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PBLs FunMed > Week 7 - Fresher's Flu > Flashcards

Week 7 - Fresher's Flu Flashcards

1
Q

Name 5 viruses that infect the upper respiratory tract

A 
Rhinovirus
Coronavirus
Influenza virus
Parainfluenza virus
Respiratory syncytial virus
Herpesvirus
Adenovirus
Bocavirus
Coxsackvirus
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2
Q

Name 5 viruses that infect the lower respiratory tract

A 
Influenza virus
Parainfluenza virus
Respiratory syncytial virus
Adenovirus
Bocavirus
Metapneumovirus
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3
Q

What are symptoms of a cold? How common are colds?

A

Sneezing
Rhinitis (blocked nose)
Cough/coryza
Sore throat

Common - multiple colds a year

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4
Q

What are the symptoms of the flu?
How frequent is the flu?
What is the onset?

A

Sudden onset (within hours)
Fever, chills, shivering
Headache

Myalgia (pain in certain muscle groups) - systemic, their whole body hurts

Cough

Rarely more than once per year, usually less frequent

Infectious from 24hrs pre symptoms to 5-7days after illness starts

Can sometimes have GI symptoms, vomitting and diarrhoea due to high temp

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5
Q

What is Fresher’s Flu?

A

Term used in UK
Affects students when they arrive at university

Usually doesn’t involve influenza

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6
Q

What are the potential causes of Fresher’s Flu?

A
  • Upper Resp tract infection (exposure to novel viruses)
  • Excess alcohol
  • Lack of sleep
  • Homesickness
  • Adjustment to living independently

Usually doesn’t involve influenza

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7
Q

How do you diagnosis a cold?

A

Based on symptoms
Exclusion of more serious illness
Mild, self-limiting

Better within 7 days, usually feel better within 2/3 days

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8
Q

How do you diagnosis a flu?

A

Presence of fever and systemic symptoms

Prolonged illness 7-10 days

Rapid onset (within hours)

Contact with flu - travel or local outbreak
Lab diagnosis

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9
Q

Which animals does Influenza A affect?

A
  • Humans
  • Mammals
  • Birds
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10
Q

Which animals does Influenza B affect?

A

Human

Seals

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11
Q

Which animals does Influenza C affect?

A

Human
Pigs
Dogs

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12
Q

Which animals does Influenza D affect?

A

Cattle

Pigs

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13
Q

How many cases of flu?

A

3 - 5 million cases a year

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14
Q

How many annual deaths are due to the flu?

A

250 000 - 750 000 deaths annually

Mostly in people over 65

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15
Q

Why is there a need for an annual vaccination?

A

The vaccine each year is based on predicted circulating strains

  • Numerous flu viruses circulating at any given time
  • Antigenic drift - minor changes in the antibody binding sites so the flu virus is not recognised by the immune system
  • Antigenic shift - major changes with the circulating virus (combo with diff viruses - mix with avian/porcine with human virus) creating a new subtype of flu
  • Potential for pandemic with antigenic shift
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16
Q

What to do if you think you have the flu?

A
  • Rest
  • Keep hydrated
  • Keep warm
  • Let people know
  • Continue to take any prescribed medication (esp insulin)
  • Self report
  • Don’t take antibiotics - they don’t work on viruses
  • Cover your mouth/nose when coughing
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17
Q

What are some red flags with the flu?

A
  • Haemoptysis
  • Persistent fever
  • Confusion
  • Non-blanching rash
  • Persistently enlarged lymph nodes
  • Lethargy
  • Difficulty breathing
  • Difficulty swallowing own saliva
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18
Q

What are 5 ways to avoid getting the flu?

A
  • Get flu vaccine each year (even if you get the flu, the symptoms will be milder)
  • Avoid being around people who have the flu
  • Try not to touch your eyes, nose or mouth (germs enter the body easiest this way)
  • Clean and distinct surfaces if you are sharing a home with someone with the flu
  • Wash your hands regularly
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19
Q

Who are at greater risk of severe disease or complications when infected by the flu?

A
  • Pregnant women
  • Children under 59 months
  • Elderly
  • Individuals with chronic medical conditions (chronic cardiac, pulmonary, renal, metabolic, neurodevelopmental, liver, hematologic diseases)
  • Individuals with immunosuppressive conditions (e.g. HIV/AIDs, people receiving chemotherapy or steroids, malignancy)
  • Health care workers increased risk of getting the flu generally due to exposure
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20
Q

Name two viruses that commonly cause colds?

