- •Global Impact
- •Epidemics and Pandemics
- •Current Situation
- •Individual Impact
- •The Virus
- •Requirements for Success
- •Virology
- •Natural Reservoir + Survival
- •Transmission
- •H5N1: Making Progress
- •Individual Management
- •Epidemic Prophylaxis
- •Exposure Prophylaxis
- •Vaccination
- •Antiviral Drugs
- •Epidemic Treatment
- •Pandemic Prophylaxis
- •Pandemic Treatment
- •Global Management
- •Epidemic Management
- •Pandemic Management
- •Containment
- •Drugs
- •Vaccines
- •Distribution
- •Conclusion
- •Golden Links
- •Interviews
- •References
- •Avian Influenza
- •The Viruses
- •Natural hosts
- •Clinical Presentation
- •Pathology
- •LPAI
- •HPAI
- •Differential Diagnosis
- •Laboratory Diagnosis
- •Collection of Specimens
- •Transport of Specimens
- •Diagnostic Cascades
- •Direct Detection of AIV Infections
- •Indirect Detection of AIV Infections
- •Transmission
- •Transmission between Birds
- •Poultry
- •Humans
- •Economic Consequences
- •Control Measures against HPAI
- •Vaccination
- •Pandemic Risk
- •Conclusion
- •References
- •Structure
- •Haemagglutinin
- •Neuraminidase
- •M2 protein
- •Possible function of NS1
- •Possible function of NS2
- •Replication cycle
- •Adsorption of the virus
- •Entry of the virus
- •Uncoating of the virus
- •Synthesis of viral RNA and viral proteins
- •Shedding of the virus and infectivity
- •References
- •Pathogenesis and Immunology
- •Introduction
- •Pathogenesis
- •Viral entry: How does the virion enter the host?
- •Binding to the host cells
- •Where does the primary replication occur?
- •How does the infection spread in the host?
- •What is the initial host response?
- •Cytokines and fever
- •Respiratory symptoms
- •Cytopathic effects
- •Symptoms of H5N1 infections
- •How is influenza transmitted to others?
- •Immunology
- •The humoral immune response
- •The cellular immune response
- •Conclusion
- •References
- •Pandemic Preparedness
- •Introduction
- •Previous Influenza Pandemics
- •H5N1 Pandemic Threat
- •Influenza Pandemic Preparedness
- •Pandemic Phases
- •Inter-Pandemic Period and Pandemic Alert Period
- •Surveillance
- •Implementation of Laboratory Diagnostic Services
- •Vaccines
- •Antiviral Drugs
- •Drug Stockpiling
- •General Measures
- •Seasonal Influenza Vaccination
- •Political Commitment
- •Legal and Ethical Issues
- •Funding
- •Global Strategy for the Progressive Control of Highly Pathogenic Avian Influenza
- •Pandemic Period
- •Surveillance
- •Treatment and Hospitalisation
- •Human Resources: Healthcare Personnel
- •Geographically Targeted Prophylaxis and Social Distancing Measures
- •Tracing of Symptomatic Cases
- •Border Control
- •Hygiene and Disinfection
- •Risk Communication
- •Conclusions
- •References
- •Introduction
- •Vaccine Development
- •History
- •Yearly Vaccine Production
- •Selection of the yearly vaccine strain
- •Processes involved in vaccine manufacture
- •Production capacity
- •Types of Influenza Vaccine
- •Killed vaccines
- •Live vaccines
- •Vaccines and technology in development
- •Efficacy and Effectiveness
- •Side Effects
- •Recommendation for Use
- •Indications
- •Groups to target
- •Guidelines
- •Contraindications
- •Dosage / use
- •Inactivated vaccine
- •Live attenuated vaccine
- •Companies and Products
- •Strategies for Use of a Limited Influenza Vaccine Supply
- •Antigen sparing methods
- •Rationing methods and controversies
- •Pandemic Vaccine
- •Development
- •Mock vaccines
- •Production capacity
- •Transition
- •Solutions
- •Strategies for expediting the development of a pandemic vaccine
- •Enhance vaccine efficacy
- •Controversies
- •Organising
- •The Ideal World – 2025
- •References
- •Useful reading and listening material
- •Audio
- •Online reading sources
- •Sources
- •Laboratory Findings
- •Introduction
- •Laboratory Diagnosis of Human Influenza
- •Appropriate specimen collection
- •Respiratory specimens
- •Blood specimens
- •Clinical role and value of laboratory diagnosis
- •Patient management
- •Surveillance
- •Laboratory Tests
- •Direct methods
- •Immunofluorescence
- •Enzyme immuno assays or Immunochromatography assays
- •Reverse transcription polymerase chain reaction (RT-PCR)
- •Isolation methods
- •Embryonated egg culture
- •Cell culture
- •Laboratory animals
- •Serology
- •Haemagglutination inhibition (HI)
- •Complement fixation (CF)
- •Ezyme immuno assays (EIA)
- •Indirect immunofluorescence
- •Rapid tests
- •Differential diagnosis of flu-like illness
- •Diagnosis of suspected human infection with an avian influenza virus
- •Introduction
- •Specimen collection
- •Virological diagnostic modalities
- •Other laboratory findings
