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Influenza (Flu)
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com

Facts
• Influenza is a highly contagious viral
infection of the nose, throat, and lungs
that occurs most often in the late fall,
winter, and early spring.
http://www.nfid.org/idinfo/influenza
22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani
2

Facts
• Influenza is a serious infection that
affects between 5-20% of the US
population annually.
3

• During the 2017-2018 season:
 An estimated 900,000 individuals
were hospitalized
 Nearly 80,000 deaths
Occurred in the US from flu and flu-
related complications.
4Facts

• In temperate climates:
Seasonal epidemics occur mainly during
winter
• In tropical regions:
Influenza may occur throughout the year,
causing outbreaks more irregularly.
5Facts

• Incubation period, is about 2 days, but
ranges from one to four days
6Facts

The pathogen
• There are 4 types of seasonal influenza
viruses, types A, B, C and D.
• Influenza A and B viruses circulate and
cause seasonal epidemics of disease.
http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
7

Influenza A viruses
• Influenza A viruses are further classified
into subtypes according to the
combinations of the hemagglutinin (HA)
and the neuraminidase (NA), the
proteins on the surface of the virus.
8

Viral Proteins
TCI Chemicals
9

Influenza A viruses
• Currently circulating in humans are
subtype A(H1N1) and A(H3N2)
influenza viruses.
• Only influenza type A viruses are known
to have caused pandemics.
10

Influenza B viruses
• Influenza B viruses are not classified into
subtypes, but can be broken down into
lineages.
• Currently circulating influenza type B
viruses belong to either B/Yamagata or
B/Victoria lineage.
11

Influenza C virus
• Influenza C virus is detected less
frequently and usually causes mild
infections, thus does not present public
health importance.
12

Influenza D viruses
• Influenza D viruses primarily affect
cattle and are not known to infect or
cause illness in people.
13

Epidemiology
• All age groups can be affected but
there are groups that are more at risk
than others.
14

Epidemiology (Cont.)
• Pregnant women
• Children under 59 months
• The elderly
15

Epidemiology(Cont.)
• Individuals with:
Chronic medical conditions (such as
chronic cardiac, pulmonary, renal, metabolic,
neurodevelopmental, liver or hematologic
diseases)
Immunosuppressive conditions
(such as HIV/AIDS, receiving chemotherapy or
steroids, or malignancy).
16

• Health care workers are at high risk
acquiring influenza virus infection
 due to increased exposure to the
patients
 risk further spread particularly to
vulnerable individuals.
17

• Illnesses range from mild to
severe and even death
• Hospitalization and death occur
mainly among high risk groups.
18

Transmission
• Seasonal influenza spreads easily,
with rapid transmission in
crowded areas including schools
and nursing homes.
19

Transmission (Cont.)
• Coughs or sneezes, droplets
containing viruses (infectious
droplets)
• Infectious droplets can spread up
to one meter
20

Transmission (Cont.)
• Infect persons in close proximity
who breathe these droplets in.
• The virus can also be spread by
hands contaminated with
influenza viruses.
21

Transmission(Cont.)
• To prevent transmission, people should:
 Cover their mouth and nose with a tissue
when coughing
 Wash their hands regularly
22

Signs and symptoms
• Seasonal influenza is characterized by
a sudden onset of :
23
Fever Muscle and Joint pain
Cough
(usually dry)
Severe malaise
Headache Sore throat
Runny nose

Diagnosis
• The majority of cases of human
influenza are clinically diagnosed
24

Diagnosis (Cont.)
• The clinical differentiation of
influenza from other pathogens is
difficult:-
During periods of low influenza
activity
Outside of epidemics situations,
25

Diagnosis (Cont.)
• Other respiratory viruses that can present
as Influenza-like Illness (ILI) include:
Rhinovirus
Respiratory syncytial virus
Parainfluenza
Adenovirus
26

Laboratory confirmation
of influenza virus
• Throat, nasal and nasopharyngeal
secretions or tracheal aspirate or
washings is commonly performed
27
WHO recommended surveillance standards, Second edition.

Laboratory confirmation
of influenza virus (cont.)
• Direct antigen detection
• Virus isolation
• Detection of influenza-specific RNA
by reverse transcriptase-polymerase
chain reaction (RT-PCR).
28
WHO recommended surveillance standards, Second edition.

Treatment
• Uncomplicated seasonal influenza:
Not from a high risk group
Symptomatic treatment
if symptomatic
Stay home in order to minimize the
risk of infecting others in the community
Group at high risk
Antivirals + Symptomatic treatment
29

Treatment(Cont.)
• Severe or progressive clinical illness
(associated with suspected or confirmed
influenza virus infection)
 Clinical syndromes of :
Pneumonia
Sepsis
Exacerbation of chronic underling
diseases
Antiviral drug
30

Treatment(Cont.)
• Neuraminidase inhibitors (i.e. Oseltamivir)
as soon as possible (ideally, within 48
hours following symptom onset) to
maximize therapeutic benefits.
31

Treatment(Cont.)
Administration of the drug should
also be considered in patients
presenting later in the course of
illness.
32

Treatment(Cont.)
A minimum of 5 days, but can be
extended until there is satisfactory
clinical improvement
33

Treatment(Cont.)
• Corticosteroids should not be used
routinely (unless indicated for other
reasons e.g.: asthma and other specific
conditions); as it has been associated
with:
 Prolonged viral clearance
 Immunosuppression leading to
bacterial or fungal superinfection.
34

