The underestimated threat of Influenza Virus Types A, B, and C

1. FLU . The underestimated threat Dr Esteghamati

2. Influenza Virus Types • Type A • humans and other animals • all age groups • moderate to severe illness • Type B • milder epidemics • humans only • primarily affects children • Type C - uncommon strain, no epidemic

3. Increased Risk • Age 65 and older • Any age with chronic medical conditions • Pregnant women • Children 6-23 months

4. How the Flu Spreads

5. Spread of Flu • Droplet Spread • from a person’s cough or sneeze • person touches respiratory droplets on another person or object and then touches their own mouth or nose • Incubation period = 1-4 days

6. Symptoms • Adults- shed virus 1 day before developing symptoms to 7 days after getting sick • Young children- can shed virus for longer than 7 days

7. Hospitalization from Influenza • Highest rate among young children and persons >65 yrs • 114,000 hospitalizations/yr with 57% occurring in ages < 65 yrs • Highest # caused by type A (H3N2) viruses

8. Death rates from influenza-associated pulmonary and circulation deaths/100,000 persons • 0-44 yr: 0.4 - 0.6 • 50-64yr: 7.5 •  65yrs: 98.3 • Reasons: • more older people has inc. • Influenza A associated with higher mortality • Influenza A predominates in 90% of seasons from 1990-99 compared w/57% of seasons 1976-90

9. Preventing the Flu • Good Health Habits • Vaccination • Antiviral Medications

10. Avoid close contact Stay home when you are sick Cover your mouth Clean your hand Avoid touching your eyes, nose or mouth Get plenty of rest Drink plenty of liquids The simplest way to avoid the flu is to avoid crowds. Can’t keep you kids cooped up? Frequent hand washing is the next best thing Good Health Habits

11. Vaccination

12. Vaccine Production Capacities • 65-70% of global vaccine production located in Europe (5 companies) • 50% of that production is exported outside of Europe

16. Use of influenza vaccine in 14 countries. (Vaccine 2003 (16) :1780-1785)

17. Live virus LAIV Inactivated vaccine WV Split vaccine SPL Subunit vaccine SU rosettes Adjuvanted vaccine Virosomal vaccine

18. Vaccination • Best way to prevent flu • Selection of virus for manufactured vaccine made in Feb and April each year • Get vaccinated each fall • People at high risk should get vaccinated • 2 kinds of vaccines • inactivated • live attenuates (LAIV) (for ages 5 - 49)

19. Who Should Not Get Vaccine • Have severe allergy to hen’s eggs (anaphylactic allergic rxn) • People who previously developed Guillian-Barre syndrome (GBS) w/in 6 weeks after getting a flu shot

20. Influenza Vaccination Strategy • Yearly vaccination of high risk persons is the most effective means of reducing the effect of influenza • persons with increased risk • close contacts and care-givers of persons with increased risk

21. Persons at High Risk • All persons 50 years of age or older • Persons >6 months of age with chronic illness • Residents of long-term care facilities • Pregnant women (2nd and 3rd trimesters) • Children 6 months to 18 years receiving chronic aspirin therapy • Children 6-23 months of age

22. Chronic Medical Conditions • Pulmonary (e.g. COPD, asthma) • Cardiovascular (e.g. CHF) • Metabolic (e.g. diabetes) • Renal (e.g. chronic renal failure) • Hemoglobinopathies (e.g. sickle cell) • Immunosuppression (e.g. HIV)

23. HIV Infection • Persons with HIV at higher risk for complications of influenza • Vaccine induces protective antibody titers in many HIV-infected persons • Transient increase in HIV replication reported • Vaccine will benefit many HIV-infected persons

24. Pregnancy and Inactivated Influenza Vaccine • Risk of hospitalization 4 times higher than nonpregnant women • Risk of complications comparable to nonpregnant women with high-risk medical conditions • Vaccination recommended if pregnant during influenza season

25. Contacts of High-Risk Persons • Household members and caregivers of high-risk persons (including children 0-23 months) • Health care providers, including home care • Employees of long-term care facilities

26. Other Groups • Providers of essential community services • Foreign travelers • Students • Anyone who wishes to reduce the likelihood of becoming ill from influenza

