lecture of 48 slides

1. ‫سورة‬‫البقرة‬(۳۲)

2. DR. Magdy Shafik
Senior Pediatric Consultant
Diploma, M.S ,Ph.D of Pediatrics

4. Influenza is a serious respiratory illness which can be
debilitating and causes complications that lead to
hospitalization and death, especially in the elderly.
Influenza virus is a genus of the orthomyxoviridae family
of viruses. Influenza A virus causes influenza in bird and
some mammals.
There are three groups of influenza virus: influenza A, B,
and C. Influenza B and C viruses are associated with low-
level sporadic disease and are never causes of pandemic
influenza. influenza A is responsible for most seasonal
influenza and all known pandemics.

5. On the surface of influenza virus reside two major
proteins; Haemagglutinin (HA) and Neuraminidase (NA).
Sixteen subtypes of HA (H1 to H16) and nine subtypes of
NA (N1 to N9) are recognized in aquatic birds.
Death mostly occurs as a consequence of primary viral
pneumonia or of secondary respiratory bacterial
infections, especially in patients with underlying
pulmonary or cardiopulmonary diseases.

8. The aim of this work is to study the current status of
emerging influenza viruses infections and their
clinical implications.

10. Avian flu is influenza infection in birds. The disease is of
concern to humans, who have no immunity against it. The
virus that causes this infection in birds can mutate to easily
infect humans.
There are many subtypes of avian influenza viruses,
but only some strains of four subtypes have been highly
pathogenic in humans. These are types H5N1, H7N3, H7N7
and H9N2.

11. Avian influenza transmission to humans appears to occur
predominantly as a result of direct contact with infected
poultry.
People at risk include those who are exposed to water and
surfaces contamination by bird droppings
There is no evidence that properly cooked poultry meat or
poultry products are a source of human infection by H5N1
influenza virus.

13. After exposure to infected poultry, the incubation
period generally appears to be 7 days or less, and in many
cases this period is 2 to 5 days.
Initial symptoms of H5N1 influenza may include fever
(typically a temperature of more than 38°C), headache,
malaise, myalgia, sore throat, cough, and rhinitis with lower
respiratory tract symptoms, shortness of breath and
radiological evidence of pneumonia.

14. Isolation
 Nose, Throat Swab
 Tissue culture

15. Two groups of antiviral agents are available for treatment
and prophylaxis of influenza
- Amantadine - Rimantadine
- Oseltamivir phosphate - Zanamivir
Oseltamivir is taken orally (75 mg twice daily), and
Zanamivir is taken via an inhalation apparatus (10 mg bid
for 5 days).

19. Swine influenza is an infection by any one of several
types of swine influenza virus. Swine Influenza Virus is
any strain of the influenza family of viruses that is
endemic in pigs. As of 2009, the known SIV strain
include influenza C and the subtypes of influenza A
known as H1N1, H1N2, H3N1, H3N2 and H2N3.
The virus appears to have emerged first in Mexico in
late February 2009, this likely represents the first large-
scale transmission of this virus.

20. The main route of transmission is through direct contact
between infected and uninfected animals.
The direct transfer of the virus probably occurs either by
pigs touching noses, or through dried mucus.
Swine influenza (H1N1) is spread primarily via droplets and
to a lesser extent via hand-to-face transmission.
People with regular exposure to pigs are at increased risk of
swine flu infection.

21.  Chronic respiratory diseases (eg, asthma, COPD, bronchiectasis,
lung surgery)
 Obesity
 Pregnancy
 Smoking
 Diabetes mellitus
 Chronic cardiovascular diseases
 Renal diseases
 Immunosuppression (such as blood disorders, malignancy)
 Delay in presentation to hospital (and hence delay in initiating
antiviral therapy)

22.  Dyspnea
 Cyanosis
 Bloody or colored sputum
 Chest pain
 Altered mental status
 High fever that persists beyond 3 days
 Hypotension
 In children, danger signs include tachypnea or dyspnea,
drowsiness, and no desire to play
Symptoms include fever, cough, sore throat, body aches,
headache, chills and fatigue.

23. Diagnosis
1- CBC:  Relative lymphopenia
2- Serum enzymes:
-(AST/ALT) are often elevated
- Creatine phosphokinase  elevated
3- Radiographic:
-Initially (CXR)  shows no or minimal infiltrates.
-Later  bilateral patchy interstitial infiltrates

30. For patients with underlying medical conditions that
increase the risk of more severe disease, WHO
recommends treatment with either oseltamivir or
zanamivir. These patients should also receive treatment as
soon as possible after symptom onset, without waiting for
the results of laboratory tests.

31. Antiviral agents
Drugs indicated for treatment of H1N1 influenza A virus
include neuraminidase inhibitors (i.e. oseltamivir and
zanamivir).
Oseltamivir (Tamiflu)
Treatment for acute illness :75 mg capsule twice daily for
5 days .
Prophylaxis :75 mg capsule twice daily for 5 days .
Zanamivir
Treatment for acute illness : 10 mg inhaled orally twice
daily for 5 days .
Prophylaxis of household contact: 10 mg inhaled orally
twice daily for 10 days .

