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Influenza Virus PHA 5601: Pediatric Ambulatory Care Dr. Angela Thornton, PharmD

Influenza Virus PHA 5601: Pediatric Ambulatory Care Dr. Angela Thornton, PharmD. Jaslyn Adams Alesha Daley Corey Gammon Jayme Rentz . Definition.

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Influenza Virus PHA 5601: Pediatric Ambulatory Care Dr. Angela Thornton, PharmD

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  1. Influenza VirusPHA 5601: Pediatric Ambulatory CareDr. Angela Thornton, PharmD Jaslyn Adams Alesha Daley Corey Gammon Jayme Rentz

  2. Definition • Influenza, commonly known as "the flu," is a very contagious viral infection of the respiratory tract. Influenza affects all age groups, however children are at higher risk than adults.

  3. Etiology • Influenza virus: • Belongs to the family Orthomyxoviridae • Large single-stranded RNA virus • Has 2 major surface proteins that determine serotype • Hemagglutin (HA) • Neuraminidase (NA) • Divided into three types: A, B, and C • Types A and B are primarily responsible for the epidemic disease • Types A and B are further divided into specific serotypic strains • Type C is primarily responsible for sporadic cases of upper respiratory tract disease

  4. Epidemiology • Location: Influenza affects all countries around the world • Transmission: may be transmitted through large liquid droplets (ex: sneezing into the air) or touching contaminated surfaces and then touching eyes, nose, or mouth. A person with influenza may be contagious for up to ten days after the onset of symptoms.

  5. Temporal Pattern: “Flu Season” in the U.S. is generally from October to May with a peak in February. • While everyone is at risk for getting the flu, there are some high risk populations: • Children younger than 5 years old • Adults older than 65 years old • Pregnant Women • Patients with a weakened immune system • Patients with chronic illnesses including: • Asthma • COPD • Cystic fibrosis • HIV/AIDs • Cancer

  6. Pathophysiology • Influenza virus is transmitted from infected mammals through the air by coughs or sneezes, creating a aerosols like effect that contains the influenza virus.

  7. Symptoms • Fever • Typically lasts 2-4 days (100°F or higher under the arm, 101°F orally, or 102°F rectally) • Myalgias • Chills • Headache • Malaise • Anorexia • Coryza • Pharyngitis • Dry cough • May persist for a long period of time

  8. Diagnosis • If flu-like symptoms arise in the midst of flu season or a flu pandemic, the diagnosis is generally geared towards influenza • Flu Season: October through May; peak in February • Laboratory methods to diagnose influenza: • Viral Culture: • If implemented within the first four days of the illness, the virus may be isolated from the nasopharynx via nasopharyngeal swab, nasal swab, or nasal aspirate. • Rapid Influenza Diagnostic Tests: • These test may not detect all strains of influenza, and may not differentiate between Influenza A and Influenza B

  9. Polymerase chain reaction (PCR) • Detects viral RNA in the presence of a virus • Immunosorbent assay • Detects the presence of antigens and antibodies • Serologic testing: • Tests for antibodies in the serum • Needs to be drawn during illness and post illness to confirm influenza • Will not aid in clinical decision making, will only confirm diagnosis • These test should only be implemented if the results will influence the clinical care of the patient or of other patients

  10. Differential Diagnosis

  11. Complications • Otitis media • Pneumonia • Secondary to bacterial infection • Acute myositis • Usually seen with Type B • Myocarditis • Toxic shock syndrome

  12. Treatment & Prevention

  13. Methods • Supportive care • Pharmacological • Nonpharmacological • Alternative medicine and therapies

  14. Supportive Care • Acetaminophen (Tylenol) • 10-15mg/kg/dose orally every 4-6 hours • Ibuprofen (Motrin) • 5-10mg/kg/dose orally every 6-8 hours • Not for children < 6 months

  15. Oseltamivir (Tamiflu) • Mechanism of action • Inhibits Influenza virus neuraminidase, affecting particle release • Indicated for Influenza Type A&B • Used to treat patients at least 2 weeks old and prophylaxis in children 1 year and older • Dosage • 2weeks- 1year: 3mg/kg twice daily for 5 days or 0.5mL/kgf oral suspension • 1-12 years: 10 capsules 30-75mg twice daily • Weight dependent • Adverse Effects • Nausea, vomiting, arrhythmia, swelling of face or tongue, abdominal pain • Monitoring Parameters • Renal function, serum glucose, in diabetic patients signs of unusual behavior

  16. Non-Pharmacalogical • Get plenty of rest • Increase fluid intake • Warm tea • Soup • Frequently wash hands • Give warm bath or warm compress • Avoid contact with sick people

  17. Influenza Vaccine • Types seen in the U.S. • A/California/7/2009 (H1N1) pdm09-like virus • A/Victoria/361/2011 (H3N2)-like virus • B/Wisconsin/1/2010-like virus • Determined based on age • 1 dose is preferred, unless vaccine has never been received • Side effects: • Injection site reaction • Low/ high grade fever • Body aches

  18. MF59 • Used since 1997 as TIV adjunct to seasonal vaccination • Used in children 6-72 months and adults • Must have not previously received influenza vaccine • Combined with trivalent inactivate influenza vaccine (TIV), abbreviated ATIV

  19. Alternative prevention • Mainly for prevention • American ginseng (panaxquinquefolius) • Don’t take with Tylenol • Increase Vitamin D intake • Cinnamon • Hydrogen peroxide in ear • Garlic

  20. References • Nicola J. High, “Molecular Medical Microbiology”2002, Pages 1967–1988 Volume 3, School of Biological Science, University of Manchester, Manchester, UK. <http://www.sciencedirect.com/science/article/pii/B9780126775303503123> • Kliegman, Wright P. Influenza Viruses. In: Saunders, An Imprint of Elsevier. Nelson Textbook of Pediatrics. New York: McGraw-Hill; 2007. chapter 255. • CDC. Prevention and control of influenza with vaccines: recommendations of the Advisory Committee on Immunization Practices (ACIP), 2010. MMWR 2010;59 (No. RR-8).

  21. Vesikari, Timo et al. Oil-in-Water Emulsion adjuvant with Influenza Vaccine in Young Children. N Engl J Med 2011; 365:1406-1416 • Harper SA, Bradley JS, Englund JA, et al. Seasonal influenza in adults and children—diagnosis, treatment, chemoprophylaxis, and institu- tional outbreak management: clinical practice guidelines of the Infectious Diseases Society of America. Clin Infect Dis 2009;48:1003–32. • CDC. Influenza-Associated Pediatric Mortality, 2013. < http://gis.cdc.gov/GRASP/Fluview /PedFluDeath.html>

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