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Isbandiyah dr, SpPD

What is influenza?

• An acute respiratory illness resulting

from infection with an influenza virus
• Highly infectious and can spread rapidly
from person to person
• Some strains cause more severe illness
than others
Types of influenza viruses

• Influenza viruses are divided into three main types:

influenza A, B, and C
• A viruses – infect birds and other animals, as well as
• A viruses – source of seasonal influenza epidemics and
all pandemics
• B and C viruses – infect humans only and do not cause
Influenza Virus Types A and B
Type A Type B
(Seasonal, avian, swine (Seasonal influenza)
Generally causes milder
Can cause significant disease disease but may also cause
severe disease
Infects humans and other
Limited to humans
species (e.g., birds; H5N1)
Can cause epidemics and
Generally causes milder
pandemics (worldwide

What is AI

Linda Stannard

Haemaglutinin (16)
Neuraminidase (9)
• RNA, enveloped

• Viral family: Orthomyxoviridae

• Size:
80-200nm or .08 – 0.12 μm
(micron) in diameter Credit: L. Stammard, 1995

• Three types
• A, B, C

• Surface antigens
• H (haemaglutinin)
• N (neuraminidase)
Where does influenza A virus
come from?

Human influenza A viruses start as avian (bird) influenza viruses

Migratory Domestic birds Humans

water birds and other
How influenza spreads ?
• Spreads easily from person to person
through coughing and sneezing
• Transmitted by:
– inhaling respiratory aerosols containing the virus,
produced when infected person talks, coughs, or
– touching an infected person or an item contaminated
with the virus and then touching your eyes, nose, or

• Fever> 38⁰C
• Sore throat
• Cough, runny nose, sneezing, myalgia
• In severe circumstances could arise respiratory
• Contact in the last 7 days with poultry farms,
especially if many infected poultry were found sick or
dead with unknown cause

Sandrock & Kelly, 2007

Laboratory Diagnosis
a. Confirmation test : b. Another examination
1. Culture and identification of 1. Routine Blood Count:
viruses. Leukophenia, lymphocytopenia, and
2. Real Time Nested PCR Test. thrombocytopenia

3. Serologic Test: 2. Chemistry:

a) Immunofluorescence test. Decrease in Alb, LFT and RFT
enhancement, Increased
b) Neutralization test.
creatinine kinase, BGA
c) Screening test: abnormal.
a) Rapid Test Influenza A
3. Radiology:
b) HI test
Interstitial infiltrates, lobar
consolidation, airbronchogram
Depkes, 2010, Sandrock & Kelly, 2007
Case Definitions
• Under Investigation Case
• Suspected Case
• Probable Case
• Confirm Case

WHO, 2007 12
Suspected Case
• A person presenting with unexplained acute lower respiratory illness with
fever (>380C) and cough, shortness of breath or difficulty breathing
One or more of the following exposure in the 7 days prior to symptom
a. Close contact with a person who is suspected, probable, or confirmed
H5N1 case
b. Exposure to poultry or wild birds with special circumstances
c. Consumption of raw or undercooked poultry products in an area
where H5N1 infections have been suspected or confirmed in the last
d. Handling samples suspected of containing H5N1

Probable Case
• Probable definition 1:
– A person meeting the criteria for a suspected case
One of the following additional criteria:
a. Infiltrates or evidence of an acute pneumonia (CXR)
b. Positive lab confirmation of an influenza A infection but
insufficient lab evidence for H5n1 infection
• Probable definition 2:
– A person dying of an unexplained acute respiratory illness
who is considered to be epidemiologically linked by time,
place, and exposure to a probable of confirmed H5n1 case.

Confirmed Case
a. Isolation of H5N1 virus.
b. Positive PCR results.
c. A rise of> 4-fold titer neutralizing antibodies.
d. Microneutralization H5N1 antibody titer> 1/80 with
positive results of other serological tests, such as HI
titer of horse red blood cells> 1/160 or H5-specific
western blot positive.

 Swine influenza A, H1N1 swine flu is a new strain of
the flu that moves from pigs to humans and can be
transmitted from human to human.
 Swine flu is different from seasonal flu because:
 It is a new strain of the virus
 Humans do not have an immunity from it
 Immunizations received last fall or this winter do not offer
protection against the H1N1 swine flu

Signs and Symptoms
 Similar to symptoms of regular human flu:
 Influenza-like-illness (ILI)
• Fever, cough, sore throat, runny nose, headache,
muscle aches
 May include diarrhea and vomiting
 May cause more serious symptoms in individuals with chronic
medical conditions
 Pneumonia, respiratory failure, and deaths have been

Case Definitions
• Suspected Case
• Probable Case
• Confirmed Case

Suspected Case

• A person with acute febrile respiratory illness with onset :

– within 7 days of close contact with a person who is a
confirmed case of swine influenza A (H1N1) virus infection, or
– within 7 days of travel to community either within the United
States or internationally where there are one or more
confirmed swine influenza A(H1N1) cases, or
– resides in a community where there are one or more
confirmed swine influenza cases.

Source: CDC
Probable Case
• A person with an acute febrile respiratory illness who is:
– positive for influenza A, but negative for H1 and H3 by
influenza RT-PCR, or
– positive for influenza A by an influenza rapid test or an
influenza immunofluorescence assay (IFA) plus meets
criteria for a suspected case

Confirmed Case
• A person with an acute febrile respiratory illness with
laboratory confirmed swine influenza A (H1N1) virus
infection at CDC by one or more of the following
• real-time RT-PCR
• viral culture

Swine Influenza A(H1N1)
 No vaccine available
 Antiviral for the treatment and/or prevention of infection:
 Oseltamivir (Tamiflu) or
 Zanamivir (Relenza)
 Use of anti-virals can make illness milder and recovery faster
 They may also prevent serious flu complications
 For treatment, antiviral drugs work best if started soon after
getting sick (within 2 days of symptoms)

Source: CDC