Ministerial Briefing Paper on Flu Season in Australia

The report provides a briefing on the current status of the flu season in Australia, including recommendations for gene therapy, health literacy among pregnant women, and rapid diagnostic tests.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

1
NURSING
Subject
Ministerial briefing paper on flu season in Australia
Executive summary
The following report is a briefing paper written for the kind perusal of the Minister for
Health, the Hon Greg Hunt in order to understand the current status flu season in Australia.
The report states that through the rate of occurrence of flu have reduced in Australia in 2019
in comparison to the last 5 years, there are certain gaps in promoting effective vaccination
among the pregnant women and early detection of the disease. The three main
recommendations that have been put forward in this review include increasing the provision
for gene therapy in order to treat influenza, increasing health literacy among pregnant women
in the remote and very remote areas and use of rapid diagnostic test apart from reverse
transcriptase polymerase chain reaction for early identification of the disease.

2
NURSING
Statement Issues
According to the Australian Influenza Surveillance Report and Activity Updates
(2019), overall reported cases of influenza or influenza like illness are comparatively less in
comparison to the previous year in Australia. The number of reported cases of death rising
out of influenza is also considered low and the main virus identified is influenza A (H3N2) in
comparison to the influenza (H1N1). Thus the aim of this report is to find answer to the
question, How should a department respond to the high infection rate of influenza A (H3N2)
and thereby reducing the overall reported cases of influenza?.
Background
The reported cases of influenza and influenza like illness (ILI) in Australia have
reduced in comparison to the last five years data. The overall doctor’s consultation occurring
as a result of ILI has also reduced from 13.4% per 1000 consultations to 9.3% per 1000
consultation (Australian Government Department of Health 2019). Majority of the people
who fall sick with flu have mild to moderate illness and generally require no medical care or
the use of antiviral drugs and gets recovered soon within less than two weeks. However, in
some people, the flu complications might lead to hospitalization and at times death. The
primary flu complications include pneumonia, sinus infections, and bronchitis and ear
infections. In some cases people who are suffering from asthma might develop congestive
heart failure upon the trigger of flue, worsening the condition further. the vulnerable group of
population who are prone towards developing flue during the change of season include the
older adults who are over 65 years of age, pregnant women, young children below 15 to 12
years of age, people who have previous reported history of asthma, heart diseases, stroke,
diabetes, cancer, HIV AIDS and children with neurologic anomalies (World Health
Organization 2019). Centre of Disease Control and Prevention [CDC] (2019) stated that

3
NURSING
Mode of transmission of influenza occurs from person who is infected with flue and is away
from another healthy person who is 6-feet away. The flu virus mainly spreads through the
droplets of cough, sneeze and cough. The flu virus can also travel through air within the 6
feet and is inhaled through lungs by the healthy person resulting in the disease transmission.
An infected individual can transmit the disease within one day after getting affected with
disease. Children with weakened immune systems might pass virus for longer than 7 days
(CDC, 2019). The main viral strain that is common among the Australian population is
Influenza A (H3N2) in comparison to H1N1 (Australian Government Department of Health
2019).
According to the ABC news, every millions of influenza vaccinations are produced
and injected among the Australian population however, there is a sudden surge in the number
of the infected cases of influenza. The highest reported cases of flue came during 2018-19
summer from the NSW (ABC News 2019). However, this information seems fabricated in
comparison to the data published by the Australian Government in Australian Influenza
Surveillance Report and Activity Updates (2019). The main preventive measure that is used
in Australia for the prevention of flu is vaccination and the use of the anti-viral drugs.
Influenza vaccine is given every year and the vaccine is changed every year in order to match
the change in viral strains (Australian Government Department of Health 2018).
Pre-existing policies/activities
Australian Government Department of Health (2017) has a definite guideline for the
prevention, control and effective public health management of influenza under the residential
healthcare facilities. The guide was developed by the working group over the outbreak of
influenza and was endorsed in 2017 March by Communicable Diseases Network Australia
(CDNA). This guide provides a detailed information about the signs and symptoms of flu,

