for patients over 6 months of age. Younger children should be protected by vaccinating their mothers during pregnancy. Children under 2 years of age should be vaccinated, as they are susceptible to severe and, in some cases, life-threatening complications. Patients aged 2 to 5 years respond well to vaccination, therefore inducing broad protection in their age category. This applies to school-age and adolescent patients.
   • Elderly people aged 65 and over are the group most at risk for flu complications and death. For them, vaccination has a lesser effect than for other categories of the population.
   • People with chronic diseases are a high-risk group for developing a severe form of the disease and exacerbation of existing pathologies.
2. Persons who are exposed to increased viral exposure due to the nature of their profession – medical workers and anyone whose work involves close contact with the population.

The priority group for disease prevention is healthcare workers. Their vaccination allows maintaining the provision of medical care at the proper level during epidemics. This also applies to other people, whose vaccination reduces the risk of spreading the virus among the most vulnerable categories. Each of the above risk groups is susceptible to the most severe forms of the disease. At the same time, timely vaccination minimizes the severity of the disease.

[ 3 ], [ 4 ]

Flu Season 2018 – Infection is Already in the Air

With the arrival of the first cold weather, colds begin, which affect both adults and children. The 2018 flu season made itself known much earlier than expected. These epidemiological changes are primarily associated with climatic factors and, of course, with a weakened immune system that is not prepared for viral attacks.

In order to have a correct understanding of this pathology and its prognostic factors, one should know the structure of the RNA-containing virus:

1. The virus has internal antigens NP and M and surface. Outside the structures there is a lipoprotein membrane with two external antigens-proteins: hemagglutinin and neuraminidase.
2. According to the antigen structure, the virus has several types: A, B, C. There are also antigenically independent viruses. In this case, epidemics arise from types A and B, and pandemics - type A.
3. Type A is characterized by high variability:
   • Antigenic drift is a point mutation in the gene that controls the H antigen.
   • Antigenic shift is a complete change of several antigens or the entire RNA segment due to the exchange of genetic material with animals and birds. It leads to the emergence of new antigenic variations for which the human body is not prepared.
4. The A virus currently has 13 subtypes of H1-H13 and 10 varieties of N1-N10. The most dangerous for humans are the first three H subtypes and two N.

If the flu season starts with mutated strains of type A, it causes an epidemic that can easily develop into a pandemic. This is due to the fact that the immune system does not have time to develop timely protection, as well as the lack of proper preventive measures and vaccination.

Flu Symptoms 2018

The mechanism of development of influenza infection has a number of features. The first symptoms of influenza 2018 will completely depend on which strain is progressing. The disease begins with an incubation period. From infection to the appearance of the first symptoms, it takes from several hours to several days (2 days for type A, C and 4 days for type B). The disorder begins very acutely, so the patient does not always accurately indicate the onset of painful symptoms.

Symptoms of intoxication:

• Feverish condition and elevated body temperature, in severe cases above 40 ºС.
• Chills, general weakness and malaise.
• Pain in joints, legs, lower back, muscles.
• Severe headache (in the forehead and eye sockets).
• Nausea and vomiting.
• Appetite disorders.

The above symptoms of intoxication persist for 5-7 days. If the temperature persists longer, this may indicate bacterial complications.

Influenza disease can have several forms of severity, which differ in their symptoms:

1. Mild form – weakly expressed signs of intoxication. The patient experiences moderate headaches, decreased appetite, minor catarrhal symptoms and body temperature up to 38°C.
2. Moderate form – moderate intoxication, temperature up to 39°C. Catarrhal syndrome.
3. Severe – this is a toxic form with pronounced signs of intoxication. It occurs with a feverish state, temperature up to 40°C, hemorrhagic signs.
4. Hypertoxic form – occurs extremely rarely. Characterized by sudden acute onset, development of hemorrhagic, respiratory and encephalic syndrome. In the first hours of the disease, a weakly expressed catarrhal syndrome is observed.

Most often, the disease occurs with catarrhal (inflammation and swelling of the mucous membranes, hyperemia), hemorrhagic phenomena (increased bleeding) and respiratory infectious toxicosis. Such processes are observed in the nasopharynx, conjunctiva of the eyes, and upper respiratory tract.

Catarrhal symptoms last for 7-10 days:

• Runny nose.
• Dry cough.
• Increased lacrimation and stinging eyes.
• Sore throat and hoarseness.

Hemorrhagic symptoms:

• Hemorrhages into the mucous membranes.
• Nosebleeds.
• Hyperemia of the face with general pallor of the skin.
• Minor hemorrhages and dilation of scleral vessels.
• Nausea, vomiting, diarrhea.

Respiratory infectious toxicosis consists of several stages:

• Compensated – there is a disturbance of peripheral blood flow, which is manifested by hyperthermia, tachycardia, and increased blood pressure. Irritative disturbances of consciousness, convulsions, paleness of the skin, and increased diuresis are possible.
• Subcompensated – increased permeability of vascular walls, cerebral edema, muscle hypertension, persistent hyperthermia, pallor and mottling of the skin, severely reduced blood pressure.
• Decompensated - due to circulatory hypoxemia, damage to cell membranes, muscle atony, areflexia occurs. Pale cyanotic skin, bradycardia, abnormal respiratory rhythms, disruption of vital organs and body functions.

