Influenza Dr. Burchette EXAM I Flashcards
Influenza A and B
-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
Influenza A and Influenza B are categorized into subtypes
T or F
False
Only Influenza A is categorized into subtypes
Hemaglutinin: cell entry (16 subtypes)
Neuraminidase: release of new virion (9 subtypes)
What are diseases that cause mortality in people infected with Influenza?
-bacterial pneumonia
-viral pneumonia,
-exacerbation of underlying comorbidities (heart diseases, COPD, asthma)
Genetic Drift
-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
Genetic Shift
-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
Flu Signs and Symptoms
-Rapid onset and fever
-Myalgias (muscle pain)
-Malaise
-Headache
-Non-productive cough
-Rhinitis
-sore throat
-Kids: N/V
What is the time period someone is contagious when infected with the flu?
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)
What is the timeframe within prophylaxis is recommended after exposure?
48 hours
High-Risk Groups for Influenza
-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
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
Types of Flu Vaccines
-Inactivated Influenza Vaccine (IIV)
-Live-Attenuated Influenza Vaccine (LAIV)
-Recombinant Quadrivalent Vaccine (RIV4)
-Cell-Culture QuadrivalentVaccine (ccIIV4)
Recommended age for Flu vaccines
there are available vaccines for all persons 6 months or older
Which patient population is appropriate for adjuvanted IIV or high-dose vaccines?
65 and over
-their immune systems are not as strong
-we need a greater stimulus for an immune response
Which patient population is appropriate for live vaccines (LAIV)?
2 to 49
-the only Intranasal vaccine
Which patient population is appropriate for recombinant vaccines (LAIV)?
18 and over
What to consider in patients old enough to get a vaccine but younger than 9?
-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
What to consider regarding egg allergies
If the reaction is not worse than hives it is fine to give any age-appropriate vaccine
Which vaccine is appropriate for patients with severe egg allergies?
-any age-appropriate IIV RIV4 with close monitoring
-(Flublok
RIV4 is the only one considered completely egg-free
What is the patient population that has to be treated with antivirals regardless of the time of exposure or diagnosis?
-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)
Direction for Oseltamivir
-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
Direction for Baloxavir
-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
When is Chemoprophylaxis appropriate to use?
- 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
Pre-exposure Chemoprophylaxis
-Cannot take or low response to vaccine + high risk for flu complications
-should last for the whole season
-Standard Dose = 75 mg once daily
Post-exposure Chemoprophylaxis
-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
What are patients likely to be infected after pneumonia or when they have pneumonia?
MRSA
