FLU (fr. grippe; synonym influenza) — the viral disease which is characterized by the acute beginning, a short current with the phenomena of the general intoxication, damage of a mucous membrane of respiratory tracts.
- 1 History
- 2 The statistics
- 3 An etiology
- 4 The epidemiology
- 5 A pathogeny
- 6 Pathological anatomy
- 7 Immunity
- 8 the Clinical picture
- 9 The diagnosis
- 10 Treatment
- 11 The forecast
- 12 Prevention
- 13 Flu at children
G.'s Diseases were known in ancient times. Still Hippocrates described a disease, persistent cough, an inflammation of a pharynx, weakness, fever, a skoroprekhodyashchy inflammation of eyes were the main symptoms to-rogo. There are data on 126 epidemics and G.'s pandemics for eight centuries (12 — 19). G.'s pandemics in 1889 — 1890 and were 1918 — 1920 especially big. Both pandemics captured all countries of the world; in 1918 — 1920, according to incomplete data, the St. 20 million persons died. After a pandemic of 1918 — 1920 of epidemic of G. each 2 — 4 years were observed on average, but they never reached such intensity both on incidence, and on mortality of the population. Only in a pandemic of 1957 — 1959 and 1968 — 1969 incidence was very high in all countries.
In Russia the first descriptions of clinic of G. were made in Moscow and St. Petersburg in epidemic of 1729 — 1730 when the Medical office published «The warning of the diseases coming from the infected air». In this unique document the clinic, G.'s treatment and its prevention are stated. However the abundance described a wedge, forms demonstrates that G. at that time, undoubtedly, was not allocated from among other acute respiratory diseases.
Long time the activator G. considered the stick allocated with R. Pfeyffer in 1892. The true story of studying of G. began with establishment by R. Shoup in 1931 of a virus etiology of an influenza of pigs and opening in 1933 W. Smith with soavt, a virus G. of the person. In the USSR the virus G. is for the first time allocated by A. A. Smorodintsev with sotr. in 1936. The method of specific prevention (1937) and G.'s treatment by means of anti-influenza serum (1938) is for the first time offered them.
G. in the general incidence of infectious diseases takes an important place. Under G.'s diagnosis quinsies, rhinitis, pharyngitis, a tracheobronchitis etc. quite often are registered; therefore at the statistical analysis based on the accounting of only clinically diagnosed diseases summary data on incidence of various acute respiratory diseases (ARD) and flu (tab.) are used.
INCIDENCE of the POPULATION of the USSR of FLU AND ACUTE RESPIRATORY DISEASES
G.'s Incidence and ORZ in the USSR exceeds total incidence of all other infectious diseases. In separate years G. and ORZ made more than 80% of all infectious pathology, more than 60% of diseases of children.
The actual incidence of G. exceeds a little registered on negotiability. Bo time of epidemics she is especially great in preschool child care facilities and at the enterprises. The highest rates of incidence — on large enterprises which nature of production is connected with intensive contacts of working. G.'s incidence is approximately twice lower than country people, than city. Men and women are ill with an identical frequency. At considerable number of patients complications from ENT organs are noted and lungs (pneumonia). In 0,3% of cases of G. leads to development of defeats of a nervous system.
A lethality from G., having reached in a pandemic of 1918 — 1920 of high rates, continuously decreased. Increase in a lethality from G. is noted usually in the period of epidemics caused by new antigenic options of an influenza virus of type A.
The developed system preventive, protivoepid and to lay down. measures at G. in our country allowed to stabilize mortality from this disease on low indicators.
The lethality from G. is rather small and the hl is observed. obr. among children till 1 year and elderly people.
The damage to health of the population and economy from G.'s epidemics is extremely high that puts forward a problem of fight against G. as one of priorities of health care.
Activators G. — the pnevmotropny RNA-containing viruses three antigenically isolated serol, types A, B and C — belong to this. Orthomyxoviridae (see. Orthomyxoviruses ).
Activators G. are adsorbed on cells of various origin and easily desorbed from their surface; possess enzymatic (a neuraminidase, a RNA polymerase) and the hemagglutinating activity. Multiple reactivation is inherent to them (see. Viruses ), genetic recombinations (see. Recombination ) and formation of an incomplete virus (the particle containing a defective genome and having the lowered infectivity with the high hemagglutinating activity). Viruses G. have the rounded or oval shape with dia, particles of 80 — 100 nanometers. The polymorphism, education threadlike are characteristic of svezhevydelenny viruses (length to 1000 nanometers at dia. 80 — 100 nanometers) and large (to dia, to 250 nanometers) rounded shapes.
Virions have a dense cover, are covered with ledges 10 — 12 nanometers high. The core of a virus (nucleocapsid) consists of a spiral tyazh of a ribonucleoprotein (RNP) to dia. 9 nanometers. Chemical structure of viruses G.: RNA — 1,0%, protein — 70%, lipids — to 24%, carbohydrates — to 5%.
RNA of viruses G. one-filamentous, with dominance of uracil. A genome of a virus (see. Genome ) the pier is fragmented and represents set of several molecules RNA of different length, the general. weighing 4 — 5 X 106 dalton.
Proteins of viruses are made of seven types of polypeptides of different size. Four of them do not contain carbohydrates and are in the central part of virion. Two polypeptides have a pier. weight 81 000 — 94 000 dalton, their function is not clear; the third polypeptide is connected with RNA, a pier. weight 53 000 — 65 000 dalton; the fourth polypeptide — a pier. weight 25 000 — 26 000 dalton — makes the membrane covering a nucleocapsid.
Other three polypeptides contain carbohydrate groups and are glycoproteins about a pier. weighing 55 000 — 58 000, 46 000 — 50 000 and 25 000 — 29 000 dalton; they make a periblast of an obodochka and are functionally connected with the hemagglutinating and neyraminidazny activity. Hemagglutinin — a glycoprotein of a complex structure, consists of two-three dimer, each of which in turn includes a heavy and light chain of polypeptides about a pier. weighing 46 000 — 50 000 and 25 000 — 29 000 dalton respectively. The neuraminidase is the tetramer consisting of four polypeptides; in general the functional complex has a pier. weight 220 000 — 250 000 dalton. Distinction in a pier. the weight of polypeptides depends on a strain like a virus and a method of allocation. Hemagglutinin and a neuraminidase are isolated structurally, antigenically and functionally. Their change under natural conditions goes independently. Each of them can be allocated in the cleared look. According to the nomenclature of Committee of WHO experts (1971) viruses G. of the person have four antigenically isolated subtypes of hemagglutinin (H0, H1, H2 and H3) and two subtypes of a neuraminidase (N1 and N2).
Enzyme the polymerase (transcriptase) of viruses G. catalyzes RNA-dependent process of inclusion of ribonucleotides in affiliated virus RNA (the mechanism of synthesis of virus RNA — see. Viruses ).
Lipids are a part of a medine of virion. As well as carbohydrates, they are structurally connected with virus proteins, their synthesis and specificity depend on a genome of a cell. Internal proteins have standard specificity and immunological are designated as S-antigen (English soluble soluble). Outside glycoproteins have shtammovy specificity and immunological are designated as V-antigen (English viral virus).
Synthesis of components of a virus is carried out in the infected cell, «maturing» of a virus happens on a membrane of cells, and release of a virus goes way of budding on the transformed sites of a cellular membrane.
It is established that the genome of a virus G. represents a complex composition of fragments of RNA, each of which is closely connected to protein; the fragments associated with protein are connected among themselves by labile bridges. The fragmentariness of a genome of viruses G. and its separate synthesis in the course of a reproduction cause heterogeneity of population, characteristic of viruses G., formation of incomplete viruses with a defective genome, and also make a basis of genetic recombinations.
