influenza clinical presentation
TRANSCRIPT
-
8/2/2019 Influenza Clinical Presentation
1/37
Influenza: ClinicalInfluenza: ClinicalBackground InformationBackground Information
-
8/2/2019 Influenza Clinical Presentation
2/37
Influenza: ClinicalInfluenza: Clinical
Background InformationBackground Information
Prepared By :
Admiral Retired Dr.Adel Abd El Wahhab
Consultant of Occupational Health &
Safety
-
8/2/2019 Influenza Clinical Presentation
3/37
Types Of InfluenzaTy
pes Of Influenza
VirusesViruses
There are three types of influenza viruses: types A, B,and C.
Seasonal influenza outbreaks can be caused by eithertype A or type B Influenza viruses.
Only type A influenza viruses cause pandemic.
Influenza type C viruses cause mild illness in humansbut do not cause epidemics or pandemics.
-
8/2/2019 Influenza Clinical Presentation
4/37
Subtypes Of Influenza VirusesSubtypes Of Influenza Viruses
Only type A is divided into subtypes.Subtype designations are based on the
presence of two viral surface proteins(antigens:
(hemagglutinin (H and neuraminidase (N.
To date, 16 different hemagglutinin and 9different neuraminidase surface proteins
have been identified in influenza A viruses.The H protein type (116 followed by the Nprotein type (19 (e.g., H5N1.
-
8/2/2019 Influenza Clinical Presentation
5/37
History Of Influenza PandemicsHistory Of Influenza Pandemics
Historically, influenza has caused
outbreaks of respiratory illness
for centuries, including three pandemics
(Worldwide outbreaks of disease in the
20th century. Three different subtypes
(i.e., H1N1, H2N2, and H3N2 havecaused pandemics in the 20th century.
-
8/2/2019 Influenza Clinical Presentation
6/37
Prior Influenza PandemicsPrior Influenza Pandemics
The 1918 influenza pandemic, caused by
subtype H1N1 viruses, resulted in death for
an estimated 500,000 U.S. citizens and as
many as 40 million people worldwide. The 1957 (caused by subtype H2N2 viruses
killed an estimated 70,000 .
1968 (caused by subtype H3N2 viruses killed
an estimated 34,000 U.S.
-
8/2/2019 Influenza Clinical Presentation
7/37
Seasonal influenzaSeasonal influenza
Seasonal influenza or flu refers to
periodic outbreaks of acute onset viral
respiratory infection caused by
circulating strains of human influenza
A and B viruses. Itoccurs most
frequently during the winter months
when the humidity and outdoortemperatures are low (generally from
December until April.
-
8/2/2019 Influenza Clinical Presentation
8/37
Prevalence Of Seasonal FluPrevalence Of Seasonal Flu
Between 520 percent of the population may beinfected annually. Most people have some immunityto the currently circulating strains of influenza virusand, as a result, the severity and impact of seasonal
Influenza is substantially less than during pandemics.Seasonal influenza is responsible for approximately36,000 deaths and 226,000
hospitalizations annually in the United States.
The risk of death is highest among the elderly,
the very young, and patients with cardiopulmonary
and other chronic conditions.
-
8/2/2019 Influenza Clinical Presentation
9/37
Clinical Presentation ofClinical Presentation of
Seasonal InfluenzaSeasonal Influenza Seasonal influenza typically has an abrupt onset,
with symptoms offever, chills, fatigue, muscle
aches, headache, dry cough, upper respiratorycongestion and sore throat.
The time from exposure to disease onset is usually
1 to 4 days, with an average of 2 days.
Most patients recover within 3 to 7 days.
In adults, fever usually last for 2 to 3 days,
but may last longer in children.
Cough and weakness can persist for up to 2 weeks.
-
8/2/2019 Influenza Clinical Presentation
10/37
Vaccination Against SeasonalVaccination Against Seasonal
FluFlu
Every year, a trivalent influenza vaccine
is prepared in advance of the
anticipated seasonal outbreak and itincludes those strains (two type A and
one type B that are expected to be the
most likely to circulate in the upcomingflu season.
-
8/2/2019 Influenza Clinical Presentation
11/37
Pandemic InfluenzaPandemic Influenza
A pandemic is a global disease outbreak.
A flu pandemic occurs when a new influenza
virus emerges for which people have little orno immunity, and for which there is no
available vaccine.
The disease spreads easily person-to-
person, causes serious illness, and can
sweep across the country and around the
world in a very short time.
-
8/2/2019 Influenza Clinical Presentation
12/37
WHO Pandemic Alert SystemWHO Pandemic Alert System
WHO Plan describes six phases of
increasing public health risk associated
with the emergence of a new influenza
virus subtype that may pose a pandemic
threat
-
8/2/2019 Influenza Clinical Presentation
13/37
WHO Pandemic Alert SystemWHO Pandemic Alert System
(Phases 1 and 2 there is a novel influenza A virus in animals, butno human cases have been observed.
