Influenza: Epidemiology, Clinical Features, Therapy, and Prevention

被引:83
作者
Clark, Nina M. [2 ]
Lynch, Joseph P., III [1 ]
机构
[1] Univ Calif Los Angeles, David Geffen Sch Med, Div Pulm Crit Care Med Allergy & Clin Immunol, Dept Internal Med, Los Angeles, CA 90095 USA
[2] Univ Illinois, Dept Med, Infect Dis Sect, Chicago, IL USA
关键词
Influenza A and B; epidemics; pandemics; novel H1N1 influenza; neuraminidase inhibitors; vaccination; GUILLAIN-BARRE-SYNDROME; NEURAMINIDASE INHIBITOR ZANAMIVIR; HUMAN-IMMUNODEFICIENCY-VIRUS; HEALTHY WORKING ADULTS; 2009; H1N1; INFLUENZA; LONG-TERM-CARE; RESPIRATORY-TRACT INFECTIONS; CRITICALLY-ILL PATIENTS; NURSING-HOME RESIDENTS; ACUTE OTITIS-MEDIA;
D O I
10.1055/s-0031-1283278
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Influenza A and B are important causes of respiratory illness in all age groups. Influenza causes seasonal outbreaks globally and, less commonly, pandemics. In the United States, seasonal influenza epidemics account for >200,000 hospitalizations and >30,000 deaths annually. More than 90% of deaths occur in the elderly population. Interestingly, in the novel 2009 H1N1 influenza pandemic, attack rates were highest among children and young adults. Fewer than 10% of cases occurred in adults >60 years old, likely because preexisting antibodies against other H1N1 viruses afforded protection. Despite concerns about a high lethality rate with the novel 2009 H1N1 strain, most illnesses caused by the 2009 H1N1 viruses were mild (overall case fatality rate <0.5%). Clinical features of influenza infection overlap with other respiratory pathogens (particularly viruses). The diagnosis is often delayed due to low suspicion and the limited use of specific diagnostic tests. Rapid diagnostic tests are widely available and allow detection of influenza antigen in respiratory secretions within 1 hour; however, sensitivity ranges from 50 to 90%. Neuraminidase inhibitors (NAIs) (eg, oseltamivir and zanamivir) are effective for treating influenza A or B and for prophylaxis in selected adults and children. Resistance to NAIs is rare, but influenza strains resistant to oseltamivir have been detected. Vaccines are the cornerstone of influenza control. Currently, trivalent inactivated vaccine (TIV) and live attenuated influenza vaccine (LAIV) are available. These agents reduce mortality and morbidity in high-risk patients (ie, the elderly or patients with comorbidities), and expanding the use of vaccines to healthy children and adults reduces the incidence of influenza, pneumonia, and hospitalizations due to respiratory illnesses in the community.
引用
收藏
页码:373 / 392
页数:20
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