INFLUENZA 2009INFLUENZA 2009 Seasonal FluSeasonal Flu A/Brisbane/59/2007 (H1N1)A/Brisbane/59/2007 (H1N1) A/Uruguay/716/2007 (H3N2)A/Uruguay/716/2007 (H3N2) B/Brisbane/60/2008B/Brisbane/60/2008

H1N1 “Swine” FluH1N1 “Swine” Flu Influenza A 2009 H1N1 Influenza A 2009 H1N1

A / Mexico / 001 / 2009 (H1N1) A / Mexico / 001 / 2009 (H1N1)

Jim Gervase, R.Ph.,Jim Gervase, R.Ph.,Director of Pharmacy, Corry Memorial Director of Pharmacy, Corry Memorial

Hospital, Corry, PaHospital, Corry, Pa October, 2009October, 2009

Outline For TodayOutline For Today

What is Influenza ?What is Influenza ? Why is it important to us?Why is it important to us? History of InfluenzaHistory of Influenza 2009-2010 Seasonal Influenza2009-2010 Seasonal Influenza Influenza A 2009 H1N1 Influenza A 2009 H1N1

A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

VaccinesVaccines AntiviralsAntivirals

What is InfluenzaWhat is Influenza

VirusVirus UnpredictableUnpredictable Most strains evolve constantly (drift)Most strains evolve constantly (drift) Very ContagiousVery Contagious

What is InfluenzaWhat is Influenza

PATHOGENISISPATHOGENISIS Transmitted in Respiratory Transmitted in Respiratory

SecretionsSecretions Replicates in the Endothelium of the Replicates in the Endothelium of the

Respiratory TractRespiratory Tract Causes Cell DestructionCauses Cell Destruction Viral Shedding begins on contact and Viral Shedding begins on contact and

continues for 10 dayscontinues for 10 days

What is InfluenzaWhat is Influenza

CLINICAL FEATURESCLINICAL FEATURES Incubation Period 1 to 4 DaysIncubation Period 1 to 4 Days Severity of Illness depends on Prior Severity of Illness depends on Prior

Exposure to Same or Similar StrainExposure to Same or Similar Strain Onset of Symptoms is Abrupt: Onset of Symptoms is Abrupt:

Nonproductive Cough, Fever, Muscle Nonproductive Cough, Fever, Muscle Aches, Sore Throat, HeadacheAches, Sore Throat, Headache

What is InfluenzaWhat is Influenza

INFLUENZA VIRUS STRAINSINFLUENZA VIRUS STRAINS Type A Moderate to severe Type A Moderate to severe

symptomssymptoms All age groupsAll age groups Affects humans and animalsAffects humans and animals Type B Milder DiseaseType B Milder Disease Primarily Affects ChildrenPrimarily Affects Children Humans OnlyHumans Only Type C Rare reports in HumansType C Rare reports in Humans

What Is What Is NOTNOT Influenza? Influenza? Colds and other VirusesColds and other Viruses low fever or no fever, productive low fever or no fever, productive

cough, feel sick but ABLE cough, feel sick but ABLE to functionto function

Bronchitis / COPD / PneumoniaBronchitis / COPD / Pneumonia Smoking, predisposition, immune Smoking, predisposition, immune

compromisedcompromised GI “flu”GI “flu” Often caused by Bacteria due to Often caused by Bacteria due to

Food PoisoningFood Poisoning May be caused by other virusesMay be caused by other viruses

WHY IS FLU IMPORTANT TO WHY IS FLU IMPORTANT TO US ?US ?

We Feel We Feel AwfulAwful We Miss WorkWe Miss Work We Infect Our Loved OnesWe Infect Our Loved Ones We Infect the Community Around UsWe Infect the Community Around Us They Feel AwfulThey Feel Awful They Miss WorkThey Miss Work …………………………………………Some will be Some will be

HospitalizedHospitalized …….. ……………………..Some will Die.. ……………………..Some will Die

THE HISTORY OF INFLUENZATHE HISTORY OF INFLUENZA

First World Wide Pandemic was in First World Wide Pandemic was in 15801580

There were at least 4 pandemics in There were at least 4 pandemics in the 19the 19thth Century Century

Pandemic of 1918 Killed 21 Million Pandemic of 1918 Killed 21 Million PeoplePeople

