Influenza in Humans 2009

2. Influenza in Humans 2009 DR A.M.ALIZADEH Assistant Professor Of ID SHAHID BEHESHTI MEDICAL UNIVERSITY

7. What is Swine Influenza Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza virus that regularly causes outbreaks of influenza in pigs. most outbreaks occur during the late fall and winter months similar to outbreaks in humans. The classical swine flu virus (an influenza type A H1N1 virus) was first isolated from a pig in 1930

9. 25%-30% of world’s population (~500 million people) fell ill >40 million deaths worldwide; ~60% in people ages 20-45 >500,000 deaths in United States; 196,000 in October, 1918 alone Influenza Pandemic of 1918-19

10. Influenza: Antigenic Drift and Shift Hemagglutinin Neuraminidase Drift Shift Influenza Virus

11. Transmission - Large- particel droplets - Small-droplet unclei ( airborne transmission) - Contact with contaminated surfaces - All respiratory secretions and boldily fluids (diarrheal stool ) of novel influenza A (H1N1) cases should be considered potentially infections .

12. Swine Flu Symptoms • like seasonal flu, symptoms of swine flu infections can include: • fever, which is usually high, but unlike seasonal flu, is sometimes absent • cough • runny nose or stuffy nose • sore throat • body aches • headache • chills • fatigue or tiredness, which can be extreme • diarrhea and vomiting, sometimes, but more commonly seen than with seasonal flu

13. Serious swine flu • Signs of a more serious swine flu infection might include; • pneumonia and • Rapidly Progressive Pneumonia • respiratory failure.

14. Serious Swine Flu Symptoms • More serious symptoms that would indicate that a child with swine flu would need urgent medical attention

15. Swine Flu High Risk Groups • With regular seasonal flu, infants and the elderly are usually thought to be most at risk for serious infections, in addition to people with chronic medical problems. • Swine flu high risk groups, people who are thought to be at risk for serious, life-threatening infections, are a little different and can include:

16. High Risk Group • pregnant women • people with chronic medical problems, such as chronic lung disease, like asthma, cardiovascular disease, diabetes, and immunosuppression • children and adults with obesity

17. Serious Form • Fast breathing or trouble breathing • Bluish or gray skin color • Not drinking enough fluids • Severe or persistent vomiting • Not waking up or not interacting • Being so irritable that the child does not want to be held • Flu-like symptoms improve but then return with fever and worse cough

18. Swine Flu Symptoms vs. a Cold or Sinus Infection • spring allergies- runny nose, congestion, and cough • common cold- runny nose, cough, and low grade fever • sinus infections - lingering runny nose, cough, and fever • strep throat - sore throat, fever, and a positive strep test

19. Diagnosis of swine influenza A respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to Refference laboratory testing.

20. Diagnosis of swine influenza A respiratory specimen would generally need to be collected within the first 4 to 5 days of illness (when an infected person is most likely to be shedding virus). However, some persons, especially children, may shed virus for 10 days or longer. Identification as a swine flu influenza A virus requires sending the specimen to Refference laboratory testing.

21. Treatment of swine flu infections There are four different antiviral drugs that are licensed for use for the treatment of influenza: amantadine, rimantadine, oseltamivir and zanamivir. The most recent swine influenza viruses isolated from humans are resistant to amantadine and rimantadine. At this time, CDC recommends the use of oseltamivir or zanamivir for the treatment and/or prevention of infection with swine influenza viruses.

25. Antiviral Therapies for Influenza Neuraminidase (NA) • NA Inhibitors • Oseltamivir • Zanamivir Matrix protein (M2 ) • M2 Inhibitors • Amantadine • Rimantadine

29. Influenza in ChildrenOverview • Flu symptoms in school-age children and adolescents are similar to those in adults • Temperature of 101°F or above, cough, muscle ache, headache, sore throat, chills, fatigue, general malaise • Public advised to contact physician for these symptoms • Children tend to have higher temperatures than adults, ranging from 103°F to 105°F • Flu in preschool children and infants is hard to pinpoint, since its symptoms are so similar to infections caused by other viruses

30. Influenza in Immunocompromised Patients • Immunocompromised patients suffer more complications and have higher morbidity and mortality from influenza infection • High rate of hospitalization and ICU admissions • Higher rate of pulmonary complications • 50% of BMT and 13% renal transplant patients had lower respiratory tract infections • 50% of BMT and 7% of renal transplant patients with influenza complicated by pneumonia • 63% progressed to pneumonia • 43% mortality http://www.shea-online.org/Assets/files/W_-_Seasonal_and_Pandemic_Influenza_-_Children__Immunocompromised_Hosts__Pregnant_Women__and_Nursing_Home_Residents.ppt.

31. Pregnant Women - Pregnant women are Known to be at higher risk for complications - Cases of confirmed novel (H1N1) influenza virus infection in pregnant women resulting in server disease have been reported - Oseltamivir and zanamivir are “ pregnant categoty c” medictions - Oselatamivir is preferred for treatment of pregnant Women - The drug of choice for chemopropohylaxis in less clear. Zananmivir may be preferable because of it limited systemic absoption

32. SeasonalInfluenzaPreparedness PandemicInfluenzaPreparedness