Avoid crowding to prevent influenza

On March 18, the Ministry of health announced an outbreak of Influenza A and B among school children after 198 samples out of 439 from students in Wakiso District returned positive.

According to Dr Joyce Moriku Kaducu, the State Minister for Primary Education, over the years, influenza type A follows a cyclic pattern and it normally occurs between the months of February and March, with the peak in early March. 

A number of school staff suspected that learners were suffering from Covid-19 but the government, through the Ministry confirmed that the spike in flu and cough cases in the country has been triggered by a more severe influenza virus type A. 

Dr Charity Asaba, a medical officer at St Catherine’s Hospital, says: “Influenza, one of the most common infectious diseases, is a highly contagious airborne disease that occurs in seasonal epidemics and manifests as an acute febrile illness with variable degrees of systemic symptoms, ranging from mild fatigue to respiratory failure and death. Influenza causes significant loss of work days, human suffering, and mortality.”

Viral
Influenza is a common viral infection that can be deadly, especially in high-risk groups. The flu attacks the lungs, nose and throat. Young children, older adults, pregnant women and people with chronic disease or weak immune systems are the most vulnerable groups due to their weak immune system. 

Dr Asaba says there are four types of influenza viruses; A, B, C and D. Human influenza A and B viruses cause seasonal epidemics of disease (known as flu season) . Influenza A viruses are the only influenza viruses known to cause flu pandemics. 

A pandemic can occur when a new and different influenza A virus emerges that both infects people and has the ability to spread efficiently among people. Influenza C virus infections generally cause mild illness and are not thought to cause human epidemics. Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people.

“Influenza A is more aggressive than influenza B. But they run in clusters, mainly in congregate settings; more so in schools. It is usually worse in much younger age groups (between two and five years), and much older age groups (65 years and above),” she says.

On average, the incubation period of influenza is two days but may range from one to four days. Aerosol transmission may occur one day before the onset of symptoms; thus, it may be possible for transmission to occur via asymptomatic persons or persons with subclinical disease, who may be unaware that they have been exposed to the infection.

How it spreads
● Airborne respiratory droplets from coughs or sneezes of an infected person. 
● By touching a contaminated surface.
● By saliva (kissing or shared drinks with the infected person).
● By skin-to-skin contact (handshakes or hugs).
From this outbreak, schools reported that learners presented with fever, ranging from low grade to high-grade fevers, coughs, headaches, flu and joint pain and by the time the Minister declared the outbreak, Mulago National Referral Hospital was admitting 25 patients per day. 
According to Dr Sabrina Kitaka, a paediatrician at Mulago National Referral Hospital, the symptoms include fever, chills, muscle aches, cough, congestion, fast heartbeat, red, teary eyes, frontal headache, runny nose, and fatigue. “Prevention is the most effective management strategy for influenza,” she adds. 

Prevention and treatment 
To prevent seasonal flu, the Advisory Committee on Immunization Practices (ACIP) of the US Centres for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) recommend routine annual influenza vaccination for all persons aged six months or older, preferably before the onset of influenza activity in the community.

“Prevention is the most effective management strategy. Influenza A and B vaccine can be administered each year before flu season. The CDC analyses the vaccine subtypes each year and makes any necessary changes for the coming season on the basis of worldwide trends,” Dr Asaba says.

Since the influenza vaccination is not routinely provided in our country, it is important to have a high level of suspicion to make the diagnosis. 

The influenza vaccine is available in the private sector but it is not yet available in public hospitals. A shot of influenza vaccination costs Shs80,000.

At school
Dr Kaducu appeals to school authorities to ensure there is strict adherence to preventive measures such as wearing of face masks, handwashing and avoiding gatherings.

“We call upon authorities to ensure that children observe respiratory etiquette by covering their nose and mouth while coughing and sneezing. We urge administrators to ensure students are well hydrated by taking water or juice,” she says.

The Ministry also advised schools to introduce learning shifts where different groups of learners study at different times of the day. This will minimise crowding and in turn curb the spread of the influenza virus.

Treatment options
Ministry officials emphasise that the virus has no cure and can recur but supportive treatment for fever, flu, and cough can fight it off. 

Treatment is usually aimed at symptomatic management with pain killers, flu or cough syrups, prophylactic antibiotics and antivirals where deemed necessary by the healthcare provider.

At home
Home treatment will include tepid sponging, good hydration, fruits rich in vitamin C, and a safe antipyretic agent.

If the child develops persistent fever, difficulty breathing or excessive vomiting, parents are advised to see a Paediatrician as soon as possible.