influenza

Question 1

how many types

Answer 1

3: A, B, C

Question 2

which type if more virulent and occurs more frequently

Answer 2

A

Question 3

which type presents a milder course of disease but still has potential to cause outbreaks

Answer 3

B

Question 4

which type causes mild or asymptomatic disease, similar to the common cold

Answer 4

C

Question 5

which types can be further categorised into subtypes depending on their principle H and N antigens?

Answer 5

A and B

Question 6

transmission occurs via

Answer 6

droplets, aerosols, or direct contact with respiratory secretions from an infected person

Question 7

usual incubation period

Answer 7

1-3 days

Question 8

what does incubation period mean

Answer 8

the period between exposure to an infection and the appearance of the first symptoms

Question 9

symptoms usually appear suddenly or take a while?

Answer 9

suddenly

Question 10

symptoms include…

Answer 10

chills
fever
headache
extreme fatigue
myalgia
dry cough
sore throat
nasal congestion

Question 11

complications - respiratory and non-respiratory

Answer 11

• usually respiratory in nature and may include bronchitis, secondary bacterial pneumonia or otitis media (in children)
• non-respiratory complications rarer and may be cardiac or neurological in nature

Question 12

influenza is usually self limiting with recovery occurring within how many days?

Answer 12

2-7 days

Question 13

classifications of influenza (not types!)

Answer 13

uncomplicated
complicated (either needing hospitalisation, having signs or symptoms of LRTI, CNS involvement or exacerbation of an underlying condition)

Question 14

risk of more serious illness is greater for those in at risk groups….

Answer 14

children under 6 months
pregnant females, including females up to 2 weeks PP
adults over 65
pt with long term conditions e..g respiratory, renal, hepatic, neurological or cardiac disease, DM or morbid obesity (BMI ≥ 40 kg/m²), or those with severe immunosuppression)

Question 15

patients with this BMI are at risk of more serious illness

Answer 15

BMI ≥ 40 kg/m² - morbid obesity

Question 16

which two antivirals are used for both treatment and post exposure prophylaxis of influenza?

Answer 16

oseltamivir and zanamivir

Question 17

oseltamivir and zanamivir are used for both treatment and post exposure prophylaxis of influenza. there is evidence that some strains of influenza are more likely to develop resistance to which one of these?

Answer 17

oseltamivir

Question 18

the risk of developing oseltamivir resistance is considered to be greater for which type ?

Answer 18

A , risk if higher in pt who are severely immunocompromised

Question 19

the risk of developing oseltamivir resistance is higher in which set of pt

Answer 19

severely immunocompromised

Question 20

can you give amantadine HCl for treatment or post exposure prophylaxis of influenza A

Answer 20

No not recommended

Question 21

treatment of suspected or confirmed influenza - when treatment with oseltamivir is indicated, it should be started…

Answer 21

ASAP ideally within 48 hours of symptom onset

Question 22

for treatment of suspected or confirmed influenza, when treatment with oseltamivir is indicated, it should be started ASAP ideally within 48 hours of symptom onset. can be be started later than this ?

Answer 22

treatment initiation beyond 48h onset is unlicensed and clinical judgement should be used
there is evidence to suggest the risk of mortality may be reduced even if treatment is started up to 5 days after symptom onset

Question 23

treatment if suspected or confirmed influenza - where treatment with inhaled zanamivir is indicated, it should be started…

Answer 23

ASAP ideally within 48 hours (36 hours in children) of symptom onset
treatment initiation beyond this time is unlicensed and clinical judgement should be used

Question 24

treatment if suspected or confirmed influenza - where treatment with IV zanamvir is indicated , it should be started

Answer 24

ASAP and within 6 days of symptom onset

Question 25

for those with uncomplicated influenza but considered to be at serious risk of developing complications, offer this antiviral drug

Answer 25

oseltamivir

Question 26

for patients in at risk group (including pregnant🤰but excluding severely immunocompromised), offer this antiviral and do not wait for lab test results to treat

Answer 26

oseltamivir

Question 27

when would a pregnant female be given zanamivir first line?

