Influenza Teaching Current Update 2023 by Dr.T.V.Rao MD

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3/12/2023 Dr.T.V.

Rao MD @ Current updates on H3 N2 Influenza 1

INFLUENZA
CURRENT UPDATES
H3 N2
2023
Dr.T.V.Rao MD
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 2

Current infections with Influenza


H3 N2
• A sharp rise in H3N2 influenza cases has been
reported in India. The virus leads to respiratory
symptoms including persistent cough and many
more. A quick change in weather from extremely cold
to warm has been identified as one of the major
reasons behind this rapid increase in flu symptoms
among people. This virus can also infect birds and
mammals. According to WHO, H3N2 is a subtype of
Influenza A virus which majorly affects humans. A
report by the Centers For Disease Control And
Prevention (CDC), this virus was first identified
in pigs in the US in 2010. Later in 2012, 12
infections were detected in humans followed
by several H3N2 outbreaks in the same year.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 3

WHAT IS H3 N2
• H3N2 is a non-human influenza
virus that normally circulates in
pigs and has infected humans,
according to the US Centre for
Disease Control and Prevention
(CDC). Symptoms are similar to
those of seasonal flu viruses
and can include fever and
respiratory symptoms such as
cough and runny nose, and
possibly other symptoms,
including body ache, nausea,
vomiting or diarrhoea.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 4

Basics on Influenza virus


Mycovirus
• Classified into
1 Influenza virus
2 Parainluenza virus
A Mumps virus
B Parainluenza virus
C Measles virus
D Respiratory syncytial virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 5

Influenza Virus belong to


Myxovirus
• Enveloped RNA virus
• Absorb to mucoprotein receptors
• Many viruses are included in this group
Influenza

Mumps
Measles.
Newcastle disease
Parainluenza virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 6

Historically Speaking
• Influenza can be
traced as far back as
400 BC
• In Hippocrates’ Of
the Epidemics, he
describes a cough
outbreak that
occurred in 412 BC in
modern-day Turkey
at the turn of the
autumn season
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 7

Early Recognized Pandemics


• The first recognized pandemic
occurred in July and August of
1510 when an outbreak of
“gasping oppression” appeared
nearly everywhere at once. It was
described as a “‘gasping
oppression’ with cough, fever, and
a sensation of constriction of the
heart and lungs”, leaving an
impression strong enough for
people to write of it decades later
(Morens et al, 2010). At least
seven contemporary and near-
contemporary reports exist of the
1510 pandemic (Morens, North &
Taubenberger, 2010).
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 8

1918 Spanish Flu


A great Memorable Event
• Mortality was greater than the 4-year “Black
Death” Bubonic Plague
• Mortality rate was 2.5%, other epidemics
had been 0.1%
• Unusually, most deaths associated with
young, healthy adults
• Researchers isolated a wide selection of
bacteria – virus for influenza unknown
• Years later, H1NI strain found responsible for infection
• However, bacteria responsible for the severe secondary
complications of pneumonia causing death
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 9

Circulating Seasonal Influenza A Sub-Types


from Pandemics of the 20th Century

1918/19 1957/58 1968/69


40-100 million deaths ~2 million deaths ~1 million deaths

H3N2 Seasonal Flu


H2N2
H1N1 Seasonal Flu H1N1 Seasonal Flu
1920 1940 1960 1980 2000
4 pandemics since 1889, with 11 to 39 years (average ~30 years) between
each = ~3.3% annual risk of pandemic onset (but likely higher now)
Camp Funston, Kansas,Dr.T.V.Rao
3/12/2023 MarchMD1918:
@ CurrentSadly,
updates onthe
H3 N2comparatively
Influenza 10
benign first wave was not at all predictive of what was to come
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 11

INFLUENZA
• Cause of the
infection of the
Respiratory tract.
• Occurs as
Sporadic
Epidemic
Pandemic
Major pandemic
in 1918 – 1919
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 12

Scientific contributions

• Shoppe ( 1931 ) Isolated the Swine


influenza
1933 Smith, Andrews, Laidlaw identifies
Etiological agent
Land mark in advances of Medical
virology
• 1935 Burnet developed chick embryo techniques
• 1941 McClelland and Hare influenza virus tests
showing agglutination of fowl erythrocytes
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 13