(Phases 35 a novel influenza virus causes human infection with
a new subtype, but does not exhibit efficient and sustained
human to- human transmission.Once a new influenza A virus develops the capacity for efficient
and sustained human-to-human transmission in the general
population
(Phase 6 the WHO declares that an influenza pandemic is inprogress (this is known as the Pandemic Period.
-
8/2/2019 Influenza Clinical Presentation
14/37
Swine influenza H1N1-
is a respiratory
disease of pigs caused
by type A influenza
viruses and has amajor economic
impact on the swine
industry.
-
8/2/2019 Influenza Clinical Presentation
15/37
Signs of swine flu in pigsSigns of swine flu in pigs
S.Flu outbreaks in pigs are common, especially
during winter months.
In pigs influenza infection produces fever, lethargy,
sneezing, coughing, difficulity breathing anddecreased appetite.
In some cases the infection can cause abortion.
Although mortality is usually low (around 1-4%, thevirus can produce weight loss and poor growth,
causing economic loss to farmers.
http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Sneezinghttp://en.wikipedia.org/wiki/Coughinghttp://en.wikipedia.org/wiki/Dyspneahttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Growth_failurehttp://en.wikipedia.org/wiki/Growth_failurehttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Dyspneahttp://en.wikipedia.org/wiki/Coughinghttp://en.wikipedia.org/wiki/Sneezinghttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Fever -
8/2/2019 Influenza Clinical Presentation
16/37
Can people catch swine flu fromCan people catch swine flu from
porkpork?? The 1918 flu pandemic in humans was associated with H1N1
and influenza appearing in pigs.
This may reflect a zoonosis either from swine to humans or
from humans to swine.
Although it is not certain in which direction the virus was
transferred, some evidence suggests that, in this case, pigs
caught the disease from humans.
Direct transmission of a swine flu virus from pigs to humans isoccasionally possible In all, 50 cases are known to have
occurred since the first report in medical literature in 1958,
which have resulted in a total of six deaths.
http://en.wikipedia.org/wiki/1918_flu_pandemichttp://en.wikipedia.org/wiki/1918_flu_pandemic -
8/2/2019 Influenza Clinical Presentation
17/37
20092009pandemic in humanspandemic in humans
The H1N1 viral strain implicated in the
2009 flu pandemic among humans is called
Swine Flu" because the initial testing
showed many of the genes in the virus weresimilar to influenza viruses normally
occurring in North American swine.
Further research has shown that theoutbreak is due to a new strain of H1N1 not
previously reported in pigs.
http://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/Strain_(biology)http://en.wikipedia.org/wiki/2009_flu_pandemichttp://en.wikipedia.org/wiki/2009_flu_pandemichttp://en.wikipedia.org/wiki/Strain_(biology)http://en.wikipedia.org/wiki/H1N1 -
8/2/2019 Influenza Clinical Presentation
18/37
symptoms of 2009 Swine Flusymptoms of 2009 Swine Flu"" According to the
Centers for Disease Control and Prevention (CDC, inhumans the symptoms of the 2009 "swine flu" H1N1virus are similar to those ofinfluenza and ofinfluenza-like illness in general.
Symptoms include fever, cough, sore throat, bodyaches, headache, chills and fatigue.
The 2009 outbreak has shown an increasedpercentage of patients reporting diarrhea and
vomiting. The 2009 H1N1 virus is not zoonotic swine flu, as it is
not transmitted from pigs to humans, but from person
to person.
http://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Influenza-like_illnesshttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Sore_throathttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Chillshttp://en.wikipedia.org/wiki/Fatiguehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Fatiguehttp://en.wikipedia.org/wiki/Chillshttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Sore_throathttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Influenza-like_illnesshttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention -
8/2/2019 Influenza Clinical Presentation
19/37
The H1N1 flu virus can spreadThe H1N1 flu virus can spread
from person to person whenfrom person to person when:: Someone with the flu coughs or sneezes into air that
others breathe in.
Someone touches a door knob, desk, computer, orcounter with the H1N1 germs on it and then touches
their mouth, eyes, or nose.
Someone touches mucus of a child or others whiletaking care of them when they are ill with the H1N1 fluvirus
You CANNOT get H1N1 flu virus from eating pork orany other food, drinking water, swimming in pools, orusing a hot tubs or saunas
-
8/2/2019 Influenza Clinical Presentation
20/37
How is swine flu (H1N1How is swine flu (H1N1
diagnoseddiagnosed?? Swine flu is diagnosed clinically by the patient's
history of association with people known to have thedisease and theirsymptoms listed above.nasopharyngeal swab sample is done to see if the
patient is infected with influenza A or B virus. Most ofthe tests can distinguish between A and B types. Thetest can be negative (no flu infection or positive fortype A and B. If the test is positive for type B, the fluis not likely to be swine flu (H1N1. If it is positive for
type A, the person could have a conventional flustrain or swine flu (H1N1. Swine flu (H1N1 isdefinitively diagnosed by identifying the particularantigens associated with the virus type.
