Influenza

INFLUENZA
SGD 23
WHAT IS INFLUENZA?
Influenza, commonly called “FLU" is an illness

caused by Influenza viruses that are enveloped,
negative-sense, single-stranded RNA viruses of
the family Orthomyxoviridae.
Flu is a contagious respiratory illness that infects
the nose, throat, and sometimes the lungs of
many animals, birds, and humans. It can cause
mild to severe illness, and at times can lead to
death. The best way to prevent flu is by getting
a flu vaccine each year.
INFLUENZA VIRUSES ARE DIVIDED INTO
THREE TYPES:
 INFLUENZA TYPE A = infects

humans, other mammals,
and birds, and causes all flu
pandemics
 INFLUENZA TYPE B = infects

humans and seals
 INFLUENZA TYPE C = infects

humans, pigs, and dogs.
INFLUENZA TYPE A
 Influenza A viruses are further
classified, based on the viral
surface proteins Hemagglutinin
(HA or H) and Neuraminidase
(NA or N). Sixteen H subtypes (or
serotypes) and nine N subtypes
of influenza A virus have been
identified.
 Influenza type A viruses undergo
two kinds of changes:
Antigenic drift
Antigenic shift
INFLUENZA TYPE A
 The type A viruses are the most virulent human pathogens among
the three influenza types and cause the most severe disease. The
serotypes that have been confirmed in humans, ordered by the
number of known human pandemic deaths, are:
 H1N1 caused "Spanish flu" in 1918, "Swine flu" in 2009
 H2N2 caused "Asian Flu"
 H3N2 caused "Hong Kong Flu"
 H5N1 is a pandemic threat
 H7N7 has unusual zoonotic potential
 H1N2 is endemic in humans and pigs
 H9N2, H7N2, H7N3, H10N7
INFLUENZA TYPE B
 Influenza B virus is almost exclusively a
human pathogen, and is less common
than influenza A. The only other animal
known to be susceptible to influenza B
infection is the seal.
 This type of influenza mutates at a rate 2–3
times lower than type A. As a result of this
lack of antigenic diversity, a degree of
immunity to influenza B is usually acquired
at an early age. However, influenza B
mutates enough that lasting immunity is
not possible. This reduced rate of
antigenic change, combined with its
limited host range (inhibiting cross species
antigenic shift), ensures that pandemics of
influenza B do not occur
INFLUENZA TYPE C
 The influenza C virus infects humans and pigs, and can

cause severe illness and local epidemics. However,
influenza C is less common than the other types and
usually seems to cause mild disease or no symptoms at
all in children
EPIDEMIOLOGY
 In tropical areas, influenza occurs throughout the year. In the Northern
Hemisphere, the influenza season typically starts in early fall, peaks in mid-
February, and ends in the late spring of the following year. The duration and
severity of influenza epidemics vary, however, depending on the virus subtype
involved.
 The World Health Organization estimates that worldwide, annual influenza
epidemics result in about 3-5 million cases of severe illness and about 250,000 to
500,000 deaths.
 Typically, in a year's normal two flu seasons, there are between three and five
million cases of severe illness and around 500,000 deaths worldwide. Although the
incidence of influenza can vary widely between years, approximately 36,000
deaths and more than 200,000 hospitalizations are directly associated with
influenza every year in the United States
 Influenza seasonality in the Philippines is from June to November. The ideal time to
administer Southern Hemisphere influenza vaccine should be from April to May.
With two lineages of influenza B circulating annually, quadrivalent vaccine might
have more impact on influenza control than trivalent vaccine
PATHOGENESIS
 Influenza viruses spread from human to human via aerosols created when
an infected individual coughs or sneezes. Infection occurs after an
immunologically susceptible person inhales the aerosol. If not neutralized by
secretory antibodies, the virus invades airway and respiratory tract cells.
 Once the virus is within host cells, cellular dysfunction and degeneration
occur, along with viral replication and release of viral progeny. As in other
viral infections, systemic symptoms result from release of inflammatory
mediators.
 Transmission of influenza from poultry or pigs to humans appears to occur
predominantly as a result of direct contact with infected animals. The risk is
especially high during slaughter and preparation for consumption; eating
properly cooked meat poses no risk. Avian influenza can also be spread
through exposure to water and surfaces contaminated by bird droppings.
CLINICAL PRESENTATION
 The presentation of influenza virus infection varies, but it usually includes many
of the following signs and symptoms:
 Fever
 Sore throat
 Myalgias
 Frontal or retro-orbital headache
 Nasal discharge
 Weakness and severe fatigue
 Cough and other respiratory symptoms
 Tachycardia
 Red, watery eyes
 The incubation period of influenza is 2 days long on average but may range
from 1 to 4 days in length. Aerosol transmission may occur 1 day before the
onset of symptoms thus, it may be possible for transmission to occur via
asymptomatic persons or persons with subclinical disease, who may be
unaware that they have been exposed to the disease
DIAGNOSIS
 CBC = Leukopenia and Relative Lymphopenia are typical findings
 Rapid Diagnostic Tests = high specificity but only moderate
sensitivity
 QuickVue Influenza A+B test (Quidel) = provide results in 10 minutes or
less
 ZstatFlu (ZymeTx) = provides results in 20 minutes
 Viral Culture = Gold Standard
 RT-PCR
 Direct Immunofluorescent Tests and Serologic Testing
 Chest Radiograph
TREATMENT
 ANTI-HISTAMINE = for runny nose, postnasal drip, or itchy, watery eyes
 COUGH SUPPRESSANTS AND EXPECTORANTS = for cough
 IBUPROFEN = for fever and pain
 ANTIVIRAL DRUGS = to decrease the severity and duration of flu symptoms.

