Influenza

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"Flu" redirects here. For other uses, see Flu (disambiguation).
This article is about the disease influenza. For the family of viruses that cause the disease, see
Orthomyxoviridae.

Influenza
Classification and external resources

TEM of negatively stained influenza virions, magnified
approximately 100,000 times
ICD-10

J10., J11.

ICD-9

487

DiseasesDB

6791

MedlinePlus

000080

eMedicine

med/1170 ped/3006

MeSH

D007251

Influenza (Flu) Types Avian (A/H5N1 subtype) · Canine Equine · Swine (A/H1N1 subtype) Vaccines 2009 pandemic (Pandemrix) ACAM-FLU-A · Fluzone · Influvac Live attenuated (FluMist) · Optaflu Treatment Amantadine · Arbidol · Laninamivir Oseltamivir · Peramivir · Rimantadine Vitamin D · Zanamivir Pandemics 2009 · 1968–1969 Hong Kong · 1918 Outbreaks .

fever. coughing. An avian strain named H5N1 raised the concern of a new influenza pandemic.000 people every year. after it emerged in Asia in the 1990s. influenza is transmitted through the air by coughs or sneezes. On average 41. Airborne aerosols have been thought to cause most infections. particularly in children. although which means of transmission is most important is not absolutely clear. In more serious cases. but it has not evolved to a form that spreads easily between people. resulting in the deaths of between 250.2008 West Bengal 2007 Bernard Matthews H5N1 2007 Australian equine 2006 H5N1 India · 1976 swine flu See also Flu season · Influenza evolution Influenza research Influenza-like illness v•d•e Influenza. disinfectants and detergents. creating aerosols containing the virus. with each of these pandemics being caused by the appearance of a new strain of the virus in humans. Influenza can also be transmitted by direct contact with bird droppings or nasal secretions.000 and 500. influenza is a more severe disease than the common cold and is caused by a different type of virus. Influenza spreads around the world in seasonal epidemics. muscle pains. or when an existing human strain picks up new genes from a virus that usually infects birds or pigs. is an infectious disease caused by RNA viruses of the family Orthomyxoviridae (the influenza viruses).[1] Sore throat. Although it is often confused with other influenza-like illnesses. that affects birds and mammals. which is sometimes called "stomach flu" or "24-hour flu". particularly for the young and the elderly.[3] Typically.[9] In April 2009 a novel flu strain evolved that combined genes from . severe headache. especially the common cold.400 people died each year in the United States between 1979 and 2001 from influenza. weakness/fatigue and general discomfort.[7] up to millions in some pandemic years. influenza causes pneumonia. Often. The most common symptoms of the disease are chills. fever and coughs are the most frequent symptoms.[1] but these symptoms are more common in the unrelated gastroenteritis.[4] Influenza viruses can be inactivated by sunlight. which can be fatal.[2] Influenza may produce nausea and vomiting. frequent hand washing reduces the risk of infection. sore throat.[5] [6] As the virus can be inactivated by soap.[8] Three influenza pandemics occurred in the 20th century and killed tens of millions of people. or through contact with contaminated surfaces. these new strains appear when an existing flu virus spreads to humans from other animal species. commonly referred to as the flu.

and subtype nomenclature o 1. since the influenza virus evolves rapidly. The World Health Organization officially declared the outbreak to be a pandemic on June 11. with neuraminidase inhibitors being particularly effective. and new strains quickly replace the older ones. the United States. and it has very low reactivity.1. not severity.1. Contents [hide]  1 Classification o 1.1 Influenzavirus A  1.1 Types of influenza virus  1.1.2 Pathophysiology  4 Prevention . initially dubbed "swine flu" and also known as influenza A/H1N1.[12] The most common human vaccine is the trivalent influenza vaccine (TIV) that contains purified and inactivated material from three viral strains. emerged in Mexico. pig. this vaccine includes material from two influenza A virus subtypes and one influenza B virus strain.[13] The TIV carries no risk of transmitting the disease.3 Influenzavirus C o 1. and several other nations. the strain actually having a lower mortality rate than common flu outbreaks. The WHO's declaration of a pandemic level 6 was an indication of spread. A vaccine formulated for one year may be ineffective in the following year. 2009 (see 2009 flu pandemic). properties. Typically.2 Influenzavirus B  1.1 Transmission o 3.human.[10] Vaccinations against influenza are usually given to people in developed countries[11] and to farmed poultry. and bird flu.2 Structure. Antiviral drugs can be used to treat influenza.3 Replication  2 Signs and symptoms  3 Mechanism o 3.

