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INFLUENZA VIRUS
FLU
True influenza
influenza virus A or influenza virus B (or influenza virus C infections - much milder)
Febrile respiratory disease with systemic symptoms caused by a variety of other organisms often called flu
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no virus
CULTURE RESULTS
influenza A influenza B
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http://www.state.sc.us/dhec/LAB/labbu017.htm
1918-19 Spanish flu 500,000 US 20,000,000 world 1957-58 Asian flu 70,000 US
ORTHOMYXOVIRUSES
pleomorphic influenza types A,B,C febrile, respiratory illness with systemic symptoms
http://www.uct.ac.za/depts/mmi/stannard/fluvirus.html
ORTHOMYXOVIRUSES
HA - hemagglutinin NA - neuraminidase
polymerase complex
M1 protein
TRANSMISSION
AEROSOL
100,000 TO 1,000,000 VIRIONS PER DROPLET
3 DAYS POST-INFECTION
Lycke and Norrby Textbook of Medical Virology 1983
7 DAYS POST-INFECTION
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Lycke and Norrby Textbook of Medical Virology 1983
RECOVERY
INTERFERON - SIDE EFFECTS INCLUDE:
FEVER, MYALGIA, FATIGUE, MALAISE
TISSUE REPAIR
CAN TAKE SOME TIME
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An immunological diversion
INTERFERON
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INTERFERON
INTERFERON
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INTERFERON
antiviral state
antiviral state
antiviral state
antiviral state
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INTERFERON
antiviral state
antiviral state
antiviral state
antiviral state
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INTERFERON
antiviral state
antiviral state
antiviral state
antiviral state
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INTERFERON
THE VIRUSES ARE COMING!
PAUL REVERE
http://www.mfa.org/collections/one_hour/6.htm
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http://www.paulreverehouse.org/midnight.html
TYPES OF INTERFERON
TYPE I Interferon-alpha (leukocyte interferon, about 20 related proteins) - leukocytes, etc Interferon-beta (fibroblast interferon) - fibroblasts, epithelial cells, etc TYPE II Interferon-gamma (immune interferon) - certain activated T-cells, NK cells
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INDUCTION OF INTERFERON
interferon-alpha and interferon-beta - viral infection (especially RNA viruses), double stranded RNA, certain bacterial components - strong anti-viral properties interferon-gamma - antigens, mitogenic stimulation lymphocytes
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INTERFERON
induce various proteins in target cells
many consequences, not all fully understood
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induction of ribonuclease L
25oligo A
activated ribonuclease L
mRNA degraded
interferons
only made when needed
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ACTIVATE NK CELLS
CAN KILL VIRALLY INFECTED CELLS
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MACROPHAGE ACTIVATION
interferon-gamma has been tried for e.g. lepromatous leprosy, leishmaniasis, toxoplasmosis
ANTI-TUMOR
have been used in e.g. melanoma, Kaposis sarcoma, CML
MULTIPLE SCLEROSIS
interferon-beta
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BACK TO INFLUENZA
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SYMPTOMS
FEVER HEADACHE MYALGIA COUGH RHINITIS OCULAR SYMPTOMS
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CLINICAL FINDINGS
SEVERITY
VERY YOUNG ELDERLY IMMUNOCOMPROMISED HEART OR LUNG DISEASE
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PULMONARY COMPLICATIONS
CROUP (YOUNG CHILDREN) PRIMARY INFLUENZA VIRUS PNEUMONIA SECONDARY BACTERIAL INFECTION
Streptococcus pneumoniae Staphlyococcus aureus Hemophilus influenzae
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NON-PULMONARY COMPLICATIONS
myositis (rare, > in children, > with type B) cardiac complications recent studies report encephalopathy
studies of patients <21 yrs in Michigan - 8 cases seen last season
Reyes syndrome
liver - fatty deposits brain - edema vomiting, lethargy, coma risk factors
youth certain viral infections (influenza, chicken pox) aspirin
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NON-PULMONARY COMPLICATIONS
myositis (rare, > in children, > in type B) cardiac complications encephalopathy liver and CNS
Reyes syndrome
Guillian-Barr syndrome
1976/77 swine flu vaccine
35,000,000 doses
354 cases of GBS 28 GBS-associated deaths recent vaccines much lower risk
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MORTALITY
MAJOR CAUSES OF INFLUENZA VIRUS- ASSOCIATED DEATH
BACTERIAL PNEUMONIA CARDIAC FAILURE