Doctors identify a number of symptoms that require an emergency call to an ambulance: a temperature above 40°C that lasts longer than 3-5 days, severe headaches (that do not go away after taking painkillers), as well as shortness of breath, impaired consciousness, convulsions, and hemorrhagic rashes on the skin.

The severity of flu symptoms in 2018, like those of previous years, depends on the state of the patient's immune system. The disease is most severe in people with chronic diseases of the cardiovascular system, lungs, kidneys and hematopoietic system. Also, patients from special risk groups should not be excluded, such as children, pregnant women and the elderly.

Features of flu 2018

According to forecasts by medical experts, the peculiarities of the 2018 flu will consist of the functioning of three dangerous strains at once.

Characteristic features of influenza infection:

• Rapid development of the disease – due to the rapid development of influenza infection, doctors are not always able to make a diagnosis and begin treatment in time. Therefore, it is necessary not to neglect the prevention of seasonal diseases.
• High fatality rate – according to medical statistics, about 500 thousand patients with this infection die annually worldwide. During epidemics, the mortality rate doubles.
• Severe complications – neglect of timely diagnosis and treatment can cause a variety of consequences. This can be pneumonia, problems with the central nervous system, diseases of internal organs and much more.

The mechanism of origin and development of the disease goes through five pathological phases:

1. Reproduction of the virus in the cells of the upper respiratory tract, production of inflammatory factors:

• Disruption of metabolism and integrity of epithelial cell membranes.
• Death of epithelial cells.
• Further spread of the virus and its penetration into the blood.

At the site of inflammation, activation of non-specific defense factors of the body occurs.

2. The virus and cellular decay products enter the blood, exerting a selective destructive effect on capillaries and precapillaries, the receptor apparatus of the meninges and vascular plexuses of the brain, and the autonomic nervous system. Microcirculatory disorders lead to the development of hypoxemia and tissue hypoxia, acute cardiovascular failure, pulmonary edema, hemorrhagic, meningeal and encephalic syndrome.
3. Inflammatory processes in the respiratory system. The damage most often occurs on the part of the epithelial cells of the trachea. If the disease is severe, the respiratory tract, including the alveoli, is involved in the pathological process.
4. Various bacterial complications, most often occurring in patients from the risk group. As a rule, this is pneumonia, which can be caused by both exogenous (staphylococci, streptococci) and endogenous flora.
5. Reverse development of the pathological process due to activation of non-specific defense factors of the body.

The source of infection can be either sick people or animals. The main route of transmission is airborne.

[ 5 ], [ 6 ], [ 7 ]

Complications of flu 2018

The main danger of influenza infection is the risk of developing serious consequences. Complications of influenza 2018 most often arise due to improper treatment of the disease, when the pathology becomes advanced.

Main complications:

• Primary viral pneumonia is a severe complication of influenza caused by the spread of infection from the upper respiratory tract along the bronchial tree with damage to the lungs. It is accompanied by intoxication, shortness of breath and severe respiratory failure. The cough is dry with the separation of scanty sputum and blood impurities.
• Bacterial pneumonia – begins 2-3 days after the acute course of the disease. After a slight improvement, the temperature rises sharply, cough with green or yellow sputum.
• Infectious toxic shock is the most severe degree of intoxication with severe disruption of the functioning of important organs (cardiovascular system, kidneys).
• Otitis, sinusitis is a bacterial inflammation of the nasal sinuses and ear.
• Glomerulonephritis is an inflammatory lesion of the renal tubules with a marked decrease in kidney function.
• Meningitis, encephalitis – inflammation of the tissues and membranes of the brain. Most often occurs in patients from the risk group.

In addition to the above complications, in particularly severe cases, septic conditions are observed. This is the penetration of bacterial pathogens into the blood. Such a complication significantly increases the risk of death.

What is the difference between a cold and the flu?

Influenza, unlike a cold, is a rather serious disease that without timely treatment threatens serious consequences and complications. That is why it is necessary to know the difference between a cold and flu.

TOP 10 differences between flu and cold:

1. Infection – flu symptoms appear immediately, which is not the case with a cold. Its symptoms increase gradually, and in some cases they occur in a latent form.
2. The first signs - a cold begins to manifest itself very slowly. At first, a runny nose appears, then a sore throat and a subfebrile temperature closer to the evening. With the flu, the symptoms are acute: severe headaches and high temperature throughout the day.
3. Symptoms - with a cold, its first signs gradually increase. Flu is characterized by a stable feverish state, a strong dry cough.
4. Throat - a cold is characterized by a sore throat, followed by a short cough and sneezing. With a flu infection, a sore throat appears immediately, as does an active cough. Pain in the chest may also occur.
5. Headache - with a cold, discomfort occurs against the background of general weakness. While with the flu, headaches are more complex. Due to general intoxication of the body, the patient experiences a severe migraine.
6. Deterioration of general condition (lethargy, weakness) - such symptoms are observed both in the first and in the second disease. With a cold, discomfort persists throughout the illness, while with the flu only at the moment of its resolution.
7. Muscle pains are typical for influenza infection. The patient complains of severe body aches, pain when bending the limbs.
8. Nausea and vomiting – the presence of such symptoms can cause difficulties in diagnosis. And this is not surprising, as such signs are characteristic of severe poisoning. Intoxication is not observed with a cold, but gastrointestinal disorders are characteristic of the flu.
9. Painful sensations in the eyeballs - due to severe intoxication of the body during influenza infection, the eyes water heavily and there is pain in the eye sockets.
10. Recovery period - a cold passes and is treated faster than the flu, the course of the disease is sluggish. Flu is treated for a long time and often causes severe complications.

