1. Influenza What is it?

2. Influenza Virus

3. Understanding Terminology Epidemic: serious outbreak in a single community, population or region Pandemic: epidemic spreading around the world affecting hundreds of thousands of people, across many countries

4. More on pandemics Usually a novel strain, the majority of the population has not been exposed to it before (no immunity) highly contagious old flu vaccines are not effective

5. Influenza Family orthomyxoviridae Enveloped viruses – 80-120 nm, negative stranded RNA with 8 different segments. Allows for genetic re-assortment when >1 virus infects a single cell Types A, B, and C: Significant differences in structure, genetics, organization, host range, epidemiologic and clinical characteristics Covered with surface projections or spikes – Hemagglutinin and neuraminidase—used to subtype influenza A virus types.

6. Influenza Types Influenza TypesHosts Type AHumans, birds, pigs and horses Type BHumans only Type CHumans only

7. Naming of influenza viruses Named by type / place isolated / culture # / year of isolation For example: – A/Fujian/411/2002 (H3N2) – B/Shanghai/361/2002-like

8. Spread direct transmission (infected person sneezes mucus into the eyes, nose or mouth of another person) through people inhaling the aerozolized droplets produced by infected people coughing, sneezing and spitting hand-to-mouth transmission from either contaminated surfaces or direct personal contact, such as a hand-shake (doorknobs, light switches, bank notes…)

9. Symptoms of the cold and flu

11. Influenza – Epidemiology (study of health and illness at the population level) Incubation period 1-4 days Virus first detected just before onset of illness. Virus usually not detected after 5 - 10 days. More prolonged shedding in children, immunosuppressed hosts Transmission: via respiratory droplets – person to person, – direct contact,

12. Epidemiology continued Attack rates 10-20% general population, selected populations 40- 50% Typical Season: 200,000 hospitalizations and 36,000 deaths

13. How Does Influenza Change? Particular characteristic that enables influenza A viruses to cause annual epidemics, even pandemics Type A viruses undergo frequent changes in their surface antigens or proteins Minor changes - antigenic drift Major changes - antigenic shift

14. Antigenic Drift Occurs among influenza A viruses resulting in emergence of new variants of prevailing strains every year New variants result in seasonal flu each winter Some years are worse than others – partly related to degree of ‘drift’

15. Antigenic Shift Occurs in two ways: Sudden ‘adaptive’ change during replication of a normal virus OR From an exchange of genes between human strain of an influenza A virus and an animal strain (e.g. avian flu)

16. Influenza Diagnosis Most often a clinical diagnosis Laboratory tests – molecular detection of virus in clinical specimens – culture of virus – serology Rapid ‘near patient’ tests – detect the presence of flu within 30 minutes – cannot determine the specific virus

17. Treatment options Let the immune system deal with it If symptoms severe – antiviral drugs

18. Antiviral drugs Prevent the flu virus from reproducing Treatment can shorten the illness by a day and reduce hospitalisations by an estimated 50% (based on seasonal flu) To be effective, must be taken within 48 hours of the onset of flu symptoms Some common anti-virals for the flu are zanamivir and oseltamivir (Tamiflu)

19. Prevention 1) Basic measures to reduce the spread of infection Hand washing: washing hands frequently with soap and water reduces the spread of the virus from the hands to the face, or to others Respiratory hygiene: covering the mouth and nose when coughing or sneezing; using a tissue when possible; disposing of dirty tissue promptly and carefully – bag and bin Avoiding non essential travel: non attendance at large gatherings such as concerts, theatres, cinemas, sports arenas etc

20. Prevention 2) Vaccines Vaccines can prevent influenza infection, particularly important for the elderly and infants Vaccine coverage is generally poor for infants – less than 10 percent; for the elderly, it can be above 60 percent

21. Influenza Vaccine Vaccine takes 6-8 months to produce following the emergence of a new virus Supplies will be limited, if available at all – Priority groups are usually established for use of limited vaccine (like who?) – 2nd dose after 30 days will likely be required – Need to monitor vaccine safety and efficacy

22. Priority groups for vaccinations Children 6-23 months of age Adults >65 years Persons 2-64 years of age with underlying chronic medical conditions Women who will be pregnant during influenza season

23. Examples of influenza outbreaks

24. Bird and human influenza

25. Birds to humans or birds to animals to humans Hong Kong 1997, H5N1 HK, China 1999, H9N2 Netherlands 2003, H7N7 Hong Kong 2003, H5N1 Viet Nam and Thailand, 2004 H5N1 Bottom shows bird to animal to human influenza

26. H1N1/09 virus thought to have originated in Asia mix of swine, avian, and human flu, with pigs as the “mixing vessel”

27. H1N1 Viral Structure an enveloped RNA virus has Hemagluttinin and Neuraminidase glycoproteins on its surface RNPs: ribonucleoproteins, transcribe viral RNA into cellular RNA

28. Life Cycle influenza attaches itself to cell’s surface using hemagluttinin (H) it is brought into the cells entire and disassembles in it once the virus has made copies of itself it uses nueraminidase (N) to leave the cell