2 Epidemic and pandemic spread  8 History o 8.2 M2 inhibitors (adamantanes)  6 Prognosis  7 Epidemiology o 7.o 4.1 Seasonal variations o 7.1 Vaccination o 4.2 Pandemics  9 Society and culture  10 Research  11 Infection in other animals o 11.1 Bird flu o 11.1 Etymology o 8.2 Swine flu  12 See also  13 References  14 Further reading  15 External links .1 Neuraminidase inhibitors o 5.2 Infection control  5 Treatment o 5.

Occasionally. and the 2009 flu pandemic . which caused Spanish flu in 1918. viruses are transmitted to other species and may then cause devastating outbreaks in domestic poultry or give rise to human influenza pandemics. The hemagglutinin (HA) and neuraminidase (NA) proteins are shown on the surface of the particle.[15] but can also cause a disease similar to influenza in adults. influenza A virus. ordered by the number of known human pandemic deaths.[16] [edit] Influenzavirus A This genus has one species. Wild aquatic birds are the natural hosts for a large variety of influenza A. In virus classification influenza viruses are RNA viruses that make up three of the five genera of the family Orthomyxoviridae:[14]  Influenzavirus A  Influenzavirus B  Influenzavirus C These viruses are only distantly related to the human parainfluenza viruses. The influenza A virus can be subdivided into different serotypes based on the antibody response to these viruses. which are RNA viruses belonging to the paramyxovirus family that are a common cause of respiratory infections in children such as croup.[17] The type A viruses are the most virulent human pathogens among the three influenza types and cause the most severe disease.[18] The serotypes that have been confirmed in humans. The viral RNAs that make up the genome are shown as red coils inside the particle and bound to Ribonuclear Proteins (RNPs). are:  H1N1.[edit] Classification [edit] Types of influenza virus Structure of the influenza virion.

ensures that pandemics of influenza B do not occur. influenza B mutates enough that lasting immunity is not possible.[24] [edit] Influenzavirus C . pigs and birds  H9N2  H7N2  H7N3  H10N7 [edit] Influenzavirus B Influenza virus nomenclature (for a Fujian flu virus) This genus has one species.[18] As a result of this lack of antigenic diversity. with only one influenza B serotype. a current pandemic threat  H7N7. The only other animals known to be susceptible to influenza B infection are the seal[20] and the ferret.[23] This reduced rate of antigenic change. H2N2. which caused Asian Flu in 1957  H3N2. which caused Hong Kong Flu in 1968  H5N1. endemic in humans. Influenza B almost exclusively infects humans[18] and is less common than influenza A. combined with its limited host range (inhibiting cross species antigenic shift). However. a degree of immunity to influenza B is usually acquired at an early age. which has unusual zoonotic potential[19]  H1N2.[21] This type of influenza mutates at a rate 2–3 times slower than type A[22] and consequently is less genetically diverse. influenza B virus.

M1. although filamentous forms can occur. and subtype nomenclature Influenzaviruses A. NS1. sometimes causing both severe illness and local epidemics.[34] Thus.[32] However. wrapped around a central core. nucleoprotein (NP). instead. they are antigens to which antibodies can be raised. properties. Influenza A viruses are classified into subtypes based on antibody responses to HA and NA. influenza C virus. the viral particles of all influenza viruses are similar in composition. but only H 1. 2 and 3. by cleaving sugars that bind the mature viral particles.[30] [31] These filamentous forms are more common in influenza C. HA is a lectin that mediates binding of the virus to target cells and entry of the viral genome into the target cell.[31] Unusually for a virus. RNA tends to be single stranded but in special cases it is double. which infects humans.[36] There are 16 H and 9 N subtypes known. each piece of RNA containing either one or two genes. B and C are very similar in overall structure. encoding for 11 proteins: hemagglutinin (HA). and N 1 and 2 are commonly found in humans. The central core contains the viral RNA genome and other viral proteins that package and protect this RNA. for example.[33] Hemagglutinin (HA) and neuraminidase (NA) are the two large glycoproteins on the outside of the viral particles. influenza C is less common than the other types and usually only causes mild disease in children. which can form cordlike structures up to 500 micrometres long on the surfaces of infected cells.[35] Furthermore. the influenza A genome contains 11 genes on eight pieces of RNA. PB1. these proteins are targets for antiviral drugs. while NA is involved in the release of progeny virus from infected cells.[37] [edit] Replication .This genus has one species. PB1-F2 and PB2. despite these varied shapes.[25][26] However. PA. H5N1. neuraminidase (NA).[29] The virus particle is 80–120 nanometres in diameter and usually roughly spherical. M2. [32] For example. NS2(NEP). it contains seven or eight pieces of segmented negative-sense RNA. dogs and pigs. These different types of HA and NA form the basis of the H and N distinctions in. its genome is not a single piece of nucleic acid.[27][28] [edit] Structure.[32] These are made of a viral envelope containing two main types of glycoproteins.