DIAGNOSIS
ISOLATION
NOSE, THROAT SWAB TISSUE CULTURE OR EGGS
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cell enzymes
acid pH
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NA protein - neuraminidase
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ANTIGENIC DRIFT
HA and NA accumulate mutations
RNA virus
ANTIGENIC SHIFT
new HA or NA proteins
pre-existing antibodies do not protect may get pandemics
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INFLUENZA A PANDEMICS
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pigs
avian and human
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SURVEILLANCE
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CDC/Katherine Lord
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H1N1 H3N2 B
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VACCINE
BEST GUESS OF MAIN ANTIGENIC TYPES
CURRENTLY
type A - H1N1 type A - H3N2 type B each year choose which variant of each subtype is the best to use for optimal protection
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VACCINE
inactivated egg grown sub-unit vaccine for children
reassortant live vaccine approved 2003
for healthy persons (those not at risk for complications from influenza infection) ages 5-49 years
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CDC 55
RECOMMENDATIONS
Persons at High Risk for Influenza-Related Complications $ 65 years residents of nursing homes and other chronic-care facilities adults/children who have chronic pulmonary or cardiovascular disorders, including asthma adults/children who have required regular medical follow-up or hospitalization during the last year because of chronic metabolic diseases (including diabetes mellitus), renal dysfunction, hemoglobinopathies, or immunosuppression (including immunosuppression caused by medications)
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RECOMMENDATIONS
Persons at High Risk for Influenza-Related Complications children and teenagers (6 mths to 18 yrs) receiving long-term aspirin therapy - might be at risk for developing Reye syndrome after influenza women who will be in the 2nd or 3rd trimester of pregnancy during the influenza season.
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RECOMMENDATIONS
Persons aged 50-64 years increased prevalence of high-risk conditions from public health point of view, easier to target by age than by high-risk condition (which may not have been discovered)
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RECOMMENDATIONS
Persons Who Can Transmit Influenza to Those at High Risk Persons who are clinically or subclinically infected can transmit influenza virus to persons at high risk for complications from influenza.
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RECOMMENDATIONS
physicians, nurses, and other personnel in both hospital and outpatient-care settings employees of nursing homes and chronic-care facilities who have contact with patients or residents employees of assisted living and other residences for persons in high-risk groups persons who provide home care to persons in high-risk groups household members (including children) of persons in high-risk groups.
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RECOMMENDATIONS
Children from 0-23 mths are at increased risk for hospitalization from influenza, vaccination is encouraged for their household contacts and out-of-home caretakers, particularly for contacts of children aged 05 months because influenza vaccines have not been approved for use among children aged <6 months.
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RECOMMENDATIONS
others, including travellers and the general population may wish to be vaccinated
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PREVENTION - DRUGS
RIMANTADINE
type A only
(M2)
(M2) (NA)
AMANTADINE
type A only
ZANAMIVIR
OSELTAMIVIR
types A and B
(NA)
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TREATMENT - DRUGS
RIMANTADINE
AMANTADINE ZANAMIVIR
(M2)
(M2) (NA)
OSELTAMIVIR
(NA)
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NA protein - neuraminidase
. . . . . . . . . . . . ... . . . .
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OTHER TREATMENT
REST, LIQUIDS, ANTI-FEBRILE AGENTS (NO ASPIRIN FOR AGES 6MTHS-18YRS)
BE AWARE OF COMPLICATIONS AND TREAT APPROPRIATELY
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TYPE A severity of illness animal reservoir human pandemics human epidemics antigenic changes segmented genome amantadine, rimantidine zanamivir surface glycoproteins ++++ yes yes yes shift, drift yes sensitive sensitive 2
END
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