Influenza is a contagious respiratory illness caused by influenza viruses. Major influenza pandemics in the early 20th century like the 1918 Spanish Flu killed millions worldwide. Influenza outbreaks have occurred regularly in Ireland since the early 1900s. Public health measures to control influenza transmission have included vaccination programs and the wearing of masks. Monitoring of influenza is conducted through surveillance systems. Public policies aim to increase vaccination rates through health education campaigns.

3. “Influenza is an acute contagious
respiratory illness caused by infection with
an influenza virus.”
(HPSC, 2015)

4. Influenza History
• 1918-19 Spanish Flu – killed 50m worldwide.
American soldiers sought protection through
wearing protective gauze masks
• 1957-58 Asian Flu - Nobody aged 40 or under
has immunity because strain has not
circulated in humans since 1968.

5. Influenza History
• 1968-69 Hong Kong Flu – originated in Hong Kong
and killed 34,000 people in UK. Prevention took place
through the wearing of surgical face masks.
(Colin Parish, 2007)

6. History in Ireland
• 1916-23 influenza killed 20,000 out of a 4m population
- Proportional to that of other EU countries
• Outbreak of Spanish Flu in Ireland brought back by
returning soldiers
• Accentuated by intense political activism eg being
imprisoned (several thousand republican activism) and
victory parades such as one for Great War in Dublin in
early 1919
(John Dorney, 2013)

7. • Viral cause not identified until 1930
• One of the epidemics clearest effects was to
expose the flawed structure of the public
health system
History in Ireland contd.

8. Modern system of global communication,
steamships and railways provided conditions for
easily and speedy spread of virus
(Phillips and Killingray, 2003)

9. 1970’s outbreak
• Vaccinations in place to deal with threat of 1968 Hong
Kong influenza but no vaccination to deal with new virus
(Irish Independent, 1976)
• Media campaigns were used to warn people from visiting
people in hospitals
(Aine Mitchell, 2010)
• 1976- time of crippling recession in Ireland which brought
a halt to modernisation of health services

10. Vaccination or not
Anti-influenza vaccinations for members of An Garda Síochána
No. of
Patients
Number who received the vaccination 208
Number who did not receive the vaccination 8252
Number who reported sick on account of influenza (having
received the vaccination) 34
Number of days absent (having received the vaccination) 148
Number who reported sick on account of Influenza (having not
received the vaccination) 1592
Number of days absent (having not received the vaccination) 8573
• Preventative vaccinations were available but
only in moderation during 1976 swine flu
threat (Corish Dail Debates Vol 288, 1976)
(Aine Mitchell, 2010)

11. Infectious disease such
as influenza was very
common in the early part
of the century, it is now
however much more
rare.
This is as a result of the
implementation of
specific vaccinations
against certain diseases.

12. CDC ‘Take 3’ Actions to fight the flu.
1.Take time to get the flu vaccine
2.Take everyday preventative actions to
stop the spread of germs
3.Take flu antiviral drugs if your
Doctor prescribes them

13. 100 million people infected every year
in Northern Hemisphere*
1:10 adults 1:3 children 10,000-40,000
deaths in the USA
13

14. Summary influenza/ILI general outbreaks in health care facilities/residential
institutions by HSE area; 2013/2014 flu season
14
HSE-area
No. of
outbreaks
Total no.
ill
Total no.
hospitalised
Total
no.
dead
Total no.
lab
confirmed
Total no. lab
investigated
East 23 431 26 13 94 167
Midlands 2 10 0 1 5 6
Midwest 4 41 23 0 13 4
Northeast 6 90 12 0 18 28
Northwest 4 30 11 0 14 17
Southeast 7 154 11 6 26 43
South 9 103 18 7 2 5
West 3 40 2 1 12 19
58 899 103 28 184 289
*Source CIDR data

