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8/19/2019 Lecture Influenza a (H1N1)
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Infuenza A (H1N1)
National Center for Disease Prevention and Control, DOH
Disampaikan
oleh
Dr FERMIZET RUDY SpPD
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3
Pandemics oinfuenza
H7
H5
H9*
1980
1997
Recorded new avian influenzas
1996 2002
1999
2003
1955 1965 1975 1985 1995 2005
H1N1
H2N2
1889RussianinfluenzaH2N2
H2N2
1957 AsianinfluenzaH2N2
H3N2
1968Hong onginfluenzaH3N2
H3N8
1900!ld Hongong influenzaH3N8
1918"#anis$influenzaH1N1
1915 1925 1955 1965 1975 1985 1995 20051895 1905 2010 2015
2009NovelinfluenzaH1N1v
Recorded $u%an #ande%ic influenza&earl' su()'#es inferred+
Re#roduced and ada#ed &2009+ wi$ #er%ission of ,r -asao .as$iro/ ,irecor/ ener for nfluenza irus Researc$/
Naional nsiue of nfecious ,iseases &N,+/ a#an4 Ani%aed slide ress s#ace (ar
H1N1
H1N1v
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Infuenza A reservoir
ild auaic (irds are $e %ain reservoir of influenza A viruses4 irus rans%ission $as (een re#ored fro% weild waerfowl o #oulr'/ sea
%a%%als/ #igs/ $orses/ and $u%ans4 iruses are also rans%ied (eween #igs and $u%ans/ and fro% #oulr' o $u%ans4 uine
influenza viruses $ave recenl' (een rans%ied o dogs4 &:ro% :ields riolog' &2007+ 5$ ediion/ ni#e/ ,- ; Howle'/ -/ eds/ olers
luwerins/ $iladel#$ia/ :ig ?841+
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Infuenza A (H1N1)Is PANDEMIC Imminent?
National Center for Disease Prevention and Control, DOH
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Infuenza is usually a respiratory inection
Transmission
@ Regular person-to-person transmission @ Primarily through contact ith
res!iratory dro!lets
@ Transmission rom o"#ects (omites)!ossi"le
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Transmission o Infuenza $imited studies% varying
inter!retations &ontact% dro!let% and dro!letnuclei (air"orne) transmission allli'ely occur
@ elative contri"ution o each
unclear ro!let thought most im!ortant
@ &oughing% sneezing% tal'ing
@ *ost studies either Animals or human e+!eriments
under arti,cial conditions -ut"rea' investigations
@ .nclear o inection source
National Center for Disease Prevention and Control, DOH
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/ey &haracteristics
&ommunica"ility
@ 0iral shedding can "egin 1day "eore sym!tom onset
@ Pea' shedding ,rst 3 days
o illness @ &orrelates ith
tem!erature
@ u"sides usually "y 24thday in adults
@ can "e 156 days inchildren
@ Inants% children and theimmunocom!romised mayshed the virus longer
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Incu"ation !eriod
@ Time rom e+!osure to onset osym!toms
@ 1 to 7 days (average 8 9 days)
easonality @ In tem!erate zones% shar! !ea's in inter
months
@ In tro!ical zones% circulates yearroundith seasonal increases:
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&linical Illness% easonalInfuenza
A"ru!t onset
;ever and constitutional sym!toms< "ody aches%headaches% atigue
&ough% rhinitis% sore throat
=I sym!toms and myositis more common in young
children e!sisli'e syndrome in inants
&om!lications< viral and "acterial !neumonia%e"rile seizures% cardiomyo!athy%ence!halo!athy>ence!halitis% orsening underlyingchronic conditions
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Individuals at Increased is' orHos!italizations and eath
?lderly @ 2 years
&hildren less than to years
&ertain chronic diseases
@ Heart or lung disease% including asthma @ *eta"olic disease% including dia"etes
@ HI0>AIs% other immunosu!!ression
@ &onditions that can com!romise res!iratory unction orthe handling o res!iratory secretions
Pregnant omen
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0accination
Infuenza vaccine is the "est !revention orseasonal infuenza:
Inactivated viruses in the vaccine develo!edrom three circulating strains (generally 9
Ty!e A and 1 Ty!e B strain) @ Thereore% seasonal Cfu shotD only or's or 3
infuenza su"ty!es and ill not or' on !andemicstrains:
$ive% intranasal s!ray vaccine or healthynon!regnant !ersons 27E years
Inactivated% in#ecta"le vaccine or !ersons months and olderNational Center for Disease Prevention and Control, DOH
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Infuenza 0iruses
&lassi,ed into ty!es A% B%and &F-nly Ty!es A and B cause
signi,cant disease
F Ty!es B and & limited tohumansF Ty!e A viruses
*ore virulent AGect many s!ecies
Bolds%i$/ ,
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Infuenza A 0iruses
Infuenza A viruses categorized "y su"ty!eF&lassi,ed according to to surace !roteins Hemagglutinin (H) 1 'non
@ ite o attachment to host cells @ Anti"ody to HA is !rotective
Neuraminidase (N) E 'non @ Hel!s release virions rom cells @ Anti"ody to NA can hel! modiy disease severity
N
H
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nfluenza re#licaion
