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152 > Influenza Important > Flashcards

Influenza Important Flashcards

1
Q

What are the more common ILI

A
  • *Influenza A and B are most common
    • Some others include influenza C, parainfluenza virus, respiratory syncytial virus, mycoplasma pneumoniae
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2
Q

How is influenza spread

A
  • Inhalation of droplets
    • Direct and indirect contact with contaminated respiratory secretions
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3
Q

What is the incubation period for influenza

A
  • 1.5-2 days (range between1-4 days)
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4
Q

How long is influenza spread for

A
  • Adults can spread virus for 1 day before symptoms and 5 days after onset
    • Children/immunocompromised can be infectious longer
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5
Q

What is the biology of virus

A
  • They are a negative strand RNA viruses that are covered with a protective envelope
    • Each RNA segment is encapsulated by nucleoproteins-> this forms a ribonucleotide nucleoprotein complex (RNP)
    • The lipid envelope is covered in a haemagglutinin (HA), neuraminidase (NA) and matrix 2 (M2) ion channels (the antigenic portion)
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6
Q

What are the steps in invasion and replication of influenza

A
  • Step 1
    • HA molecule starts infection through binding to receptors on host cells within the respiratory tract
    • Endocytosis brings the virus into the cell
    • Step 2
    • Viral RNA (vRNA) along with other things are released into the cytoplasm
    • Transported into the nucleus
    • Step 3/4
    • Complementary (+) sense vRNA is transcribed and may be exported into the cytoplasm to get translated or stay in the nucleus
    • Step 5
    • New viral proteins (HA, NA…) are secreted through the golgi apparatus onto the cell surface or may be transported back to the nucleus to form new viral genome particles
    • Step 6
    • Viral RNA and important proteins leave nucleus and bulge out of the host cell membrane which is coated in viral surface proteins (HA, NA)
    • Step 7
    • The mature virus buds off from the cell
    • After release of the new viruses the cell dies
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7
Q

What is the most important step in invasion and replication of influenza in regards to drugs

A
  • Step 7
    • Drugs inhibit this step so the virus cant infect other cells
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8
Q

What does the H and N in influenza mean

A
  • H= hemagglutinin
    • N= neuraminidase
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9
Q

What are signs and symptoms of influenza

A
  • Sudden onset
    • High fever (chills first) for 7-10 days
    • Cough (2 weeks)
    • Sore throat
    • Myalgias and fatigue (can be weeks)
    • Can include headache, loss of appetite, fatigue, coryza, NVD (in kids)
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10
Q

What kind of infection is influenza

A
  • Acute respiratory tract infection
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11
Q

What are the respiratory complications of influenza

A
  • Pneumonia (most common): viral or secondary bacterial
    • Can make chronic lung disease worse
    • Croup/ bronchiolitis (kids)
    • Otitis media
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12
Q

What are non respiratory complications of influenza

A

a) Exacerbation of comorbid conditions
- Febrile seizures
- Reye syndrome
- Encephalitis
- Guillain barre syndrome
- Myositis (inflammation of muscle)
- Myocarditis (inflammation of heart muscle)

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13
Q

Patients with what conditions have a higher risk of complications with influenza

A
  • Heart disease
    • Lung disease
    • Diabetes
    • Renal disease
    • Rheumatologic disease
    • Dementia
    • Stroke
    • Pregnant (3rd trimester is worst), extremes of age, immunosuppressed
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14
Q

What is the best way to prevent influenza

A
  • Vaccine
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15
Q

What does the WHO recommend be included in the vaccine

A
  • 3 strains be included in the trivalent vaccine being 1 influenza A (H1N1), one influenza A (H3N2) and one influenza B
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16
Q

What strains are included in the trivalent/ quadrivalent vaccines (based on the WHO)

A

a) Trivalent
- Influenza A: H1N1
- Influenza A: H3N2
- One influenza B
b) Quadrivalent
- Same 3 as above
- One more influenza B (from lineage that is not included in trivalent)

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17
Q

How many lineages of influenza B is there

A

2

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18
Q

What does IIV3 mean

A
  • Inactivated influenza vaccine trivalent
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19
Q

What does IIV4

A
  • Inactivated influenza vaccine quadrivalent
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20
Q

What does LAIV3 mean

A
  • Live attenuated influenza vaccine trivalent
    • Not available in canada
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21
Q

What does LAIV4 mean

A
  • Live attenuated influenza vaccine quadrivalent
    Available but not publicly funded
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22
Q

What does IIV3-SD/ IIV4-SD refer to

A
  • Standard dose, unadjuvanted IM administered
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23
Q

what does IIV3-Adj refer to

A
  • Adjuvanted; IM administered
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24
Q

What is the benefit of an attenuated vaccine

A
  • Live vaccine can give you disease while attenuated is a weaker version
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25
Q

Can you get influenza from an inactivated vaccine

A
  • No you cant
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26
Q

What does IIV3-HD refer to

A
  • High dose, unadjuvanted; IM administered
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27
Q

What does IIV4-HD refer to

A
  • High dose, unadjuvanted; IM administered
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28
Q