15. Influenza Vaccine
• 2014-2015 seasonal flu vaccine
• Trivalent containing antigens from two type A and
one type B virus strains
• 2014/2015 A/California/7/2009 (H1N1)pdm09-like virus,
A/Texas/50/2012 (H3N2)-like virus, a
B/Massachusetts/2/2012-like virus
• Cultured in Eggs or cell based
• Inactivated Vaccine
• No Thimerosal
• No adjuvants
• Quadrivalent vaccines available
• Live attenuated vaccine, intranasal vaccine used in UK to vaccinate
children

16. Influenza Vaccine
• Vaccine given at onset of winter season every year
• Licenced for > 6months of age
• Given by I.M injection, thigh or deltoid muscle
• Antibodies take 10-14 days to develop
Suitable for most people
Contraindicated
• Anaphylaxis to previous dose or it constituents (other that ovalbumin)
Precautions
• Acute severe febrile illness defer
• Egg allergy- if confirmed egg anaphylaxis or egg allergy can be given influenza
vaccine with ovalbumin content <0.1micrograms per dose
• Children 12-23mths separate from PCV by one week

17. Influenza vaccine
Side effects
• Soreness redness at vaccination site in 1/3 of
people
• Fever,Malaise and myalgia 6-12hrs after
immunisation and lasts for about 48hrs
• Guillain barre syndrome rare, risks of GBS are
higher following influenza like illness
• Anaphylaxis rare
• Injected influenza vaccine ‘inactivated’ cannot
cause influenza

18. Who should get the Influenza
vaccine?
Everyone!
Anyone who does not want to get influenza!

19. Influenza vaccine recommended for persons
who are at increased risk of influenza
complications
• Greater than 50yrs
• Chronic illness, heart disease,liver disease,resp disease, diabetes
• Immunosuppression due to disease or treatment
• Conditions that compromise respiratory function
• Downs syndrome
• Children with moderate to severe neurodevelopment disorder
• Morbid obesity BMI . 40
• Residents of nursing homes or long stay facilities

20. Influenza vaccine recommended for
Pregnant women
• All pregnant women at any stage of pregnancy
• Pregnancy increases risk of complications from influenza because of
alterations in heart rate lung capacity and immunological function
• Immunisation could prevent 1-2 hospitalisations per 1000 pregnant
women
• It is inactivated vaccine so very safe in pregnancy

21. ECDC council recommendation on Seasonal
influenza vaccination (2009/2010/EU)
• Targets of Council recommendation
• Reach 75% vaccination coverage of Older age groups by 2014-15
• This target of 75% should, if possible be extended to the risk group of
people with chronic conditions
• Member states are also encouraged to improve vaccination coverage
among healthcare workers

22. Vaccine European New Integrated Collaboration Effort ‘VENICE’
On December 2013 the VENICE III project started.
• The main change, from the previous VENICE I and II projects, is that the
VENICE network is going to move into an official ECDC Vaccine
Preventable Diseases network, with experts appointed as competent bodies
of each member state.
The activities of the first two-year project mainly focus on:
• Seasonal influenza vaccination programmes,
• Quality of vaccine coverage data,
• Countries immunization schedules, plan of priorities for introduction and
implementation of new vaccinations, roadmap for sharing and improving
data, methodology and resources among the National Immunisation
Technical Advisory Groups of EU/EEA countries.(17-02-2014)

23. Impact on Public Policies - Europe

24. • Influenza viruses always changing
• Strains monitored by WHO surveillance laboratories
• WHO recommends strains for inclusion in seasonal flu vaccine every year
• Seasonal flu vaccine formulated to ‘match’ circulating strains
24

25. Influenza vaccine recommended for those likely
to transmit influenza to a person at high risk for
influenza complications
• Health Care workers, for their own protection and protection of
patients
• Household contacts of at risk persons
• Out of home care givers to at risk persons

26.  HCWs frequently implicated as the source of influenza transmission in
health care settings
 Employees continue to work while sick with influenza
 Unvaccinated workers who are not sick can still spread the virus
 Benefits of influenza vaccination of HCWs:
 Reduce risk of outbreaks in health care facilities
 Decrease staff illness and absenteeism
 Reduce costs resulting from loss of productivity
26

27. 0
10
20
30
40
50
60
70
80
90
100
Vaccinationcoverage(%)
2008-09 2009-10 2010-11 2011-12United Kingdom
27

