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FLU. Orthomyxoviridae. Eight segmented pieces of RNA, a structure that permits the introduction of new RNA. This is called genetic reassortment. This is called antigenic shift.

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Eight segmented pieces of RNA, a structure that permits the introduction of new RNA. This is called genetic reassortment. This is called antigenic shift.
  • The hemagglutinin spikes which provide viral attachment to cell membranes. They are strain specific antigens that mutate frequently because of inefficient proofreading by RNA polymerase. This is called antigenic drift.
  • And ditto for the Neuraminidase spike, which provides release from cell membranes
faq s
FAQ’s
  • Type A: The Main Player
    • It causes annual outbreaks
    • It mutates easily. This is called antigenic drift and is why the vaccine changes every year, usually causing an epidemic affecting 10% to 20% of the population.
    • It is susceptible to RNA reassortment, where a portion of avian influenza RNA is inserted. This is called antigenic shift and is responsible for pandemics or infections occurring over a wide geographic area and affecting a high proportion of the population.
    • It is characterized by the H and N antigens.
five pandemics
Five Pandemics
  • 1918: Possibly an avian influenza strain that adapted to infect humans.
  • 1957 and 1968: A human/avian reassortment strain.
  • 2009: A human/swine/avian reassortment virus.
transmission
Transmission
  • Person to Person
  • Viral shedding—day prior to symptom onset—5-7 days after symptom onset
  • Can get from pigs not from eating pork
vaccination
Vaccination
  • EVERYONE >6months and older
  • IM (inactivated) Intranasal (live attenuated)
  • Intranasal NOT USED IN: chronic disease, immunsuppression, pregnancy, prior h/o GB from prior vaccinations
  • SMALL AMOUNTS of EGG in each
  • Anaphylaxis is rare
  • What do we carry?
  • Efficacy: 50%-80% rate of protection if closely matched
vaccine
Vaccine

Three strains: (always A-A-B) this year:

-A-California h1n1-”like” virus

-A-Perth h3n2 ”like” virus

-B Brisbane

Every year the strains are selected based on worldwide surveillance for most active strains– a little guess-work involved

suspected cases
Suspected Cases
  • Fevers, Myalgias
  • TEST—flu swab, nasal
treatment ppx
Treatment & PPX
  • Oseltamivir: TAMIFLU
  • Zanamavir: Ralenza
  • Rx for Type A &B
  • Low levels of resistance
  • In 48 hours TREAT (as per Dr. Chung)
  • PPX: NH Residents within 48 h, Case by case

Babies, pregnant women

practical concerns
PRACTICAL CONCERNS
  • HOW TO ORDER THE VACCINE
  • HOW TO BILL FOR IT
  • ALLERGIES: EGGS!!! Relative Contraindication
  • No inhaled form of vaccine here
  • Rapid antigen—Nasal swab in 6th floor Micro
  • ?????s
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