Turkulov V, Madle-Samardzija N
Medicinski fakultet, Novi Sad Klinika za infektivne bolesti, Klinicki centar, Novi Sad.
Med Pregl. 2000 Mar-Apr;53(3-4):154-8.
Influenza virus infects about 10 million persons worldwide each year. Two important characteristics of influenza are its epidemic outbreak and high mortality rate, mostly caused by complications. Influenza virus is characterised by a great antigenic variability. Major modifications, called antigenic shifts or type changes, occur approximately three times per century and result in worldwide epidemics--pandemics. Minor modifications, called antigenic drifts or strain changes demand new vaccine compositions each year.
Pandemics and epidemics caused by influenza virus, such as the "Spanish Flu", the "Asian Flu", the "Hong Kong Flu" killed many people worldwide. Presently the epidemic, caused by influenza A virus Sydney/97 H3N2 is spreading over USA and most of Europe, including Yugoslavia. EPIDEMIOLOGY AND CLINICAL FEATURES: In humans influenza virus spreads over respiratory secretions, thrown out by coughing and sneezing. Children and older people, as well as immunosuppressed patients are prone to the infection. The onset of illness is sudden, with fever usually over 39 degrees C. Headache and myalgia are prominent. Other signs include fatigue, sore throat, nasal congestion and red eyes. Cough is a very important symptom, which starts as dry and progresses to wet with thick mucous.
Pneumonia is the main cause of death among the high-risk patients. Bronchitis and tracheobronchitis also occur. Croup is a serious complication, often encountered in small children. Cardiac complications, especially myocarditis, are described as influenza complications. Neurological complications include encephalitis, encephalopathy, myelitis, Guillain-Barré syndrome, Reye syndrome, etc. Neurotropism of the influenza virus is under investigation. DIFFERENTIAL DIAGNOSIS AND DIAGNOSIS: Differential diagnosis of influenza includes all diseases which exhibit by increased body temperature, cough, headache, sore throat, myalgia and lethargy. Among serious diseases, pneumonia, sepsis, and meningitis should be considered. Various tests are used when diagnosing influenza: antigen detection, polymerase chain reaction, immunofluorescent tests, etc.
Treatment of influenza by antiviral drugs can be prophylactic and therapeutic. Amantadine and rimantadine are older drugs effective in cases caused by virus type A. The newest generation of influenza antiviral agents are neuraminidase inhibitors--zanamivir and oseltamivir, effective against both virus types. The symptomatic therapy is still a basis of influenza treatment.
The main means of influenza prevention is a yearly vaccine. The three-valent vaccine is in common use. It is recommended that high-risk population should be vaccinated. If the composition of the vaccine is well matched with the prevalent virus strain, it is efficient in 50-80% of vaccinees.
Influenza is the sixth cause of death in the world, the forth among the older population. The next pandemic can occur at anytime. It will be a different virus subtype, never before encountered by humans. Are we ready?
每年全球约有1000万人感染流感病毒。流感的两个重要特征是其爆发流行和高死亡率，这主要是由并发症所致。流感病毒的特点是具有极大的抗原变异性。主要的变异，即抗原转变或类型改变，大约每世纪发生三次，会导致全球范围的流行——大流行。较小的变异，即抗原漂移或毒株变化，每年都需要新的疫苗配方。
由流感病毒引起的大流行和流行，如“西班牙流感”“亚洲流感”“香港流感”，在全球造成了许多人死亡。目前，由甲型流感病毒悉尼/97 H3N2引起的疫情正在美国和包括南斯拉夫在内的欧洲大部分地区蔓延。
在人类中，流感病毒通过咳嗽和打喷嚏时排出的呼吸道分泌物传播。儿童、老年人以及免疫抑制患者容易感染。发病突然，通常发热超过39摄氏度。头痛和肌痛较为突出。其他症状包括疲劳、喉咙痛、鼻塞和眼睛发红。咳嗽是一个非常重要的症状，开始时为干咳，随后发展为伴有浓稠黏液的湿咳。
肺炎是高危患者死亡的主要原因。支气管炎和气管支气管炎也会发生。哮吼是一种严重的并发症，在幼儿中经常出现。心脏并发症，尤其是心肌炎，被描述为流感并发症。神经并发症包括脑炎、脑病、脊髓炎、格林-巴利综合征、瑞氏综合征等。流感病毒的神经嗜性正在研究中。
流感的鉴别诊断包括所有表现为体温升高、咳嗽、头痛、喉咙痛、肌痛和嗜睡的疾病。在严重疾病中，应考虑肺炎、败血症和脑膜炎。诊断流感时会使用各种检测方法：抗原检测、聚合酶链反应、免疫荧光检测等。
用抗病毒药物治疗流感可分为预防性和治疗性。金刚烷胺和金刚乙胺是较老的药物，对甲型病毒引起的病例有效。最新一代的流感抗病毒药物是神经氨酸酶抑制剂——扎那米韦和奥司他韦，对两种病毒类型均有效。对症治疗仍然是流感治疗的基础。
预防流感的主要手段是每年接种疫苗。常用的是三价疫苗。建议高危人群接种疫苗。如果疫苗成分与流行的病毒株匹配良好，对50%至80%的接种者有效。
流感是全球第六大致死原因，在老年人群中位列第四。下一次大流行随时可能发生。将会是一种人类从未遇到过的不同病毒亚型。我们准备好了吗？