27. Composition of the 2003-2004 Influenza Vaccine • A/Moscow/10/99 (H3N2) (A/Panama/2007/99) • A/New Caledonia/20/99 (H1N1) • B/Hong Kong/330/2001

28. Composition of the 2004-2005 Influenza Vaccine* • A/Fujian/411/2002 (H3N2) (A/Wyoming/3/2003) • A/New Caledonia/20/99 (H1N1) • B/Shanghai/361/2002 (B/Jilin/20/2003 or B/Jiangsu/10/2003) *strains in (parenthesis) are antigenically identical to the selected strains and may be used in the vaccines

29. Live Attentuated Intranasal Influenza (LAIV) • Contains weakened live influenza vs killed viruses • Administered by nasal spray • Contains 3 different live (but weakened) viruses, which stimulate body to make antibodies

30. Dosage-LAIV • 0.5 mL of vaccine: 0.25 mL for each nostril • Children aged 5-8 previously unvaccinated: receive 2 doses separated by 6-10 weeks • Children aged 5-8 previously vaccinated: receive 1 dose (do not require a 2nd dose) • Persons aged 9-49: receive 1 dose

31. Efficacy & Effectiveness of LAIV-adults • 85% overall efficiency • Fewer days of illness • 15-42% fewer health care provider visits • 43-47% less use of antibiotics

32. Children runny nose headache vomiting muscle aches fever Adults runny nose headache sore throat cough fever LIAV Side Effects

33. Inactivated Influenza Vaccine • Contains two type A and one type B • Made from purified, egg grown viruses that have been inactivated or killed • Antibiotics can be added to prevent bacterial contamination • Vaccinated people develop high postvaccination hemagglutination inhibition antibody titers

34. Effectiveness of Inactivated Vaccine- Children • 77% - 91% effective against influenza respiratory illness

35. Effectiveness of Inactivated Vaccine-Adults • Aged < 65 yrs old: • 70-90% efficient •  work absenteeism,  health-care resources • Aged > 65 yrs old: • 50-60% effective in preventing hospitalization for pneumonia and influenza • 80% effective in preventing death

36. Side Effects to Inactivated Vaccine • Soreness at vaccination site • Fever, malaise, myalgia • Guillain Barre Syndrome: 1 additional case per 1 million people • Body's immune system attacks part of the nervous system and results in weakness or tingling sensations in the legs that can spread to the arms and upper body. • Can result in paralysis

37. Similarities contain one influenza A (H3N2) virus, one A (H1N1) virus, and one B virus vaccines grown in eggs administered annually Differences Inactivated has killed virus, LAIV contains attentuated viruses Cost: LAIV more expensive Administration LAIV: intranasally dead: intermuscularly Inactivated v. Live Vaccines

38. پيشگيري و كنترل آنفلوانزاي بيمارستاني • طغيان هاي بيمارستاني ناگهاني و انفجاري هستند • سه منبع مهم انتشار عفونت در بيمارستان شامل بيمار، كاركنان و ملاقات كنندگان ميباشد • تشخيص بموقع طغيان هاي بيمارستاني اهميت زيادي دارد • ضرر اقتصادي • كاهش نيروي انساني ارائه دهنده خدمت • افت كيفيت خدمات ارائه شده • كاركنان تبديل به مخزن بالقوه براي انتقال به بيماران و اعضاء خانواده خود مي شوند • كاركنان غير ايمن نسبت به ساير اقشار در معرض خطر بيشتري هستند

39. پيشگيري و كنترل آنفلوانزاي بيمارستاني • احتمال انتقال از طريق افشانه هاي آلوده صورت ميگيرد لذا لازم است به محل بستري بيماران مشكوك توجه گردد • بيماران با علائم تنفسي تا قبل از روشن شدن وضعيت در ميان ساير بيماران بستري نشوند • از تردد بيماران با علائم تنفسي در بخش حتي الامكان جلوگيري شود ( لااقل با ماسك باشد ) • به پرسنل بيمار داراي علائم تنفسي مرخصي اجباري داده شود • نياز به اطاق با تجهيزات فشار منفي نيست • تا 24 ساعت ويروس در دماي اطاق زنده ميماند • امكانات ضروري جهت پذيرش بيماران در هنگام اپيدمي ها پيش بيني گردد • به بخش هاي بيماران خاص توجه بيشتري مبذول گردد