MIC1IEP

Topic 12 Influenza
26th May 2016
ANNA MORRIS
ROOM 310
THOMAS CHERRY BUILDING
PH: 9479- 1501
a.morris@latrobe.edu.au

Influenza : Orthomyxoviruses
Respiratory Tract Infection
Systemic rather than localised infection of
the respiratory tract and lungs
Transmission via droplets or fomites
Seasonal more common in winter
months & also in spring

Influenza Virus
WHO: Annual epidemics cause 250,000
500,000 deaths worldwide
Vaccine preventable disease (Aust Govt -NNDSS)
71,528 cases Australia wide in 2015 ytd
67,757 cases in 2014

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campaigns

Notifiable disease
Communicable disease
Required by law to be reported to the Health
Authorities

Infectious disease that is transmitted

readily from one individual to another
usually in normal everyday activities

Symptoms of Influenza

How far do your droplets travel

in a sneeze?
Brock Biology of microorganisms
100mph
30 feet = 9 metres

Myth busters
17 and 13 feet
4 5 metres

Either way, its a long way!!

Influenza types
Influenza type A
Humans, birds, animals
Epidemics and pandemics

Influenza type B
Humans
epidemics

Influenza type C
Mild respiratory infection
Not assoc with epidemics or pandemics

Influenza A virus
Icosahedral
Enveloped
Negative sense
ssRNA
~ 500 spikes or
projections
Hemagglutinin (HA)
4 x more than NA

Neuraminidase (NA)

Influenza Envelope

Envelope carries Hemagglutinin and Neuraminidase

Hemagglutinin assists with attachment
Neuraminidase assists in liberation of mature viruses from host cells

Replication cycle of Influenza A

virus

Influenza type A
Only A is subtyped
Typed according to surface glycoprotein
antigens
Hemagglutinin
Neuraminidase

18 H and 11 N recognized & named

accordingly

The 2015 Southern Hemisphere influenza

season vaccine strains
A/California/7/2009 (H1N1)pdm09 - like virus
A/Switzerland/9715293/2013 (H3N2) - like virus
B/Phuket/3073/2013 like virus (Yamagata
lineage)
The Australian Influenza Vaccine Committee
(AIVC) selected influenza viruses for the
composition of the trivalent influenza vaccines.
Therapeutic Goods Administration accepted the
recommendations of the AIVC.

Glycoproteins Haemagglutinin and

Neuraminidase
Type of H or N depending on which type of
each expresses
A/California/7/2009 (H1N1)pdm09 - like
virus
A/Switzerland/9715293/2013 (H3N2) - like
virus

Resistance to reinfection??
Infected individuals will produce antibodies
to both H and N antigens
Lack of resistance to Flu from season to
season is due to mutation in surface
antigens
Mutation due to antigenic shift and drift
Drift: small and constant
Shift: sudden and major
Only seen in Influenza type A
Results in pandemics due to new strain

Influenza : Five major pandemics

Spanish flu
1918
(H1N1)
20 50 million deaths

Asian Flu
H2N2
1957
2 million deaths

Hong Kong Flu

H3N2
1968
1 million deaths

Influenza : Five major pandemics

Russian flu
1977
(H1N1)
17,000 deaths

Swine Flu
2009
H1N1
18,500 deaths
Swine origin
Pandemic lasted until August 2010

Transmission
Droplet transmission
Inhalation
Fomites

Virus survival is high (many hours) outside

the body
Surfaces
Cloths, tissues

Infective period immediately prior to

signs and symptoms for up to 7 days after

Duck for cover!!

Infectious Droplets & Droplet
Nuclei Travel Lengths

Pathogenesis
Entry via respiratory tract
Attachment to respiratory epithelial cells
H spikes

Asymptomatic infection common

Mild infection possible
Cold-like infection

Symptoms appear 1 3 days following infection

Fever, chills, malaise, muscle pain
Due to release of cytokines from damaged cells & infiltrating leukocytes

Virus spread
Runny nose
Sore throat
Dry cough

Infection may increase in severity

Results in bronchitis or pneumonia

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Pathogenesis
Recovery
1 3 weeks
Unless progresses to more severe infection

Infective period starts before symptoms appear

Shedding of virus from this stage for a week

Death most common in:

elderly
Immunocompromised
2 0 bacterial infection most likely cause
Eg Pneumonia

Exacerbation of pre-existing chronic cardiac or respiratory illness

Predisposing factors
Impaired Immunity
Immunocompromised individuals

Age
< 5 - >65 years of age

Pregnancy
Aborigines & Torres Strait Islanders > 15
years
Medical condition
Heart disease, chronic lung disease
asthma, emphysema,

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Predisposing factors
Homelessness
Nursing home or long term care residents
Pre-existing chronic condition
Obesity, diabetes, alcoholism, kidney disease

Asthma patients who have frequent hospital

visits
Downs syndrome
Vaccination is recommended for high risk individuals

Universal influenza vaccine

Research being conducted into universal
vaccine
Aim is for vaccine to trigger immune
responses against conserved antigens
These are viral protein targets that mutate
only slowly
And are also similar among many strains of
influenza viruses
Therefore can generate immune responses
that cross-react among virus strains

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Do I have a cold or the Flu??