2009-2010 Seasonal Influenza 2009-2010 Seasonal Influenza VaccineVaccine

A/Uruguay/716/2007 (H3N2)A/Uruguay/716/2007 (H3N2) B/Brisbane/60/2008B/Brisbane/60/2008 A/Brisbane/59/2007 (H1N1)A/Brisbane/59/2007 (H1N1)

Mismatch of Vaccine to Circulating VirusesMismatch of Vaccine to Circulating Viruses 197 Flu Viruses Circulating197 Flu Viruses Circulating New substrain has emerged New substrain has emerged A/Brisbane/01/2009 (H3N2) From A/Brisbane/01/2009 (H3N2) From

A/Brisbane/10/2007 (H3N2) A/Brisbane/10/2007 (H3N2) (drift)(drift)

2009-2010 Seasonal 2009-2010 Seasonal InfluenzaInfluenza

Has JUST STARTED to be seen in the Has JUST STARTED to be seen in the United States in large numbers United States in large numbers ..

80 to 90 % of all Type A Influenza is 80 to 90 % of all Type A Influenza is “Swine” Flu at this time.“Swine” Flu at this time.

October 12, 2009October 12, 2009

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

(Swine Flu)(Swine Flu)

SymptomsSymptoms PrevalencePrevalence How to prevent it’s spreadHow to prevent it’s spread When do you call the Doc?When do you call the Doc? Family PreparednessFamily Preparedness

..

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

SymptomsSymptoms

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

PrevalencePrevalence

Pandemic influenza A/H1N1

08-09 seasonal influenza

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

DistributionDistribution

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

USE OF ANTIVIRALSUSE OF ANTIVIRALS

Tamiflu and Relenza only.Tamiflu and Relenza only. May decrease duration and severity May decrease duration and severity

of illness.of illness. Must be given within the first 24 – 48 Must be given within the first 24 – 48

hrs.hrs. Seasonal Influenza has shown some Seasonal Influenza has shown some

resistance to antivirals. Swine Flu has resistance to antivirals. Swine Flu has now demonstrated rare resistance.now demonstrated rare resistance.

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

..

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

..

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

..

Influenza A 2009 H1N1 Influenza A 2009 H1N1 A / Mexico / 001 / 2009 (H1N1)A / Mexico / 001 / 2009 (H1N1)

..

SHOULD I GET THE SWINE FLU SHOULD I GET THE SWINE FLU VACCINE ?VACCINE ?

(Non Healthcare Worker)(Non Healthcare Worker) 1. I SHOULD GET IT TO PROTECT MY 1. I SHOULD GET IT TO PROTECT MY

LOVED ONES.LOVED ONES. 2. I SHOULD GET IT SO THAT I CAN 2. I SHOULD GET IT SO THAT I CAN

TAKE CARE OF MY LOVED ONES IF TAKE CARE OF MY LOVED ONES IF THEY GET SICK.THEY GET SICK.

3. I SHOULD GET IT SO THAT I DON’T 3. I SHOULD GET IT SO THAT I DON’T MISS WORK.MISS WORK.

4. I SHOULD GET IT BECAUSE I AM AT 4. I SHOULD GET IT BECAUSE I AM AT HIGH RISK OF COMPLICATIONSHIGH RISK OF COMPLICATIONS

SHOULD I GET THE SWINE FLU SHOULD I GET THE SWINE FLU VACCINE ?VACCINE ?

( Healthcare Worker)( Healthcare Worker) 1. I SHOULD GET IT TO PROTECT MY LOVED 1. I SHOULD GET IT TO PROTECT MY LOVED

ONES.ONES. 2. I SHOULD GET IT SO THAT I CAN TAKE 2. I SHOULD GET IT SO THAT I CAN TAKE

CARE OF MY PATIENTS WHO HAVE IT.CARE OF MY PATIENTS WHO HAVE IT. 3. I SHOULD GET IT SO THAT I DON’T MISS 3. I SHOULD GET IT SO THAT I DON’T MISS

WORK.WORK. 4. I SHOULD GET IT SO THAT I DON’T CARRY 4. I SHOULD GET IT SO THAT I DON’T CARRY

IT HOME TO MY LOVED ONES.IT HOME TO MY LOVED ONES. 5. I SHOULD GET IT BECAUSE IT IS MY 5. I SHOULD GET IT BECAUSE IT IS MY

DUTY.DUTY.

SHOULD I GET THE SWINE FLU SHOULD I GET THE SWINE FLU VACCINE ?VACCINE ?

( Healthcare Worker)( Healthcare Worker)