Influenza virus

Presented by Teck Kim Tie

Topic will be covered include:~
1)Introduction
2)Classification
3)Pathophysiology
4)Signs and symptoms
5)Treatment
6)Complication
7)Prevention
8)Diet requirement
9)Supplementary
10)Vaccination
11)conclusion
1) Introduction:’
- Commonly referred as flu
- Different from common cold
- Can cause pandemic
- According to WHO divided into 6 phases.
- Seasonal influenza and H1N1 (2009)
2) Classification:
-Influenza A, B and C
a) influenza A- cause flu pandemics and infect humans,
other mammals, and birds
b) influenza B- infect humans and seals
c) influenza C- infect humans and pigs
- type A and C infect multiple species while influenza B
almost exclusively infects humans
-H1N1 (2009)- type A virus
3) Pathophysiology:
-transmitted from infected mammals through the air by
coughs or sneezes, creating aerosols containing the
virus and from the birds through their droppings.
- can also be transmitted by saliva, nasal secretions,
feces and blood.
- Haemagglutinin + sialic acid → endocytosis→
endosomes → H+ flows through M2 protein → release
viral RNA plus accessory protein → nucleus → mRNA
→ ribosome → protein synthesis → assemble →
released.
4) Signs and symptoms:
-Chills
- fever (38-39
-sore throat
- muscle pain
- severe headache
- coughing
- weakness and general malaise.
-cause nausea and vomiting particularly in children
5) Treatment:
a)Make sure the patient fulfills
-Temperature ≥ 38
-Coughing
-Sore throat
-Within 48 hours of onset of symptoms
-With co-morbidities
i)Cardiac disease
ii)Chronic respiratory disease
iii)Chronic disease (DM, RF, haemoglobinopathies)
iv)Chronic neurological disorders
v)Impaired immunity
vi)Children aged 6 months-10 years on long term aspirin
therapy
vii)Malnourished or obesity
Viii) Pregnant lady, especially 2nd and 3rd trimester
iX) Extreme age groups : ≥ 65 years old
Then:~
-Fill up borang A and attach the form with the
prescription and send to pharmacy.
-Inpatient and outpatient treatment
-Only MO are allowed to prescribed the antiviral
treatment
-Pharmacy staffs need to fill in borang B and the nurse
that is going to administered the medication need to fill
in borang C
- flu pamphlet and advice need to be given
-neuraminidase inhibitor and M2 protein inhibitors.
-Only neuraminidase inhibitor, Oseltamivir and
Zanamivir are used in hospital Malaysia because they
are less toxic and more effective.
- However M2 inhibitors, Amantadine and Rimantadine
are used together with neuraminidase inhibitor in
oseltamivir-resistant infection as empirical therapy as
recommended by CDC.
Dosage of Oseltamivir (≥12 months, ≥ 40kg):
-75mg bd for 5 days for treatment
-75mg od for 10 days for prophylaxis

Dosage of Zanamivir (≥ 5 years):

-2 inhalation (10mg) bd for 5 days for treatment
-2 inhalation (10mg) od for 10 days for prophylaxis

Dosage for amantadine (10-65 years old):

-100mg bd for 10 days for treatment.

Dosage for Rimantadine:

-
Dosing recommendation for Oseltamivir:
Age In-patient Out-patient
treatment for 10 treatment for 5
days days
< 3 months 20 mg bd 12 mg bd

3-5 months 25mg bd 20mg bd

6-11 months 30mg bd 25mg bd

Children > 12 months

15kg or less 45mg bd 30mg bd

16-23 kg 60mg bd 45mg bd

24-40kg 75mg bd 60mg bd

> 40kg 150mg bd 75mg bd

Side effect of the medications:
1)Oseltamivir- N, V, D, abdominal pain, headache
2)Zanamivir- bronchospasm, dyspnoea, allergic reaction
3)Amantadine- nervousness, depression, nightmares,
hallucinations, insomnia, dizziness, heahace, blurred
vision, constipation, dry mouth, orthostatic hypotension

-All treatment must start within 48 hours of onset of

symptoms for maximal benefits.
-Treatment only decrease the severity of symptoms
-immune system plays a vital role
Criteria for discharge of patients:
-Has completed 5 days course of oseltamivir and at least
24 hours afebrile
-Can be dischargeed earlier, after completing 3 days or
6 dosesas long as the patient does not have
complications and afebrile for at least 24 hours and not
from the high risk group.
-Need further home isolation for a total of 7 days
6) Prevention:
-Practise good personal hygeine is important to prevent
transmission.
-Frequent disinfection will destroy the virus as well
-Cover your mouth when cough or sneeze
-Wear a face mask
7) Complication:
-Pneumonia
-Ear infection
-Sinus infection
-Dehydration
-Worsening of chronic medical condition
8) Diet requirement:
-Drink plenty of hot fluid to promote excretion of toxin
-Avoid diuretic like tea and coffee
-Avoid dairy products
-Avoid alcoholic drinks as it deplete vit C
-Foods should be as light and easily digestable
-Avoid high fat food
-Eat a balance diet with plenty of vegetables and fruits
-Mushrooms, contain compound that can boost the
immune system
- Avoid sweets, neutrophils become lethargic when you
eat sweets
8) Food supplement:
a)Vit C
-At least 2g/day of intake proved to be beneficial
-Start as early as you feel uncomfortable
-Not suitable for kidney patient due to kidney stone
accumulation

b) Zinc
-Proven to shorter cold compare to placebo
-23g of zinc lozenge every 2 hours
-Start ASAP until symptoms subside
-Don’t use for longer than 1 week because it can
suppress the immune system if used for an extended
period of time.
e) Garlic:
-Can help to boost immune system, 2 capsules tds

f) Echinacea:
-2 capsule tds for maximum of 8 weeks

g) Ginseng:
-
9) Vaccination:
-trivalent influenza vaccine that contains purified and
inactivated material from 3 viral strains.
- typically from 2 influenza A virus subtypes and 1
influenza B virus strain.
- carries no risk of transmitting disease and has very low
reactivity.
- for children, elderly, asthmatic, diabetes, heart
diseases
-H1N1 vaccine is expected to be available in the fall
according to CDC.