The international nomenclature of influenza viruses And provides the standard designation of a strain including the following data: type of a virus, a type of the owner, the place of allocation, own designation of a strain or its number, the last two figures of year of allocation, a formula of a cover, i.e. the reduced designation of an antigenic subtype of hemagglutinin and a neuraminidase. At designation of strains of viruses G. of the person the type of the owner falls; at designation of the strains isolated from animals, designation of a type of a feral host from to-rogo this strain, surely is allocated. At designation of an antigenic formula of subunits of a cover subtypes of hemagglutinin and neuraminidase characteristic of Viruses. Animals, except number of a subtype, are designated by initial letters of a type of the owner, at to-rogo this sample of antigen was for the first time found: the horse — eq (equine), a pig — sw (swine), birds — av (avian), etc.
E.g., a strain And / Hong Kong — 1/68 (H3N2) is the virus G. allocated from the person in Hong Kong in 1968 has a subtype 3 hemagglutinins and a subtype 2 neuraminidases of a human sample; the strain And / horse / Miami — 2/63 (Heq2 Neq2) is a virus G. of type A, the strain No. 2 allocated from a horse in Miami in 1963 has hemagglutinin of a subtype 2 of a horse sample and a neuraminidase of a subtype 2 of a horse sample.
Activators of pandemics and large epidemics of G. are antigenic options of a virus of A type, division to-rogo on serol, (H0N1), A (H2N2) and A (H3N2) subtypes A reflects the main stages of its evolution. The virus for the first time allocated in 1933 with Smith, K. Andrews and P. Laidlaw was carried to the A (H0N1) subtype later. In 1947 there were viruses A with new hemagglutinin, but with a former subtype of a neuraminidase A (H1N1), in 1957 new viruses G. — subtype A/Singapore — 1/57 (H2N2) and in 1968 — subtype A/Hong Kong — 1/68 (H3N2) were allocated.
Influenza strains of type B were for the first time allocated in 1940 independently from each other by Fransis (T. Francis) in America and Medzhill (T. Magill) in England. Flu epidemics of V type arise time in 3 — 4 years, extend more slowly, are characterized by a long current and limited to territories of the certain cities. Change of antigenic options of a new subtype happens at an interval of 10 — 20 years, differences between them are expressed much less sharply, than at a virus of A type. Emergence of new antigenic option of a virus of V type is followed by obsolescence of earlier circulating viruses in this connection in the same area the options of a virus of V type differing on antigenic properties can be allocated.
The influenza virus of type C differs from two previous types in big constancy of the antigenic structure which almost did not change after its allocation in 1947 by R. Taylor. Viruses of S type affect hl. obr. children; the flashes caused by it are strictly limited on distribution and the wedge, currents are characterized by ease.
Uniform classification of an influenza virus of type B and C is not created, subtypes of hemagglutinin or a neuraminidase in the name of strains do not join.
The experimental influenzal infection is reproduced at white mice, the African polecats, white rats, is more rare at hamsters, Guinea pigs, monkeys. In vitro the simplest and convenient model for cultivation of a virus G. are 10 — the 12-day developing chicken embryos. Reproduction of some strains on initially tripsinizirovanny cultures of renal fabric of embryos of the person, hens, cows, young monkeys of macaques Rhesus factors and green monkeys is described. Existence of a virus G. in the infected chicken embryos is revealed on P HECTARES, in fabric cultures — on RGA and a hemadsorption virus test based on sticking of erythrocytes of hens or Guinea pigs to cells of the infected monolayer (see. Hemagglutination , Hemadsorption ), and also on a cytopathic effect.
Viruses G. are sensitive to external influences. They lose infectivity (in vitro) after warming up within 20 — 30 min. at t°60 ° or 2 — 3 days at t ° 37 °, after UF-radiation, under the influence of formalin, ether, ultrasound. The virus G. remains for a long time at t ° — 25 ° — 70 °. Viruses G. quickly perish in fiziol, solution, but 6% of solution of peptone, 20% of solution of ovalbumin or the normal inactivated serum remain in the presence of 10% of solution of skim milk.
In the majority viruses G. are characterized by the expressed plasticity antigenic and biol, properties. The variability of surface antigens observed under natural conditions sharply distinguishes an influenza virus of type A from other viruses. It proceeds in the form of two forms: a) antigenic «drift» (partial shift and updating of antigenic determinants — active groups of antigens) hemagglutinin or a neuraminidase within one subtype; b) the «explosive» form of variability designated as antigenic «шифт» (full substitution of a fragment of the genome coding only hemagglutinin or hemagglutinin and a neuraminidase) is shown in emergence of a new subtype among influenza viruses of type A. Antigenic «drift» formation of mutants and their subsequent selection under influence immunol is the cornerstone, of factors of the population. The origins of pandemic strains (a «explosive» form of variability) are insufficiently clear. On this matter there is a number of hypotheses. One of them assumes a possibility of formation of pandemic strains of viruses G. in a subsoil of earlier circulating strains under the selecting influence immunol, factors of protection; the second — emergence of natural mutants; the third — «splash» in human society of viruses G. from animals; the fourth — the most popular — is based on a possibility of a genetic recombination between a human virus G. and viruses G. of birds and animals.
G. meets almost everywhere. As any infectious disease, G. is capable to epidemic, and is frequent also to pandemic distribution to rather short terms; it strikes tens and hundreds of millions people on all continents of the globe. It is defined by the following factors: a large number of easy forms of a disease and a short incubation interval that leads to bystry increase of number of patients (new sources of an infection) among the population; in the air way of transmission of infection providing simultaneous infection of many persons from one patient; a general susceptibility of people to flu; emergence in each next epidemic (pandemic) of new antigenic version of the activator G., to Krom the population has no immunity; short duration of postinfectious immunity that involves a possibility of a recurrent disease. So, in the USSR from 1957 to 1966 annually had from 9 thousand to 21 thousand on 100 000 population, and all for these 10 years had apprx. 145 thousand on 100000 population, i.e. on average apprx. 1,5 diseases on each resident of the country (tab). At the same time it is necessary to consider that at the full general accounting of infectious patients in the USSR the known number of patients with easy forms G., undoubtedly, does not address for medical aid and, therefore, is not among considered.
A source of causative agents of infections at G. is only the sick person with clinically expressed or erased form of a disease. In an incubation interval of the patient can already allocate a virus G. to the environment through upper respiratory tracts (at cough, sneezing, a conversation). Since 7th day of a disease it is not possible to allocate a virus from the patient, as a rule. Exceptional cases of allocation of a virus of A type on 15 — at had are described the 40th day. However an opportunity hron, carriages of a virus G. is not proved.
Ways of spread of an infection. The virus is brought out of the damaged cells of a fleecy epithelium of respiratory tracts in air with drops of saliva, slime, a phlegm at breath, a conversation, shout, crying, cough, sneezing. Preservation of a virus G. in the air environment depends on a degree of dispersion of the aerosol containing virus particles, influences on it of light, moisture, heating and time of its sedimentation. The drops of a secret of respiratory tracts allocated to patients in air and containing virus particles, drying for fractions of a second, form the drop kernels capable a long time to keep in air in the form of an aerosol. The virus G. survives in the air environment till several o'clock. The influenza virus of type A is steadier, than a virus of V type. It remains in the dried and settled drops of an aerosol: on bed linen — to 2 weeks, in room dust — to 5 weeks. In this regard at flu of A type there is a possibility of transfer of a virus through a secondary (dust) aerosol. However the leader in transfer of a virus G. is the airborne way. Perhaps also infection and through the objects of use infected with allocations of the patient (toys, nipples, ware, towels, etc.).
