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| {{Influenza}} | | {| class="infobox" style="float:right;" |
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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
| | | [[File:Siren.gif|30px|link=Influenza resident survival guide]]|| <br> || <br> |
| | | [[Influenza resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
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| {{Infobox_Disease | | | {{Infobox_Disease | |
| Name = Influenza | | | Name = Influenza | |
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| Caption = [[transmission electron microscopy|TEM]] of negatively stained influenza virons, magnified approximately 70,000 times | | | Caption = [[transmission electron microscopy|TEM]] of negatively stained influenza virons, magnified approximately 70,000 times | |
| Width = 226 | | | Width = 226 | |
| DiseasesDB = 6791 |
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| ICD10 = {{ICD10|J|10||j|09}}, {{ICD10|J|11||j|09}} |
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| ICD9 = {{ICD9|487}} |
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| MedlinePlus = 000080 |
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| MeshID = D007251 |
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| }} | | }} |
| {{Flu}} | | __NOTOC__ |
| | {{Influenza}} |
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
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| {{CMG}}
| | '''For more information about non-human (variant) influenza viruses that may be transmitted to humans, see [[Zoonotic influenza]]''' |
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| ==[[Influenza overview|Overview]]==
| | {{CMG}}; {{AE}} {{AL}}; {{Ammu}} |
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| ==[[Influenza historical perspective|Historical perspective]]==
| | {{SK}} Flu; influenza A; influenza B; influenza C; human influenza; human influenza virus |
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| | ==[[Influenza overview|Overview]]== |
| | ==[[Influenza historical perspective|Historical Perspective]]== |
| ==[[Influenza classification|Classification]]== | | ==[[Influenza classification|Classification]]== |
| | ==[[Influenza pathophysiology |Pathophysiology]]== |
| | ==[[Influenza causes|Causes]]== |
| | ==[[Influenza differential diagnosis|Differentiating Influenza from other Diseases]]== |
| | ==[[Influenza epidemiology and demographics|Epidemiology and Demographics]]== |
| | ==[[Influenza risk factors|Risk Factors]]== |
| | ==[[Influenza natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Diagnosis== | | ==Diagnosis== |
| | [[Influenza history and symptoms|History and Symptoms]] | [[Influenza physical examination|Physical Examination]] | [[Influenza laboratory findings|Laboratory Findings]] | [[Influenza chest x ray|Chest X Ray]] | [[Influenza other diagnostic studies|Other Diagnostic Studies]] |
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| ==[[History & Symptoms]]== | | ==Treatment== |
| | | [[Influenza medical therapy|Medical Therapy]] | [[Influenza primary prevention|Primary Prevention]] | [[Influenza cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Influenza future or investigational therapies|Future or Investigational Therapies]] |
| ==[[Influenza laboratory tests|Lab Tests]]==
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| ==[[Influenza epidemiology and demographics|Epidemiology & Demographics]]==
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| ==[[Influenza primary prevention|Primary Prevention]]==
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| ==[[Influenza medical therapy|Medical Therapy]]==
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| ==[[Influenza future or investigational therapies|Future or Investigational Therapies]]==
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| {{further|[[Influenza research]]}}
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| [[Image:Influenza research.jpg|thumb|220px|right|CDC scientist working on influenza under high bio-safety conditions]]
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| Research on influenza includes studies on [[molecular virology]], how the virus produces disease ([[pathogenesis]]), host [[immune response]]s, [[genomics|viral genomics]], and how the virus spreads ([[epidemiology]]). These studies help in developing influenza countermeasures; for example, a better understanding of the body's immune response helps [[vaccine]] development, and a detailed picture of how influenza invades cells aids the development of antiviral drugs. One important basic research program is the [[Influenza Genome Sequencing Project]], which is creating a library of influenza sequences; this library should help clarify which factors make one strain more lethal than another, which genes most affect [[immunogenicity]], and how the virus [[evolution|evolves]] over time.<ref> [http://msc.tigr.org/infl_a_virus/index.shtml Influenza A Virus Genome Project] at The Institute of Genomic Research. Accessed 19 Oct 06</ref>