where the RNA-dependent RNA polymerase begins transcribing complementary positive-sense vRNA (Steps 3a and b). accessory proteins and RNA-dependent RNA polymerase are then released into the cytoplasm (Stage 2).Host cell invasion and replication by the influenza virus.[41] The M2 ion channel is blocked by amantadine drugs.[39] After the hemagglutinin is cleaved by a protease.[32] Influenza viruses bind through hemagglutinin onto sialic acid sugars on the surfaces of epithelial cells. The steps in this process are discussed in the text. assemble these components into new viral particles and finally exit the host cell. or remains in the nucleus. step 5b) or transported back into the nucleus to bind vRNA and form new viral genome particles (step 5a).[43] The vRNA is either exported into the cytoplasm and translated (step 4). Newly synthesised viral proteins are either secreted through the Golgi apparatus onto the cell surface (in the case of neuraminidase and hemagglutinin.[40] Once inside the cell. Other viral proteins have multiple actions in the host cell. typically in the nose. the cell imports the virus by endocytosis. which causes the core to dissemble and release the viral RNA and core proteins. then deliver its genome to a site where it can produce new copies of viral proteins and RNA. the acidic conditions in the endosome cause two events to happen: first part of the hemagglutinin protein fuses the viral envelope with the vacuole's membrane.[38] Influenza infection and replication is a multi-step process: firstly the virus has to bind to and enter the cell.[42] These core proteins and vRNA form a complex that is transported into the cell nucleus. throat and lungs of mammals and intestines of birds (Stage 1 in infection figure).[32] The viral RNA (vRNA) molecules. including degrading cellular mRNA and using the released nucleotides for vRNA synthesis and also inhibiting translation of host-cell mRNAs. Viruses can only replicate in living cells.[44] . then the M2 ion channel allows protons to move through the viral envelope and acidify the core of the virus. preventing infection.

Because of the absence of RNA proofreading enzymes. Hence. as discussed below in the section on Epidemiology. the viruses adhere to the cell through hemagglutinin. which is the approximate length of the influenza vRNA. the mature viruses detach once their neuraminidase has cleaved sialic acid residues from the host cell. The vRNA and viral core proteins leave the nucleus and enter this membrane protrusion (step 6).[46] The separation of the genome into eight separate segments of vRNA allows mixing or reassortment of vRNAs if more than one type of influenza virus infects a single cell.[36] This is important in the emergence of pandemics. which is a slow change in the antigens on the viral surface over time. the RNA-dependent RNA polymerase that copies the viral genome makes an error roughly every 10 thousand nucleotides. Hemagglutinin and neuraminidase molecules cluster into a bulge in the cell membrane.Negative-sense vRNAs that form the genomes of future viruses. and other viral proteins are assembled into a virion. the host cell dies. therefore prevent the release of new infectious viruses and halt viral replication. RNA-dependent RNA polymerase. [edit] Signs and symptoms Most sensitive symptoms for diagnosing influenza[47] Symptom: sensitivity specificity Fever 68–86% 25–73% Cough 84–98% 7–29% Nasal 68–91% 19–41% congestion  All three findings. the majority of newly manufactured influenza viruses are mutants. this causes "antigenic drift".[35] After the release of new influenza viruses. The resulting rapid change in viral genetics produces antigenic shifts. The mature virus buds off from the cell in a sphere of host phospholipid membrane. . which are sudden changes from one antigen to another. especially fever. such as oseltamivir.[45] As before. acquiring hemagglutinin and neuraminidase with this membrane coat (step 7). These sudden large changes allow the virus to infect new host species and quickly overcome protective immunity. were less sensitive in patients over 60 years of age.[39] Drugs that inhibit neuraminidase.