What does IIV4-cc refer to

A
  • Standard dose, unadjuvanted, IM administered, cell culture based (usually cultured birds or ducks)
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29
Q

What does RIV4 refer to

A
  • Recombinant protein; IM administered
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30
Q

What were the strains for influenza in quadrivalent vaccines for 2022-2023

A
  • Influenza A (H1N1)
    • Influenza A (H3N2)
    • Influenza B (Victoria lineage)
    • Influenza B (Yamagata lineage)
31
Q

Explain the IIV4-SD vaccines

A
  • Afluria Tetra (>5 years) Flulaval tetra (>6 months) Influvac tetra (>6 mounths
    • It is unadjuvanted; has 15 ug HA per strain
    • 0.5mL dose through IM
32
Q

Explain the IIV4-HD vaccine

A
  • High dose
    • Fluzone High dose (>65 years)
    • 50ug HA for a 0.7mL dose
33
Q

Explain the IIV4-cc vaccine

A
  • Flucelvax (>6 month)
    • Unadjuvanted
    • 15ug HA per strain
    • 0.5 ml dose through IM
34
Q

Explain the RIV4 vaccine

A
  • Supemtek (>18 years)
    45ug; 0.5 mL dose through IM
35
Q

Explain the LAIV4 vaccine

A
  • Flumist quadrivalent (2-59 years)
    • Given as 0.1 mL per nostril
    • Live attenuated
36
Q

Explain the characteristics of the IIV-Adj influenza vaccine

A
  • Trivalent
    • Adjuvant MF59
    • Fluad pediatric (6-23 months): 7.5 ug HA per strain as a 0.25mL dose through IM
    • Fluad for adults (65<): 15 ug HA per strain as a 0.5mL dose through IM
37
Q

What does an adjuvant agent do within a vaccine

A
  • It increase the immune response to the vaccine
38
Q

What are the two ways of producing vaccines

A

a) Split virus vaccine
- Virus has been disrupted by a detergent
b) Subunit virus vaccine
HA and NA are further purified by removal of other viral components

39
Q

Explain the characteristics of the FluMist quadrivalent influenza vaccine

A
  • Live attenuated, quadrivalent (2-59 years), intranasal spary; 0.1ml per nostril)
    • Common side effects: nasal congestion and runny nose
    • don’t want to give it to immune compromised as it is live so the individual needs its immune system to keep the virus at bay
    • Not recommended for HCW
40
Q

What does effectiveness of the influenza vaccine depend on

A
  • Age
    • Immunocompetence
    • Match of vaccine to the circulating virus
41
Q

How is the vaccine beneficial to elderly and kids (also people with COPD)

A
  • Elderly: decreases incidence of pneumonia, hospital admissions and death
    • Kids: decrease mortality in older adults as less risk of the child bringing home the virus
    • COPD: reduces exacerbations
42
Q

Once the influenza vaccine is administered what occurs (when protection occurs)

A
  • As soon as it is administered it results in production of IgG antibodies to the viral HA and NA
    • Protection occurs in about 2 weeks and lasts about 6 months (in elderly only 4 months)
43
Q

If the vaccine does not protect all patients from disease what is the benefit to it

A
  • Decrease severity of illness
    • Decrease risk of death
    • Decrease rate of hospitalization and pneumonia
44
Q

What are the people at high risk of complications or hospitalization who it is recommended to get the vaccine

A
  • Pregnant women
    • Cardiac or pulmonary disorders
    • Diabetes mellitus (other metabolic diseases too)
    • Cancer, immune compromising conditions
    • Renal disease
    • Anemia/ hemoglobinopathy
    • Neurologic/ neurodevelopment conditions
    • Morbid obesity (BMI >40)
    • Kids on long term ASA treatment
    • Age >65
    • Children 5-59 months
    • Indigenous
    • Residents of nursing homes/ chronic care facilities
    • People capable of giving flu to those at high risk
    • Providing essential community services
    • In direct contact during culling operations with poultry infected with avian influenza
45
Q

What are the dosing recommendations for influenza

A
  • First time children (<9) get 2 doses (min interval of 4 weeks)
    • Everyone else gets a single dose
    • NACI recommends full doses to everyone (even kids)
46
Q

What are adverse effects of the influenza vaccine

A
  • Soreness at injection site (up to 48 hours)
    • Fever, malaise, myalgia (starts in 6-12 hours and lasts up to 2 days): an immune response and occurs in about 12% of people
    • Oculo-respiratory syndrome (ORS): benefits outweigh the risk and not a CI to future vaccinations
47
Q

What are contraindications to the influenza vaccine

A
  • Anaphylaxis to previous influenza vaccine
    • Anaphylactic allergy to a component of the virus (except egg allergy)
    • Developed Guillain- Barre syndrom within 6 weeks of previous vaccine
    • Has a serious acute illness (wait till symptoms relieve)
48
Q

If an person has a minor or moderate acute illness should they get the vaccine

A
  • Yes do not delay
49
Q

What are strategies to increase use of influenza vaccine

A
  • Standing order policies (hospitals, LTC)
    • Opt out rather then opt in
    • At discharge from hospital/ ER
    • Promotions
    • Increase accessibility
    • Collaborate with HCP
50
Q

