Influenza

Question 1

What is the most dangerous Influenza Virus?

Answer 1

Type A

Question 2

What are the Type A subtypes?

Answer 2

Hemagglutinins H1, H2, H3 Neuraminidases N1, N2

Question 3

How is influenza transmitted?

Answer 3

Air Droplets

Question 4

When are the seasonal outbreaks of Influenza?

Answer 4

Winter time: Jan-Feb

Question 5

What are the symptoms of Influenza that separate it from the common cold?

Answer 5

• Abrupt onset - Fever - Myalgias - Severe Cough - Photophobia

Question 6

Influenza Physical Exam Findings

Answer 6

Relatively Benign ( does not seem like a big deal) - Flushing due to fever - Hot & dry skin - Red mucus membranes

Question 7

How to decide between a FLU vs COLD pt: “FACTS”

Answer 7

Fever Aches Chills Tiredness Sudden Onset

Question 8

How do we diagnose Influenza?

Answer 8

Rapid Influenza Diagnostic Tests aka Rapid Antigen Test.

Question 9

Rapid Influenza Diagnostic Test aka Rapid Antigen Tests (RAT) has a low ______________

Answer 9

sensitivity low sensitivity = a negative test does not rule influenza out

Question 10

Rapid Molecular Assay is used in the __________ setting

Answer 10

Hospital setting: can identify the H and M proteins of the influenza. They are more accurate but take too long and too expensive.

Question 11

What kind of swab do patients need for the RAT?

Answer 11

nasopharyngeal swab

Question 12

When would you do diagnostic tests for the patient?

Answer 12

• If you can’t identify what the patient has from the history and physical exam. - If you can’t decide whether you want to treat the patient with antivirals or not - Institutionalized patients in nursing homes who may spread it and cause harm to other patients

Question 13

4 Additional Diagnostics

Answer 13

• CBC
• BMP: dehydration and electrolytes
• Pulse Oximetry: difficulty breathing
• CXR: flu vs. pneumonia (rule out pneumonia)

Question 14

Populations you want to treat with antivirals

Answer 14

• illness requiring hospitalization
• not hospitalized but very severe and complicated illness
• high risk for complications

Question 15

High Risk Groups that require antiviral treatment

Answer 15

• Extremes of age: under 2 years old and over 65 years old
• Chronic illnesses: cardiac and pulmonary dz or diabetes
• Immunosuppression
• Pregnancy or post-partum (2 wks)
• Children <19 y/o on chronic Aspirin therapy: @ risk of Reyers Syndrome (affects liver + brain) because they have high fever + aspirin
• American Indians and Alaskan Natives
• Morbidly obese BMI greater than or equal to 40
• Residents of nursing homes, chronic care facilities

Question 16

Antiviral Medications you would prescribe (3)

Answer 16

Neuraminidase Inhibitors for Influenza A/B:

• Oseltamivir (most common)
• Zanamivir Peramivir (IV only- seen in hospital settings)
• Peramivir

Question 17

How do Neuraminidases work?

Answer 17

Decreases and inhibits further spread to the additional cells in the body. Does not kill the virus.

Question 18

When do you need to give Neuraminidase for it to have its greatest benefit?

Answer 18

Within the first 24-48 hours

Question 19

What are the benefits of Neuraminidase?

Answer 19

Decreases the course and severity a bit

Question 20

Adverse effects of Oseltamivir (Tamiflu)

Answer 20

• Nausea and Vomiting - Reports of neuropsych symptoms in peds (fever causes hallucinations, agitation)

Question 21

Adverse effects of Zanamivir (Relenza)

Answer 21

• bronchospasm - decreased respiratory function

Question 22

Most common complication of Influenza

Answer 22

Pneumonia

Question 23

Who should get vaccinated and when?

Answer 23

Everyone over the age of 6 months in October

Question 24

How is the live virus vaccine administered?

Answer 24

nasal spray

Question 25

Which populations should we be cautious with in regards to giving the live vaccine?

Answer 25

• Pregnant women - Immunocompromised - Eldery - The very young

Question 26

How many doses do the pediatric population (6mo- 8yrs) need to get of the Flu Vaccine?

Answer 26

2 doses that must be 4 weeks apart 1st time: primes immune system 2nd time: immunity develops

Question 27

Can patients with a regular egg allergies receive the influenza vaccine? Do they need to be monitored afterwards?

Answer 27

The advisory committee on Immunization Practices says they can receive the vaccine and DO NOT need 30 mins of monitoring after the vaccine.

Question 28

Can patients with a severe egg allergy receive the influenza vaccine?

Answer 28

Yes. They must be vaccinated in a medical setting and be supervised by a health care provider who is able to recognize and manage severe allergic conditions.

Question 29

Contraindications to Influenza Vaccine?

Answer 29

Hx of severe allergic reaction to any component of the vaccine or after previous dose of any influenza vaccine.

Question 30

What are 2 precautions for the Influenza Vaccine?

Answer 30

• Pt has Moderate-severe acute illness with or without fever
• Hx of Guillain-Barre syndrome within 6 weeks of receipt of influenza vaccine

Question 31

How does the dosage of the Influenza Vaccine differ for adults 65+?

Answer 31

• Give a higher dose vaccine since it is harder for older pts to mount an immune response - Adjuvanted seasonal vaccine for adults 65+

Question 32

• What do you give to high risk patients to prevent flu?
• 2 scenarios it is given

Answer 32

Neuraminidase Inhibitors

1. Pre-exposure chemoprophylaxis: Flu is circulating and you have not been exposed but you want to prevent yourself from getting sick.
2. Post-exposure chemoprophylaxis (rare): you do this to patients who don’t have access to the vaccine or there is a shortage of the flu vaccine. You need to vaccinate the patient at the same time of the treatment.