Fatal Flu Presentation

8/14/2019 Fatal Flu Presentation

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Fatal Flu


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Introduction:

Human influenza pandemics over the last100 years have been caused by H1, H2,and H3 subtypes of influenza A viruses.More recently, avian influenza virussubtypes (that is,H5, H7) have been foundto directly infect humans from their avian

hosts.


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H5N1:


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-Swine Influenza:

1918 pandemic in humans. 1976 U.S. outbreak.

1988 zoonosis. 1998 US outbreak in swine. 2007 Philippine outbreak in swine.

2009 Pandemic in humans.


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-Influenza A viruses:


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-Avian Influenza subtypes : Heamagglutininbinds to sialic acid linked to galactose by -2,3 linkages, which are found in avian

intestinal and respiratory epithelium.-Human Subtypes bind to -2,6 linkages

found in human respiratory epithelium .

-Swine contain both -2,3 and -2,6 linkages intheir respiratory epithelium, allowing for easyco-infection with both human and aviansubtypes.

- Humans have been found to contain both -


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Epidemiology:

Human interaction with infected secretions and birds was the major mode of transmission, withcontact including consumption of undercooked or raw

poultry products, handling of sick or dead birds withoutprotection, or food processing at bird cleaning sites.

In a few cases, limited human to human transmissionhas been reported among health care workers and

family members.


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-In H1N1:

Handling poultry and swine.

Other professions:VeterinariansMeat processing workers

Human to human transmission.


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Clinical manifestation:


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H1N1:

The most common cause of death is respiratoryfailure.


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Diagnosis:

Isolation of the virus. Neutralizing antibody titer assays. Reverse transcription-PCR.


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H1N1:

Rapid influenza diagnostic tests ( RIDTs )

Direct immunofluorescence assays ( DFAs )

Nucleic acid amplification tests, includingrRT-PCR, are the most sensitive and specific

influenza diagnostic tests.


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*Treatment:

-H5N1 : Adamantanes (rimantadine and amantadine) m

*The greatest level of protection was seen if the NA inhibitors werestarted within 48 hours of infection, and protection rapidly droppedafter 60 hours.

.


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Ribavirin by inhalation has been evaluated in vitro with some avian influenza A subtypes.

Supportive care with:Intravenous rehydration, mechanical ventilation,vasopressor therapy, and renal replacementtherapy

If multiorgan failure and ARDS occurred. If progression of pneumonia to ARDS occurred

early intubation may be beneficial before overtrespiratory failure ensues.

Corticosteroids


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-H1N1:

CDC recommendations:-Home isolation

-Household contacts who are not ill-School dismissal and childcare facility

closure-Social distancing

WHO guidelines for H1N1

Antiviral agents


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- gu e nes orH1N1:

Treating serious cases immediately.

For patients who initially present with severe illnessor whose condition begins to deteriorate, initiateoseltamivir as soon as possible.( applies to all patient groups, including pregnant women, and all agegroups, including young children and infants ).

For patients with underlying medical conditions thatincrease the risk of more severe disease, WHOrecommends treatment with either oseltamivir orzanamivir.


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-Antiviral agents: Oseltamivir (Tamiflu):

-It decreases release of viruses from infected cellsand thus viral spread as it Inhibitor of neuraminidase.

- Effective to treat influenza A or B Start within 40h of symptom onset. Available as 30-mg, 45-mg,and 75-mg oral capsules and as a powder forsuspension that contains 12 mg/mL afterreconstitution.


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Zanamivir (Relenza): Individuals with asthma or other

respiratory conditions that may decreaseability to inhale the drug should be givenoseltamivir (eg, asthma).


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)eramivir (investigational

Emergency-use authorization issued by US FDA foruse of peramivir in hospitalized adult and pediatricpatients with suspected or laboratory-confirmed 2009H1N1 influenza unresponsive to oseltamivir orzanamivir, unable to take PO or inhaled drugs


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-Indications: Prophylaxis(pre-exposure or post-exposure)-Close household contacts at high risk for complications (eg, chronic medical conditions,

persons >65 y or 65 y, pregnant women)

Treatment


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Pediatric considerations:Aspirin or aspirin-containing products should not be

included in the treatment of confirmed or suspected viral

infection in persons aged 18 years or younger because of the risk of Reye syndrome . For relief of fever, otherantipyretic medications. (eg, acetaminophen,nonsteroidal anti-inflammatory drugs) are recommended.

Pregnant womenOseltamivir and zanamivir are "Pregnancy Category C"

medications, indicating that no clinical studies have beenconducted to assess the safety of them, Pregnancyshould not be considered a contraindication tooseltamivir or zanamivir use.


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-Prevention:

In H5N1:-Mass slaughter of millions of chickens.- Personal protective equipment.

In H1N1:-Avoid large gathering.-Mask wearing.- Hand washing.

-Anyone with flu-like symptoms should stayhome.


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Vaccination:

Vaccines of H5N1:- H5 vaccines have resulted in the development of neutralizing

antibodies, but to a limited degree.-May 2009:A new H5N1 recombinant vaccine virus has been

developed by the WHO Collaborating Center for the Surveillance,Epidemiology and Control of Influenza at the Centers for DiseaseControl and Prevention (WHO CC), Atlanta, USA fromA/Egypt/2321-NAMRU3/2007, the Ministry of Health & Populationof Egypt have provided the virus specimens.


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Vaccines of H1N1: Influenza A virus vaccine (H1N1):

- Stimulates active immunity.-Administer IM injection in anterolateralaspect of thigh for infants AND in deltoid

muscle of upper arm in toddlers and children.*Avoid gluteal region or areas with major

nerve trunk .

I fl A i i (H1N1) i l


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Influenza A virus vaccine (H1N1), intranasal:- Stimulates active immunity.

-Adverse effects include rhinitis, nasal congestion,

fever >100F in children aged 2-6 y, and sorethroat in adults.-With caution to individuals with asthma or recurrentwheezing.

*Trivalent seasonal influenza immunization isrecommended for all children aged 6 monthsthrough 18 years. Healthy children aged 2 through

18 years can receive either TIV or LAIV . Also the combination of A (H1N1) vaccine with

trivalent seasonal vaccine would have significantregulatory implications.


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Fatal Flu Presentation

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