In some cases they may be used to prevent flu.
 Amantadine, Rimantadine = Effective for prevention and treatment of Influenza
Type A only.
 Zanamivir, Oseltamivir = treatment of uncomplicated Influenza Type A & B
 Oseltamivir = also approved for prophylaxis.
 Prophylaxis must be continued throughout the epidemic; treatment must begin

within 24 hrs of onset of illness.
PREVENTION
 VACCINATION = a yearly flu vaccine is recommended as the first and most
important step in protecting against flu viruses. CDC recommends
vaccination by the end of October
 TYPES OF VACCINE:
 Inactivated = consisting of (1) whole-virus, (2) subvirion, (3) purified surface
antigen. Only subvirion or purified antigen should be used in children. Any of the
three can be used for adults
 Live attenuated
 Trivalent 2018-2019 Northern Hemisphere vaccine season contains the
following components:
 A/Michigan/45/2015 (H1N1)pdm09-like virus (no change from last season)
 A/Singapore/INFIMH-16-0019/2016 (H3N2)-like virus (new for 2018-2019)
 B/Colorado/06/2017-like virus (B/Victoria/2/87 lineage) (new for 2018-2019)
 Quadrivalent influenza vaccines contain an additional B strain,
B/Phuket/3073/2013-like virus (B/Yamagata lineage) in addition to the 3
viral strains listed above
Influenza Vaccine, who should receive it
 Persons 65 yrs. or older
 Persons with heart, pulmonary,
renal and metabolic diseases.
 Persons in nursing homes and
other long-term care facilities
 Persons 6 mos. -18 yrs. old
receiving aspirin therapy
 Women in 2nd or 3rd trimester of
pregnancy during flu season.
 Household members of persons
in high-risk groups
 Health care workers and others
providing essential community
services
 Secondary prevention involves chemoprophylaxis to treat asymptomatic
persons who have risk factors but in whom the condition is not clinically
apparent and influenza vaccination especially to persons with
cardiovascular diseases.
 Tertiary prevention includes:

 Good personal health and hygiene habits
 Wearing face mask
 Sanitation of potentially contaminated surfaces with either alcohol or quaternary
ammonium compounds
THANK
YOU!

Influenza

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INFLUENZA

Influenza, commonly called “FLU" is an illness

 INFLUENZA TYPE A = infects

 INFLUENZA TYPE B = infects

 INFLUENZA TYPE C = infects

 The influenza C virus infects humans and pigs, and can

 ANTI-HISTAMINE = for runny nose, postnasal drip, or itchy, watery eyes

 COUGH SUPPRESSANTS AND EXPECTORANTS = for cough

 IBUPROFEN = for fever and pain

 ANTIVIRAL DRUGS = to decrease the severity and duration of flu symptoms.

 Prophylaxis must be continued throughout the epidemic; treatment must begin

 Tertiary prevention includes:

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