Influenza virus: Clinical manifestations, Complications, Diagnosis, Treatment and Preventio

Influenza virus: Clinical manifestations, Complications, Diagnosis, Treatment and Prevention

Q. 1 In India facilities for isolation of influenza virus are available at all the following institutes EXCEPT:
 A Haffkine Institute, Mumbai
 B Pasture Institute Coonor, South India
 C All India Institute of Medical Sciences, New Delhi
 D All India Institute of Hygiene and Public Health, Kolkata.
Q. 1 In India facilities for isolation of influenza virus are available at all the following institutes EXCEPT:
 A Haffkine Institute, Mumbai
 B Pasture Institute Coonor, South India
 C All India Institute of Medical Sciences, New Delhi
 D All India Institute of Hygiene and Public Health, Kolkata.
Ans. D

Explanation:

(A.I Institute of Hygiene and Public Health, Kolkata)

In India, facilities for isolation of influenza virus are available at the following institutes:

1. Govt. of India, Influenza Centre, Pasture Institute, Coonor, South India

2. Haffkine Institute, Mumbai

3. School of Tropical Medicine, Kolkata

4. All India Institute of Medical Sciences, New Delhi

5. Vallabhai Patel Chest Institute, Delhi

6. Armed Forces Medical College, Poona


Q. 2

As per the WHO, H1NI influenza pandemic is in which of the phase descriptions?

 A

phase 3

 B

phase 4

 C

phase 5

 D

phase 6

Q. 2

As per the WHO, H1NI influenza pandemic is in which of the phase descriptions?

 A

phase 3

 B

phase 4

 C

phase 5

 D

phase 6

Ans. D

Explanation:

In the 2009 revision of the phase descriptions, WHO has retained the use of a six-phased approach for easy incorporation of new recommendations and approaches into existing national preparedness and response plans.

Phase 1 no viruses circulating among animals have been reported to cause infections in humans.

In Phase 2 an animal influenza virus circulating among domesticated or wild animals is known to have caused infection in humans, and is therefore considered a potential pandemic threat.

In Phase 3, an animal or human-animal influenza reassortant virus has caused sporadic cases or small clusters of disease in people, but has not resulted in human-to-human transmission sufficient to sustain community-level outbreaks. Limited human-to-human transmission may occur under some circumstances, for example, when there is close contact between an infected person and an unprotected caregiver

Phase 4 is characterized by verified human-to-human transmission of an animal or human-animal influenza reassortant virus able to cause “community-level outbreaks.” Phase 4 indicates a significant increase in risk of a pandemic but does not necessarily mean that a pandemic is a forgone conclusion.

Phase 5 is characterized by human-to-human spread of the virus into at least two countries in one WHO region. While most countries will not be affected at this stage, the declaration of Phase 5 is a strong signal that a pandemic is imminent.

Phase 6, the pandemic phase, is characterized by community level outbreaks in at least one other country in a different WHO region in addition to the criteria defined in Phase 5. Designation of this phase will indicate that a global pandemic is under way.

Ref: http://www.who.int/csr/disease/swineflu/phase/en/


Q. 3

There has been an outbreak of H1N­1 influenza in your locality. You are the medical officer of the health centre. A 11 month old child of a woman, who had died due to H1N1 has been brought to you with symptoms of URTI. Which of the following is the appropriate antiviral regime of the child?

 A

Oseltamivir 3 mg/kg BID x 5 days

 B

Oseltamivir 2 mg/kg BID x 5 days

 C

Zanamivir 10 mg BID x 5 days

 D

Zanamivir 5mg BID x 5 days

Q. 3

There has been an outbreak of H1N­1 influenza in your locality. You are the medical officer of the health centre. A 11 month old child of a woman, who had died due to H1N1 has been brought to you with symptoms of URTI. Which of the following is the appropriate antiviral regime of the child?