How to treat flu 2018?

Treatment of influenza infection, like any other disease, begins with a comprehensive diagnosis. How to treat flu 2018 will depend entirely on the results of the studies. Particular attention is paid to differentiation from other ARVI:

Parainfluenza:

• It is characterized by a slow onset, differing from the flu by mild intoxication and subfebrile body temperature.
• Painful sensations in the larynx. Possible development of laryngitis: dry cough, hoarseness.
• The mucous membrane of the oropharynx is slightly hyperemic, while influenza is characterized by pronounced hyperemia.

Adenoviral infection:

• Enlarged regional lymph nodes and other symptoms of tonsillitis.
• Moderate coughing fits.
• Pronounced expectoration of sputum during coughing.
• Asymmetric conjunctivitis.
• Dyspeptic symptoms.
• Feverish period lasting more than 10 days.

Treatment of influenza consists of the following main stages:

1. Antiviral and antipyretic therapy is carried out for both children and adults from the first days of the disease. Patients are prescribed oral, injection and inhalation forms of drugs. Taking vitamins is also recommended.
2. Physiotherapy procedures – to improve the drainage function of the bronchi and enhance the removal of sputum, warm inhalations with bronchodilators are performed, and mucolytics are prescribed for oral administration.
3. Hospitalization is indicated in severe cases of the disease with symptoms such as: severe hyperthermia of 40-41°C, nausea and vomiting, cyanosis of the skin, arrhythmia, meningeal syndrome, risk of complications.

Special attention is paid to non-drug treatment. Patients are prescribed strict bed rest for 5-7 days. During this period, it is not recommended to read, work on the computer or watch TV. It is recommended to drink plenty of fluids - at least two liters of water per day, drinks enriched with vitamin C, rosehip tinctures, fruit drinks. A gentle diet with a predominance of food rich in vitamins is also recommended.

How to prevent flu this 2017-2018 season?

The most effective way to prevent viral infection is a set of preventive measures. Let's take a closer look at how to prevent flu in the current 2017-2018 season:

Strengthening the immune system

• First of all, you need to prevent viruses from entering your body. To do this, you should minimize contact with infected people and maintain personal hygiene.
• Complete nutrition, rich in proteins, fats, carbohydrates and vitamins.
• An active lifestyle and regular physical activity.
• Maintaining a sleep and rest regime.
• Minimizing stress and strain.
• Giving up bad habits (smoking, alcoholism, drug addiction) that negatively affect resistance to infectious diseases.

Vaccination

Every year, flu vaccines undergo strain updates. Vaccination is carried out using viruses that circulated in the previous season. The effectiveness of this method of preventing infection depends on how similar the viruses are to the real ones. With repeated vaccinations, the effectiveness increases. Today, there are such types of vaccines that contain two strains of type A and one strain of type B:

1. Trivalent inactivated (TIV)

• Split vaccines
• Subunit
• Whole virion

Only TIV is licensed for children under two years of age, pregnant women, and patients over 50 years of age. The vaccine is available in multi-dose and single-dose vials. The drug is intended for intramuscular injection into the deltoid muscle or anterolateral thigh. TIV is considered the safest, although it can cause temporary allergic reactions at the injection site.

2. Live attenuated influenza viruses (LAIV)

There is a trivalent lyophilized vaccine based on live attenuated viruses adapted to cold. The vaccine is derived from a donor strain of the A subtype virus, which is recombined with seasonal strains A(H1N1) and A(H3N2). Due to sensitivity to temperature, vaccine viruses reproduce well in the cold environment of the nasopharynx, but poorly at body temperature in the lower respiratory tract.

Vaccination should be done in advance, that is, before the epidemic develops, preferably in September. Vaccination can be done during an epidemic, but it should be taken into account that immunity is formed within two weeks. Also, do not forget about the risk of developing side effects. Most often, there is redness at the injection site, fever, general malaise, muscle pain, allergic reactions.

Emergency prevention

It is carried out during an outbreak of the disease in a closed group. Vaccination is not used, since at least 2 weeks are needed to form the protective properties of the immune system. It is recommended to take Rimantadine, Oseltamivir or Tamiflu. It will also not be superfluous to take specific anti-flu immunoglobulin.

Flu 2018, like viral diseases of previous years, requires comprehensive prevention. With timely vaccination and strengthening of the immune system's protective properties, there is every chance that the body will cope with the seasonal problem and will not cause serious complications.