32. What is Tamiflu?
Tamiflu (oseltamivir) is an antiviral medication that blocks
the actions of influenza virus types A and B in your body.
Tamiflu is used to treat flu symptoms caused by
influenza virus in patients who have had symptoms
for less than 2 days.
It may also be given to prevent influenza in people
who may be exposed but do not yet have
symptoms.
This medicine will not treat the common cold.

33. Tamiflu Dosage
TAMIFLU capsules (30 mg, 45 mg, 75 mg)
TAMIFLU for oral suspension (6 mg per mL

34. Recommended Dosage and Duration of Influenza
Antiviral Medications for Treatment or Chemoprophylaxis
Oral Oseltamivir (Tamiflu)
AdultsChildrenUse
75 mg twice
daily
If younger than 1 yr old1 :
3 mg/kg/dose twice daily
If 1 yr or older, dose varies by child’s
weight:
15 kg or less, the dose is 30 mg twice a
day
>15 to 23 kg, the dose is 45 mg twice a
day
>23 to 40 kg, the dose is 60 mg twice a
day
>40 kg, the dose is 75 mg twice a day
Treatment (5 days)
75 mg once
daily
Chemoprophylaxis
(7 days)

35. If younger than 1 yr old1 :
3 mg/kg/dose once daily
If 1 yr or older, dose varies by child’s
weight:
15 kg or less, the dose is 30 mg once a day
>15 to 23 kg, the dose is 45 mg once a day
>23 to 40 kg, the dose is 60 mg once a day
>40 kg, the dose is 75 mg once a day
Chemoprophylaxis (7 days)

36. Inhaled Zanamivir
AdultsChildrenUse
10 mg (two 5-mg
inhalations)
twice daily
10 mg (two 5-mg inhalations) twice
daily (FDA approved and recommended
for use in children 7 yrs or older)
Treatment (5 days
10 mg (two 5-mg
inhalations) once
daily
10 mg (two 5-mg inhalations) once
daily (FDA approved for and
recommended for use in children 5 yrs
or older
Chemoprophylaxis (7
days)
COMMON BRAND(S): Relenza
GENERIC NAME(S): Zanamivir

37. Intravenous Peramivir
AdultsChildrenUse
One 600 mg dose, via
intravenous infusion
for 15-30 minutes
N/A = not applicableTreatment (1 day)
N/A = not applicableN/A =Chemoprophylaxis

38. Prevention of swine influenza has three components:
prevention in swine, prevention of transmission to
humans, and prevention of its spread among humans.
The use of vaccines on swine to prevent their infection is a
major method of limiting swine to human transmission.
Influenza spreads between humans when infected people
cough or sneeze, then other people breathe in the virus or
touch something with the virus on it and then touch their
own face (avoid touching your eyes, nose or mouth.
Germs spread this way). Swine flu cannot be spread by
pork products, since the virus is not transmitted through
food.

39. Chance of transmission is also reduced by disinfecting
household surfaces, which can be done effectively with
a diluted chlorine bleach solution.
Recommendations to prevent spread of the virus among
humans include using standard infection control against
influenza. This includes frequent washing of hands with
soap and water or with alcohol-based hand sanitizers,
especially after being out in public

40. Available as monovalent, inactivated influenza A virus
vaccine (H1N1) for IM injection. Indicated for active
immunization against influenza caused by pandemic (H1N1)
2009 virus. Stimulates active immunity to influenza virus
infection by inducing production of specific antibodies.
U.S. President Barack Obama
Being vaccinated against H1N1 flu

42. Who Needs Influenza Vaccination?
Age 65 years and older
Chronic illness
Immunocompromised
Pregnancy
Prior splenectomy
Healthcare professionals
Young children
No excuse to miss this
vaccine
and its protective value
at near zero risk!

43. Effectiveness of influenza vaccine
Vaccine effectiveness depends on the similarity between
vaccine strains and the strains in circulation during influenza
season
With a good "match," influenza immunization prevents disease
in 70 to 90% of healthy individuals
This drops to 30 to 40% in the frail and elderly
It does, however, prevent death in 85% of the frail and elderly
It prevents hospitalization in 50 to 60% of individuals
immunized
Even with an imperfect match, Canadian studies show the
vaccine still reduces the overall risk of infection by about 40-60%
A vaccine that is not perfectly matched can still offer

45. Influenza Vaccine for the 2019-2020 Season
The committee recommended that the trivalent formulation
influenza vaccines for the U.S. 2019-2020 influenza season contain
the following:
an A/Brisbane/02/2018 (H1N1)pdm09-like virus;
an A/Kansas/14/2017 (H3N2)-like virus;
a B/Colorado/06/2017-like virus (B/Victoria lineage).
The committee also recommended that quadrivalent influenza
vaccines contain the above three strains and the following additional B
strain:
a B/Phuket/3073/2013-like virus (B/Yamagata lineage)

48. 1- Vaccination against seasonal influenza is
recommended for all persons ≥6 months old,
including pregnant women.
2-Quadrivalent vaccines offer broader coverage
against influenza B viruses, which primarily infect
children.
3-The intranasal live-attenuated vaccine is once again
an ACIP-recommended option for the 2018-19 season.
CONCLUSION