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PHAR 152* > Influenza > Flashcards

Influenza Flashcards

1
Q

What is the significance of influenza?

A

It causes high rates of morbidity and mortality
One of the most common causes of respiratory infections

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2
Q

What are the most common causes of influenza like illness (ILI)?

A

Influenza A and B viruses
Spread by inhalation of droplets (coughing and sneezing) and direct and indirect contact with contaminated respiratory secretions

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3
Q

What are other less common causes of influenza?

A

influenza C, parainfluenza virus, respiratory syncytial virus (RSV) or mycoplasma pneumoniae

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4
Q

What is the timing of infection and spreading for influenza? Does it differ in adults vs kids? When is influenza season?

A

Incubation period 1.5-2 days

Adults spread the virus from 1 day before sx to 5 days after onset

Children and immunocompromised may be infectious longer

Nov to April in N America

Peaks during winter months

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5
Q

Explain the anatomy of a virus

A

-ve strand RNA viruses covered in a protective lipid envelope
RNA segments are encapsulated by nucleoproteins forming a ribonucleotide-nucleoprotein complex (RNP)

Lipid envelope is covered in hemagglutinin( HA), neuraminidase (NA) and matrix 2 (M2) ion channels (antigenic portions)

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6
Q

What are the steps of invasion and replication of viruses

A
  1. HA molecule initiates infxn by binding to host cell receptors in the respiratory tract (nose, throat, lungs), enter via endocytosis
  2. Viral RNA (vRNA) and other items are released into cytoplasm and transported to the nucleus

3/4. complementary positive sense vRNA is transcribed and may be exported into the cytoplasm to get translated or stay in the nucleus

  1. new viral prot (HA,NA, etc) are secreted thru the golgi apparatus onto cell surface or may be transported back to the nucleus to form new viral genome particles
    -some viral proteins can inhibit translation of host-cell mRNAs
  2. viral RNA and important proteins leave nucleus and bulge out of the host cell membrane that is coated in viral surface proteins (HA, NA)
  3. mature virus buds off from the cell, release causes cell death (our drugs inhibit this step - prevent release )
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7
Q

What is antigenic shift/drift?

A

Appearance of influenza virus (usually A) with new HA or NA subtypes

Immunity to one strain or subtype does not protect against others
This is why vaccines must be reformulated each year

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8
Q

What causes antigenic shift or drift?

A

Mutations during viral replication
Viruses have no proof reading

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9
Q

What was the influenza pandemic of 1819-1919?

A

The Spanish flu
infected 205 of the world popn
mortality rate of 2.5-20%
Most deadly for the productive class (age 20-40)
Killed 50M ppl

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10
Q

Explain the H1N1 pandemic

A

Began in Canada mid April 2009
Peaked for the first 3 weeks in June then declined
the second wave began middle of sept 2009
Peaked late Oct - mid Nov
Second wave was much larger with 4-5 times more hospitalized and fatal cases than the first wave

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11
Q

What are the signs and sx of influenza?

A

high fever that lasts for 7-10 days
Cough (may persist for 2 weeks)
Sore throat
Myalgias and fatigue (severe)
May include headache, loss of appetite, fatigue, coryza, nausea, vomiting, diarrhea (esp in kids)
Most recover in 7-10 days

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12
Q

What is a better word for influenza?

A

acute respiratory tract infxn

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13
Q

What are the respiratory complications of influenza?

A

Pneumonia (most common) - could be viral or secondary bacterial pneumonia
Exacerbation of chronic lung disease
Croup of bronchiolitis (in young kids)
Otitis media

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14
Q

What are the non-respiratory complications of influenza?

A

Exacerbation of comorbid conditions:
Febrile seizures
Reye syndrome -> fat accumulations in the liver and other organs with severe increase in pressure in the brain
encephalitis
Guillain barre syndrome (autoimmune attack on the PNS)
Myositis = muscle inflamm
Myocarditis = heart inflamm

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15
Q

What groups of ppl have a higher risk of influenza complications?

A

Patients with:
Heart disease
Diabetes
Lung disease
Renal disease
Rheumatologic disease
Dementia
Stroke

Pregnant women (esp in 3rd trimester)
extremes of age
immunosuppressed individuals

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16
Q

What is the best way to prevent influenza?

A

Thru the use of the vaccine

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17
Q

What is the formulation of the influenza vaccine based on?

A

The HA and NA of each virus subtype that are the most common

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18
Q

What does WHO recommend for the trivalent and quadrivalent vaccine?

