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Control of communicable diseases

Respiratory diseases
Stage 4-L3-online
Influenza viruses
By Dr. Muslim N. Saeed \ FAMCO dept.
December 21st
, 2020

Influenza
-Highly infectious viral illness
-First pandemic in 1580
-At least 4 pandemics in 19th century
-Estimated 21 million deaths worldwide in
pandemic of 1918-1919
-Virus first isolated in 1933

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Influenza Virus
-Single-stranded RNA virus Orthomyxoviridae family
-3 types: A, B, C
-Subtypes of type A determined by hem-agglutinin and
neuraminidase

Influenza A causes moderate to severe illness

and affects all age groups. The virus infects
humans and other animals. Influenza A viruses
are perpetuated in nature by wild birds,
predominantly waterfowl.
Most of these viruses are not pathogenic to
their natural hosts and do not change or
evolve.

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Influenza B generally causes milder disease than

type A and primarily affects children. Influenza
B is more stable than influenza A, with less
antigenic drift and consequent immunologic
stability. It affects only humans.
Influenza C is rarely reported as a cause of
human illness, probably because most cases
are subclinical. It has not been associated with
epidemic disease.

Antigenic Changes
Hemagglutinin and neuraminidase periodically change,
apparently due to sequential evolution within immune or
partially immune populations.
Influenza Antigenic Changes
1-Antigenic Drift
-minor change, same subtype
-caused by point mutations in gene
-may result in epidemic
2-Antigenic Shift
-major change, new subtype
-caused by exchange of gene segments
-may result in pandemic

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2009 Influenza A(H1N1)

-In April 2009 a novel influenza A(H1N1) virus
appeared and quickly spread across North
America.
-By May 2009 the virus had spread to many
areas of the world cause of the first influenza
pandemic since 1968
-Pandemic monovalent influenza vaccine
produced and deployed in nationwide
vaccination campaign.

Viral Re-assortment

Reassortment in
humans

Reassortment in pigs
Pandemic Influenza
Virus

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Influenza Pathogenesis

-Respiratory transmission of virus

-Replication in respiratory epithelium
-destruction of cells
-Viremia rarely documented
-Virus shed in respiratory secretions for 5-10
days

Clinical Features
The incubation period for influenza is usually 2
days, but can vary from 1 to 4 days. Influenza
illness can vary from asymptomatic infection
to severe. In general, only about 50% of
infected persons will develop the classic
clinical symptoms of influenza.

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“Classic” influenza disease is characterized by the abrupt

onset of fever, myalgia, sore throat, nonproductive
cough, and headache.
Myalgias mainly affect the back muscles.
Additional symptoms may include rhinorrhea (runny
nose), headache, substernal chest burning and ocular
symptoms (e.g., eye pain and sensitivity to light).
Systemic symptoms and fever usually last from 2 to 3
days, rarely more than 5 days.
-Aspirin should not be used for infants, children, or
teenagers because they may be at risk for contracting
Reye syndrome following an influenza infection.

Influenza Complications
1-Pneumonia secondary bacterial or primary
influenza viral.
2-Reye syndrome
3-Myocarditis
4-Death is reported than less than 1 per 1,000
cases

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Influenza Diagnosis

-Clinical and epidemiological characteristics

-Isolation of influenza virus from clinical
specimen (e.g., throat, nasopharynx, sputum)
-Significant rise in influenza IgG by serologic
assay

Epidemiology
Occurrence
Influenza occurs throughout the world.
Reservoir
Humans are the only known reservoir of influenza
types B and C. Influenza A viruses may infect
both humans and animals. There is no chronic
carrier state.
Transmission
-Influenza is primarily transmitted from person to
person via large droplets (particles more than 5
microns in diameter) that are generated when
infected persons cough or sneeze.