According to V. A. Bashenin (1955), pandemic flu 1889 — carried away 1890 the greatest victims among old men. In a pandemic of 1918 — 1920 the blossoming age (15 — 35 years) was most struck. Usually G. are ill more often children among whom children of younger age most suffer: from 6 months to 3 years. Children of the first half of the year of life have the oroimmunity received from mother.
G.'s incidence has obviously expressed seasonal nature. In our country G.'s epidemics arise, as a rule, during the winter period, but are registered also in the early spring or late fall. G.'s epidemics which began in the spring with approach of summer calm down though G.'s incidence can exceed considerably the level, average for the summer period, and in the fall growth of diseases accepts stable character as it was, e.g., in 1957. Were suggested about influence meteorol, factors on G.'s incidence, but convincing data it is in this respect not obtained. On the other hand, undoubtedly, the huge role is played by such factors as density and movement of the population, density of people indoors and its insufficient ventilation, the growing transport bonds as in the countries, and on a global scale. So, e.g., if G. registered for the first time in Australia in 1946 reached the USSR only 3 years later, then in 1968 it extended on all globe of all for half a year.
The ecology of influenza viruses studies relationship of activators G. with the environment of their dwelling and an effect of this interaction both for a virus, and for feral hosts, including the person. Special attention is paid to studying of the evolution of a virus happening in these conditions and its forecasting.
Need of use ekol, approaches to a solution of the problem of G. arose in connection with new ideas that G., perhaps, should be considered as a zoonotic infection. In natural - conditions the influenza virus of type A strikes not only the person, but also a number of mammals — pigs, horses, a cattle, dogs, apparently, seals, and also numerous types house (Hens, ducks, turkey-cocks), wild (pheasants, perepela, ducks, morwennols, gagara, seagulls etc.) and synanthropic (crows, etc.) birds. The strains of influenza viruses of type A circulating among different types of owners differ among themselves not only biol, signs, but also is cardinal on antigenic and proteinaceous composition of hemagglutinin and a neuraminidase. At the known viruses G. of the person and animals 15 subtypes of hemagglutinin and 9 subtypes of a neuraminidase are revealed. From 15 antigenic subtypes of hemagglutinin 4 were found for the first time in the strains allocated from people and treat a human subtype, 1 — a pork subtype, 2 — to horse and 8 — to bird's. From 9 known antigenic subtypes of neuraminidases 2 treat to human, 2 — to horse, 5 — bird's samples. However all 9 known subtypes of neuraminidases are found in viruses G. of birds. At the same time the subtype of 1 neuraminidase designated as human is found in the strain allocated from hens in 1902 i.e. 31 year prior to detection of a virus G. of the person.
Feral hosts of influenza viruses of type A are divided into 5 groups: 1) the person, an organism to-rogo is surprised only certain antigenic kinds of influenza viruses And; 2) horses, pigs, hens who, in addition to the antigenic kinds of a virus G. parasitizing at them, are infected with the antigenic kinds of a virus striking the person; 3) the cattle, dogs who do not have the virus G. under natural conditions, but struck by influenza viruses And the person; 4) wild migratory and synanthropic birds at whom the disease can be caused as the antigenic kinds of a virus G. inherent to them, and versions striking all other types; 5) the pulmonary ascarids of pigs, earthworms capable to store an influenza virus And long time in an abeyance and to give him transovarialno.
The epidemic process inherent to flu of A type has cyclic character. Huge value is gained by periodically happening replacement of earlier circulating antigenic options with new. Emergence of the new subtypes of a virus capable to overcome earlier developed immunity can lead to emergence of epidemics or G.'s pandemics when a considerable part of the susceptible population has, epidemic calms down. In the following epid, a season (in 1,5 — 2 from emergence of option) usually there passes the second wave of G., in time a cut the people who are not affected by the first wave generally are ill, but also recurrent diseases of persons at which strong immunity, especially children was not created are possible. In the next years the implemented option causes hl. obr. local flashes, then disappears. Emergence epidemics (see) it is connected with distribution of the options possessing changes of hemagglutinin or a neuraminidase within antigenic «drift». Such options in one subtype can be a little, one gain wider, others limited distribution in these or those zones of the globe. A new pandemic cycle (see. Pandemic ) begins after emergence of the following subtype of a virus, a cut, on preliminary observations, occurs in 11 — 18 years.
Assume that earlier circulating options of a virus can be returned in 60 — 80 years. Confirmations of it were received on a basis serol, inspections of aged people as, according to Fransis (1960) theory, the first in human life infection with a virus G. leaves the strongest immunol., the trace and antibodies to this version remain all life. By such way it was established that the kinds of a virus similar to a version And (Hong Kong) 68, already had epid, distribution in 1890, and the kind of A(Hsw1N1) known as the causative agent of flu of pigs, was the cause of a pandemic of the Spanish G. in 1918 — 1920. Isolation of the strains similar to this virus, from people during G.'s flash in the USA in 1976 shows a basic possibility of return and this kind of a virus.
Epizootic process at domestic animals (mammals and birds) substantially depends on properties of a strain, population density and intensity of trans-species contacts. The most pathogenic for poultry are the virus strains with hemagglutinin of the first bird's subtype which were earlier designated as true plague of birds.
Circulation of viruses G. among people, and also in populations of animals is carried out by means of transmission of infection from a sick individual or the carrier to healthy. In addition to an airborne way of transfer of activators, at animals the fecal and oral way of transfer, and also transfer of activators with participation of the intermediate owner takes place. So, G. of pigs is transmitted in the direct way from one individual to another, and also through pulmonary ascarids who, catching a virus G. in an organism of a sick pig, transfer activators transovarialno. The infected eggs of ascarids are removed in external environment, absorbed by earthworms or remain in the soil. At the same time the virus G. which is in eggs keeps the activity.
Long preservation of a virus G. in ascarids and earthworms leads to emergence of the local centers of an infection and promotes its transition to other populations of owners, napr, on wild birds.
Activators G. of the person, in particular the Hong Kong kind of a virus — type A, can be transferred under natural conditions from the person to dogs, a cattle, pigs, hens, synanthropic and migratory birds, and it is possible, and to other animal species. The infection caused by viruses G. of the person at hens, pigs, cows proceeds is good-quality, however in the presence of accessory factors (cooling, avitaminosis, a bacterial and mycoplasmal infection) severe forms with mass diseases and death are observed. More often the young growth suffers. Therefore during G.'s epidemics during the carrying out protivoepid, and antiepizootic actions in rural areas it is necessary to pay special attention to prevention of a drift of G. to animals from the personnel servicing them.
Wild birds are an important link in natural circulation of influenza viruses of type A among animals and in their distribution between continents. There are no proofs of direct transition with preservation of pathogenicity of viruses G. from animals on the person. The antigenic options striking a livestock, domestic or wild birds do not cause epidemics in the person.
However the possibility of hybridization of viruses G. of the person and animals, and also emergence under natural conditions epidemic of the active versions having an antigenic community with viruses G. of birds and horses on a neuraminidase or hemagglutinin is experimentally proved. It gives the grounds to consider that the return influence of epizootic processes on epidemic can indirectly be carried out through processes of the genetic recombinations stimulating natural evolution and variability of the viruses G. of the person promoting formation of pandemically dangerous viruses. In this process viruses G. of mammals and especially birds are donors of additional genetic information. Epizootic processes in populations of different types of feral hosts can independently be carried out, but it is supposed that in the nature the influenza virus of type A has a general circulation including many types of living beings.
the Virus G., getting into upper airways, breeds in epithelial cells, causing their necrosis and exfoliating. The important role in development of a disease belongs to intoxication caused by a resorption of toxic proteins of the activator and influence of toxins on walls of vessels. At easy forms G. of defeat are limited to upper respiratory tracts, at heavier — process passes to a trachea, quickly extends to bronchial tubes, causing dystrophic and necrotic changes, gaining lines of a generalized infection.
