1. New Influenza “Variants” : coming to Alberta TARRANT Symposium 2014 Kevin Fonseca Clinical Virologist ProvLab Kevin.fonseca@albertahealthservices.ca

4. Themes  Biology & Transmission  Lab Testing  Disease Spectrum  (Surveillance)

5. Subtypes of Influenza A N1 - human N2 - human N3 - avian N4 - avian N5 - avian N6 - avian N7 - equine N8 - equine N9 - avian H1 - swine, human H2 - human H3 - human H4 - avian H5* - avian, (human) H6 - avian H7* - equine,avian,human H8 - avian H9 - avian, (human) H10 – H16 – avian

6. H5N1H7N9H10N8H6N1 First Appearance (humans) 1997March 2013Dec 2013May 2013 Nos of Cases65035431 AcquisitionInfected Poultry Infected poultry & (humans) Infected poultry Person-to-personRareLess rareUnknown AgeYoung & oldOlderOld DiseaseGenerally severe (asymptomatic) (Severe)(mild) Case Fatality59%32%67%< Geographical Distribution Asia, AfricaChina Taiwan Pathogenicity classification HighLow

18. Key Virulence Elements  Attachment of virus to host receptor Mediated by hemagglutinin (HA)  Fusion and uncoating Mediated by hemagglutinin  Replication of viral RNA Role of polymerase  Assembly  Release/Transmission Role of neuraminidase (NA )

19. Eurosurveillance pic

20. Laboratory Detection of Influenza Test for Influenza A & B Positive for Influenza A Positive for Influenza B Negative for both Determine Lineage Perform Subtyping Positive for: A(H1N1)pdm09 OR H3 seasonal Unresolved/not subtyped:  Low viral load OR  novel subtype

21. Could This Be ?  Recent travel, or in contact with travelers  Contact with poultry (abroad)  Out of season cases  Clinical symptoms not “typical”  Discuss with local MOH  Don’t be afraid to swab !

22. Questions ?