Influenza 2006

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Information about Influenza 2006

Published on October 25, 2007

Author: Amateur



Influenza: Nothing to sneeze at :  Influenza: Nothing to sneeze at Laura Banks, DVM, MPH Mike Richards, MD, MPA University of New Mexico Health Sciences Center Center for Disaster Medicine b:  b Basic Description of Influenza:  Basic Description of Influenza Orthomyxoviridae Virus Single-stranded RNA Three Types of Influenza Virus A = Primary form for human infections, also a zoonotic disease B = Sporadic outbreaks, rare C = Milder form Influenza Structure:  Influenza Structure Hemagglutinin Lipid membrane M1 protein M2 Neuraminidase RNP Polymerase Nucleoprotein vRNA Influenza A Typing:  Influenza A Typing Influenza A is classified into subtypes based on the presence of the genes for these proteins: Hemagglutinin protein – 15 subtypes Neuraminidase proteins – 9 subtypes Example: Subtype H3N2 = hemagglutinin 3 and neuraminidase 2. The most common prevailing human influenza A subtypes: Influenza A (H1N1) and Influenza A (H3N2) Pathophysiology:  Pathophysiology Infection occurs by respiratory secretions Virus invades airway and respiratory tract cells cellular dysfunction and degeneration occur viral replication and release of viral progeny Systemic symptoms from inflammatory mediators, similar to other viruses. Incubation period: 1 to 5 days from exposure to onset of symptoms Communicability: 1-2 days before to 4-5 days after onset of symptoms Children shed for several weeks Signs and Symptoms:  Signs and Symptoms Abrupt high fever 38-40º C (100-104º F) Chills, shivering, myalgias, headache, malaise, and anorexia Conjuntivitis, pharyngitis, and dry cough Physical Findings:  Physical Findings Mild illness  Severely Ill, “toxic” Fever, Tachycardia Pharyngitis/ inflammation Eyes red and watery; Nasal discharge is usually absent Skin may be warm-to-hot, signs of mild volume depletion with dry skin. Pulmonary with active cough, wheezing, and/or rhonchi. Secondary infection Strep. pneum, H. influenzae DX - Screen with rapid test for Influenza A (OP swab) - Labs use RT-PCR (best method), culture and seroconversion Influenza Epidemiology – U.S.:  Influenza Epidemiology – U.S. Infects over 30 million people Over 150,000 people are hospitalized annually Influenza and its complications are the sixth leading cause of death - Killing 20,000-40,000 people a year Mortality/Morbidity increased for: Extremes of age Pre-existing illnesses Third trimester pregnancy Influenza Epidemiology – U.S.:  Influenza Epidemiology – U.S. 60% of those with influenza are misdiagnosed and begun on antibiotics “Flu season" increases emergency department wait-times Business productivity drastically drops due to flu sick time Total costs exceed $10,000,000,000 in the U.S. Influenza Vaccination:  If the vaccine works so great – then why not just get it once and put an end to the worry? Influenza Vaccination A Changing Virus:  A Changing Virus Antigenic Drift (A and B) Same H and N combination, but newer virus strains appear by point mutation of individual amino acids on the H and N molecules Circulating antibodies may no longer work Need to get flu shot update Antigenic Shift  (A only) Re-assortment or recombination of H and N molecules – abrupt and major change Likely the result of reassortment of genes within animals infected by multiple subtypes, followed by transmission to humans Most people will have little or no protection Influenza vaccinations:  Influenza vaccinations Vaccine includes three components: two A strains and the B strain. Changing nature of the virus (drift and shift) requires new vaccines. New emergence of an old strain may necessitate vaccinations in younger patients – no immunologic “memory” 2005-2006 Season:  2005-2006 Season A/New Caledonia/20/99 (H1N1) A/California/7/04 (H3N2) B/Shanghai/361/02 Slide16:  Pandemic Influenza Definition:  Definition A pandemic is a worldwide epidemic of a disease.  