new influenza “variants” : coming to alberta tarrant symposium 2014 kevin fonseca clinical...
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New Influenza “Variants” :coming to Alberta
TARRANT Symposium 2014
Kevin Fonseca
Clinical Virologist
ProvLab
Themes
Biology & Transmission Lab Testing Disease Spectrum (Surveillance)
Subtypes of Influenza A
N1 - humanN2 - humanN3 - avianN4 - avianN5 - avianN6 - avianN7 - equineN8 - equineN9 - avian
H1 - swine, human
H2 - human
H3 - human
H4 - avian
H5* - avian, (human)
H6 - avian
H7* - equine,avian,human
H8 - avian
H9 - avian, (human)
H10 – H16 – avian
H5N1 H7N9 H10N8 H6N1
First Appearance
(humans)
1997 March 2013 Dec 2013 May 2013
Nos of Cases 650 354 3 1
Acquisition Infected Poultry
Infected poultry & (humans)
Infected poultry
Infected poultry
Person-to-person Rare Less rare Unknown Unknown
Age Young & old Older Old Old
Disease Generally severe
Generally severe
(asymptomatic)
(Severe) (mild)
Case Fatality 59% 32% 67% <
Geographical Distribution
Asia, Africa China China Taiwan
Pathogenicity classification
High Low Low Low
Key Virulence Elements Attachment of virus to host receptor
Mediated by hemagglutinin (HA) Fusion and uncoating
Mediated by hemagglutinin Replication of viral RNA
Role of polymerase Assembly Release/Transmission
Role of neuraminidase (NA)
Eurosurveillance pic
Laboratory Detection of Influenza
Test for Influenza A & B
Positive for Influenza A
Positive for Influenza B
Negative for both
Determine Lineage
Perform Subtyping
Positive for: A(H1N1)pdm09 ORH3 seasonal
Unresolved/not subtyped:Low viral load OR novel subtype
Could This Be ?
Recent travel, or in contact with travelers
Contact with poultry (abroad) Out of season cases Clinical symptoms not “typical” Discuss with local MOH Don’t be afraid to swab !
Questions ?