Influenza

Question 1

What are the types of influenza viruses?

Answer 1

There are three types of influenza virus; A, B and C.

Types A and B account for the majority of clinical disease.

Question 2

A new NHS influenza vaccination programme for children was announced in 2013. There are three key things to remember about the children’s vaccine:

Answer 2

• it is givenintranasally
• the first dose is given at2-3 years, thenannually after that
• it is alive vaccine (cf. injectable vaccine below)

Question 3

Some other points about vaccinating children?

Answer 3

• children who were traditionally offered the flu vaccine (e.g. asthmatics) will now be given intranasal vaccine unless this is inappropriate, for example if they are immunosuppressed. In this situation the inactivated, injectable vaccine should be given
• only children aged 2-9 years who have not received an influenza vaccine before need 2 doses
• it is more effective than the injectable vaccine

Question 4

Contraindications of influenza vaccination of children

Answer 4

• immunocompromised
• aged < 2 years
• current febrile illness or blocked nose/rhinorrhoea
• current wheeze (e.g. ongoing viral-induced wheeze/asthma) or history of severe asthma (BTS step 4)
• egg allergy
• pregnancy/breastfeeding
• if the child is taking aspirin (e.g. for Kawasaki disease) due to a risk of Reye’s syndrome

Question 5

Side-effects of influenza vaccine for children

Answer 5

• blocked-nose/rhinorrhoea
• headache
• anorexia

Question 6

The influenza vaccine: Adults and at-risk groups

Answer 6

• it is an inactivated vaccine, so cannot cause influenza. A minority of patients however develop fever and malaise which may last 1-2 days
• should be stored between +2 and +8ºC and shielded from light
• contraindications include hypersensitivity to egg protein.
• in adults the vaccination is around 75% effective, although this figure decreases in the elderly
• it takes around 10-14 days after immunisation before antibody levels are at protective levels

Question 7

The Department of Health recommends annual influenza vaccination for all people older than 65 years, and those older than 6 months if they have:

Answer 7

• chronic respiratory disease (including asthmatics who use inhaled steroids)
• chronic heart disease (heart failure, ischaemic heart disease, including hypertension if associated with cardiac complications)
• chronic kidney disease
• chronic liver disease: cirrhosis, biliary atresia, chronic hepatitis
• chronic neurological disease: (e.g. Stroke/TIAs)
• diabetes mellitus (including diet controlled)
• immunosuppression due to disease or treatment (e.g. HIV)
• asplenia or splenic dysfunction
• pregnant women
• adults with a body mass index >= 40 kg/m²

Question 8

Other at risk individuals include:

Answer 8

• health and social care staff directly involved in patient care (e.g. NHS staff)
• those living in long-stay residential care homes
• carers of the elderly or disabled person whose welfare may be at risk if the carer becomes ill (at the GP’s discretion)

Question 9

physiology of why a cough can persist weeks/months after a viral infection has gone?

Answer 9

immune reaction still there

Antibody!! mediated response of body