An Influenza pandemic requires that: A new subtype of flu virus forms due to antigenic shift The new virus causes illness in people The disease can be spread easily from person to person Epidemics and Pandemics of the 20th Century:  Epidemics and Pandemics of the 20th Century 1918-19, “Spanish flu” :  1918-19, “Spanish flu” Influenza A(H1N1) Caused the highest number of known flu deaths more than 500,000 people died in the United States 20-50 million people may have died worldwide Many died within the first few days after infection Almost half of the people who died were young, healthy adults Spanish Flu Facts:  Spread faster than any disease in history It took little more than a week to sweep across America Three months to sweep around the world Spanish Flu Facts Slide21:  Photo: National Archives Spanish Flu Facts:  Spanish Flu Facts World War 1, which had just ended, took 9 million lives; this epidemic would quadruple that. Despite the name "Spanish", it probably began in America Slide23:  Source: Stanford University Spanish Flu Facts:  Spanish Flu Facts Killed more people in less time than all of the great plagues of history. In Alaska, 60% of the Eskimo population was wiped out. Islands in the South Pacific lost 20% of their populations, primarily adults. Spanish Flu in New Mexico:  Spanish Flu in New Mexico The City of Albuquerque Board of Health spent 25% of its entire budget for 1918 on a line item described simply as “Spanish Flu” A quote from the Albuquerque newspaper included “the ghost of fear walked everywhere…” The New Mexico Department of Health was created in 1919 in response to the Spanish Flu pandemic 1957-58, “Asian flu”:  1957-58, “Asian flu” Influenza A(H2N2) Caused approximately 70,000 deaths in the United States First identified in late February, 1957 in China and spread to the United States by June, 1957 1968-69, “Hong Kong flu”:  1968-69, “Hong Kong flu” Influenza A (H3N2)] Caused approximately 34,000 deaths in the United States.  First detected in Hong Kong in early 1968 and spread to the U.S. later that year. A(H3N2) viruses still circulate today. The Avian Connection:  The Avian Connection Wild waterfowl are the natural reservoir for all subtypes of Influenza A, but rarely get sick Domestic fowl do get sick H5, H7 and H9 infections in humans have been confirmed with close contact of birds Pathogenicity in birds in not clearly related to pathogenicity in humans H5 and H7 viruses are highly pathogenic to the embryonated chicken eggs that are used to grow vaccine But wait…:  But wait… There has been no sustained person-to-person transmission of H5N1 avian influenza. “ There are no historical data, either in 1918 or in any other pandemic, for establishing that a pandemic “precurser” virus caused a highly pathogenic outbreak in poultry and no highly pathogenic avian influenza virus has ever been know to cause a major human epidemic.” Taubenberger and Morens, 2006 The Next Pandemic:  The Next Pandemic Many experts consider influenza pandemics to be inevitable. There may be very little warning. Outbreaks are expected to occur simultaneously throughout the U.S., preventing shifts in resources. The effect on individual communities will be relatively prolonged compared to most other natural disasters. What to Expect?:  What to Expect? Vaccines and antiviral agents -- will likely be in short supply Health-care workers and other first responders will likely be at even higher risk - further impeding the care of victims. Significant shortages of personnel: military personnel, police, fire, utility workers, and transportation workers, just to name a few. Next pandemic: estimates of impact:  Next pandemic: estimates of impact Attack rate ranging from 15% to 35% Typical mortality ~0.1% US Deaths: 89,000 - 207,000 US Hospitalizations: 314,000 - 733,000 NM Deaths: 1,500 - 2,000 NM Hospitalizations: > 9,000 (4,000 beds) Source: Meltzer et al. EID 1999;5:659-71 Modeling the Impact at UNMH:  Modeling the Impact at UNMH Admits:1,320 Deaths: 259 Pandemic Vaccine:  Pandemic Vaccine “In development” Plan advocates cell-based technology (rather than hens eggs) Developing capacity to produce 300 million courses in 6 months Current production: 60-100 million doses per year 2 doses one month apart may be necessary to ensure immunity Influenza control: antiviral medications:  Influenza control: antiviral medications Uses Prophylaxis: needs to be continued for duration of epidemic Treatment: dose, duration, efficacy all unknown at this point for new strains Influenza control: antiviral medications:  Influenza control: antiviral medications Issues Limited supply-20 million courses for US projected for end 2006 Need for prioritization among risk groups prophylaxis versus treatment Emergence of resistance in H5N1 Limited data coming from less than a dozen cases in Asia World Health Organization:  World Health Organization Recognizes the limitations of pharmacological therapy during a pandemic Recommends national and community measures to control spread: Isolation and quarantine Traveler warnings Social distancing measures Personal protection and hygiene Slide38:  Questions? 505-272-6240

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