The influenza virus is a pathogenic virus responsible for large numbers of deaths and long-term disabilities worldwide. Although the very young, the very old, and immunocompromised individuals are most susceptible, the effects of the influenza virus can be observed across the entire spectrum of individuals.
Discussion:
Infection with the influenza virus induces a substantial inflammatory and immunologic response and induces marked pulmonary inflammation. Many aspects of influenza affect surgical patients directly. Vaccines are one of the most effective measures aimed at reducing the prevalence and severity of many infectious diseases, including the influenza virus. Vaccination programs remain one of the highest priorities across the spectrum of countries, research institutions such as the National Institutes of Health, international health agencies such as the World Health Organization (WHO), and major non-profit organizations.
Conclusion:
This review addresses aspects of the immune and inflammatory response to influenza, with a focus on the elderly population and healthcare providers who may act as reservoirs for virus transmission to the vulnerable surgical population.
Get full access to this article
View all access options for this article.
References
1.
MorensD, TaubenbergerJ, HarveyH, MemoliM. The 1918 influenza pandemic: Lessons for 2009 and the future. Crit Care Med, 2010; 38(Suppl 4):e10–20.
2.
JohnsonN, MuellerJ. Updating the accounts: Global mortality of the 1918–1920 “Spanish” influenza pandemic. Bull Hist Med, 2002; 76:105–115.
3.
JosephC, TogawaY, ShindoN. Bacterial and viral infections associated with influenza. Influenza Other Respir Viruses, 2013; 7(Suppl 2):105–113.
4.
MazickA, GergonneB, WuillaumeF, et al.Higher all-cause mortality in children during autumn 2009 compared with the three previous years: Pooled results from eight European countries. Euro Surveillance, 2010; 15:19480.
5.
Nguyen-Van-TamJ, OpenshawP, HashimA, et al.Risk factors for hospitalization and poor outcome with pandemix A/H1N1 influenza: United Kingdon first wave (May-September 2009). Thorax, 2010; 65:645–651.
SamjiT.Influenza A: Understanding the viral life cycle. Yale J Biol Med, 2009; 82:153–159.
8.
ZhangH, WangL, CompansR, WangB. Universal influenza vaccines, a dream to be realized soon. Viruses, 2014; 6:1974–1991.
9.
LauringA, AndinoR. Quasispecies theory and the behavior of RNA viruses. PLos Pathogens, 2010; 6:e1001005.
10.
KawaokaY, KraussS, WebsterR. Avian-to-human transmission of the PB1 gene of influenza A viruses in the 1957 and 1968 pandemics. J Virol, 1989; 63:4603–4608.
11.
PoonL, SongT, RosenfeldR, et al.Quantifying influenza virus diversity and transmission in humans. Nat Genet, 2016; 48:195–200.
12.
StrelkowaN, LassigM. Clonal interference in the evolution of influenza. Genetics, 2012; 92:671–682.
13.
OttingerM, MonaghanS, GravensteinS, et al.The geriatric cytokine response to trauma: Time to consider a new threshold. Surg Infect, 2014; 15:800–805.
14.
AgarwalD, SchmaderK, KossenkovA, et al.Immune response to influenza vaccination in the elderly is altered by chronic medication use. Immun Aging, 2018; 15:1–13.
15.
JutelA, BakerM, StanleyJ, et al.Self diagnosis of influenza during a pandemic: A cross sectional survey. BMJ Open, 2011; 1:e000234.
16.
CarratF, VerguE, FergusonN, et al.Time lines of infection and disease in human influenza: A review of volunteer challenge studies. Am J Epidemiol, 2008; 167:775–785.
17.
UyekiT, BernsteinH, BradleyJ, et al.Clinical practice guidelines by the Infectious Diseases Society of America: 2018 update on diagnosis, treatment, chemoprophylaxis and institutional outbreak management of seasonal influenza. Clin Infect Dis, 2018:1–47.
18.
UiprasertkulM, KitphatiR, PuthavathanaP, et al.Apoptosis and pathogenesis of avian influenza A (H5N1) virus in humans. Emerg Infect Dis, 2007; 13:708–712.
19.
AllenI, ScullM, MooreC, et al.The NLRP3 inflammasome mediates in vivo innate immunity to influenza A virus through recognition of viral RNA. Immunity, 2009; 30:556–565.
