Transcript Influenza PHA 5601: Pediatric Ambulatory Care Dr. Angela Thornton

INFLUENZA VIRUS
PHA 5601: PEDIATRIC AMBULATORY CARE
DR. ANGELA THORNTON, PHARMD
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Jaslyn Adams
Alesha Daley
Corey Gammon
Jayme Rentz
DEFINITION
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Influenza, commonly known as "the flu," is a very
contagious viral infection of the respiratory tract.
Influenza affects all age groups, however children
are at higher risk than adults.
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ETIOLOGY
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Influenza virus:
Belongs to the family Orthomyxoviridae
 Large single-stranded RNA virus
 Has 2 major surface proteins that determine serotype
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Hemagglutin (HA)
 Neuraminidase (NA)
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Divided into three types: A, B, and C
 Types A and B are primarily responsible for the
epidemic disease
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Types A and B are further divided into specific serotypic
strains
Type C is primarily responsible for sporadic cases of
upper respiratory tract disease
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EPIDEMIOLOGY
Location: Influenza affects all countries around
the world
 Transmission: may be transmitted through
large liquid droplets (ex: sneezing into the air) or
touching contaminated surfaces and then
touching eyes, nose, or mouth. A person with
influenza may be contagious for up to ten days
after the onset of symptoms.
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Temporal Pattern: “Flu Season” in the U.S. is
generally from October to May with a peak in
February.
 While everyone is at risk for getting the flu, there
are some high risk populations:
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Children younger than 5 years old
Adults older than 65 years old
Pregnant Women
Patients with a weakened immune system
Patients with chronic illnesses including:
Asthma
 COPD
 Cystic fibrosis
 HIV/AIDs
 Cancer
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PATHOPHYSIOLOGY
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Influenza virus is transmitted from infected
mammals through the air by coughs or sneezes,
creating a aerosols like effect that contains the
influenza virus.
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SYMPTOMS
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Fever
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Typically lasts 2-4 days (100°F or higher under the
arm, 101°F orally, or 102°F rectally)
Myalgias
 Chills
 Headache
 Malaise
 Anorexia
 Coryza
 Pharyngitis
 Dry cough
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May persist for a long period of time
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DIAGNOSIS
1.
If flu-like symptoms arise in the midst of flu
season or a flu pandemic, the diagnosis is
generally geared towards influenza
Flu Season: October through May; peak in February
a.
2.
Laboratory methods to diagnose influenza:
Viral Culture:
a.
i.
If implemented within the first four days of the illness,
the virus may be isolated from the nasopharynx via
nasopharyngeal swab, nasal swab, or nasal aspirate.
Rapid Influenza Diagnostic Tests:
b.
i.
These test may not detect all strains of influenza, and
may not differentiate between Influenza A and Influenza
B
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ii.
iii.
Serologic testing:
c.
i.
ii.
iii.
d.
Polymerase chain reaction (PCR)
1.
Detects viral RNA in the presence of a virus
Immunosorbent assay
1.
Detects the presence of antigens and antibodies
Tests for antibodies in the serum
Needs to be drawn during illness and post illness to
confirm influenza
Will not aid in clinical decision making, will only confirm
diagnosis
These test should only be implemented if the results
will influence the clinical care of the patient or of
other patients
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DIFFERENTIAL DIAGNOSIS
Symptoms
Influenza
Common
Cold
Pharyngitis
Infectious
mononucleosis
Meningitis
Fever
Common
Uncommon
Possible
Common
Common
Aches/Chills
Common
Uncommon
Possible
Common
Common
Fatigue/Weakness
Common
Possible
Uncommon
Common
Possible
Cough/Sneezing
Common
Common
Common
Uncommon
Uncommon
Headache
Common
Uncommon
Possible
Uncommon
Common
Stuffy Nose
Possible
Common
Uncommon
Uncommon
Uncommon
Sore Throat
Possible
Common
Common
Common
Uncommon
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COMPLICATIONS
Otitis media
 Pneumonia
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Secondary to bacterial infection
Acute myositis
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Usually seen with Type B
Myocarditis
 Toxic shock syndrome
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TREATMENT & PREVENTION
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METHODS
Supportive care
 Pharmacological
 Nonpharmacological
 Alternative medicine and therapies
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SUPPORTIVE CARE
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Acetaminophen (Tylenol)
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10-15mg/kg/dose orally every 4-6 hours
Ibuprofen (Motrin)
5-10mg/kg/dose orally every 6-8 hours
 Not for children < 6 months
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OSELTAMIVIR (TAMIFLU)
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Mechanism of action
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Inhibits Influenza virus neuraminidase, affecting particle
release
Indicated for Influenza Type A&B
Used to treat patients at least 2 weeks old and prophylaxis
in children 1 year and older
Dosage
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2weeks- 1year: 3mg/kg twice daily for 5 days or 0.5mL/kgf oral
suspension
1-12 years: 10 capsules 30-75mg twice daily
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Adverse Effects
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Weight dependent
Nausea, vomiting, arrhythmia, swelling of face or tongue,
abdominal pain
Monitoring Parameters
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Renal function, serum glucose, in diabetic patients signs of
unusual behavior
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NON-PHARMACALOGICAL
Get plenty of rest
 Increase fluid intake
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Warm tea
 Soup
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Frequently wash hands
 Give warm bath or warm compress
 Avoid contact with sick people
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INFLUENZA VACCINE
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Types seen in the U.S.
A/California/7/2009 (H1N1) pdm09-like virus
 A/Victoria/361/2011 (H3N2)-like virus
 B/Wisconsin/1/2010-like virus
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Determined based on age
 1 dose is preferred, unless vaccine has never been
received
 Side effects:
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Injection site reaction
 Low/ high grade fever
 Body aches
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MF59
Used since 1997 as TIV adjunct to seasonal
vaccination
 Used in children 6-72 months and adults
 Must have not previously received influenza
vaccine
 Combined with trivalent inactivate influenza
vaccine (TIV), abbreviated ATIV
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ALTERNATIVE PREVENTION
Mainly for prevention
 American ginseng (panax quinquefolius)
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Don’t take with Tylenol
Increase Vitamin D intake
 Cinnamon
 Hydrogen peroxide in ear
 Garlic
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REFERENCES
Nicola J. High, “Molecular Medical
Microbiology”2002, Pages 1967–1988 Volume 3,
School of Biological Science, University of
Manchester, Manchester, UK.
<http://www.sciencedirect.com/science/article/pii/
B9780126775303503123>
 Kliegman, Wright P. Influenza Viruses. In:
Saunders, An Imprint of Elsevier. Nelson
Textbook of Pediatrics. New York: McGraw-Hill;
2007. chapter 255.
 CDC. Prevention and control of influenza with
vaccines: recommendations of the Advisory
Committee on Immunization Practices (ACIP),
2010. MMWR 2010;59 (No. RR-8).
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Vesikari, Timo et al. Oil-in-Water Emulsion
adjuvant with Influenza Vaccine in Young
Children. N Engl J Med 2011; 365:1406-1416
 Harper SA, Bradley JS, Englund JA, et al.
Seasonal influenza in adults and children—
diagnosis, treatment, chemoprophylaxis, and
institu- tional outbreak management: clinical
practice guidelines of the Infectious Diseases
Society of America. Clin Infect Dis 2009;48:1003–
32.
 CDC. Influenza-Associated Pediatric Mortality,
2013. < http://gis.cdc.gov/GRASP/Fluview
/PedFluDeath.html>
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