Treatment(Cont.)
• All currently circulating influenza
viruses are resistant to adamantane
antiviral drugs (such as amantadine and
rimantadine), and these are therefore
not recommended for monotherapy.
35

Prevention
• The most effective way to prevent
the disease is vaccination
36

Prevention
• Annual vaccination is
recommended to protect against
influenza as immunity from
vaccination wanes over time
37

Prevention
• Injected inactivated influenza
vaccines are most commonly used
throughout the world.
38

Prevention(Cont.)
• Vaccination is especially important
for people:
 At high risk of influenza
complications
 Who live with or care for the
people at high risk
39

Prevention(Cont.)
WHO recommends annual vaccination for:
• Pregnant women at any stage of pregnancy
• Children aged between 6 months to 5 yrs.
• Elderly individuals (aged more than 65yrs.
• Individuals with chronic medical conditions
• Health-care workers.
40

Prevention(Cont.)
• Personal protective measures
 Regular hand washing
 Good respiratory hygiene
 Early self-isolation of those feeling unwell,
feverish and having other symptoms of influenza
 Avoiding close contact with sick people
 Avoiding touching one’s eyes, nose or
mouth
41

Summary
Antiviral Treatment Recommendations for
Seasonal Influenza
42
Patient with
Flu Symptoms
Assess clinically
and investigate
Mild or Uncomplicated illness. Severe Acute Respiratory
Infection(SARI)
· Requiring hospital admission
· Pregnancy
· Severe illness
No risk
factor
High risk*
Treat with Tamiflu immediately
do not wait for lab confirmation

Summary Cont.)
Antiviral Treatment Recommendations for
Seasonal Influenza (Cont.)
43
Mild or Uncomplicated illness
No risk
factor
High
risk*
.Consider Antiviral if within 48 Hrs.
· Infection control
· Return to care within 72 Hrs. if no
improvement
.Treat with Antiviral
· Close follow up
· Infection control
· Return to care within 72 Hrs in no
improvement
*High Risk :
· Children below 5 especially
<2 years
· Elderly >65 years
· Pregnant women till 2Wks
post partum
· Comorbidities

Seasonal Influenza Contact Management
Recommendations
44Summary Cont.)
• No need to screen contacts ·
• Vaccination is not recommended as post exposure measure
• Close Contact: Resides with or taking care of confirmed
H1N1 case, Sharing eating or drinking utensils,
 Does not include walking by infected person or sitting
across the room
• Infectious Period: “One day before fever begins until 24
Hrs. after fever ends”

45Summary Cont.)
Assess contact risk profile
High risk contacts
• Provide Tamiflu as Prophylaxis
• Follow up
• Report to service if symptoms develop

46Summary Cont.)
Assess contact risk profile (Cont.)
Healthcare workers and Emergency Medical
personnel
• Provide Tamiflu as Prophylaxis
• Follow up
• Report to service if symptoms develop

47Summary Cont.)
Assess contact risk profile
Healthy Children and Adults
• Do not provide prophylaxis especially
 >48 Hrs. since last close contact
 Contact not during the infectious period

Consider Early treatment as an alternative to
Chemoprophylaxis:
• Counsel contacts on early Flu symptoms,
• Close follow up for high risk contacts,
• Start Tamiflu as treatment as soon as
symptoms develop
48Summary Cont.)

Seasonal Influenza Laboratory Testing Guide
49Summary Cont.)
Asymptomatic contact of laboratory
confirmed influenza case
Laboratory testing not required**

(Cont.)
50Summary Cont.)
Influenza Like Illness: (ILI)
An acute respiratory infection with measured fever
of ≥ 38 C°, and cough; with onset within the last 10
days.
Healthy Children and Adults High risk category*
Laboratory testing not
required**
Laboratory testing
recommended

(Cont.)
51Summary Cont.)
days.
High risk category*
Laboratory testing
recommended
*Start Antiviral treatment immediately
Do not wait for the Laboratory result

(Cont.)
52Summary Cont.)
days.
Healthy Children and Adults
Laboratory testing not
required**
**Post exposure
Preventive measure
done without screening

(Cont.)
53Summary Cont.)
Severe Acute Respiratory Infection: (SARI)*
An acute respiratory infection with: History
of fever or measured fever of ≥ 38 C°; and
cough; with onset within the last 10 days;
and requires hospitalization.
Laboratory testing recommended

(Cont.)
54Summary Cont.)
Severe Acute Respiratory Infection: (SARI)*
An acute respiratory infection with: History
of fever or measured fever of ≥ 38 C°; and
cough; with onset within the last 10 days;
and requires hospitalization.
Laboratory testing recommended
*Start Antiviral treatment immediately
Do not wait for the Laboratory result

Reference
• Influenza seasonal : https://www.who.int/en/news-room/fact-
sheets/detail/influenza-(seasonal)
• Estimates of US influenza-associated deaths made using four
different methods.
Thompson WW, Weintraub E, Dhankhar P, Cheng OY,
Brammer L, Meltzer MI, et al. Influenza Other Respi Viruses.
2009;3:37-49
• Global burden of respiratory infections due to seasonal
influenza in young children: a systematic review and meta-
analysis.
Nair H, Abdullah Brooks W, Katz M et al. Lancet 2011; 378:
1917–3
• WHO recommended surveillance standards, Second edition.
55

Thank you
56

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