Upper Respiratory Tract Infection Embattling against Flu Season in Community Setting

Transcription

1 Upper Respiratory Tract Infection Embattling against Flu Season in Community Setting DR. CHAN PUI KWONG SPECIALIST IN COMMUNITY MEDICINE 1

2 Upper Respiratory Tract Infection (URTI) Illnesses caused by an acute infection which involves the upper respiratory tract including the nose, sinuses, pharynx or larynx Commonly includes tonsillitis, pharyngitis, laryngitis, sinusitis, otitis media, and the common cold Other names Influenza like illness Common cold Flu 2

3 Causative agents Viral Over 200 different viruses have been isolated in patients with URIs. Most common virus is called the rhinovirus. Others e.g. coronavirus, parainfluenza virus, adenovirus, enterovirus, and respiratory syncytial virus. [2] Bacteria Up to 15% of acute pharyngitis cases may be caused by bacteria most commonly Streptococcus pyogenes a Group A streptococcus in Streptococcal pharyngitis ("Strep Throat"). [3] Others e.g. Streptococcus pneumoniae, Haemophilus influenzae, Corynebacterium diphtheriae, Bordetella pertussis, and Bacillus anthracis Streptococcus pyogenes 3

4 Influenza 4

5 Influenza Acute illness of respiratory tract Fever, headache, muscle ache, running nose, cough, sore throat Usually self-limiting Recovery in 2-7 days The body produces antibody to the virus Young children, elderly, persons with chronic illness more likely to have complications 5

6 How is a common cold different from the flu? Cold symptoms Low or no fever Sometimes a headache Stuffy, runny nose Sneezing Mild, hacking cough Slight aches and pains Mild fatigue Sore throat Normal energy level Flu symptoms High fever Commonly a headache Sometimes a stuffy nose Sometimes sneezing Cough, may progress Often severe aches and pains Fatigue, may persist Sometimes a sore throat Exhaustion 6

7 Global Situation 2014/15 winter influenza season beginning of Influenza activity United States: mid-november 2014 Canada: December 2014 Europe: mid-december 2014 Japan: early December 2014 Influenza season lasted until early May 7

8 Global Situation circulating virus: Influenza A (H3N2) was the major one increase in influenza B towards end of the season Influenza A(H1N1)pdm09 co-circulated with the above two 8

9 Global Situation Antigenic characteristic of circulating viruses Influenza A (H3N2): significant proportion were antigenically different from the A/Texas/50/2012(H3N2) Most were similar to A/Switzerland/ /2013 Influenza A(H1N1)pdm09 : majority similar to A/California/7/2009 Influenza B: B/Yamagata/16/88 predominated over B/Victoria/2/87 B/Victoria/2/87 is closely related to B/Brisbane/60/2008 B/Yamagata/16/88 is closely related to B/Phuket/3073/2013 (Underline ----used in 2014/15 trivalent vaccine) (Strike through ---used in 2014/15 quadrivalent vaccine) 9

10 Hong Kong Situation 2014/15 winter Influenza Season Arrived in the last week of December 2014 Continued to increase rapidly in January 2015 Reached the peak in early February Started to decrease gradually Returned to a low level in the third week of April 10

11 ILI consultation rate at sentinel private doctors,

12 ILI consultation rate at sentinel GOPCs,

13 Hong Kong Situation 2014/15 winter Influenza Season Breakdown of the positive influenza virus isolates of Public Health Lab of of CHP (from Dec 28, 2014 to Apr 25, 2015): A(H3N2): 90.1% ( >95% were A/Switzerland/ /2013-like) B : 8.4% A(H1N1) pdm09 : 1.1% C : 0.4% 13

14 Laboratory surveillance in (1) Percentage of respiratory specimens tested positive for influenza viruses, (overall positive percentage) 14

15 Laboratory surveillance in (2) Percentage of respiratory specimens tested positive for influenza viruses, (positive percentage by subtypes) 15

16 General Prevention Measures Wearing Mask Persons who are in contact with those suffered from flu / respiratory symptoms (e.g. running nose, cough and sore throat) should wear a mask to prevent inhalation of droplets with flu virus 16

