Epidemiology of viral

infections
Lecture-2- 4th stage
Dept. of Family & Community medicine
By Dr. Muslim Nahi Saeed \Ph. D Family medicine
November 1st ,2021
 Epidemiology
-Occurrence
Rubella occurs worldwide.
-Reservoir
Rubella is a human disease. There is no known animal reservoir.
Although infants with CRS may shed rubella virus for an extended
period, a true carrier state has not been described.
-Transmission
Rubella is spread from person to person via droplets shed
from the respiratory secretions of infected persons. There is
no evidence of insect transmission.
-Rubella may be transmitted by persons with subclinical or
asymptomatic cases (up to 50% of all rubella virus infections).
-Temporal Pattern
In temperate areas, incidence is usually highest in late winter and early
spring.
-Communicability
Rubella is only moderately contagious. The disease is most contagious
when the rash first appears, but virus may be shed from 7 days before to
5–7 days or more after rash onset.
-Infants with CRS shed large quantities of virus from body secretions for
up to 1 year and can therefore transmit rubella to persons caring for
them who are susceptible to the disease.
 Clinical Features
Acquired Rubella
The incubation period of rubella is 14 days, with a range of 12 to 23 days.
Symptoms are often mild, and up to 50% of infections may be subclinical or
in-apparent.
In children, rash is usually the first manifestation and a prodrome is rare.
In older children and adults, there is often a 1 to 5 day prodrome with low-
grade fever, malaise, lymphadenopathy, and upper respiratory symptoms
preceding the rash.
The rash of rubella is maculopapular and occurs 14 to 17 days after
exposure.
Clinical Features cont.
The rash usually occurs initially on the face and then progresses from
head to foot.
It lasts about 3 days and is occasionally pruritic. The rash is fainter than
measles rash and does not coalesce.
The rash is often more prominent after a hot shower or bath.
Lymphadenopathy may begin a week before the rash and last several
weeks.
Post-auricular, posterior cervical, and sub-occipital nodes are
commonly involved.
 Clinical Features cont.
Arthralgia and arthritis occur so frequently in adults that
they are considered by many to be an integral part of
the illness rather than a complication.
Other symptoms of rubella include conjunctivitis,testalgia,
or orchitis.
Complications:
Complications of rubella are not common, but they generally occur
more often in adults than in children.
-Arthralgia or arthritis may occur in up to 70% of adult women who
contract rubella, but it is rare in children and adult males.
Joint symptoms tend to occur about the same time or shortly after
appearance of the rash and may last for up to 1 month; chronic arthritis
is rare.
-Encephalitis occurs in one in 6,000 cases, more frequently in adults
(especially in females) than in children.
-Hemorrhagic manifestations occur in approximately one per 3,000
cases, occurring more often in children than in adults.
-Additional complications include orchitis, neuritis, and a rare late
syndrome of progressive pan-encephalitis.
 Congenital Rubella Syndrome
Infection with rubella virus is most severe in early gestation.
The virus may affect all organs and cause a variety of congenital
defects. Infection may lead to fetal death, spontaneous abortion,
or preterm delivery. The severity of the effects of rubella virus on
the fetus depends largely on
the time of gestation at which infection occurs.
85% of infants infected in the first trimester of pregnancy will be
found to be affected if followed after birth.
Defects are rare when infection occurs after the 20th week of
gestation.
The overall risk of defects during the third trimester is probably no
greater than that associated with uncomplicated pregnancies.
 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
 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.
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
 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
 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.
“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
 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.
-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).
 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.
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).
 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.
 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
 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 …
Isolation Precautions
Droplet precautions: Surgical
Masks

Source: Rosie Sokas, MD MOH UIL at Chicago

Personal Protective Equipment
(PPE)
End