20.
JulkunenI, SarenevaT, PirhonenJ, et al.Molecular pathogenesis of influenza A virus infection and virus-induced regulation of cytokine gene expression. Cytokine Growth Factor Rev, 2001; 12:171–180.
21.
OsterlundP, PirhonenJ, IkonenN, et al.Pandemic H1N1 2009 influenza A virus induces weak cytokine responses in human macrophages and dendritic cells and is highly sensitive to the antiviral actions of interferons. J Virol, 2010; 84:1414–1422.
22.
HoeveM, NashA, JacksonD, et al.Influenza virus A infection of human monocyte and macrophage subpopulations reveals increased susceptibility associated with cell differentiation. PLoS One, 2012; 7:e29443.
23.
BrandesM, KlauschenF, KuchenS, GermainR. A systems analysis identifies a feedforward inflammatory circuit leading to lethal influenza infection. Cell, 2013; 154:197–212.
MorensD, TaubenbergerJ, FauciA. Predominant role of bacterial pneumonia as a cause of death in pandemic influenza: Implications for pandemic influenza. J Infect Dis, 2008; 198:962–970.
26.
MorganD, CasulliJ, ChewC, et al.Innate immune cell suppressioni and the link with secondary lung bacterial pneumonia. Front Immunol, 2018; 9:2943.
27.
RaniM, ZhangW, OppeltzR, SchwachaM. Gamma delta T cells regulate inflammatory cell infiltration of the lung after trauma-hemorrhage. Shock, 2015; 43:589–597.
28.
GibbingsS, ThomasS, AtifS, et al.Three unique interstitial macrophages in the murine lung at steady state. Am J Respir Cell Molec Biol, 2017; 57:66–76.
29.
PenalozaH, NietoP, Munoz-DurangoN, et al.Interleukin-10 plays a key role in the modulatioin of neutrophil recruitment and lung inflammation during infection with Streptococcus pneumoniae. Immunology, 2015; 146:100–112.
ChengM, HuS. Lung resident gd T cells and their roles in lung diseases. Immunology, 2017; 151:375–384.
32.
LiW, MoltedoB, MoranT. Type 1 interferon induction during influenza virus infection increases susceptibility to secondary Streptococcus pneumoniae infection by negative regulation of gd T-cells. J Virol, 2012; 86:12304–12312.
33.
HeffernanD, MonaghanS, ChungC, et al.A divergent response of innate regulatory T-cells to sepsis in humans: Circulating invariant natural killer T-cells are preserved. Hum Immunol, 2014; 75:277–282.
34.
VenetF, ChungC, MonneretG, et al.Regulatory T cell populations in sepsis and trauma. J Leukoc Biol, 2008; 83:523–535.
35.
van der SluijsK, van EldenL, NijhuisM, et al.IL-10 is an important mediator of the enhances susceptibility to pneumococcal pneumonia after influenza infection. J Immunol, 2004; 172:7603–7609.
36.
KokotovicD, BurcharthJ, HelgstrandF, GogenurI. Systemic inflammatory response after hernia repair: A systematic review. Langenbecks Arch Surg, 2017; 402:1023–1037.
37.
BrockmannL, GiannouA, GaglianiN, HuberS. Regulation of Th17 cells and associated cytokines in wound healing, tissue regeneration, and carcinogenesis. Int J Molec Sci, 2017; 18:e1033.
38.
RobertsonL, CaleyJ, MooreJ. Importance of Staphylococcus aureus in pneumonia in the 1957 epidemic of influenza A. Lancet, 1958; 2:233–236.
39.
McCullenJ.Insights into the interaction between influenza virus and pneumococcus. Clin Microbiol Rev, 2006; 19:571–582.
40.
LeeS, EickA, BloomM, BrundageJ. Influenza immunization and subsequent diagnosis of group A streptococcus illnesses among US army trainees, 2002–2006. Vaccine, 2008; 26:3383–3386.
41.
SmithA, HuberV. The unexpected impact of vaccines on secondary bacterial infections following influenza. Viral Immunol, 2018; 31:159–173.
42.
RizzoC, CaporaliM, RotaM. Pandemic influenza and pneumonia due to Legionella pneumophila: A frequently underestimated coinfection. Clin Infect Dis, 2010; 51:115.