17 Hand hygiene Studies have shown that proper cleaning your hands is the most effective method of preventing the spread of infectious diseases Hand hygiene is a fundamental measure to prevent and control the spread of infectious diseases Wash hands thoroughly with liquid soap or use alcohol-based handrub are efficient measure to maintain hand hyigene 17

18 When should we wash hands? For example: Before touching the eyes, nose and mouth When hands are contaminated with respiratory secretions, such as coughing and sneezing After handling contaminated objects Eating and before handling food after using the toilet and so on 18

19 Frequently clean hands & Pay attention to hand hygiene When hands is visibly soiled or stained with body fluids & secretions, wash hands with liquid soap and water If hands are not visibly soiled, 70-80% alcohol-based handrub should be used for washing hand 19

20 Proper hand washing 20

21 Personal Hygiene (1) To be effective in preventing influenza, students and staff in school should be reminded to develop good hygiene habits to prevent the spread of germs in schools: Cough etiquette Attention to hand hygiene Do not wipe the eyes, nose and mouth See doctor when sick. Rest at home and avoid going out 21

22 Personal Hygiene (2) Handle common eating food with care to avoid contamination Avoid sharing personal items with others (e.g. towels, utensils, toothbrushes ) Adequate sleep, exercise regularly, do not have excessive amount of pressure, drink plenty of waters, and also eat healthy foods Develop good health habits 22

23 Environmental Hygiene (1) Since virus could survive in the environment for some time, paying attention to sanitation is very important Maintain good indoor ventilation Daily cleaning and disinfecting in schools & centers, including: classrooms, kitchen, dining halls, toilets, bathrooms, etc For items which is regularly contacted, frequency of washing should be increased Instant wash contaminated environment 23

24 Environmental Hygiene (2) Different disinfectant can be used to clean the environment. Household bleach containing 5.25% sodium hypochlorite is a convenient and effective disinfectant For general cleaning, 1:99 diluted household bleach (5.25%) could be used For cleaning area polluted by respiratory secretions, vomit, apply 1 to 49 diluted household bleach (5.25%) Wait for mins, wash with water As to disinfect metal surface, use 70% alcohol 24

25 Culture & Gargling The custom of gargling as a preventive approach is not widespread in many Western countries. In Japan, however, health authorities have officially recommended gargling to prevent respiratory infections for more than 90 years, and almost all Japanese believe in the preventive effect of gargling Noda et al Gargling for Oral Hygiene and the Development of Fever in Childhood: A Population Study in Japan. J Epidemiol 2012;22(1):

26 Japan Ministry of Health Ministry of Health LaW: Guideline for new type of influenza management(phase 4 or later)

27 Wearing face masks in public during the influenza season may reflect other positive hygiene practices in Japan Wearing a face mask in public was associated with various self-reported hygiene practices including: Frequent hand washing (adjusted Odds Ratio [OR]: 1.67; 95% Confidence Interval [95%CI]: ), Occasional hand washing (OR: 1.43; 95%CI: ), Frequently avoiding crowds (OR: 1.85; 95%CI: ), Occasionally avoiding crowds (OR: 1.65; 95%CI: ), Frequent gargling (OR: 1.68; 95%CI: ), Occasional gargling (OR: 1.46; 95%CI: ), Regularly avoiding close contact with an infected person(or: 1.50; 95%CI: ) Occasionally avoiding close contact with an infected person (OR: 1.31; 95%CI: ) Being vaccinated of influenza in the last season (OR: 1.31; 95%CI: ). Wada et al. BMC Public Health 2012, 12:

28 Role of gargling in preventing viral upper respiratory tract infection Comparison of outcomes in gargling and non-gargling children 1 Gargling Non-gargling Total: 391,900 person-days Fever onset Yes No Sickness absence Yes No 317,180 persondays 1,095 (0.4%) 316,085 (99.7%) 12,672 (4.0%) 304,508 (96.0%) Data are numbers unless otherwise indicated 74,720 persondays 711 (1.0%) 74,009 (99.1%) 3,874 (5.2%) 70,846 (94.8%) P value <0.001 <0.001 n = 19, Noda et al J Epidemiol 2012;22(1):

