flu the underestimated threat.. influenza virus types type a –humans and other animals –all age...
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FLU
The underestimated threat
.
Influenza Virus Types• Type A
– humans and other animals– all age groups– moderate to severe illness
• Type B – milder epidemics– humans only– primarily affects children
• Type C - uncommon strain, no epidemic
Increased Risk
• Age 65 and older
• Any age with chronic medical conditions
• Pregnant women
• Children 6-23 months
How the Flu Spreads
Spread of Flu
• Droplet Spread– from a person’s cough or sneeze– person touches respiratory droplets on another
person or object and then touches their own mouth or nose
• Incubation period = 1-4 days
Symptoms
• Adults- shed virus 1 day before developing symptoms to 7 days after getting sick
• Young children- can shed virus for longer than 7 days
Hospitalization from Influenza
• Highest rate among young children and persons >65 yrs
114,000 hospitalizations/yr with 57% occurring in ages < 65 yrs
• Highest # caused by type A (H3N2) viruses
Death rates from influenza-associated pulmonary and circulation
deaths/100,000 persons
• 0-44 yr: 0.4 - 0.6• 50-64yr: 7.5 65yrs: 98.3• Reasons:
– more older people has inc.– Influenza A associated with higher mortality– Influenza A predominates in 90% of seasons from
1990-99 compared w/57% of seasons 1976-90
Preventing the Flu
• Good Health Habits
• Vaccination
• Antiviral Medications
Good Health Habits
• Avoid close contact• Stay home when you
are sick• Cover your mouth• Clean your hand• Avoid touching your
eyes, nose or mouth• Get plenty of rest• Drink plenty of liquids
• The simplest way to avoid the flu is to avoid crowds. Can’t keep you
kids cooped up? Frequent hand
washing is the next best thing
Vaccination
Vaccine Production Capacities
• 65-70% of global vaccine production located in Europe (5 companies)– 50% of that production is exported outside of Europe
1
14
22
76
120
148
164
168
181
186
204
218
289
328
0 50 100 150 200 250 300 350
Egypt
UAE
Mexico
Brazil
Sweden
Greece
Japan
France
Germany
UK
Australia
Korea
US
Canada
Doses vaccine/1000 population
Use of influenza vaccine in 14 countries. (Vaccine 2003
(16) :1780-1785)
Live virus
LAIV Inactivated vaccine WV
Subunit vaccine SU
Split vaccine SPL
rosettes
Adjuvanted vaccine
Virosomalvaccine
Vaccination
• Best way to prevent flu
• Selection of virus for manufactured vaccine made in Feb and April each year
• Get vaccinated each fall
• People at high risk should get vaccinated
• 2 kinds of vaccines– inactivated– live attenuates (LAIV) (for ages 5 - 49)
Who Should Not Get Vaccine
• Have severe allergy to hen’s eggs (anaphylactic allergic rxn)
• People who previously developed Guillian-Barre syndrome (GBS) w/in 6 weeks after getting a flu shot
Influenza Vaccination Strategy
• Yearly vaccination of high risk persons is the most effective means of reducing the effect of influenza
– persons with increased risk
– close contacts and care-givers of persons with increased risk
Persons at High Risk
• All persons 50 years of age or older
• Persons >6 months of age with chronic illness
• Residents of long-term care facilities
• Pregnant women (2nd and 3rd trimesters)
• Children 6 months to 18 years receiving chronic aspirin therapy
• Children 6-23 months of age
Chronic Medical Conditions
• Pulmonary (e.g. COPD, asthma)
• Cardiovascular (e.g. CHF)
• Metabolic (e.g. diabetes)
• Renal (e.g. chronic renal failure)
• Hemoglobinopathies (e.g. sickle cell)
• Immunosuppression (e.g. HIV)
HIV Infection
• Persons with HIV at higher risk for complications of influenza
• Vaccine induces protective antibody titers in many HIV-infected persons
• Transient increase in HIV replication reported
• Vaccine will benefit many HIV-infected persons
Pregnancy and Inactivated Influenza Vaccine
• Risk of hospitalization 4 times higher than nonpregnant women
• Risk of complications comparable to nonpregnant women with high-risk medical conditions
• Vaccination recommended if pregnant during influenza season
