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Infleunza

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What is influenza ,ethology ,types ,presentations signs and symptoms ,epidemic influenza ,laboratory investigations , management , the WHO guidelines in dealing with cases and contact

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Infleunza

  1. 1. Influenza (Flu) Prof. Dr. Saad S Al Ani Senior Pediatric Consultant Head of Pediatric Department Khorfakkan Hospital Sharjah ,UAE saadsalani@yahoo.com
  2. 2. 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
  3. 3. Facts • Influenza is a serious infection that affects between 5-20% of the US population annually. http://www.nfid.org/idinfo/influenza 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 3
  4. 4. • 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. http://www.nfid.org/idinfo/influenza 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 4Facts
  5. 5. • In temperate climates: Seasonal epidemics occur mainly during winter • In tropical regions: Influenza may occur throughout the year, causing outbreaks more irregularly. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 5Facts
  6. 6. • Incubation period, is about 2 days, but ranges from one to four days 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 6Facts
  7. 7. 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) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 7
  8. 8. 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. http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 8
  9. 9. Viral Proteins TCI Chemicals 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 9
  10. 10. 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. http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 10
  11. 11. 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 11
  12. 12. Influenza C virus • Influenza C virus is detected less frequently and usually causes mild infections, thus does not present public health importance. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 12
  13. 13. Influenza D viruses • Influenza D viruses primarily affect cattle and are not known to infect or cause illness in people. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 13
  14. 14. Epidemiology • All age groups can be affected but there are groups that are more at risk than others. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 14
  15. 15. Epidemiology (Cont.) • Pregnant women • Children under 59 months • The elderly 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 15
  16. 16. 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). 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 16
  17. 17. Epidemiology (Cont.) • 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 17
  18. 18. Epidemiology (Cont.) • Illnesses range from mild to severe and even death • Hospitalization and death occur mainly among high risk groups. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 18
  19. 19. Transmission • Seasonal influenza spreads easily, with rapid transmission in crowded areas including schools and nursing homes. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 19
  20. 20. Transmission (Cont.) • Coughs or sneezes, droplets containing viruses (infectious droplets) • Infectious droplets can spread up to one meter 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 20
  21. 21. Transmission (Cont.) • Infect persons in close proximity who breathe these droplets in. • The virus can also be spread by hands contaminated with influenza viruses. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 21
  22. 22. Transmission(Cont.) • To prevent transmission, people should:  Cover their mouth and nose with a tissue when coughing  Wash their hands regularly 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 22
  23. 23. Signs and symptoms • Seasonal influenza is characterized by a sudden onset of : 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 23 Fever Muscle and Joint pain Cough (usually dry) Severe malaise Headache Sore throat Runny nose
  24. 24. Diagnosis • The majority of cases of human influenza are clinically diagnosed 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 24
  25. 25. Diagnosis (Cont.) • The clinical differentiation of influenza from other pathogens is difficult:- During periods of low influenza activity Outside of epidemics situations, 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 25
  26. 26. Diagnosis (Cont.) • Other respiratory viruses that can present as Influenza-like Illness (ILI) include: Rhinovirus Respiratory syncytial virus Parainfluenza Adenovirus 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 26
  27. 27. Laboratory confirmation of influenza virus • Throat, nasal and nasopharyngeal secretions or tracheal aspirate or washings is commonly performed 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 27 WHO recommended surveillance standards, Second edition.
  28. 28. Laboratory confirmation of influenza virus (cont.) • Direct antigen detection • Virus isolation • Detection of influenza-specific RNA by reverse transcriptase-polymerase chain reaction (RT-PCR). 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 28 WHO recommended surveillance standards, Second edition.
  29. 29. 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 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 29
  30. 30. 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 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 30
  31. 31. Treatment(Cont.) • Neuraminidase inhibitors (i.e. Oseltamivir) as soon as possible (ideally, within 48 hours following symptom onset) to maximize therapeutic benefits. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 31
  32. 32. Treatment(Cont.) Administration of the drug should also be considered in patients presenting later in the course of illness. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 32
  33. 33. Treatment(Cont.) A minimum of 5 days, but can be extended until there is satisfactory clinical improvement 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 33
  34. 34. 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 34
  35. 35. 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 35
  36. 36. Prevention • The most effective way to prevent the disease is vaccination 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 36
  37. 37. Prevention • Annual vaccination is recommended to protect against influenza as immunity from vaccination wanes over time 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 37
  38. 38. Prevention • Injected inactivated influenza vaccines are most commonly used throughout the world. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 38
  39. 39. 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 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 39
  40. 40. 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 40
  41. 41. 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 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 41
  42. 42. Summary Antiviral Treatment Recommendations for Seasonal Influenza 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  43. 43. Summary Cont.) Antiviral Treatment Recommendations for Seasonal Influenza (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  44. 44. Seasonal Influenza Contact Management Recommendations 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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”
  45. 45. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 45Summary Cont.) Assess contact risk profile High risk contacts • Provide Tamiflu as Prophylaxis • Follow up • Report to service if symptoms develop
  46. 46. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  47. 47. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  48. 48. 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 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 48Summary Cont.)
  49. 49. Seasonal Influenza Laboratory Testing Guide 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 49Summary Cont.) Asymptomatic contact of laboratory confirmed influenza case Laboratory testing not required**
  50. 50. Seasonal Influenza Laboratory Testing Guide (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  51. 51. Seasonal Influenza Laboratory Testing Guide (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 51Summary Cont.) Influenza Like Illness: (ILI) An acute respiratory infection with measured fever of ≥ 38 C°, and cough; with onset within the last 10 days. High risk category* Laboratory testing recommended *Start Antiviral treatment immediately Do not wait for the Laboratory result
  52. 52. Seasonal Influenza Laboratory Testing Guide (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 52Summary 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 Laboratory testing not required** **Post exposure Preventive measure done without screening
  53. 53. Seasonal Influenza Laboratory Testing Guide (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  54. 54. Seasonal Influenza Laboratory Testing Guide (Cont.) 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 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
  55. 55. 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. 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 55
  56. 56. Thank you 22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani 56

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