Chapter 127: Influenza

KEY CONCEPTS

• Influenza is a viral illness associated with high mortality and high hospitalization rates among persons older than 65 years of age. The aging of the population is contributing to an increased disease burden in the United States.

• Seasonal influenza epidemics are the result of viral antigenic drift, which is why the influenza vaccine is changed on a yearly basis. Antigenic drift forms the foundation of the recommendation for annual influenza vaccination.

• The acquisition of a new hemagglutinin and/or neuraminidase by the influenza virus is called antigenic shift, which results in a novel influenza virus that has the potential to cause a pandemic.

• The primary route of influenza transmission is person-to-person via inhalation of respiratory droplets, and transmission can occur for as long as the infected person is shedding virus from the respiratory tract.

• Clinical diagnosis of influenza is difficult. Classic signs and symptoms include abrupt onset of fever, muscle pain, headache, malaise, nonproductive cough, sore throat, and rhinitis. These signs and symptoms usually resolve within 1 week of presentation.

• In the United States, the primary mechanism of influenza prevention is annual vaccination. Vaccination not only prevents influenza illness and influenza-related hospitalizations and deaths but may also decrease healthcare resource use and the overall cost to society.

• The inactivated influenza vaccine (IIV) and the live-attenuated influenza vaccine (LAIV) are commercially available for prevention of seasonal influenza. Both vaccines contain influenza A subtypes H3N2 and H1N1, and influenza B virus, which are initially grown in hens’ eggs.

• Antiviral drugs for prophylaxis of influenza should be considered adjuncts to vaccine and are not replacements for annual vaccination.

• The sooner antiviral drugs are started after the onset of illness, within 48 hours of symptom onset, the more effective they are.

• Neurominidase inhibitors (oseltamivir, zanamivir, and peramivir) and cap-dependent endonuclease inhibitor (baloxavir) that have activity against both influenza A and influenza B viruses. Although the adamantanes inherently have activity against influenza A H1N1 viruses, they are no longer used clinically due to overwhelming viral resistance.

Preclass Engaged Learning Activity

1. Complete the influenza vaccine table

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   Approved Influenza Vaccines for Different Age Groups—United States
   Vaccine	Trade Name	Manufacturer	Dose/Presentation	Thimerosal Mercury Content (mcg Hg/0.5-mL dose)	Age Group	Number of Doses
   aIIV3
   IIV3 High Dose
   IIV4
   IIV4
   IIV4
   IIV4
   IIV4-High Dose
   ccIIV4
   RIV4
   LAIV4

2. Complete the below treatment recommendation for influenza and duration of use. Please define appropriate ages for zanamivir use

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   ...

   	Treatment	Chemoprophylaxis
   Oseltamivir
   Adults
   Children ≥12 months by Body Weight (kg)
   ≤15 kg
   >15 kg to 23 kg
   >23 kg to 40 kg
   >40 kg
   Zanamivir
   Adults
   Children
   Peramivir
   Adult
   Children
   Baloxivir
   Adult