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| Research into new vaccines is particularly important: as current vaccines are slow and expensive to produce and must be reformulated every year. The sequencing of the influenza genome and [[recombinant DNA]] technology may accelerate the generation of new vaccine strains by allowing scientists to substitute new antigens into a previously-developed vaccine strain.<ref>{{cite journal | author = Subbarao K, Katz J | title = Influenza vaccines generated by reverse genetics. | journal = Curr Top Microbiol Immunol | volume = 283 | issue = | pages = 313-42 | year = | id = PMID 15298174}}</ref> New technologies are also being developed to grow virus in [[cell culture]]; which promises higher yields, less cost, better quality and surge capacity.<ref>{{cite journal | author = Bardiya N, Bae J | title = Influenza vaccines: recent advances in production technologies. | url=http://www.springerlink.com/content/jdt26gc39v4bwk9q/ | journal = Appl Microbiol Biotechnol | volume = 67 | issue = 3 | pages = 299–305 | year = 2005 | id = PMID 15660212}}</ref> The U.S. government has purchased from [[Sanofi Pasteur]] and [[Chiron Corporation]] several million doses of vaccine meant to be used in case of an [[influenza pandemic]] of [[H5N1]] avian influenza and is conducting clinical trials with these vaccines.<ref> [http://www.nytimes.com/2006/03/30/health/30vaccine.html?_r=1&oref=slogin New York Times article ""Doubt Cast on Stockpile of a Vaccine for Bird Flu""] by Denise Grady. Published: March 30, 2006. Accessed 19 Oct 06</ref> The UK government is also stockpiling millions of antiviral drugs(tamiflu, oseltamivir, zanimivir) to give to its citizens in the event of an outbreak, the UK [[Health Protection Agency]] has also gathered a limited amount of HPAI H5N1 vaccines for experimental purposes.
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| ==Infection in other animals==
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| {{H5N1}}{{further|[[Influenzavirus A]], [[H5N1]] and [[Transmission and infection of H5N1]]}}
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| Influenza infects many animal species and transfer of viral strains between species can occur. Birds are thought to be the main [[host (biology)|animal reservoir]]s of influenza viruses.<ref>{{cite journal | author = Gorman O, Bean W, Kawaoka Y, Webster R | title = Evolution of the nucleoprotein gene of influenza A virus. | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=2319644 | journal = J Virol | volume = 64 | issue = 4 | pages = 1487–97 | year = 1990 | id = PMID 2319644}}</ref> Sixteen forms of [[hemagglutinin]] and 9 forms of [[neuraminidase]] have been identified. All known subtypes (HxNy) are found in birds but many subtypes are endemic in humans, dogs, horses, and pigs; populations of camels, ferrets, cats, seals, mink, and whales also show evidence of prior infection or exposure to influenza.<ref name=webster/> Variants of flu virus are sometimes named according to the species the strain is endemic in or adapted to. The main variants named using this convention are: Bird flu, [[Human flu|Human Flu]], Swine Flu, Horse Flu and Dog Flu. (Cat flu generally refers to Feline viral rhinotracheitis or Feline calicivirus and not infection from an influenza virus.) In pigs, horses and dogs, influenza symptoms are similar to humans, with cough, fever and loss of appetite.<ref name=webster/> The frequency of animal diseases are not as well-studied as human infection, but an outbreak of influenza in harbour seals caused approximately 500 seal deaths off the New England coast in 1979–1980.<ref>{{cite journal | author = Hinshaw V, Bean W, Webster R, Rehg J, Fiorelli P, Early G, Geraci J, St Aubin D | title = Are seals frequently infected with avian influenza viruses? | url=http://www.pubmedcentral.nih.gov/articlerender.fcgi?tool=pubmed&pubmedid=6471169 | journal = J Virol | volume = 51 | issue = 3 | pages = 863-5 | year = 1984 | id = PMID 6471169}}</ref> On the other hand, outbreaks in pigs are common and do not cause severe mortality.<ref name=webster/>
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| Flu symptoms in birds are variable and can be unspecific.<ref>{{cite journal | author = Elbers A, Koch G, Bouma A | title = Performance of clinical signs in poultry for the detection of outbreaks during the avian influenza A (H7N7) epidemic in The Netherlands in 2003. | journal = Avian Pathol | volume = 34 | issue = 3 | pages = 181-7 | year = 2005 | id = PMID 16191700}}</ref> The symptoms following infection with low-pathogenicity avian influenza may be as mild as ruffled feathers, a small reduction in egg production, or weight loss combined with minor respiratory disease.<ref>Capua I, Mutinelli F. "Low pathogenicity (LPAI) and highly pathogenic (HPAI) avian influenza in turkeys and chicken." In: Capua I, Mutinelli F. (eds.), A Colour Atlas and Text on Avian Influenza, Papi Editore, Bologna, 2001, pp. 13–20</ref> Since these mild symptoms can make diagnosis in the field difficult, tracking the spread of avian influenza requires laboratory testing of samples from infected birds. Some strains such as Asian [[H9N2]] are highly virulent to poultry, and may cause more extreme symptoms and significant mortality.<ref>{{cite journal | author = Bano S, Naeem K, Malik S | title = Evaluation of pathogenic potential of avian influenza virus serotype H9N2 in chickens. | journal = Avian Dis | volume = 47 | issue = 3 Suppl | pages = 817-22 | year = 2003 | id = PMID 14575070}}</ref> In its most highly pathogenic form, influenza in chickens and turkeys produces a sudden appearance of severe symptoms and almost 100% mortality within two days.<ref>{{cite journal | author = Swayne D, Suarez D | title = Highly pathogenic avian influenza. | journal = Rev Sci Tech | volume = 19 | issue = 2 | pages = 463-82 | year = 2000 | id = PMID 10935274}}</ref> As the virus spreads rapidly in the crowded conditions seen in the intensive farming of chickens and turkeys, these outbreaks can cause large economic losses to poultry farmers.