WHO defines Influenza


• Influenza is a viral infection that affects
mainly the nose, throat, bronchi and,
occasionally, lungs. Infection usually
lasts for about a week, and is
characterized by sudden onset of high
fever, aching muscles, headache and
severe malaise, non-productive cough,
sore throat and rhinitis.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 14

Spread of Influenza
• The virus is
transmitted easily
from person to
person via
droplets and
small particles
produced when
infected people
cough or sneeze.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 15

Most recover few Suffer


• Most infected
people recover
within one to two
weeks without
requiring medical
treatment. However,
in the very young,
the elderly, and
those with other
serious medical
conditions.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 16

Origin of Pandemics Influenza


(All human flu
pandemics come
from bird flu by 1
of 2 mechanisms)

Migratory water birds

H 1-16

Domestic pig

N 1-9

Domestic birds
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 17

Where do “new” HA and NA


come from?
• >13 types HA
• 9 types NA
• all circulate in birds
• pigs
• avian and human
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 18

Where do “new” HA and NA


come from?
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 19

Current incidence of Influenza


3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 20

Pandemics and Pandemic Threats of


the 20th Century

• 1918-19 “Spanish flu” H1N1


• 1957 “Asian flu” H2N2
• 1968 “Hong Kong flu” H3N2
• 1976 “Swine flu” episode H1N1
• 1977 “Russian flu” H1N1
• 1997 “Bird flu” in HK H5N1
• 1999 “Bird flu” in HK H9N2
• 2003 “Bird flu” in Netherlands H7N7
• 2004 “Bird flu” in SE Asia H5N1
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 21

Structure of Virion
HA - hemagglutinin

NA - neuraminidase

helical nucelocapsid (RNA plus


100 n m
NP protein)

lipid bilayer membrane

polymerase complex

Influenza virions are SMALL. The average eukaryotic cell diameter is 10,000 nm
(10 microns), which is 100 times bigger than the influenza virion diameter.
M1 protein http://www.med.sc.edu:85/pptvir2002/INFLUENZA-2002.ppt
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 22

Influenza Virus
• Virus are
spherical in
shape
• Size is 80 -120
nm
• Pleomorphism is
common with
variant forms
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 23

Viral structure
A negative
sense Single
stranded
RNA
genome is
segmented
into 8
segments
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 24

Viral structure

• The nucelocapsid is
surrounded by an
envelope with inner
membrane protein
layer and outer lipid
• From the envelop
there are projections of
two types
• 1 Hem agglutinins
• 2 Neuraminidase
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 25

Resistance of Virus
• Inactivated by heating at 500c for 30
mt
• Survive for 1 week at 0 – 40c for 1
week
• Virus preserved at – 700c
• Survive in the blankets for 2 weeks
• Ether, formaldehyde, Phenol destroy
the virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 26

Prominent Characters of the Virus


• Haemagglutination Important character, when
mixed with Fowl erythrocytes virus absorbed onto
mucoprotein receptors on the cell surface
Links other cells produce Haemagglutination
• Elution Detachment of virus from cell surface
resisting Haemagglutination is called elution.
Caused by enzyme neuraminidase
Act on cell receptor splits off N –
Acetylneuraminiase
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 27

Haemagglutination defines the nature of the Virus


3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 28

HN terminology
• H refers to Haemagglutinnins types
and each is given a number H1, H2
etc,
• Neuraminidase is designated N and
different forms are available as well
e.g. H5N1 (avian) and H1N1.
• Different combinations of H and N
glycoproteins give rise to different
strains
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 29

Haemagglutination
• Act with red cells of
different species
• Type A and B – RBC’s of Fowl, Human and
guinea pigs
• Type C only RBC’s of Fowl at 40c
• Haemagglutination titer - Highest titer of virus
with fixed quantity of RBC
• Haemagglutination Inhibition titers convenient
way of measuring quantity o antibodies to
virus.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 30

Types of Haemagglutinnins
• Haemagglutination is
strain specific
• Great variation
• H A there are 15
subtypes H 1 to H15
in avian influenza
• But only 4 variants in
humans
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 31

Neuraminidases
• Neuraminidase are glycoprotein's
• Destroys cell receptors by hydrolysis cleavage
• Anti neuraminidase antibodies are produced
following infection and immunization
• Not protective as Antihemagglutinin antibodies
• Helps to inhibit the release and spread of
progeny
• Strain specific exhibit variation, There are nine
different subtypes N 1 – N9.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 32