 A

Oseltamivir 3 mg/kg BID x 5 days

 B

Oseltamivir 2 mg/kg BID x 5 days

 C

Zanamivir 10 mg BID x 5 days

 D

Zanamivir 5mg BID x 5 days

Ans. A

Explanation:

Zanamivir is indicated in individuals > 5 year of age only. The dose is 5 mg inhalation (twice) two times a day for 5 days.

 
The dosage of Oseltamivir for children
0 – 1 month of age               2 mg/kg BID x 5 days
>1 month – 3 months       2.5 mg/kg BID x 5 days
> 3 month – 1 year          3 mg/kg BID x 5 days
 
Ref: Park, 21st Edition, Page 148.

Q. 4

Recommended dose of Oseltamavir for a 9 month old baby for treating swine flu is:

 A

2 mg/ kg twice daily for five days

 B

2.5 mg/ kg twice daily for five days

 C

3 mg/ kg twice daily for five days

 D

3.5 mg/ kg twice daily for five days

Q. 4

Recommended dose of Oseltamavir for a 9 month old baby for treating swine flu is:

 A

2 mg/ kg twice daily for five days

 B

2.5 mg/ kg twice daily for five days

 C

3 mg/ kg twice daily for five days

 D

3.5 mg/ kg twice daily for five days

Ans. C

Explanation:

Recommended dose of Oseltamavir:

  age   dose
  0-1 month   2 mg/ kg twice daily for five days
  >1-3 month   2.5 mg/ kg twice daily for five days
  3-12 month   3 mg/ kg twice daily for five days

For infants older than 1 year of age and for children 2 to 12 years of age recommended doses are as follows:

15kg or less – 30 mg orally twice a day for 5 days

 
15-23 kg -45 mg orally twice a day for 5 days

24-40 kg – 60 mg orally twice a day for 5 days

>40kg – 75 mg orally twice a day for 5 days  

Ref: Park’s textbook of Preventive and Social Medicine, 21stedition, page-148


Q. 5

Influenza vaccines is administered

 A

Subcutaneosly

 B

Intradermal

 C

Nasal drops

 D

a and c

Q. 5

Influenza vaccines is administered

 A

Subcutaneosly

 B

Intradermal

 C

Nasal drops

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Subcutaneously; ‘c’ i.e., Nasal drops

  1. Prevention of influenza

1. Immunization

Three types of vaccines are available :most commonly used                    

   • Used subcutaneously Administered as nasal drops

a)  Split virus vaccine ( sub-virion vaccine)

b)  Recombinant vaccine

c)  Neuraminidase vaccine

2. Chemoprophylaxis

Type A                                  Amantadine and rimantidine

Both Type A & B                —> Zamamivir, Osteltamivir


Q. 6

Avian influenza is treated by-

 A

Amantadine

 B

Ribavarin

 C

Interferon

 D

Oseltamivir

Q. 6

Avian influenza is treated by-

 A

Amantadine

 B

Ribavarin

 C

Interferon

 D

Oseltamivir

Ans. D

Explanation:

Ans. is ‘d’ i.e., Oseltamivir

o Avian influenza or bird flu is a contagious disease of animal caused by viruses that normally infect only birds and less commonly pigs.

o On rare occaions, avian influenza viruses cross the species barrier to infect humans.

o Two drugs are commonly used for avian influenza :- i) Oseltamivir, ii) Zonamivir

o Both of these are neuraminidase inhibitors.


Q. 7

Newer Influenza vaccine –

 A

Split-virus vaccine

 B

Neuraminidase 

 C

Live attennuated vaccine

 D

a and b

Q. 7

Newer Influenza vaccine –

 A

Split-virus vaccine

 B

Neuraminidase 

 C

Live attennuated vaccine

 D

a and b

Ans. D

Explanation:

Ans. is ‘a’ i.e., Split-virus vaccine & ‘b’ i.e., Neuraminidase 


Q. 8

Swine Flu pandemic in 2009 was caused due to which strain:      

September 2010

 A

H1N1

 B

H3N1

 C

H5N1

 D

H7N1

Q. 8

Swine Flu pandemic in 2009 was caused due to which strain:      

September 2010

 A

H1N1

 B

H3N1

 C

H5N1

 D

H7N1

Ans. A

Explanation:

Ans. A: H1N1

Swine flu is also known as swine influenza, hog flu and pig flu.

