Influenza Public Health Research Articles

The upcoming flu seasons: how worried should we be?

The simple answer to the title question is very. As the COVID-19 pandemic raged through 2020–21, little to no influenza activity was detected.1 It was hypothesised that interventions imposed to curb COVID-19 had a positive effect on influenza transmission. This, coupled with the focus on producing and distributing SARS-CoV-2 vaccines might have reduced the levels of influenza immunity in the population that are raised through natural infection or vaccination. Consequently, this has prompted a gut-feeling among the influenza public health and research communities that the influenza seasons post-COVID-19 are going to be severe.

Comments on: Managing sick or injured wild birds under avian influenza public health restrictions

In PracticeVolume 44, Issue 7 p. 431-431 Opinion Comments on: Managing sick or injured wild birds under avian influenza public health restrictions First published: 08 September 2022 https://doi.org/10.1002/inpr.243Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume44, Issue7September 2022Pages 431-431 RelatedInformation

Managing sick or injured wild birds under avian influenza public health restrictions

In PracticeVolume 44, Issue 6 p. 365-366 Opinion Managing sick or injured wild birds under avian influenza public health restrictions Aneesa Malik, Aneesa MalikSearch for more papers by this author Aneesa Malik, Aneesa MalikSearch for more papers by this author First published: 22 July 2022 https://doi.org/10.1002/inpr.232Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume44, Issue6July/August 2022Pages 365-366 RelatedInformation

An agent-based model simulation of influenza interactions at the host level: insight into the influenza-related burden of pneumococcal infections

BackgroundHost-level influenza virus–respiratory pathogen interactions are often reported. Although the exact biological mechanisms involved remain unelucidated, secondary bacterial infections are known to account for a large part of the influenza-associated burden, during seasonal and pandemic outbreaks. Those interactions probably impact the microorganisms’ transmission dynamics and the influenza public health toll. Mathematical models have been widely used to examine influenza epidemics and the public health impact of control measures. However, most influenza models overlooked interaction phenomena and ignored other co-circulating pathogens.MethodsHerein, we describe a novel agent-based model (ABM) of influenza transmission during interaction with another respiratory pathogen. The interacting microorganism can persist in the population year round (endemic type, e.g. respiratory bacteria) or cause short-term annual outbreaks (epidemic type, e.g. winter respiratory viruses). The agent-based framework enables precise formalization of the pathogens’ natural histories and complex within-host phenomena. As a case study, this ABM is applied to the well-known influenza virus–pneumococcus interaction, for which several biological mechanisms have been proposed. Different mechanistic hypotheses of interaction are simulated and the resulting virus-induced pneumococcal infection (PI) burden is assessed.ResultsThis ABM generates realistic data for both pathogens in terms of weekly incidences of PI cases, carriage rates, epidemic size and epidemic timing. Notably, distinct interaction hypotheses resulted in different transmission patterns and led to wide variations of the associated PI burden. Interaction strength was also of paramount importance: when influenza increased pneumococcus acquisition, 4–27% of the PI burden during the influenza season was attributable to influenza depending on the interaction strength.ConclusionsThis open-source ABM provides new opportunities to investigate influenza interactions from a theoretical point of view and could easily be extended to other pathogens. It provides a unique framework to generate in silico data for different scenarios and thereby test mechanistic hypotheses.

State barriers to appropriating public health emergency response funds during the 2009 H1N1 response.

We examined state-specific administrative barriers to allocating 2009 H1N1 influenza public health emergency response (PHER) funds. We conducted a qualitative review of PHER grants management reports to identify and code barriers reported by states in allocating funds. Using linear regression, we examined the relationship between the percentage of funds allocated and each individual barrier and, separately, the cumulative effect of multiple barriers. States reported 6 barrier types, including regulatory issues (n = 14, or 28%), contracting issues (n = 14, or 28%), purchasing issues (n = 6, or 12%), legislative issues (n = 5, or 10%), staffing issues (n = 5, or 10%), and issues transferring funds between state and local health departments (n = 4, or 8%). In multivariate models, having experienced a purchasing barrier was associated with a significant decrease in PHER allocation (B = -26.4; P = .018). Separately, the cumulative effect of having 3 barriers was associated with a decrease in PHER allocation (B = -16.0; P = .079). Purchasing barriers were associated with delayed use of PHER funds. Moreover, the cumulative effect of any 3 barriers hampered the allocation of funds. Understanding barriers to using funds can inform future funding guidance for improved efficiency of response efforts.

