HERIBERTO SEDENO, M.D. LECTURE ON INFLUENZA

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Influenza is a potentially severe acute respiratory illness caused by various strains of the influenza virus. The different strains all produce characteristic symptoms, and because major outbreaks are associated with increased mortality, occurrences can be identified in history.

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HERIBERTO SEDENO, M.D. LECTURE ON INFLUENZA

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INFLUENZA Influenza is a potentially severe acute respiratory illness caused by various strains of the influenza virus. The different strains all produce characteristic symptoms, and because major outbreaks are associated with increased mortality, occurrences can be identified in history. Outbreaks consistent with influenza can be traced back at least to the court of Elizabeth I. Some have speculated that the Plague of Athens described by Thucydides was influenza complicated by bacterial superinfection. The influenza syndrome, commonly known as the flu, with its fever, cough, rapid onset and body aches, is not only typical enough to be recognized in the past, but it also allows physicians to recognize it,

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especially when it is known that the virus is circulating. Unfortunately, death is the other consistent phenomena associated with influenza. Mortality statistics are the principal way the intensity of an influenza outbreak is quantified, and are so characteristic that viral identification of etiology is not required. PREVENTION AND CONTROL OF INFLUENZA A vaccine for the prevention of influenza was developed during World War II in order to maintain military readiness. This was done in recognition of the high morbidity that could result among troops exposed to the virus. A similar inactivated vaccine is still in use, improved in both potency and lack of side effects.

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It is known to be 70 to 90 percent efficacious in healthy young adults as long as the vaccine viruses resemble those circulating. This necessitates updating the viruses in the vaccine each year. For this and other reasons, the vaccine must be given annually. Since vaccination programs must be sustained, the goal in most countries has been to reduce influenza mortality by vaccinating older individuals and those with chronic underlying diseases. An exception to this has been Japan, where, for a time, school-age children were vaccinated in an effort to control influenza morbidity. It has been repeatedly demonstrated that the inactivated vaccine is effective in preventing hospitalization and death in older individuals and,

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as such, is also cost effective. The inactivated vaccine is cost effective in healthy adults only when the attack rates are above 12 percent. A live attenuated influenza vaccine has been used in the former Soviet Union for many years, and another is in development in the United States. Because of its delivery—intranasally rather than by injection—it may prove to be particularly useful in children and younger adults. Antiviral drugs have been available both for treatment and prophylaxis. Two of these are active only against type A viruses. A new group of drugs, acting as neuraminidase inhibitors, is active against both type A and B viruses.

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These drugs have been shown to have a prevention efficacy similar to vaccines. They start protecting more quickly than the vaccine, but have to be taken daily to continue protection. Therefore, vaccination will continue to be the usual means of prophylaxis.The neuraminidase inhibitors also significantly shorten the duration of illness, reducing severity and preventing complications. Influenza can be debilitating, even in the absence of complications, so that the drugs will be used for treatment during defined influenza outbreaks. They are likely also to be useful prophylactically, especially for outbreak control in nursing homes.

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