- •New developments and the future of influenza diagnostics
- •Conclusion
- •Useful Internet sources relating to Influenza Diagnosis
- •References
- •Clinical Presentation
- •Uncomplicated Human Influenza
- •Complications of Human Influenza
- •Secondary Bacterial Pneumonia
- •Primary Viral Pneumonia
- •Mixed Viral and Bacterial Pneumonia
- •Exacerbation of Chronic Pulmonary Disease
- •Croup
- •Failure of Recovery
- •Myositis
- •Cardiac Complications
- •Toxic Shock Syndrome
- •Reye’s Syndrome
- •Complications in HIV-infected patients
- •Avian Influenza Virus Infections in Humans
- •Presentation
- •Clinical Course
- •References
- •Treatment and Prophylaxis
- •Introduction
- •Antiviral Drugs
- •Neuraminidase Inhibitors
- •Indications for the Use of Neuraminidase Inhibitors
- •M2 Ion Channel Inhibitors
- •Indications for the Use of M2 Inhibitors
- •Treatment of “Classic” Human Influenza
- •Antiviral Treatment
- •Antiviral Prophylaxis
- •Special Situations
- •Children
- •Impaired Renal Function
- •Impaired Liver Function
- •Seizure Disorders
- •Pregnancy
- •Treatment of Human H5N1 Influenza
- •Transmission Prophylaxis
- •General Infection Control Measures
- •Special Infection Control Measures
- •Contact Tracing
- •Discharge policy
- •Global Pandemic Prophylaxis
- •Conclusion
- •References
- •Drug Profiles
- •Amantadine
- •Pharmacokinetics
- •Toxicity
- •Efficacy
- •Resistance
- •Drug Interactions
- •Recommendations for Use
- •Warnings
- •Summary
- •References
- •Oseltamivir
- •Introduction
- •Structure
- •Pharmacokinetics
- •Toxicity
- •Efficacy
- •Treatment
- •Prophylaxis
- •Selected Patient Populations
- •Efficacy against Avian Influenza H5N1
- •Efficacy against the 1918 Influenza Strain
- •Resistance
- •Drug Interactions
- •Recommendations for Use
- •Summary
- •References
- •Rimantadine
- •Introduction
- •Structure
- •Pharmacokinetics
- •Toxicity
- •Efficacy
- •Treatment
- •Prophylaxis
- •Resistance
- •Drug Interactions
- •Recommendations for Use
- •Adults
- •Children
- •Warnings
- •Summary
- •References
- •Zanamivir
- •Introduction
- •Structure
- •Pharmacokinetics
- •Toxicity
- •Efficacy
- •Treatment
- •Prophylaxis
- •Children
- •Special Situations
- •Avian Influenza Strains
- •Resistance
- •Drug Interactions
- •Recommendations for Use
- •Dosage
- •Summary
- •References
90 Virology of Human Influenza
The activity of the M2 protein is inhibited by amantadine, rimantadine and related substances.
Possible function of NS1
Human messenger RNA carries a poly-A tail at the 5' end. NS1, with a molecular weight of 26,000, and forms a dimer that inhibits the export of poly-A containing mRNA molecules from the nucleus, thus giving preference to viral RNA which is transported to the ribosome and translated. NS1 might also inhibit splicing of premRNA. In addition, NS1 is probably able to suppress the interferon response in the virus-infected cell leading to unimpaired virus production.
Possible function of NS2
NS2 is a small molecule with a molecular weight of 11,000. In the particle it might be bound to M1 protein. Its function is believed to facilitate the transport of newly synthesised RNPs from the nucleus to the cytoplasm to accelerate virus production.
Replication cycle
Adsorption of the virus
The influenza virus binds to the cell surface by fixing the outer top of the HA to the sialic acid of a cell’s glycoproteins and glycolipids. The sialic acid linkage to the penultimate galactose, either alpha 2,3 (in birds) or alpha 2,6 (in humans), determines host specificity. Since sialic acid-presenting carbohydrates are present on several cells of the organism, the binding capacity of the HA explains why multiple cell types in an organism may be infected.
Entry of the virus
After attachment, the virus is taken up by the cell via a clathrin-coated receptormediated endocytosis process. When internalised, the clathrin molecules are liberated and the vesicle harbouring the whole virus fuses with endosomes. The contents of the vesicle are usually digested through a stepwise lowering of the pH within the phagosome.
Uncoating of the virus
When a certain level is reached, the lowering of the pH is stopped by the action of the M2 protein which induces the partial liberation of the fusion peptide of the HA. This allows the fusion of the HA with the membrane of the vesicle and liberation of the ribonucleoproteins (RNPs) into the cytoplasm, as described above. The ion influx from the endosome to the virus particle leads to disconnection of the different viral proteins; M1-protein aggregation is disrupted and RNPs no longer adhere to the M1-protein complex. Uncoating is completed within 20-30 min of virus attachment.