Influenza Clinical Presentation

8/2/2019 Influenza Clinical Presentation

1/37

Influenza: ClinicalInfluenza: ClinicalBackground InformationBackground Information


2/37

Influenza: ClinicalInfluenza: Clinical

Background InformationBackground Information

Prepared By :

Admiral Retired Dr.Adel Abd El Wahhab

Consultant of Occupational Health &

Safety


3/37

Types Of InfluenzaTy

pes Of Influenza

VirusesViruses

There are three types of influenza viruses: types A, B,and C.

Seasonal influenza outbreaks can be caused by eithertype A or type B Influenza viruses.

Only type A influenza viruses cause pandemic.

Influenza type C viruses cause mild illness in humansbut do not cause epidemics or pandemics.


4/37

Subtypes Of Influenza VirusesSubtypes Of Influenza Viruses

Only type A is divided into subtypes.Subtype designations are based on the

presence of two viral surface proteins(antigens:

(hemagglutinin (H and neuraminidase (N.

To date, 16 different hemagglutinin and 9different neuraminidase surface proteins

have been identified in influenza A viruses.The H protein type (116 followed by the Nprotein type (19 (e.g., H5N1.


5/37

History Of Influenza PandemicsHistory Of Influenza Pandemics

Historically, influenza has caused

outbreaks of respiratory illness

for centuries, including three pandemics

(Worldwide outbreaks of disease in the

20th century. Three different subtypes

(i.e., H1N1, H2N2, and H3N2 havecaused pandemics in the 20th century.


6/37

Prior Influenza PandemicsPrior Influenza Pandemics

The 1918 influenza pandemic, caused by

subtype H1N1 viruses, resulted in death for

an estimated 500,000 U.S. citizens and as

many as 40 million people worldwide. The 1957 (caused by subtype H2N2 viruses

killed an estimated 70,000 .

1968 (caused by subtype H3N2 viruses killed

an estimated 34,000 U.S.


7/37

Seasonal influenzaSeasonal influenza

Seasonal influenza or flu refers to

periodic outbreaks of acute onset viral

respiratory infection caused by

circulating strains of human influenza

A and B viruses. Itoccurs most

frequently during the winter months

when the humidity and outdoortemperatures are low (generally from

December until April.


8/37

Prevalence Of Seasonal FluPrevalence Of Seasonal Flu

Between 520 percent of the population may beinfected annually. Most people have some immunityto the currently circulating strains of influenza virusand, as a result, the severity and impact of seasonal

Influenza is substantially less than during pandemics.Seasonal influenza is responsible for approximately36,000 deaths and 226,000

hospitalizations annually in the United States.

The risk of death is highest among the elderly,

the very young, and patients with cardiopulmonary

and other chronic conditions.


9/37

Clinical Presentation ofClinical Presentation of

Seasonal InfluenzaSeasonal Influenza Seasonal influenza typically has an abrupt onset,

with symptoms offever, chills, fatigue, muscle

aches, headache, dry cough, upper respiratorycongestion and sore throat.

The time from exposure to disease onset is usually

1 to 4 days, with an average of 2 days.

Most patients recover within 3 to 7 days.

In adults, fever usually last for 2 to 3 days,

but may last longer in children.

Cough and weakness can persist for up to 2 weeks.


10/37

Vaccination Against SeasonalVaccination Against Seasonal

FluFlu

Every year, a trivalent influenza vaccine

is prepared in advance of the

anticipated seasonal outbreak and itincludes those strains (two type A and

one type B that are expected to be the

most likely to circulate in the upcomingflu season.


11/37

Pandemic InfluenzaPandemic Influenza

A pandemic is a global disease outbreak.

A flu pandemic occurs when a new influenza

virus emerges for which people have little orno immunity, and for which there is no

available vaccine.

The disease spreads easily person-to-

person, causes serious illness, and can

sweep across the country and around the

world in a very short time.


12/37

WHO Pandemic Alert SystemWHO Pandemic Alert System

WHO Plan describes six phases of

increasing public health risk associated

with the emergence of a new influenza

virus subtype that may pose a pandemic

threat


13/37

WHO Pandemic Alert SystemWHO Pandemic Alert System

(Phases 1 and 2 there is a novel influenza A virus in animals, butno human cases have been observed.

(Phases 35 a novel influenza virus causes human infection with

a new subtype, but does not exhibit efficient and sustained

human to- human transmission.Once a new influenza A virus develops the capacity for efficient

and sustained human-to-human transmission in the general

population

(Phase 6 the WHO declares that an influenza pandemic is inprogress (this is known as the Pandemic Period.


14/37

Swine influenza H1N1-

is a respiratory

disease of pigs caused

by type A influenza

viruses and has amajor economic

impact on the swine

industry.


