Influenza Presentation for Health Care Workers We are glad you can join us for a presentation on influenza geared toward health care workers working in facility settings. This presentation has been updated for the 2018-2019 season.

LEARNING OBJECTIVES To gain a better understanding of: Influenza Virus and the Disease: Transmission, symptoms, diagnosis, and treatment Influenza Vaccine Components, types available, effectiveness, benefits and side effects The objectives of this presentation are to gain a better understanding of influenza the disease, influenza the vaccine

INFLUENZA VIRUS & DISEASE

DISEASE FACTS Influenza, commonly known as ‘the flu’ A respiratory illness caused by influenza A or B viruses that can be mild or serious Symptoms usually last 7-10 days, sometimes longer in the elderly Cough and fatigue can last weeks Influenza is very contagious, you can spread the disease 24 hours before you become symptomatic and for about 5 days after symptom onset Influenza is a respiratory infection caused primarily by influenza A and B viruses. In Canada, influenza generally occurs each year in the late fall and winter months. Symptoms typically include the sudden onset of high fever, cough and muscle aches. Other common symptoms include headache, chills, loss of appetite, fatigue and sore throat. Nausea, vomiting and diarrhea may also occur, especially in children. Most people will recover within a week or ten days, but some are at greater risk of more severe complications, such as pneumonia. People with chronic diseases may have worsening of their underlying disease. Common symptoms: high fever, cough, muscle aches Children: may transmit the virus for longer than 7 days [CDC (2013). How flu spreads. Retrieved from http://www.cdc.gov/flu/about/disease/spread.htm] Seasonal: Occurs annually in Canada in late fall and winter months Global Attack Rate: 5-10% in adults and 20-30% in children Incubation Period: Average 2 days (ranges from 1-4 days) for seasonal influenza Period of Communicability: In adults, viral shedding is greatest in the first 3-5 days of illness. In young children, virus shedding can occur for longer, 7-10 days, and may be even longer in severely compromised persons. Heymann, D. (ed.) (2008). Control of Communicable Diseases Manual, 19th edition. Washington, American Public Health Association, pp. 315-322

MODES OF TRANSMISSION Respiratory Droplet Transmission Droplets are generated when a sick person coughs or sneezes droplets can travel up to two meters in distance Droplets need to be inhaled by nearby individuals or land on their mouth, eyes or nose to transmit the virus Contact Transmission Respiratory droplets can also contaminate surfaces or objects the flu virus can survive up to 48 hours on hard, non-porous surfaces such as stainless steel If an individual touches a surface or object contaminated with the flu virus and then touches their mouth, nose or eyes the virus can be transmitted (CDC, 2013; Public Health Agency of Canada, 2011; WHO, 2010) Influenza is primarily transmitted by droplet spread through coughing or sneezing and may also be transmitted through direct or indirect contact with contaminated respiratory secretions. The incubation period of seasonal influenza is usually two days but can range from one to four days. Adults may be able to spread influenza to others from one day before symptom onset to approximately five days after symptoms start. Children and people with weakened immune systems may be infectious longer.

WHO IS MOST VULNERABLE TO THE FLU? Adults and children with underlying health conditions Residents of LTCHs and other chronic care facilities People > 65 years of age Children < 60 months of age Pregnant women Indigenous peoples The people at greatest risk of influenza-related complications are adults and children with underlying health conditions, residents of nursing homes and other chronic care, facilities, people 65 years of age and older, children under 60 months of age, pregnant women, and Indigenous peoples.

FLU – DISEASE DISTRIBUTION Globally 1 billion cases of influenza around the world annually, resulting in 250,000 to 500,000 deaths In Canada 23,000 laboratory-confirmed cases of influenza annually Influenza is estimated to be responsible for: 12,200 hospitalizations 3,500 deaths Influenza and pneumonia is ranked among the top 10 leading causes of death Global Influenza occurs globally with an annual attack rate estimated at 5–10% in adults and 20–30% in children Worldwide, annual epidemics result in an approximately one billion cases of influenza, about three to five million cases of severe illness, and about 250,000 to 500,000 deaths. National Influenza and pneumonia is ranked among the top 10 leading causes of death in Canada(2). Current influenza activity information can be found on the FluWatch website. The FluWatch program collects data and information from various sources to provide a national picture of influenza activity. An average of 23,000 laboratory-confirmed cases of influenza is reported to the FluWatch program each year. Although the burden of influenza can vary from year to year, it is estimated that, in a given year, an average of 12,200 hospitalizations related to influenza(3) and approximately 3,500 deaths attributable to influenza occur It should be noted that the incidence of influenza is often underreported since the illness may be confused with other viral illnesses and many people with influenza-like illness (ILI) do not seek medical care or have viral diagnostic testing done.

INFLUENZA SYMPTOMS Symptoms Flu Cold Fever Usually high, sudden onset, lasts 3-4 days *May not be prominent in adults > 65 years Rare Chills Common Sore throat Coughing Common – can be severe Sometimes - mild to moderate Muscle aches and pains Common – often severe Sometimes, - mild Headache Tiredness and weakness Common – severe, (may last 2-3 weeks) Sometimes - mild Runny, stuffy nose Sneezing Sometimes Gastrointestinal Symptoms Unusual Symptoms typically include the sudden onset of high fever, cough and muscle aches. Other common symptoms include headache, chills, loss of appetite, fatigue and sore throat. Nausea, vomiting and diarrhea may also occur, especially in children. Most people will recover within a week or ten days, but some, including those 65 years of age and older, young children, and adults and children with chronic conditions, are at greater risk of more severe complications or worsening of their underlying condition.

SICK WITH THE FLU? Stay home and get plenty of rest Seek medical attention as appropriate Limit your contact with others Wash your hands frequently with soap and water or with alcohol-based hand sanitizer, particularly after coughing or sneezing Ensure you practice respiratory etiquette (cough/sneeze into your sleeve or into a tissue, then wash your hands or use hand sanitizer) Reference: Ministry of Health and Long-Term Care (2015). Flu facts. Retrieved from http://www.ontario.ca/page/flu-facts

CONFIRMING DIAGNOSIS Nasopharyngeal (NP) Swab Should be obtained from the most severe and most recently ill residents (i.e. during the first 4 days of their illness) Rapid test is takes a few hours; PCR up to 3-4 days and culture up to 10 days. Serology may be done but not very common. This test would need to be done as an acute and convalescent serology taken 10-14 days apart. Reference: Infectious Disease Protocols (2014). Appendix A: Disease Specific Chapters

TREATMENT Antiviral treatment for influenza must be started within 48 hours (or less) of onset of symptoms for maximum effectiveness Oseltamivir (Tamiflu) effective against influenza A and B recommended drug of choice for both prophylaxis and treatment in an influenza outbreak Zanimivir (Relenza) used when predominant circulating strain is resistant to Tamiflu Rapid test is takes a few hours; PCR up to 3-4 days and culture up to 10 days. Serology may be done but not very common. This test would need to be done as an acute and convalescent serology taken 10-14 days apart. Reference: Infectious Disease Protocols (2014). Appendix A: Disease Specific Chapters

INFLUENZA PREVENTION – see part 2