Professional Documents
Culture Documents
Learning Objectives
Discuss the characteristics of seasonal
influenza
Discuss the differences between seasonal and
pandemic influenza
Discuss the status of the current concern over
avian influenza (H5N1) and the novel H1N1
(swine) influenza
2
CPM Influenza
26
19.5
13
6.5
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
Source: National Center for Health Statistics
CPM Influenza
CPM Influenza
Influenza-Associated Hospitalizations
by Age Group
Hospitalizations per 100,000
600
450
472
300
150
115
90
22
0
0-4 Yrs
5-49 Yrs
50-64 Yrs
Age Group
CPM Influenza
65 Yrs
Source: Thompson, unpublished data, 2004 5
CPM Influenza
Influenza Virus:
Two Important Types and Hosts
Type A
Most virulent group, causes epidemics
Multiple hosts
Humans
Birds, both wild and poultry
Swine
Horses
Hemagglutinin (H or HA)
Neuraminidase (N or NA)
Type B
Humans
CPM Influenza
CPM Influenza
Influenza A
Surface Antigens and Subtypes
16 Hemagglutinins (HA)
Sites of attachment to host
cells
9 Neuraminidases (NA)
CPM Influenza
H1
H2
H3
H1
H3
H3
H7
H1
H2
H3
H4
H5
H6
H7
H8
H9
H10
H11-H16
Neuraminidase subtype
N1
N2
N1
N2
N7
N8
N1
N2
N3
N4
N5
N6
N7
N8
N9
10
CPM Influenza
Antigenic shift
Much larger immunologic change (reassortment)
11
CPM Influenza
Antigenic Drift
Point mutations in the HA gene cause minor
antigenic changes to HA protein
Gradual, continuous process
Immunity against one strain may be limited
Vaccine strains must be updated each year
Antigenic drift causes seasonal epidemics
12
CPM Influenza
Antigenic Shift
Emergence of new human influenza type A virus
subtype (new HA subtype) through:
Genetic reassortment (human and animal viruses)
Direct animal (poultry) to human transmission
CPM Influenza
14
CPM Influenza
CPM Influenza
15
83% of population!
CPM Influenza
16
Pandemics Do Occur
Spanish flu
26
19.5
13
6.5
0
1900 1910 1920 1930 1940 1950 1960 1970 1980 1990 2000
Year
National Center for Health Statistics
CPM Influenza
17
CPM Influenza
18
Pandemic of 19181919
Began with first cases in March 1918 in Europe,
USA
In Spring, highly contagious, but not
deadly
Virus probably traveled between Europe/USA
on troop ships
Land, sea travel to Africa, Asia
Warning signal missed
19
CPM Influenza
Pandemic of 19181919
August, 1918 simultaneous explosive outbreaks in in
France, Sierra Leone, USA
Fall 1918 Winter 1918-1919
25-35% of world infected
10-fold increase in death rate
Highest death rate ages 15-35 years
Leading cause of death among WW I soldiers
Deaths from primary viral pneumonia, secondary
bacterial pneumonia
Deaths within 48 hours of illness
20
CPM Influenza
Pandemic of 19181919
Came to be known as Spanish Flu, even though
probably originated in U.S.
Substantial morbidity and mortality
20-50 million deaths worldwide
>500,000 U.S. deaths
In many communities, so many deaths occurred so quickly that bodies
buried in mass graves
43,000 U.S. military deaths (out of ~100,000 U.S. troop casualties during
WW I)
21
CPM Influenza
22
CPM Influenza
Virulence
Asymptomatic in most wild birds and domestic ducks
Highly fatal in domestic poultry
Felines and other mammals can be infected
23
CPM Influenza
CPM Influenza
25
CPM Influenza
No. Cases
150
Lived
Died
100
50
0
2003
2004
2005
2006
Year
CPM Influenza
2007
2008
2009
WHO, 1 July 2009 26
27
CPM Influenza
http://www.who.int/csr/disease/swineflu/Virologicaldata2009_12_04.pdf
28
CPM Influenza
Pandemic alert
New virus causes human cases
Pandemic
29
CPM Influenza
30
CPM Influenza
AND
Causes serious illness
AND
Spreads easily from human-to-human
CPM Influenza
CPM Influenza
32
33
CPM Influenza
34
35
CPM Influenza
600
549
538
450
391
300
223
183
150
121
37
0-9
10-19
20-29
30-39
40-49
50-59
60+
NA
Age Group
CPM Influenza
10
100
7.5
75
50
2.5
25
16.1 17.9
3.6
1.8
3.6
3.6
7.1
12.5
5.4
10.7 12.5
1.8
1.8
Case-Fatality (%)
No. of Deaths
1.8
0
>75
70-74
65-69
60-64
55-59
50-54
45-49
40-44
35-39
30-34
25-29
20-24
15-19
10-14
5-9
1-4
<1
Age Group
38
CPM Influenza
Pandemic alert
New virus causes
human cases
Pandemic
1
2
Since
2004
April 27
April 29
June 11
Source: WHO
CPM Influenza
39
Deaths
108
5878
392
at least 918
766
706
Total
at least 8768
CPM Influenza
41
Influenza A(H1N1)
General Population Prevention Guidelines
Cover nose and mouth with tissue
when coughing or sneezing
Dispose of tissue in trash after use
CPM Influenza
42
Influenza A(H1N1)
Treatment
Vaccine available
Antivirals for treatment and/or prevention (?) of
infection:
Oseltamivir (Tamiflu) or
Zanamivir (Relenza)
CPM Influenza
43
Influenza A(H1N1)
Other Protective Measures
separation
of symptomatic
patents either inpatents
the home or
separation
of
symptomatic
Isolation:
hospital so that they will not infect others
either in the home
or hospital
so that
they
not
separation
of asymptomatic
persons
thatwill
may have
been exposed
to infection
infect
others
Quarantine: separation from of asymptomatic persons that may have been
exposed to infection
Source: CDC
CPM Influenza
44
Influenza A(H1N1)
Summary
Vaccine available
Anti-virals available
45
CPM Influenza
H5N1
Novel
H1N1
46
CPM Influenza
H5N1
Novel
H1N1
X
47
48
CPM Influenza