Etiology

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Prévention de l’InfluenzaPublished by: Groupe de travail Développement de recommandations de première ligneLast published: 2018Preventie van influenzaPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2018

Seasonal influenza virus is a member of the orthomyxovirus family. It has a segmented, single-stranded RNA genome that can be classified into influenza A, B, and C based on antigenic differences. The RNA codes for five structural proteins and three non-structural proteins. Protein M and nucleoprotein NP elements are used to classify the virus into the types A, B, and C. Other elements of the virus structure, haemagglutinin (H antigen) and neuraminidase (N antigen), are important in the pathogenesis of the disease. The H antigen is required for binding and entry of the virus into the cell. The N antigen helps the mature virus to escape from the cell.

Seasonal influenza virus types A and B are also divided into a number of subtypes. These subtypes are defined by the H and N antigens present on the virus. There are three antigenic subtypes of H antigen (H1, H2, and H3) and two antigenic subtypes of N antigen (N1 and N2), allowing for a number of different combinations. Antibodies to one subtype of H or N antigen do not react with another type of the H or N antigen.

Influenza C is not associated with epidemics or pandemics and causes mild disease. Influenza A is responsible for frequent (usually annual) local outbreaks or larger epidemics of varying intensity every 2-3 years, and occasional pandemics. Influenza B causes outbreaks approximately every 4 years, with usually milder disease than influenza A.[12] Epidemics usually occur from late autumn to early spring.

New vaccines are required each influenza season because small point mutations in the proteins that make up the influenza virus cause antigenic drift. Larger changes that result in new haemagglutinin or neuraminidase proteins cause antigenic shifts and may result in pandemics. Special terminology used when discussing an influenza virus includes the type of influenza virus, the place it was first located, and the year it was first discovered.

Pathophysiology

Seasonal influenza virus is transmitted through infected respiratory droplets that are aerosolised by coughing, sneezing, or talking. Less commonly, contact with fomites may cause transmission.[5]

The virus binds to and enters the tracheobronchial ciliated epithelium by utilising the viral surface haemagglutinin (H antigen). Viral replication then occurs. Peak viral shedding occurs in the first 48 to 72 hours of exposure to the virus, then declines and becomes undetectable within 10 days. Children and immunocompromised people may shed virus for several weeks.[13]

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