Flu is not the common cold!!
Flu is more severe
Cold symptoms last from two to a few days
flu lasts up to a week
Flu - high fever
Cold : usually only mild fever
Flu - Muscular pains and shivering attacks
flu usually starts with a dry sensation in the nose and
throat
Colds - runny nose
Flu symptoms onset rapid
Cold symptom onset gradual

Complications
Most common in immucompromised
Increases chances of complications and
risk of death
Primary Influenza pneumonia
Difficult breathing, cyanosis

20 bacterial pneumonia
Shortness of breath, green or yellow phlegm, chest
pains, fever

Inflammation of brain or heart

Often assoc with recovery process

Reyes syndrome

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Prevention
Annual immunization
Good personal hygiene
Cover nose and mouth when coughing or
sneezing
Dispose of tissue appropriately
Wash hands after cough or sneeze
Soap & water
Alcohol based hand sanitizer

Avoid touching eyes, nose & mouth

Stay home from work and school

Treatment
Bed & rest until body temp is in normal
range for 48 hours
Drink fluids to maintain normal urine
output
Paracetamol (+/or aspirin in adults) to
control fever, aches & pains
Antiviral treatment to reduce severity &
length of illness
Avoid further damage or challenge of
respiratory tract

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Mucocilliary escalator

Antiviral drugs
Relenza Zanamivir
Tamiflu oseltamivir
Used against both Types A & B Influenza

Act by inhibiting viral neuraminidase

Blocks release of new virus particles being
released from infected host cells

Recommended under severe infection or

in high risk individuals
Effective if treatment commences within
48 hours of symptoms appearing

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Identification/Diagnosis
Reverse transcription polymerase chain
reaction (RT-PCR) (1 6 hours)
RIDT Rapid Influenza Diagnostic test
Used for Influenza types A & B although not
can distinguish (<30 min)

Viral culture of nasopharyngeal or throat

secretions (3 10 days)
Identification
critical for epidemics or pandemics
Not so much for individual cases

Growth of viruses in
embryonated eggs

Influenza is still produced this way

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Influenza vaccine manufacture

Avian Flu Influenza type A

Bird Flu
Human infection after virus crosses
species barrier
Usually results after contact with infected
poultry or environments
Human to human contact is rare but does
occur
Different types have been isolated

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H5NI (HPAI Highly pathogenic avian

influenza)
H5N1 causes infection in man and
animals other than poultry, eg domestic
cats and dogs
Highly pathogenic
high incidence of disease & death
wild birds and domestic poultry

HPAI H5N1
first isolated in 1996
farmed goose
Guandong province, China

H5NI (HPAI Highly

pathogenic avian influenza)
Followed by outbreaks in 1997
poultry farms & live animal markets

18 humans infected & 6 deaths

Increasingly assoc with infection in
chickens
Culling of commercial poultry flocks
Hong Kong
Effective
Outbreaks in 2003 resulted in infection in over
60 countries

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H5NI (HPAI Highly pathogenic avian

influenza)
Re-emerged in 2003 in birds
Death of 100s of millions of birds
Disease
culling

Re-emerged in humans
630 cases
375 deaths
By June 2013

Infection is with direct contact with birds

rather than human to human transmission

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References
Microbiology and Infection Control for Health
Professionals. Chapter 19, 6th Ed, Lee &
Bishop.
Chapter 8, Brock Biology of Microorganisms,
14th Ed, 2015
Microbiology and Infection control for Health
professionals. Chapter 19 , Lee & Bishop.
http://www.fda.gov/BiologicsBloodVaccines/Scie
nceResearch/ucm353397.htm
http://www.medical-supplies-equipmentcompany.com/flu-transmission-and-fluprevention-576.htm

References
http://www.rapidreferenceinfluenza.com/ch
apter/B978-0-7234-3433-7.500098/aim/influenza-virus-structure
http://www.virology.ws/2009/04/30/structur
e-of-influenza-virus/
http://www.betterhealth.vic.gov.au/bhcv2/b
hcarticles.nsf/pages/Flu_influenza

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Learning Objectives
At completion of this lecture students should
be familiar with:
Some of the basic characteristics & clinical

features of the Influenza virus and the Flu

disease
The mode of transmission, pathogenesis,

symptoms, treatment and prevention of

Influenza

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