i nfluenza v irus pha 5601: p ediatric a mbulatory c are d r. a ngela t hornton, p harm d jaslyn...
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INFLUENZA VIRUSPHA 5601: PEDIATRIC AMBULATORY CAREDR. ANGELA THORNTON, PHARMD
Jaslyn Adams
Alesha Daley
Corey Gammon
Jayme Rentz
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DEFINITION
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
Influenza virus: Belongs to the family Orthomyxoviridae Large single-stranded RNA virus Has 2 major surface proteins that determine
serotype Hemagglutin (HA) Neuraminidase (NA)
Divided into three types: A, B, and C Types A and B are primarily responsible for the
epidemic disease 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: 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
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
Fever 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
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
a. Flu Season: October through May; peak in February
2. Laboratory methods to diagnose influenza:a. Viral Culture:
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.
b. Rapid Influenza Diagnostic Tests: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. Polymerase chain reaction (PCR)1. Detects viral RNA in the presence of a virus
iii. Immunosorbent assay1. Detects the presence of antigens and antibodies
c. Serologic testing: i. Tests for antibodies in the serumii. Needs to be drawn during illness and post illness to
confirm influenza iii. Will not aid in clinical decision making, will only
confirm diagnosis
d. 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
Secondary to bacterial infection Acute myositis
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
Acetaminophen (Tylenol) 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) Mechanism of action
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
2weeks- 1year: 3mg/kg twice daily for 5 days or 0.5mL/kgf oral suspension
1-12 years: 10 capsules 30-75mg twice daily Weight dependent
Adverse Effects Nausea, vomiting, arrhythmia, swelling of face or tongue,
abdominal pain Monitoring Parameters
Renal function, serum glucose, in diabetic patients signs of unusual behavior
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NON-PHARMACALOGICAL
Get plenty of rest Increase fluid intake
Warm tea Soup
Frequently wash hands Give warm bath or warm compress Avoid contact with sick people
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INFLUENZA VACCINE
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
Determined based on age 1 dose is preferred, unless vaccine has never
been received Side effects:
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)
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>