A

Trivalent = 3 strains included - influenza A (H1N10, one influenza A (H3N2) and one influenza B

Quadrivalent = same as above but with an additional influenza B type that is not already in the trivalent vaccine

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19
Q

What is a vaccine adjuvant?

A

Creates a stronger immune response in the ppl who receive the vaccine

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20
Q

What are the vaccine types?

A

IIV3 = inactivated influenza vaccine trivalent
IIV4 = inactivated influenza vaccine quadrivalent
LAIV3 = Live attenuated influenza vaccine trivalent
LAIV4 = Live attenuated influenza vaccine quadrivalent
IIVS-SD or IIV4-SD - refers to standard dose, unadjuvanted, IM admin
IIV3-Adj = adjuvanted IM admin
IIVS-HD = high dose, unadjuvanted, IM admin
IIV4-HD = high does, unadjuvanted, IM admin
IIV4-cc = SD, unadjuvanted, IM admin, cell-culture-based
RIV4 = recombinant protein, IM admin

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21
Q

What are the two vaccines approved for use in SK? What are their age guidelines and dosages? How about for the other vaccines?

A

IIV4-SD (6mo and older; unadj, 15ug HA/strain, 0.5ml dose via IV injection)
IIV4-HD (65+; 50ug HA/0.7 mL dose)

Not approved in SK:
IIV4-cc (6mo and older; unadj, 15ug HA/strain, 0.5 mL dose via IM injection)
RIV4 (18+; 45ug, 0.5mL dose, IM admin)
LAIV4 (2-59years; 10^6.5-7.5 FFU/0.2 ml given as 0.1mL per nostril)
IIV-adj (trivalent, adj MF59, children 6-23mo 7.5ug HA/strain 0.25mL dose via IM injection OR adults 15ug HA/strain 0.5 ml dose via IM injection

22
Q

What is the difference between split virus vaccines and subunit virus vaccines?

A

Split- virus disrupted by a detergent (used to have more s/e)
Subunit - HA and NA further purified by removal of other viral components

23
Q

What is the name of the intranasal spray vaccine?

A

FluMistQuadrivalent

24
Q

Explain the FluMistQuadrivalent vaccine

A

Live attenuated (weakened virus)
Quadrivalent
Ages 2-59
Intranasal spray
0.1mL per nostril

25
Q

What are the side effects and contraindications of the FluMistQuadrivalent vaccine?

A

S/E: Nasal congestion and runny nose

CI: In children less than 24mo, ppl with severe asthma, children receiving ASA, pregnant women, ppl with immune compromising conditions, ppl with receipt of anti-influenza drugs in previous 48 hours

26
Q

Why would the FluMistQuadrivalent vaccine not be good for people who are immunocompromised?

A

Because the vaccine contains a live attenuated virus, since the body has a weak immune system, the virus make take over the host

27
Q

Should recipients of the FluMistQuadrivalent vaccine avoid close contact with persons with severe immune compromising conditions? If so, how long? If not, why not?

A

They should avoid close association with immunocompromised persons

Two weeks following the vaccination

28
Q

What is the effectiveness of the influenza vaccine dependent on?

A

Age -> due to less robust antibody production when older
Immunocompetence -> these ppl may not produce good antibodies
Match between the virus and the vaccine

29
Q

What my cat’s name?

A

Guapo

30
Q

What is the significance of the influenza vaccine for the elderly? How about in school aged children?

A

Elderly - vaccine decreases the incidence of pneumonia, hospital admission and death
50-60% effective in preventing hospitalization and up to 85% in preventing death in nursing home residents

Children (school aged) - Immunization decreases the mortality in older adults as children serve as biological viral reservoirs.
Also, reduces exacerbations in ppl with chronic obstructive pulmonary disease

31
Q

What occurs in the body after the vaccine is administered? how long does protection last?

A

Body produces IgG antibodies to the viral HA and NA
Protection for approx 2 weeks after vaccination and lasts for around 6 mo

In the elderly, protection only lasts for 4mo

32
Q

True or false: There is no reason to vaccinate near the middle-end of the influenza season

A

False, better late than never
Protection is good

33
Q

What groups of ppl would you see a reduced antibody response? Do we vaccinate these groups?