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-Transmission may also occur through direct contact or

indirect contact with respiratory secretions such as
when touching surfaces contaminated with influenza
virus and then touching the eyes, nose or mouth.
Temporal Pattern
-Influenza activity peaks from December to March in
temperate climates, but may occur earlier or later.
-Influenza occurs throughout the year in tropical areas.
Communicability
Adults can transmit influenza from the day before
symptom onset to approximately 5 days after
symptoms begin. Children can transmit influenza to
others for 10 or more days.

Prevention and control

Influenza Vaccines
1-Inactivated subunit (IIV) intramuscular or
intra-dermal (available in Iraq).
2-Live attenuated vaccine (LAIV) (intranasal).

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Inactivated Influenza Vaccine Recommendations

When vaccine supply is limited, vaccination efforts should
focus on delivering vaccination to the following groups of
persons:
1-Children 6 months through 4 years (59 months) of age
2-persons 50 years and older
3-persons with chronic pulmonary (including asthma),
cardiovascular (except hypertension), renal, hepatic,
neurologic, hematologic, or metabolic disorders (including
diabetes mellitus)
4-persons who are immunosuppressed (including
immunosuppression caused by medications or by human
immunodeficiency virus)
5-women who are or will be pregnant during the influenza
season

6-children 6 months through 18 years of age and

receiving long-term aspirin therapy(Reye syndrome risk
after influenza virus infection).
7-Residents of nursing homes and other chronic-care
facilities.
8-Persons who are morbidly obese (body-mass index is 40
or greater) .
9-Healthcare personnel
10-Household contacts and caregivers of children
younger than 5 years of age and adults 50 years of age
or older.
11-Household contacts and caregivers of persons with
medical conditions that put them at higher risk for
severe complications from influenza.

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Pregnancy and Inactivated Influenza Vaccine

-Risk of hospitalization 4 times higher than non
pregnant women
-Risk of complications is higher comparable to
non-pregnant women.
-Vaccination (with IIV) recommended if pregnant
during influenza season.
-Vaccination can occur during any trimester

Inactivated Influenza Vaccine Contraindications

and Precautions
1-Severe allergic reaction (e.g., anaphylaxis) to a
vaccine component or following a prior dose
of inactivated influenza.
2-Moderate or severe acute illness
3-History of Guillain-Barré syndrome (GBS).

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Influenza Antiviral Agents

-Amantadine and Rimantadine not
recommended because of documented
resistance.
-Zanamivir and oseltamivir are neuraminidase
inhibitors are effective against influenza A and
B.
-oseltamavir and zanamavir approved for
prophylaxis.

Antivirals- Oseltamivir
-Treatment is 75 mg twice a day for 5 days.
-Prophylaxis is 75 mg once a day for 7 days
after last exposure.
-Prophylaxis:
1.High risk exposure (household contacts)
2.Moderate risk (unprotected very close exposure
to sick animals; Health Care Workers with
unprotected exposure to patients).
3.Low risk exposure: no need for prophylaxis.

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Cough etiquette

Respiratory etiquette
-Cover nose / mouth
when coughing or
sneezing
-Hand washing.

Voluntary Isolation
-Separation and restricted movement of ill persons
with contagious disease (often in a hospital setting
and Primarily individual level)
-Isolate severe and mild cases
-Location of isolation (home, hospital) depends on
several factors (severity of illness, the number of
affected persons, the domestic setting)
-Do not wait for lab confirmation
-Plan for large number of severe cases
-Provide medical and social care

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Voluntary Quarantine
1-Separation and restricted movement of well
persons presumed exposed
2-Identification of contacts
-Often at home, but may be designated
residential facility or hospital
-Applied at the individual or community level
3-Regular health monitoring is essential part of
quarantine
-Self-health monitoring and reporting

Patients Care at Home

-Potential for transmission

-Must educate family caregivers
-Fever / symptom monitoring
-Infection control measures
Hand washing
Use of available material as mask …

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Isolation Precautions

Droplet precautions: Surgical

Masks

Source: Rosie Sokas, MD MOH UIL at Chicago

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Personal Protective Equipment

(PPE)

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End

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