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FL U. The underestimated threat. Dr Esteghamati. 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 - PowerPoint PPT Presentation
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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
11422
76120
148164
168181186
204218
289328
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•