In connection with exfoliating of the changed cells of an epithelium the mucous membrane of respiratory tracts becomes permeable for a virus which in these conditions gets into a blood flow together with decomposition products of the struck cells, and also the various bacteria which are intensively breeding in the tissues of airways affected with a virus G.
The virus is found in blood and in the absence of its allocation from a nose, and also is quite often allocated from blood from the 2nd to the 14th day of a disease not only at in a fever, but also at patients with a standard temperature. According to Miers (R. of D. Meers, 1969), Dadzhena (J. A. Dudgeon, 1969) et al., among other factors in G.'s pathogeny matters also the allergic component caused both by proteins of the activator, and complexes antigen — an antibody and antigen — the damaged tissue of the patient (see. Autoallergy ).
Morfol. changes at G. are expressed by damages of a respiratory organs and toxic defeat of other bodies, and systems. Expressiveness of these changes depends on virulence of the activator, a condition of specific and nonspecific immunity, and also on the nature of the accompanying diseases and bacterial complications.
Mucous and vacuolar dystrophy of an epithelium, his partial death throughout respiratory tracts with the subsequent reactive changes are characteristic of local changes at G.
It is characteristic serous, catarral and purulent, hemorrhagic and necrotic rhinitis (see), laryngitis (see) and a tracheobronchitis (see. Tracheitis ). In smears prints from an average nasal sink a large number of distrofizirovanny cells of a cylindrical epithelium in which cytoplasm oxyphilic inclusions quite often are found is found. Most sharply the subcopular area of a throat, trachea and large bronchial tubes (fig. 1), and also a mucous membrane of language are surprised. A mucous membrane — bright-red, dot hemorrhages and islands of yellowish color (the centers of necroses) are frequent. In more hard cases a mucous membrane of a trachea and large bronchial tubes throughout grayish-yellow color, with small sites of hemorrhages (tsvetn. fig. 2 and 3). Histologically the epithelium of a trachea and bronchial tubes takes a form of the arkadoobrazny structures arising for the account hypostasis (see), vacuolations (see) and amotio of surface layers of the cells Containing a viral antigen. Formation of fuchsinophil cytoplasmic inclusions (fig. 2) and development of regenerator (pseudo-metaplastic) processes is often observed. Cells of a bronchial epithelium under the influence of a virus G. lose fibers, the quantity of granules in them sharply decreases. Cytoplasmic inclusions represent the autofagosoma which are formed in a zone of a partial necrosis of cytoplasm owing to a reproduction of a virus G. (fig. 3). The sharp plethora, hypostasis and kruglokletochny infiltration of subepithelial layers is combined with a thickening of a basal membrane and strengthening of secretion of glands forming slime. In other places death of an epithelium, the expressed plethora and leukocytic infiltration of a subepithelial layer of bronchial tubes and purulent exudate with colonies of microbes in a gleam of respiratory tracts is noted. Such centers it is purulent - a necrotic tracheobronchitis are a source of bacterial damages of pulmonary fabric.
At macroscopic studying in lungs the sharp plethora, hypostasis, the centers of acute emphysema is noted (see. Emphysema of lungs ), sites of consolidation of intensivnokrasny color with a smooth surface of a section, and also purulent are frequent bronchitis (see) and bronchiolitis (see), sites of the purulent, abscessing pneumonia and pleurisy (tsvetn. fig. 3) which are usually developing in cases of accession bacterial, a thicket staphylococcal, infections («motley» influenzal lungs). Histologically often find the centers of an atelectasis, a thickening of interalveolar partitions due to proteinaceous treatment and a plethora, dystrophy and desquamation of alveolotsit. In a gleam of alveoluses, except the collapsing alveolotsit, the few macrophages and leukocytes weighed in serous liquid, the leukocytes or edematous liquid which in places are breaking up with colonies of microbes are found.
Bronchial pneumonia (see. Pneumonia ), the stafilokokkam often caused, are inclined to abscessing with the subsequent break in a pleural cavity. The epithelium of bronchial tubes at the same time perishes on a big extent. Walls of vessels of a lung are thickened due to plasmatic treatment, an endothelium quite often giperplazirovan. Along with the phenomena staza (see) the blood clots connected with the centers of a staphylococcal infection in places are visible.
In cases of a malignant current of G. often connected with bacterial stratifications, the phenomena of a plethora of lungs and internals are expressed sharply, and cellular reactions are suppressed that is explained by the combined influenzal and staphylococcal intoxication. Development toxic hemorrhagic is characteristic of such fulminant form G. fluid lungs (see).
On 6 — the 10th day of a disease along with the expressed circulatory disturbances and dystrophic changes there are regenerator processes in a mucous membrane of upper respiratory tracts. In lungs the suppurative processes caused by a bacterial infection that is promoted by disturbances of drainage function of bronchial tubes owing to defeat of a muscular layer of a wall of bronchial tubes and metaplastic processes in a mucous membrane quite often develop. The phenomena of a purulent bronchitis and a bronchiolitis with final fracture of an epithelial vystilka and the subsequent obliteration of a gleam of bronchioles or development of a bronchietasia are quite often noted.
Postgrippal changes in a respiratory organs (11 — the 30th day) are characterized by growths and a differentiation of proliferating epithelial cells of bronchial tubes. In sites of an atelectasis the small cavities corresponding to alveoluses, covered by a cubic epithelium with eosinophilic cytoplasm are formed. Gleams of such cavities contain slime, neutrophilic leukocytes with impurity of the died cells and microbic flora. Formation of such structures can promote development of postgrippal bacterial pneumonia. Further the differentiation of epithelial growths occurs unevenly, and on later terms in lungs it is possible to see the islands of a cubic epithelium reminding colossal cells (fig. 4). It, apparently, gave a reason to call the pneumonia arising during this period, giant-cell an unknown etiology.
In other internals, especially at heavy G., the various dystrophic changes connected with circulator frustration are observed. Acute swelling of a brain is noted (see. Swelled also swelling of a brain ), expressed the phenomena of a staz, hemorrhages (tsvetn. fig. 1) and dystrophic changes of cells of bark, sometimes with lymphoid infiltration. These phenomena which were mistakenly considered earlier as influenzal encephalitis are regarded as result of influenzal neurotoxicosis. In sympathetic gangliya and trunks of peripheral nerves dystrophic changes are defined.
In heart at G. dystrophic changes of muscle fibers and nervous cells intramural gangliyev are found. Dystrophic and inflammatory changes in vessels are sometimes combined with a vein thrombosis (see. Thrombosis ). In a liver along with dystrophic changes of hepatocytes the diffusion hyperplasia and proliferation of kupferovsky cells, kruglokletochny infiltration of connective tissue layers is quite often noted.
Death at G. is most often connected with accession of bacterial suppurative processes, and also with actually viral toxicosis which is expressed in sharp and acute circulator frustration.
the Person does not possess a congenital immunity to G. Lish newborns have antibodies to G. received at pre-natal development from mother and disappearing by 7th month of life. Artificial immunity at G. tipo-and shtammospetsifichen. Antigenic options of an influenza virus of type A cause only a partial cross immunity. Antibodies to the activator appear already on 2 — 3 days from an onset of the illness and reach the most high level on 10 — the 14th day. Artificial immunity at flu of S type remains, apparently, for life, immunity to flu of V type — 3 — 5 years, to flu of A type — 1 — 2 years. To homologous strains of flu of A type immunity is stronger and long. Artificial immunity is provided by two types of factors — local (secretory) and the general (humoral). Cofactors belong to nonspecific factors of immunity (see. virus-induced immunity ), serumal inhibitors (see) and interferon (see) which reduce probability of a disease of G.
the Clinical picture
the Incubation interval at flu of A type — from several hours to two days, at flu of V type — up to three days.
