Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases...
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![Page 1: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/1.jpg)
Influenza
Timothy Wiemken, PhD MPH CICAssistant Professor
Division of Infectious DiseasesUniversity of Louisville
![Page 2: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/2.jpg)
Overview
• The influenza virus• Influenza transmission• Available Vaccines• Vaccine Efficacy/Effectiveness
![Page 3: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/3.jpg)
The Influenza Virus
![Page 4: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/4.jpg)
The Influenza Virus
Three types of influenza viruses
A
B
C
![Page 5: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/5.jpg)
The Influenza Virus
Three types of influenza viruses
Influenza A Separated into serotypes using
Hemagglutinin and Neuraminidase
16 different H’s9 different N’s
![Page 6: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/6.jpg)
Influenza A Strains
1918-19
Severe
1957-58
Severe
1968-69
Moderate
1977-78
Mild
2009- 12
H1N1
Mild
1918 1950 1960 1970 1980 2000 2009 2012
H2N2 H3N2 2009 H1N1
The Influenza Virus
2012-
H3N2
H1N1
![Page 7: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/7.jpg)
Influenza A Strains
1918-19
Severe
1957-58
Severe
1968-69
Moderate
1977-78
Mild
2009- 12
H1N1
Mild
1918 1950 1960 1970 1980 2000 2009 2012
H2N2 H3N2 2009 H1N1
The Influenza Virus
2012-
H3N2
H1N1
![Page 8: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/8.jpg)
Influenza A Strains
1918-19
Severe
1957-58
Severe
1968-69
Moderate
1977-78
Mild
2009- 12
H1N1
Mild
1918 1950 1960 1970 1980 2000 2009 2012
H2N2 H3N2 2009 H1N1
The Influenza Virus
2012-
H3N2
H1N1
![Page 9: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/9.jpg)
Influenza A Strains
1918-19
Severe
1957-58
Severe
1968-69
Moderate
1977-78
Mild
2009- 12
H1N1
Mild
1918 1950 1960 1970 1980 2000 2009 2012
H2N2 H3N2 2009 H1N1
The Influenza Virus
2012-
H3N2
H1N1
![Page 10: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/10.jpg)
Influenza A Strains
1918-19
Severe
1957-58
Severe
1968-69
Moderate
1977-78
Mild
2009- 12
H1N1
Mild
1918 1950 1960 1970 1980 2000 2009 2012
H2N2 H3N2 2009 H1N1
The Influenza Virus
2012-
H3N2
H1N1
![Page 11: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/11.jpg)
The Influenza Virus
6 19 33
12984
190
321
431
686
1195
65
358
0
200
400
600
800
1000
1200
Age group (yrs)
Pe
r 1
00
,00
0 p
op
ula
tio
n
Influenza-related mortality Influenza-related hospitalizations
65-69 70-74 75-79 80-84 ≥8550-64
![Page 12: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/12.jpg)
The Influenza Virus
Naming of influenza viruses
1. Antigenic type (A, B, C)2. Host of Origin (unless human)3. Geographical Origin4. Strain Number5. Year of Isolation6. For A’s, H and N antigens
![Page 13: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/13.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
![Page 14: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/14.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
No Host – Human!
![Page 15: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/15.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
No Host – Human!
From Perth
![Page 16: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/16.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
No Host – Human!
From Perth
16th strain
![Page 17: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/17.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
No Host – Human!
From Perth
16th strain
First isolated in 2009
![Page 18: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/18.jpg)
The Influenza Virus
A/Perth/16/2009 (H3N2)
Influenza A
No Host – Human!