28. 28
Note: numbers of hospitals participating varied by season,
2011-2012 (n= 41), 2012-2013 (n=35) and 2013-2014 (n=46)

29. 70
14
21
35
13
10
8
0 10 20 30 40 50 60 70 80
Perceived low risk
Only good for elderly people
I don’t get the flu/rarely sick
I don’t need it
Problems with Vaccine / Injection /
Side-effects
Problems with awareness / access
Other reason
Percentage (%)
Reasonfornon-vaccination
29

30. Influenza & Public Health
“Public Health refers to all organised measures
(whether public or private) to prevent disease,
promote health, and prolong life among the
population as a whole”
- Assessment and monitoring
- Public Policy
- Access
*Vaccination and control of infectious diseases*
World Health Organization, 2015

31. CDC ‘Take 3’ Actions to fight the flu.
1.Take time to get the flu vaccine
2.Take everyday preventative actions to
stop the spread of germs
3.Take flu antiviral drugs if your
Doctor prescribes them

32. Disease Prevention

33. Health Promotion/Education

35. HPSC Monitor/Assessment

36. The Department of Public Health
GPs
Lab samples
Shared on communal Computerised Infectious Disease
Reporting (CIDR)
Outbreak = Department of Public Health contact
hospital/nursing home (etc.) with outbreak advise
e.g. Isolation, restrict visiting.

37. Influenza & Public Policy
• Health Information and Quality Authority (HIQA) & HPSC
‘Guidelines on influenza outbreaks’
• HSE ‘Guidelines for infection prevention and control
management of a patient with suspect/probable/confirmed
influenza’
• National Immunisation Advisory Committee (NIAC)
recommendations for seasonal influenza vaccination
(Campaigns)

38. Access

39. References
• Centres for disease control and infection (2015) available online at:
http://www.cdc.gov/flu/about/disease/index.htm accessed 17th April 2015
• Corish Dail Debate (1976), Volume 288
• Dorney, J (2013) available online at: http://www.theirishstory.com/2013/05/16/ireland-and-the-great-flu-
epidemic-of-1918/#.VTjSRhtFDX4 accessed 12th April
• Health Protection Surveillance Centre (2015) available online at: https://www.hpsc.ie/A-
Z/Respiratory/Influenza/SeasonalInfluenza/Factsheets/File,12960,en.pdf accessed 15th April 2015
• Irish Independent (1976) Getting ready for swine flu, (5)
• Mitchell, A (2010) available online at: http://www.ucd.ie/ibp/MADissertations2009/Mitchell.pdf accessed 12th
April
• Parish, C (2007) Pandemic Influenza: a daunting challenge for health services, Nursing Centre, V 31 (38)
• Phillips, H & Killingray, D (2003) The Spanish influenza pandemic of 1918-19:new pserpectives, London,
Routledge

40. References
• http://www.cdc.gov/flu/protect/preventing.htm
• http//www.eswi.org/library/bulletins/0499-4.html.
• CDC. MMWR. 2001;50(RR-04)1-46.
• National Immunisation Guidelines for Ireland 2014
• *Health care workers in GPs practice
• Source VENICE survey ; http://venice.cineca.org/
• HPSC;http://www.hpsc.ie/A-
Z/Respiratory/Influenza/SeasonalInfluenza/Vaccination/
• Mereckiene J et al. Euro Surveill. 2007;12(12).

41. References
• http://undertheweather.ie/ailment/flu
• http://hse.ie/portal/eng/health/az/F/Flu-influenza-,-seasonal/
• http://www.hse.ie/eng/health/immunisation/pubinfo/fluvaccine/flulandingpg.
html
• http://www.flunewseurope.org
• http://www.hpsc.ie/A-Z/Respiratory/Influenza/SeasonalInfluenza/
• http://www.thejournal.ie/flu-on-the-rise-in-ireland-1884574-Jan2015/
• http://health.gov.ie/blog/press-release/minister-varadkar-hse-launch-
annual-seasonal-flu-vaccination-campaign/