INFLUENZA (flu)

KEY POINTS

  1. Infection rates are highest in children, but complications and death highest in those
    ≥ 65yrs. Average 36,000 U.S. deaths/yr., mostly with underlying medical problems.

  2. Persons most infectious from 1 day pre-symptom onset to 5 days after.

  3. Prevalence: Worldwide

    a. Northern Hemisphere: Nov. – April*

    b. Southern Hemisphere: April – Oct.*
    *Sporadic cases year-round

  4. All travelers should be vaccinated who are high-risk for flu complications and when flu virus is actively circulating at their destination.

Disease: An highly contagious viral respiratory illness, which may occur sporadically or in epidemics.

Types,

  1. A (H3N2 and H1N1) – the only strain that causes epidemics

  2. B – milder disease, usually kids (no epidemics)

3. C – rare, no epidemics

Incubation: Up to 4 days 

Signs/Symptoms,

  1. Fever

  2. Cough – dry

  3. Headache

  4. Muscle Aches

  5. Malaise

Prevalence:

  1. Worldwide

    a. Northern Hemisphere: Nov. – April*

    b. Southern Hemisphere: April – Oct.*
    *Sporadic cases year round

Transmission:

  1. Aerosol/droplet cough or direct hand contact

  2. Persons most infectious from 1 day pre-symptom onset to 5 days after.

Treatment:

  1. Oseltamivir* (Tamiflu) – Flu A and B

  2. Zanamivir* (Relenza) – Flu A and B
    * ≥ 5yrs-old for prevention; ≥ 7yrs-old for treatment

  3. Baloxavir-marboxil (Xofluza) - Flu A and B prevention or treatment in ≥ 12 yrs-old

Prevention:

1. N-95 Respiratory Masks

2. Handwashing

3. Oseltamivir/Zanamivir/Baloxavir in high-risk groups

4. Vaccines

a. Vaccine components are changed annually according to World Health Organization data on predicted prevalent flu strains for the upcoming flu season.

b. It takes about 2 weeks to develop immunity after vaccination.

c. Single dose

i. Except in children under 9 yrs-old getting their 1st ever flu vaccine – need 2 doses, at least 4 weeks apart.

ii. Intranasal (live/FluMist)

d. Intramuscular Trivalent (3 killed strains*)

e. Side-Effects

i.Minor: For up to 2 days, injection site pain, fever, muscle aches, malaise

ii. Red eyes, cough

iii.Hives, allergic reaction
*Flu vaccine does not give you the flu

f. Precautions/Contraindications

i. Latex and thimerosal are in some preparations (avoid if allergic).

ii. Postpone vaccine when moderately ill.

iii. Egg or egg protein hypersensitivity is a contraindication.

iv. Guillaine-Barré syndrome history is a contraindication.

v. Specific Intranasal Flu Vaccine Problems,

1. Not for < 2yrs. or ≥ 50yrs-old.

2. Children 2-4yrs-old with wheezing past 12 mo.’s

3. Asthma contraindicates.

4. Pregnancy contraindicates.

5. Children 6mo. – 18yrs-old receiving any salicylates (including aspirin)

6. Chronic lung, heart, kidney, neurologic, neuromuscular, blood-organ, or metabolic disorders

vi. Immune suppression from medications or HIV contraindicates

vii. Avoid contact between recently intranasal vaccinated and severely immune-compromised

viii. Breastfeeding and pregnancy are not contraindications to trivalent (injectable), but are for intranasal vaccine.

Vaccine Targets,

  1. Universal vaccination of all (6 mo.’s-old to oldest), tailored to “Contraindications/Precautions”

  2. All travelers who are high-risk for flu complications and when flu virus is actively circulating

Access the VIS Sheet here

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