The UK is being hit with one of the worst flu seasons in recent decades. A total of 664 hospital admissions and 85 confirmed deaths have been reported since the beginning of winter 2017.
The British media have blamed “Aussie flu” for the outbreak. The truth is, there is not just one flu strain we should be worried about, and “Aussie flu” is a bit of a misnomer.
First, a bit about flu strains. There isn’t really a flu virus. Flu virus is a name we give a group of four closely related viruses: influenza A, influenza B, influenza C and influenza D. While humans can’t catch influenza D (that’s for pigs and cows), we can be infected with influenza A, B and C. Public health officials, however, are less worried about influenza C as it isn’t a major cause of illness. But influenza A and B are a real worry.
Influenza A has been found in – and causes disease in – lots of animals, including birds, bats, dogs, pigs and penguins. One of the major worries is pandemic influenza, where a new virus jumps from animals and spreads across the world easily because we haven’t had a chance to build up immunity to that new type.
Influenzas A and B can be subdivided even further by the proteins they carry on their surface – hemagglutinin (H) and neuraminidase (N). These proteins help the virus identify the right cells to infect.
For influenza A there are 18 Hs and 11 Ns identified so far. Hence we get names such as H1N1 for swine flu or H5N1 for bird flu. Contrast this with the fact that there are really only two lineages of influenza B, named after cities in Japan and Australia: Yamagata and Victoria, respectively.
The Hs and Ns are continuously evolving in response to our immune systems, which recognise and make antibodies to stop the virus taking hold. A vaccine usually supplies the H and N proteins without the potentially dangerous virus. Scientists also continuously track the H and N of circulating influenza viruses and adjust the vaccine to match what’s out there. This is the basis for flu vaccination and why you have to get a new vaccine jab every year.
Enter ‘Aussie flu’
“Aussie flu” refers to one kind of influenza A virus strain, the H3N2 strain.
The southern hemisphere, including Australia, just experienced one of its worst influenza seasons in recent history and this is the virus that has reached British shores. But we don’t actually know where the virus originated from. All we can say is, it probably wasn’t from Australia.
One place it is more likely to have come from is the sub-tropical regions that do not have winter seasons. These regions do not suffer from the same large flu epidemics that temperate countries like the UK and Australia have (we don’t know why, but some scientists have suggested it’s to do with temperature or humidity), but have continuous lower-level circulation of flu that allows influenza viruses to persist between winters.
What’s worrying about this season is the experience Australia had last flu season. Australia was hit particularly hard by influenza virus H3N2. H3N2 is a typical seasonal flu strain – like H1N1 – but it tends to be more difficult to control.
There are three red flags this flu season, and they are that H3N2 viruses typically causes more hospitalisations and deaths in older people, there are difficulties in producing effective H3N2 vaccines (explained below), and there’s more than just H3N2 to consider, especially in the UK this year.
Although good against the other strains, this season the vaccine is about 20% protective against H3N2 viruses (not great, but better than nothing) as the virus changed unavoidably during production. This is due to a quirk of how flu vaccines are produced. They are grown in chicken eggs, and then inactivated before being used in vaccines.
Flu viruses mutate quickly and they mutate to adapt to their environment. Of course, a chicken egg is a different environment to a human body, so the end result may be a virus that’s not best suited to a flu vaccine. This appears to have been what happened with the latest H3N2 vaccine.
Seasonal flu epidemics are usually caused by a mixed bag of viruses. This year, the mix is so far mainly shared between H3N2 and influenza B.
What’s worse is that this increase in proportion of influenza B makes it more difficult to protect from because the most popular vaccine in the UK is a “trivalent” that protects against three flu viruses (H1N1, H3N2 and one of the two kinds of influenza B). This year, though, the other type of influenza B (Yamagata) is more common meaning that those with the trivalent vaccine will be protected less, although they would likely get some cross-influenza B protection.
One vaccine to rule them all
Influenza is incredibly diverse. And this diversity can have devastating consequences for human and animal health. Although our ability to track flu, predict the viruses making up the next season and produce safe and effective vaccines is improving, we are always playing catch up. Efforts to produce a universal flu vaccine are, however, being pursued by scientists across the world. The idea would be that a single vaccine given a few times during your life would protect you from any flu virus, irrespective of H, N, A or B.