Factors Associated with the Willingness of Health Care Personnel to Work During an Influenza Public Health Emergency: An Integrative Review

The first decade of the 21st century has witnessed three major influenza public health emergencies: (1) the severe acute respiratory syndrome of 2002-2003; (2) the avian flu of 2006; and (3) the 2009 H1N1 pandemic influenza. An effective public health response to an influenza public health emergency depends on the majority of uninfected health care personnel (HCP) continuing to report to work. The purposes of this study were to determine the state of the evidence concerning the willingness of HCP to work during an influenza public health emergency, to identify the gaps for future investigation, and to facilitate evidence-based influenza public health emergency planning. A systemic literature review of relevant, peer-reviewed, quantitative, English language studies published from January 1, 2001 through June 30, 2010 was conducted. Search strategies included the Cochrane Library, PubMed, PubMed Central, EBSCO Psychological and Behavioral Sciences Collection, Google Scholar, ancestry searching of citations in relevant publications, and information from individuals with a known interest in the topic. Thirty-two studies met the inclusion criteria. Factors associated with a willingness to work during an influenza public health emergency include: being male, being a doctor or nurse, working in a clinical or emergency department, working full-time, prior influenza education and training, prior experience working during an influenza emergency, the perception of value in response, the belief in duty, the availability of personal protective equipment (PPE), and confidence in one's employer. Factors found to be associated with less willingness were: being female, being in a supportive staff position, working part-time, the peak phase of the influenza emergency, concern for family and loved ones, and personal obligations. Interventions that resulted in the greatest increase in the HCP's willingness to work were preferential access to Tamiflu for the HCP and his/her family, and the provision of a vaccine for the individual and his/her family. Understanding the factors that contribute to the willingness of HCP to report to work during an influenza public health emergency is critical to emergency planning and preparedness. Information from this review can guide emergency policy makers, planners, and implementers in both understanding and influencing the willingness of HCP to work during an influenza public health emergency.

Practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic

We examined practices of obstetrician-gynecologists regarding nonvaccine-related public health recommendations during the 2009 H1N1 influenza pandemic. From February to May 2010, a survey was sent to a random sample of members of the American College of Obstetricians and Gynecologists involved in obstetric care. Obstetrician-gynecologists varied in their adherence to 2009 H1N1 influenza public health recommendations. Nearly all reported prescribing antiviral medications to pregnant women with suspected influenza. Most obstetrician-gynecologists reported using preventive practices in the outpatient setting to reduce exposure of well patients to ill ones. A wide range of responses was provided regarding postpartum infection control practices, suggesting lack of awareness of, disagreement with, or difficulty adhering to these recommendations. Obstetrician-gynecologists reported that they adhered to some recommendations related to 2009 H1N1 influenza, but not to others. These data provide insight into strategies for development and dissemination of recommendations in a future pandemic.

Senior clinical nurses effectively contribute to the pandemic influenza public health response

Objective: To describe the experience of engaging senior clinical nurses as surge staff in a pandemic public health response and determine the effect of an on‑line training package and exercise participation on these individuals’ perceptions and confidence of being deployed during an influenza pandemic. Design: After action reviews, end of exercise surveys, and pre‑ and post‑training risk perceptions questionnaire completion. Setting: The study was conducted within the operational aspects of a public health exercise response to an influenza pandemic. Subjects: Clinical nurse consultants, nurse educators and nurse managers sourced from areas defined as not clinically critical during the early containment phase of an influenza pandemic response. Interventions: Four hour on‑line training package and a four day influenza pandemic exercise. Main outcome measures: Expert observation and self‑perceived appropriateness of surge staff and measured changes in risk perception. Results: Observers’ comments and after action reviews indicated that by the end of the deployment, day surge staff were able to perform public health surveillance functions competently. The end of day survey showed that the on‑line training package served as a useful reference document but alone was an inadequate means of equipping staff for deployment. Exercise pre‑ and post‑perceptions surveys found that self‑perceived knowledge and confidence in performing duties increased following the exercise from 46% to 93% (p<0.01) and from 46% to 90% (p<0.01), respectively. Conclusion: Clinical nurse consultants, nurse educators and nurse managers working within a health authority are an appropriate surge workforce during public health emergencies if provided with appropriate training and support.

‘Plausible uncertainty’: The negotiated indeterminacy of pandemic influenza in the UK

Policymakers in the UK (and worldwide) are preparing for what is said to be an inevitable and imminent influenza pandemic. However, aside from its inevitability, there is a considerable amount of uncertainty surrounding the pandemic. Public health policy is flexible and ad hoc, and this, the public is told, is a direct result of the natural unpredictability of the influenza virus, This article argues that we should not uncritically accept policymakers’ assertion that the uncertainty surrounding pandemic influenza public health is simply a result of this natural unpredictability. Uncertainty in public health policy must be understood in terms of its socio-political, as well as its scientific, context. Uncertainty is seen to occupy two separate but related levels: basic scientific uncertainty and public health policy uncertainty. This study shows how the former, which to an extent is real uncertainty, is translated into the latter which is (re)constructed and politicised as ‘plausible uncertainty’. The actors are seen to displace accountability onto the influenza virus through a naturalistic account of uncertainty which fails to include a public discussion of those socio-political factors, such as funding and licensing, which also help to shape both scientific research and policy formulation, and which subsequently have an impact on how well prepared we are for coping with a pandemic. The danger, it is suggested, is that the existence of a ‘culture of precaution’ too easily allows for a naturalistic account of uncertainty to be seen as a justifiable solution to a difficult policy problem, in instances where the full social and political context of the issue may not have been openly discussed.