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인플루엔자 FAQ

 

1. 인플루엔자는 무슨 병입니까?

흔히 ‘독감’이라고 불리며 호흡기를 통하여 인플루엔자 바이러스에 감염되어 갑자기 고열, 두통, 근육통, 피로감, 인후통, 기침, 가래, 콧물 등이 나타나는 질환입니다. 건강한 사람은 수일간 증상을 보인 후 회복되지만 만성폐질환자, 심장질환자, 면역저하자 등은 폐렴과 같은 합병증이 발생하여 사망할 수도 있는 질환입니다.

2. 인플루엔자에 걸리면 어떤 증상이 나타나나요?

열감(발열), 두통, 전신쇠약감, 마른기침, 인후통, 코막힘 및 근육통 등이 흔한 증상입니다. 어린이의 경우에는 성인과는 달리 오심, 구토 및 설사 등의 위장관 증상이 동반될 수 있습니다.

3. 인플루엔자에 걸리면 어떤 합병증이 발생할 수 있습니까?

인플루엔자는 세균성 폐렴, 탈수 등과 같은 합병증을 발생할 수 있고, 울혈성 심부전증이나 천식, 당뇨 등 기존에 앓고 있던 만성질환을 악화시킬 수 있습니다. 어린이는 부비동염(축농증)과 중이염 등과 같은 합병증이 발생할 수 있으며, 노인이나 만성질환자는 중대한 합병증 발생위험이 크기 때문에 만성질환자의 경우 인플루엔자 예방접종을 권장하고 있습니다.

4. 인플루엔자 바이러스에 노출된 후 얼마 만에 증상이 나타나며, 얼마동안 전염력을 가지고 있나요?

인플루엔자 바이러스에 노출된 후 보통 1-4일(평균 2일)정도 지나면 증상이 나타나게 됩니다. 인플루엔자 환자의 경우 나이에 따라서 전염기간에 차이가 있는데, 성인의 경우 증상이 생기기 하루 전부터 증상이 생긴 후 3-7일 동안 전염력이 있으나 소아의 경우에는 1주일 이상 전염력이 있는 경우도 있습니다. 

5. 감기에 자주 걸리는데 인플루엔자 예방접종을 맞으면 감기가 예방되나요?

그렇지 않습니다. 흔히 인플루엔자라고 불리기 때문에 감기와 같은 병으로 생각하는 경우가 있는데, 동일한 급성 호흡기 감염증이라 하더라도 인플루엔자와 감기는 다른 병이라고 할 수 있습니다. 하지만 증상만으로 인플루엔자와 다른 호흡기 감염증을 구분하는 것은 매우 힘든 일이며, 정확한 진단은 증상발생 후 처음 2-3일에 인플루엔자 바이러스 검사를 통해 알 수 있습니다.

감기는 다양한 바이러스에 의해서 발병하는 급성 호흡기 질환으로 보통 2-5일 만에 합병증 없이 회복되는 경우가 대부분이며 특별한 치료법은 없습니다. 감기는 콧물, 기침, 가래, 인후통 등이 주 증상이고, 인플루엔자와는 달리 증상이 가볍고 발열, 근육통, 오한 등의 전신증상은 아주 드물게 나타납니다.

하지만, 인플루엔자는 인플루엔자 바이러스에 의한 감염증이며, 독감 예방접종은 인플루엔자 바이러스에 대한 백신이므로 다양한 바이러스에 의해 발병하는 감기에는 효과가 없습니다.

6. 인플루엔자 예방접종 때문에 인플루엔자에 걸릴 수도 있나요?

주사용 인플루엔자 백신은 사백신으로 이 때 사용되는 바이러스는 죽이거나 약화시킨 바이러스로 질병을 일으킬 능력이 없습니다. 그러나 최근에 도입된 비강 내 분무하는 형태의 백신은 생백신으로 질병을 일으킬 가능성이 있습니다. 따라서 임신부, 면역저하자, 만성질환자 등에게는 분무용 생백신이 아닌 주사용 사백신을 권장하고 있습니다.

7. 인플루엔자 예방접종은 얼마나 효과가 있나요?

건강한 젊은 사람에서는 약 70-90%의 예방효과가 있으나, 노인이나 만성질환이 있는 사람에서는 효과가 약간 떨어집니다. 그러나 노인이나 만성질환자들의 입원을 줄이고 인플루엔자로 인한 사망을 줄이는 데 매우 효과적이므로 예방접종 받는 것이 좋습니다.

8. 인플루엔자 예방접종은 매년 맞아야 하나요?

그렇습니다. 인플루엔자 바이러스는 계속적인 항원변이를 통하여 아형이 변하기 때문에 매년 유행하는 인플루엔자 바이러스에 적합한 백신이 개발됩니다. 따라서 우선접종 권장대상자인 경우는 매년 접종 받는 것이 좋습니다.