2 marks

A 
Any two from:
·      Rhinovirus
·      Adenovirus
·      Coronavirus
·      Respiratory syncytial virus
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21
Q

List 3 symptoms of flu that distinguish it from a cold

3 marks

A 
Any 3 from:
·      Fever >38ºC
.      Muscle aches
·      Rapid onset of symptoms (within hours)
·      Headache
·      Chest discomfort/cough
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22
Q

Name the two glycoproteins on the flu virus envelope that are the target for antiviral agents and vaccines

(1 marks)

A

Hemagglutinin (1/2 mark)
and
neuraminidase (1/2 mark)

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23
Q

Explain how osetltamivir (Tamiflu) works

2 marks

A

Oseltamivir is competitive inhibitor of an influenza’s neuraminidase enzyme (1/2 mark).

The enzyme cleaves the sialic acid which is found on glycoproteins (1/2 mark) on the surface of human cells that helps new virions to exit the cell (1/2 mark).

Oseltamivir prevents new viral particles from being released from an infected host cell (1/2mark).

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24
Q

Explain why flu vaccination needs to be administered annually.

(2 marks)

A

Multiple strains of flu can be in circulation (1/2),

Errors in virus replication mean that antigenic drift is continually producing variant viruses (1/2),

Previous infection or vaccination will not protect against new strains particularly if antigenic shift occurs (1)

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25
Q

Where are the different sites you can take someone’s temperature?

A

Oral
Rectal
Tympanic
Forehead

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26
Q

Which method of taking someone’s temperature is closest to the core temperature?

A

Tympanic and rectal

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27
Q

What is the range for having a high temperature for a baby or young child?

A

Above 38 degrees

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28
Q

What is the range for having a high temperature for a older child or adult?

A

37.2 - 37.5 degrees

For tympanic 35 degrees is high

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29
Q

What is tympanic temperature?

A

Reading someone’s temperature from their ear

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30
Q

Are upper resp tract or lower resp tract infections more serious?

A

Lower

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31
Q

How many URTIs do pre school children usually get in a year?

A

6-10 URTIs

Children aren’t very good at clearing their airways, they don’t cough properly and clear everything

Children will often present with constant runny noses when actually they are just getting infected from different viruses

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32
Q

What is part of the upper respiratory tract?

A

Nasal cavity
Pharynx
Larynx

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33
Q

What is part of the lower respiratory tract?

A

Trachea
Primary bronchi
Lungs

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34
Q

How many viruses can cause mild URTIs?

A

200+

Not pneumonia or bronchitis/chest infections

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35
Q

Which viruses specifically cause colds?

A 
Main ones:
Rhinovirus
Coronavirus
Adenovirus
Respiratory Syncytial virus (can cause hospitalisation in young children)

Parainfluenza virus
Influenza B can be mild

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36
Q

What time of year is flu prevalent in the UK?

A

November - Feb/March

Winter months

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37
Q

What virus causes flu?

A

Influenza

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38
Q

What virus family is influenza a part of?

What are their properties?

A

Orthomyxovirus

Properties:
Single stranded RNA

Spherical or filamentous vision with numerous surface projections of glycoprotein

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39
Q

What is the main mode of transmission for influenza?

A

Respiratory droplets

If someone is coughing and sneezing near you and you breathe it in

40
Q

Is influenza stable?

A

Yes very stable
Can survive at room temperature for days

Even more stable in cold temperature conditions

41
Q

What is the structure of influenza?

A

Enveloped
Single-stranded RNA

Lots of glycoproteins on its surface

Haemagluttinin facilitates entry to the cell by binding to silica acid on epithelial cells in the URT

Neuraminidase cleaves new virus particles from host cell allowing release

HA and NA are targets sites for anti-viral drugs

42
Q

How many different types of orthomyxoviruses are there?

A

7

4 of them are influenza

3 of them don’t cause diseases in humans (note Influenza D also doesn’t cause disease in humans)

43
Q

Why do we get new flu viruses that no one has immunity to?

A

Adaptation of influenza viruses from humans, birds, pigs

44
Q

What are some targets for anti-viral drugs?

A

Haemagluttinin which facilitates entry to the cell by binding to sialic acid on epithelial cells in the URT

Neuraminidase that cleaves new virus particles from host cell allowing release

8 segments of negative sense RNA (humans don’t have this)

45
Q

What is negative sense RNA?

