InfluenzaInfluenzaPuja A. Sehgal, MDPuja A. Sehgal, MD

Kelsey-Seybold ClinicKelsey-Seybold Clinic

Seasonal FluSeasonal Flu Influenza (Flu) is an acute respiratory illness Influenza (Flu) is an acute respiratory illness

caused by Influenza A or B viruses that occurs in caused by Influenza A or B viruses that occurs in outbreaks or epidemics worldwide, mainly in outbreaks or epidemics worldwide, mainly in winter season.winter season.

It is a highly contagious viral illness that can It is a highly contagious viral illness that can occur in children or adults of any age.occur in children or adults of any age.

Transmission is through large respiratory droplets Transmission is through large respiratory droplets while coughing, sneezing, talking. Each year in while coughing, sneezing, talking. Each year in the United States on average, 5% to 20% of the the United States on average, 5% to 20% of the population gets the flu; on average, more than population gets the flu; on average, more than 200,000 people are hospitalized from flu-related 200,000 people are hospitalized from flu-related complications, and; about 36,000 people die from complications, and; about 36,000 people die from flu-related causes. flu-related causes.

The Flu Is Contagious The Flu Is Contagious Most healthy adults may be able to infect Most healthy adults may be able to infect

others beginning 1 day others beginning 1 day beforebefore symptoms symptoms develop and up to 5-7 days develop and up to 5-7 days afterafter becoming sick . Children may be able to becoming sick . Children may be able to pass the virus for more than seven days.pass the virus for more than seven days.

Symptoms start one to four days after the Symptoms start one to four days after the virus enters the body .virus enters the body .

Some persons can be infected with the flu Some persons can be infected with the flu virus but have no symptomsvirus but have no symptoms

Anyone Can Get the Flu, But the Disease Anyone Can Get the Flu, But the Disease Is More Severe for Some People Is More Severe for Some People

SymptomsSymptoms Can vary from mild to severe and can even lead Can vary from mild to severe and can even lead

to deathto death Fever (usually high) Fever (usually high) Headache Headache Extreme tiredness Extreme tiredness Dry cough Dry cough Sore throat Sore throat Runny or stuffy nose Runny or stuffy nose Muscle aches Muscle aches Stomach symptoms, such as nausea, vomiting, Stomach symptoms, such as nausea, vomiting,

and diarrhea, also can occur but are more and diarrhea, also can occur but are more common in children than adults common in children than adults

ComplicationsComplications

PneumoniaPneumonia Acute sinusitisAcute sinusitis Ear InfectionEar Infection Myositis/Muscle inflammationMyositis/Muscle inflammation Central nervous system involvementCentral nervous system involvement DeathDeath

Prevention of FLUPrevention of FLU

““Take 3” ActionsTake 3” Actions To Fight The Flu To Fight The Flu Flu vaccine is the first and most important Flu vaccine is the first and most important

step in protecting against seasonal step in protecting against seasonal influenza. influenza.

Vaccination is especially important for Vaccination is especially important for people at high risk of serious flu people at high risk of serious flu complications, including young children, complications, including young children, pregnant women, people with chronic pregnant women, people with chronic health conditions like asthma, diabetes or health conditions like asthma, diabetes or heart and lung disease and people 65 years heart and lung disease and people 65 years and older. and older.

Health care workers, and other people who Health care workers, and other people who live with or care for high risk people.live with or care for high risk people.

Everyday preventionEveryday prevention Cover your nose and mouth with a tissue when you Cover your nose and mouth with a tissue when you

cough or sneeze. Throw the tissue in the trash after cough or sneeze. Throw the tissue in the trash after you use it. you use it.

Wash your hands often with soap and water. If soap Wash your hands often with soap and water. If soap and water are not available, use an alcohol-based and water are not available, use an alcohol-based hand rub. hand rub.

Avoid touching your eyes, nose and mouth. Germs Avoid touching your eyes, nose and mouth. Germs spread this way. spread this way.

Try to avoid close contact with sick people.Try to avoid close contact with sick people. If you are sick with flu-like illness, you should stay If you are sick with flu-like illness, you should stay

home for at least 24 hours after your fever is gone home for at least 24 hours after your fever is gone except to get medical care or for other necessities. except to get medical care or for other necessities. (Your fever should be gone without the use of a fever-(Your fever should be gone without the use of a fever-reducing medicine.) reducing medicine.)

While sick, limit contact with others as much as While sick, limit contact with others as much as possible to keep from infecting them. possible to keep from infecting them.