But, until then, you can defend yourself and your loved ones from the flu this year by getting your vaccine, practising good personal hygiene, such as handwashing, and avoiding crowded spaces if you are experiencing flu-like symptoms.
Connor Bamford, Virologist, University of Glasgow and Julien Amat, PhD Candidate, University of Glasgow. This article was originally published on The Conversation. Read the original article.
Safe staffing and equality have been an issue since the start
Parliament passed the Nurses Registration Act in 1919.
A new exhibition charts the history of nursing from the Nurses Registration Act to modern-day.
In the centenary year of nurse registration, a new exhibition charts the history of the journey from the Nurses Registration Act in 1919 through to the modern-day.
Called ‘Wake up Slackers! The great nursing registration controversy’ the exhibition looks at the heated arguments around the official registration of nurses through the first registration of men, overseas nurses and one of the first nurses to be struck off.
The Royal College of Nursing (RCN) was just three years old when registration first happened and securing this had been part of its founding ambitions.
The exhibition shows how many of the discussions and controversies of the past, including safe staffing, continue today and influence many of the discussions around modern nursing.
The Nurses Registration Act.
The exhibit contains artefacts from the RCN archive including invites to member meetings to discuss the College’s proposals for state registration, House of Commons Parliamentary debates during the year the Nurses Registration Act was passed in 1919, as well as drafts of legislation.
Opening during Black History Month, the exhibition also showcases the story of Eva Lowe, one of the first known black nurses on the register. Research shows how, despite being well qualified she was rejected many times before finding employment. It shows how she received vague and unsatisfactory excuses for her rejection, some based on false concern for her welfare.
As well as letters and documents from the RCN’s own archive, the exhibition will also feature items loaned from other collections such as that of the regulator the Nursing and Midwifery Council.
Are nurses born or made?
Frances Reed, Events and Exhibitions Co-ordinator at the Royal College of Nursing said: “It is incredible today to think that 100 years ago there were arguments about whether or not nurses should be registered.
“Today it seems unthinkable for somebody with such responsibility for the welfare of patients not to be registered and yet there were strident clashes over it, despite other health professions securing regulation well before nursing.
“The story of the first black nurse on the register, Eva Lowe is important to highlight too. There is little known about black nurses whose names are on the very early 1920s registers. It is essential we recognise that their contribution to health care existed well before Windrush.
“It’s also particularly striking to see how hard Eva Lowe had to fight to become the first black nurse on the register, and how 100 years later racial inequalities still exist in the health and care system.
The exhibition runs at RCN HQ in Cavendish Square, London 17 October – 20 March 2020
One in six nursing associates drop out before qualifying, finds report
Despite this trainees showed “high levels of enthusiasm and commitment to the programme”.
Only 65% of trainee nursing associates said they planned to work as a nursing associate once qualified.
An independent evaluation of the nursing associate role commissioned by Health Education England (HEE) has found that while there are “high levels of enthusiasm and commitment to the programme”, one in six nursing associates are dropping out before completing the course.
Attrition rates for trainee nursing associates fell slightly below that of student nurses, with 18% leaving before completing the course.
While ill health and personal issues were some of the most common reasons for leaving the programme, nearly a quarter (23%) withdrew because they failed to meet the academic requirements of the programme – with numeracy skills cited as a key issue.
One trainee said they found the “attitudes towards the role and the negative feedback about Nursing Associates” challenging.
Only 65% of trainees said they intend to continue working as a nursing associate once qualified as the programme is often seen as a stepping stone to becoming a registered nursing.
Mark Radford, Chief Nursing Officer, Health Education England said the report “highlights some challenges that we must address to ensure that students such as ensuring the quality and oversight of placements, attrition and numeracy support.”
“We also recognise that further work and research is required to ensure that the profession is supported and utilised in the workforce of health and social care as part of the MDT. I am pleased to be able to report that we are in the process of identifying candidates to be considered as NA ambassadors across England.
Commenting on the report, Andrea Sutcliffe, Chief Executive and Registrar for the Nursing and Midwifery Council (NMC), said; “Having had the pleasure of meeting many nursing associates across the country, I am continually inspired by their enthusiasm and dedication for providing care and they should be very proud of the difference they make for the people they support.”
“I look forward to seeing how nursing associates continue to develop and be supported in their work, long into the future.”
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