FLU

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FLU
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Orthomyxoviridae
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• Eight segmented pieces of RNA, a structure that
  permits the introduction of new RNA. This is
  called genetic reassortment. This is called
  antigenic shift.
• The hemagglutinin spikes which provide viral
  attachment to cell membranes. They are strain
  specific antigens that mutate frequently because
  of inefficient proofreading by RNA polymerase.
  This is called antigenic drift.
• And ditto for the Neuraminidase spike, which
  provides release from cell membranes

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FAQs

• Type A The Main Player
• It causes annual outbreaks
• It mutates easily. This is called antigenic
  drift and is why the vaccine changes every year,
  usually causing an epidemic affecting 10 to 20
  of the population.
• It is susceptible to RNA reassortment, where a
  portion of avian influenza RNA is inserted. This
  is called antigenic shift and is responsible for
  pandemics or infections occurring over a wide
  geographic area and affecting a high proportion
  of the population.
• It is characterized by the H and N antigens.

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Type B and Type C
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Five Pandemics

• 1918 Possibly an avian influenza strain that
  adapted to infect humans.
• 1957 and 1968 A human/avian reassortment
  strain.
• 2009 A human/swine/avian reassortment virus.

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SWINE FLUWhat does this mean?
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Transmission

• Person to Person
• Viral sheddingday prior to symptom onset5-7
  days after symptom onset
• Can get from pigs not from eating pork

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Vaccination

• EVERYONE gt6months and older
• IM (inactivated) Intranasal (live attenuated)
• Intranasal NOT USED IN chronic disease,
  immunsuppression, pregnancy, prior h/o GB from
  prior vaccinations
• SMALL AMOUNTS of EGG in each
• Anaphylaxis is rare
• What do we carry?
• Efficacy 50-80 rate of protection if closely
  matched

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Vaccine

• Three strains (always A-A-B) this year
• -A-California h1n1-like virus
• -A-Perth h3n2 like virus
• -B Brisbane
• Every year the strains are selected based on
  worldwide surveillance for most active strains a
  little guess-work involved

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I dont want it today Doc
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Suspected Cases

• Fevers, Myalgias
• TESTflu swab, nasal

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Treatment PPX

• Oseltamivir TAMIFLU
• Zanamavir Ralenza
• Rx for Type A B
• Low levels of resistance
• In 48 hours TREAT (as per Dr. Chung)
• PPX NH Residents within 48 h, Case by case
• Babies, pregnant women

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PRACTICAL CONCERNS

• HOW TO ORDER THE VACCINE
• HOW TO BILL FOR IT
• ALLERGIES EGGS!!! Relative Contraindication
• No inhaled form of vaccine here
• Rapid antigenNasal swab in 6th floor Micro
• ?????s