Take FLU ANTIVIRAL MEDICINES Take FLU ANTIVIRAL MEDICINES AS RECOMMENDEDAS RECOMMENDED

Antiviral drugs are prescription medicines (pills, Antiviral drugs are prescription medicines (pills, liquid or an inhaled powder) that fight against the liquid or an inhaled powder) that fight against the flu by keeping flu viruses from reproducing in flu by keeping flu viruses from reproducing in your body. your body.

Antiviral drugs can make illness milder and Antiviral drugs can make illness milder and shorten the time you are sick. They may also shorten the time you are sick. They may also prevent serious flu complications. prevent serious flu complications.

Antiviral drugs are not sold over-the-counter and Antiviral drugs are not sold over-the-counter and are different from antibiotics. are different from antibiotics.

For treatment, antiviral drugs work best if started For treatment, antiviral drugs work best if started within the first 2 days of symptoms. within the first 2 days of symptoms.

SWINE/H1N1 FLUSWINE/H1N1 FLU H1N1 is a new influenza virus, first detected in H1N1 is a new influenza virus, first detected in

the United States in April 2009.the United States in April 2009. This virus was originally referred to as “swine flu” This virus was originally referred to as “swine flu”

because laboratory testing showed that many of because laboratory testing showed that many of the genes in this new virus were very similar to the genes in this new virus were very similar to influenza viruses that normally occur in pigs influenza viruses that normally occur in pigs (swine) in North America .(swine) in North America .

This is, in fact, a "This is, in fact, a "quadruple reassortantquadruple reassortant" virus. " virus. It has two genes from flu viruses that normally It has two genes from flu viruses that normally circulate in pigs and bird (avian) genes and circulate in pigs and bird (avian) genes and human genes. It has two genes from flu viruses human genes. It has two genes from flu viruses that normally circulate in pigs in Europe and Asia that normally circulate in pigs in Europe and Asia and bird (avian) genes and human genes. and bird (avian) genes and human genes.

Symptoms Symptoms 2009 H1N1 virus is contagious and is spreading 2009 H1N1 virus is contagious and is spreading

from human to human. from human to human. Symptoms include fever, cough, sore throat, Symptoms include fever, cough, sore throat,

runny or stuffy nose, body aches, headache, chills runny or stuffy nose, body aches, headache, chills , fatigue, nausea/vomiting and diarrhea. , fatigue, nausea/vomiting and diarrhea.

People may be infected with the flu, including People may be infected with the flu, including 2009 H1N1 and have respiratory symptoms 2009 H1N1 and have respiratory symptoms without a fever .without a fever .

While most people who have been sick have While most people who have been sick have recovered without needing medical treatment, recovered without needing medical treatment, hospitalizations and deaths from infection with hospitalizations and deaths from infection with this virus have occurred. this virus have occurred.

““Emergency warning signsEmergency warning signs” ” In children:In children: Fast breathing or trouble Fast breathing or trouble

breathing breathing Bluish skin color Bluish skin color Not drinking enough fluids Not drinking enough fluids Not waking up or not Not waking up or not

interacting interacting Being irritable Being irritable Flu-like symptoms improve Flu-like symptoms improve

but then RETURN WITH but then RETURN WITH WORSENING FEVER AND WORSENING FEVER AND COUGHCOUGH

Fever with a rashFever with a rash

In adults:In adults: Difficulty breathing or Difficulty breathing or

shortness of breath shortness of breath Pain or pressure in the Pain or pressure in the

chest or abdomen chest or abdomen Sudden dizziness Sudden dizziness Confusion Confusion Severe or persistent Severe or persistent

vomiting vomiting

Contamination & CleaningContamination & Cleaning

Influenza virus can survive on environmental Influenza virus can survive on environmental surfaces and can infect a person for 2 to 8 hours surfaces and can infect a person for 2 to 8 hours after being deposited on the surface. after being deposited on the surface.

Influenza virus is destroyed by heat (167-212°F Influenza virus is destroyed by heat (167-212°F [75-100°C]), chemical germicides, including [75-100°C]), chemical germicides, including chlorine, hydrogen peroxide, detergents (soap), chlorine, hydrogen peroxide, detergents (soap), iodophors (iodine-based antiseptics), and alcohols iodophors (iodine-based antiseptics), and alcohols ..

Germs can be spread when a person touches Germs can be spread when a person touches something that is contaminated with germs and something that is contaminated with germs and then touches his or her eyes, nose, or mouth then touches his or her eyes, nose, or mouth

2009 H1N1 viruses are not spread by 2009 H1N1 viruses are not spread by eating pork or pork products. eating pork or pork products.