Answer 27

meets additional criteria treamtent should be discussed with a local infection specialist

Question 28

what to do when you are considering treatment for severely imunocompromised paeople + which treatment to offer

Answer 28

consider the subtype of influenza causing infection, or if not yet know, take into account the current dominant circulating strain 1st line oseltamivir unless strain has higher risk of resistance, in which case offer inhaled zanamivir if unable to use inhaled due to underlying severe resp disease or inability to use device (including under 5), offer oseltamivir and assess repsonse to therapy

Question 29

for patients with uncomplicated influenza who require treatment due to being at serious risk of devleoping complications etc and they have suspected or confirmed oseltamivir resistant influenza, offer ...

Answer 29

inhaled zanamivir if unable to use this, consider IV (unlicensed)

Question 30

what to do with pt who have complicated flu

Answer 30

all pt should be tested and treated often in hospital do not wait for lab results to treat

Question 31

treatment of complicated flu for pt where there is risk of reduced GI absoprtion, or if inital oseltamivir unsuccessful

Answer 31

inhaled zanamivir

Question 31

treatment of complicated flu for pt who are not severely immunosuppressed

Answer 31

1st line oseltamivir

Question 32

who should be offered post exposure prophylaxis following exposure to a person in the same household or residential setting with influenza like illness (when influenza is circulating)?

Answer 32

contacts in at risk group who arent adequately protected through vaccination (e.g. due to infection by different circulating strain or exposure within 14 days post vaccination)

Question 33

when does flu vaccine start giving you protection

Answer 33

after 14 days

Question 33

who may be considered for antiviral prophylaxis post-exposure regardless of vax status?

Answer 33

certain populations that are susceptible to localised outbreaks e..g care homes, prisons, detention centres

Question 33

when is oseltamivir given 1st line regardless of risk of resistance of circulating or index strain

Answer 33

when its used for post exposure prophylaxis in pt in at risk group (including pregnant, but excluding severely immunocompromised

Question 33

what are the treatment options available for post exposure prophylaxis and when should they be started

Answer 33

prophylaxis should be started ASAP following exposure ideally within 48h for oseltamivir ideally within 36h for inhaled zanamivir initation beyond these times is unlicnesed, seek specialist advoce

Question 33

1st line for post exposure prophylaxis for pt in at risk group (incl pregnant females, EXCL severely immunosuppressed and children under 5)

Answer 33

oseltamivir regardless of risk for resistance of the circulating or index case strain

Question 34

post exposure prophylaxis for pt exposed to a strain with suspected or confirmed oseltamivir resistance

Answer 34

inhaled zanamivir

Question 35

treatment post exposure prophylaxis for severely immunosuppressed pt EXCL under 5

Answer 35

oseltamivir if risk for resistance is low if risk for resistance is high, suspected or confirmed, offer inhaled zanamivir

Question 36

post exposure prophylaxis treatment for pt at higher risk of oseltamivir resistance who are unable to used inhaled zanamivir (due to underlying severe respiratory disease or unable to use device)

Answer 36

oseltamivir and advice pt to seek immediate medical attention if symptoms develop subsequently

Question 37

post exposure prophylaxis treatment for pt who are exposed to suspected or confirmed oseltamivir resistance influenza who are unable to use inhaled zanamivir

Answer 37

seek specialist advice monitor pt closely for influenza like illness arrangements made for prompt treatment if symptoms develop

Question 38

post exposure prophylaxis for a child who is severely immunocompromised

Answer 38

seek specialist advice

Question 39

by which route can oseltamivir be given

Answer 39

by mouth

Question 40

how long is oseltamivir given for TREATMENT of influenza

Answer 40

BD 5 days 10 days if immunocompromised

Question 41

how long is oseltamivir given for PREVENTION of influenza

Answer 41

OD for 10 days, for up to 6 weeks up to 12 weeks if immunocompromised

Question 42

which route can zanamivir be given via

Answer 42

inhalation of powder iV infusion