9. 유행시기에는 모든 사람이 인플루엔자 예방접종을 맞아야 하나요?

인플루엔자에 걸렸을 때에 심각한 합병증을 유발하거나 사망의 위험이 있는 노인, 면역저하자, 만성 심폐질환자, 임신부, 영유아 등과 이러한 고위험 환자에게 인플루엔자를 전염시킬 수 있는 보건의료 종사자 및 고위험군의 가족은 우선접종 권장대상자로서 우선적으로 접종하도록 권고하고 있습니다.

다만, 인플루엔자 우선접종 권장대상자가 아니더라도 접종희망자는 가까운 의료기관에서 접종받으실 수 있습니다.

10. 인플루엔자 예방접종은 언제 맞아야 하나요?

우리나라의 경우, 인플루엔자는 주로 12월부터 다음해 4월까지 유행합니다. 따라서 통상적으로 인플루엔자 유행 시기 이전인 10〜12월에 예방접종을 받는 것이 좋습니다. 고위험군은 인플루엔자 유행이 일단 시작되었다 하더라도 예방접종 받을 것을 권장합니다.

※ ‘10-’11절기 인플루엔자 예방접종 시기는 9〜12월입니다.

11. 임신부가 인플루엔자 예방접종을 받아도 괜찮은가요?

임신부는 일반인에 비해 인플루엔자 감염으로 인한 합병증 위험성이 더 크기 때문에 예방접종을 권장하고 있습니다. 임신 시기에 상관없이 인플루엔자 사백신은 안전하다고 보고되고 있습니다. 하지만 비강 내 분무하는 생백신은 임신부의 경우 접종 금기군에 해당하니 반드시 주사용 사백신으로 접종받으시는 것이 좋습니다.

**  이 글은 질병관리본부 '인플루엔자 예방접종FAQ'에서 발췌한 글입니다.

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올겨울에는 지난해 발생했던 신종인플루엔자 바이러스(Agud H1N1)가 대유행 수준까지는 아니지만 통상적인 계절인플루엔자(독감) 수준으로 재유행할 것으로 예상됩니다.


하지만 인플루엔자 같은 호흡기 질환은
손 씻기와 기침 에티켓을 잘 지키고 유행시기 이전에 예방접종 받는다면 충분히 예방할 수 있습니다.


생후
6-59개월 소아, 학동기, 50세이상 어르신, 만성질환자 등 인플루엔자 감염으로 인한 합병증 발생 위험이 높은 대상자들은 꼭 예방접종 받으시기 바랍니다.



** 올해 생산된 독감 백신은 계절 인플루엔자 유행을 예방할 수 있으며
, 신종플루 바이러스도 포함
   
되어 있습니다.

** gf소아청소년과에서는 9월1일부터 접종을 시작하였습니다.
   가족이 함께 조기에 접종하는것이 예방에 도움되오니 서둘러 접종하시기 바랍니다.

** 2009년도에 신종플루 2회 접종을 안한 영유아(만8세미만)는 올해 독감접종을 2회 접종 해야합니다.
   단, 2009년에 신종플루 확진을 받은 영유아(만8세미만)는 1회만 접종하면 됩니다.

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Antiviral drugs and pandemic (H1N1)
 
2009

6 October 2009 (originally posted on 21 May 2009)

  Contents

Antiviral drugs: definitions
 
and treatment

applications

What are antiviral drugs?

Antiviral drugs are medicines that act directly on viruses to stop them from multiplying.

Are antiviral drugs used for treatment of pandemic (H1N1) 2009 infection?

Yes, two antiviral drugs are being used to treat pandemic (H1N1) 2009 infection. These are oseltamivir and zanamivir, which both block the action of an influenza virus protein called neuraminidase. In clinical trials with seasonal influenza, these antiviral drugs have been shown to reduce the symptoms and duration of illness and may also contribute to preventing severe disease and death. Since these antivirals have been effective in treating seasonal influenza, they are also expected to be effective for pandemic (H1N1) 2009 infections.

For the treatment of pandemic (H1N1) 2009, how many antiviral drugs are there?

There are two approved antiviral drugs for influenza that are available for treatment of pandemic influenza. These are the neuraminidase inhibitors oseltamivir and zanamivir, more commonly known by their trade names Tamiflu and Relenza.

Another class of approved antiviral drugs known as M2 inhibitors (amantadine and rimantadine) can be effective for treating seasonal influenza. However, the pandemic (H1N1) 2009 virus has been shown to be resistant to these particular antiviral drugs.

What is WHO’s guidance on the use of antiviral drugs?

Studies show that early treatment, preferably within 48 hours after the first sign of symptoms, appear associated with better clinical outcome.