mouth.[2] but a flu can be identified by a high fever with a sudden onset and extreme fatigue.[49] Many people are so ill that they are confined to bed for several days.[50] The symptoms most reliably seen in influenza are shown in the table to the right. Usually the first symptoms are chills or a chilly sensation.[50][51] (may be severe in children with influenza B)[52] It can be difficult to distinguish between the common cold and influenza in the early stages of these infections. shaking (rigor))  Cough  Nasal congestion  Body aches. with aches and pains throughout their bodies.Symptoms of influenza.[47] although it has been seen in some human cases of the H5N1 "bird flu"[53] and can be a symptom in children. with body temperatures ranging from 38-39 °C (approximately 100-103 °F). watering eyes  Reddened eyes. skin (especially face).[47] .[48] with fever and cough the most common symptoms. especially joints and throat  Fatigue  Headache  Irritated. which are worse in their backs and legs.[1] Symptoms of influenza may include:  Fever and extreme coldness (chills shivering. throat and nose  In children. gastrointestinal symptoms such as diarrhea and abdominal pain.[47] Symptoms of influenza can start quite suddenly one to two days after infection. Diarrhea is not normally a symptom of influenza in adults. but fever is also common early in the infection.

nose or mouth of another person).[56] The available laboratory tests for influenza continue to improve. sore throat and/or nasal congestion can improve diagnostic accuracy. or periinfluenza season (prevalence=10%[56]). or hand-to-mouth transmission.[58][60] The transmission of influenza can be modeled mathematically. The relative importance of these three modes of transmission is unclear. These tests may be especially useful during the influenza season (prevalence=25%) but in the absence of a local outbreak.[59] Children are much more infectious than adults and shed virus from just before they develop symptoms until two weeks after infection. below). Influenza virus shedding (the time during which a person might be infectious to another person) begins the day before symptoms appear and virus is then released for between 5 to 7 days. the combinations of fever with cough. the prevalence will be over 70%.Since antiviral drugs are effective in treating influenza if given early (see treatment section. it can be important to identify cases early. with higher amounts of virus shed when temperatures are highest. hand-to-nose. Of the symptoms listed above. [edit] Mechanism [edit] Transmission Sneezing can transmit influenza. which helps predict how the virus will spread in a population.[58] The amount of virus shed appears to correlate with fever.[61] Influenza can be spread in three main ways:[62][63] by direct transmission (when an infected person sneezes mucus directly into the eyes. either from contaminated surfaces or from direct personal contact such as a hand-shake. and they may all contribute to the spread of the virus. sneezing or spitting) and through hand-to-eye. treatment may be justified in the elderly during the influenza season as long as the prevalence is over 15%. the airborne route (when someone inhales the aerosols produced by an infected person coughing. although some people may shed virus for longer periods. People who contract influenza are most infective between the second and third days after infection. rapid diagnostic tests have a sensitivity of 70–75% and specificity of 90–95% when compared with viral culture.[54] Two decision analysis studies[55][56] suggest that during local outbreaks of influenza. The United States Centers for Disease Control and Prevention (CDC) maintains an up-to-date summary of available laboratory tests.[56] and thus patients with any of these combinations of symptoms may be treated with neuraminidase inhibitors without testing.[4][64] .[57] According to the CDC. Even in the absence of a local outbreak.

[68] [edit] Pathophysiology The different sites of infection (shown in red) of seasonal H1N1 versus avian H5N1.In the airborne route. non-porous surfaces such as plastic or metal. part of the process that allows influenza viruses to invade cells is the cleavage of the viral hemagglutinin protein by any one of several human proteases. the structure of the hemagglutinin means that it can only be cleaved by proteases found in the throat and lungs. with the virus surviving for one to two days on hard. so these viruses cannot infect other tissues. it can also be transmitted by contaminated surfaces such as banknotes. and only five minutes on skin. such as H5N1.000 droplets.[40] In mild and avirulent viruses.[62] As the influenza virus can persist outside of the body.[65] most of these droplets are quite large and will quickly settle out of the air.[1] The length of time the virus will persist on a surface varies.[66] doorknobs. the hemagglutinin can be cleaved by a wide variety of proteases.[67] However. This influences their lethality and ability to spread. predict the strain's pathophysiology).[62][66] Avian influenza viruses can survive indefinitely when frozen. However.[62] How long influenza survives in airborne droplets seems to be influenced by the levels of humidity and UV radiation: with low humidity and a lack of sunlight in winter aiding its survival. this can protect it for longer periods (up to 17 days on banknotes).[68] They are inactivated by heating to 56 °C (133 °F) for a minimum of 60 minutes. as well as by acids (at pH <2). the droplets that are small enough for people to inhale are 0.[69] Knowing which genes are carried by a particular strain can help predict how well it will infect humans and how severe this infection will be (that is. if the virus is present in mucus. The mechanisms by which influenza infection causes symptoms in humans have been studied intensively.[26][70] For instance. in highly virulent strains.5 to 5 µm in diameter and inhaling just one droplet might be enough to cause an infection. light switches and other household items.[62] Although a single sneeze releases up to 40. for about fifteen minutes from dry paper tissues. allowing the virus to spread throughout the body. One of the mechanisms is believed to be the inhibition of adrenocorticotropic hormone (ACTH) resulting in lowered cortisol levels.[70] .

