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Influenza (Flu)
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah ,UAE
saadsalani@yahoo.com

Facts
• Influenza is a highly contagious viral
infection of the nose, throat, and lungs
that occurs most often in the late fall,
winter, and early spring.
http://www.nfid.org/idinfo/influenza
22/12/2018Influenza (Flu) Prof. Dr. Saad S Al Ani
2

Facts
• Influenza is a serious infection that
affects between 5-20% of the US
population annually.
3

• During the 2017-2018 season:
 An estimated 900,000 individuals
were hospitalized
 Nearly 80,000 deaths
Occurred in the US from flu and flu-
related complications.
4Facts

• In temperate climates:
Seasonal epidemics occur mainly during
winter
• In tropical regions:
Influenza may occur throughout the year,
causing outbreaks more irregularly.
5Facts

• Incubation period, is about 2 days, but
ranges from one to four days
6Facts

The pathogen
• There are 4 types of seasonal influenza
viruses, types A, B, C and D.
• Influenza A and B viruses circulate and
cause seasonal epidemics of disease.
http://www.who.int/news-room/fact-sheets/detail/influenza-(seasonal)
7

Influenza A viruses
• Influenza A viruses are further classified
into subtypes according to the
combinations of the hemagglutinin (HA)
and the neuraminidase (NA), the
proteins on the surface of the virus.
8

Viral Proteins
TCI Chemicals
9

Influenza A viruses
• Currently circulating in humans are
subtype A(H1N1) and A(H3N2)
influenza viruses.
• Only influenza type A viruses are known
to have caused pandemics.
10

Influenza B viruses
• Influenza B viruses are not classified into
subtypes, but can be broken down into
lineages.
• Currently circulating influenza type B
viruses belong to either B/Yamagata or
B/Victoria lineage.
11

Influenza C virus
• Influenza C virus is detected less
frequently and usually causes mild
infections, thus does not present public
health importance.
12

Influenza D viruses
• Influenza D viruses primarily affect
cattle and are not known to infect or
cause illness in people.
13

Epidemiology
• All age groups can be affected but
there are groups that are more at risk
than others.
14

Epidemiology (Cont.)
• Pregnant women
• Children under 59 months
• The elderly
15

Epidemiology(Cont.)
• Individuals with:
Chronic medical conditions (such as
chronic cardiac, pulmonary, renal, metabolic,
neurodevelopmental, liver or hematologic
diseases)
Immunosuppressive conditions
(such as HIV/AIDS, receiving chemotherapy or
steroids, or malignancy).
16

• Health care workers are at high risk
acquiring influenza virus infection
 due to increased exposure to the
patients
 risk further spread particularly to
vulnerable individuals.
17

• Illnesses range from mild to
severe and even death
• Hospitalization and death occur
mainly among high risk groups.
18

Transmission
• Seasonal influenza spreads easily,
with rapid transmission in
crowded areas including schools
and nursing homes.
19

Transmission (Cont.)
• Coughs or sneezes, droplets
containing viruses (infectious
droplets)
• Infectious droplets can spread up
to one meter
20

Transmission (Cont.)
• Infect persons in close proximity
who breathe these droplets in.
• The virus can also be spread by
hands contaminated with
influenza viruses.
21

Transmission(Cont.)
• To prevent transmission, people should:
 Cover their mouth and nose with a tissue
when coughing
 Wash their hands regularly
22

Signs and symptoms
• Seasonal influenza is characterized by
a sudden onset of :
23
Fever Muscle and Joint pain
Cough
(usually dry)
Severe malaise
Headache Sore throat
Runny nose

Diagnosis
• The majority of cases of human
influenza are clinically diagnosed
24

Diagnosis (Cont.)
• The clinical differentiation of
influenza from other pathogens is
difficult:-
During periods of low influenza
activity
Outside of epidemics situations,
25

Diagnosis (Cont.)
• Other respiratory viruses that can present
as Influenza-like Illness (ILI) include:
Rhinovirus
Respiratory syncytial virus
Parainfluenza
Adenovirus
26

Laboratory confirmation
of influenza virus
• Throat, nasal and nasopharyngeal
secretions or tracheal aspirate or
washings is commonly performed
27
WHO recommended surveillance standards, Second edition.

Laboratory confirmation
of influenza virus (cont.)
• Direct antigen detection
• Virus isolation
• Detection of influenza-specific RNA
by reverse transcriptase-polymerase
chain reaction (RT-PCR).
28
WHO recommended surveillance standards, Second edition.

Treatment
• Uncomplicated seasonal influenza:
Not from a high risk group
Symptomatic treatment
if symptomatic
Stay home in order to minimize the
risk of infecting others in the community
Group at high risk
Antivirals + Symptomatic treatment
29

Treatment(Cont.)
• Severe or progressive clinical illness
(associated with suspected or confirmed
influenza virus infection)
 Clinical syndromes of :
Pneumonia
Sepsis
Exacerbation of chronic underling
diseases
Antiviral drug
30

Treatment(Cont.)
• Neuraminidase inhibitors (i.e. Oseltamivir)
as soon as possible (ideally, within 48
hours following symptom onset) to
maximize therapeutic benefits.
31

Treatment(Cont.)
Administration of the drug should
also be considered in patients
presenting later in the course of
illness.
32

Treatment(Cont.)
A minimum of 5 days, but can be
extended until there is satisfactory
clinical improvement
33