4
NURSING
mode of transmissions, associated complications and mode of prevention. Here vaccination is
considered as the most effective approach for the prevention of flue. Seasonal vaccination
program helps to reduce 60% of the cases of influenza development among the adults who
are below 65 years of age. Seasonal vaccination is also provided to healthcare staffs in order
to epidemic spread of the disease. The family members of the patients are also given annual
vaccine. The Government of Australia also undertakes standard precautions in order to
reduce the chances of epidemic spread of the contagious viral infections. The standard
precautions include hand hygiene and use of personal protective equipments. The
transmission based precaution includes droplet precaution by the use of facial masks and this
in turn helps to reduce the chances of developing respiratory infection.
The Australian Technical Advisory Group on Immunisation (ATAGI) has developed
advice for immunization techniques in order to prevent seasonal prevention of influenza
outbreak in the year 2019. The main guidelines include timing of influenza vaccination, the
eligibility of influenza vaccination that is being funded by the National Immunisation
Program (NIP) and the associated medical conditions that are associated with an increased
risk of influenza development (Australian Government Department of Health 2019).
Australian Government Department of Health Therapeutic Goods Administration (2019),
runs Australian Influenza Vaccine Committee (AIVC) in order to increase the supply of the
influenza vaccination.
Consideration
Gene therapy with miRNA
Gene therapy can be a promising alternative towards vaccinations in order to eradicate
the infection of influenza from the gene level. Under gene therapy research has been
undertaken for using microRNAs or small non-coding RNAs to function the process of RNA

5
NURSING
silencing and RNA interference and post translational modification of the viral RNA gene
thus leading to negative inhibition of the viral transcription. This helps in generating
bactericidal effects. Host miRNA are able to down-regulate the expression of the viral gene.
Thus miRNA insertion is regarded as a promising approach in the effective treatment of
influenza (Gasparini et al. 2014).
One of the advantages that are associated with the use of the miRNA for the
treatment of influenza includes it induce the sequence-specific degradation of the
homologous mRNA. It is also regarded as a negative regulator of the antiviral response and
thus helping to down regulate the infection of influenza. Thus the use of the miRNA helps in
reducing the chances of influenza infection from the gene level leading to complete cessation
of the viral infection within the body (Gasparini et al. 2014). However, there are certain
disadvantages associated with the use of the miRNA for the treatment of influenza. Dowdy
(2017) stated that RNA interference is a mechanism that is used for controlling the normal
gene expression and is used as a potential therapeutic agent for influenza. However,
challenges associated with the miRNA therapy include off-target effects, lack of safe delivery
of the methods, high level of toxicity within the body due to gene delivery. The toxicity
generating out of the delivery of the miRNA hamper the ethical domain of beneficence and
non-maleficence’s cost benefit analysis, creating an ethical barrier behind successful
implementation of the therapy. The gene therapy might also receive political barrier and
public based unrest behind conducting trial and promoting successful therapy
implementation. Moreover, gene therapy is also expensive and might not be suitable for the
people residing under the poor socio-economic determinants (Dowdy 2017).
Special screening and treatment for pregnant women
Yudin (2014) stated that influenza cast unique risks to pregnant women and they are
susceptible to increased risk of mortality and morbidity. Pregnant women are over-

6
NURSING
represented among the patients with severe illness and numerous complications associated
with influenza and thus requiring frequent hospitalizations in the ICU. The pregnant women
affected with influenza also experience negative developmental consequences over the
foetuses. In order to reduce both the pandemic and non-pandemic risk of influenza
development proper vaccinations and anti-viral therapy must be conducted. Proper
precautions during pregnancy against influenza help to improve the overall health outcomes
of both mother and the baby. The improved outcome during the time of pregnancy helps in
reducing the overall cost of care and also helps to improve the infant mortality rate Yudin
(2014). One of the advantage of this therapy is the vaccinations has no significant side-
effects over the other and the child. One of the disadvantages of this therapy is, lack of
proper adherence of the therapy procedure by the pregnant mothers. For example, pregnant
mother at times are reluctant to use antiviral medications during the time of pregnancy. Lack
of proper adherence of the anti-viral therapy increase the chance of developing resistant viral
particle and it increases the chances of more epidemic outbreaks of flu (Yudin 2014).
Improving the clinical management of influenza
Providing evidence based information must be done in order to support the patient are
for the effective management of dementia. Like identifications of the risk factors leading to
the development of influenza, effective specimen collection, proper pharmacological
management and case management for influenza. Providing proper information at the
different levels of healthcare helps in improving overall treatment based approach. One of the
evidence-based practice for the management of influenza include use of the rapid diagnostic
test. The rapid diagnostic test helps in the early identification of the influenza and thus
assisting in better implementation of the intervention (World Health Organization 2019). One
of the advantages of the rapid diagnostic test it is superior to the traditional reverse
transcriptase polymerase chain reaction that is used for the detection of the influenza. It helps

