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
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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
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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
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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
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85% overall efficiency
Fewer days of illness
15-42% fewer health care provider visits
43-47% less use of antibiotics
LIAV Side Effects
• Children
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runny nose
headache
vomiting
muscle aches
fever
• Adults
–
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–
–
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
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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