In 2009 the media labeled as “swine flu” the flu caused by 2009’s new strain of swine-origin A/H1N1 pandemic virus just as it had earlier dubbed as “avian flu” flu caused by the recent Asian-linage HPAI (High Pathogenic Avian Influenza) H5N1 strain that is still endemic in many wild bird species in several countries.


Q. 9

True about influenza ‑

 A

Incubation period 2-3 weeks

 B

Most infections are subclinical

 C

Type-A virus causes Reye’s syndrome

 D

Pandemic is caused by Type-B virus

Q. 9

True about influenza ‑

 A

Incubation period 2-3 weeks

 B

Most infections are subclinical

 C

Type-A virus causes Reye’s syndrome

 D

Pandemic is caused by Type-B virus

Ans. B

Explanation:

Ans. is ‘b’ i.e., Most infections are subclinical

Influenza

  • Influenza virus a RNA virus, belongs to orthomyxovirus.
  • There are three viral subtypes : i) Type A (causes all pandemics and most epidemics); type B; and type C (not circulating currently).
  • Currently the influenza viruses circulating in the world are : 111 N, of type A (causes swine flu); H2 N2 of type A; H3 N2 of type A ; H5 NI of type A (causes birdflu or avian influenza); H7 N9 of type A (caused epidemic of avian influenza in China in 2013); and type B.
  • Influenza shows cyclic trend with epidemic occuring every 2-3 years in case of influenza – A and every 4-7 years in case of influenza-B. Pandemics are caused by only influenza – A every 10-15 years.
  • Influenza affects all ages and both sexes.
  • Source of infection of influenza is a clinical case or subclinical case.
  • Major reservoir of influenza virus exists in animal and birds.
  • Incubation period is 18-72 hours. Most of the infections are subclinical. Clinical cases present with cough, fever, myalgia and headache.

Q. 10

In a child who is allergic to egg, which vaccine should be avoided ‑

 A

Measles

 B

MMR

 C

Influenza

 D

DPT

Q. 10

In a child who is allergic to egg, which vaccine should be avoided ‑

 A

Measles

 B

MMR

 C

Influenza

 D

DPT

Ans. C

Explanation:

Ans. is ‘c’ i.e., Influenza


Q. 11

A pandemic of H1N1 is suspected when?

 A

Cases occur within 2 weeks period

 B

Cases are spread over 5 or more cities

 C

At least one or more laboratory confirmed H1N1 case

 D

25 or more people are affected

Q. 11

A pandemic of H1N1 is suspected when?

 A

Cases occur within 2 weeks period

 B

Cases are spread over 5 or more cities

 C

At least one or more laboratory confirmed H1N1 case

 D

25 or more people are affected

Ans. B

Explanation:

Ans. b. Cases are spread over 5 or more cities


Q. 12

School closure is recommended during an outbreak of swine flu. All of the following support this except:

 A

Closure of school will not lead to reduction in contact between children

 B

Children are the most common affected population by swine flu

 C

Increased rates of transmission due to more opportunities for contact

 D

Playing together of students increases transmission

Q. 12

School closure is recommended during an outbreak of swine flu. All of the following support this except:

 A

Closure of school will not lead to reduction in contact between children

 B

Children are the most common affected population by swine flu

 C

Increased rates of transmission due to more opportunities for contact

 D

Playing together of students increases transmission

Ans. A

Explanation:

