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Influenza epidemiology preventionandcontrol TomD Y Chin MD MPHDepartmentofPreventiveMedicineandofMedicineUniversityofKansasMedicalCenter ImportanceofInfluenza OneofthemostimportantEmergingandReemerginginfectiousdiseasesCauseshighmorbidityandmortalityincommunities epidemic andworldwide pandemic Epidemicsareassociatedwithexcessmortality LeadingCausesofDeathsintheUS HeartDiseaseCancerCVDChrObstLungDisAccidents Pneumonia InfluenzaDiabetesMellitusHIVSuicideHomicide LeadingCausesofDeathsintheUS HeartDiseaseCancerCVDChrObstLungDisAccidents Pneumonia InfluenzaDiabetesMellitusHIVSuicideHomicide CharacteristicsofInfluenzaVirus TypesA B CDiameter80 120nmPleomorphic spherical filamentousparticlesSingle strandedRNASegmentedgenome 8segmentsinAandBHemagglutininandNeuraminidaseonsurfaceofvirion CausativeAgentofInfluenza CausedbyavirusbelongingtotheMYXOVIRUSgroupwhichcomprisesofOrthomyxovirusandParamyxovirusInfluenzavirusisanOrthomyxovirus ClassificationofInfluenzavirus Classifiedonthebasisofhemagglutinin HA andneuraminidase NA 15subtypesofHAand9subtypesofNAareknowntoexistinanimals HA1 15 NA1 9 3subtypesofHA 1 3 and2subtypesofNA 1 2 arehumaninfluenzaviruses HA5 7 9andNA7canalsoinfecthumans DiscoveryofInfluenzaVirus Firstisolatedfromapigin1931 swineflu Isolatedfromhumanin1933 NomenclatureofHumanInfluenzaVirus ModeofTransmissionInHuman Thevirusisspreadfromperson to personthroughrespiratorysecretionseitherasdroplets closecontact orasairborneinfectionbydropletnucleisuspendedintheair Incubationperiod1 3days ClinicalManifestations Influenzaisanacuterespiratoryillnesscharacterizedbyfever headache myalgia coryza sorethroatandcough Coughisfrequentlysevereandprotracted Durationofillnessisusually2 7days ClinicalDiagnosis Theclinicalpictureofinfluenzaisnonspecific Influenza likeillnesscanbecausedbymanymicrobialagentsotherthaninfluenzavirus suchasadenovirus parainfluenzaviruses coronavirus Mycoplasmapneumoniae Chlamydiapneumoniae beta hemolyticstreptococcus LaboratoryDiagnosis Sincetheclinicalpictureofinfluenzaisnonspecific itsspecificdiagnosismustbeconfirmedbylaboratorytests Thisisusuallymadebyvirusisolation identificationofspecificantigensorantibodyrise AntigenicVariationInfluenzavirusestendtoundergochangesfromtimetotime Therearetwotypesofchanges 1 antigenicshift 2 antigenicdrift Thesechangesintheantigeniccharacteristicsofinfluenzavirusesdeterminetheextentandseverityofinfluenzaepidemics AntigenicShift ThistermdenotesMAJORchangesinhemagglutininandneuraminidaseresultingfromreassortmentofgenesegmentsinvolvingtwodifferentinfluenzaviruses Whenthisoccurs worldwideepidemicsmaybetheconsequencesincetheentirepopulationissusceptibletothevirus PandemicInfluenzaViruses AntigenicDrift ThistermdenotesMINORchangesinhemagglutininandneuraminidaseofinfluenzavirus ThisresultsfrommutationintheRNAsegmentscodingforeithertheHAorNAThisinvolvesnochangeinserotype thereismerelyanalterationinaminoacidsequenceofHAorNAleadingtochangeinantigenicity InfluenzaA H3N2 Variants A PortChalmer 73A Victoria 3 75A Texas 1 77A Bangkok 79A Philippines 2 82 InfluenzaAEpidemicExcessMortality US DeathRatesofPersonswithARIduringInfluenzaEpidemics Houston 1978 1981 HospitalizationRatesforARIduringInfluenzaEpidemic Houston 1980 81 RatesofVisitstoPhysiciansforARIduringInfluenzaEpidemic Houston 1983 ReservoirsofInfluenzaViruses AquaticbirdsPigsHumans ControlMeasures ImmunoprophylaxiswithvaccineChemoprophylaxisandchemotherapy TypesofVaccine Inactivated consistingof 1 whole virus 2 subvirion 3 purifiedsurfaceantigen Onlysubvirionorpurifiedantigenshouldbeusedinchildren Anyofthethreecanbeusedforadults Liveattenuated InfluenzaVaccine whoshouldreceiveit Persons65yrsorolderPersonswithheart pulmonary renalandmetabolicdiseases Personsinnursinghomesandotherlong termcarefacilitiesPersons6mos 18yrsoldreceivingaspirintherapy Influenzavaccinerecipients continued Womenin2ndor3rdtrimesterofpregnancyduringfluseason Householdmembersofpersonsinhigh riskgroupsHealthcareworkersandothersprovidingessential
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