1

Influenza:
What we know
MOHAMMAD NURIMAN BIN MOHD ZAINUDDIN (AA0890)
LABLINK, KPJ PUTERI SPECIALIST HOSPITAL
Overview 2

 Introduction
 A bit virology
 Mode of Transmission
 Sign and Symptoms
 Respiratory specimens
 Laboratory Diagnosis
 Infection Control
 Vaccination
 Treatment
What is influenza? 3

 Influenza virus A, B and C, all belonging to the

Orthomyxoviruds family
 Influenza A, B and C viruses are distinguished on
the basis of their internal nucleoprotein and
matrix proteins which are specific for each viral
type
 Influenza A viruses are further categorized into
subtypes that are determined by the
antigenicity of the surface glycoproteins, the
hemagglutinin (H) and neuraminidase (N).
What does an Influenza virus look like? 4
How big is an influenza? 5
Why does influenza come back 6

again?
How is influenza spread between 7

humans?
What are the signs and symptoms? 8

Rapid onset of:

 – Fever > 38.5°/Chills
 – Dry (non-productive) cough
 – Body aches / headaches
 – Sore throat

Range of symptoms differ by age

 – Vomiting, diarrhoea, encephalitis are more common in children
 – Fever, often alone, in infants

Symptoms indicating severity and need for referral

 – Shortness of breath / difficulty breathing
 How to collect respiratory 9
specimens?

Nasopharyngeal Nasopharyngeal Nasopharyngeal Deep Nasal

Swab /Nasal Aspirate /Nasal Wash Swab

Bronchoalveolar
Throat Swab Sputum
lavage
10
What tests are available? 11

Rapid Diagnostic Test

Immunofluorescence Assay

Serological Assay

Cell Culture Based Detection

Nucleic Acid-Based Tests

Rapid Diagnostic Test 12

 Antigen detection assays that detect viral

antigens in 10-15 minutes with 50-80%
sensitivity and high specificity
 User friendly.
 None of the RIDTs provide information about
influenza A virus subtypes and C virus.
 Sofia test with the fluorescence reader had
best sensitivity.
 False negatives are common -recommend
using molecular assays to determine if positive
(CDC, 2018)
How RIDTS works? 13
Immunofluorescence Assay 14

- Antigen detection
with fluorescent
microscope usage.

- Subtyping of
influenza A is not
possible.
Serological Assay
1) Load samples &
controls into wells

Wash

2) Add primary
ELISA antibody to all wells

Wash

3) Add enzyme-
linked secondary
antibody to all wells

Wash

4) Add enzyme
substrate to all wells
 Results

 Some positive

 Some negative

 Did the controls work?

Cell Culture Based Detection 17

- Transport using Viral Transport Medium

(VTM)

- Inoculate into MDCK cells to isolate

influenza virus.

- Propagation for a week (up tp 10 days.

- Observation of the cytopathic effect.

- Results do not yield timely results to

inform clinical management .
Nucleic Acid-Based Tests
 The most sensitive & specific laboratory
tests are rRT-PCRs (real-time reverse
transcriptase PCR)

 Able to identify specific influenza

subtypes

 Tests for H1N1 are done only for cases

hospitalized.

 expensive

 Cannot be performed in doctor’s office;

2-4 days to get results (test takes 6-8
hours)
What to do? 19

 Wash your hands

 Wear a facemask/respirator
 Clean surfaces frequently
 wipe tables and equipments with Mikrozid

 Keep your distance !

 Cover coughs and sneezes !
Would there be a vaccine?
Nasal spray
Flu shot
flu vaccine

Inactivated vaccine Live attenuated

virus vaccine
Killed virus
(LAIV)

Indicated in healthy
people and chronic
Indicated in healthy
medical condition
people 2-49 years old
patients
Non pregnant
6 month of age and
older
Are there medicines to treat
influenza infection?
 Antiviral Medications Antiviral
 can prevent complications if Medications
taken within first 48 hours of
Amatadine (Symmetrel)
illness
 may not be effective against Rimantadine (Flumadine)
a pandemic flu virus
 extremely limited supply now Zanamivir (Relenza)
 would be prioritized
 initial use probably only for Oseltamivir (Tamiflu)
treatment, not prophylaxis
Conclusion 22
Questions? 23
Test your knowledge 24

Who is Most At Risk for a Severe Case of Influenza?

Can I get influenza more than once?

What the difference between RSV & Influenza?

Which method is optimal for respiratory specimens?

If positive, what is the shortest time the result will be available by Sofia?