29 Efficacy of povidone-iodine against enveloped and non-enveloped viruses Virucidal activities of povidone-iodine (PVP-I) and other antiseptics Adeno Herpes Rubella Measles Mumps Flu Rota Polio Rhino HIV Enveloppe no yes yes yes yes yes no no no yes PVP-I solution PVP-I gargle PVP-I cream CHG X? X X X AEG X?? X X X X BAC X? X X BEC X? X X =clearly effective =effective X= ineffective?=uncertain -=not tested PVP-I: povidone-iodine CHG: chlorhexidine gluconate PVP-I is effective against all the virus species tested AEG: alkyldiaminoethylglycine hydrochloride BAC: benzalkonium chloride BEC: benzethonium chloride PVP-I had a wider virucidal spectrum, covering both enveloped and non-enveloped viruses, than the other commercially available antiseptics Kawana R, Kitamura T, Nakagomi O, Matsumoto I, Arita M, Yoshihara N, Yanagi K, Yamada A, Morita O, Yoshida Y, Furuya Y, Chiba S. Inactivation of human viruses by povidone-iodine in comparison with other antiseptics. Dermatology 1997;195(suppl 2):29-35

30 Efficacy of povidone-iodine for the prevention of common cold and influenza Comparison of absence rates due to common cold and influenza between: School A: 1 middle school where the PVP-I gargle was used School B: 7 middle schools where it was not Results: The absence rate due to common cold and influenza was significantly lower at the middle school where the use of the PVP-I gargle was encouraged as compared to those at middle schools where it was not (P<0.05) Encouragement of the use of the PVP-I gargle: proven significant decrease in absence rates due to common cold and influenza useful for the prevention of common cold and influenza Shiraishi T, et al. Dermatology 2002;204:

31 Vaccination 31

32 Type of Vaccine Available (1) Trade name Manufacturer Presentation Mercury content from thimerosal (µg Hg/0.5 ml) Ovalbumin content (µg/0.5ml) Age indications Inactivated influenza vaccine, quadrivalent (IIV4), standard dose Latex Route Fluarix Quadrivalent FluLaval Quadrivalent GlaxoSmithKline ID Biomedical Corp. of Quebec (distributed by GlaxoSmithKline) 0.5 ml singledose prefilled syringe 5.0 ml multidose vial yrs No IM < yrs No IM Fluzone Quadrivalent Fluzone Intradermal Quadrivalent Sanofi Pasteur Sanofi Pasteur 0.25 ml singledose prefilled syringe 0.5 ml singledose prefilled syringe 0.5 ml singledose vial 5.0 ml multidose vial 0.1 ml singledose prefilled microinjection system mos No IM 36 mos No IM 36 mos No IM 6 mos No IM yrs No ID** 32

33 Type of Vaccine Available (2) Inactivated influenza vaccine, trivalent (IIV3), standard dose. Afluria biocsl 0.5 ml single-dose prefilled syringe Fluvirin Fluzone Novartis Vaccines and Diagnostics Sanofi Pasteur 5.0 ml multidose vial 0.5 ml single-dose prefilled syringe 5.0 ml multidose vial 5.0 ml multidose vial <1 9 yrs No IM 24.5 <1 9 yrs via needle; years via jet injector No IM yrs Yes IM yrs No IM 25 6 mos No IM 33

34 Type of Vaccine Available (3) Inactivated influenza vaccine, cell-culture-based (cciiv3), standard dose Flucelvax Novartis Vaccines and Diagnostics 0.5 ml singledose prefilled syringe Inactivated influenza vaccine, trivalent (IIV3), high dose. 18 yrs Yes IM Fluzone High- Dose*** Sanofi Pasteur 0.5 ml singledose prefilled syringe Recombinant influenza vaccine, trivalent (RIV3), standard dose 65 yrs No IM FluBlok Protein Sciences 0.5 ml singledose vial 0 18 yrs No IM Live attenuated influenza vaccine, quadrivalent (LAIV4) FluMist Quadrivalent MedImmune 0.2 ml singledose prefilled intranasal sprayer <0.24 (per 0.2 ml) 2 49 yrs No IN 34