A

Single stranded RNA usually have a polarity - either positive or negative

They need to be converted into positive sense RNA to replicate

46
Q

What protein allows the virus to enter the host cell?

A

Haemagluttinin

47
Q

What protein breaks the virus off the host cell and allows it to be released?

A

Neuraminidase

The host cell dies after the virus leaves

48
Q

When was the Spanish flu?
What influenza was responsible?

How many deaths did it cause?

A

1918-1919
Straight after WW2
H1N1

Influenza A
20-50 million deaths

49
Q

When was swine flu? What are some general facts?

A

2009
H1N1

Started in Mexico
Disproportionate number of younger people got serious ill

Less lethal than initially feared (0.026% mortality rate)

50
Q

When was avian flu?

A

2014
H5N1
Egypt

51
Q

What mortality rate are pandemics?

A

2-3%

52
Q

What are the two main treatments for flu?

A

Tamiflu (Oseltamivir) - oral preparation

Relenza (Zanamivir) - inhaled

53
Q

What are some side effects from oseltamivir?

A

Slight increase in risk of GI disturbance and neuropsychiatric symptoms

54
Q

What are some side effects from zanamivir?

A

Fewer systemic side effects but cannot be used in patients with asthma or COPD (risk of bronchospasm)

55
Q

How does oseltamivir or zanamivir work?

A

Neuraminidase inhibitor

Oseltamivir is competitive inhibitor of an influenza’s neuraminidase enzyme (1/2 mark).

The enzyme cleaves the sialic acid which is found on glycoproteins (1/2 mark) on the surface of human cells that helps new virions to exit the cell (1/2 mark).

Oseltamivir prevents new viral particles from being released from an infected host cell (1/2mark).

56
Q

Why are anti-influenza drugs controversial?

A

Side effects were in the headlines

Concern about how much was spent (£650 million) for only modest benefits (‘useless’)

57
Q

How can you monitor the epidemiology of flu in the UK?

A
  • Primary care monitoring of ILI (influenza-like illness) consultations (swabs not really sent off though)
  • Self reporting
  • Hospital cases
  • Deaths (find out the virus that they died from)
  • Respiratory virology at Colindale
58
Q

Epidemiology internationally recorded by who?

A

WHO

59
Q

Epidemiology in US recorded by who?

A

CDC

Centre of Communicable diseases

60
Q

What are the different vaccinations available for flu in 2018?

A

Adjuvanted trivalent flu (aTIV) - licensed for over 65 years. Has 3 different strains of flu in it

Quadrivalent vaccine (QIV) - recommended for children aged 6 months to 2 years and adults from 18 years to 65 who are at increased risk from flu due to a long term health condition. Has antigens from 2 Influenza A strains and 2 Influenza B strains

Live attenuated influenza vaccine (LAIV) - Nasal spray and is licensed for children and young people from 2-18 years old. Targeted 2-3 years olds (through GP surgery) and school children from reception - Year 5 (through schools)

61
Q

Who is targeted for the LAIV vaccine?

A

Live attenuated influenza vaccine (LAIV) - Nasal spray and is licensed for children and young people from 2-18 years old. Targeted 2-3 years olds (through GP surgery) and school children from reception - Year 5 (through schools)

62
Q

Who is targeted for the QIV vaccine?

A

Quadrivalent vaccine (QIV) - recommended for children aged 6 months to 2 years and adults from 18 years to 65 who are at increased risk from flu due to a long term health condition. Has antigens from 2 Influenza A strains and 2 Influenza B strains

63
Q

Who is targeted for the aTIV vaccine?

A

Adjuvanted trivalent flu (aTIV) - licensed for over 65 years. Has 3 different strains of flu in it

64
Q

How are strains chosen for the vaccine?

A

They predict which strains may be prevalent but it is not uncommon for a new virus to infect people

65
Q

Who should get vaccinated for the flu?

A

Risk groups that are at risk of having a severe disease or complications when infected by flu

Pregnant women
Children under 59 months (5 years)

Elderly

Individuals with chronic medical conditions (e.g. chronic cardiac, pulmonary, renal, metabolic, neurodevelopment, liver or haematological disease)

Individuals with immunosuppressive conditions (HIV/AIDs, receiving chemotherapy, steroids, malignancy)

Health care workers due to increased exposure to patients and risk further spread to vulnerable individuals

66
Q

Why should we have an annual vaccination?