7
NURSING
to discriminate between influenza A and influenza B rapidly both in children and in adults
with high level of specificity (Merckx et al. 2017). However, there are few disadvantages as
well associated with the comprehensive implementation of the rapid diagnostic test. For
example, the installation of the setup of the rapid diagnostic test under rural healthcare
settings might impose certain challenges over the government due to lack of skilled
healthcare professionals. Moreover use of the rapid diagnostic test for the detection of
influenza might increase the overall healthcare cost and thereby creating a barrier for people
form poor socio-economic determinants of health to avail the healthcare. Thus protests might
come from the general public (Busson et al. 2017).
Recommendations
One of the recommendation for the in order to improve the comprehensive prevention
of influenza include increase the level of awareness and health literacy among the pregnant
women to avail the vaccination regime for influenza prevention and to complete the full
course of the antiviral therapy. Australian Government Department of Health (2019) stated
that women in Australia especially those who are residing the remote or very remote areas are
more likely to become victim of influenza during their second and third trimester of
pregnancy and the condition becomes more vulnerable during the monsoon. However, due to
lack of comprehensive coverage of the antiviral therapy or immunization, the influenza viral
infection within the body spreads exponential leading to partum birth or developmental
anomalies in the newborn. Moreover, since the disease is contagious, it gives shape to
epidemic. Under these circumstances, it is the duty of the Australian government to undertake
comprehensive health awareness program in order to increase the vaccination and antiviral
dosage adherence. The government of Australia can increase the level of awareness in the
remote or in the very remote areas through organizing community based health awareness

8
NURSING
program. The community nurses will head the community based health awareness program
and the main mode of education to the target group of population will be conducted through
face to face communication and the use of the interactive session. At the end, audio-visual aid
like videos or power-point presentation will be used in order to keep the entire educational
sessions engaging. For increasing the percentage of the people taking part in the health
awareness program, special incentive based approach can be used. Moreover, the presence of
female nurses and culturally competent workforce from the aboriginal origin might increase
the footfall of the indigenous population in the health education program (Bigsby et al. 2017).
Sources consulted
Apart from referring to the grey literatures or the governmental website, this policy
brief was also constructed with the help of the few literary articles for enriching the
information cited in the body brief. The list of annotated bibliography is given below in order
to evaluation the methodological efficiency of the selected studies
Name or the
author and year of
publication
Aims and
objectives of the
paper
Methodology
used
Results Implications to
practice
Yudin (2014) The objective of
the study is to
represent data
over the effective
risk management
of influenza
among the
pregnant women
along with proper
This is a review
paper. However,
it is difficult to
understand
whether the
review is a
narrative review
or systematic
review. The paper
The final results
of the review
highlighted that
pregnant women
are vulnerable
towards influenza
infection. The
study also showed
that proper
The review
provide a detailed
scenario of the
morbidity and
mortality of
influenza among
pregnant women
and also helped in
improving

9
NURSING
presentation of
the safety and
efficacy of the
data of
vaccination and
antiviral therapy
has no distinct
methodology
section and thus
reducing the
overall validity
and reliability of
the study
endorsement of
the vaccinations
and increasing the
healthcare
awareness can
help in
comprehensive
termination of the
spread of
influenza among
the pregnant
women.
knowledge about
successful
prevention of the
disease
development
Merckx et al.
(2017)
The aim of the
study is to
understand the
diagnostic
accuracy of the
rapid diagnostic
test and
polymerase chain
reaction
Systematic review
and meta-
analysis. The
study also has a
detailed structure
of the underlying
methodology that
is being use for
the process of
data collection
thus increasing
the validity of the
research
The review
showed that rapid
diagnostic test is a
novel test that can
be used for the
accurate and
timely detection
of the influenza.
This is proved to
be more accurate
than the
Polymerase chain
reaction test
The main
implications of
the study include
promoting rapid
and accurate
detection and
influenza and
hereby helping in
timely diagnosis
Gasparinin et al.
(2014)
The aim of the
study include
evaluation of the
The paper
conducted a
qualitative review
The review
helped in
understanding
The new
therapeutic
approaches will

