Systemic Hi Disease in Childrens Hospital

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• Treatment Care

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• Avian Flu

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Influenza
Influenza A - most common - humans
animals (avian swine) - related with
pandemic Influenza B - less common - only
human - mild diseases Influenza C - very mild
diseases - not significant
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History of Human Avian-Flu
Year country strain
outcome (case/death)
1997 Hong Kong H5N1 18/6 1999 Hong
Kong H9N2 2/0 2003 Netherland H7N7
83/1 2003 Hong Kong H5N1
2/1 2004 Vietnam H5N1
18/6 2004 Thailand H5N1 3/2
28 Jan 2004
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Clinical Forms of Human Avian-Flu
1. Asymptomatic 2. Mild URI 3. Severe
pneumonia 4. Multiple organ failure (CID 2002
34558-564)
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Clinical Features of Human Avian-Flu
Fever Conjunetivitis Headache Diarrhea Malaise
Myalgia Severe Pneumonia Sorethroat ARDS Cough
Organ failure Runny rose
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Laboratory Diagnostic Procedure for Influenza
(Including Avian-Flu)
Procedure Specimen Time Viral culture NP
Swab, nasal wash 5-10 d bronchial wash,
sputum TSC IFA staining (same) 2-4
hr. EIA (same) 2 hr. Rapid
Test (same) lt 30 min (Directigen Flu
A) Serology Paired serum gt 14 d.
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Treatment of Avian-Flu
1. Supportive care - Ventilator support when
needed 2. Antiviral agents eg. Amantadine,
Rimantadine, Zanamivir, Oseltamivir etc
(Antiviral agents is the most effective when
given within 2 days of onset, but dont know in
Avian Flu)
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Antiviral Agents for Influenza Rx
1. Adamantanes derivative (for influenza A) -
Amantadine ( gt 1 y.o.) - Rimantadine ( gt 13
y.o.) 2. Neuranimidase inhibitors (for influenza
AB) - Zanamivir ( gt 7 y.o.) inhaled
powder - Oseltamivir ( gt 1 y.o.)

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Indication for Antiviral Therapy in Influenza
1. patient who tend to have severe
complication 2. healthy children with severe
illness 3. people with special environmental,
family, social situation for which onging
illness would be detrimental
(data from human influenza) (Red Book 2003
384-5)
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Limitation of Antiviral Agents
1. effective within 48 hr. of onset 2. decreased
duration of symptoms by 1-2 d. 3. decreased viral
population (data from human
influenza) (Red Book 2003 384-5)
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Antiviral Drug for Influenza
Amantadine Rimantadine Zanamivir
Oseltamivir
Virus A A A and B A and
B Administration Oral
Oral Inhalation
Oral Treatment gt1 y of age gt13 y
of age gt7 y of age gt1 y of age
indications1 Prophylaxis gt1 y of age
gt1 y of age Not licensed gt13 y of age
indications1 Adverse effects Central nervous
Central nervous Bronchospasm Nausea,
system, anxiety system, anxiety
vomiting
1 Licensed ages.
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Daily Dosage Oseltamivir (Tamiflu) in Children
For Prophylaxis and
Treatment Weight lt 15 kg Oseltamivir 30 mg,
bid x 5d. 16-23 kg Oseltamivir 45 mg, bid x
5d. 24-40 kg Oseltamivir 60 mg, bid x 5d. gt
40 kg Oseltamivir 75 mg, bid x 5d.
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Treatment Recommended for Severe Avian-Flu
1. Ventilator - high frequency 2. Antivirus -
oseltamivir
Treatment Not Recommended for Severe Avian-Flu
1. Steriod 2. Antivirus - ribavirin (IV, PO) 3.
Aerosolized medication
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Prophylaxis of Avian Flu
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Antiviral Agents Chemoprophylaxis
70-90 efficacy in clinical illness asymptomatic
infection can occur amantadine rimantadine
prevention in children gt 1 y.o. oseltamivir
prevention in children gt 13 y.o. chemoprophylaxis
vaccine - no interfere with immune response
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Vaccine for Avian-Flu
Influenza vaccine do not protection against
H5N1 No H5N1 vaccine available Vaccine
composition change every year (antigenic drift)
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Prevention of Avian-Flu for Health Care Worker
Same as SARS measure 1. Isolation
room 2. PPE (as SARS is more than enough) 3.
disinfectants of material
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Risk of H5N1 Infection among HCWs Exposed to H5N1
patients, HK.
Characteristics Exposed Non-Exposed
P (N217) (N309)
Median age 30 29 0.1 No ()
of nurses, 171 (79) 234 (76)
0.2 doctor No () with 121 (56) 190 (61)
0.2 poultry exposure No () H5N1 8 (4)
2 (0.7) 0.01 antibody-positive
(JID 2000 181344-8) all were contact without
protection because late diagnosis and severe
illness 2 cases of seroconversion
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Prevalence of H5 antibody-positive individuals in
cohorts, stratified by poultry exposure
No. of antibody-positive
individuals/total () Exposed
Not exposed Cohort n
to poultry to poultry P
Household contacts 45a 5/24 (21)
1/21 (5) .13 Tour group members 26
1/16 (6) 0/10 (0)
.62 Coworkers exposed 23 0/9
(0) 0/14 (0) NA Not exposed
24 0/3 (0) 0/21 (0)
NA
(JID 1999 1801763-70)
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Factors Influenzing HCW AcquiredH5N1 from Patient
1. Severity of patient - quantity of virus 2. No.
of days from admission to diagnosis 3. Infection
- control practice - droplet precaution
(human to human unlikely to occur, if occur it
is asymptomatic)
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Influenza Pandemics -could it occur ?
Pandemic influenza 3-4 times/century (1st
1918-1919 2nd 1957-1958 3rd
1968-1969) more human infected with human (H1,
H2, H3) and avian influenza mixing
vessel pandemic expert suspect pandemic occur
soon
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Thank you