A

Numerous flu viruses circulating at any given time

Antigenic drift - minor changes in the antibody binding sites so the flu virus is not recognised by the immune system

Antigenic shift - major changes in the circulating virus, combo of different viruses, often assortments of material from avian and or porcine with human virus to create a new subtype of flu

67
Q

Antigenic drift

A

minor changes in the antibody binding sites so the flu virus is not recognised by the immune system,

68
Q

Antigenic shift

A

major changes in the circulating virus, combo of different viruses, often assortments of material from avian and or porcine with human virus to create a new subtype of flu

Happens due to reassortment of the RNA segments

69
Q

What does myalgia mean?

A

Pain in a muscle/group of muscles

70
Q

What does pyrexia mean?

A

Fever

71
Q

What does rhinitis mean?

A

Inflammation of the mucous membrane of the nose caused by a viral infection or an allergic reaction

Leads to stuffy nose, runny nose and sneezing

72
Q

What 3 types of influenza affects humans?

A

Type A, B, C

73
Q

How many RNA segments does Type A Influenzae have?

A

8

74
Q

How many RNA segments does Type B Influenzae have?

A

8

75
Q

How many RNA segments does Type C Influenzae have?

A

7

76
Q

What are some common features of Influenza Type A?

A

Most common type, causes most severe illness

Subdivided based on HA and NA glycoproteins on its protective envelope surface

The glycoproteins can vary in structure and are identified by a number

H3N2 and H1N1 are the most common type of A subtypes to infect humans and some other animals

77
Q

What are the most common A subtypes that affect humans?

A

H3N2

H1N1

78
Q

What are some common features of Influenza Type B?

A

Less common
Doesn’t mutate as often

Limited types of H and N glycoproteins on its surface

Only infects humans

79
Q

What are some common features of Influenza Type C?

A

Least common and least likely to mutate of the three

Only has 1 species

Presence of haemagglutinin-esterase fusion proteins on surface used to enter and exit cells

Causes mild disease in children

Can infect humans and pigs

80
Q

What is the pathophysiology of influenza?

A

Virus uses haemagglutinin to bind to silica acid sugars on the surface of epithelial cells in the URT

Endocytosis of virus and release of -ve sense RNA

RNA polymerase converts -ve sense RNA to +ve sense mRNA

mRNA transcribed into proteins and assembled into new viruses

Viruses leave cell via exocytosis using neuraminidase which cleaves sialic acid sugars from membrane

81
Q

Symptoms of meningitis

A

Rare but serious disease
Involves inflammation of the meninges covering the brain and the spinal cord

Symptoms:
Stiff neck
Severe headache
Fever
Confusion 
Discomfort from bright lights
Seizures 
Rashes

Flu bacteria can spread to the brain and cause meningitis

82
Q

How long does it take for bacterial meningitis symptoms to happen?

A

Few hours

83
Q

How long does it take for viral meningitis symptoms to happen?

A

Might appear over several days

84
Q

Which influenza type affects humans only?

A

Type B

85
Q

What type of nucleic acid is found within the viral genome?

A

Single-stranded negative sense RNA

86
Q

Which of the following anti-viral drugs prevent the release of the virus from the host cell?

A

Neuraminidase inhibitor

87
Q

Which symptoms would confirm your diagnosis of meningitis?

A

Stiff neck

Photophobia

88
Q

How many RNA segments does type C influenza virus have?

A

7

89
Q

When is flu contagious?

A

1 day before

2 weeks after feeling better

90
Q

Who is not recommended to get the flu vaccine?

A

Severe egg alergies

History of Guillain Barre

91
Q

What are high risk complications of influenza in children less than 6 months?

A

Neurologic (encephalitis and febrile seizures)

Reye syndrome

92
Q

Diagnosis of Influenza

A

Rapid Influenza Diagnostic Tests (detects in minutes, vary in reliability, can detect type but not strain)

Viral culture

PCR (detects viral RNA)

93
Q

What are the two general types of treatments for influenza?

A

Neuraminidase inhibitors

M2 Proton channel inhibitors (prevents replication)

94
Q

How is the trivalent inactivated influenza vaccine administered?

A

Injected into the muscle

95
Q

How do they predict the next flu strains?

A

Previous Seasons

Strains that are circulating around the globe

PBLs FunMed (8 decks)

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