Table of Contents
Pathophysiology and Immunological mechanisms
Patient education considerations
Type B- Influenza is a communicable viral disease caused by the B strain of seasonal flu virus or the influenza virus that contains four strains: A, B, C, and D (World Health Organisation, 2018). The influenza B differs from influenza A as it can pass only from human to human. The common indicators of the flu caused include fever, fatigue, muscular pain, sneezes, and cold. It is known to cause seasonal outbreaks but can be communicated in the population throughout the year (Amin et al., 2019).
The disease results in 3-5 million cases of severe illness and 250 000-500 000 deaths occur annually across the globe (World Health Organisation, 2016). In Australia, influenza outbreaks are a major public health problem. However, most of the influenzas cases that are reported belong to type A. Type A influenza has been known to account for 82.2% of total cases with 17.1% of affected individuals being affected by type B (Moa et al., 2017). The disease is a major health problem in Australia as it results in about 1500-3000 deaths annually (Government of Australia, 2020b).
According to the present statistics, 20,434 individuals in Australia are living with influenza (Government of Australia, 2020a). The common risk factors associated with Influenza B infection include age as it is more common in children younger than 12 months and adults above 65 years, obesity, pregnancy, weakened immune system, socio-demographic conditions, etc. (Bahadoran et al., 2016). The virus is transmitted through human interaction in the form of respiratory droplets, therefore, people who live in close contact and stringent species have high chances of communicability (Kalil& Thomas, 2019).
The pathophysiology of the virus is initiated with its entry into the host cells through a receptor mediated endocytosis. The HA proteins of the virus interact with the host cell and forms galactosidase linkages and enter the cells via endocytosis. The endosomes in the host cell possess acidic pH that alters the structure of the HA proteins. The cascade results in the release of ribonucleoprotein (RNP) molecules in the cytoplasm of the host cell that is transferred to the host nucleus. The viral RNPs then mediate the synthesis of the viral mRNA and the complementary RNA using the host cell machinery (Flannery et al.,2017). The virus can be active in bother upper as well as lower respiratory tracts. The sialic acid on the epithelial cells serves as the receptors for viral recognition and endocytosis. The incubation period of the virus ranges from 24 hours to 4 days and results in symptoms like fever, coughing, sneezing, and irritation in the respiratory tract (Kalil& Thomas, 2019).
The alveolar macrophages and monocytes are initially activated in the infection that results in the development of a proinflammatory response in the respiratory tract. Phagocyte-mediated opsonophagocytosis is carried out by the macrophages to limit the viral spread. The natural killer cells also play a critical role by binding to the HA proteins of the virus and restricting its action (Bahadoran et al., 2016). The innate immunity of the hosts plays an essential role in the limitation of the viral infections and also assists the limitation by initiating adaptive immunity response. The innate immune system recognises the virus through various pathogen recognition receptors (PRRs), namely, RIG-I, TLR3, TLR7 and TLR8, and NOD-like receptors (Flannery et al.,2017).
This identification initiates a cascade where the cytokines and the interleukins are activated. The NF-kB activates the pro-inflammatory cytokines to limit the virus. The monocytes and the macrophages of the immune system also play an essential role. Role of cytoplasmic complexes, inflammasomes have also been found to be associated with influenza virus detection (Bahadoran et al., 2016). This results in activation of IFN-α/β as type I IFNs that phosphorylate the tyrosine kinases and Janus kinases and further promote activation of transcription factors that aid in the establishment of an antiviral state in the body (Bahadoran et al., 2016). The adaptive immune memory response is mediated by the action of IFN-γ that activates the cytotoxic T cells against the influenza virus infection.
The immunoglobulins (Ig) A and M play a role in acting on the mucosal tissues for the prevention of viral spread. The IgA acts as an agent against the HA proteins and helps in the neutralisation of reaction limiting the infection. In primary responses against the virus, IgM has been found to be dominant, whereas IgG plays a crucial role in the viral elimination and management in secondary responses against the influenza B virus (Kalil& Thomas, 2019). The cellular immunity against the virus is mediated by CD4+ and CD8+, and T cells. The Th1 and Th2 viral specific cells are activated along with CD8+. T helper 17 (Th17) and the regulatory T cells also play a crucial role in the management and elimination of viral infection against influenza. The T cells also prompt the B cell responses and enhance the immunogenic reaction (Bahadoran et al., 2016).
The common antiviral drugs that are used for the treatment and management of Influenza B include zanamivir (Relenza) and oseltamivir (Tamiflu). The drugs function by inhibiting the action of the neuraminidase enzyme that is present on the viral surface. This inhibition promotes the release of virus from the infected cells. It also inhibits the viral replication assisting in recovery (Amin et al., 2019). The drug is administered by oral inhalation and is prescribed twice a day for five days with a gap of 12 hours. 10-mg dose is provided by 2 inhalations (one 5-mg blister per inhalation). The drug is prescribed to adults and paediatric patients aged above 7. The drug is not recommended for individuals with underlying respiratory health conditions like asthma or COPD as it can result in bronchospasms (Abraham et al., 2020).
