M30- Influenza Flashcards
What is the largest burden on healthcare?
Influenza
what do many dental procedures have the potential to generate and what is the significance of this?
potential to generate aerosols so risk assessment and effective risk-management actions must be taken to avoid aerosol exposure
what should remain available throughout a pandemic?
Emergency dental care should remain available throughout a pandemic, although non- urgent services may be reduced if there are shortages of staff and specialist consumables
why is emergency dental care important in a pandemic?
there may be opportunities to use the assessment and treatment skills of dental practitioners or other health professionals to support the wider delivery of healthcare in a pandemic
Name some viral respiratory infections.
- Respiratory syncytial virus (RSV)
- Rhinovirus (100+ serotypes)
- Parainfluenza (1-4)
- Human metapneumovirus
- Coronaviruses (4 types)
- Adenoviruses
- Enteroviruses
Name 2 severe viral infections.
- Severe Acute Respiratory Syndrome (SARS)
* Middle Eastern Respiratory Syndrome (MERS)
Where does SARS and MERS originate from?
Transmission between animal and human
what are the two types of flu?
Type A and B
what percentages of young and old develop the flu?
5% adults and 20% of children
when are the death rates high in relation to flu?
secondary infections after having the flu
What populations does flu cause the most deaths?
elderly and young
Why is flu considered seasonal?
seasonal temperate climates (temperature, more cases in winter )
Which type of flu has a pandemic threat?
Type A
Describe the clinical presentation of the flu.
- Droplet infection
- Incubation period 48 hours (24-96)
- Abrupt onset
- High Fever, headache, photophobia, cough, shivering, muscle aches, malaise.
- Inflammation of upper respiratory tract & trachea
- Weakness & fatigue persists (weeks) – depression
In what time do acute symptoms resolve?
7-10 days (biphasic)
what flu is more severe?
Flu A is more severe than flu B
why is flu hard to treat?
abrupt onset
where are the principal sites of viral replication in the respiratory tract?
Trachea, bronchi & pulmonary alveoli
when does the damage to respiratory tract and inflammatory response peak?
48 hours
what is the acute phase to the respiratory tract?
Desquamation of epithelium of trachea & bronchi
– Reports that in areas only basal layer of cells remain
what occurs to the respiratory tract after the acute phase?
Edema & congestion of submucosa
– Desquamation of epithelial cells
what happens to the respiratory tract in the later stages?
Later stages mononuclear inflammatory cells observed, initially no neutrophils detected
what type of secondary infection occurs?
bacterial
What is the mortality of the flu?
• General figure of 600 deaths due to complications of flu annually in UK
– Infection extends to lower respiratory tract
– Hemorrhagic bronchitis to pulmonary edema associated with death in 48 hours
– Infants & elderly
– Chronic pulmonary or cardiac disease
– Diabetics
what are the different types of influenza?
A , B and C
what components make up the flu virus?
- Enveloped virus
- Segmented genome (7-8) – Each encapsulated by nucleoprotein
- ssRNA
where is the flu virus grown?
in embryonated hens eggs
what flu has the widest range of hosts?
Type A
-Humans/mammals/birds
what is a major component of the flu virus?
variation
What is significant about the segmented genome of the flu virus?
– 8 gene sequences encoding for at least one protein
– RNA polymerase has no proof reading capacity
– High mutation rate 1-8 x 10-3 substitutions per year
– Amino acid changes in antigenic portions of surface proteins key to evolution
what structure of the flu binds the cell surface?
Heamagglutinin (HA)
what structure of the flu facilitates exit?
Neuraminidase (NA)
what are N and H targets for?
immune response
what do the different types of flu affect?
All infect birds (some pigs and horses)
what is important in the pandemics of influenza?
zoonotic element ( i.e. bird flu & swine flu avian flu in aquatic birds likely to be key reservoir)
why effect do animal hosts have?
Increase antigenic drift
what was the mortality rate in 1918-1920 for influenza?
40-50%
what is antigenic drift?
Drift (A & B) - minor changes in amino acids on surface structure changes antigenicity
-Allows escape of a virus from collective immunity
What is antigenic shift?
• Shift (A only) entirely new H or N combinations
– Re-assortment between distinct HA types
What population was mostly affected in the 1918 pandemic influenza?
20-40 year olds most severely impacted
why were 20-40 year affected in 1918?
- Inflammatory response proposed as key
* Cytokine storm
Describe the cytosine storm of the pandemic influenza.
– Virus infects pnemocytes
– Macrophages activated
– Peptides on surface of macrophage activate T lymphocytes
– Pro-inflammatory chemokines & cytokines released
– Dilation of blood vessels, increased permeability & drop in blood pressure
Describe the vaccines of flu.
- Strains circulating monitored worldwide
- Takes 6 months to produce vaccine
- Three strains (two type A & one B)
- Grown in hens eggs & inactivated
- Now tissue culture grown
- Attenuated live vaccines – young & healthy
- Target at-risk groups
- Annual vaccination
Describe the antiviral drugs that treats Flu A only.
• Amantadine (Flu A only)
- M2 component of FluA
- Allows acidification of virus interior
- Removal of ribonucleoproteins key step in genome becoming active
- Blocks M2 ion channel
Describe the antiviral drug that treats Flu A and B.
• Zanamivir
- neuraminidase inhibitor, binds to active site
- interfered with escape from host cell
- take at onset of symptoms & maybe reduce development by 12% at best & concerns abourt resistance
- Inhalation, studies on IV delivery
Describe the use of the antiviral drug Oseltamivir.
- Oral : neuraminidase inhibitor
- Can be used prophylactically (> 12 yrs old)
- Must be given within 48 hrs of symptoms Tend to reduce disease by 1-2 days
Summary slide.
• Viral respiratory diseases & dentistry • Awareness of SARS & MERS • Influenza, structure H & N classification • TypeA&B,Cmild • Seasonal flu & Pandemic flu • Symptoms & risks • Prevention & treatment – Vaccines – Anti-viral – Animal/Bird threat