10
NURSING
different novel
approaches that
can be used for
the successful yet
fast treatment of
influenza
however, it is not
a narrative review
or systematic
review and thus
there was no
elaboration of the
process of the
paper selection.
This hampered
the validity and
reliability of the
study
latest therapeutic
approaches for the
treatment of
influenza
help in faster
treatment of
influenza and
thereby helping to
reduce the
chances of
epidemic spread
of the disease

11
NURSING
References
ABC News. 2019. Flu is surging, and it's up to GPs and microbiologists to stay on top of the
virus' changing nature. Access date: 3rd September 2019. Retrieved from:
https://www.abc.net.au/news/2019-05-25/why-do-i-need-another-flu-shot-this-year/11142380
Australian Government Department of Health . 2018. Flu (influenza) immunisation service.
Access date: 3rd September 2019. Retrieved from:
https://www.health.gov.au/health-topics/immunisation/immunisation-services/flu-influenza-
immunisation-service
Australian Government Department of Health Therapeutic Goods Administration. 2019.
Australian Influenza Vaccine Committee (AIVC). Access date: 3rd September 2019. Retrieved
from: https://www.tga.gov.au/committee/australian-influenza-vaccine-committee-aivc
Australian Government Department of Health. 2017. Guidelines for the Prevention, Control
and Public Health Management of Influenza Outbreaks in Residential Care Facilities in
Australia. Access date: 3rd September 2019. Retrieved from:
https://www1.health.gov.au/internet/main/publishing.nsf/Content/27BE697A7FBF5AB5CA2
57BF0001D3AC8/$File/RCF_Guidelines.pdf
Australian Government Department of Health. 2019. ATAGI advice on seasonal influenza
vaccines in 2019. Access date: 3rd September 2019. Retrieved from:
https://www.health.gov.au/resources/publications/atagi-advice-on-seasonal-influenza-
vaccines-in-2019
Australian Government Department of Health. 2019. Australian Influenza Surveillance
Report and Activity Updates. Access date: 3rd September 2019. Retrieved from:

12
NURSING
https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-
flucurr.htm
Australian Government Department of Health. 2019. Immunisation for pregnancy. Access
date: 3rd September 2019. Retrieved from:
https://www.health.gov.au/health-topics/immunisation/immunisation-throughout-life/
immunisation-for-pregnancy
Bigsby, E., Seitz, H.H., Halpern, S.D., Volpp, K. and Cappella, J.N., 2017. Estimating
acceptability of financial health incentives. Health Education & Behavior, 44(4), pp.513-518.
Busson, L., Mahadeb, B., De Foor, M., Vandenberg, O. and Hallin, M., 2017. Contribution of
a rapid influenza diagnostic test to manage hospitalized patients with suspected
influenza. Diagnostic microbiology and infectious disease, 87(3), pp.238-242.
Centre of Disease Control and Prevention. 2019. How Flu Spreads. Access date: 3rd
September 2019. Retrieved from: https://www.cdc.gov/flu/about/disease/spread.htm
Dowdy, S. F. 2017. Overcoming cellular barriers for RNA therapeutics. Nature
biotechnology, 35(3), 222.
Gasparini, R., Amicizia, D., Lai, P.L., Bragazzi, N.L. and Panatto, D., 2014. Compounds with
anti-influenza activity: present and future of strategies for the optimal treatment and
management of influenza Part II: Future compounds against influenza virus. Journal of
preventive medicine and hygiene, 55(4), p.109.
Merckx, J., Wali, R., Schiller, I., Caya, C., Gore, G.C., Chartrand, C., Dendukuri, N. and
Papenburg, J., 2017. Diagnostic accuracy of novel and traditional rapid tests for influenza
infection compared with reverse transcriptase polymerase chain reaction: a systematic review
and meta-analysis. Annals of internal medicine, 167(6), pp.394-409.

13
NURSING
World Health Organisation. 2019. People at High Risk For Flu Complications . Access date:
3rd September 2019. Retrieved from: https://www.who.int/influenza/spotlight
World Health Organization. 2019. Clinical management. Access date: 3rd September 2019.
Retrieved from: https://www.who.int/influenza/patient_care/clinical/en/
Yudin, M.H., 2014. Risk management of seasonal influenza during pregnancy: current
perspectives. International journal of women's health, 6, p.681.