43.
RothbergM, HaeselerS, BrownR. Complications of viral influenza. Am J Med, 2008; 121:258–264.
44.
FinelliL, FioreA, DharaR, et al.Influenza-associated pediatric mortality in the United States: Increase of Staphylococcus aureus coinfection. Pediatrics, 2008; 122:805–11.
45.
ZimmermanA, MarwahaJ, NunezH, et al.Preoperative myocardial injury as a predictor of mortality in emergency general surgery: An analysis using the American College of Surgeons NSQIP database. J Am Coll Surg, 2016; 223:381–386.
46.
HorrS, ReedG, MenonV. Troponin elevation after noncardiac surgery: Significance and management. Cleve Clin J Med, 2015; 82:595–602.
47.
SmeethL, ThomasS, HallA, et al.Risk of myocardial infarction and stroke after acute infeciton or vaccination. N Engl J Med, 2004; 351:2611–2618.
48.
ScraggR.Effect of influenza epidemics on Australian mortality. Med J Aust, 1985; 142:98–102.
49.
HuY, ChenY, LinY, ChenS. Inflammation and the pathogenesis of atrial fibrillation. Nat Rev Cardiol, 2015; 12:230–243.
50.
ChangT, ChaoT, LiuC, et al.The association between influenza infection, vaccination, and atrial fibrillation: A nationwide case-control study. Heart Rhythm, 2016; 13:1189–1194.
51.
KaoP, LiuJ, HsuY, et al.Influenza vaccination might reduce the risk of ischemic stroke in patients with atrial fibrillation: A population-based cohort study. Oncotarget, 2017; 8:112697–112711.
52.
LiuJ, WangT, SungL, et al.Influenza vaccination reduces hemorrhagic stroke risk in patients with atrial fibrillation: A population-based cohort study. Int J Cardiol, 2017; 232:315–323.
53.
FordA, TouchetteN, HallB, et al.Global vaccine and immunization research forum: Opportunities and challenges in vaccine discovery, development, and delivery. Vaccine, 2016; 34:1489–1495.
54.
BouvierN.The future of Influenza vaccines: A historical and clinical perspective. Vaccines, 2018; 6:e58.
55.
DemicheliV, JeffersonT, Di PietrantonjC, et al.Vaccines for preventing influenza in the elderly. Cochrane Database of Syst Rev, 2018; 2:CD004876.
56.
TartofS, QianL, RiegG, et al.Safety of seasonal influenza vaccination in hospitalized surgical patients: A cohort study. Ann Intern Med, 2016; 164:593–599.
57.
EspositoS, FrancoE, GavazziG, et al.The public health value of vaccination for seniors in Europe. Vaccine, 2018; 36:2523–2528.
58.
GrohskopfL, SokolowL, BroderK, et al.Prevention and control of seasonal influenza with vaccines. MMWR Morb Mortal Wkly Rep, 2016; 65:1–54.
59.
CoelinghK, LukeC, JinH, TalaatK. Development of live attenuated influenza vaccines against pandemic influenza strains. Expert Rev Vaccines, 2014; 13:855–71.
60.
LeeY, KimK, KoE, et al.New vaccines against influenza virus. Clin Exp Vaccine Res, 2014; 3:12–28.
FlemingD, HarcourtS, SmithG. Influenza and adult hospital admissions for respiratory conditions in England 1989–2001. Commun Dis Public Health, 2003; 6:231–237.
65.
MontoA, AnsaldiF, AspinallR, et al.Influenza control in the 21st century: Optimizing protection of older adults. Vaccine, 2009; 27:5043–5053.
CiabattiniA, NardiniC, SantoroF, et al.Vaccination in the elderly: The challenge of immune changes with aging. Semin Immunol, 2018; 40:83–94.
68.
HeoJ, SongJ, NohJ, et al.Effects of influenza immunization on pneumonia in the elderly. Hum Vaccin Immunother, 2018; 14:744–749.
69.
LambertN, OvsyannikovaI, PankratzV, et al.Understanding the immune response to seasonal influenza vaccination in older adults: A systems biology approach. Expert Rev Vaccin, 2012; 11:985–994.
70.
PandaA, QianF, MohantyS, et al.Age associated decrease in TLR function in primary human dendritic cells predicts influenza vaccine response. J Immunol, 2010; 184:2518–2527.