Antigenic Variation

• Unique feature of this virus lies with


antigenic variation.
• High in type A virus
• Less in type B virus
• Not in type C virus
• RNP and Matrix proteins are stable
• Haemagglutination and Neuraminidase are
independent of the variations.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 33

Influenza prominent Antigenic


Changes
• Antigenic Shift
• major change, new subtype
• caused by exchange of gene segments
• may result in pandemic
• Example of antigenic shift
• H2N2 virus circulated in 1957-1967
• H3N2 virus appeared in 1968 and
completely replaced H2N2 virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 34

Influenza Antigenic Changes


• Antigenic Drift
• minor change, same subtype
• caused by point mutations in gene
• may result in epidemic
• Example of antigenic drift
• in 2002-2003, A/Panama/2007/99 (H3N2)
virus was dominant
• A/Fujian/411/2002 (H3N2) appeared in
late 2003 and caused widespread illness
in 2003-2004
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 35

Antigenic Variations
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 36
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 37

Antigenic Shift
• It is abrupt and Drastic
• Discontinuous variation
in structure in antigens
• Results in novel virus
and unrelated to
previous strains causing
infections
• Involves –
Haemagglutinnins,
Neuraminidase or both
• Subtypes depends only
on antigenic shifts,
occurs on
Haemagglutinnins
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 38

Antigenic shift initiates


Pandemics
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 39

Terminology by WHO
• Ao A1 A2 ( Asian ) A2 ( H K )
• Ho H1 H2 H3

Designated on the Basis of


Type, Place of Origin, Serial Number,
Year of isolation – Followed by Antigenic subtypes of
H and NA

A /Hong Kong / 1/68 ( H3 N2 )


3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 40

Host Range
• Experimented in Animals
• Spread through respiratory shredding
• Respiratory disease in Ferrets
• Intranasal passage in Mice
• Infect the amniotic cavity of Allantois
and Amniotic fluids
• Virus can be grown in primary
monkey kidney and in continuous cell
lines
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 41

Life cycle of the ‘flu virus


3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 42

Pathogenesis
• Infects the respiratory tract
• Even 3 or few viral particles can infect
• Neuraminidase facilitates infection reducing
the viscosity of Mucous
• Ciliated cells are infected in the Respiratory
tract - site of viral infection
• When superficial layers are damaged
exposes the basal layers
• And exposure of the basal layer causes the
bacterial infections.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 43

Reservoirs of Virus
• Virus harbored as
Asymptomatic infection
• All isolates from Non
human hosts harbor
type A virus
• Types B and C are
exclusively common to
Humans, Not identified
in animals or birds
• Plays a great role in
emerging pandemics
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 44

TRANSMISSION
• AEROSOL
• 100,000 TO 1,000,000
VIRIONS PER
DROPLET

• 18-72 HR
INCUBATION

• SHEDDING
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 45
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 46

Pathogenesis – Viral Pneumonia

• Thickening of the Alveolar cells


• Intestinal infiltration with leucocytes
with capillary thrombosis of
Leucocytic exudates
• Hyaline membrane is formed
occupying alveolar ducts and alveoli
• In late stages infiltration with
Macrophages
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 47

Clinical features
• Incubation 1 to 3 days
• Present with mild cold lead to
fulminating rapidly fatal Pneumonia
• Can abruptly present with head ache
malign
• Can also present with abdominal pain
with type B in children
• Bacteria superinfect
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 48

SYMPTOMS
• FEVER
• HEADACHE
• MYALGIA
• COUGH
• RHINITIS
• OCULAR SYMPTOMS
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 49

CLINICAL FINDINGS
• SEVERITY
• VERY YOUNG
• ELDERLY
• IMMUNO-
COMPROMISED
• HEART OR
LUNG DISEASE
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 50

Complications of Influenza
• Bacterial super infections
• Cardiac complications
• Congestive heart failure
• Myocarditis
• Neurological involvement
• Encephalitis
• Type B virus can produce Reye’s syndrome
• Degenerative changes in the Brain and Liver
• Gastric flu with type B virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 51