A

In the very elderly, immunocompromised, and those with renal failure

It is still worth it to immunizing these groups, as it lessens disease severity (illness severity, risk of death, hospitalization/pneumonia rate)

34
Q

What are the people at high risk of complications or hospitalization? (recommended recipients)

A

All pregnant women
Adults and children with chronic health conditions
Cardiac or pulmonary disorders
Diabetes mellitus
Cancer, immune compromising conditions
Renal disease
Anemia or hemoglobinopathy
Neurological or neurodevelopment conditions
Morbid obesity (BMI >40)
Children and adolescents on long term ASA treatment
Residents of nursing homes or chronic care facilities
Ppl above 65 years
Children 6-59 months
Indigenous ppl
healthcare/care providers
Those who have a newborn under 6mo in the household
Those providing care to children < 59 mo
Those providing services in closed settings to those at high risk

35
Q

Why are vaccines not recommended for children under 6 months?

A

Because they don’t develop a proper antibody response at this age
Ultimately, vaccine is of no use

36
Q

What are other groups of people who should be immunized?

A

Those who provide essential community services
Those in direct contact during the culling or operations with poultry infected with avian influenza

We don’t want the human virus to combine with the avian influenza

37
Q

What should health care workers consider?

A

Annual influenza vaccinations
Should be part of their responsibility to provide the highest standard of care

38
Q

What are the dosing recommendations for the vaccine?

A

2 dose: for children under 9 who are receiving their first influenza vaccine, 2nd dose administered after 4 weeks

1 dose: everyone else

Half-does (0.25mL) previous recommended for 6mo-35mo, but now NACI recommends full doses

39
Q

What are the guidelines for concurrent vaccine use in children 6mo to 5 years? How about children above 5 years?

A

6mo - 5years: They should wait at least 14 days between COVID-19 vaccines and non-COVID-19 vaccines, including the influenza vaccine

Above 5 years: administrations can occur anytime, and before or after

40
Q

Can influenza vaccines cause influenza?

A

No, because the vaccines do not contain live viruses

Exception: FluMist

41
Q

What are the adverse effects of influenza vaccines?

A

Soreness at injection site for up to 48 hours

Fever, malaise, myalgia may occur in 6-12 hours and can last 1-2 days (the immune response [12% of ppl], making antibodies here)

Oculo-respirator syndrome (ORS)

42
Q

What is ORS?

A

Oculo-respiratory syndrome:

Red eyes, respiratory sx, facial edema within 24hrs of immunization and lasts less than 2days

(Think: Allergy-like, but not a true allergy)

Mild and self-resolving
benefits > risks
Occurred in the 2000-2001 vaccine, and it is not a contraindication to future vaccines

43
Q

What are the public’s concerns to vaccines?

A

Link to autism (proven not true)
Concerns with Hg (actually very little, less than Hg found in food)
Overwhelming the immune system (immune system already exposed to many antigen daily)

44
Q

What groups of people is the influenza vaccine contraindicated in?

A

People who have had an anaphylaxis rxn to a previous dose of influenza vaccine (exception: egg allergy people can get the vaccine)
Pt who have developed Guillain-barre Syndrome within 6 weeks of a previous influenza vaccine
If a pt has a serious acute illness, then wait until sx decrease

45
Q

What is the goal of vaccination programs in terms of yeild?

A

to vaccinate more than 90% of eligible recipients

(only 20-40% of adults and children with medical conditions receive the vaccine)

46
Q

What are the reasons for the low rate of vaccine utilization?

A

Fear of s/e
Belief that the vaccine is ineffective, unnecessary, or causes the flu
Don’t believe that they will get sick

47
Q

What are some strategies to increase vaccine use?

A

Standing order policies in hospitals and long term care (ppl auto opted in unless the withdraw themselves)
Force vaccine prior to discharge from hospital or ER
Promotion where high risk pts are seen (i.e. cancer, cardia, pulmonary clinics)
Increase vaccine accessibility
Collaborate with other HCPs

48
Q

What are the roles of the pharmacist when it comes to influenza vaccinations?

A

Educate the pt (vaccines don’t cause flu, vaccine benefits)
ID pt who should be immunized
host clinics
Lead by example by getting immunized

49
Q

What are neuraminidase inhibitors used for and what is their MOA?

A

used in prevention and treatment of influenza (effective against A and B)

MOA: competitively bind to neuraminidase (NA) active site, ultimately impeding sialidase activity and release from cells
No release = no infxn

50
Q

What are examples of NA inhibitors?

A

Oseltamivir and zanamivir

51
Q

What do NA inhibitors accomplish in terms of patient symptoms?

A

Decrease the sx severity
Cause earlier resolution of sx by 1 to 1.5 days
Reduce hospitalization in high-risk patients
Oseltamivir may reduce mortality (for certain populations)

PHAR 152* (16 decks)

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