Influenza

The currently available antiviral drugs rimantadine and amantadine are effective only for influenza A viruses. Another class of influenza antiviral drugs is the neuraminidase inhibitors, which selectively inhibit both influenza A and B viruses. Recent studies have found the neuraminidase inhibitors zanamivir and oseltamivir to be 67 - 82% effective in preventing laboratory-confirmed infection when administered as prophylaxis during the influenza season. As treatment, they reduce the duration of illness by 1 - 1.5 days when started within 36 - 48 h of illness onset. The reported adverse effects of these drugs are minimal, and unlike amantadine and rimantadine, the drugs do not appear to affect the central nervous system. Poor oral bioavailability and rapid renal clearance limit the use of zanamivir to inhalation and concern has been raised about its use in asthmatics. The sialic acid analogue, GS4071, has been shown to be a potent inhibitor of neuraminidase activity and is shown to be effective in controlling influenza, and its prodrug form - GS4104 (oseltamivir) can be given orally. Direct comparison of zanamivir and oseltamivir, their use for prophylaxis and treatment in high-risk groups, and evaluation of their cost effectiveness are all required before they enter routine clinical practice.     

Influenza

The currently available antiviral drugs rimantadine and amantadine are effective only for influenza A viruses. Another class of influenza antiviral drugs is the neuraminidase inhibitors, which selectively inhibit both influenza A and B viruses. Recent studies have found the neuraminidase inhibitors zanamivir and oseltamivir to be 67-82% effective in preventing laboratory-confirmed infection when administered as prophylaxis during the influenza season. As treatment, they reduce the duration of illness by 1-1.5 days when started within 36-48 h of illness onset. The reported adverse effects of these drugs are minimal, and unlike amantadine and rimantadine, the drugs do not appear to affect the central nervous system. Poor oral bioavailability and rapid renal clearance limit the use of zanamivir to inhalation and concern has been raised about its use in asthmatics. The sialic acid analogue, GS4071, has been shown to be a potent inhibitor of neuraminidase activity and is shown to be effective in controlling influenza, and its prodrug form--GS4104 (oseltamivir) can be given orally. Direct comparison of zanamivir and oseltamivir, their use for prophylaxis and treatment in high-risk groups, and evaluation of their cost effectiveness are all required before they enter routine clinical practice.     

大流行流感与甲型H1N1流感

目的对大流行流感和甲型H1N1进行综述。方法参考国内外近期的有关文献和WHO的相关报道,介绍了流感病毒的基本知识、大流行流感的定义和发展,以及甲型H1N1流感的特点和流行现状等。结果与结论大流行流感具有传播性强、危害大等特点,2009年的甲型H1N1流感为21世纪的第1次大流感,应加以重视。     

Influenza vaccine and adjuvant

Adjuvant is originated from the Latin word "adjuvare" which means "help" in English to enhance the immunological responses when given together with antigens. The beginning of adjuvant was mineral oil which enhanced the immune response when it was given with inactivated Salmonella typhimurium. Aluminium salt was used to precipitate diphtheria toxoid and increased level of antibody response was demonstrated when administered with alum-precipitated antigens. Since 1930, aluminium salt has been used as DTaP (diphtheria-tetanus-acellular pertussis vaccine) adjuvant. Many candidates were tested for adjuvant activity but only aluminum salt is allowed to use for human vaccines. New adjuvant MF59, oil-in-water emulsion type, was developed for influenza vaccine for elderly (Fluad) and series of AS adjuvant are used for hepatitis B, pandemic flue, and human papiloma virus vaccines. Oil-adjuvanted influenza pandemic vaccines induced higher antibody response than alum-adjuvanted vaccine with higher incidence of adverse events, especially for local reactions. Alum-adjuvanted whole virion inactivated H5N1 vaccine was developed in Japan, and it induced relatively well immune responses in adults. When it applied for children, febrile reaction was noted in approximately 60% of the subjects, with higher antibodies. Recent investigation on innate immunity demonstrates that adjuvant activity is initiated from the stimulation on innate immunity and/or inflammasome, resulting in cytokine induction and antigen uptake by monocytes and macrophages. The probable reason for high incidence of febrile reaction should be investigated to develop a safe and effective influenza vaccine.     

Influenza in The Netherlands

This paper reports on the occurrence of influenza and the associated burden of illness in The Netherlands. In addition, attention is paid to the effectiveness of vaccination vaccination status and the national strategy to raise the vaccination rate among risk groups. The incidence of influenza in the community appears to be 3 to 6 times higher than the incidence observed in general practice, since most cases do not present to the general practitioner (GP). Annually, 15,000 to 30,000 hospital admissions (1 to 2 per 1000 inhabitants) and 2000 to 2200 deaths (1.3 to 1.5 per 10,000), mostly among the elderly, are related to influenza. Vaccination has been shown to prevent about 50% of the influenza cases. Between 1991 and 1994 the vaccination rate among risk groups increased from 28 to 43%. In this period, a very active campaign was mounted. Much energy is being invested in further raising the vaccination rate among risk groups, with GPs holding a key position. In addition, the Dutch Health Council advises vaccination for persons > or = 65 years of age.     