Viral Pneumonia is Leading cause of Death


3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 52

Complications in Influenza
• Pneumonia
• secondary bacterial
• primary influenza viral
• Reye’s syndrome
• Myocarditis
• Death 0.5-1 per 1,000 cases
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 53

Immunity in Influenza
• After infection immunity
lasts 1 to 2 years
• Immunity lasts short
duration due antigenic
variants infecting at
intervals.
• Antibodies produced
locally are effective IgA
immunoglobulin.
• Anti Hemagglutinins and
Antinerumanidase are
effective in prevention of
infection.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 54

Epidemiology
• Virus enters through respiratory route
• In 3 – 4 days majority manifest
• Many are subclinical infections
• Type A produce pandemics
• Type B sporadic cases, epidemics
• Dangerous in the Temperate regions
• Higher mortality in aged and patients with
existing cardiopulmonary involvement
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 55

RECENT MAJOR
PANDEMICS
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 56

New strain Hon Kong


H5 N1 strain
• Originated in Hong
Kong
• 18 confirmed 6
dead
• Can spread from
Chicken to Humans
• Wild aquatic birds
spread.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 57

What is Bird Flu


• Avian Influenza in Animals
• Only birds get infected
• Less common Pigs
• Avian influenza is species specific
• Less common in Humans
• Can spread from poultry to Humans
can produce sever disease
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 58
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 59

BIRD FLU
• Birds, just like
people, get the flu.
Bird flu viruses
infect birds,
including chickens,
other poultry and
wild birds such as
ducks. Most bird flu
viruses can only
infect other birds.
However, bird flu
can pose health
risks to people.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 60

Bird flu can spread from Birds to Humans


• The first case of a
bird flu virus
infecting a person
directly, H5N1, was
in Hong Kong in
1997. Since then,
the bird flu virus
has spread to
birds in countries
in Asia, Africa and
Europe
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 61

Wild Birds Migrate and spread the Disease


Globally
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 62

Influenza Diagnosis
• Clinical and
epidemiological
characteristics
• Isolation of influenza
virus from clinical
specimen (e.g.,
nasopharynx, throat,
sputum)
• Significant rise in
influenza IgG by
serologic assay
• Direct antigen testing
for type A virus
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 63

Be familiar with Importance of


Throat Swab in Diagnosis
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 64

Isolation of Virus
• In the first 2 -3 days from gargle samples
• Specimens inoculated into eggs, and Monkey kidney
cells.
• Eggs are inoculated into Amniotic and Allantoic cavity
Grows at 370 C in 3 days
• The virus causes Haemagglutination of Guinea pig
and Fowl erythrocytes at 370 C
• Type A and B agglutinate guinea pig and fowl red cells
• Type C Hem agglutinates only Fowl cells
• Cytopathic effects on Monkey Kidney and Continuous
cell lines
• RNA detection by RT – PCR
• Immuno florescence – surface of Nasopharyngeal
cells
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 65

Serology
• Compliment fixation
test
• Haemagglutination
Inhibition testing
• Testing on paired
sera
• Detection of
Haemagglutination
Inhibition testing
• Radial
Immunodiffusion
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 66

SWINE FLU 2009


• Swine influenza (also
called H1N1 flu, swine
flu, hog flu, and pig
flu) is an infection by
any one of several
types of swine
influenza virus. Swine
influenza virus (SIV)
is any strain of the
influenza family of
viruses that is endemic
in pigs
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 67

2009 H1N1 Flu

• H1N1 (sometimes called “swine flu”) is a new


influenza virus causing illness in people. This
new virus was first detected in people in the
United States in April 2009. This virus is
spreading from person-to-person worldwide,
probably in much the same way that regular
seasonal influenza viruses spread. On June
11, 2009, the World Health Organization
(WHO) declared that a pandemic of 2009
H1N1 flu was underway.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 68
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 69
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 70
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 71

Pigs infect Humans


• Pigs can pass
mutated viruses
back to humans,
and these can be
passed from human
to human.
Transmission
among humans is
thought to occur in
the same way as
with seasonal flu.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 72

(Injectable
Peramivir has
completed
phase-1 trials)

Tamiflu!
(oral)

Ralenza
(inhaled)

(Older
drugs)
(Viral resistance to these is more common)
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 73