At a part of patients the so-called harbingers of a disease which are shown an easy indisposition, chilling, an ache in joints and muscles, short-term fervescence to 37,1 — 37,5 ° are observed.
The onset of the illness often acute — almost healthy person within several hours turns into the seriously ill patient. G.'s clinic allocates two main syndromes: intoksikatsionny and catarral.
The first symptoms of a disease — symptoms of intoxication: fever, fervescence, dizziness, headache, weakness, muscular and joint pains. The catarral phenomena (allocations from a nose, cough, irritation in a throat, pain during the swallowing, etc.) appear by the end of 1 — 2 days more often or are not shown at all. The headache has characteristic localization in a forehead, temples, superciliary arches, eyes. Dizziness and tendency to faints are more often observed at youthful and senile age, and also at the persons having a hypertension or atherosclerosis of vessels of a brain. Fever — one of the main symptoms of. The maximum temperature at most of patients is observed in the first, the second day of a disease is more rare. Duration of fever of 2 — 5 days. Decrease in temperature at a part of patients happens critically, at others — the accelerated lysis. Some patients can have a two-humped type of a temperature curve that is caused by an aggravation hron, the centers of infections, emergence of complications of inflammatory character, virus superinfection (see. Infection ). Without feverish forms G. are extremely rare.
Following or together with early symptoms of a disease also other symptoms of intoxication begin to appear: adynamia, general weakness, hyperemia of integuments of the person, sleeplessness, nonsense, nausea, vomiting, spasms, Meningeal symptoms. Hemorrhages are quite often observed (nasal bleedings, bleeding of gums, blood in a phlegm, etc.).
The catarral syndrome is shown in a look pharyngitis (see), rhinitis (see), tracheitis (see), is more rare than laryngitis and bronchitis. The pharyngitis which is shown a hyperemia of a pharynx meets with characteristic granulation of a back wall of a throat and occasionally hemorrhages more often. From the 3rd day of a disease the mucous membrane of a pharynx begins to turn pale, and granulations — to be flattened, leaving the expressed vascular drawing in the form of a grid. Rhinitis in the first days of a disease is shown by the difficulty of nasal breath caused by a hyperemia of a mucous membrane of the nasal courses. The rhinorrhea steps on the second — third day of a disease at 1/2 — 1/3 patients. Cough usually dry, hoarse, is followed by pain behind a breast, sneezing is observed at 1/2 patients. Conjunctivitis, a photophobia and dacryagogue are rather rare. Herpetic rashes develop usually not earlier than 3 — the 4th day of a disease.
Weight of a current of G. is defined by a complex of clinical signs and first of all a syndrome of intoxication (fever, a headache, disturbance of cardiovascular activity, accession of hemorrhages).
From cardiovascular system the priglushennost of cardiac sounds, hypotension is observed; at rentgenol. a research on 2 — the 3rd day sometimes is defined strengthening of the pulmonary drawing testimonial of a hyperemia of lungs. At pneumotachometric inspection (see. Pnevmotakhografiya ) reveal the decrease in bronchial passability which was more expressed at flu of A type. Changes from kidneys correspond to weight of intoxication and are characterized by reduction of volume of the emitted urine, proteinuria (see), is more rare a microhematuria (see. Hamaturia ). Increase in a liver at G. is noted seldom. Under the influence of toxin of the activator G. disturbances in activity of a liver are sometimes observed, up to toxic influenzal hepatitis, disturbance of activity of kidneys, and also depression of function of pituitary and adrenal system. The leukocytic formula in the first days of a disease is characterized by the expressed band shift, the leukopenia appears further. The average duration of a disease — 6 days, at severe forms — 11 — 13 days (epidemic of 1968 — 1969 and 1972 — 1973).
Complications. The most frequent and terrible complication of G. is pneumonia of virus, bacterial or virus and bacterial genesis (see. Pneumonia ).
In 1968 — 1969 and 1972 — 1973, according to separate clinics, at X-ray inspection at considerable number of sick G. were defined intersticial melkoochagovy, macrofocal and share pneumonia. More often they were localized in the lower share of the right lung. Also bilateral pneumonia was observed. More than were diagnosed for 0,5 inpatients of G. of pneumonia in the first 3 days of a disease. Pneumonia at G. in most cases virus and bacterial and, in particular, influenzal and staphylococcal. Quite often they accept a long current, passing in hron, a form or pulmonary suppuration. Fulminant hemorrhagic pneumonia meets rather seldom. At children of younger age and old men of pneumonia meet more often. There is an opinion that the virus A causes pneumonia more often, than a virus B.
Acute average otitis, damage of adnexal bosoms of a nose, acute catarral laryngotracheitis come to light approximately at 1/3 patients.
From a nervous system of a complication are observed at 1/4 seriously ill patients. At their most part early neurologic complications in the form of wet brain and increase in intracranial pressure are noted (see. Hypertensive syndrome ). In smaller number of cases symptoms are observed late nevrol: neuralgia, radiculitises, plexites, and also a so-called astenovegetativny syndrome (see. Asthenic syndrome ). Acute mental disorders with sleeplessness and a disorientation sometimes note at children and teenagers (see. Infectious psychoses ).
G.'s Diagnosis, especially early, is sometimes difficult. Discrepancy a wedge, and serol, diagnoses is often observed. A basis of early diagnosis of G. is characteristic the wedge, a picture, the anamnesis, assessment epid, situations (the instruction on contact with in the fever patient, existence in the settlement of outbreaks of diseases or epidemics), an objective research and datas of laboratory.
Clinical signs characteristic of G.: the acute beginning which is shown rough increase of symptoms of intoxication, emergence of fever, headache with typical localization in a forehead, superciliary arches, eyeglobes, especially at their movement; existence of an adynamia, phenomena of a meningism, nausea, vomiting, hemorrhagic phenomena; typical picture of blood; frequent complications, in particular pneumonia.
Differential diagnosis. Similarity wedge, pictures ORZ (parainfluenza, adenoviral, rinovirusny and respiratornosintsitialny infection, etc.) with G. often complicates their differential diagnosis.
, unlike ORZ, has more acute beginning. The expressed symptoms of intoxication at G. accrue and reach the maximum very quickly, sometimes within several hours. At ORZ they reach the maximum on 2 — the 3rd day of a disease and are expressed moderately or poorly. Temperature at G., as a rule, reaches 38 ° above in 1 — 2 days from the moment of a disease; at ORZ temperature often keeps on subfebrile figures, and sometimes and normal. Catarral symptoms (cold, conjunctivitis, pharyngitis, cough, etc.) at G. arise 1 — 2 days after symptoms of intoxication and are expressed poorly or moderately while at ORZ they appear along with the first symptoms of a disease, are often expressed sharply and make the main symptomatology of a disease.