甲型H1N1流感流行期间发热门诊的护理研究

目的探讨甲型H1N1流感流行期间发热门诊的护理管理。方法通过构建完全独立的发热门诊,制定完善的工作制度流程、并加强对医护人员的培训,实施规范化的管理,严格落实消毒隔离措施,并做好医护人员的防护。结果全部患者均主动愿意接受隔离,积极配合医院的工作,经治疗均有效治愈出院,无院内感染,无医护人员感染现象。结论在甲型H1N1流感流行期间采用相应的护理管理措施,能有效防控甲型H1N1流感的流行。     

Influenza vaccination rates among pharmacists

ObjectivesTo quantify influenza vaccination rates and determine perceived barriers to influenza vaccination among U.S. pharmacists from various practice settings.DesignProspective study.SettingUnited States in 2008.Participants1,028 respondents, including 895 pharmacists.InterventionA survey request was distributed manually at the 2008 National Community Pharmacists Association annual meeting, and an initial e-mail was sent with two follow-up e-mails to all pharmacists who receive e-mails via Pharmacist e-link.Main outcome measuresVaccination rates and barriers to vaccination among pharmacists.ResultsPharmacists reported an influenza vaccination rate of 78%, with coverage varying across practice settings: hospital (88%), academia (86%), clinic (83%), and community (75%). Employers infrequently required the influenza vaccine as a condition of employment (7%), and slightly more than one-half (58%) compensated pharmacists for being vaccinated; both of these were significantly associated with higher influenza vaccination rates (P < 0.001 for both). One-quarter of pharmacists (26%) expressed at least one issue regarding the influenza vaccine. Pharmacists were significantly less likely to be vaccinated if they expressed a concern (91% vs. 43%, P < 0.0001). Community pharmacists were significantly less likely to be compensated for receiving the influenza vaccination and significantly more likely to express one or more concerns than pharmacists from any other practice setting.ConclusionPharmacists reported high influenza vaccination rates overall, with slight variability among practice settings. Although employers infrequently required influenza vaccination, approximately one-half of employers compensated their pharmacists for being vaccinated. Employer incentives and pharmacist attitudes were highly correlated with influenza vaccination.     

The Clinical Diagnosis of Influenza

Summary

Effective management of influenza depends on early recognition of influenza in the community and on rapid diagnosis. Early recognition is achieved by integrated clinical and laboratory based surveillance programmes in representative populations. The recent introduction of 'near patient tests' for influenza provide increased opportunities for surveillance but diagnosis remains largely clinically based. The combination of cough and fever in conditions of known local influenza virus circulation provide a useful indicator of diagnosis to guide management.     

Influenza: Epidemiologie en preventie

The morbidity and mortality rates of influenza in The Netherlands are discussed. The great impact of influenza on public life is emphasised. The assignment to health authorities to combat the last modern plague influenza is corroborated by international and national influenza centres guided by theWho. The antigenic variation in manifestations of the influenza virus, the so-called recycling, and the relation between influenza A viruses of man and animals play the most important part in influenza epidemiology. The study of these aspects is stressed as being essential in finding an effective solution for the influenza problem. The composition of influenza vaccines is described and the currently available vaccines are compared. Future developments in and indications and contra-indications for influenza immunisation are discussed.Samenvatting Het ziektecijfer en de sterfte aan influenza in Nederland worden besproken. De grote invloed van influenza op de samenleving wordt benadrukt. Aan de opdracht aan gezondheidsautoriteiten tot bestrijding van de volksziekte influenza wordt meegewerkt door internationale en nationale centra onder leiding van deWho. De antigene wisselingen in verschijningsvorm, de zgn. kringloop, van het influenzavirus en de relatie tussen influenza A-virussen bij mens en dier speien de hoofdrol in de influenza-epidemiologie. Alleen het op de voet volgen van deze aspecten vormt momenteel een mogelijkheid tot effectieve bestrijding van influenza. De samenstelling van de influenzavaccins wordt aangegeven en de nu beschikbare vaccins worden opgesomd. Tevens wordt ingegaan op toekomstige ontwikkelingen in en de indicaties en contra-indicaties voor immunisatie tegen influenza.     

大流行流感疫苗研发问题

 自2003年以来,已有250多人感染H5N1禽流感,均导致了严重的疾病和/或50%以上死亡率.合法和非法的家禽流动可携带高致病性H5N1病毒跨越长距离,从而使病毒在宽广的地域中传播.除了疫苗接种者的免疫状况以外,疫苗类型、抗原含量、接种方式、接种剂次及佐剂的使用都将影响疫苗的免疫应答.政府、疫苗生产企业和研究机构应该联合起来进行基础研究和临床试验,以决定能诱导最适免疫应答的疫苗配方、浓度和接种剂次.急需抓紧时间制备合适的大流行流感疫苗.