INFLUENZA

characterized by lesions of the upper respiratory tract with the

development of intoxication and catarrhal syndrome.

Virus is pneumotropic belongs the family Orthomyxoviridae;

- contains of RNA, nucleocapsid, lipoglycoprotein envelop;
has a rounded or oval shape;
nucleocapsid has S - antigen, H-antigen (hemagglutinin),
N-antigen (neuraminidase),

- has tropicity to the upper respiratory tract;
- resistant to low temperature;
- sensitive to heat, boiling, ultraviolet irradiation, disinfectants.

significant economic costs and mortality!
5-10 %
5-10 %
adults and
20-30 %
children
Die from

complications:

250 – 500 th.

people

Economic costs:

1- 6 mln $ USA

on 100 000 population

According to WHO suffer from the influenza every year:

- H15)
9 types of neuraminidase (N1 - N 9)
Viruses on

the difference of specific antigens of the nucleoprotein and matrix protein are divided into 3 types:
A, B and C.
Subtypes of influenza virus are isolated by antigenic variants of the surface glycoprotein
hemagglutinin (H) and neuraminidase (N)

Every change in the antigenic structure of surface glycoproteins causes the development of new pandemics and epidemics!

morbidity and mortality
associated primarily with the virus
А
seldom
В
С
as a rule, is

asymptomatic and does not affect the incidence

only people
in humans, pigs, dogs

with the increase in the incidence of other ARVI!
Revealed a

clear dependence of the level of INFLUENZA morbidity of the population of the CITY:

> 1 MLN

FROM 500 TH TILL 1 MLN

LESS 500 TH

< 11,3 %

10,9 %

9,7 %

THE AUTUMN-WINTER PERIOD

THE BEST SURVIVAL OF VIRUS IN AEROSOLS AT LOW TEMPERATURE

A CROWDING OF PEOPLE IN ENCLOSED ROOMS

to:
The INFLUENZA can occur without fever, with scanty pulmonary symptoms,

but with rapid, sometimes catastrophic, development of toxicity and complications, therefore, these portions of the population require special attention and control.

children first year of life

the elderly

persons with concomitant diseases of the heart, lungs, diabetes, other chronic diseases

RNA consisting of 8 segments that encode 10 viral proteins
Fragments

of RNA have a general protein envelope, which unites them, forming a nucleoprotein

Nucleoprotein permanent in its structure and determines the virus type (A, B or C).

The surface antigens (H and N), in contrast, is variable and define different strains of the same type of virus.

virus in the human body lasts about 4 hours and

can be described as follows:

Hemagglutinin on the surface of the virus, binds to sialic acid on epithelial cells lining the respiratory tract.

1

The virus enters the epithelial cell by endocytosis and starts to multiply

2

The synthesis of new viral RNA and proteins, which are collected into viral particles occurs via the structures of the host cell

3

Viral particles are transported to the surface cells in the sheath which contains the hemagglutinin, neuraminidase and M2 channels.

4

Collecting of virions is completed, but they remain bound to cell surface via hemagglutinin and sialic acid.

5

The neuraminidase releases new viruses
which infect other cells

6

the respiratory tract
«ENTRANCE GATE»
involvement of intact cells
replication of the virus

in the cells

structural changes, degradation, rejection of cells

Do not sneeze!

source of the infection, the virus through coughing and sneezing

transmitted to healthy people by aerogenic mechanism through airborne, air–dust way
and by contact–household route

the replication cycle of 4-6 hours

isolation of virus from the respiratory tract

STARTS 1-2 days before onset of symptoms

ENDS after 5 –7days after the disappearance of clinical manifestations

temperature (38-40°C);
Chills, dizziness, muscle pain, headache, weakness;
Rhinorrhea usually not observed,

patients often complain of a feeling of dryness in the nose and throat;
In some cases there is a dry, hard cough accompanied by pain behind the breastbone;

2 days
Incubation period

3-5 days
CLIMAX (febrile) period

The total duration of disease is 7-10 days

SPESIFIC SDs – CATARRHAL AND INTOXICATION
INITIAL: NONSPESIFIC SD – GENERAL

INTOXICATION

CONVALESCENCE: DISAPPEARANCE OF LIDING SDs;
ASTENOVEGETATIVE SD

38.5–39°C,
moderate intoxication,
weakness, headache
Hypertoxic form occurs only in influenza, accompanied by

expressed hyperthermic, meningo - encephalitic and hemorrhagic syndrome !

body temperature can to remain
normal or not rise above 38°C,
the symptoms of intoxication
less expressed or absent

Increase of body temperature
up to 40-40,5°C,
dizziness, delirium,
seizures, hallucinations, vomiting

TRACT
SUPPRESSION OF FUNCTION
of mucociliary clearance
macrophages
T - lymphocytes
INFLUENZA VIRUS
NEURAMINIDASE OF INFLUENZA

VIRUS

modifies cell surface glycoproteins

promotes the formation of new places for bacteria adhesion and the development of secondary purulent infection !

the influenza virus gets into the blood, causing viremia that

resulted in severe intoxication.

