Adapting global influenza management strategies to address emerging viruses

Abstract

Death by respiratory complications from influenza infections continues to be a major global health concern. Antiviral drugs are widely available for therapy and prophylaxis, but viral mutations have resulted in resistance that threatens to reduce the long-term utility of approved antivirals. Vaccination is the best method for controlling influenza, but vaccine strategies are blunted by virus antigenic drift and shift. Genetic shift in particular has led to four pandemics in the last century, which have prompted the development of efficient global surveillance and vaccination programs. Although the influenza pandemic of 2009 emphasized the need for the rapid standardization of global surveillance methods and the preparation and dissemination of global assay standards for improved reporting and diagnostic tools, outbreaks of novel influenza strains continue to occur, and current efforts must be enhanced by aggressive public education programs to promote increased vaccination rates in the global population. Recently, a novel H7N9 avian influenza virus with potential to become a pandemic strain emerged in China and was transmitted from animals to humans with a demonstrated >20% mortality rate. Sporadic outbreaks of highly lethal avian virus strains have already increased public awareness and altered annual vaccine production strategies to prevent the natural adaption of this virus to human-to-human transmission. Additional strategies for combating influenza include advancement of new antivirals for unexploited viral or host cellular targets; novel adjuvants and alternate vaccine delivery systems; and development of universal protein, DNA, or multivalent vaccines designed to increase immune responsiveness and enhance public health response times.

Emerging viral respiratory tract infections—environmental risk factors and transmission

“…The poorly understood pathogenesis and unknown mode of transmission of H7N9, 83 coupled with the absence of mass deaths in poultry and wild birds before disease outbreaks makes public health intervention measures diffi cult to implement. 84 The risk of humanto-human transmission of infl uenza A H7N9 is controversial since cases of family clustering could be a result of between-human transmission or a result of common exposure to infected poultry or other environ mental risk factors.…”

A critical review of the American Journal of Physiology-Lung Cellular and Molecular Physiology: 2012–2015

“…At the same time, the Editor and Associate Editors have "our fingers on the pulse" of lung research and do our best to promote and encourage research in hot topics by issuing call for papers on various topics (see http://ajplung. physiology.org/).influenza (34), and lung ischemia-reperfusion injury (7). These articles are authoritative bench-to-bedside reviews, highly relevant to basic and translational scientists and clinicians alike.…”

“…Noah and Noah (34), "influenza type A and B virus infections in humans result in an estimated 150,000 -200,000 hospitalizations and 30,000 -50,000 deaths in the United States annually and many thousands more globally." Influenza H5N1 viruses are highly pathogenic and result in over 60% mortality in humans.…”

From hidden outbreaks to epidemic emergencies: the threat associated with neglecting emerging pathogens

“…Due to lessons learned, increased surveillance for these infectious agents and other well-known species, such as avian influenzaviruses [28], polioviruses [29], and measles [30] are now in place. Yet, several pathogens given little attention have begun to show signs of expansion from hidden outbreaks into large scale epidemics.…”