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anchors the virus to the cell it is infecting
hemagglutinin HA
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helps digest the body's mucous defenses and aids in later release of replicated viruses
neuraminidase NA
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allo the virus to infect cells
M2 & M1
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3 characteristics of type A
- moderate to severe illness
- all age groups
- humans and other animals
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4 characteristics of type B
- changes less rapidly than type A
- milder epidemics
- humans only
- primarily affects children
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2 characteristics of type C
- rarely reported in humans
- no epidemic
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3 characteristics of antigenic drift
- minor change, same subtype
- caused by point mutations in gene
- may result in epidemic
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3 characteristics of antigenic shift
- major change, new subtype
- caused by exchange of gene segments
- may result in pandemic
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3 characteristics of epidemic
- sudden onset of infection
- large percentage of people
- disappears in approx 3 months
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3 characteristics of pandemic
- appear suddenly in an isolated area
- spread is worldwide and infects millions
- large number of deaths
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2 imprtant points of the pathogenesis of influenza
- 1. grows best at 25 C, not great at 37 C, and dies at 40C
- 2. virus survives 5 minutes on skin
- 1-2 days on dry non-porous surfaces
- incubation period 2 days
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communicability of influenza
- 1. 18-72 hr incubation
- 2. infectious 1-2 days before onset
- 3. viral shedding in respiratory secretions 5-10 days after onser
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when are throat and naopharyngeal swabs obtained
within 3 days of onset of illness
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what is the most frequent common complicaion of influenza
pneumonia
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how is the influenza vaccine decided
- 1. 3 strains that are most likely to cause influenza infection the next year are chosen
- 2. 2 type A and 1 type B are used
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advisory committee on immunization practices (ACIP) recommendations for annual influenza vaccination
every person > 6 months of age unless there is a contraindication
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what is the immune response to TIV and LAIV
- TIV - high serum IgG antibody response
- LAIV - lower IgG and high IgA mucosal response
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safety side effect of TIV
sore arem
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safety side effect of LAIV
runny nose
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who is indactied for TIV
>6 mo and healthy
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who is indicated for LAIV
5-49 and healthy
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which influenza virus vaccine is for immunocompetent or compromised
TIV
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when should pregnant women or postpartum use anti-virals for the flu
withing 2 weeks after delivery
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which influenzas are the neuraminidase inhibitors effective against
both A & B
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11 CI for LAIV
- 1. anaphylaxis
- 2. guillain-barre syndrome
- 3. history of hypersensitivity
- 4. < 2yo
- 5. asthma
- 6. > 50 years of age
- 7. chronic pulmonary, cardiovascular, renal, hepatic, neurologic, hematologic, or metaboic disorders
- 8. immunosuppressed
- 9. 6mo - 18yo receiving aspirin or other salicylates
- 10. pregnant women
- 11. precaution with a moderate or severe illness w/ or w/o fever
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4 common symptoms of a cold
- 1. stuffy nose
- 2. sore throat
- 3. sneezing
- 4. chest discomfort, hacking cough
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5 symptoms of the flu that aren't seen with a cold
- 1. fever - usually high 100-102
- 2. headache
- 3. general aches, pains - often severe
- 4. fatigue, weakness - can last 2-3 wks
- 5. extreme exhaustion - at the beginning
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complications of a cold
- sinus congestion
- middle ear infection
- asthma
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complications of the flu
- brochitis
- pneumonia - can be life threatening
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prevention of a cold
- wash hands often
- avoid close contact with anyone with a cold
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prevention of the flu
- annual vaccinations
- antiviral medicines
- see your doctor
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Tx of a cold
- antihistamines
- decongestants
- NSAIDS
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Tx of the flu
- antiviral medicines
- see your doctor
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8 high risk people to recommend antiviral therapy
- 1. <2yo
- 2. >65 yo
- 3. comorbidities - many
- 4. women who are pregnant or postpartum
- 5. <19yo and receiving lng-term ASA therapy
- 6. american indians/alaska natives
- 7. morbidly obese - bmi >40
- 8. resident of nursing home or chronic care facility
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which neuramidase inhibitor needs to be adjusted for < 30 ml/min CrCl
oseltamivir - tamiflu
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side effect seen in relenza but not tamiflu and group not recommended for use in
- cough
- people with underlying respiratory disease
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Tx durations of tamiflu and relenza
- tamiflu - >2wks
- relenza - >7wks
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prophylaxis Tx for tamiflu and relenza
- tamiflu - > 1wks
- relenza - > 5wks
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general antiviral Tx recommendationduration
5 days
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general anti-viral prophylaxis recommended duration
- 7 days
- for control of outbreaks in ling-term care facilities and hospitals is minimum 2 wks
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dosing schedule of neuramidase inhibitors for Tx and prophylaxis
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