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INFLUENZA & IMMUNISATION (TRUTHS AND MYTHS (MYTH: You can catch a cold…
INFLUENZA & IMMUNISATION
PREVENTION
Wash and dry hands
thoroughly
or use hand sanitiser before touching your mouth, nose, or eyes
Annual immunisation prior to or during the influenza season is recommended for everyone who can be vaccinated. The vaccine is funded for people most at risk who include:
Children aged 4 years or under who have been hospitalised for asthma or other breathing conditions.
Pregnant women
People aged 65 years or older
People with existing medical conditions such as heart or lung conditions.
Use disposable tissues - one blow and throw the tissue away.
Cover coughs and sneeze with a disposable tissue, or, if no tissues are available, cough or sneeze into the inside of your elbow.
Regularly clean flat surfaces, door handles, light switches, bathroom sinks, and taps.
Stay at home if you are sick.
Two funded quadrivalent influenza vaccines for 2019:
INFLUVAC TERTRA - for adults and children aged 3 years or older
FLUARIX TETRA - for children aged under 3 years
Vaccination is effective in preventing 70-90% of influenza in adults.
In order to be effective, the vaccine must be given in the autumn before exposure occurs.
Common responses
:
Mild pain, redness, and swelling around injection site
Feeling unwell or tired
Fever
Muscle pain
As with any medication, very rarely anaphylaxis can occur following immunisation.
Influenza virus
Symptoms may include
Fever - can last 3-5 days
Some patients, particularly older adults, experience weakness that persists for weeks.
Cough - can last for two or more weeks
In uncomplicated cases, symptoms subside within 7 days.
The onset of influenza is typically abrupt with systemic symptoms of
cough, fever, and myalgia often accompanied with a headache and sore throat.
DX
Most diagnosis are based on symptoms
laboratory - usually from PCR testing of secretions from nasopharyngeal swab - samples should be collected within first 4 days of illness
Can be difficult to diagnosis
Important to consider:
Patients health history, clinical findings, and presence of other cases of influenza in the community.
Transmission
Transmitted among people by
direct contact
or by
inhalation
of droplets when coughing, laughing sneezing, or talking.
The influenza virus enters the upper airways from airborne secretions of an infected individual. If the virus is not immobilised by the inflammatory and immune systems, it invades the respiratory tract lining and proliferates.
Can generally spread to others up to 6 feet away.
Complication
The most common complication of influenza is
pneumonia
.
Patients who develop secondary bacterial pneumonia often experience a gradual improvement of influenza symptoms, then worsening cough and purulent sputum.
Treatment with antibiotics can be effective if started early. It is important to recognise that the infleunza alone, and also combined with complications such as pneumona can be
deadly.
ANAPHYLXIS
Defined as a hypersensitivity (allergic) reaction to a sensitising substance.
Anaphylactic shock is an acute, life-threatening hypersensitivity.
This reaction quickly causes
massive vasodilation
, release of vasoactive mediators and an increase in capillary permeability. This
increase in capillary permeability
causes
fluid to leak from the vascular space into the interstitial space
Vascular space:
relates to blood vessels, including the arteries and veins.
Interstitial space:
Surrounds tissue cells filled with interstitial fluid which allows for the movement of ions, proteins, and nutrients across the cell wall.
Severe cases of anaphylaxis may result in hypovalemic shock because of the loss of intravascular fluid into interstitial spaces.
If shock is not treated immediately, the body cannot compensate for long and irreversible tissue damage will occur, leading to death.
Anaphylactic shock can
result
in massive respiratory distress due to laryngeal oedema or severe bronchospasm, and circulatory failure due to vasodilation.
TRUTHS AND MYTHS
MYTH: You can catch a cold from the influenza vaccine. In order for the vaccination to be successful, it must be given prior to or at the beginning of winter. This is when there are many common colds circulating through communities. If you get sick following the influenza immunisation this is just a coincidence and you would have got this cold whether you had the influenza immunisation or not.
MYTH: You shouldn't get the cold if they have the influenza vaccination - immunising against the common cold would be impossible as there are far too many strands.
TRUTH: If you are unlucky enough to acquire influenza - the severity of symptoms and complications will be much less if you have been immunised.
TRUTH: Pregnant women with influenza are more likely to develop complications including pneumonia, and are more likely to be admitted to hospital, ICU, and
die
from influenza than women who are not pregnant.
TRUTH: Influenza can develop into pneumonia, encephalitis (brain inflammation), septicaemia, labour and/or delivery problems, croup, bronchiolitis, heart failure, and death.
TRUTH: If you feel unwell following the influenza immunisation this is actually a good thing because it is suggesting that your body has recognised bacteria has entered the system and effectively destroying it.
MYTH: The flu is just a bad cold. Influenza may cause
bad cold symptoms
but they are different and the influenza results in deaths and hospitalisations.
Useful facts
Immunisation is the best protection against influenza, even if you still catch influenza after immunisation, your symptoms are much
less severe
Health care workers are
twice as likely
to have influenza than non-health care workers
4 out of 5 people infected show
no symptoms
of influenza making it be very easily spread among family, co-workers, classmates, and patients without realising.
There are three main groups of the influenza viruses -
A, B, and C.
Type A is most prevalent.
It is important to educate people on the seriousness of the infleunza and how this is
different
to the common cold or flu. It is also vital to note the cold/flu
is not
the influenza and using these terms interchangeable should stop to minimise confusion.
RECOGNISING AND TREATING ANAPHYLATIC SHOCK
The patient will have a
sudden
onset of symptoms, including dizziness, chest pain, incontinence, decreased HR, decreased B/P, swelling of the lips or tongue, wheezing and stridor.
A patient can have a severe allergic reaction, possibly leading to anaphylactic shock following contact, inhalation, ingestion, or injection with an antigen.
Management of anaphylactic shock:
1) recognition of signs and symptoms of anaphylactic reaction
2) maintenance of a patent airway
3) prevention of spread of the allergen by using a tourniquet and stopping treatment if applicable.
4) Administration of drugs
Adrenaline
is the drug of choice
For the treatment of acute allergic reactions, life-threatening angioneurotic oedema, and anaphylactic shock resulting from reactions to drugs, animal serums, insect stings and other allergens.
For
IM
use only. In emergency situations, adrenaline may be injected
very slowly intravenously
but only as a dilute solution of
1: 10,000
as opposed to 1: 1,000.
Vasodilators
can counteract the effects of adrenaline.
MOA:
Adrenaline is a direct-acting sympathomimetic agent exerting effect of alpha and beta adrenoreceptors.
Adrenaline is rapidly distributed to the
heart, spleen, several glandular tissues, and adrenergic nerves.
Onset of action: rapid and the half-life is approx 5-10 minutes.
It is a powerful cardiac stimulant with
vasopressor properties
with one of its main therapeutic actions being
increasing systolic B/P, decreasing diastolic B/P, and increasing tachycardia.
It also acts as an antihistamine and as a bronchodilator.
BP and HR needs to be stable prior to administration as if these are elevated, administering adrenaline will result in a rise in BP and HR due to the potent vasoconstriction it will cause.
Dosage:
0.3 - 0.5 mL administered slowly, the dose may be repeated every
10 minutes
and if the reaction is severe the dose may be
increased
to 1mL .
5) Treatment of shock