Chemotherapy
• Tamiflu (oseltamivir) – inhibits the
neuraminidase and thus prevents the
spread of the virus in the body
• Tamiflu can therefore be used to
reduce the length of illness and its
transmission within a household
• Resistance of H1N1 strain to
oseltamivir has been reported at 25%
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 74

Prevention
• WHO monitors the
events on Influenza
• Identifies the
subtypes circulating
all over the world.
• Vaccine
Cocktail vaccine
contains one or
two types of A and
type B virus of the
previous winter
months.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 75

Influenza Vaccines
• Inactivated subunit
(TIV) vaccine
• intramuscular
• trivalent
• split virus and subunit
types
• duration of immunity 1
year or less
• Live attenuated
vaccine (LAIV)
• intranasal
• trivalent
• duration of immunity at
least 1 year
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 76

Influenza Vaccine
Recommendations
• Healthcare
providers,
including home
care*
• Employees of long-
term care facilities
• Household contacts
of*LAIV
high-risk persons
should not be administered to healthcare workers who have
contact with severely immunosuppressed persons who require
hospitalization and care in a protective environment
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 77

Indication to Vaccinate Patents ?

• To all high risk groups


1 Elderly,
2 Chronic heart and
Lung disease
patients,
3 Asthmatic patients
4 Metabolic and,
renal disease patients.
5 HIV patients.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 78

Inactivated Influenza Vaccine


Contraindications and Precautions
• Severe allergic reaction
to a vaccine component
(e.g., egg) or following a
prior dose of vaccine
• Moderate or severe
acute illness
• History of Guillian Barre’
syndrome within 6
weeks following a
previous dose of TIV
(precaution)
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 79

Emerging trends in Vaccines

• A live
attenuated Cold
adopted
temperature
sensitive used
as nasal spray
on major trails.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 80

Newer Vaccines are available


• The 2011-2012 vaccine
will protect against an
influenza A H3N2 virus,
an influenza B virus and
the H1N1 virus that
emerged in 2009 to
cause a pandemic.
Everyone 6 months of
age and older should get
a flu vaccine as soon as
the 2011-2012 vaccines
are available.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 81

HIV Infection and Inactivated Influenza


Vaccine
• Persons with HIV at
increased risk of
complications of
influenza
• TIV induces protective
antibody titers in many
HIV infected persons
• TIV will benefit many
HIV-infected persons
• Do not administer LAIV
to persons with HIV
infection
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 82

Prevention is the Best option

• Covering your
nose and mouth
with a tissue
when you cough
or sneeze.
Throw the tissue
in the trash after
you use
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 83

Hand washing a Top priority

• Washing your
hands often with
soap and water,
especially after
you cough or
sneeze. You can
also use alcohol-
based hand
cleaners.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 84

Influenza is a Global Concern


Be Familiar with Facts
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 85

UPDATES ON H3 N2
2023
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 86

What is H3N2 virus?


• It is an influenza virus that causes respiratory
infection. The virus can also infect birds and
mammals. In bird and other animals, it has
mutated into many strains.

• H3N2 is a subtype of Influenza A virus, which


is an important cause of human influenza,
according to Centres for Disease Control
(CDC) and World health Organization (WHO).
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 87

WHAT ARE THE SYMPTOMS


According to WHO, avian, swine and other zoonotic influenza infections
in humans may cause disease ranging from mild upper respiratory
infection (fever and cough) to rapid progression to severe pneumonia,
acute respiratory distress syndrome, shock and even death. Some of
the common symptoms of H3N2 virus are:

Chills
Coughing
Fever
Nausea
Vomiting
Throat ache/sore throat
An ache in muscles and body
In some cases, diarrhoea
Sneezing and runny nose
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 88

WHEN TO CONSULT A DOCTOR


• If a person
experiences difficulty
in breathing, pain or
discomfort in chest,
continuous fever and
pain in throat while
gulping down the
food, it is very
important to see a
doctor.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 89

Diagnosis
• Laboratory tests are required to diagnose human
infection with zoonotic influenza. WHO, through its
Global Influenza Surveillance and Response System
(GISRS), periodically updates technical guidance
protocols for the detection of zoonotic influenza in
humans using molecular e.g. RT-PCR and others
methods.

