Lecture Influenza a (H1N1)

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?



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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



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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



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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 ?*?=?



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SIV

Beneic Re)assor%en



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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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%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 !

Lecture Influenza a (H1N1)

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