2009 H1N1 Influenza Vaccine2009 H1N1 Influenza Vaccine

The U.S. Food and Drug Administration The U.S. Food and Drug Administration (FDA) has approved the use of one dose of (FDA) has approved the use of one dose of 2009 H1N1 flu vaccine for persons 10 2009 H1N1 flu vaccine for persons 10 years of age and older. years of age and older.

Seasonal flu vaccine is not expected to Seasonal flu vaccine is not expected to protect against the 2009 H1N1 flu. protect against the 2009 H1N1 flu.

People who are allergic to eggs might be People who are allergic to eggs might be at risk for allergic reactions from receiving at risk for allergic reactions from receiving influenza vaccines, including the 2009 influenza vaccines, including the 2009 H1N1 vaccine. H1N1 vaccine.

TARGET GROUPS for H1N1 TARGET GROUPS for H1N1 VACCINEVACCINE

pregnant women, pregnant women, persons who live with or provide care for infants persons who live with or provide care for infants

aged <6 months (e.g., parents, siblings, and aged <6 months (e.g., parents, siblings, and daycare providers), daycare providers),

health-care and emergency medical services health-care and emergency medical services personnel who have direct contact with patients personnel who have direct contact with patients or infectious material, or infectious material,

children aged 6 months--4 years, and children aged 6 months--4 years, and children and adolescents aged 5--18 years who children and adolescents aged 5--18 years who

have medical conditions that put them at higher have medical conditions that put them at higher risk for influenza-related complications risk for influenza-related complications

(These 5 groups comprise approximately 42 (These 5 groups comprise approximately 42 million persons in the United States) million persons in the United States)

Two types of vaccinesTwo types of vaccines

Both seasonal and 2009 H1N1 vaccines Both seasonal and 2009 H1N1 vaccines are available as inactivated and live are available as inactivated and live attenuated (LAIV) formulations. attenuated (LAIV) formulations.

Seasonal flu and 2009 H1N1 vaccines may Seasonal flu and 2009 H1N1 vaccines may be administered on the same day. Two be administered on the same day. Two shots can be given, each in a different shots can be given, each in a different place on the body, or a shot and a nasal place on the body, or a shot and a nasal spray vaccine can be given. spray vaccine can be given.

Who should not get nasal H1N1 Who should not get nasal H1N1 vaccine?vaccine?

People younger than 2 years of age; People younger than 2 years of age; Pregnant women; Pregnant women; People 50 years of age and older; People 50 years of age and older; People with a medical condition that places them at higher People with a medical condition that places them at higher

risk for complications from influenza. risk for complications from influenza. Children younger than 5 years old with a history of Children younger than 5 years old with a history of

recurrent wheezing; recurrent wheezing; Children or adolescents receiving aspirin therapy; Children or adolescents receiving aspirin therapy; People who have had Guillain-Barré syndrome (GBS), a rare People who have had Guillain-Barré syndrome (GBS), a rare

disorder of the nervous system, within 6 weeks of getting a disorder of the nervous system, within 6 weeks of getting a flu vaccine, flu vaccine,

People who have a severe allergy to chicken eggs or who People who have a severe allergy to chicken eggs or who are allergic to any of the nasal spray vaccine components are allergic to any of the nasal spray vaccine components

Diagnostic testingDiagnostic testing Most patients with clinical illness consistent with Most patients with clinical illness consistent with

uncomplicated influenza who reside in an area uncomplicated influenza who reside in an area where influenza viruses are circulating where influenza viruses are circulating do notdo not require diagnostic influenza testing for clinical require diagnostic influenza testing for clinical management.management.

Patients who should be considered for influenza Patients who should be considered for influenza diagnostic testing include: diagnostic testing include:

Hospitalized patients with suspected influenza Hospitalized patients with suspected influenza Patients for whom a diagnosis of influenza will Patients for whom a diagnosis of influenza will

inform decisions regarding clinical care, infection inform decisions regarding clinical care, infection control, or management of close contacts. control, or management of close contacts.

Patients who died of an acute illness in which Patients who died of an acute illness in which influenza was suspectedinfluenza was suspected

TREATMENTTREATMENT Antiviral medicines : started within first 48 hours Antiviral medicines : started within first 48 hours

if symptoms are severe or risk of complications is if symptoms are severe or risk of complications is high. high. Most healthy persons who develop an Most healthy persons who develop an illness consistent with uncomplicated illness consistent with uncomplicated influenza, or persons who appear to be influenza, or persons who appear to be recovering from influenza, do not need recovering from influenza, do not need antiviral medications for treatment or antiviral medications for treatment or prophylaxis. prophylaxis.

RestRest Adequate Fluid Intake.Adequate Fluid Intake. Hand Hygiene measuresHand Hygiene measures Cough suppressants are usually not helpful.Cough suppressants are usually not helpful.

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