بسم الله الرحمن الرحيم

1. بسم الله الرحمن الرحيم قالوا سُبحانَكَ لا عِلمَ لَنا إلا ما عَلمتَنا إنَكَ أنتَ العليمُ الحَكيم صدق الله العظيم سورة البقرة (۳۲)

2. EMERGING INFLUENZA VIRUSES

3. INTRODUCTION

4. Influenza is a serious respiratory illness which can be debilitating and causes complications that lead to hospitalization and death, especially in the elderly. • Influenza virus is a genus of the orthomyxoviridae family of viruses. Influenza A virus causes influenza in bird and some mammals. • There are three groups of influenza virus: influenza A, B, and C. Influenza B and C viruses are associated with low-level sporadic disease and are never causes of pandemic influenza. influenza A is responsible for most seasonal influenza and all known pandemics.

5. On the surface of influenza virus reside two major proteins; Haemagglutinin (HA) and Neuraminidase (NA). Sixteen subtypes of HA (H1 to H16) and nine subtypes of NA (N1 to N9) are recognized in aquatic birds. • Death mostly occurs as a consequence of primary viral pneumonia or of secondary respiratory bacterial infections, especially in patients with underlying pulmonary or cardiopulmonary diseases.

6. AIM OF THE WORK

7. The aim of this work is to study the current status of emerging influenza viruses infections and their clinical implications.

8. Avian flu

9. Avian flu is influenza infection in birds. The disease is of concern to humans, who have no immunity against it. The virus that causes this infection in birds can mutate to easily infect humans. Subtypes: There are many subtypes of avian influenza viruses, but only some strains of four subtypes have been highly pathogenic in humans. These are types H5N1, H7N3, H7N7 and H9N2.

10. Transmission: • Avian influenza transmission to humans appears to occur predominantly as a result of direct contact with infected poultry. • People at risk include those who are exposed to water and surfaces contamination by bird droppings • There is no evidence that properly cooked poultry meat or poultry products are a source of human infection by H5N1 influenza virus.

11. Symptoms of H5N1 Virus Infection in Humans

12. Incubation period: After exposure to infected poultry, the incubation period generally appears to be 7 days or less, and in many cases this period is 2 to 5 days. Symptoms: Initial symptoms of H5N1 influenza may include fever (typically a temperature of more than 38°C), headache, malaise, myalgia, sore throat, cough, and rhinitis with lower respiratory tract symptoms, shortness of breath and radiological evidence of pneumonia.

13. Isolation  Nose, Throat Swab  Tissue culture

14. Treatment • Two groups of antiviral agents are available for treatment and prophylaxis of influenza • a) Viral M2 Protein Inhibitors: • - Amantadine - Rimantadine • b) Selective Neuraminidase Inhibitors: • - Oseltamivir phosphate - Zanamivir • Oseltamivir is taken orally (75 mg twice daily), andZanamivir is taken via an inhalation apparatus (10 mg bid for 5 days).

15. WHO Recommendations

16. The WHO advises travelers to avoid contact with high-risk environments in affected countries. • The WHO continues to recommend that travelers to affected areas avoid contact with live animal markets and poultry farms. • Populations in affected countries are advised to avoid contact with dead migratory birds or wild birds showing signs of disease. • Avoid contact with infected poultry or with surfaces and objects contaminated by their droppings .

17. Infection Control Recommendations

18. Infection control guidelines for H5N1 avian influenza:

19. Swine Flu

20. Swine influenza is an infection by any one of several types of swine influenza virus. SwineInfluenza Virus is any strain of the influenza family of viruses that is endemic in pigs. As of 2009, the known SIV strain include influenza C and the subtypes of influenza A known as H1N1, H1N2, H3N1, H3N2 and H2N3. • The virus appears to have emerged first in Mexico in late February 2009, this likely represents the first large-scale transmission of this virus.

21. Transmission: Transmission between pigs: The main route of transmission is through direct contact between infected and uninfected animals. The direct transfer of the virus probably occurs either by pigs touching noses, or through dried mucus. Transmission to humans: Swine influenza (H1N1) is spread primarily via droplets and to a lesser extent via hand-to-face transmission. People with regular exposure to pigs are at increased risk of swine flu infection.

22. Risk factors for severe infections

23. Signs and symptoms: • Symptoms include fever, cough, sore throat, body aches, headache, chills and fatigue. • Warning signs indicating more severe disease

24. Diagnosis 1- CBC: Relative lymphopenia 2- Serum enzymes: -(AST/ALT) are often elevated - Creatine phosphokinase  elevated 3- Radiographic: -Initially (CXR) shows no or minimal infiltrates. -Later  bilateral patchy interstitial infiltrates

26. Treatment: • For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.

27. Antiviral agents • Drugs indicated for treatment of H1N1 influenza A virus include neuraminidase inhibitors (i.e. oseltamivir and zanamivir). • Oseltamivir (Tamiflu) • Treatment for acute illness :75 mg capsule twice daily for 5 days . • Prophylaxis :75 mg capsule twice daily for 5 days . • Zanamivir • Treatment for acute illness : 10 mg inhaled orally twice daily for 5 days . • Prophylaxis of household contact: 10 mg inhaled orally twice daily for 10 days .

28. Influenza A virus vaccine (H1N1) U.S. President Barack Obama  Being vaccinated against H1N1 flu Available as monovalent, inactivated influenza A virus vaccine (H1N1) for IM injection. Indicated for active immunization against influenza caused by pandemic (H1N1) 2009 virus. Stimulates active immunity to influenza virus infection by inducing production of specific antibodies.

29. Prevention • Prevention of swine influenza has three components: prevention in swine, prevention of transmission to humans, and prevention of its spread among humans. • The use of vaccines on swine to prevent their infection is a major method of limiting swine to human transmission. • Influenza spreads between humans when infected people cough or sneeze, then other people breathe in the virus or touch something with the virus on it and then touch their own face (avoid touching your eyes, nose or mouth. Germs spread this way). Swine flu cannot be spread by pork products, since the virus is not transmitted through food.

30. Chance of transmission is also reduced by disinfecting household surfaces, which can be done effectively with • a diluted chlorine bleach solution. • Recommendations to prevent spread of the virus among humans include using standard infection control against influenza. This includes frequent washing of hands with soap and water or with alcohol-based hand sanitizers, especially after being out in public