Contacts of High-Risk Persons
• Household members and caregivers of high-risk persons (including children 0-23 months)
• Health care providers, including home care
• Employees of long-term care facilities
Other Groups
• Providers of essential community services
• Foreign travelers
• Students
• Anyone who wishes to reduce the likelihood of becoming ill from influenza
Composition of the 2003-2004 Influenza Vaccine
• A/Moscow/10/99 (H3N2)
(A/Panama/2007/99)
• A/New Caledonia/20/99 (H1N1)
• B/Hong Kong/330/2001
Composition of the 2004-2005 Influenza Vaccine*
• A/Fujian/411/2002 (H3N2)
(A/Wyoming/3/2003)
• A/New Caledonia/20/99 (H1N1)
• B/Shanghai/361/2002
(B/Jilin/20/2003 or B/Jiangsu/10/2003)
*strains in (parenthesis) are antigenically identical to the selected strains and may be used in the vaccines
Live Attentuated Intranasal Influenza (LAIV)
• Contains weakened live influenza vs killed viruses
• Administered by nasal spray
• Contains 3 different live (but weakened) viruses, which stimulate body to make antibodies
Dosage-LAIV
• 0.5 mL of vaccine: 0.25 mL for each nostril
• Children aged 5-8 previously unvaccinated: receive 2 doses separated by 6-10 weeks
• Children aged 5-8 previously vaccinated: receive 1 dose (do not require a 2nd dose)
• Persons aged 9-49: receive 1 dose
Efficacy & Effectiveness of LAIV-adults
• 85% overall efficiency
• Fewer days of illness
• 15-42% fewer health care provider visits
• 43-47% less use of antibiotics
LIAV Side Effects
• Children– runny nose
– headache
– vomiting
– muscle aches
– fever
• Adults– runny nose
– headache
– sore throat
– cough
– fever
Inactivated Influenza Vaccine
• Contains two type A and one type B
• Made from purified, egg grown viruses that have been inactivated or killed
• Antibiotics can be added to prevent bacterial contamination
• Vaccinated people develop high postvaccination hemagglutination inhibition antibody titers
Effectiveness of Inactivated Vaccine- Children
• 77% - 91% effective against influenza respiratory illness
Effectiveness of Inactivated Vaccine-Adults
• Aged < 65 yrs old:– 70-90% efficient work absenteeism, health-care resources
• Aged > 65 yrs old:– 50-60% effective in preventing hospitalization
for pneumonia and influenza– 80% effective in preventing death
Side Effects to Inactivated Vaccine
• Soreness at vaccination site• Fever, malaise, myalgia• Guillain Barre Syndrome: 1 additional case
per 1 million people– Body's immune system attacks part of the
nervous system and results in weakness or tingling sensations in the legs that can spread to the arms and upper body.
– Can result in paralysis
Inactivated v. Live Vaccines
• Similarities– contain one influenza
A (H3N2) virus, one A (H1N1) virus, and one B virus
– vaccines grown in eggs
– administered annually
• Differences– Inactivated has killed
virus, LAIV contains attentuated viruses
– Cost: LAIV more expensive
– Administration• LAIV: intranasally
• dead: intermuscularly
پيشگيري و كنترل آنفلوانزاي بيمارستانيطغيان هاي بيمارستاني ناگهاني و انفجاري هستند•سه منبع مهم انتشار عفونت در بيمارستان شامل •
بيمار، كاركنان و مالقات كنندگان ميباشدتشخيص بموقع طغيان هاي بيمارستاني اهميت •
زيادي داردضرر اقتصادي–كاهش نيروي انساني ارائه دهنده خدمت–افت كيفيت خدمات ارائه شده –
كاركنان تبديل به مخزن بالقوه براي انتقال به •بيماران و اعضاء خانواده خود مي شوند
كاركنان غير ايمن نسبت به ساير اقشار در معرض • خطر بيشتري هستند
پيشگيري و كنترل آنفلوانزاي بيمارستانياحتمال انتقال از طريق افشانه هاي آلوده صورت ميگيرد لذا •
الزم است به محل بستري بيماران مشكوك توجه گرددبيماران با عالئم تنفسي تا قبل از روشن شدن وضعيت در •
ميان ساير بيماران بستري نشونداز تردد بيماران با عالئم تنفسي در بخش حتي االمكان •
جلوگيري شود ) الاقل با ماسك باشد (به پرسنل بيمار داراي عالئم تنفسي مرخصي اجباري داده •
شود نياز به اطاق با تجهيزات فشار منفي نيست • ساعت ويروس در دماي اطاق زنده ميماند24تا •امكانات ضروري جهت پذيرش بيماران در هنگام اپيدمي ها •
پيش بيني گرددبه بخش هاي بيماران خاص توجه بيشتري مبذول گردد•
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