• Rapid influenza diagnostic tests (RIDTs) have lower


sensitivity compared to PCR and their reliability depends
largely on the conditions under which they are used.
Commercially available RDTs in general cannot provide
subtype information. RIDTs are sometimes used in clinical
settings, but their use in detection of zoonotic viruses is
limited.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 90

Treatment Guidelines
As per suggestions of WHO
Evidence suggests that
some antiviral drugs,
notably neuraminidase
inhibitor (oseltamivir,
zanamivir), can reduce
the duration of viral
replication and improve
prospects of survival,
however ongoing clinical
studies are needed.
Emergence of oseltamivir
resistance has been
reported.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 91

Treatment Guidelines
As per suggestions of WHO
• In suspected and confirmed cases, neuraminidase
inhibitors should be prescribed as soon as possible
(ideally, within 48 hours following symptom onset) to
maximize therapeutic benefits. However, given the
significant mortality currently associated with A(H5)
and A(H7N9) subtype virus infections and evidence of
prolonged viral replication in these diseases,
administration of the drug should also be considered
in patients presenting later in the course of illness.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 92

As per suggestions of WHO


Current suggestions
• Treatment is recommended for a minimum of 5 days, but can
be extended until there is satisfactory clinical improvement.
• Corticosteroids should not be used routinely, unless indicated
for other reasons (eg: asthma and other specific conditions); as
it has been associated with prolonged viral clearance,
immunosuppression leading to bacterial or fungal
superinfection.
• Most recent A(H5) and A(H7N9) viruses are resistant
to adamantane antiviral drugs (e.g. amantadine and
rimantadine) and are therefore not recommended for
monotherapy.
• Presence of co-infection with bacterial pathogens can
be encountered in critically ill patients.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 93

PREVENTION
As per suggestions of WHO
• Apart from antiviral treatment, the public health
management includes personal protective
measures like:
Regular hand washing with proper drying of the
hands
• Good respiratory hygiene – covering mouth and
nose when coughing or sneezing, using tissues
and disposing of them correctly
• Early self-isolation of those feeling unwell,
feverish and having other symptoms of influenza
• Avoiding close contact with sick people
• Avoiding touching one’s eyes, nose or mouth
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 94

As per suggestions of WHO


• Health care workers preforming aerosol generating procedures
should use airborne precautions. Standard contact and droplet
precautions and appropriate personal protective equipment
(PPE) should be made available and used during epidemics.

• Travelers to countries and people living in countries with known


outbreaks of avian influenza should, if possible, avoid poultry
farms, contact with animals in live poultry markets, entering
areas where poultry may be slaughtered, and contact with any
surfaces that appear to be contaminated with faeces from
poultry or other animals. Good food safety and food hygiene
practices e.g. hands washing with soap and water should be
followed. Travelers returning from affected regions should
report to local health services if respiratory symptoms
suspecting zoonotic influenza virus infection.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 95

Is there a Vaccine for H3 N2


• During a season where
influenza A(H3N2) was
antigenically different from
the vaccine virus,
vaccination was
associated with a reduced
risk of influenza
hospitalization in younger
immunocompetent adults.
However, vaccination did
not provide protection in
adults ≥65 years of age.
Improvements in vaccines,
antivirals, and prevention
strategies are warranted.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 96

For current Treatment and Vaccination


do consult your physician
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 97

Programs Today
Influenza program focuses on three main areas:
strengthening the Influenza Surveillance Network,
public health research, and pandemic
preparedness. CDC collaborations with GOI
partners aim to increase capacity of influenza
sentinel surveillance sites and laboratory services
for the timely detection and characterization of
respiratory viruses with pandemic potential. The
public health research helps assess influenza
burden (e.g., hospitalizations, mortality, and
estimated cost) and informs critical preventive and
control measures through improved
understanding of the epidemiology of respiratory
pathogens.
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 98

Major References
• WHO current issues on Influenza
• CDC Literature on facts, and prevention
• Open resources from Google
• National Institute on Health USA
• Public information resources
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 99

To know more about articles of current Interest


on Infectious diseases follow me ..
3/12/2023 Dr.T.V.Rao MD @ Current updates on H3 N2 Influenza 100

• Programme Created by Dr.T.V.Rao


MD for ‘ e ‘ learning resources for
Medical and Paramedical Students
Globally
• Email

• doctortvrao@gmail.com

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