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The Journal for Employee Protection
The Journal for Employee Protection
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With the World Health Organization declaring 2019-nCoV (novel coronavirus) a global health emergency, Dr Ioanna G Alexandropoulou takes a look back at the spread of respiratory viruses from recent history.
Whether in people, pigs or poultry, due to its airborne nature influenza
can spread quickly. Here with information on how to protect ourselves against
emerging respiratory viruses is Dr
Ioanna G Alexandropoulou.
During the last
decade, new respiratory viruses of concern occurred worldwide, mainly with high
mortality. In 2011 was the virus influenza subtype A (H3N2)v, which was derived
from pigs was detected in humans. The following year Middle East respiratory
Syndrome coronavirus, or MERS-CoV was detected in countries of the Arabian Peninsula.
The influenza virus A (H7N9) was detected in 2013 in China. Recently, new
influenza viruses emerged: A (H10N8), A
(H6N1) and A (H5N8) in SE Asia.
It seems that the
ability of certain viruses to cross the species barrier and infect humans, in
conjunction with increased human-animal contact, was the main reason for the
emergence of SARS coronavirus in 2003 and MERS in 2013.
In parallel, the
increased alertness of public health authorities and the WHO combined with the
new diagnostic tools for viral infections, has contributed to the increased
possibility of detecting cases of emerging viruses. In previous outbreaks of
respiratory infections, even fatal ones, was not always possible to be
diagnosed, thus, many emerging viruses were not always known.
Endemics and pandemics
infections can be endemic or pandemic.
word endemic comes from a combination of two Greek words: endon, meaning within,
and dimikos, meaning municipality or community. By understanding this
linguistic root it becomes clear that the disease incidence of an endemic is
localised to a specific population or certain community. The term endemic also
characterises the appearance of a disease, which occurs continuously in time in
the same area and has a constant effect in that region or group of people who
live in that region.
A pandemic, on the
other hand, is the large-scale spread of an epidemic disease affecting a very
large percentage of the population worldwide.
The word pandemic
refers to diseases of global importance, such as AIDS and Malaria.
The outbreak is the spread
of a disease observed in a large group of people in a certain geographical
area. If a disease reaches an epidemic this means highly contagious spreading e.g.
epidemic viral gastroenteritis.
The acute respiratory
infections are the main causes of morbidity and mortality worldwide, especially
in paediatric populations. Approximately half of these are due to respiratory
viruses, with the most important, at least from a public health perspective, being
collectively the flu viruses. They are responsible for seasonal flu epidemics each year, which can affect thousands of people throughout
winter in each country.
Influenza is an
infectious disease of the respiratory tract, which can cause mild to severe
illness and can even lead to death, depending on the virus strain and the
population group that it infects.
Influenza is also
responsible for unpredictable pandemics with significant loss of life and large
economic costs. Influenza has struck globally throughout history: the Spanish
flu of 1918, as well as influenza pandemics in Asia, Hong Kong and Russia in
1957, 1968 and 1977, respectively.
literature, influenza viruses primarily infect birds, but can also infect
mammals. Therefore, there is an enormous reservoir of influenza viruses in
nature, with the majority of them not capable of affecting humans.
Nevertheless, when influenza
viral genes derived from birds and mammals, pigs in particular, combine with
human strains of the virus, this creates new subtypes of influenza virus that can
infect humans and cause severe disease. If these viruses then achieve the human-to
human transmission route they could cause pandemics.
The flu wave
The endemic wave of
flu is spreading in Europe, USA and Canada and based on all data, there is a
new, differentiated strain of influenza H3N2. This strain is characterised by
increased morbidity and increased frequency of serious complications, compared
to other influenza strains.
In Greece according to
the Hellenic CDC, during 2013-2014, 338 cases were recorded that required
hospitalisation in the ICU. A total of 145 of the hospitalised patients
eventually died from complications of the flu.
The epidemic wave of
influenza in Greece generally takes place the period between January and March,
with peak activity during February and March. This winter just gone, however,
the wave began earlier – almost in December.
Similar was the situation
across Europe. According to data recorded by the European Centre for Disease
Control (ECDC) a significant increase in flu cases was recorded in late
December throughout Europe. In addition, according to the European Observation
System for Morbidity in primary care, in European countries the influenza
morbidity level increased week on week.
characterised by the sudden onset of severe symptoms such as high fever, severe
fatigue, myalgia, arthralgia, headache and cough that can last between two and
seven days. Children may have gastrointestinal symptoms such as nausea,
vomiting and diarrhoea, while in adults the symptoms are less frequent.
One of the major
complications of influenza, which in some cases leads to death, is pneumococcal
pneumonia. Sometimes, even the flu virus itself can cause pneumonia. Other
complications are also asthma attacks in people suffering from bronchial
asthma, exacerbation of chronic bronchitis, worsening of heart failure or
diabetes. Children may also be co-infected and suffer from sinusitis and
How infection occurs
As the nursery rhyme
goes – coughs and sneezes spread diseases. When infectious persons sneeze and
cough their virus becomes airborne and can be inhaled by others in the
surrounding area, hence the importance of covering the mouth and nose when
sneezing and coughing. Droplets can also settle onto surfaces, further
spreading the transmission.
In general, influenza
viruses cause respiratory infection cases that run for just a few days. Nevertheless,
in some cases there can be serious complications, especially for people of high
risk groups such as:
The following are general
guidelines for personal protection and restricting the spread of all
In the event of
clinical symptoms seek help, advice and treatment from the healthcare services.
Population groups at
high risk of developing a complication of influenza, together with those in enclosed
populations, should be vaccinated in a timely manner. It should be noted that
the vaccine against influenza must be timely because it provides protection
around two to three weeks after the completion of vaccination.
What should be
There is a need for
special awareness in the community for the scrupulous observance of hand and
respiratory hygiene measures. In addition, doctors should administrate timely antiviral
therapy to high risk groups and persons with severe infections.
It is also advised
that patients seek medical advice in the event of prolonged or severe influenza
symptoms, even if they are not at increased risk of complications. The global
alert to prevent pandemic influenza and other respiratory infections should
lead to a better informed population and should increase the appropriate
preventive, diagnostic and therapeutic measures.
Dr Ioanna G Alexandropoulou
Dr Ioanna Alexandropoulou studied Molecular Biology and Genetics at the Democritus University of Thrace, Greece. In April 2013, she received her PhD in Public Health and Molecular Epidemiology from the Laboratory of Hygiene and Environmental Protection in the Medical School of Democritus University of Thrace.
Dr Alexandropoulou is a research collaborator in the Laboratory of Hygiene and Environmental Protection, where since 2006 she has developed her skills in both microbial detection and identification using cultural and molecular techniques, and also in public health protection.
Dr Alexandropoulou is a post-doctoral researcher in the department of Environmental Engineering’s Laboratory of Wastewater Management and Treatment Technologies, and in the Laboratory of Microbiology of Democritus University of Thrace.
Her research areas of interest are the prevention of Legionella infections, molecular typing, surveillance and environmental monitoring of Legionella spp, clinical and environmental microbiology and especially bacteriology, parasitology and molecular epidemiology. She has an adequate knowledge of a wide range of molecular techniques such as PCR, Real Time PCR, RAPD, PFGE, sequencing analysis and phylogenetics.
Her current position is PhD Molecular Biologist at the Regional Public Health Laboratory of Eastern Macedonia and the Thrace Region of Hellenic’s Centres for Disease Control and Prevention in Alexandroupolis, Greece.
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