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Management of Influenza

This ppt is about influenza virus, its epidemiology, replicative stages and management.

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Management of Influenza

  1. 1. Dr Asif Hussain JR-2 JNMCH, AMU
  2. 2.  An acute respiratory illness caused by influenza viruses.  Affects the upper and/or lower respiratory tract.  Nearly every year outbreaks of illness occurs of variable extent and disease severity.  Result in significant morbidity in general population and increased in mortality rates among high-risk patients.
  3. 3.  Shortness of breath  Pain or pressure in the chest or abdomen  Dizziness  Confusion  Severe or persistent vomiting  Flu-like symptoms improve but then return with fever and worse cough
  4. 4.  Dyspnoea  Bluish discoloration of skin  Not drinking enough fluids  Severe or persistent vomiting  Not waking up or not interacting  Irritable  Flu-like symptoms
  5. 5.  Birth to 4 years old  Pregnant women  >65 years old  Long-term aspirin therapy  Disorders of the pulmonary or cardiovascular system.  Metabolic diseases
  6. 6.  Outbreaks recorded virtually every year, their extent and severity varies.  Localized outbreaks take place at variable intervals, usually every 1–3 years.  The most recent pandemic emerged in March of 2009.  Caused by an influenza A/H1N1 virus that rapidly spread worldwide over several months.
  7. 7.  RNA viruses of orthomyxoviridae family ,influenza A, B, and C viruses are clinically important.  A, B, or C is based on antigenic characteristics of the nucleoprotein (NP) and matrix (M) protein antigens.  Influenza A viruses are further subdivided on the basis of the surface hemagglutinin (H) and neuraminidase (N) antigens .  individual strains are designated according to the site of origin, isolate number, year of isolation, and subtype—for example, influenza A/California/07/2009 (H1N1).
  8. 8.  Influenza A has 16 distinct H subtypes and 9 distinct N subtypes.  H1, H2, H3, N1, and N2 have been associated with epidemics of disease in humans.  Influenza B and C viruses are similarly designated, H and N antigens from these viruses do not receive subtype designations.  Intratypic variations in influenza B :less extensive ,  In Influenza C virus: Absent
  9. 9.  The hemagglutinin is the site by which the virus binds to sialic acid cell receptors, whereas the neuraminidase degrades the receptor and plays a role in the release of the virus from infected cells after replication has taken place.
  10. 10.  Samples  Nasal swab/wash  Tracheal aspirate  Laboratory findings 1. Leukopenia and/or lympopenia 2. Elevated Serum lactate dehydrogenase (LDH) Management
  11. 11.  Investigations:  Rapid antigen detection  Immunofluorescence  Nucleic acid test : rRT-PCR  Viral culture  Antibody testing
  12. 12.  Supportive  Isolation  Oxygen therapy  Intravenous hydration  Symptomatic relief  Critical care needs: ventilatator, hemodynamic support.  Antiviral therapy  Adjunct therapy:Prophylactic antibiotics
  13. 13.  Benefits of antiviral therapy  Shortening the duration of symptoms  Decreases the risk of complicated disease  Decreases viral shedding  Timing  Best if initiated with in <48 hrs of initiation  May still help after 48 hr if the symptoms are severe or pregnant patient
  14. 14.  Secondary bacterial infection  Retrospective pathological review suggested secondary bacterial infection as the major cause of death in pandemic H1N1 in 1918  Occurs several days after onset  Staphylocoocci aureus including MRSA  Nacrotizing pneumonia  Pneumatocele  Gram negative bacteria
  15. 15. Inhibitors of viral penetration and uncoating Amantadine Rimantadine Neuraminidase inhibitors Oseltamavir Zanamavir Peramivir
  16. 16.  Amantadine and its -methyl derivative rimantadine are uniquely configured tricyclic amines.
  17. 17.  They inhibit an early step in viral replication, viral uncoating.  Have an effect on a late step in viral assembly.  Site of action :M2 protein, an integral membrane protein that functions as an ion channel.  Drug inhibit the acid-mediated dissociation of the ribonucleoprotein complex in replication.
  18. 18. Side effects include :  nervousness,  light-headedness,  difficulty concentrating,  insomnia, and  loss of appetite  Nausea & vominting  Ankle edema
  19. 19.  Seasonal prophylaxis: amantadine or rimantadine (200 mg/day) is ~70-90% protective against influenza A illness.  Pandemic influenza, in preventing nosocomial influenza and outbreaks.  Treatment : Influenza A , modest effect (100mg bd x 5 days)