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| An avian-adapted, highly pathogenic strain of H5N1 (called HPAI A(H5N1), for "highly pathogenic avian influenza virus of type A of subtype H5N1") causes [[transmission and infection of H5N1|H5N1 flu]], commonly known as "avian influenza" or simply "bird flu", and is [[endemic (epidemiology)|endemic]] in many bird populations, especially in Southeast Asia. This Asian lineage strain of HPAI A(H5N1) is [[global spread of H5N1|spreading globally]]. It is [[epizootic]] (an epidemic in non-humans) and panzootic (a disease affecting animals of many species, especially over a wide area) killing tens of millions of birds and spurring the culling of hundreds of millions of other birds in an attempt to control its spread. Most references in the media to "bird flu" and most references to H5N1 are about this specific strain.<ref>{{cite journal | author = Li K, Guan Y, Wang J, Smith G, Xu K, Duan L, Rahardjo A, Puthavathana P, Buranathai C, Nguyen T, Estoepangestie A, Chaisingh A, Auewarakul P, Long H, Hanh N, Webby R, Poon L, Chen H, Shortridge K, Yuen K, Webster R, Peiris J | title = Genesis of a highly pathogenic and potentially pandemic H5N1 influenza virus in eastern Asia. | journal = Nature | volume = 430 | issue = 6996 | pages = 209-13 | year = 2004 | id = PMID 15241415}}</ref><ref>Li KS, Guan Y, Wang J, Smith GJ, Xu KM, Duan L, Rahardjo AP, Puthavathana P, Buranathai C, Nguyen TD, Estoepangestie AT, Chaisingh A, Auewarakul P, Long HT, Hanh NT, Webby RJ, Poon LL, Chen H, Shortridge KF, Yuen KY, Webster RG, Peiris JS. [http://darwin.nap.edu/books/0309095042/html/116.html "The Threat of Pandemic Influenza: Are We Ready?" Workshop Summary] The National Academies Press (2005) "Today's Pandemic Threat: Genesis of a Highly Pathogenic and Potentially Pandemic H5N1 Influenza Virus in Eastern Asia", pages 116–130</ref>
| | ==Case Studies== |
| | :[[Influenza case study one|Case #1]] |
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| At present, HPAI A(H5N1) is an avian disease and there is no evidence suggesting efficient human-to-human transmission of HPAI A(H5N1). In almost all cases, those infected have had extensive physical contact with infected birds.<ref>{{cite journal | author = Liu J | title = Avian influenza—a pandemic waiting to happen? | url=http://jmii.org/content/pdf/v39n1p4.pdf | journal = J Microbiol Immunol Infect | volume = 39 | issue = 1 | pages = 4–10 | year = 2006 | id = PMID 16440117}}</ref> In the future, H5N1 may mutate or reassort into a strain capable of efficient human-to-human transmission. Due to its high lethality and [[virulence]], its [[endemic (epidemiology)|endemic]] presence, and its large and increasing biological host reservoir, the H5N1 virus is the world's pandemic threat in the 2006–7 flu season, and billions of dollars are being raised and spent researching H5N1 and preparing for a potential [[influenza pandemic]].<ref name=Rosenthal> Rosenthal, E. and Bradsher, K. [http://www.nytimes.com/2006/03/16/business/16bird.html?_r=1&oref=slogin Is Business Ready for a Flu Pandemic?] The New York Times 16-03-2006 Accessed 17-04-2006</ref>
| | ==Related Chapters== |
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| ==[[Influenza cost-effectiveness of therapy|Cost-Effectiveness of Therapy]]==
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| ==See also==
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| <!-- Please do not add links already featured in the body of the article above --> | | <!-- Please do not add links already featured in the body of the article above --> |
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| *[[Center for Biologics Evaluation and Research]] | | *[[Center for Biologics Evaluation and Research]] |
| *[[H5N1 genetic structure]] | | *[[H5N1 genetic structure]] |
| | *[[ICEID]] |
| | *[[Influenza Genome Sequencing Project]] |
| | *[[Cytokine storm]] |
| | *[[International Partnership on Avian and Pandemic Influenza]] |
| | *[[National Influenza Centers]] |
| | *[[Pandemic Preparedness and Response Act]] |