15/37

Signs of swine flu in pigsSigns of swine flu in pigs

S.Flu outbreaks in pigs are common, especially

during winter months.

In pigs influenza infection produces fever, lethargy,

sneezing, coughing, difficulity breathing anddecreased appetite.

In some cases the infection can cause abortion.

Although mortality is usually low (around 1-4%, thevirus can produce weight loss and poor growth,

causing economic loss to farmers.
http://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Sneezinghttp://en.wikipedia.org/wiki/Coughinghttp://en.wikipedia.org/wiki/Dyspneahttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Growth_failurehttp://en.wikipedia.org/wiki/Growth_failurehttp://en.wikipedia.org/wiki/Weight_losshttp://en.wikipedia.org/wiki/Abortionhttp://en.wikipedia.org/wiki/Dyspneahttp://en.wikipedia.org/wiki/Coughinghttp://en.wikipedia.org/wiki/Sneezinghttp://en.wikipedia.org/wiki/Lethargyhttp://en.wikipedia.org/wiki/Fever


16/37

Can people catch swine flu fromCan people catch swine flu from

porkpork?? The 1918 flu pandemic in humans was associated with H1N1

and influenza appearing in pigs.

This may reflect a zoonosis either from swine to humans or

from humans to swine.

Although it is not certain in which direction the virus was

transferred, some evidence suggests that, in this case, pigs

caught the disease from humans.

Direct transmission of a swine flu virus from pigs to humans isoccasionally possible In all, 50 cases are known to have

occurred since the first report in medical literature in 1958,

which have resulted in a total of six deaths.
http://en.wikipedia.org/wiki/1918_flu_pandemichttp://en.wikipedia.org/wiki/1918_flu_pandemic


17/37

20092009pandemic in humanspandemic in humans

The H1N1 viral strain implicated in the

2009 flu pandemic among humans is called

Swine Flu" because the initial testing

showed many of the genes in the virus weresimilar to influenza viruses normally

occurring in North American swine.

Further research has shown that theoutbreak is due to a new strain of H1N1 not

previously reported in pigs.
http://en.wikipedia.org/wiki/H1N1http://en.wikipedia.org/wiki/Strain_(biology)http://en.wikipedia.org/wiki/2009_flu_pandemichttp://en.wikipedia.org/wiki/2009_flu_pandemichttp://en.wikipedia.org/wiki/Strain_(biology)http://en.wikipedia.org/wiki/H1N1


18/37

symptoms of 2009 Swine Flusymptoms of 2009 Swine Flu"" According to the

Centers for Disease Control and Prevention (CDC, inhumans the symptoms of the 2009 "swine flu" H1N1virus are similar to those ofinfluenza and ofinfluenza-like illness in general.

Symptoms include fever, cough, sore throat, bodyaches, headache, chills and fatigue.

The 2009 outbreak has shown an increasedpercentage of patients reporting diarrhea and

vomiting. The 2009 H1N1 virus is not zoonotic swine flu, as it is

not transmitted from pigs to humans, but from person

to person.
http://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Preventionhttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Influenza-like_illnesshttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Sore_throathttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Chillshttp://en.wikipedia.org/wiki/Fatiguehttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Vomitinghttp://en.wikipedia.org/wiki/Diarrheahttp://en.wikipedia.org/wiki/Fatiguehttp://en.wikipedia.org/wiki/Chillshttp://en.wikipedia.org/wiki/Headachehttp://en.wikipedia.org/wiki/Sore_throathttp://en.wikipedia.org/wiki/Coughhttp://en.wikipedia.org/wiki/Feverhttp://en.wikipedia.org/wiki/Influenza-like_illnesshttp://en.wikipedia.org/wiki/Influenzahttp://en.wikipedia.org/wiki/Centers_for_Disease_Control_and_Prevention


19/37

The H1N1 flu virus can spreadThe H1N1 flu virus can spread

from person to person whenfrom person to person when:: Someone with the flu coughs or sneezes into air that

others breathe in.

Someone touches a door knob, desk, computer, orcounter with the H1N1 germs on it and then touches

their mouth, eyes, or nose.

Someone touches mucus of a child or others whiletaking care of them when they are ill with the H1N1 fluvirus

You CANNOT get H1N1 flu virus from eating pork orany other food, drinking water, swimming in pools, orusing a hot tubs or saunas


20/37

How is swine flu (H1N1How is swine flu (H1N1

diagnoseddiagnosed?? Swine flu is diagnosed clinically by the patient's

history of association with people known to have thedisease and theirsymptoms listed above.nasopharyngeal swab sample is done to see if the

patient is infected with influenza A or B virus. Most ofthe tests can distinguish between A and B types. Thetest can be negative (no flu infection or positive fortype A and B. If the test is positive for type B, the fluis not likely to be swine flu (H1N1. If it is positive for

type A, the person could have a conventional flustrain or swine flu (H1N1. Swine flu (H1N1 isdefinitively diagnosed by identifying the particularantigens associated with the virus type.


