Influenza

Question 1

What is the make up of H1N1pdm09?

Answer 1

Quadruple reassortant

1) Eurasian swine
2) Classic swine H1N1
3) Human H3N2
4) Avian

Question 2

What are the receptors for HA?

Answer 2

a2,6-linked sialic acid in URT
a2,3-linked sialic acid in LRT and duck gut epithelium

Question 3

What are the risk factors for complicated flu?

Answer 3

Underlying disease - hepatic, cardiac, neurological, renal, pulmonary

Severe immunosuppression

Over 65 years

Under 6 months

Pregnancy

Morbid obesity

Diabetes

Asplenia/splenic dysfunction

Learning disability

Question 4

When do neurological symptoms occur in relation to flu infection, and what neurological disorders can occur?

Answer 4

Encephalopathy

Encephalitis

Transverse myelitis

ADEM

Seizures

GBS

Reye’s syndrome (with salicylate exposure)

Question 5

What supportive care is available in flu infection?

Answer 5

Hydration

Pain killers

Treating exacerbation of underlying conditions

Oxygen

Antibiotics

Question 6

Options for flu positive mum in labour

Answer 6

Treat mum

Baby

1) prophylax with oral oseltamivir suspension
2) separation until after 5 days symptom onset
3) monitor

Question 7

How long post partum are pregnant woman still at risk of severe influenza?

Answer 7

2 weeks

Question 8

Treatments of:

1. Uncomplicated flu in previously healthy patient
2. Uncomplicated flu in at risk group, not severely immunosuppressed
3. Complicated flu, not severely immunosuppressed
4. Uncomplicated flu in severely immunosuppressed
5. Complicated flu in severely immunosuppressed

Answer 8

1. No treatment (unless at risk of complications)
2. Oseltamivir 5d
3. Oseltamivir 5d (second line zanamavir)
4. Oseltamivir if H3 or IBV. Zanamavir if H1
5. Oseltamivir if H3 or IBV, second line Zanamavir if poor clinical response, gastro dysfunction. Zanamavir if H1