ORZ significantly differ depending on their ability to strike preferential this or that department of respiratory tracts. At G. along with damage of all respiratory tract the most expressed symptoms of tracheitis which are shown dry cough and pains on the course of a trachea are observed. At a parainfluenza (see. Parainfluenza diseases ) preferential the throat is surprised and there are symptoms of laryngitis: aphonia or osiplost of a voice. Adenoviral diseases (see) (rhinitis), drinks (pharyngitis), almonds are shown by damage of mucous membranes of eyes (conjunctivitis), a nose (tonsillitis with the expressed exudative component). Rinovirusny diseases (see. Rinovirusnaya disease ) are preferential shown by rhinitis and a rhinorrhea. At a respiratory and syncytial disease at children (see. Respiratory viral diseases ) quite often there is an asthmatic bronchiolitis (see. Bronchial asthma ), with hypostasis and a spasm of smooth muscles of the smallest bronchial tubes, at adults pharyngitis takes place more often. ORZ of a mycoplasmal etiology are followed by dryness and irritation in a drink and hoarse dry cough. The isolated damage of a throat is noted at G. seldom. At a parainfluenza the leading catarral symptom is slight laryngitis (pharyngalgias, dry cough and an osiplost of a voice), at overwhelming number of patients meeting separately though patol, process can sometimes extend also to a trachea.
At the adenoviral diseases which are followed by damage of upper airways at a number of patients abdominal pains are observed, dysfunction of intestines and increase in a liver, and at 1/z patients painless, insignificant or moderate increase limf, nodes, preferential cervical, submaxillary and is much more rare axillary and inguinal; sometimes on skin of a trunk rash is noted.
It is considered to be what the most characteristic of G. is rinofaringolaringotrakheit, for a parainfluenza — rinofaringolaringit, for an adenoviral infection — rinofaringotonzillit (isolated) in combination with conjunctivitis and rinofaringokonjyunktivit. The respiratory and syncytial disease with damage of upper airways at a half of patients proceeds as a nasopharyngitis. In group of patients with damage of the lower airways at this infection it is, as a rule, observed rinofaringobronkhit — independent and with pneumonia. However at each ORZ also the general catarral syndromes meet.
Are used virusol., serol, and tsitol, methods.
The virus G. is allocated in the first days of a disease from the separated nasal courses and a pharynx of patients. The most effective method — infection of chicken embryos in amniotic and allantoisny cavities with the subsequent incubation at t ° 32 — 37 °. It is possible to use, especially for a virus G. of type B, infection of initially tripsinizirovanny cultures from kidneys of a chicken embryo, young monkeys or an embryo of the person. For indication of a virus in allantoisny or amniotic liquids of a chicken embryo, and also in cultural liquid apply reaction hemagglutinations (see). Existence of a virus in the infected monolayer is determined by a hemadsorption virus test (to sticking of erythrocytes to a mono-layer of the infected cells), is more rare on existence of cytopathic effect (granular regeneration of cells and depression of a monolayer). In the absence of a virus in the first passage do additional passages.
Identification of the allocated viruses is carried out on RSK, RTGA, a neutralization test (PH) and a precipitation test in agarose gel. Belonging of hemagglutinin to this or that serotype (And, In, C) establish by type-specific diagnostic serums then use strain-specific serums for definition of antigenic option within this serotype. Antigenic specificity of a neuraminidase of the allocated viruses G. is established in the reaction of suppression of neyraminidazny activity (RSNA). After contact of a virus with various antiserums define residual neyraminidazny activity of mix. Action of a neuraminidase is estimated on its ability to chip off N-atsetilneyraminovuyu to - that ovomucin or a fetuin.
Serol, G.'s diagnosis is based on identification of a gain of antibodies in serums of convalescents in 4 and more times on RSK, RTGA, PH or reaction of indirect hemagglutination (RNGA). In RSK use type-specific antigens from influenza viruses of type A and B. It gives the chance to distinguish flu of A type from flu of V type, but does not provide identification of the antigenic subtype which caused epidemic. In three last reactions use epidemic active antigenic options of viruses G. of types A and B. High shtammovy specificity of antigen is especially important at a research of blood serum of the children of younger age who for the first time had G. containing strictly specific anti-influenza antibodies.
Statement of RTGA often is complicated by existence in serums of the nonspecific inhibitors simulating action of antibodies and distorting specificity of reaction. For their destruction serums process a receptor about destruktiruyushchy enzymes of a bacterial origin or Rivanolum, and also carbon dioxide gas, periyodaty potassium or sodium, and also adsorb koaliny. For production of antigens use options of strains, resistant to inhibitors.
PH on chicken embryos, fabric cultures or on color test is sensitive, but more labor-consuming diagnostic method of G., than RTGA. In PH it is necessary to use ingibitororezistentny virus strains of G. or to delete nonspecific inhibitors from serum.
As a diagnosticum for RNGA use the special drugs representing tinned erythrocytes with the viruses fixed on their surface. Sensibilized erythrocytes are specifically agglutinated by viruses under the influence of anti-influenza antibodies. RNGA can be put by a drop method. Results of RNGA are not influenced by nonspecific inhibitors.
Express (or early) G.'s diagnosis during the first days of a disease is carried out tsitol, method with use of fluorescent antibodies. The method is based on ability of anti-influenza antibodies, marked by flyuorokhroma, to connect specifically to a virus G. and to find its presence at cells of a cylindrical epithelium during the viewing of smears prints from a nasal cavity in a luminescent microscope.
For early diagnosis of G. use the method of a rinotsitoskopiya based on studying morfol, changes of epithelial cells of a mucous membrane of a nose of sick people much less often. One of characteristic signs of G. — the virus inclusions located in cells of a cylindrical epithelium or vnekletochno.
Before purpose of medicines the doctor shall isolate the patient from other family members, neighbors in the hostel, the apartment and to set in the acute period an obligatory bed rest at a disease of any weight.
Apply the complex therapy directed to suppression of a reproduction of a virus in an organism, neutralization of influenzal toxin, elimination of catarral and other symptoms to G.'s treatment. Treatment of the patient at typical a wedge, a picture G. is carried out in house conditions. Patients with the heavy, and also complicated forms G. are hospitalized, as well as patients with the accompanying serious cardiovascular or other somatopathies.
The milk and vegetable diet enriched with vitamins with plentiful amount of liquid is recommended to patients (warm milk, hot tea, a fruit drink, fruit juice, etc.). It is necessary to recommend frequent airing of the room of the patient, a toilet of an oral cavity, overseeing with function of intestines.
Drug treatment is carried out depending on weight of disease, and also from existence of these or those complications. For patients with easy or moderately heavy current appoint in the first two days of a disease Remantadinum on 50 mg 3 times a day, within 3 — 5 days, sometimes in a combination with ascorbic to - that. It is reasonable to inhale anti-influenza serum on 0,5 ml in each nostril 2 — 3 times a day within 2 — 3 days. In addition to these drugs, to the patient appoint pathogenetic and symptomatic means in various combinations.
Apply to removal of a headache, muscular and joint pains acetilsalicylic to - that, pyramidon, analginum or other febrifugal and soothing drugs (askofen, piraminat, novotsefalgin, Novomigrophenum, etc.); at excitement and sleeplessness — phenobarbital, barbamyl and other drugs in sedative or somnolent doses; at a severe cough codeine, ethyl morphine a hydrochloride, expectorants, mustard plasters, alkaline heatwet inhalations is recommended; for elimination of dryness and irritation in a drink — warm drink (warm milk with borzhomy); at rhinitis — introduction to a nose in 3 — 4 hours of 2 — 5% of solution of ephedrine, Naphthyzinum or other vasoconstrictive drugs. At rhinitis apply Oxolinum (oxolinic ointment) which along with preventive possesses and to lay down. action. Cordiaminum inside is useful to prevention of cardiovascular frustration.