From Perth
16th strain
First isolated in 2009
Since it is Flu A, need H and N type, H3N2
![Page 19: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/19.jpg)
The Influenza Virus
• B’s are named the same but don’t have subtypes
• Lineages are Victoria or Yamagata
![Page 20: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/20.jpg)
The Influenza Virus
![Page 21: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/21.jpg)
Overview
• The influenza virus• Influenza transmission• Available Vaccines• Vaccine Efficacy/Effectiveness
![Page 22: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/22.jpg)
Influenza Transmission
Droplet
Contact
![Page 23: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/23.jpg)
Influenza Transmission
![Page 24: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/24.jpg)
Overview
• The influenza virus• Influenza transmission• Available Vaccines• Vaccine Efficacy/Effectiveness
![Page 25: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/25.jpg)
Available Vaccines
• Trivalent (2 A’s, 1 B) Intramuscular• Trivalent Intramuscular High Dose• Trivalent Intradermal• Quadrivalent (2A’s, 2 B’s)
Intramuscular• Quadrivalent Intranasal
![Page 26: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/26.jpg)
Available Vaccines
• What should I use?• When should I use it?
![Page 27: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/27.jpg)
Available Vaccines
• CDC says whatever.
![Page 28: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/28.jpg)
Available Vaccines
• Kids/around kids = quadrivalent– Intranasal (quadrivalent)
• HCW = quadrivalent• Comorbidities = quadrivalent• ≥65 = high dose
![Page 29: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/29.jpg)
Available Vaccines
• Kids/around kids = quadrivalent– Intranasal (quadrivalent)
• HCW = quadrivalent• Comorbidities = quadrivalent• ≥65 = high dose
In other words, don’t waste the quadrivalent on creepers.
![Page 30: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/30.jpg)
Available Vaccines
![Page 31: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/31.jpg)
Overview
• The influenza virus• Influenza transmission• Available Vaccines• Vaccine Efficacy/Effectiveness
![Page 32: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/32.jpg)
Vaccine Efficacy/Effectiveness
Efficacy: Did it work in the clinical trial versus placebo?
Effectiveness: Does it work in real life?
The numbers vary based on the outcome under study.
![Page 33: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/33.jpg)
Vaccine Efficacy/Effectiveness
• Trivalent (2 A’s, 1 B) Intramuscular
![Page 34: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/34.jpg)
Vaccine Efficacy/Effectiveness
• Trivalent (2 A’s, 1 B) Intramuscular• Effectiveness for preventing ARI due
to Flu
Age Group Subtype Vaccine Effectiveness (95% CI)
Overall All 56% (47%-63%)
Overall H3N2 47% (35%-58%)
Overall B 67% (51%-78%)
![Page 35: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/35.jpg)
Vaccine Efficacy/Effectiveness
• Trivalent (2 A’s, 1 B) Intramuscular• I heard it was 9% though?
![Page 36: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/36.jpg)
Vaccine Efficacy/Effectiveness
• Trivalent (2 A’s, 1 B) Intramuscular• I heard it was 9% though?
• For H3N2 only… for those over 65…– Effectiveness 9%– 95% CI: -84% to 55%– ~200 people only!!!
![Page 37: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/37.jpg)
Available Vaccines
Pop quiz
How effective is the flu vaccine if you don’t receive it?
![Page 38: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/38.jpg)
Vaccine Efficacy/Effectiveness
Influenza B effectiveness… historicallySeason % B % Yamagata % Victoria Vaccine
2000–2001 46 100 0 Yamagata
2001–2002 13 23 77 Yamagata
2002–2003 43 0.4 99.6 Victoria
2003–2004 1 93 7 Victoria
2004–2005 25 74 26 Yamagata
2005–2006 19 22 78 Yamagata
2006–2007 21 24 77 Victoria
2007–2008 29 98 2 Victoria
2008–2009 33 17 83 Yamagata
2009–2010 0.2 12 88 Victoria
2010–2011 30 6 94 Victoria
2011–2012 14 51 49 Victoria
![Page 39: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/39.jpg)
Vaccine Efficacy/Effectiveness
• Quadrivalent (2 A’s, 2 B) Intramuscular
![Page 40: Influenza Timothy Wiemken, PhD MPH CIC Assistant Professor Division of Infectious Diseases University of Louisville tim.wiemken@louisville.edu.](https://reader036.fdocuments.net/reader036/viewer/2022062516/56649d945503460f94a7b92d/html5/thumbnails/40.jpg)
Overview
• The influenza virus• Influenza transmission• Available Vaccines• Vaccine Efficacy/Effectiveness