or in people who have asthma. the virus is inactivated (for example.[77] and the 1918 pandemic strain. the highly lethal H5N1 strain binds to receptors that are mostly found deep in the lungs. allowing pharmaceutical companies to develop vaccines that will provide the best immunity against these strains. such as in the nose. This effect has been proposed to be the cause of the unusual lethality of both the H5N1 avian influenza. the World Health Organization predicts which strains of the virus are most likely to be circulating in the next year. and the immune response does not itself contribute to the disease. Influenza vaccines can be produced in several ways. but is not easily transmitted by people coughing and sneezing. In contrast.[76] This massive immune response might produce a life-threatening cytokine storm. heart disease. the most common method is to grow the virus in fertilized hen eggs. After purification. another possibility is that these large amounts of cytokines are just a result of the massive levels of viral replication produced by these strains. These vaccines can be effective against . Every year. a particular influenza vaccine usually confers protection for no more than a few years. Due to the high mutation rate of the virus. so symptoms are not entirely due to the inflammatory response. by treatment with detergent) to produce an inactivated-virus vaccine.[78][79] However. such as children and the elderly.[2][75] In contrast to the rhinovirus that causes the common cold. or are immuno-compromised.[36] The effectiveness of these influenza vaccines are variable.[80] [edit] Prevention [edit] Vaccination Further information: Influenza vaccine Giving an influenza vaccination Vaccination against influenza with an influenza vaccine is often recommended for high-risk groups. diabetes.[73][74] Common symptoms of the flu such as fever. and fatigue are the result of the huge amounts of proinflammatory cytokines and chemokines (such as interferon or tumor necrosis factor) produced from influenza-infected cells. headaches. the virus can be grown in eggs until it loses virulence and the avirulent virus given as a live vaccine.[81] Vaccines have also been developed to protect poultry from avian influenza.The viral hemagglutinin protein is responsible for determining both which species a strain can infect and where in the human respiratory tract a strain of influenza will bind.[71] Strains that are easily transmitted between people have hemagglutinin proteins that bind to receptors in the upper part of the respiratory tract.[72] This difference in the site of infection may be part of the reason why the H5N1 strain causes severe viral pneumonia in the lungs. Alternatively. throat and mouth. influenza does cause tissue damage.

and staying home yourself if you are sick.[92][93] there is mixed evidence on beneficial effects in the community. Live attenuated (egg-based or cell-based) technology and recombinant technologies (proteins and virus-like particles) could provide better "real-time" access and be produced more affordably. where an influenza pandemic may likely originate.[84] The 2006–2007 season was the first in which the CDC had recommended that children younger than 59 months receive the annual influenza vaccine. As of July 2009. and general infection symptoms (many cold and flu symptoms are just general infection symptoms) can appear. The rapid development. production. The most dangerous side effect is a severe allergic reaction to either the virus material itself or residues from the hen eggs used to grow the influenza.[89] frequent hand washing (with soap and water.[85] Vaccines can cause the immune system to react as if the body were actually being infected.[87] In September 2009. researchers are looking at non-egg-based options for vaccine production.multiple strains and are used either as part of a preventative strategy. these reactions are extremely rare. thereby increasing access for people living in low. and expect the initial vaccine lots to be available within the following month. the US Food and Drug Administration approved four vaccines against the 2009 H1N1 influenza virus (the current pandemic strain). and distribution of pandemic influenza vaccines could potentially save millions of lives during an influenza pandemic. The vaccine is reformulated each season for a few specific flu strains but cannot possibly include all the strains actively infecting people in the world for that season. Due to the short time frame between identification of a pandemic strain and need for vaccination.[88] [edit] Infection control Further information: Influenza prevention Reasonably effective ways to reduce the transmission of influenza include good personal health and hygiene habits such as: not touching your eyes. more than 70 known clinical trials have been completed or are ongoing for pandemic influenza vaccines. though these symptoms are usually not as severe or long-lasting as influenza.[91][94] Smoking raises the risk of .[91] Although face masks might help prevent transmission when caring for the sick.[83] It is also possible to get infected just before vaccination and get sick with the very strain that the vaccine is supposed to prevent.[90] covering coughs and sneezes. however. Avoiding spitting is also recommended.[86] In addition to vaccination against seasonal influenza. or with alcohol-based hand rubs). as the vaccine takes about two weeks to become effective.and moderate-income countries. or combined with culling in attempts to eradicate outbreaks. occasionally. It takes about six months for the manufacturers to formulate and produce the millions of doses required to deal with the seasonal epidemics.[82] It is possible to get vaccinated and still get influenza. a new or overlooked strain becomes prominent during that time and infects people although they have been vaccinated (as by the H3N2 Fujian flu in the 2003–2004 flu season). researchers are working to develop a vaccine against a possible influenza pandemic. avoiding close contact with sick people. nose or mouth.