At uncomplicated G. easy both antibiotics and sulfanamide drugs do not appoint a moderately severe current, except for elderly people or weakened by the accompanying diseases. The tableted antibiotics are shown to this group of patients with the preventive purpose (tetracycline, Vitacyclinum, Rondomycinum, Oletetrinum, etc.) or sulfanamide drugs in to lay down. doses. Nek-rym the patient appoint physical therapy: an aero ionotherapy by means of devices for individual (AIR-2) and group (AF-2) use, UF-radiation, UVCh, an induktoterapiya.
At a severe form with the expressed syndrome of intoxication enter intramusculary donor anti-influenza gamma-globulin in a dose of 3,0 ml. Usually after administration of gamma-globulin in 6 — 12 hours temperature decreases, symptoms of intoxication decrease or disappear, the condition of the patient improves. If it does not occur, the repeated injection of drug in a former dose is recommended; it is also possible to enter donor protivokorevy gamma-globulin or serumal polyglobulin on 3,0 ml intramusculary according to the same scheme, as anti-influenza gamma-globulin. Specific polyglobulin is effective at a parainfluenza, adenoviral, respiratory and syncytial and other grippopodobny diseases. Gamma-globulin does not exert noticeable impact on the current of a catarral syndrome. Leukocytic interferon is applied with to lay down. the purpose at an early stage of a disease, at emergence of the first a wedge, symptoms of.
Biological products should be entered the seriously ill patient repeatedly, up to decrease in temperature and disappearance of the expressed intoxication.
At the first signs of cardiovascular insufficiency intravenously enter glucose with Korglykonum, strophanthin or other cardiac glycosides, appoint inhalation of oxygen.
By G., sick with a heavy current, for the prevention of pneumonia appoint the tableted antibiotics. At suspicion on accession to G. of pneumonia antibiotics enter intramusculary, and in hard cases — intravenously. The following scheme of treatment of pneumonia is recommended. Intramusculary enter anti-influenza gamma-globulin (or polyglobulin), intravenously - — Morphocyclinum or Olemorphocyclinum, inside — tablets of Oletetrinum or Sigmamycinum, antiinflammatory, desensibilizing, cordial, expectorants, banks. In 2 — 3 days intravenous administration of antibiotics is stopped. Appoint aerosols of antibiotics in a combination with enteral administration of oxytetracycline, Kanamycinum, etc.
In the absence of effect in 5 — 7 days after an initiation of treatment apply intramusculary semi-synthetic Penicillin (metatsillin, Oxacillinum) or antibiotics of a tseporinovy row (tseporin, etc.); at emergence of blood in a phlegm add intravenously calcium chloride.
It is especially vigorously necessary to carry out treatment at hypertoxical, extremely severe forms of G. according to the following approximate scheme: repeated administration of anti-influenza gamma-globulin and other antiviral means for fight against a virus toxaemia; drop introduction isotonic (from 200 to 500 ml) solution of glucose or sodium chloride for the purpose of desintoxication; intravenous administration of Morphocyclinum or Olemorphocyclinum; intramuscular introduction (4 — 5 times a day) Methicillinum, Oxacillinum or a tseporin, i.e. antibiotics of antistaphylococcal action; intravenous, and then intramuscular introduction of a hydrocortisone, noradrenaline, a metazone, ephedrine for elimination of vascular disorders; at cardiovascular insufficiency — intravenous administration of strophanthin or Korglykonum, hypodermic introduction of Cordiaminum; purpose of oxygen or the room of the patient in an oxygen tent for fight against a hypoxia. If necessary add others to it to lay down. actions, in particular an antihemorrhagic complex to lay down. Means at identification of a hemorrhagic syndrome; dehydrational therapy at sharply expressed cerebral symptoms (intravenous administration of hypertensive solutions of glucose, intramusculary — Novuritum, a lumbar puncture etc.).
the Forecast at the heavy and especially complicated forms G. at old men and children — serious.
Prevention is provided with a complex a dignity. - a gigabyte. and protivoepid, the actions directed to protection of the population against G.'s infection, restriction of spread of an infection.
For the timely and effective organization of preventive actions the big role is got by forecasting of expected G.'s epidemic and establishment of dynamics of its distribution over the country. The modeling of character and scales of arising G.'s epidemics allowing to organize correctly and in time measures of prevention and rendering medical aid by the diseased is carried out to the All-Russian Research Institute of flu M3 of the USSR with sufficient success.
In the period of G.'s epidemic of an action are directed to early identification of patients and their dissociation with healthy faces that is reached by isolation of patients in families or-tsakh. For this purpose considerably the ambulatory and hospital care by the diseased with preferential repeated service of patients extends at home for what additional vehicles are allocated.
At treatment of the sick house the persons who are looking after him are recommended to carry 4 — 6-layer gauze masks. Objects of use of the patient disinfect, carry daily out wet cleaning and regularly air the room where there is a patient.
For reduction of danger of distribution of G. in the period of epidemic work of out-patient institutions will be reorganized. The number of district doctors for service of patients increases at home; if it is necessary, then for this purpose doctors of other specialties, paramedical staff, students of older years of medical in-comrade are also attracted. In premises of policlinics and children's consultations carry out 2 — 3 times a day wet cleaning of the room using 0,5% of the clarified solution of lime chloride or 0,2% of solution of chloroamine with the subsequent airing. For disinfecting of air radiation of rooms is recommended by germicidal black light lamps.
Hospitalize in the period of G.'s epidemic of patients with the heavy and complicated forms, and also the persons having serious associated diseases. Surely isolate patients from hostels and other collectives.
In specialized departments for hospitalization of seriously ill patients would open, additional beds are developed. In to lay down. institutions establish protivoepid. the mode (see. Isolation of infectious patients ), limiting spread of cases of flu.
In pharmacy chain beforehand create a reserve of medicines and desinfectants for uninterrupted supply of the population and to lay down. institutions.
In the period of epidemic spectacular and other mass actions, especially for children are limited. Obligatory carrying gauze bandages by employees of the medical, transport, trade, household and other enterprises connected with service of the population is entered.
Implementation of the specified actions is promoted wide by a dignity. - a gleam. work among the population with promotion on radio, television, at cinema of rules of personal hygiene, importance of the timely address to the doctor etc.
Specific prevention of G. is based on active immunization by an influenza vaccine. There are two types of influenza vaccines (live and inactivated) which began to be developed since 1937. In the USSR against G. apply the offered A. A to active immunization. Smorodintsev the live influenza vaccine (LIV), to-ruyu enter into upper respiratory tracts. The USA, Great Britain, France and other countries use the inactivated egg vaccine for hypodermic or intramuscular introduction.
The live influenza vaccine is made from allantoisny liquid of the developing chicken embryos infected with the weakened virus strains G. Preparat is issued in the form of influenzal monovalent vaccines of type A and B. Efficiency of ZhGV in many respects depends on compliance of vaccinal strains to the activator G. causing the current epidemics. Therefore the structure of ZhGV on vaccinal strains, epidemiologically urgent activators G., identical on properties of hemagglutinin and a neuraminidase, is updated 1 time in 3 — 4 years. So, vaccinal virus strains of type A were replaced in 1957, 1965, 1969 and 1973. Virus strains of type B replace in 5 — 10 years. Need of periodic replacement of vaccinal strains complicates G.'s vaccinal prevention and reduces efficiency of this action during emergence of new subtypes of a virus G. when the old structure of ZhGV is insufficiently specific.
For receiving vaccinal virus strains of G. harmless to people, apply a method of successive passages in the developing chicken embryos. Decrease in virulence happens through 15 — 25 passages. The vaccinal strains received in the specified conditions, vysokoreaktogenna for children up to 15 years.