Ans. a. Closure of school will not lead to reduction in contact between children

It was estimated that school holidays reduced the reproduction number of Influenza H1N1 by 14-27% in different regions of India, relative to levels seen outside holiday periods. This work reinforces studies showing the significant impact of school holidays on spread of pandemic influenza virus, and by inference the role of contact patterns in children on transmission.’- http://www.ncbi.nlm.nih.gov/pubmed/24267871 Transmission dynamics of the 2009 influenza A (H1N1) pandemic in India: the impact of holiday-related school closure. J Epidemics


Q. 13

A 70-year-old female suffered from an attack of influenza but refused to take the vaccine. She subsequently developed pneumonia and died in 5 days. What is the most common cause of post-influenza pneumonia?

 A

Staphylococcus aureus

 B

Legionella pneumophila

 C

Measles

 D

Cytomegalovirus

Q. 13

A 70-year-old female suffered from an attack of influenza but refused to take the vaccine. She subsequently developed pneumonia and died in 5 days. What is the most common cause of post-influenza pneumonia?

 A

Staphylococcus aureus

 B

Legionella pneumophila

 C

Measles

 D

Cytomegalovirus

Ans. A

Explanation:

Ans. a. Staphylococcus aureus

Staphylococcus aureus is the most common cause of post-influenza pneumonia.

`Secondary Bacterial Pneumonia follows Acute Influenza: Improvement of the patient’s condition over 2-3 days is followed by a reappearance of fever along with clinical signs and symptoms of bacterial pneumonia, including cough, production of purulent sputum, and physical and x-ray signs of consolidation. The most common bacterial pathogens in this setting are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae— organisms that can colonize the nasopharynx and that cause infection in the wake of changes in bronchopulmonary defenses

Secondary Bacterial Pneumonia follows Acute Influenza

  • Improvement of the patient’s condition over 2-3 days is followed by a reappearance of fever along with clinical signs symptoms of bacterial pneumonia, including cough, production of purulent sputum, and physical and X-ray of consolidation.
  • The most common bacterial pathogens in this setting are Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae organisms that can colonize the nasopharynx and that cause infection in the wake of changes in bronchopulmonary defenses
  • Theetiology can often be determined by Gram’s staining and culture of an appropriately obtained sputum specimen.
  • Secondary bacterial pneumonia occurs most frequently in high-risk individuals with chronic pulmonary and cardiac disease and in elderly individualsQ.
  • Patients with secondary bacterial pneumonia often respond to antibiotic therapy when it is instituted promptly

Q. 14

Influenza vaccine cause ‑

 A

Local swelling

 B

Fever

 C

Itching

 D

All of above

Q. 14

Influenza vaccine cause ‑

 A

Local swelling

 B

Fever

 C

Itching

 D

All of above

Ans. D

Explanation:

Ans. is ‘d’   i.e., All of above

Mild problems following inactivated flu vaccine:

  • Soreness, redness, or swelling where the shot was given
  • Hoarseness
  • Sore, red or itchy eyes
  • Cough
  • Fever
  • Aches
  • Headache
  • Itching
  • Fatigue
  • If these problems occur, they usually begin soon after the shot and last 1 or 2 days.

Moderate problems following inactivated flu vaccine:

  • Young children who get inactivated flu vaccine and pneumococcal vaccine (PCV13) at the same time may be at increased risk for seizures caused by fever. Ask your doctor for more information. Tell your doctor if a child who is getting flu vaccine has ever had a seizure.

Problems that could happen after any vaccine:

  • Brief fainting spells can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes can help prevent fainting, and injuries caused by a fall. Tell your doctor if you feel dizzy, or have vision changes or ringing in the ears.
  • Severe shoulder pain and reduced range of motion in the arm where a shot was given can happen, very rarely, after a vaccination.
  • Severe allergic reactions from a vaccine are very rare, estimated at less than 1 in a million doses. If one were to occur, it would usually be within a few minutes to a few hours after the vaccination.


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