such measures would also be difficult to enforce and might be unpopular.[107] These drugs are often effective against both influenza A and B. according to the laws of mathematical modelling of infectious diseases. as well as producing more severe disease symptoms.[99] During past pandemics.[80] The CDC recommended against using M2 inhibitors during the 2005–06 influenza season due to high levels of drug resistance.[106] [edit] Neuraminidase inhibitors Antiviral drugs such as oseltamivir (trade name Tamiflu) and zanamivir (trade name Relenza) are neuraminidase inhibitors that are designed to halt the spread of the virus in the body.[91] When small numbers of people are infected. antibiotics have no effect on the infection. Since influenza spreads through both aerosols and contact with contaminated surfaces. quaternary ammonium compounds and bleach are used to sanitize rooms or equipment that have been occupied by patients with influenza symptoms. avoid using alcohol and tobacco and.contracting influenza. unless prescribed for secondary infections such as bacterial pneumonia.[103] Since influenza is caused by a virus. prompt treatment with anti-influenza drugs has been recommended. because doing so can lead to Reye's syndrome. drink plenty of liquids. Antiviral medication can be effective. but some strains of influenza can show resistance to the standard antiviral drugs.[100][101] It is uncertain if reducing public gatherings. isolating the sick might reduce the risk of transmission. a rare but potentially fatal disease of the liver. if necessary.[95][96] Thus.[108] The Cochrane Collaboration . smokers raise the exponential growth rates of influenza epidemics and may indirectly be responsible for a large percentage of influenza cases. will reduce transmission since people with influenza may just be moved from one area to another. take medications such as acetaminophen (paracetamol) to relieve the fever and muscle aches associated with the flu. closing schools. churches and theaters slowed the spread of the virus but did not have a large effect on the overall death rate.[98] At home.[97] Alcohol is an effective sanitizer against influenza viruses. Neuraminidase inhibitors are currently preferred for flu virus infections since they are less toxic and more effective.[105] As pregnant women seem to be more severely affected than the general population by the 2009 H1N1 influenza virus. by for example closing schools and workplaces. while quaternary ammonium compounds can be used with alcohol so that the sanitizing effect lasts for longer. surface sanitizing may help prevent some infections.[91] [edit] Treatment Further information: Influenza treatment People with the flu are advised to get plenty of rest. this can be done effectively with a diluted chlorine bleach.[104] The two classes of antiviral drugs used against influenza are neuraminidase inhibitors and M2 protein inhibitors (adamantane derivatives).[102] Children and teenagers with flu symptoms (particularly fever) should avoid taking aspirin during an influenza infection (especially influenza type B).[98] In hospitals.

and it is impossible to predict what degree of resistance a future pandemic strain might have.[42] These drugs are sometimes effective against influenza A if given early in the infection but are always ineffective against influenza B because B viruses do not possess M2 molecules.[110] [edit] M2 inhibitors (adamantanes) The antiviral drugs amantadine and rimantadine block a viral ion channel (M2 protein) and prevent the virus from infecting cells.[112] and their use to prevent outbreaks of influenza in farmed poultry.[108] Measured resistance to amantadine and rimantadine in American isolates of H3N2 has increased to 91% in 2005.[109] Different strains of influenza viruses have differing degrees of resistance against these antivirals.[111] This high level of resistance may be due to the easy availability of amantadines as part of over-the-counter cold remedies in countries such as China and Russia.reviewed these drugs and concluded that they reduce symptoms and complications.[113][114] .

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