FLU

The underestimated threat

.

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

Increased Risk

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

How the Flu Spreads

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

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

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

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

Preventing the Flu

• Good Health Habits• Vaccination• Antiviral Medications

Good Health Habits

• 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

Vaccination

Vaccine Production Capacities

• 65-70% of global vaccine production located in Europe (5 companies)– 50% of that production is exported outside of Europe

11422

76120

148164

168181186

204218

289328

0 50 100 150 200 250 300 350

Egypt

UAE

Mexico

Brazil

Sweden

Greece

Japan

France

Germany

UK

Australia

Korea

US

Canada

Doses vaccine/1000 population

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

Live virus

LAIV Inactivated vaccine WV

Subunit vaccine SU

Split vaccine SPL

rosettes

Adjuvanted vaccine

Virosomalvaccine

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)

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

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

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

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)

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

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

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

Other Groups

• Providers of essential community services

• Foreign travelers

• Students

• Anyone who wishes to reduce the likelihood of becoming ill from influenza

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

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

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

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

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

LIAV Side Effects

• Children– runny nose – headache – vomiting – muscle aches – fever

• Adults– runny nose– headache– sore throat– cough– fever

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

Effectiveness of Inactivated Vaccine- Children

• 77% - 91% effective against influenza respiratory illness

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

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

Inactivated v. Live Vaccines

• 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

پيشگيري و كنترل آنفلوانزاي بيمارستانيطغيان هاي بيمارستاني ناگهاني و انفجاري هستند•سه منبع مهم انتشار عفونت در بيمارستان شامل •

بيمار، كاركنان و مالقات كنندگان ميباشدتشخيص بموقع طغيان هاي بيمارستاني اهميت •

زيادي داردضرر 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

پيشگيري و كنترل آنفلوانزاي بيمارستانياحتمال انتقال از طريق افشانه هاي آلوده صورت ميگيرد لذا •

الزم است به محل بستري بيماران مشكوك توجه گرددبيماران با عالئم تنفسي تا قبل از روشن شدن وضعيت در ميان •

ساير بيماران بستري نشونداز تردد بيماران با عالئم تنفسي در بخش حتي االمكان جلوگيري •

شود ) الاقل با ماسك باشد (به پرسنل بيمار داراي عالئم تنفسي مرخصي اجباري داده شود •نياز به اطاق با تجهيزات فشار منفي نيست • ساعت ويروس در دماي اطاق زنده ميماند24تا •امكانات ضروري جهت پذيرش بيماران در هنگام اپيدمي ها •

پيش بيني گرددبه بخش هاي بيماران خاص توجه بيشتري مبذول گردد•