Re#licaion of influenza A virus4 Afer (inding &1+ o sialic acid)conaining rece#ors/ influenza is endoc'osed and fuses &2 + wi$ $e vesicle
%e%(rane4 Cnli>e for %os o$er RNA viruses/ ranscri#ion &3+ and re#licaion &5 + of $e geno%e occur in $e nucleus4 iral #roeins are
s'n$esized &4+/ $elical nucleoca#sid seg%ens for% and associae &6 + wi$ $e -1 #roein)lined %e%(ranes conaining -2 and $e HA and NA
gl'co#roeins4 .$e virus (uds &7 + fro% $e #las%a %e%(rane wi$ 11 nucleoca#sid seg%ens4 &)+/ Negaive senseD &E+/ #osiive senseD R/endo#las%ic reiculu%4 &:ro% -edical -icro(iolog'/ 5$ ed4/ -urra'/ Rosen$al ; faller/ -os(' nc4/ 2005/ :igure 60)24+
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A > ydney > 52 > E4 (H3N9)
Nomenclatur
e
Virus type Strain number Virus subtype
Place virusisolated
Year isolated
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Infuenza A (H1N1) is anovel virus
.nusual com"ination o geneticmaterial rom !igs% "irds humanshich have reassorted
humantohuman transmission occursthrough res!iratory dro!lets generatedrom sneeze or cough
AGects all age grou!s
0accines or human seasonal fu can not!rotect humans against the novel virus
National Center for Disease Prevention and Control, DOH
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ine Infuenza 0iruses
NA viruses
Pigs can "e inected "y avianinfuenza and human infuenzaviruses as ell as sine infuenzaviruses:
eassort and ne viruses that are ami+ o sine% human and avianinfuenza viruses can ?*?=?
National Center for Disease Prevention and Control, DOH
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SIV
Beneic Re)assor%en
National Center for Disease Prevention and Control, DOH
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igns ym!toms o Infuenza A(H1N1)
;ever
$ethargy
$ac' o a!!etite
&oughing
unny Nose
ore throat
Nausea > 0omiting
iarrhea
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Seasonal Influenza vs. Common ColdSeasonal Influenza vs. Common Cold
InfluenzaInfluenza ColdCold
OnsetOnset suddensudden sub acutesub acute
Fever Fever Very highVery high rarerare
HAHA severesevere rarerare
FatigueFatigue extremeextreme mildmild
MyalgiaMyalgia commoncommon mildmild
CoughCough CommonCommon rarerareSore throatSore throat SometimesSometimes commoncommon
Nasal s Nasal s SometimesSometimes commoncommon
Com!licationsCom!lications "ung# heart"ung# heart $ar# sinus$ar# sinus
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a$ogenesis of influenza A virus4 .$e s'%#o%s of influenza are caused (' viral #a$ologic and i%%uno#a$ologic effecs/ (u $e
infecion %a' #ro%oe secondar' (acerial infecion4 N"/ enral nervous s'se%4 &:ro% -edical -icro(iolog'/ 5$ ed4/ -urra'/
Rosen$al ; faller/ -os(' nc4/ 2005/ :igure 60)34+
nfluenza #a$ogenesis
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ine H1N1 vs: HumanH1N1
swine H1N1 fu virus N-T the sameas human H1N1 virus
antigenically very diGerent romhuman H1N1 viruses
vaccines or human seasonal fu cannot !rotect humans rom swine H1N1
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Transmission< ;oodBorneJ
N-
Infuenza A (H1N1) viruses are nottransmitted through ood
ae to eat !ro!erly handled andcoo'ed !or' and !or' !roducts
&oo' !or' at an internal tem!eratureo 45K& (15K;)
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iagnosis and $a"oratory&on,rmation
&linically diagnosed
es!iratory !ecimen
F,rst 7 to 2 days o illness Fcan shed or 15 days or longer
!ecimens sent to . &&
FONLY la"oratory that can isolateand identiy sine infuenza ty!e Avirus
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Treatment
Infuenza A (H1N1) is sensitive to<
@ -seltamivir (tamifu)
@ Lanamivir
el medication is discouraged% mayinduce drug resistance
&hemo!ro!hyla+is
@ -seltamivir
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0accine
No Infuenza A (H1N1) vaccine yet
Process o !roduction is underay%"ut may ta'e 2 months
easonal infuenza vaccine !rovides!rotection against the seasonalhuman infuenza strains only
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National Center for Disease Prevention and Control, DOH
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%hat can you do to !rotect yourself&
Cover mouth'nose (hen cough'sneezeCover mouth'nose (hen cough'sneeze
%ash your hands after cough'sneeze%ash your hands after cough'sneeze
)on*t touch eyes# mouth or nose)on*t touch eyes# mouth or nose
Avoid contact (ith sic+ !eo!leAvoid contact (ith sic+ !eo!le
Stay home if you are sic+ Stay home if you are sic+
Stay informed, chec+ C)C# !ublic health (ebsite-Stay informed, chec+ C)C# !ublic health (ebsite-
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%hat should you do if you thin+ you
have the flu&
Contact your doctor and follo( the advise given
"imit contact (ith others
Cover your mouth'nose
%ash hands
Stay home
ee! a(ay from school# (or+ or cro(ds
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Thank you for listening
National Center for Disease Prevention and Control DOH
and God Bless Us All !