Influenza

1. Influenza Puja A. Sehgal, MD Kelsey-Seybold Clinic

2. Seasonal Flu • Influenza (Flu) is an acute respiratory illness caused by Influenza A or B viruses that occurs in outbreaks or epidemics worldwide, mainly in winter season. • It is a highly contagious viral illness that can occur in children or adults of any age. • Transmission is through large respiratory droplets while coughing, sneezing, talking. Each year in the United States on average, 5% to 20% of the population gets the flu; on average, more than 200,000 people are hospitalized from flu-related complications, and; about 36,000 people die from flu-related causes.

3. Most healthy adults may be able to infect others beginning 1 day before symptoms develop and up to 5-7 days after becoming sick . Children may be able to pass the virus for more than seven days. Symptoms start one to four days after the virus enters the body . Some persons can be infected with the flu virus but have no symptoms Anyone Can Get the Flu, But the Disease Is More Severe for Some People The Flu Is Contagious

4. Symptoms • Can vary from mild to severe and can even lead to death • Fever (usually high) • Headache • Extreme tiredness • Dry cough • Sore throat • Runny or stuffy nose • Muscle aches • Stomach symptoms, such as nausea, vomiting, and diarrhea, also can occur but are more common in children than adults

5. Complications • Pneumonia • Acute sinusitis • Ear Infection • Myositis/Muscle inflammation • Central nervous system involvement • Death

6. Prevention of FLU • “Take 3” Actions To Fight The Flu • Flu vaccine is the first and most important step in protecting against seasonal influenza. • Vaccination is especially important for people at high risk of serious flu complications, including young children, pregnant women, people with chronic health conditions like asthma, diabetes or heart and lung disease and people 65 years and older. • Health care workers, and other people who live with or care for high risk people.

7. Everyday prevention • Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. • Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based hand rub. • Avoid touching your eyes, nose and mouth. Germs spread this way. • Try to avoid close contact with sick people. • If you are sick with flu-like illness, you should stay home for at least 24 hours after your fever is gone except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-reducing medicine.) • While sick, limit contact with others as much as possible to keep from infecting them.

8. Take FLU ANTIVIRAL MEDICINES AS RECOMMENDED • Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in your body. • Antiviral drugs can make illness milder and shorten the time you are sick. They may also prevent serious flu complications. • Antiviral drugs are not sold over-the-counter and are different from antibiotics. • For treatment, antiviral drugs work best if started within the first 2 days of symptoms.

9. SWINE/H1N1 FLU H1N1 is a new influenza virus, first detected in the United States in April 2009. This virus was originally referred to as “swine flu” because laboratory testing showed that many of the genes in this new virus were very similar to influenza viruses that normally occur in pigs (swine) in North America . This is, in fact, a "quadruple reassortant" virus. It has two genes from flu viruses that normally circulate in pigs and bird (avian) genes and human genes. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes.

12. Symptoms • 2009 H1N1 virus is contagious and is spreading from human to human. • Symptoms include fever, cough, sore throat, runny or stuffy nose, body aches, headache, chills , fatigue, nausea/vomiting and diarrhea. • People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms without a fever . • While most people who have been sick have recovered without needing medical treatment, hospitalizations and deaths from infection with this virus have occurred.

13. In children: Fast breathing or trouble breathing Bluish skin color Not drinking enough fluids Not waking up or not interacting Being irritable Flu-like symptoms improve but then RETURN WITH WORSENING FEVER AND COUGH Fever with a rash In adults: Difficulty breathing or shortness of breath Pain or pressure in the chest or abdomen Sudden dizziness Confusion Severe or persistent vomiting “Emergency warning signs”

14. Contamination & Cleaning • Influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. • Influenza virus is destroyed by heat (167-212°F [75-100°C]), chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols . • Germs can be spread when a person touches something that is contaminated with germs and then touches his or her eyes, nose, or mouth • 2009 H1N1 viruses are not spread by eating pork or pork products.

15. The U.S. Food and Drug Administration (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 years of age and older. Seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu. People who are allergic to eggs might be at risk for allergic reactions from receiving influenza vaccines, including the 2009 H1N1 vaccine. 2009 H1N1 Influenza Vaccine

16. TARGET GROUPS for H1N1 VACCINE • pregnant women, • persons who live with or provide care for infants aged <6 months (e.g., parents, siblings, and daycare providers), • health-care and emergency medical services personnel who have direct contact with patients or infectious material, • children aged 6 months--4 years, and • children and adolescents aged 5--18 years who have medical conditions that put them at higher risk for influenza-related complications • (These 5 groups comprise approximately 42 million persons in the United States)

17. Two types of vaccines • Both seasonal and 2009 H1N1 vaccines are available as inactivated and live attenuated (LAIV) formulations. • Seasonal flu and 2009 H1N1 vaccines may be administered on the same day. Two shots can be given, each in a different place on the body, or a shot and a nasal spray vaccine can be given.

18. Who should not get nasal H1N1 vaccine? • People younger than 2 years of age; • Pregnant women; • People 50 years of age and older; • People with a medical condition that places them at higher risk for complications from influenza. • Children younger than 5 years old with a history of recurrent wheezing; • Children or adolescents receiving aspirin therapy; • People who have had Guillain-Barré syndrome (GBS), a rare disorder of the nervous system, within 6 weeks of getting a flu vaccine, • People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components

19. Diagnostic testing • Most patients with clinical illness consistent with uncomplicated influenza who reside in an area where influenza viruses are circulating do not require diagnostic influenza testing for clinical management. • Patients who should be considered for influenza diagnostic testing include: • Hospitalized patients with suspected influenza • Patients for whom a diagnosis of influenza will inform decisions regarding clinical care, infection control, or management of close contacts. • Patients who died of an acute illness in which influenza was suspected

20. TREATMENT • Antiviral medicines : started within first 48 hours if symptoms are severe or risk of complications is high. Most healthy persons who develop an illness consistent with uncomplicated influenza, or persons who appear to be recovering from influenza, do not need antiviral medications for treatment or prophylaxis. • Rest • Adequate Fluid Intake. • Hand Hygiene measures • Cough suppressants are usually not helpful.

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