-
8/2/2019 Influenza Clinical Presentation
21/37
-
8/2/2019 Influenza Clinical Presentation
22/37
TreatmentTreatment
Most people who get H1N1 flu will likely
recover without needing medical care
or special antiviral medications. Checkwith your health care provider about
whether you should take antiviral
medications to treat the H1N1 flu.
A ti i l D
-
8/2/2019 Influenza Clinical Presentation
23/37
Antiviral DrugsAntiviral DrugsDoctors may prescribe antiviral drugs to treat peoplewho become very sick with the flu or are at high risk
for flu complications. The following people may be athigh risk:
Children younger than 5 years old, especially thoseyounger than age 2
Adults 65 years of age and olderPeople with: Chronic lung (including asthma or heart conditions (except
high blood pressure
Kidney, liver, neurologic, and neuromuscular conditions
Blood disorders (including sickle cell disease Diabetes and other metabolic disorders
An immune system that does not work well, such as AIDSpatients or cancer patients receiving chemotherapy
http://www.nlm.nih.gov/medlineplus/ency/article/000141.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001214.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001214.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000141.htm -
8/2/2019 Influenza Clinical Presentation
24/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
25/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
26/37
Prevention of human toPrevention of human to
human transmissionhuman transmissionEveryone should take these steps to prevent the flu fromspreading:
Cover your nose and mouth with a tissue when you cough orsneeze. Throw the tissue away after using it.
Wash your hands often with soap and water for 15 - 20 seconds,especially after you cough or sneeze. You may also use
alcohol-based hand cleaners.Avoid touching your eyes, nose, or mouth, to avoid getting
infected by germs.
Avoid close contact with sick people.
If you do get sick, consider staying home from work or school for
7 days after your symptoms begin, or until you have beensymptom-free for 24 hours, whichever is longer.
Wear a facemask , if possible, when sharing common spaces withother household members
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
27/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
28/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
29/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
30/37
2009H1N1 influenza vaccine
Vaccines are available to protect against 2009H1N1 influenza.
These vaccines are made just like seasonal
flu vaccines.
They are expected to be as safe andeffective as seasonal flu vaccines.
They will not prevent influenza-like
illnesses caused by other viruses.
They will not prevent seasonal flu. Youshould also get seasonal influenza vaccine, if
you want to be protected against seasonal
flu.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
31/37
Who should get 2009 H1N1
Flu Shots and when?Groups recommended to receive 2009 H1N1 vaccinefirst are: Pregnant women People who live with or care for infants younger than
6 months of age Health care and emergency medical personnel Anyone from 6 months through 24 years of age Anyone from 25 through 64 years of age with certainchronic medical conditions or a weakened immune
system As more vaccine becomes available, thesegroups should also be vaccinated: Healthy 25 through 64 year olds Adults 65 years and older
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
32/37
The nasal mist vaccine (LAIVThe nasal mist vaccine (LAIV
A non-shot option, the nasal mist vaccine, is
now available, but because it contains
weakened live flu viruses it is not for people
with weakened immune systems or certainhealth conditions. The nasal mist vaccine is
only for healthy, non-pregnant people
between the ages of 2 and 49 years. Check
with your doctor to see if your child can orshould get this type of flu vaccine.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
33/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
34/37
Some people should not get the
vaccine or should waitYou should not get 2009 H1N1 flu vaccine if you have a severe(life-threatening allergy to eggs, or to any other substance inthe vaccine. Also if you have ever had: a life-threatening allergic reaction after a dose of seasonal
flu vaccine, Guillain Barr Syndrome (a severe paralytic illness also
called GBS.These may not be reasons to avoid the vaccine, but themedical staff can help you decide.
If you are moderately or severely ill, you might be advised towait until you recover before getting the vaccine.If you have a mild cold or other illness, there is usually no
need to wait.
Pregnant or breastfeeding women can get inactivated 2009H1N1 fl u vaccine.
Inactivated 2009 H1N1 vaccine may be given at the same timeas other vaccines, including seasonal influenza vaccine.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
35/37
What are the risks from2009
H1N1 influenza vaccine?Mild problems:
soreness, redness, tenderness, or swelling where theshot was given fainting (mainly adolescents headache, muscle aches
fever nausea If these problems occur, they usuallybegin soon after the shot and last 1-2 days. Severproblems: Life-threatening allergic reactions to vaccines are veryrare. If they do occur, it is usually within a fewminutes to a few hours after the shot. In 1976, an earlier type of swine flu vaccine wasassociated with cases of Guillain-Barr Syndrome(GBS. Since then, flu vaccines have not been clearlylinked to GBS.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
36/37
Thanks
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm -
8/2/2019 Influenza Clinical Presentation
37/37
Any Questions?
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm