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This year's Stats of Influenza: Microbiology, pathophysiology and possible treatments.


H1N1 virus

This morning I read an article that stated the CDC was closing or is closed, I didn’t read that far into the article because I was interrupted by my child. So this morning I pulled out my medical microbiology book (Medical Microbiology 6th ed. By: Patrick R. Murry, Ken S. Rosenthal, Michael A. Pfaller) and re-looked up the Influenza virus. It was a fantastic idea, because it provided me a new perspective on treatment and prevention. I am using the CDC website (https://www.cdc.gov/flu/index.htm), my microbiology textbook previously listed, along with some other resources I will list in the text for references and will allow you to also read the information and Fact check/double check me – as I am human first.

So today (and in future) anyone who reads this blog will gain some medical terminology, microbiology on how the Influenza virus functions, the pathophysiology and some take away on what you can do naturally to protect yourself.

I do apologize if the first part of this section is hard to understand, if you do have questions, I do welcome them and will happily answer them to the best of my ability.

Influenza is a Orthomyxovirus, it is broken down into three subtypes – A, B, and C. Only A & B viruses cause significant disease (meaning that C is not known to infect and is not responsible for the outbreaks, epidemics and pandemics we know of). It is enveloped and has a segmented negative sense RNA genome (this facilitates the development of new strains though mutation and re-assortment of the gene segments among the human and animal strains or influenza A.

The genetic instability is responsible for the annual epidemics also known as drift or mutation, and the periodic pandemics also known as shift or re-assortment worldwide. Influenza as we all can basically understand is the most prevalent and significant of VIRAL infections, descriptions date back into ancient times. The most famous one to date that is depicted in writings is the Spanish Influenza Pandemic that swept the world in 1918 to 1919, killing 20 to 40 MILLION people. Not so fun fact: this pandemic killed more people than World War I had. Here is a list of notable years of influenza: 1918, 1947, 1957,1968, 1977, and again the avian influenza noted in Hong Kong in 1997 and 2009. Side note here (notice the pattern) 8,7,7,8,7,9… these are occurring in the later sections of the decades. And a strong strain occurs about every 10 years. This year’s major influence is also a TYPE of swine flu (one that effected 1918 - possibly, 1947, 1977, 2009 and 2017/2018) is H1N2, but is not the same type as the others which was H1N1. This years largest influencer is H3N2. (We will get more into the naming and categorization of these strains for further understanding later).

Influenza as many have experienced in one form or another are: respiratory symptoms. Classic “flu-like” symptoms include: Fever, malaise, headache and myalgias or body aches. The term flu is often mistakenly used to refer to many other respiratory and viral infections.

Structure and Function of the Influenza Virus:

Influenza virions (virus particles) are pleomorphic meaning it has the ability to have more than one form) appearing spherical or tubular, and ranges in diameter from 90-120 nm (nanometers – are a very small measurement within the scientific community; conversion 1 milimeter = 1,000,000 nm). The envelope contains two glycoproteins, hemagglutinin (HA) and neuraminidase (NA), the membrane (m2) protein and is internally lined by a matrix (m1) protein. A & B viruses consist of 8 different helical nucleocapsid segments each that contain a negative sense RNA associated with the nucleoprotein (NP) and the transcriptase (RNA polymerase components: PB1, PB2 and PA) whereas influenza virus C only contains 7 genomic segments.

The HA forms a spike like shape trimer, each unit is activated by a protease and is cleaved into two subunits held together by a disulfide bond (or two sulfers covalently bonded). The HA has several functions: viral attachment protein, binding to Sialic acid of the glcyoproteins on the epithelial cell surface receptors, promoting fusion of the envelope to the cell membrane (allowing for the virus to enter the host cell), hemagglutinates binds and aggregates human, chicken, and guinea pig red blood cells or a fancy way of saying these bloods clump and therefore cause damage by their impedance of flow, and elicits the protective neutralizing antibody response - hemagglutinates is also what Dr. D'Adamo's work is based on and how our different blood groups work, universal donor vs. universal recipient of blood. HA is responsible for minor or drift changes and the major or shift changes in the virus’s antigenicity. Major changes or Shifts only occur with influenza A virus, these are designated into H1, H2, H3 etc.

The NA glycoprotein forms a tetramer and has enzyme activity. The NA cleaves the sialic acid on glycoproteins, including the cell receptor. Cleavage of the sialic acid on virion proteins prevents clumping and facilitates the release of virus from infected cells, making NA a target for two antiviral drugs: zanamivir (Relenza) and oseltamirvir (Tamiflu). The NA of influenza A virus also undergoes antigenic changes and major differences acquire the designations N1, N2, N3 etc.

The membrane (m2), matrix (m1), and nucleoprotein (NP) are type specific and are used to differentiate influenza A from B from C viruses. The matrix proteins line the inside of the virus and are responsible for assembly. Membrane proteins form the proton channel in membranes and promotes uncoating and viral release, this makes it a target for pharmaceutical companies as a way to “prevent” or rather inhibit further damage and spread of the virus, drugs included are: amantadine and rimantadine.

Pathogenesis and Immunity:

Influenza initially establishes a local upper respiratory tract infection. The Virus first targets and kills mucus secreting, ciliated and other epithelial cells, causing the loss of this primary defense system. NA facilitates the development of the infection by cleaving sialic acid residues of the mucus, in turn provides access to the surface area of the tissues.

Virus travels via cell to cell meaning a neighboring cell may easily also become infected and spread this route. If the virus spreads to the lower respiratory tract, the infection may cause desquamation – or shedding of epithelial cells (a particular layer that protects all our organs, skin, and mucus membranes) particularly of the bronchial and alveolar epithelium down to a single cell basal layer or the basement membrane. This action predisoposes a person to secondary infection, primary pneumonia and secondary pneumonia (primary pneumonia means caused by the influenza virus and secondary pneumonia means a bacterial/viral build-up on the cellular matter that was compromised). Histologically, influenza infection promotes an inflammatory cell response of the mucus membrane, primarily of monocytes, lymphocytes and few neutrophils. Submucosal edema (swelling) is present. The lung tissues may reveal hyaline membrane disease, alveolar emphysema and necrosis of the alveolar walls.

Immunological response is that the interferon and cytokine responses peak at almost the same time as virus in nasal washes and are concomitant with the febrile phase of disease. Influenza infections depress macrophage and T-Cell function, hindering immune resolution. Recovery is generally underway prior to detection of the antibody in the blood or serum. Antibodies to both HA and NA are protective, each reaction is specific to each strain. However, if you have antibodies to HA and/or NA the cell mediated response is able to recognize another strain, it may not be as fast a reaction/defense if it were the same strain but it is faster than without.

The virus path:

On days 0-5ish = incubation period

Day 1 to day 9: virus is in respiratory secretions (meaning it may spread)

Before day 2 to 20+ days symptomatic influenza-like disease and convalescence. Day 2 to Day 11ish: Interferon Induction

Day 5+ to 26+ days: Cell- mediated immune response above baseline.

Day 7 to Day 14ish: Secondary bacterial infection

Day 7+ to 26+ days: pathological changes evident in respiratory tract

Day 8 to continuous: Rise in virus-specific antibody

Prevention and Treatment:

Common “Western” Allopathic Medicine:

Antiviral medications: amantadine, rimantadine to inhibit un-coating step of influenza A (not effective against influenza B & C viruses), Zanamirvir and oseltamivir to inhibit both influenza A and B as enzyme inhibitors of neuraminidase. The medical microbiology books states it is almost impossible to limit airborne spread of influenza – ( I agree with this, we can’t prevent people from living their lives, but we can protect our bodies and prevent as much as we can by increasing our own health and wellness including our settings).

Natural Immunization results from prior exposure, is protective for a long period of time. A killed virus vaccine representing the “strains of the year” which is the current vaccine is a predictor of possible strains or common strains that tend to infect. The Influenza virus is a mixture of extracts or purified HA and NA proteins from three different strains of the virus. The vaccines are prepared in egg and then chemically made inactive or killed. Ideally this vaccine will incorporate virus particles from both A and B but is not mandatory. Each vaccine type is based on the region such as: A/ New Caledonia/20/1999 (H1N1) – like and A/Wisconsin/67/2005 (H3N2) – like and B/Malaysia/2506/2004 – like antigens.

