Colds and flu

Updated 05 October 2017

Causes of flu

Influenza is caused by three types of viruses which are mainly spread by infected people.

The three types of flu

There are three types of influenza viruses: types A, B and C. Influenza A and B generally cause indistinguishable diseases, although illness due to influenza B can be milder than that caused by influenza A. Influenza C causes a mild respiratory infection in young children. You may be infected with any combination of the viruses in the same season, even, although rarely, at the same time.

The notation of influenza viruses

Influenza A viruses have two kinds of protein spikes on the outermost layer (or envelope). These spikes (called haemagglutinin and neuraminidase) are distinguishing features of each virus, and represent the way in which influenza viruses are named. A typical influenza strain might be named A/Moscow/10/99(H3N2), where A represents the type of influenza, Moscow the place of origin, 10 the 10th virus isolated from the place of origin in the particular year, 99 the year it was isolated, and H3N2 the specific spikes present on the outside of the virus’ envelope.

There are 15 different haemagglutinin molecules of which only the first three regularly infect humans, and nine neuraminidase molecules, of which the first two infect humans. Only one of each type of spike can be present on any virus. Humans are occasionally infected by H5 influenza A (bird flu) viruses, but cannot pass these on to other humans.

How does the flu virus spread?

•    Step 1 An infected person sheds the virus from their nose and throat. This starts at about the same time as flu symptoms begin and continues for about a week. By coughing or sneezing the virus is then transmitted in one of three ways:
•    Step 2a The virus can be spread in large droplets, regarded as the most common method of spreading.
•    Step 2b It can also be spread by infectious aerosols, which are tiny particles in the air, small and light enough not to settle on surfaces. These aerosols can typically stay in suspension for up to 60 minutes.
•    Step 2c The virus can contaminate hands, tissues, handkerchiefs or other objects after the affected person has sneezed or coughed. If someone else touches these objects, they may contract the virus.
•    Step 3 When the virus reaches the cells of your airways – either because of breathing in droplets or aerosols or because you’ve touched an infected surface – it can establish an infection and has thus successfully spread.

In the general community, preschool and school children are most likely to get flu. This is because children have little pre-existing immunity and are highly susceptible to the viruses, which they then bring home to their families.

The highest infection rate is among school-aged children younger than 10 to 12 years, and among people in old-age homes.

Closed communities, such as homes for the elderly, university campuses and military bases, are prone to outbreaks of influenza, which run their course over a few weeks.

How is flu diagnosed?

The first step in the diagnosis of influenza is a clinical suspicion. You or your general practitioner may suspect flu based on your symptoms and the occurrence of the illness in the community. At the peak of the flu season, laboratory tests will show that up to 70% of everyone suspected of having flu do in fact have it. (Other respiratory viruses could however cause a similar clinical picture.)

Influenza infection can only be confirmed by a laboratory test: throat and/or nasal swabs are taken and the virus is grown in cell culture. After the virus has multiplied in culture, it can be detected in many ways, for instance by adding red blood cells or using a fluorescence microscope.

More recently developed techniques include the use of methods to detect the presence of the genetic information (RNA) of the virus, termed reverse-transcription polymerase chain reaction (RT-PCR).

(Reviewed by Dr Jane Yeats, Department of Virology, University of Cape Town 2006)

 (Updated and reviewed by Dr Jean Maritz and Dr Leana Maree, medical virologists, Tygerberg Hospital and University of Stellenbosch 2010)


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Flu expert

Dr Heidi van Deventer completed her MBChB (Bachelor of Medicine and Bachelor of Surgery) degree in 2004 at the University of Stellenbosch.
She has additional training in ACLS (Advanced Cardiac Life Support) and PALS (Paediatric Advanced Life Support) as well as biostatistics and epidemiology.

Dr Van Deventer is currently working as a researcher at the Desmond Tutu Tuberculosis Centre at the University of Stellenbosch.

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