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Part 2 > Influenza > Flashcards

Influenza Flashcards

1
Q

Influenza family & genome

A

Orthomyxovirus
4 types - A to D
A to C cause human infection
A & B - 8 pieces segmented (-) SS RNA

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2
Q

Haemagglutin & Neuraminidase function

A

H - facilitate attachment to host cell
N - facilitate release of new virus particles from host cell

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3
Q

Antigenic shift and drift

A

D - mutations in H&N leading to new variants
S - reassortment between 2 distinct flu viruses in same host

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4
Q

Classes of drugs for influenza

A
  1. Adamantanes - blocks M2 ion channels of ONLY flu A. Eg - Amantidine. No longer preferred due to high resistance
  2. Neuraminidase inhibitors - competitive inhibitors of Neuraminidase of both A&B. Eg - Oseltamavir, Zanamavir.
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5
Q

Neuraminidase inhibitors

A
  1. Oseltamavir
  2. Zanamavir - not licensed for <5y
  3. Peramavir - single dose infusion
  4. Laninamivir - Japan
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6
Q

Oseltamavir resistance

A

H275Y mutation in Neuraminidase
Also affects Peramivir but NOT Zanamivir
R292K mutation - Both Oseltamavir & Zanamivir reduced susceptibility

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7
Q

Neuraminidase resistance testing

A
  1. Pyrosequencing
  2. Digital PCR
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8
Q

Newer agents in Flu

A
  1. Baloxavir - inhibits cap-dependent endonuclease (mRNA synthesis)
  2. Favipiravir - inhibits RNA dependent RNA polymerase ( NOT licenced)
  3. Peramivir - Neuraminidase inhibitor - 600mg IV single dose
  4. Laninamivir. NOT licenced
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9
Q

R0 for Flu & SRS-CoV-2

A
  1. Influenza - 1.8
  2. COVID - 2.6
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10
Q

Influenza H & N types

A

H 1 to 18
N 1 to 11

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11
Q

Avian influenza HPAIs & Swine Flu

A

Avian - H7N9 & H5N1
Swine - H1N1 & H1N2 & H3N2

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12
Q

Avian flu PEP

A

Oseltamavir 75mg OD x 10 days started up to 7 days post exposure

Followed up for 10 days from last exposure

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13
Q

Signs of bird flu in BIRDS

A
  1. Sudden death
  2. Swollen head
  3. Runny eyes
  4. Lethargy
  5. Unresponsive
  6. Lack of coordination
  7. Loss of appetite
  8. Wing droop
  9. Dragging legs
  10. Haemorrhage
  11. Breathing difficulties
  12. Fever
  13. Loose stools
  14. Drop in egg production
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14
Q

Flu treatment

A

Uncomplicated: healthy - no prophylaxis
At risk: Oseltamavir 75 BD for 5 days/ 10 if immunocompromised

Complicated: Oseltamavir as above/ inhaled Zanamivir 10mg BD for 5 days

Severely immunosuppressed: depends on circulating strain - if strain has higher chances of Oseltamavir resistance, then start Zanamivir for 5 to 10 days

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15
Q

Flu vaccine patient groups

A
  1. > 65
  2. Pregnancy
  3. BMI > 40
  4. Children 2 to 17
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16
Q

Flu vaccine types, strains & doses

A

Quadrivalent/Trivalent - 2 subtypes of A + 1 or 2 of B - B/Victoria +/- B/Yamagata

LAIV for children - 1 dose intranasal if previously immunised - CAN BE GIVEN WITH OTHER LIVE VACCINES

Inactivated chicken embryo - IM

17
Q

Flu vaccine in children

A

6mo to 2 years - only for RISK group. Quadrivalent 2 doses 4 weeks apart
2 to 9 - LAIV
9 to 18 - LAIV

18
Q

Highly pathogenic avian influenza (HPAI)

A

H5N1
Dairy cattle in the USA & persists in raw milk
4 human cases as of 7th July 2024- all mild

Found in wild birds in the UK

Vaccine: AFLUNOV
Surface antigens (H&N) of inactivated of strain - Turkey/2005 H5N1 like strain Clade 2.2.1
Propagated in fertilised hen egg

HAIRS risk - Very low

2 doses recommended in poultry workers and other farm workers >18 years

Conjunctival swab testing recommended by CDC for all suspected cases

19
Q

Influenza protein & receptor

A

Matrix 1 - viral assembly and nuclear transport PCR target
Matrix 2 - Channel protein with uncoating (Adamantines site of action)

Receptor - Sialic acid - Alpha 2-6 in humans, Alpha 2-3 in Birds, Pigs have both.

20
Q

Thogotovirus Genus

A

Tick borne Orthomyxos - 6 segmented (-)ssRNA

Thogoto
Dhori
Bourbon

21
Q

Flu plan 24/25

A

> 65: Adjuvanted quadrivalent influenza vaccine (aQIV)
High-dose quadrivalent influenza vaccine (QIV-HD)

18 to 59 years: Cell-based quadrivalent influenza vaccine (QIVc)

60 to 64 years: Cell-based quadrivalent influenza vaccine (QIVc)
High-dose quadrivalent influenza vaccine (QIV-HD)

Part 2 (55 decks)

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