71.
GoronzyJ, FulbrightJ, CrowsonC, et al.Value of immunological markers in predicting responsiveness to influenza vaccination in elderly individuals. J Virol, 2001; 75:12182–12187.
72.
BektasA, SchurmanS, SenR, FerrucciL. Human T cell immunosenescence and inflammation in aging. J Leukoc Biol, 2017; 102:977–088.
73.
WastessonJ, MorinL, TanE, JohnellK. An update on the clinical consequences of polypharmacy in older adults: A narrative review. Expert Opin Drug Saf, 2018; 17:1185–1196.
74.
KantorE, RehmC, HaasJ, ChanA, GiovannucciE. Trends in prescription drug use among adults in the United States from 1999–2012. JAMA, 2015; 314:1818–1831.
75.
CraftmanA, JohnellK, FastbomJ, et al.Time trends in 20 years of medication use in older adults: Findings from three elderly cohorts in Stockholm, Sweden. Arch Gerontol Geriatr, 2016; 63:28–35.
76.
LipskyB, PecoraroR, RobenN, et al.Influenza vaccination and warfarin anticoagulation. Ann Intern Med, 1984; 100:835–837.
77.
BlackS, NicolayU, Del GiudiceG, RappuoliR. Influence of statins on influenza vaccine response in elderly individuals. J Infect Dis, 2016; 213:1224–1248.
78.
McLeanH, ChowB, VanWormerJ, et al.Effect of statin use on influenza vaccine effectiveness. J Infect Dis, 2016; 214:1150–1158.
LietzJ, WestermannC, NiehausA, SchablonA. The occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic: A systemic review and meta-analysis of observational studies. PLoS One, 2016; 11:e0162061.
81.
BhadeliaN, SontiR, McCarthyJ, et al.Impact of the 2009 influenza A (H1N1) pandemic on healthcare workers at a tertiary care center in New York City. Infect Control Hosp Epidemiol, 2013; 34:825–831.
82.
Aguilar-MadridG, Castelan-VegaJ, Juarez-PerezC, et al.Seroprevalence of pandemic A(H1N1) pmd09 virus antibodies in Mexican health care workers before and after vaccination. Arch Med Res, 2015; 46:154–163.
83.
OlallaJ, de OryF, CasasI, et al.Seroprevalence of antibodies to the influenza A (H1N1) virus among healthcare workers prior to the 2009 pandemic peak. Enferm Infecc Microbiol Clin, 2012; 30:371–375.
84.
ChiuS, BlackC, YueX, et al.Working with influenza-like illness: Presenteeism among US health care personnel during the 2014–2015 influenza season. Am J Infect Control, 2017; 45:1254–1258.
85.
CiftciF, SenE, DemirN, et al.Beliefs, attitudes, and activities of healthcare personnel about influenza and pneumococcal vaccines. Hum Vaccin Immunother, 2018; 14:111–117.
86.
AhmedF, LindleyM, AllredN, et al.Effect of influenza vaccination of healthcare personnel on morbidity and mortality among patients: Systematic review and grading of evidence. Clin Infect Dis, 2014; 58:50–70.
87.
IpD, LauL, LeungN, et al.Viral shedding and transmission potential of asymptomatic and paucisymptomatic influenza virus infections in the community. Clin Infect Dis, 2017; 64:736–742.
88.
PatrozouE, MermelL. Does influenza transmission occur from asymptomatic infection or prior to symptom onset?. Public Health Rep, 2009; 124:193–196.
89.
ElvebackL, FoxJ, AckermanE, et al.An influenza simulation model for immunization studies. Am J Epidemiol, 1976; 103:152–165.
90.
WuJ, RileyS, FraserC, LeungG. Reducing the impact of the next influenza pandemic using household-based public health interventions. PLos Med, 2006; 3:e361.
91.
FraserC, RileyS, AndersonR, FergusonN. Factors that make an infectious disease outbreak controllable. Proc Natl Acad Sci, 2004; 101:6146–6151.
92.
YanJ, GranthamM, PantelicJ, et al.Infectious virus in exhaled breath of symptomatic seasonal influenza cases from a college community. Proc Natl Acad Sci, 2018; 115:1081–1086.