For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends that treatment with oseltamivir should start immediately, no matter when illness started and without waiting for laboratory results.

For patients at risk for serious disease, including those with certain underlying medical conditions, WHO recommends treatment with either oseltamivir or zanamivir as soon as possible after the onset of symptoms and without waiting for the results of laboratory tests.

In all cases, where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.

Are antiviral drugs suitable for everyone?

Antivirals should only be used when prescribed by a qualified health care provider, as they will be able to assess each situation and make the appropriate decisions on care. WHO recommends that all patients (including pregnant women) and all age groups (including young children and infants) should be treated with oseltamivir in the event of severe or deteriorating illness. Treatment with either oseltamivir or zanamivir should also be offered to all patients in at-risk groups in the event of illness, even if mild or uncomplicated.

What is meant by at-risk groups?

Individuals that have been identified as “at-risk” of more complicated or severe illness associated with infection by influenza virus include:

  • pregnant women (particularly in the later stages of pregnancy);
  • infants and children (<5 years);
  • patients with chronic health conditions, such as cardiovascular, respiratory or liver disease, or diabetes;
  • patients with immunosuppression related to treatment for transplant surgery, cancer, or due to other diseases.

The elderly (>65) appear less susceptible to infection by pandemic H1N1 influenza virus, but are assumed to be at higher risk of more severe or complicated illness if infected.

Is it necessary to wait for a laboratory result before starting antiviral drug treatment?

No, if antiviral drug treatment is indicated by the clinical presentation, then treatment should start as soon as possible. If there is a delay, treatment may be less effective.

What is the standard treatment regimen for antiviral drugs?

For oseltamivir, the standard adult treatment course is one 75 mg capsule twice a day for five days. For severe or prolonged illness, physicians may decide to use a higher dose or continue the treatment for longer.

Zanamivir is taken as a powder by inhalation. The recommended dose for treatment of adults and children from the age of 5 years is two inhalations (2 x 5mg) twice daily for five days.

Antiviral drugs and pandemic (H1N1) 2009: 1,2,3 | Next page 3

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Antiviral use and the risk of drug

resistance

Pandemic (H1N1) 2009 briefing note 12

25 SEPTEMBER 2009 | GENEVA -- Growing international experience in the treatment of pandemic H1N1 virus infections underscores the importance of early treatment with the antiviral drugs, oseltamivir or zanamivir. Early treatment is especially important for patients who are at increased risk of developing complications, those who present with severe illness or those with worsening signs and symptoms.[1]

The experience of clinicians, including those who have treated severe cases of pandemic influenza, and national authorities suggests that prompt administration of these drugs following symptom onset reduces the risk of complications and can also improve clinical outcome in patients with severe disease.

This experience further underscores the need to protect the effectiveness of these drugs by minimizing the occurrence and impact of drug resistance.

High-risk situations for development of drug resistance

WHO encourages clinicians to be alert to two situations that carry a high risk for the emergence of viruses resistant to oseltamivir.

The risk of resistance is considered higher in patients with severely compromised or suppressed immune systems who have prolonged illness, have received oseltamivir treatment (especially for an extended duration), but still have evidence of persistent viral replication.

The risk of resistance is also considered higher in people who receive oseltamivir for so-called “post-exposure prophylaxis” following exposure to another person with influenza, and who then develop illness despite taking oseltamivir.

In both of these clinical situations, health care staff should respond with a high level of suspicion that oseltamivir resistance has developed. Laboratory investigation should be undertaken to determine whether resistant virus is present and appropriate infection control measures should be implemented or re-enforced to prevent spread of the resistant virus.

When a drug-resistant virus is detected, WHO further recommends that an epidemiological investigation be undertaken to determine whether onward transmission of the resistant virus has occurred. In addition, community surveillance for oseltamivir-resistant pandemic H1N1 virus strains should be enhanced.

In general, WHO does not recommend the use of antiviral drugs for prophylactic purposes. For people who have had exposure to an infected person and are at a higher risk of developing severe or complicated illness, an alternative option is close monitoring for symptoms, followed by prompt early antiviral treatment should symptoms develop.

WHO has also recommended against the use of a particular antiviral where the virus is known or highly likely to be resistant to it. For this reason, zanamivir is the treatment of choice for patients who become ill while on oseltamivir prophylaxis.

Oseltamivir-resistant viruses

Systematic surveillance conducted by the Global Influenza Surveillance Network, supported by WHO Collaborating Centres and other laboratories, continues to detect sporadic incidents of H1N1 pandemic viruses that show resistance to oseltamivir. To date, 28 resistant viruses have been detected and characterized worldwide.[2]

All of these viruses show the same H275Y mutation that confers resistance to the antiviral oseltamivir, but not to the antiviral zanamivir. