This is the time of year when patients start frantically calling about the availability of influenza vaccine. After recent shortages, people have a heightened awareness of the potential health risks of influenza versus the benefits of immunization, and exhibit a greater urgency to protect themselves against the virus.
The United States survived three influenza pandemics in the 20th century. During the 1918-1919 Spanish flu, 500,000 to 675,000 in the United States and 50 million worldwide died. The Asian flu of 1957-1958 claimed 70,000 lives in the United States, and 34,000 Americans succumbed to the Hong Kong flu in 1968-1969. Scientists know that the latter two pandemics contained a combination of human influenza virus and avian influenza virus (http://www.cdc.gov/flu/avian/gen-info). Three scares followed: the swine flu in 1976, the Russian flu in 1977, and the avian flu since 1997.
A Justified Fear
The fear of serious complications from the flu is not without justification. During my hospital career, a 28-year-old woman was admitted to the acute coronary care unit when an electrocardiogram in the emergency department revealed the true cause of frequent near-syncopal episodes and periods of confusion she had been experiencing for 2 days, which she attributed to the flu and accompanying fever (> 103[degrees]F). Dehydration from the flu had not caused her symptoms; the culprit was a lethal ventricular arrhythmia triggered within a myocardium that was weakened and irritated by the virus. She rapidly deteriorated and despite all efforts to save her, she died within 24 hours of admission or approximately 3 days after the onset of her flu-like symptoms. Her devastated family was overcome by guilt; repeatedly stating they should have made her come to the hospital sooner, especially after Tylenol did not reduce her fever as usual. Everyone has probably heard similar stories; the complications of influenza have ended many lives.
Will There Be a Pandemic?
Is the time near for the next influenza pandemic? The news is full of warnings about avian flu and reports that U.S. inhabitants are not adequately protected against this emerging scourge. Influenza virus and related deaths have been reported in different areas of the world, confirming the spread of the avian influenza virus from wild birds to humans. Concern over U.S. preparedness in the case of a pandemic has resurfaced in light of events following Hurricane Katrina. The United States Department of Health and Human Services released a draft document, "Pandemic Influenza Preparedness and Response Plan" in August 2004 (available at http://www.dhhs.gov/nvpo/pandemics/). This document calls for surveillance, vaccine development and production, antiviral stockpiling, research, and public health preparedness. Two of the published responses received during the 60-day period for public comment are from nurses. I urge all nurse practitioners to read this document.
The different types of influenza virus, subtypes, and strains necessitate the manufacture of a new vaccine each year in response to anticipated viral activity for the approaching flu season. Nurse practitioners play a major role in encouraging individuals at risk to be vaccinated based on current guidelines, recognizing signs and symptoms of influenza, and identifying serious complications early. The Centers for Disease Control and Prevention's Web site, http://www.cdc.gov/flu/professionals/patiented.htm, contains a wealth of information, including downloadable provider and patient education materials. Be proactive this flu season. Know local and state surveillance and reporting requirements for influenza activity and how to access preparedness plans (and accountable individuals) in the event an epidemic or pandemic becomes reality.