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Influenza

KEY POINTS

  1. Infection rates are highest in children, but complications and death highest in those
    ≥ 65yrs. Average 36,000 U.S. deaths/yr. with underlying medical problems.
  2. Persons most infectious from 1 day pre-symptom onset to 5 days after.
  3. Prevalence:  Worldwide
    1. Northern Hemisphere: Nov. – April*
    2. 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

Signs/Symptoms,

  1. Fever
  2. Cough – dry
  3. Headache
  4. Muscle Aches
  5. Malaise

Incubation: Up to 4 days

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

 

Prevalence:

  1. Worldwide
    1. Northern Hemisphere: Nov. – April*
    2. Southern Hemisphere: April – Oct.*
      *Sporadic cases year round

 

Transmission:

  • Aerosol/droplet cough or direct hand contact
  • Persons most infectious from 1 day pre-symptom onset to 5 days after.

 

Treatment:

  • Oseltamivir* (Tamiflu) – flu A and B
  • Zanamivir* (Relenza) – flu A and B
    * ≥ 5yrs-old for prevention;
    ≥ 7yrs-old for treatment

 

Prevention:

  1. N-95 Respiratory Masks
  2. Handwashing
  3. Oseltamivir/Zanamivir in high-risk groups
  4. Vaccines
    1. Vaccine components are changed annually according to World Health Organization data on predicted prevalent flu strains for the upcoming flu season.
    2. It takes about 2 weeks to develop immunity after vaccination.
    3. Single dose
      1. Except in children under 9 yrs-old getting their 1st ever flu vaccine – need 2 doses, at least 4 weeks apart.
    4. Intranasal (live/FluMist)
      1. Side-Effects
        1. Fever, headache, muscle aches, vomiting, abdominal pain, sore throat, cough, weakness
        2. Uncommon: hives, allergic reaction, rash
    5. Intramuscular Trivalent (3 killed strains*)
      1. Side-Effects
        1. Minor: For up to 2 days, injection site pain, fever, muscle aches, malaise
        2. Red eyes, cough
        3. Hives, allergic reaction
          *Flu vaccine does not give you the flu
    6. Precautions/Contraindications
      1. Latex and thimerosal are in some preparations (avoid if allergic).
      2. Postpone vaccine when moderately ill.
      3. Egg or egg protein hypersensitivity is a contraindication.
      4. Guillain-Barré syndrome history is a contraindication.
      5. 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
        4. Pregnancy
        5. Children 6mo. – 18yrs-old receiving any salicylates (including aspirin)
        6. Chronic lung, heart, kidney, neurologic, neuromuscular, blood-organ, or metabolic disorders
        7. Immune suppression from medications or HIV
        8. Avoid contact between recently intranasal vaccinated and severely immune compromised.
      6. Breastfeeding and pregnancy are not contraindications to trivalent (injectable), but are for intranasal vaccine.
    7. 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

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