Transcript Symptoms
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 Use of influenza vaccine in 14 countries. (Vaccine 2003 (16) :1780-1785) 328 Canada 289 US 218 Korea 204 Australia UK 186 Germany 181 168 France 164 148 Japan Greece Sweden 120 Brazil 76 22 Mexico 14 UAE Egypt 1 0 50 100 150 200 250 Doses vaccine/1000 population 300 350 Live virus LAIV Split vaccine SPL Inactivated vaccine WV Subunit vaccine SU rosettes Virosomal vaccine Adjuvanted vaccine 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 GuillianBarre 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 LAIVadults • • • • 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 بيمارستاني • طغيان هاي بيمارستاني ناگهاني و انفجاري هستند • سه منبع مهم انتشار عفونت در بيمارستان شامل بيمار ،كاركنان و مالقات كنندگان ميباشد • تشخيص بموقع طغيان هاي بيمارستاني اهميت زيادي دارد – ضرر 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 بيمارستاني • • • • • • • • احتمال انتقال از طريق افشانه هاي آلوده صورت ميگيرد لذا الزم است به محل بستري بيماران مشكوك توجه گردد بيماران با عالئم تنفس ي تا قبل از روشن شدن وضعيت در ميان ساير بيماران بستري نشوند از تردد بيماران با عالئم تنفس ي در بخش حتي االمكان جلوگيري شود ( الاقل با ماسك باشد ) به پرسنل بيمار داراي عالئم تنفس ي مرخص ي اجباري داده شود نياز به اطاق با تجهيزات فشار منفي نيست تا 24ساعت ويروس در دماي اطاق زنده ميماند امكانات ضروري جهت پذيرش بيماران در هنگام اپيدمي ها پيش بيني گردد به بخش هاي بيماران خاص توجه بيشتري مبذول گردد