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ΕΛΛΗΝΙΚΗ ΕΤΑΙΡΕΙΑ ΕΛΕΓΧΟΥ ΛΟΙΜΩΞΕΩΝ 5η ΕΠΙΣΤΗΜΟΝΙΚΗ ΗΜΕΡΙΔΑ Έλεγχος Νοσοκομειακών Λοιμώξεων. ΠΡΟΛΗΨΗ ΑΝΑΠΝΕΥΣΤΙΚΩΝ ΝΟΣΟΚΟΜΕΙΑΚΩΝ ΛΟΙΜΩΞΕΩΝ Γρίπη (ινφλουέντσα ). Μαρία Πηρουνάκη Παθολόγος – Λοιμωξιολόγος Γ.Ν.Α. «Ιπποκράτειο» Νοέμβριος 20005. - PowerPoint PPT Presentation

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  • () ... 20005 5

  • ( )

  • 1580 .. 31 1918-1919 ( ) 21.000.000 1933 1936 40 1976 60 1993 2000

  • , 1918-1919 Camp Funston, Kansas,

  • : A, B & C : , , , , , , . (H) () .: 15 , : 9 : 11, 12 32 : , . C: .

  • (antigenic shift): 1957-1967 H2N2 1968 H3N2

  • Antigenic drift : 1997 A/Wuhan/359/95 (H3N2) 1997 A/Sydney/5/97 (H3N2) 1998

  • Musher D.M., N Engl J Med 2003;348:1256-66

    ()N. meningitidisS. pyogenesS. pneumoniaeM. tuberculosis RSV

  • : 2 (1-4) (attack rate) : 40% 50% : (38-400C), , : , , , : 2-3 : Reye

  • : () S. pneumoniaeH. influenzaeS. aureus () ( ) Reye ( ) , , (0.5-1.0 1000 )

  • 36.000 >90% >65 (H3N2) >120.000 0-4 : 100-500 100.000 (H3N2)

  • ( , , ) IgG CF HI 5 21

  • : 70%: 90%

  • (split) & 60-80% ( ) (): - : 5-8% : Preservative-free ()

  • 60-90%
  • () 2003 spray (FluMist) 87% 30% 25-40% Bell (?)

  • 2005-6 (A/California/7/2004(H3N2)-A/New Cal(H1N1)-B/Shanghai/361/2002) Advisory Committee on Immunization Practices, 2005 : >64 , (: 50% ) , , , ( HIV-) (6 - 18 ) ( Reye) 2 3 6-23

  • (10-64%), , 1-2 (5-10%) () Guillain-Barre: 1994: 1:1.000.000 , 1994: 75% 1993-1994 2002-2003 (JAMA 2004;292:2478) FluMist Bell FluMist

  • : : 23. 80% 5 65

  • , 2000

  • (3)

  • Wood A.J.J., N Engl J Med 2000;343:1778 ,

  • . ( ) (, ) . 5 7 (HPAI LPAI). HPAI 100%. LPAI HPAI . ; ;

  • H5N1 WHO data, Nov 9, 2005

    H5N1 (Case fatality rate)ThailandVietnamCambodiaIndonesia2092491251342456470%45%100%75%51%

  • (1968-2003)1976: (11) 1986: (11)1988: (11) 1 1993: (32) 1995: (77) . 1997: (51) Hong Kong 6 1999: (92)2003: (51) Hong Kong 1 2003: (77) 2003: (51) Guangdong, 2004: (51)

  • Pandemic InfluenzaThe influenza pandemic of 1918-19 killed more humans than any other disease in a period of similar duration in the history of the world.Alfred W. CrosbyAmericas Forgotten Pandemic The Influenza of 1918Cambridge University Press, 1989

  • 2003-4 Outbreak of Highly Pathogenic Avian (HPAI) Influenza A (H5N1) in AsiaW.H.O. Official Says Deadly Pandemic Is Likely if the Asian Bird Flu Spreads Among PeopleBy KEITH BRADSHER and LAWRENCE K. ALTMAN

    HONG KONG, Nov. 29 - A pandemic of human influenza could kill up to 100 million people around the world in a worst case, a World Health Organization official said Monday, significantly raising the agency's earlier estimates of the potential number of deaths in such a catastrophe.

  • Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia

  • Pandemic Influenza Outbreak of Avian Influenza A (H5N1) in Asia

  • Phases of an Influenza Pandemic

  • Phases of an Influenza Pandemic

  • Trends in Infectious Disease Mortality in the United States During the 20th Century

    Armstrong, GL. JAMA. 1999 Jan 6;281(1):61-6.

  • Pandemic Influenza 1918 Influenza Pandemic20-40 million persons died worldwide, possibly moreDeath rate 25 times higher than previous epidemics500-650,000 deaths in the U.S.: Ten times as many Americans died of flu than died in WW IThe epidemic preferentially affected and killed younger, healthy personsThe epidemic was so severe that the average life span in the U.S. was depressed by 10 years

  • Pandemic Influenza Potential Impact of Pandemic Influenza in the U.S.Cannot predict the severity or exact onset of a pandemicUp to 200 million persons infected38-89 million persons clinically ill18-42 million persons require outpatient care314,00-733,000 persons hospitalized89,000-207,000 deathsEconomic cost estimated at $71-$166 billion

  • Pandemic Influenza Potential Impact of Pandemic Influenza in the U.S.Vaccine and antiviral drugs will be in short supply6-8 month lag-time needed for vaccine availabilityHealthcare workers and other first responders will be at higher risk of exposure and illness than the general populationHealthcare system will be overwhelmedRisk of sudden shortages of key personnel in critical community services: police, fire, power/utilities, transportation, air traffic controllers, etc.

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