35 Vaccine Effectiveness Varies with: 1. Varies with characteristics of the person being vaccinated (such as their age and health) 2. Varies with the similarity or "match" between the flu viruses the flu vaccine is designed to protect against and the flu viruses spreading in the community 3. IF matches, 70 to 90% in those < 65; at best modest in those >65 35

36 Benefits of Flu vaccination Flu vaccination can keep you from getting sick from flu. Protecting yourself from flu also protects the people around you who are more vulnerable to serious flu illness. Flu vaccination can help protect people who are at greater risk of getting seriously ill from flu, like older adults, people with chronic health conditions and young children (especially infants younger than 6 months old who are too young to get vaccinated). Flu vaccination also may make your illness milder if you do get sick. Flu vaccination can reduce the risk of more serious flu outcomes, like hospitalizations Recent studies show vaccine can reduce the risk of flu illness by about 50-60% among the overall population 36

37 Vaccine composition in the 2015/16 season Trivalent Vaccine A/California/7/2009(H1N1)pdm09 A/Switzerland/ /2013 (H3N2) B/Phuket/3073/2013 Quadrivalent Vaccine B/Brisbane/60/2008 Both types are recommended for people six months of age or older. 37

38 Priority Groups Pregnant women elderly persons living in residential care homes Long stay residents of institutions for persons with disabilities Persons aged 50 years or above Persons with chronic medical problems Healtth care workers Children aged 6 months to 5 years Poultry workers Pig farmers and pig-slaughtering industry personnel 38

39 Dose and Schedule 9 years or above A single intramuscular injection Below 9 years (vaccine naïve) two doses with an interval of at least 4 weeks Below 9 years (had previous vaccination) one dose Below 3 years use half adult dose 39

40 Vaccine Precautions Local reaction (pain, swelling): 15-20% Systemic side effect (fever, malaise, myalgia): 1 10% Gullian-Barre syndrome : 1 to 2 cases per million Meningitis, encephalopathy : 1 in 3 million Anaphylaxis: 9 in 10 million Contraindicated in persons with severe egg allergy 40

41 Drug Treatment Antiviral Agent Activity Against Use Recommended For Not Recommended for Use in Oseltamivir (Tamiflu ) Influenza A and B Treatment Any age 1 N/A Chemo- prophylaxis 3 months and older 1 N/A Zanamivir (Relenza ) Influenza A and B Treatment 7 yrs and older people with underlying respiratory disease (e.g., asthma, COPD) 2 Chemo- prophylaxis 5 yrs and older people with underlying respiratory disease (e.g., asthma, COPD) 2 Peramivir (Rapivab ) Influenza A and B 3 Treatment 18 yrs and older N/A Chemo- prophylaxis N/A N/A Abbreviations: N/A = not applicable, COPD = chronic obstructive pulmonary disease. 41

42 Dosage Duration: The recommended duration of treatment is 5 days Dosage: Zanamivir. treatment : 2 inhalations (1 5-mg blister per inhalation for a total dose of 10 mg) twice daily (approximately 12 hours apart). chemoprophylaxis : 10 mg (2 inhalations) once a day. Oseltamivir. treatment: 75 mg B.D. chemoprophylaxis : 75 mg O.D. 42

43 Summary of Influenza Antiviral Treatment Recommendations early antiviral treatment can shorten the duration of fever and illness symptoms, and may reduce the risk of complications from influenza. Early treatment of hospitalized patients can reduce death. In hospitalized children, early antiviral treatment has been shown to shorten the duration of hospitalization. Clinical benefit is greatest when antiviral treatment is administered early, especially within 48 hours of influenza illness onset. Antiviral treatment is recommended as early as possible for any patient with confirmed or suspected influenza who: is hospitalized; has severe, complicated, or progressive illness; or is at higher risk for influenza complications 43

44 Persons at higher risk for influenza complications recommended for antiviral treatment include: children aged younger than 2 years; 1 adults aged 65 years and older; persons with chronic medical conditions; persons with immunosuppression, including that caused by medications or by HIV infection; women who are pregnant or postpartum (within 2 weeks after delivery); persons aged younger than 19 years who are receiving long-term aspirin therapy; persons who are morbidly obese (i.e., body mass index is equal to or greater than 40); and residents of nursing homes and other chronic care facilities. 44

45 Thank You! 45