Influenza update for 2010

1. Flu update 2010
Division of Internal Medicine and Adult Primary Care
September 20, 2010
Michael Wagner, MD FACP
Chief, Internal Medicine and Adult Primary Care
for educational purposes only

2. HISTORYNET.com
“Horse-drawn carts plied the streets with a call to bring
out the dead in the city where bodies lay unburied for
days. The afflicted died by the thousands, and survivors
lived in fear. But this wasn't medieval Europe being
stalked by the Black Death. This was Philadelphia,
October 1918, and the city was under siege from a new
variant of one of mankind's oldest specters: influenza.”
1918 Spanish Influenza Outbreak: The Enemy Within
By Christine M. Kreiser
50-100 million deaths from 1918 flu epidemic

3. Goals of our talk
• Review 2009 flu season
• What is the flu?
• What does the flu virus do to our bodies?
• What are the symptoms?
• Why is it potentially so life threatening?
• Flu vaccination
• How can you prevent it (getting and giving)?
• What are the treatments?
• What are the warning signs to watch for?
• Does it affect certain populations differently?

4. 2009 flu season review
• Emergence of 2009 H1N1
influenza virus
• First viral pandemic in more
than 40 years
• The 2009 H1N1 virus will
probably be spread during
the 2010-2011 flu season
• 12,000 flu related deaths
• > 90% deaths occurred in
people < 65 years old

5. Deaths attributable to pneumonia and influenza

6. Impact according to age

7. What is the flu?
• Virus
• Two major categories
– Influenza A
– Influenza B
• Immune response
determined by external
covering
– Hemagglutinin
– Neuraminidase

8. What does the flu virus do to our bodies?

9. What are the symptoms?
• fever (usually high)
• headache
• extreme tiredness
• cough
• sore throat
• runny or stuffy nose
• muscle aches, and
• nausea, vomiting, and
diarrhea, (much more
common among children than
adults)
from CDC

10. Why is it potentially so life threatening?
• Most people recover without any specific therapy within a few days to
2 weeks
• Some people will develop a secondary infection as a result of the flu
– Pneumonia (pneumococcal and staph/MRSA)
– Bronchitis
– Sinus and ear infections
• People with certain chronic medical conditions may get worse with
the flu
– Asthma
– COPD
– Congestive heart failure
• Certain populations are at higher risk to complications
– Over 65 years old
– Pregnant women
– Young children

11. Flu vaccination
• Contains
– Inactivated virus
– Antigens from 2009 H1N1, H3N2, and Influenza B
• Recommendations
– Everyone over the age of 6 months should be vaccinated
– People over 65 years old may receive high dose preparation
(Fluzone High-Dose®) instead of regular flu shot
– Children 6 months to 8 years old may need to receive two doses
• Effectiveness
– When the vaccine is well matched for the actual viruses that
circulate the vaccine is 70-90% effective
– Even if the circulating virus are not exactly as what is in the
vaccine, the vaccine can provide some protection if the virus are
related

12. Influenza
recommendations
for children 2010-
2011 season

13. How can you prevent it (getting or giving)?
• Six simple steps to reduce the spread of the virus
– Avoid close contact
– Stay home when you are sick
– Cover your mouth and nose
– Clean your hands
– Avoid touching your eyes, nose or mouth
– Practice other good habits like: plenty of sleep, physical activity,
drink plenty of fluids, eat nutritious food and manage stress
• You may be infectious from 1 day before onset of
symptoms to 3-5 days later
• Spread by small water droplets created when we cough,
sneeze or talk.

14. What are the treatments for the flu once you have it?
• Antivirals
– 2 drugs recommended for 2010-2011 flu season
• Tamiflu®(oseltamivir) – pill or liquid (age > 1 year)
• Relenza® (zanamivir) – inhaled powder (age > 7yrs)
– Indications
• Best if started within 2 days of symptom onset
• Hospitalized
• Risk factors for complications
• Most people will not needed to be treated with antivirals
– Benefit
• May decrease symptoms by 1-2 days
– Duration of treatment: 5 days
– Side effects
• GI,dizziness, sinusitis
• Confusion and abnormal behavior

15. Supportive care for the flu
• Stay home and rest
• Avoid close contact with well people in your house
• Drink plenty of fluids and other clear liquids in order to
stay hydrated
• Treat fever and cough with medicines you can buy over
the counter
– Fever: acetaminophen or ibuprofen
– Cough: Consult pharmacist, humidifier, cough drops
• If you get very sick or are pregnant or have a medical
conditions that puts you at higher risk, call your doctor.

16. Warning signs – reasons to call your healthcare provider
Children Adults
• Fast breathing or trouble • Difficulty breathing or shortness
breathing of breath
• Bluish skin color • Pain or pressure in the chest or
• Not drinking enough fluids abdomen
• Not waking up or not interacting • Sudden dizziness
• Being so irritable that the child • Confusion
does not want to be held • Severe or persistent vomiting
• Flu-like symptoms improve • Flu–like symptoms that
but then return with fever and improve but then return with
worse cough fever and worse cough
• Fever with a rash

17. Are their certain groups that are more at risk?
• Elderly > 65 years old
• Pregnant women
• Children younger than 2 years old (2-4 year olds also at
higher risk compared to older children)
• People with certain chronic medical conditions
– Asthma/COPD
– Heart failure
– Diabetes
– HIV
• People younger than 19 years old taking chronic aspirin
therapy

18. Summary
• Flu vaccination
– Indicated for all people 6 months and older
• If you are sick with the flu
– Minimize contact with others and keep hydrated
– Seek medical advice:
• If
you have one of the risk factors listed previously, or
• Fever and cough return after initially getting better
• Practice
– Good hand washing
– Covering mouth and nose when cough and sneezing

19. Death, taxes and the flu…

21. Additional resources
• The American Experience on PBS – The 1918 flu outbreak
– http://www.pbs.org/wgbh/amex/influenza/
• Historynet.com
– http://www.historynet.com/1918-spanish-influenza-outbreak-the-
enemy-within.htm
• CDC
– http://www.cdc.gov/flu