Influenza Dr. Burchette EXAM I

Question 1

Influenza A and B

Answer 1

-Flu A: Zoonotics, H and N as recognizing characteristic) – responsible for seasonal, yearly flu outbreaks

-Flu B – responsible for sporadic outbreaks in those living in facilities

Question 2

Influenza A and Influenza B are categorized into subtypes
T or F

Answer 2

False
Only Influenza A is categorized into subtypes

Hemaglutinin: cell entry (16 subtypes)
Neuraminidase: release of new virion (9 subtypes)

Question 3

What are diseases that cause mortality in people infected with Influenza?

Answer 3

-bacterial pneumonia
-viral pneumonia,
-exacerbation of underlying comorbidities (heart diseases, COPD, asthma)

Question 4

Genetic Drift

Answer 4

-small point mutation (small changes in H or NA) of the circulation flu in the community
-still the same subtype
-causes seasonal flu epidemics
-annual flu vaccine recommended

Question 5

Genetic Shift

Answer 5

-New Hemaglutinin or NA antigens on the surface due to genetic reassortment in an animal host
-creates a new flu strain
causes a broad pandemic

Question 6

Flu Signs and Symptoms

Answer 6

-Rapid onset and fever
-Myalgias (muscle pain)
-Malaise
-Headache
-Non-productive cough
-Rhinitis
-sore throat
-Kids: N/V

Question 7

What is the time period someone is contagious when infected with the flu?

Answer 7

1 day before and up to 7 days after the onset
(may be longer in children and immunocompromised)

-Incubation time: 1-7 days (average 2 days)

Question 8

What is the timeframe within prophylaxis is recommended after exposure?

Answer 8

48 hours

Question 9

High-Risk Groups for Influenza

Answer 9

-younger than 5, older than 65
-chronic disease (except HTN alone)
-immunosuppressed, HIV
-pregnant, postpartum (2 weeks after giving birth)
-18 years or younger and taking aspirin, salicylate (Reye’s syndrome)
-American Indian/Alaskian
-BMI >39
-chronic care facilities

Question 10

QUESTION

Answer 10

What if the patient has hypertension, but is not controlled, will they be considered high-risk?

Why is HTN alone not considered high-risk
INFLUENZA -> PNEUMONIA -> CARDIOVASCULAR

Question 11

Types of Flu Vaccines

Answer 11

-Inactivated Influenza Vaccine (IIV)
-Live-Attenuated Influenza Vaccine (LAIV)
-Recombinant Quadrivalent Vaccine (RIV4)
-Cell-Culture QuadrivalentVaccine (ccIIV4)

Question 12

Recommended age for Flu vaccines

Answer 12

there are available vaccines for all persons 6 months or older

Question 13

Which patient population is appropriate for adjuvanted IIV or high-dose vaccines?

Answer 13

65 and over
-their immune systems are not as strong
-we need a greater stimulus for an immune response

Question 14

Which patient population is appropriate for live vaccines (LAIV)?

Answer 14

2 to 49
-the only Intranasal vaccine

Question 15

Which patient population is appropriate for recombinant vaccines (LAIV)?

Answer 15

18 and over

Question 16

What to consider in patients old enough to get a vaccine but younger than 9?

Answer 16

-between 6 months and 9 years
-if they have received the flu vaccine the first time ever
-need a second booster at least 1 month after the first dose

Question 17

What to consider regarding egg allergies

Answer 17

If the reaction is not worse than hives it is fine to give any age-appropriate vaccine

Question 18

Which vaccine is appropriate for patients with severe egg allergies?

Answer 18

-any age-appropriate IIV RIV4 with close monitoring

-(Flublok
RIV4 is the only one considered completely egg-free

Question 19

What is the patient population that has to be treated with antivirals regardless of the time of exposure or diagnosis?

Answer 19

-Hospitalized for flu-related illness
-Outpatients with very severe or worsening illness
-Anyone who is listed as being at high risk from flu complications

-Exception = children < 2, not < 5?
stick with less than 5 and older than 65

Consider treating: not high-risk but presented within 48 hours and the symptoms are severe (outpatients)

Question 20

Direction for Oseltamivir

Answer 20

-Neuraminidase Inhibitor
-Standard 75 mg BID x 5 days
-if CrCl < 60 ml/min dose reduce

-Pediatrics based on weight/age
-Approved above 2 weeks of age

Side effects: GI, AMS

Question 21

Direction for Baloxavir

Answer 21

-Endonuclease inhibitor

-Dosing based on weight
40 – 79 kg – 40 mg x 1
80 kg or greater – 80 mg x 1

-Approved for age 5 and over
-ADE: GI

Question 22

When is Chemoprophylaxis appropriate to use?

Answer 22

• Adjunct to Vaccination
  -in those who are contraindicated to vaccination for
  duration of flu season activity
  -Neuraminidase Inhibitors only drugs available: Oseltamivir and Zanamivir
  -3 months and older

Question 23

Pre-exposure Chemoprophylaxis

Answer 23

-Cannot take or low response to vaccine + high risk for flu complications
-should last for the whole season
-Standard Dose = 75 mg once daily

Question 24

Post-exposure Chemoprophylaxis

Answer 24

-very high risk for flu complications
-the usual course is 10 days
-Should not begin if contact is more than 48 hours from presentation
-Standard Dose = 75 mg once daily

Question 25

What are patients likely to be infected after pneumonia or when they have pneumonia?

Answer 25

MRSA