Treatment(Cont.)
• Corticosteroids should not be used
routinely (unless indicated for other
reasons e.g.: asthma and other specific
conditions); as it has been associated
with:
 Prolonged viral clearance
 Immunosuppression leading to
bacterial or fungal superinfection.
34

Treatment(Cont.)
• All currently circulating influenza
viruses are resistant to adamantane
antiviral drugs (such as amantadine and
rimantadine), and these are therefore
not recommended for monotherapy.
35

Prevention
• The most effective way to prevent
the disease is vaccination
36

Prevention
• Annual vaccination is
recommended to protect against
influenza as immunity from
vaccination wanes over time
37

Prevention
• Injected inactivated influenza
vaccines are most commonly used
throughout the world.
38

Prevention(Cont.)
• Vaccination is especially important
for people:
 At high risk of influenza
complications
 Who live with or care for the
people at high risk
39

Prevention(Cont.)
WHO recommends annual vaccination for:
• Pregnant women at any stage of pregnancy
• Children aged between 6 months to 5 yrs.
• Elderly individuals (aged more than 65yrs.
• Individuals with chronic medical conditions
• Health-care workers.
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Prevention(Cont.)
• Personal protective measures
 Regular hand washing
 Good respiratory hygiene
 Early self-isolation of those feeling unwell,
feverish and having other symptoms of influenza
 Avoiding close contact with sick people
 Avoiding touching one’s eyes, nose or
mouth
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Summary
Antiviral Treatment Recommendations for
Seasonal Influenza
42
Patient with
Flu Symptoms
Assess clinically
and investigate
Mild or Uncomplicated illness. Severe Acute Respiratory
Infection(SARI)
· Requiring hospital admission
· Pregnancy
· Severe illness
No risk
factor
High risk*
Treat with Tamiflu immediately
do not wait for lab confirmation

Summary Cont.)
Antiviral Treatment Recommendations for
Seasonal Influenza (Cont.)
43
Mild or Uncomplicated illness
No risk
factor
High
risk*
.Consider Antiviral if within 48 Hrs.
· Infection control
· Return to care within 72 Hrs. if no
improvement
.Treat with Antiviral
· Close follow up
· Infection control
· Return to care within 72 Hrs in no
improvement
*High Risk :
· Children below 5 especially
<2 years
· Elderly >65 years
· Pregnant women till 2Wks
post partum
· Comorbidities

Seasonal Influenza Contact Management
Recommendations
44Summary Cont.)
• No need to screen contacts ·
• Vaccination is not recommended as post exposure measure
• Close Contact: Resides with or taking care of confirmed
H1N1 case, Sharing eating or drinking utensils,
 Does not include walking by infected person or sitting
across the room
• Infectious Period: “One day before fever begins until 24
Hrs. after fever ends”

45Summary Cont.)
Assess contact risk profile
High risk contacts
• Provide Tamiflu as Prophylaxis
• Follow up
• Report to service if symptoms develop

46Summary Cont.)
Assess contact risk profile (Cont.)
Healthcare workers and Emergency Medical
personnel
• Provide Tamiflu as Prophylaxis
• Follow up
• Report to service if symptoms develop

47Summary Cont.)
Assess contact risk profile
Healthy Children and Adults
• Do not provide prophylaxis especially
 >48 Hrs. since last close contact
 Contact not during the infectious period

Consider Early treatment as an alternative to
Chemoprophylaxis:
• Counsel contacts on early Flu symptoms,
• Close follow up for high risk contacts,
• Start Tamiflu as treatment as soon as
symptoms develop
48Summary Cont.)

Seasonal Influenza Laboratory Testing Guide
49Summary Cont.)
Asymptomatic contact of laboratory
confirmed influenza case
Laboratory testing not required**

(Cont.)
50Summary Cont.)
Influenza Like Illness: (ILI)
An acute respiratory infection with measured fever
of ≥ 38 C°, and cough; with onset within the last 10
days.
Healthy Children and Adults High risk category*
Laboratory testing not
required**
Laboratory testing
recommended

(Cont.)
51Summary Cont.)
days.
High risk category*
Laboratory testing
recommended
*Start Antiviral treatment immediately
Do not wait for the Laboratory result

(Cont.)
52Summary Cont.)
days.
Healthy Children and Adults
Laboratory testing not
required**
**Post exposure
Preventive measure
done without screening

(Cont.)
53Summary Cont.)
Severe Acute Respiratory Infection: (SARI)*
An acute respiratory infection with: History
of fever or measured fever of ≥ 38 C°; and
cough; with onset within the last 10 days;
and requires hospitalization.
Laboratory testing recommended

(Cont.)
54Summary Cont.)
Severe Acute Respiratory Infection: (SARI)*
An acute respiratory infection with: History
of fever or measured fever of ≥ 38 C°; and
cough; with onset within the last 10 days;
and requires hospitalization.
Laboratory testing recommended
*Start Antiviral treatment immediately
Do not wait for the Laboratory result

Reference
• Influenza seasonal : https://www.who.int/en/news-room/fact-
sheets/detail/influenza-(seasonal)
• Estimates of US influenza-associated deaths made using four
different methods.
Thompson WW, Weintraub E, Dhankhar P, Cheng OY,
Brammer L, Meltzer MI, et al. Influenza Other Respi Viruses.
2009;3:37-49
• Global burden of respiratory infections due to seasonal
influenza in young children: a systematic review and meta-
analysis.
Nair H, Abdullah Brooks W, Katz M et al. Lancet 2011; 378:
1917–3
• WHO recommended surveillance standards, Second edition.
55

Thank you
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