Its high activity, i.e. ability to stimulate anti-influenza immunity is among the main requirements to ZhGV. Enter it on 0,25 ml into the nasal courses by means of sprayers of liquid drugs with adjustable dispersion or the sprayer doser.
Ability of ZhGV to stimulate secretory immunity in the place of entrance infection atriums is the advantage of this drug distinguishing it from the inactivated influenza vaccine, parenteral administration a cut causes preferential accumulation of antibodies in blood. Antibodies of secrets of respiratory tracts possess wider range of specific activity.
Immunization against G. is carried out annually to the autumn and winter period. Impart healthy adults 16 years working at large factories and the plants, transport, telecommunications agencies in utility and medical institutions, trade, militia are more senior.
Vaccination is carried out in a planned order it is triple at an interval of 10 — 14 days. The effect of inoculations in many respects depends on technology of the vaccination demanding very careful introduction of a vaccine by means of the sprayer.
Preventive inoculations are allowed to be carried out at the beginning of G.'s epidemic, reducing an interval between revaccinations to 5 — 7 days. In this case vaccines at first stimulate formation of interferon — a nonspecific protective factor of anti-influenza immunity, and in 2 — 3 weeks specific immunity forms.
Intranasal ZhGV is not applied to G.'s prevention at children in view of its increased reactogenicity at introduction to respiratory tracts.
A. K. Alekseeva and O. G. Andzhaparidze (1968) developed fabric ZhGV for peroral introduction, to-ruyu make on primary culture of kidneys of an embryo of hens or quails. Drug is harmless to adults and children, has interferonogenny and protective activity. The GB, entered in the liquid state through a mouth, does not cause inoculative reactions, but stimulates antibody formation that gives the chance to use it for G.'s prevention at children.
The modern inactivated influenza vaccines represent the suspension of the virus G. which is grown up on chicken embryos and inactivated by formalin high-concentrated and cleared of ballast substances.
In the USSR the purified and concentrated drugs of the inactivated influenza vaccine are used for vaccination of donors for the purpose of receiving hemagglutinin with the high content of anti-influenza antibodies.
Vaccinal prevention reduces G.'s incidence imparted in comparison with not vaccinated in the period of epidemics by 1,5 — 3 times, sometimes — by 4 — 5 times.
For individual emergency prevention of G. use the leukocytic interferon received in culture of human leukocytes. This drug possesses a wide range of the antiviral action directed not only against a virus G., but also other respiratory viruses — ORZ activators of not influenzal nature. Leukocytic interferon is entered intranazalno by an instillation into a nose on 5 drops or ingalyatorno 1 — 3 time a day daily during all epidemic.
Flu at children
Flu at children proceeds heavier, than at adults, with frequent complications in the form of pneumonia, otitises, pyelonephritises, etc. G. at children burdens the course of other diseases, reduces reactivity of a children's organism and has considerable specific weight among the reasons of child mortality. Children of all age groups are susceptible to G. Cases of transplacental infection of a fruit from sick mother are described. The disease begins with high temperature (39 — 40 °), short fever (2 — 5 days) and quickly developing symptoms of intoxication. Dominance of the syndrome of the general intoxication connected with defeat of c is noted. N of page, over local catarral manifestations from respiratory tracts. The headache, dizziness, repeated vomitings, abdominal pains, hyperesthesia, excitement or adynamia, drowsiness, the nasal bleedings observed at children of advanced age belong to the main and early symptoms of intoxication. At high fever at certain children confusion of consciousness, nonsense, hallucinations, Meningeal symptoms, muscular pains, a fever is noted.
At children of early age quite often begins with spasms, a loss of consciousness, vomiting, is more rare than symptoms of a meningism. Spasms are usually shown against the background of high temperature, have kloniko-tonic character (see. Spasms ).
At newborns and children of the first months of life the wedge, symptoms differs in a stertost. At them against the background of standard or subfebrile temperature the complicated nasal breath, concern or slackness, failure from a breast, vomiting without deterioration in a chair is noted. In some cases perhaps short-term increase of a chair without patol, impurity. The originality a wedge, G.'s currents in this age group is caused by reduced reactivity of an organism, and in certain cases and existence of transplacental anti-influenza antibodies.
The catarral phenomena from a respiratory organs approximately in 20 — 30% of cases are absent or are expressed very poorly. At other patients the moderate hyperemia of a pharynx, a congestion of a nose is noted or there are insignificant mucous allocations, dry cough, sometimes rough, tracheal, irritation in a throat, laryngitis. Laryngitis can be followed by the phenomena of a stenosis, giving a picture grain (see).
Damages of lungs at G. proceed without more often expressed a wedge, symptoms and quite often come to light only radiological, differ in instability. Peculiar «segmented defeats» in the form of the homogeneous large shadows corresponding to an arrangement of a segment are characteristic lung lobes are more rare. These changes appear from an onset of the illness and usually disappear in several days. In a picture of blood in the first days of a disease the leukocytosis, a neutrocytosis with band shift, an eosinopenia or an aneosinophilia and toxic granularity of neutrophils is noted. In the next days — a leukopenia, a lymphocytosis. ROE within norm or is moderately accelerated.
Duration of a disease of G. without complications — 3 — 8 days. After 1 — 3 days of standard temperature its rise in the absence of complications (the second wave) is possible.
G.'s diagnosis at children at expressed a wedge, a picture is facilitated in epid, the period. It is necessary to remember existence of easy and asymptomatic forms of a disease. At diagnosis of such forms it is necessary to consider epidemiol, yielded and results of laboratory methods of a research.
Treatment of children at severe forms of G. is based on early administration of specific donor anti-influenza gamma-globulin on 1 — 3 ml intramusculary. At an early stage of a disease also administration of leukocytic interferon in the form of an aerosol on 0,25 ml in each nasal course of 4 — 5 times a day within 3 — 4 days is shown. At the same time carry out nonspecific pathogenetic and symptomatic therapy. At a hyperthermia — intramuscular administration of pyramidon or analginum, the combined introduction of a daily dose of aminazine, Dimedrol or Pipolphenum with solution of novocaine (lytic mix), cold on the head, to large vessels. For fight against acidosis cocarboxylase is shown. At spasms intramusculary enter magnesium sulfate, per os phenobarbital or in an enema — the daily dose gets divorced in 10 ml of 2% of warm solution of a hydrochloride of sodium, 20% GOMK solution intravenously or intramusculary; in case of long spasms and existence of meningeal symptoms — spinal puncture (see). For elimination of a meningoentsefalitichesky syndrome, along with hypothermal and anticonvulsants, use diuretic, hormonal drugs intramusculary, intravenously; for the purpose of dehydration and desintoxication — low-molecular solutions (Haemodesum, polyvinol, reopoliglyukin, albumine) and osmotic diuretics (15% Mannitolum, 20% sorbitol) intravenously. From cardiovascular means — korglyukon, strophanthin, digoxin, a phenylephine hydrochloride. At easy and medium-weight forms G. along with the general actions (a bed rest, plentiful drink) carry out the symptomatic and stimulating therapy (analginum, Dimedrol, vitamins, expectorant mixtures, mustard plasters, banks, hot foot baths, etc.). Prescription of antibiotics at an uncomplicated current of G. is not recommended. The exception is made by children up to 2 years at which often arose cabins of a complication; by it appoint antibiotics from the first day of a disease. Streptocides are not shown.
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D. M. Zlydnikov; G. I. Alexandrova, L. Ya. Zakstelskaya, Yu. G. Ivannikov, G. I. Karpukhin, T. Ya. Luzyanina, A.S. Shadrin (etiol., epid., lab.), G. I. Ilyin (stalemate. An.), E. A. Sirotenko (ped.).