Is characterized by:

increased permeability and fragility of blood vessels of different severity

- HEMORRHAGIC SYNDROME
- BLEEDING
HEMORRHAGES OF DIFFERENT
LOCALIZATION
Disturbance of MICROCIRCULATION
(until the development of DIC –
syndrome, infectious-toxic shock!)

SEVERE CASES:

In the development of the neurotoxic syndrome in influenza plays an important role disorder of cerebral hemodynamics and cerebral edema!

Intoxication at the influenza

to EXACERBATION:
chronic bronchitis/
chronic obstructive
pulmonary

disease;
bronchial asthma;
mucoviscidosis;

PNEUMONIA DEVELOPS:

5-38% with influenza A

10 % with influenza B

Distinguish
- primary viral pneumonia
(developed as a result of direct viral infection of the lungs) and
- secondary bacterial pneumonia (bacterial superinfection can complicate the course of primary viral pneumonia, and or to be independent late complication of the flu).

among all infectious diseases!
5-10 %
80 - 90 %
of patients older

than 65 years in the structure of mortality from the flu

6 %

of deaths due to influenza in adults, young patients without apparent risk factors!

1/3

complications associated with influenza occur among people, healthy in all other indicators

Most cases of influenza in hospitalized patients are younger than 65 years

INFLUENZA : THE RISK OF COMPLICATIONS

is not possible (!),
due to technical difficulties, the complexity and

relative high cost of virological and immunological methods.

During epidemics of influenza the performance of clinical diagnosis is high and reaches 70%!

the method of direct immunofluorescence
polymerase chain reaction – PCR
reaction of complement binding
enzyme-linked immunosorbent assay
virological method

influenza:
GBC: leukopenia, shift to the left formula, increased ESR;
urinalysis:

leukocyturia, proteinuria, microhematuria,
cylindruria;
biochemical blood: the increase of urea, creatinine;
coagulogramm changes in severe forms;

a direct effect
on the reproduction of the virus
and some
virus-specific target

in its cycle

1st generation – amantadine and rimantadine
2 generation – zanamivir and oseltamivir

ETIOTROPIC DRUGS

SPECIFIC TREATMENT

influenza virus, disrupts the process of reproduction and formation of

complete virions.

rapid development of resistance in viruses (resistance);
narrow spectrum of activity (only influenza A);
common side effects;

SPECIFIC TREATMENT

A and B.
Violates penetration of the virus into healthy cells
inhibites

further spread of the virus in the body

THE ATTACK ON NEURAMINIDASE

INHIBITION

Reduces production of proinflammatory cytokines;
Prevents development of local inflammatory reaction;
Attenuates systemic symptoms of influenza (fever, myalgia);

SPECIFIC TREATMENT

distribution
NА
the sooner the better
NА
NА
NА

virus;
It is used to treat influenza A and B;

It is used to prevent influenza A or B in people
who had contact with patients

NEUROAMINIDASE

OSELTAMIVIR

SPECIFIC TREATMENT

forms- should be hospitalized)
1. Bed rest;
2. Diet № 15, drink

plenty of liquids;

3. Etiotropic treatment:
- anti-influenza gamma-globulin (3ml) - i/m in the first 3 days,
- interferon 2-3 drops every 1-2 h for 3 days,
- rimantadine – 1-st day: 0,1 g × 3 t/d,
2-nd day and 3-rd day: 0,1 g × 2 t/d;
- oseltamivir – 0,75 g × 2 t/d (5 days);
- zanamivir - 1 inhalation × 2 t/d

4. Pathogenic therapy: - desintoxication; - desensitization;
- angioprotectors; - metabolites;

5. Symptomatic treatment: antipyretics, vitamins, local antiseptics;
6. Antitussive drugs, mucolytics, vasoconstrictor nasal drops;
7. Antibiotics - in complications, exacerbation of chronic diseases

and pre-epidemic period, regular general wet cleaning, bactericidal air

disinfection.

2. The use of personal protective equipment (disposable masks).

3. Specific prevention (vaccination). Routine immunization can be
carried out throughout the year, but the greatest its effectiveness
in the autumn before the influenza season.

4. Nonspecific prevention of influenza
and ARVI aimed at increasing the general
resistance of the human body:
- improvement of immune status with
immunomodulators;
- promotion of healthy lifestyle, tempering;
- creation of favourable temperature in the room;

PROFILAXIS OF INFLUENZA