Why Flu is a Bigger Threat to US population Than Ebola

Since December 2013, the fear of the potential effects of this disease in the U.S. has grown significantly. Fear heightened when the first patient was diagnosed in our country on September 30th. While Ebola is a major international health concern, it does not represent even a fraction of the degree of risk that influenza does for us every year. In order to understand why, a closer look at how each disease spreads and some statistics are warranted.

  • Ebola is a disease that requires direct contact with body fluids from someone who is infected with the virus or with objects contaminated with these fluids for person to person disease transmission. In contrast, flu can spread by respiratory droplets from infected individuals that can travel through the air up to six feet to potentially infect others. Additionally, the flu virus can live on surfaces outside the body for up to 48 hours and others can become infected when they touch these surfaces and then touch the eyes, nose, or throat without washing their hands first.
  • Ebola is only contagious when infected people start displaying symptoms. Flu, on the other hand, can be spread to others a full 1-2 days before a person becomes ill from it.

In West Africa, there are key factors that have facilitated the transmission of Ebola:

  • In this region of the world, the movement of human populations is approximately 7 times higher than the migration rates for other regions of the world (Alexander et al., 2014).
  • Bushmeat is a primary dietary staple in many regions of West Africa, representing as much as ¾ of an area’s meat source. The consumption of bushmeat represents a primary way for humans to become infected with Ebola from infected animals.
  • In this region, fear and mistrust of modern healthcare practices among a significant portion of the population remains, which can be very problematic for healthcare workers. In addition, these regions lack modern medical facilities and necessary medical supplies to offer humanitarian aid.
  • One of the most significant findings that has helped foster the rapid spread of Ebola in these regions are the traditional burial practices that are utilized for the dead. When a loved one dies, it is customary in many of these regions for family members and friends to help wash and prepare the body for burial and they also may spend a long period of time with the deceased person’s body. With proper protective equipment lacking and the massive loss of body fluids that are typically lost when someone with Ebola dies, this factor represents a significant potential mode of disease transmission. In Guinea alone, it has been estimated that 60% of the Ebola cases seen have been linked to traditional burial practices, including one funeral alone that was linked to the spread of the Ebola virus and subsequent deaths of 365 other people (World Health Organization, 2014).
  • The experience in the United States with the spread of the Ebola virus has been vastly different than the experiences in West Africa and can best be illustrated by looking at the cases of the first patient diagnosed with Ebola in the U.S. and the subsequent transmission to two nurses who cared for him. Both nurses who cared for the first patient did so at a time before there were clearly defined procedures for taking off equipment that healthcare workers use to help protect themselves from exposure, so it is thought that their exposures may have come from exposures to body fluid that may have occurred as part of the removal process. Furthermore, out of the 177 contacts of all three of these individuals with Ebola in Dallas (Chevalier et al., 2014) and the 164 Ohio contacts of the second nurse who traveled to this state (McCarty et al., 2014), not one person developed Ebola, even the persons living in the same household as the infected individual. While Ebola remains a significant concern today, the U.S. experience with the successful containment of the virus has been reassuring.

Unfortunately, the facts and statistics are not nearly as reassuring for influenza as can be seen from the following:

  • Each year up to 20% of people living in the U.S. becomes ill from the flu (Centers for Disease Control and Prevention, 2014a).
  •  Approximately 200,000 people each year are hospitalized with flu cases and flu deaths have ranged from approximately 3,000 people all the way up to 49,000.
  •  In 2013, nearly 60% of the cases of flu in people that had to be hospitalized occurred in people ages 18 to 64 years old (Centers for Disease Control, 2014b).
  •  Flu related deaths have been seen in college students, such as the previously healthy 22 year old Wright State University student who died in 2013  (Ohio College, 2014) and the 29 year old mother of three in Texas who died earlier this year (James, 2014).
  • College students are naturally very susceptible to getting sick from influenza in large part due to their hectic lifestyle and the exposures that they have to large numbers of others as a result of attending classes, social gatherings, and living arrangements

Fortunately, there is influenza vaccination available that can help protect college students and others against the flu and is widely regarded as the most effective way that individuals can protect themselves from becoming ill with the flu. Even in the years when it is not a perfect match for all of the strains that are circulating, such as what is occurring so far this year, it is still a good idea to get when this happens for three reasons:

  • There are usually three or more influenza strains that circulate in any given year, so it will very likely be a good match for two of the three strains and will offer protection.
  • There is also some evidence that suggests that previous exposure to flu strains in the past can offer up some protection if the same strain is encountered by the individual in the future

(http://content.time.com/time/health/article/0,8599,1835907,00.html).

  • Even when someone who has been vaccinated against the flu becomes ill from it during the same flu season, the severity of the illness tends to be milder than the cases seen in people who become ill who did not receive the flu vaccine during the season.

Another important fact to note is that many people do not realize that it takes two weeks for his/ her full immunity to build up after being vaccinated so he/ she may think that they got the flu from getting the vaccine when in actuality, they may have been exposed during to the virus during this two week period or to another disease that mimics flu symptoms.

In addition to getting the flu shot, there are other measures that people can take to help limit the spread of influenza, such as:

  • Make sure that hands are clean before touching the eyes, nose, or throat
  • Stay home when you are sick until you have been fever free for 24 hours without the use of ibuprofen, Tylenol, or other fever reducing substances.
  • Avoid close contact (within 6 feet) with others who appear to be ill.
  • Get in the habit of sneezing and coughing into your elbow, or cover them with a tissue
  • Wash your hands with soap and water or alcohol gel or foam at key opportunities, including after touching objects and surfaces that are commonly touched by many others, such as elevator buttons, doorknobs, and stair banisters.

References

Alexander, K. et al., (2014). What factors might have led to the emergence of Ebola in West Africa? Retrieved from http://blogs.plos.org/speakingofmedicine/files/2014/11/Alexanderetal.pdf

Centers for Disease Control and Prevention (2014a). Seasonal influenza questions &answers. Retrieved from http://www.cdc.gov/flu/about/qa/disease.htm

Centers for Disease Control and Prevention (2014b), Flu activity during the 2013-2014 season. Retrieved from http://www.cdc.gov/flu/pastseasons/1314season.htm

Chevalier, M.S. et al., (2014). Ebola virus disease cluster in the United States- Dallas County, Texas, 2014. MMWR, 63(46), 1087-1088.

James, S. (2014). Healthy Texas mom dies of flu, 29, leaves 3 kids. Retrieved from http://abcnews.go.com/Health/healthy-texas-mom-dies-flu-29/story?id=21467701

McCarty, C.L. et al (2014). Response to importation of a case of Ebola virus disease- Ohio, October, 2014. MMWR, 63(46), 1089-1091.

Ohio college student dies from flu complications (2014), Retrieved from http://www.wlwt.com/health/Ohio-college-student-dies-from-flu-complications/18088622

World Health Organization (2014). Sierra Leone: a traditional healer and a funeral. Retrieved from www.who.int

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