| | *[[Global Alliance for Vaccines and Immunization]] |
| | *[[IFPMA]] International Federation of Pharmaceutical Manufacturers Associations |
| | *[[Reporting disease cases]] |
| | *[[Original antigenic sin]] |
| | *[[Center for Biologics Evaluation and Research]] |
| *[[ICEID]] | | *[[ICEID]] |
| *[[Influenza Genome Sequencing Project]] | | *[[Influenza Genome Sequencing Project]] |
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| </div> | | </div> |
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| ==References and notes== | | ==Further Readings== |
| {{reflist|2}} | | {| style=width:85%" |
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| ==Further reading==
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| *[http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_3C.pdf WHO's assessment of Flu Research] as of November 2006. | | *[http://www.who.int/csr/resources/publications/influenza/WHO_CDS_EPR_GIP_2006_3C.pdf WHO's assessment of Flu Research] as of November 2006. |
| {{Col-end}} | | {{Col-end}} |
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| ==External links== | | ==External Links== |
| *[http://www.cdc.gov/flu/ Info on influenza] at [[Centers for Disease Control and Prevention|CDC]] | | *[http://www.cdc.gov/flu/ Info on influenza] at [[Centers for Disease Control and Prevention|CDC]] |
| *[http://www.who.int/mediacentre/factsheets/fs211/en/index.html Fact Sheet] Overview of influenza at [[World Health Organization]] | | *[http://www.who.int/mediacentre/factsheets/fs211/en/index.html Fact Sheet] Overview of influenza at [[World Health Organization]] |
| *[http://www.nhsdirect.nhs.uk/en.aspx?articleId=163§ionId=1725 Health encyclopedia entry] at [[NHS Direct]]
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| *[http://www.biohealthbase.org/ BioHealthBase Bioinformatics Resource Center] Database of influenza sequences and related information.
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| *[http://www.medicinenet.com/influenza/article.htm Overview of influenza] at [[MedicineNet]]
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| *[http://digital.library.unt.edu/govdocs/crs/search.tkl?q=influenza&search_crit=subject&search=Search&date1=Anytime&date2=Anytime&type=form Congressional Research Service (CRS) Reports regarding Influenza] Law related government reports at [[University of North Texas]]
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| *[http://www.fluwikie.com/index.php?n=Geographic.Geographic Influenza Surveillance and Contingency Plans] (by Country/Region)
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| *[http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/46000000.htm Orthomyxoviridae] The Universal Virus Database of the [[International Committee on Taxonomy of Viruses]] | | *[http://www.ncbi.nlm.nih.gov/ICTVdb/ICTVdB/46000000.htm Orthomyxoviridae] The Universal Virus Database of the [[International Committee on Taxonomy of Viruses]] |
| *[http://www.ncbi.nlm.nih.gov/genomes/FLU/flubiology.html Influenza Virus Resource] from the [[National Center for Biotechnology Information|NCBI]] | | *[http://www.ncbi.nlm.nih.gov/genomes/FLU/flubiology.html Influenza Virus Resource] from the [[National Center for Biotechnology Information|NCBI]] |
| *[http://www.influenzaworld.com/portal/eipf/pb/t/iwc/home InfluenzaWorld] Resource for all influenza-related information.
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| {{Influenza}}
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| {{Respiratory pathology}} | | {{Respiratory pathology}} |
| {{Viral diseases}} | | {{Viral diseases}} |
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| [[ar:فيروس إنفلونزا]] | | [[ar:فيروس إنفلونزا]] |
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| [[Category:Disease]] | | [[Category:Disease]] |
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| [[Category:Pulmonology]] | | [[Category:Pulmonology]] |
| [[Category:Influenza| ]] | | [[Category:Influenza| ]] |
| [[Category:Infectious disease]]
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