What is the role of the pharmacist in regards to influenza vaccine

A

a) Patient education
- Vaccine doesn’t cause the flu
- Benefits
- Symptom treatment
b) Get immunized
c) Host clinics
d) Identify patients who are at higher risk and get into contact

51
Q

When are neuraminidase inhibitors (NA inhibitors) used

A
  • In prevention and treatment of influenza
52
Q

What are NA inhibitors effective against

A
  • Influenza A and B
53
Q

What is the MOA of NA inhibitors

A

Bind the influenza virus neuraminidase (NA) active site -> stops sialidase activity and release from cell

54
Q

What are the NA inhibitors on the market

A
  • Oseltamivir (Tamiflu)
    • Zanamivir (Relenza)
55
Q

What will NA inhibitors do for the patient

A
  • Decrease severity of symptoms
    • Cause resolution of symptoms up to 1.5 days quicker
    • May reduce hospitalization in high risk patients
    • Oseltamivir may reduce mortality
56
Q

What are the NA inhibitors on the market

A
  • Oseltamivir (Tamiflu)
    • Zanamivir (Relenza)
57
Q

What will NA inhibitors do for the patient

A
  • Decrease severity of symptoms
    • Cause resolution of symptoms up to 1.5 days quicker
    • May reduce hospitalization in high risk patients
    • Oseltamivir may reduce mortality
58
Q

Explain characteristics of Zanamivir (Relenza)

A
  • A disk haler
    • Treatment and prophylaxis in patients >7 yo
    • 10-20% systemically absorbed (goes to lungs so less systemic side effects)
    • Better in vitro activity against influenza B in comparison to oseltamivir
59
Q

What is the treatment plan of Zanamivir (Relenza)

A
  • Inhale 10mg (2 inhalations) BID for 5 days
    • Must have started within 48 hours of symptoms
    • Can be used longer for those with severe immunodeficiency who remain symptomatic
60
Q

What is treatment with Zanamivir (Relenza) usually indicated for

A
  • Those with severe ilness
    • Those most likely to develop complications or die early
61
Q

What is the prophylaxis treatment plan of Zanamivir (Relenza)

A
  • Inhale 10mg od for 10 days
  • Caution with patients with lung disease
  • Need to counsel on inhaler use
62
Q

What are the side effects of Zanamivir (Relenza)

A
  • Many were reported but no difference btw placebo/ drug (headache, cough, sore muscles)
    • Some reports of nightmares, delirium, abnormal behaviour (in kids): high fever or complications from influenza could have caused this
    • Not much concern of side effects
63
Q

When is Oseltamivir (Tamiflu) used

A
  • Treatment and prophylaxis in patients >1 yo
    • Must begin within 48 hours of symptoms
64
Q

What formulations is Oseltamivir (Tamiflu) available in

A
  • A 30,45, 75mg capsule
    • 6 mg/ml suspension
65
Q

What is treatment plan of Oseltamivir (Tamiflu) (adults)

A
  • Adults (>13yo): 75 mg BID for 5 days
    • It is age/ weight dosing in pediatrics
    • Must adjust dose based on renal function: reduce dose with ClCR < 60 mL/min)
66
Q

What is the prophylaxis treatment plan of Oseltamivir (Tamiflu) (adults)

A

a) Adults: 75mg daily for 10 days unless a child or >65 yo then used for 14 days

67
Q

What is the treatment plan and prophylaxis plan using Oseltamivir (Tamiflu) in kids

A
  • <15kg: 30mg
    • 15-23kg: 45mg
    • 23-40kg: 60mg
    • > 40kg: 75 mg
      a) BID for treatment
      b) OD for prophylaxis
68
Q

What are the adverse effects with Oseltamivir (Tamiflu)

A
  • Nausea/ vomiting (take with food to minimize)
    • Headache
69
Q

When does antiviral resistance occur

A
  • Most common in patients who are immunocompromised and with prolonged therapy
    • Rare with zanamivir
    • Uncommon with oseltamivir but seen
70
Q

When deciding who should be treated with an antiviral what should you consider

A
  • Severity of symptoms
    • Risk factors/ comorbid medical conditions
    • Interval between start of illness and start of antiviral treatment (wont consider is outside of 48 hours and goal is within 12 hours)
71
Q

When should prophylaxis with antiviral drugs be used

A
  • Seasonal prophylaxis is not practical
    • Post exposure prophylaxis (PEP): is effective if stated within the first 48 hours of exposure to influenza, early treatment is preferred
72
Q

What is the use of prophylaxis using antiviral agents in influenza (in institutions/ closed facilities)

A

a) Control of influenza A/ B outbreaks within high risk residents of institutions or closed
- Give to all residents who arent ill
- Give to unvaccinated staff
- Use until outbreak is over (min of 8 days after start of last case)
- Those ill with flu receive antiviral treatment
- Combine with vaccination

73
Q

What is the treatment options for influenza symptoms

A
  • Analgesics/ antipyretics
    • Cough suppressants
    • Sore throat
    • Hydration
    • Bed rest
    • Stay home (to avoid spread)

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