21/37


22/37

TreatmentTreatment

Most people who get H1N1 flu will likely

recover without needing medical care

or special antiviral medications. Checkwith your health care provider about

whether you should take antiviral

medications to treat the H1N1 flu.

A ti i l D


23/37

Antiviral DrugsAntiviral DrugsDoctors may prescribe antiviral drugs to treat peoplewho become very sick with the flu or are at high risk

for flu complications. The following people may be athigh risk:

Children younger than 5 years old, especially thoseyounger than age 2

Adults 65 years of age and olderPeople with: Chronic lung (including asthma or heart conditions (except

high blood pressure

Kidney, liver, neurologic, and neuromuscular conditions

Blood disorders (including sickle cell disease Diabetes and other metabolic disorders

An immune system that does not work well, such as AIDSpatients or cancer patients receiving chemotherapy
http://www.nlm.nih.gov/medlineplus/ency/article/000141.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001214.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000594.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/001214.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000527.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000468.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/000141.htm


24/37
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


25/37


26/37

Prevention of human toPrevention of human to

human transmissionhuman transmissionEveryone should take these steps to prevent the flu fromspreading:

Cover your nose and mouth with a tissue when you cough orsneeze. Throw the tissue away after using it.

Wash your hands often with soap and water for 15 - 20 seconds,especially after you cough or sneeze. You may also use

alcohol-based hand cleaners.Avoid touching your eyes, nose, or mouth, to avoid getting

infected by germs.

Avoid close contact with sick people.

If you do get sick, consider staying home from work or school for

7 days after your symptoms begin, or until you have beensymptom-free for 24 hours, whichever is longer.

Wear a facemask , if possible, when sharing common spaces withother household members
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


27/37


28/37


29/37


30/37

2009H1N1 influenza vaccine

Vaccines are available to protect against 2009H1N1 influenza.

These vaccines are made just like seasonal

flu vaccines.

They are expected to be as safe andeffective as seasonal flu vaccines.

They will not prevent influenza-like

illnesses caused by other viruses.

They will not prevent seasonal flu. Youshould also get seasonal influenza vaccine, if

you want to be protected against seasonal

flu.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


31/37

Who should get 2009 H1N1

Flu Shots and when?Groups recommended to receive 2009 H1N1 vaccinefirst are: Pregnant women People who live with or care for infants younger than

6 months of age Health care and emergency medical personnel Anyone from 6 months through 24 years of age Anyone from 25 through 64 years of age with certainchronic medical conditions or a weakened immune

system As more vaccine becomes available, thesegroups should also be vaccinated: Healthy 25 through 64 year olds Adults 65 years and older
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


32/37

The nasal mist vaccine (LAIVThe nasal mist vaccine (LAIV

A non-shot option, the nasal mist vaccine, is

now available, but because it contains

weakened live flu viruses it is not for people

with weakened immune systems or certainhealth conditions. The nasal mist vaccine is

only for healthy, non-pregnant people

between the ages of 2 and 49 years. Check

with your doctor to see if your child can orshould get this type of flu vaccine.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


33/37


34/37

Some people should not get the

vaccine or should waitYou should not get 2009 H1N1 flu vaccine if you have a severe(life-threatening allergy to eggs, or to any other substance inthe vaccine. Also if you have ever had: a life-threatening allergic reaction after a dose of seasonal

flu vaccine, Guillain Barr Syndrome (a severe paralytic illness also

called GBS.These may not be reasons to avoid the vaccine, but themedical staff can help you decide.

If you are moderately or severely ill, you might be advised towait until you recover before getting the vaccine.If you have a mild cold or other illness, there is usually no

need to wait.

Pregnant or breastfeeding women can get inactivated 2009H1N1 fl u vaccine.

Inactivated 2009 H1N1 vaccine may be given at the same timeas other vaccines, including seasonal influenza vaccine.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


35/37

What are the risks from2009

H1N1 influenza vaccine?Mild problems:

soreness, redness, tenderness, or swelling where theshot was given fainting (mainly adolescents headache, muscle aches

fever nausea If these problems occur, they usuallybegin soon after the shot and last 1-2 days. Severproblems: Life-threatening allergic reactions to vaccines are veryrare. If they do occur, it is usually within a fewminutes to a few hours after the shot. In 1976, an earlier type of swine flu vaccine wasassociated with cases of Guillain-Barr Syndrome(GBS. Since then, flu vaccines have not been clearlylinked to GBS.
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


36/37

Thanks
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm


37/37

Any Questions?
http://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htmhttp://www.nlm.nih.gov/medlineplus/ency/article/002324.htm

Influenza Clinical Presentation

Documents

Transcript of Influenza Clinical Presentation