Influenza Update:
The 2005-06 Season

Sports Medicine Rounds

January 26, 2006

Paul W. Baumert, Jr. M.D., FAAFP

Staff Physician, SHS

Outline

•      Clinical

•      2005-06 Seasonal influenza

•    US

•    Iowa/UI

•      Avian influenza

•      Pandemic influenza

•      Questions

Influenza (“the flu”)

•      Contagious, respiratory illness

•      Typically lasts days

•      Incubation period is 1-4 days

•      Infectious from the day before symptoms begin through about 5 days after illness onset

Symptoms of Influenza

•      Fever (usually high)

•       Headache

•       Malaise (can be extreme)

•      Body aches

•       (Diarrhea/vomiting can occur, but more common in kids)

•      Cough (nonproductive)

•       Sore throat

•       Runny or stuffy nose

Morbidity/mortality

•      Risks higher for:

•    Young children, esp. <1 year

•    Persons > 65 years of age

•    Underlying medical conditions

•      114,000 hospitalizations per year

•      36,000 deaths annually

Possible complications in athletes

•      Bacterial pneumonia

•      Sinus/ear infections

•      Dehydration

•      Worsening of other chronic medical problems

•     Asthma

•     Diabetes

•      Increased risk during pandemics

Diagnosis of influenza

•      Clinical

•      Tests

•    Rapid testing

•   Affects treatment

•    Culture

•    Serology

•    Chest xray

Important warning signs

•      Difficulty breathing or shortness of breath

•      Pain or pressure in the chest or abdomen

•      Sudden dizziness

•      Confusion

•      Severe or persistent vomiting

Medication for influenza

•      Antiviral medications for type A influenza only:

•    Amantadine (Symmetrel)

•    Rimantadine (Flumadine)

•      Antiviral medications for both type A and B:

•    Oseltamivir (Tamiflu)

•    Zanamivir (Relenza)

Medication for influenza

•      If given for treatment:

•    Most helpful if given within the first 48 hours of symptoms

•    5 day regimen

•      If given for prophylaxis:

•    7 day regimen

If you get influenza:

•      Rest

•      Fluids

•      Avoid alcohol/tobacco

•      Habits for good health

•    Cover your nose/mouth

•    Don’t touch eyes/nose/mouth

•    Wash hands/hand sanitizers

•    Stay away from others

Prevention of influenza

•      Inactivated vaccine

•      Live, attenuated vaccine (FluMist)

2005-2006 Flu season at UI

•      10/24/05:  First training room flu vaccine clinic (Jacobsen Athletic Building)

•      FluMist nasal vaccine used as primary immunization due to initial supply issues at UIHC

2005-2006 Flu season at UI

•      12/05/05:  First reported case of influenza in the state of Iowa

•      12/15/05:  First reported case of influenza in Johnson County (UI athlete).

•    Sx’s began 12/11/05

•    Received nasal vaccine 10/24/05

2005-2006 Flu season at UI

•      12/16/05

•    Tamiflu prophylaxis of roommates/close contacts of the UI athlete

•    End of semester.  Vectors for possible campus-wide transmission disperse.

2005-2006 Flu season at UI

•      12/17/05

•    Tamiflu prophylaxis of unvaccinated athletes scheduled to travel to Tampa.

•      12/18/05

•    Influenza testing performed on 2 symptomatic athletes.

•      Results are NEGATIVE.

2005-2006 Flu season at UI

•      1/17/06:  Spring semester begins.  Vectors for possible transmission return.

•      1/25/06:  A number of flu-like illnesses are seen on campus.  No new influenza cases in the UI student population.

•      Personal/family experience

2005-2006 Flu season at UI

•      1/25/06:  IDPH reports 60 confirmed cases of influenza to date.  Reports of some class/school outbreaks within the state this week.  Iowa will be upgraded to “widespread” soon.

•      ??????

2005-2006 Flu lessons to date

•      Vaccine supply still an issue

•    Few manufacturers

•      No flu vaccine is perfect

•    70-90% effective at best

•      Tamiflu supply limited

•    Threat of avian flu pandemic

•    No other choices this year

•   CDC 1/14/06

Terminology

•      Avian (bird) flu

•    Caused by avian influenza viruses, which occur naturally among birds

•      Pandemic flu

•    Global outbreak when a new influenza A virus causes serious human illness and spreads easily from person to person

Stages of a Pandemic

•      Phase 1:  No new influenza subtypes detected in humans

•      Phase 2:  Same, but a circulating animal subtype poses a substantial risk.

•      Phase 3:  Human infections with a new subtype occur, but no human-to-human spread

Stages of a Pandemic (con’t)

•      Phase 4:  Highly localized, human-to-human spread.  Virus still not well adapted.

•      Phase 5:  Larger clusters.  Virus better adapted, may not be fully transmissible.

•      Phase 6:  Increased and sustained transmission in the general population.

Novel influenza strains

•      Increased virulence

•    Viremia higher and faster

•    “Cytokine storm”

•      Will affect non-respiratory tract body systems

•      Vaccine will be a non-player

•      Tamiflu will play little role

•      The KEY: Be prepared

Resources

•       http://www.cdc.gov/flu/

•       http://www.cdc.gov/flu/references.htm

•       http://www.cdc.gov/flu/weekly/usmap.htm

•       http://www.idph.state.ia.us/adper/common/pdf/flu/flu_map_05_06.pdf

•       http://www.pandemicflu.gov/plan/pdf/Individuals.pdf