This medical professional area typically recommends the vaccine to anyone over 50 years of age, healthcare workers, pregnant women (who will be in their 2nd or 3rd trimester during the season) those living in a nursing home, people effected by chronic pulmonary heart disease, and also children ages 1 to 18. It leaves a small gap of people that do not necessarily “need” this vaccine, ages 19 to 50. There is also a live vaccine that comes in the form of a nasal spray (I believe the medical profession is moving away from this form), but it would provide a more natural response in the body: providing natural protection, including cell-mediated, antibody and mucosal-secretory immunoglobulin (Ig)A antibody.

The previous information is all from the text book.

The following information will be from our current stats based on CDC & local government public health websites. Currently the interactive statewide website is mainly widespread with a couple local activity states included are D.C. and Hawaii, Regional activity in Guam, and sporadic activity in Virgin Islands.

Here are CT’s stats:

Virus type is Influenza A: H3N2. Statewide Emergency room/department (ED) attributed to fever/flu syndrome are increasing are currently at 7.4% which is above the 5% statewide level (the minimum threshold). The percentage of outpatients with influenza-like illness is approaching 5% well above the 1% statewide, baseline. The percentage of unscheduled hospital admissions due to pneumonia ate at 4% which is the statewide baseline.

A total of 456 hospitalized patients with a laboratory confirmed influenza admitted between Aug. 27, 2017 and Jan 6, 2018: of these 341 are Type A (subtype unspecified), 49 Type A (H3N2), 2 Tpe A (2009 H1N1), and 64 influenza B (unspecified). There are 15 influenza deaths to date , this season in persons 65 years +. A total of 1,015 influenza positive laboratory tests were reported during the current season. Hartford 367, Fairfield 256, New Haven 229, New London 58, Tolland 38, Middlesex 31, Litchfield 23, and Windham County 13. Of the 1,015 reported, 730 Type A (unspecified), 109 Type A (H3N2), 9 Type A (2009 H1N1), 164 Influenza B and 3 unknown types.

Looking at the graphs, It is in my opinion that we will continue to see an increase or rise of influenza (it will jump) decline momentarily then spike between now and the end of February beginning March, then decline again. This year’s influenza seems to be dramatically effecting our elderly age group of 65+ years of age, with hospitalizations. Followed by age group of 50-64, then 18-49 years of age and least our children less than 5 years, and the 5-17 year olds I do not even see their color on the graph.

I do like these pie charts… But please consider all the information when looking at it… 100 cases vs 1000s of cases is different – they all look similar in presentation however they are different with the numbering system. https://gis.cdc.gov/grasp/fluview/flu_by_age_virus.html

This following link provides some interesting information regarding mortality & influenza to date state by state and during week periods. Deaths are associated with pneumonia. This is important because it is not the flu killing it is the secondary causes. There are processes and steps we can all take to increase our health, wellbeing and vitality. https://gis.cdc.gov/grasp/fluview/mortality.html.

For Your naturopathic treatments here are some basic things you can do:

1. Increase your Vitamin A (if you are pregnant do not go above 5,000 IUs/day)

- If you are using Vitamin A use the guidance of a professional, there are serious side effects and long term effects.

- Increase your Orange and Yellow vegetables (this helps provide vitamin A in a safe manner)

2. Zinc, helps hold the cells together preventing desquamation and cell integrity.

3. Increase your berries of red, “blue” and purple, these provide proanthrocyanidins, which have antimicrobial activity and antioxidant activity keeping you feeling energized and well.

4. Wet Sock Treatment: follow the directions here! https://healthylivinghowto.com/children-fevers-the-wet-sock-treatment/

This treatment is amazing, every time I do this on myself I go to sleep early (feeling rather crummy) and come 5/6 in the morning I spring out of bed happy as a clam J so worth the chilliness that warms up.

5. Go see your naturopath… They are more than happy to help and assist you to make your plan of action that is specific to you.

I hope you all stay well out there. Make sure to breath the air deeply and enjoy your life, make connections everyday with people as this is a positive predictor of living past 100!

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