The drug must be prescribed in cases with early symptoms. The influenza B vaccine is available. According to the World Health Organisation (2019), the trivalent vaccines against influenza also provides protection against the type B virus. Trivalent vaccines include an influenza A (H1N1) virus, an influenza A (H3N2) virus and one influenza B virus. Different influenzas shots are prescribed and are suitable for people belonging to different age groups. It is suggested that children who are above 6 months should get an annual influenza vaccination (Leung et al., 2017). The vaccination provides protection from the virus that can cause severe respiratory problems in the individuals.
Patient education is essential as it can help in the prevention of the disease and promote health in the community (Leung et al., 2017). The patient education and considerations assist in the containing the community spread and minimizing the infection rates for influenza B in the community and helps in preventing the secondary complications (Abraham et al., 2020). The patient education and considerations associated with influenza B include the following:
1. Promotion of vaccination: The vaccinations must be promoted as it is essential for infection control and management of the spread in the community (Leung et al., 2017).
2. Community welfare program: Multiple community welfare and education programs must be promoted to ensure that a large section of the community is aware of the care protocols, prevention strategies, and adherence to the medication associated with the community welfare programs (Abraham et al., 2020).
3. Implementation of respiratory hygiene and cough etiquettes: The individuals must be taught about the respiratory etiquettes that involve coughing with the hands on the mouth and maintenance of proper hygiene to minimise community spread (Amin et al., 2019).
4. Adherence to infection control protocol: The infection control protocol must be adhered to in the clinical settings to limit the incidences of the hospital acquired infections of influenza B and restrict its spread in the community (Moa et al., 2017).
5. Implementation of medical adherence strategies: It is important to adhere to the medical treatments and the medication procedures so that effective treatment is ensured and there is limited community spread (Abraham et al., 2020).
Influenza-B is a common health problem that results in global epidemic. The common symptoms of the disease include cold, fever, sneezing, etc. The risk factor associated are age, obesity, immune system strength, socio-demographic conditions, etc. The virus is attacked by both innate and the adaptive immune system to maintain health in an individual. The common drugs that are used for treatment are zanamivir (Relenza) and oseltamivir (Tamiflu). Vaccine for the disease is also available. However, it is suggested that patients follow medication and vaccination regimes with adherence to infection control and respiratory hygiene protocols to prevent infection spread and to contain the spread of the disease.
Abraham, G. M., Morton, J. B., &Saravolatz, L. D. (2020). Baloxavir: A novel antiviral agent in the treatment of influenza.Clinical Infectious Diseases.23(1), 258. https://academic.oup.com/cid/article-abstract/doi/10.1093/cid/ciaa107/5722404
Amin, H. S., Arafa, M. A., & Al-Omair, B. M. (2019). Physicians’ awareness and practice toward influenza and pneumococcal vaccines for high-risk patients. Journal of Family Medicine and Primary Care, 8(7), 2294.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6691468/
Bahadoran, A., Lee, S. H., Wang, S. M., Manikam, R., Rajarajeswaran, J., Raju, C. S., & Sekaran, S. D. (2016). Immune responses to influenza virus and its correlation to age and inherited factors. Frontiers in Microbiology, 7, 1841.https://doi.org/10.3389/fmicb.2016.01841
Flannery, B., Chung, J. R., Thaker, S. N., Monto, A. S., Martin, E. T., Belongia, E. A., ... &Nowalk, M. P. (2017). Interim estimates of 2016–17 seasonal influenza vaccine effectiveness—United States, February 2017. MMWR. Morbidity and Mortality weekly report, 66(6), 167.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5657861/
Government of Australia (2020). Influenza activity surveillance. Retrieved from: https://www.immunisationcoalition.org.au/news-media/2020-influenza-statistics/
Government of Australia (2020). Influenza fast facts. Retrieved from: http://www.isg.org.au/index.php/clinical-information/influenza-fast-facts-/ https://academic.oup.com/her/article/32/5/455/4061084
Kalil, A. C., & Thomas, P. G. (2019). Influenza virus-related critical illness: Pathophysiology and epidemiology. Critical Care, 23(1), 258.https://link.springer.com/article/10.1186/s13054-019-2539-x
Leung, K. C., Mui, C., Chiu, W. Y., Ng, Y. Y., Chen, M. H., Ho, P. H., ... & Pang, H. H. (2017). Impact of patient education on influenza vaccine uptake among community-dwelling elderly: A randomized controlled trial. Health Education Research, 32(5), 455-464.
Moa, A. M., Muscatello, D. J., Turner, R. M., &MacIntyre, C. R. (2017). Epidemiology of influenza B in Australia: 2001-2014 influenza seasons. Influenza and Other Respiratory Viruses, 11(2), 102–109. https://doi.org/10.1111/irv.12432
World Health Organization (2018). Influenza (Seasonal). Retrieved from: http://www.who.int/mediacentre/factsheets/fs211/en/.
World Health Organization (2019). Recommended composition of influenza virus vaccines for use in the 2019-2020 northern hemisphere influenza season. Retrieved from: https://www.who.int/influenza/vaccines/virus/recommendations/2019_20_north/en/
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