  20. 20.  First orally active neuraminidase inhibitor  Mechanism of action  Oseltamivir is a prodrug  Competitive inhibitor of sialic acid, found on the surface proteins of normal host cells  Blocking the activity of the viral neuraminidase enzyme, oseltamivir prevents new viral particles from being released by infected cells
  21. 21. Dosing  Given to >1 yr of age  TREATMENT :75 mg twice daily for 5 days  PROPHYLACTIC : 75 mg once daily for 14 days shown to be safe and effective for up to six weeks
  22. 22. Side effects  Common ADRs:-Nausea, vomiting, diarrhea, abdominal pain, and headache.  Rare ADRs include: hepatitis and elevated liver enzymes, rash, allergic reactions including anaphylaxis, and Stevens-Johnson syndrome  Postmarketing surveillance: toxic epidermal necrolysis, cardiac arrhythmia, seizure, confusion, aggravation of diabetes
  23. 23.  Zanamivir is a sialic acid analog tha inhibits the neuraminidases of influenza A and B viruses.  Pharmacokinetic data  Bioavailability- 2% (oral)  Protein binding- <10%  Metabolism- Negligible  Half life- 2.5–5.1 hours  Excretion- Renal  Routes- Inhalation
  24. 24.  Mechanism of action  Zanamivir works by binding to the active site of the neuraminidase protein, rendering the influenza virus unable to escape its host cell and infect others.  It is also an inhibitor of influenza virus replication in vitro and in vivo
  25. 25.  Dosing  Two inhalation (10 mg per puff) twice a day for 5 days  After inhalation, zanamivir is concentrated in the lungs and oropharynx,  15% of the dose is absorbed and excreted in urine
  26. 26. Side effects  Headache  Bronchospasm and cough (contraindicated in asmatics)  Zanamivir has not been known to cause toxic effects, does not spread around through the body's systemic circulation and  No signs of viral resistance from any flu
  27. 27. Age group (in years) Antiviral drug Children≤ 12 13-64 ≥65 Oseltamivir Treatment (A&B) <15 kg: 30 mg bd; >15–23 kg: 45 mg bd; >23–40 kg: 60 mg bd 75mg po bd 75mg po bd Prophylaxis(A&B) <15 kg: 30 mg od; >15–23 kg: 45 mg od; >23–40 kg: 60 mg od 75mg od 75mg od Zanamivir Treatment (A&B) 10mg bd inhalation 10mg bd 10mg bd Prophylaxis(A&B) 10mg od 10mg od 10mg od Amantadine Treatment (A) Age 1–9, 5 mg/kg in 2 divided doses, up to 150 mg/d Age 10, 100 mg PO bd ≤ 100 mg/d Prophylaxis, (A) Age 1–9, 5 mg/kg in 2 divided doses, up to 150 mg/d Age 10, 100 mg PO bd ≤ 100 mg/d Rimantadine Treatment, (A) Not approved 100 mg PO bd 100–200 mg/d Prophylaxis, (A) Age 1–9, 5 mg/kg in 2 divided doses, up to 150 mg/d Age 10, 100 mg PO bd 100–200 mg/d
  28. 28.  Avoid close contact With sick people. Keep safe distance  Stay home when you are sick If possible, stay home from work, school and office  Cover your mouth and nose Cover mouth and nose with tissue when coughing or sneezing  Clean your hands Frequent hand washing will protect you from germs  Avoid touching your eyes, nose or mouth
  29. 29.  Drink plenty of fluids and eat nutritious food  Get plenty of sleep to be physically active.  Manage your stress.  Get treatment and/or prevention of the infection with antiviral drugs.
  30. 30. Hand washing technique
  31. 31. Facemasks (disposable, single use masks) for persons who enter crowded settings Respirators (N95 or higher filtering facepiece respirator) for persons who have unavoidable close contact with infectious person No clear scientific evidence regarding the effectiveness of facemasks and respirators in protecting against influenza When contact is unavoidable
  32. 32.  Medical institutions  To maintain good infection control  Schools  To perform preventive measures such as morning inspection, temperature measurement, school suspension for the sick, outbreak notification
  33. 33.  The influenza vaccine, also known as flu shot, is an annual vaccination using a vaccine specific for a given year to protect against the highly variable influenza virus  Two types of influenza vaccines are available:  TIV :of trivalent (three strains; usually A/H1N1, A/H3N2, and B) inactivated (killed) vaccine)  LAIV: (nasal spray )of live attenuated influenza vaccine
  34. 34.  Mechanism of action  TIV works by putting into the bloodstream those parts of three strains of flu virus that the body uses to create antibodies  LAIV works by inoculating the body with those same three strains, but in a modified form that cannot cause illness.  Prepration  Pandemrix by GlaxoSmithKline (GSK)  Focetria by Novartis

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This ppt is about influenza virus, its epidemiology, replicative stages and management.

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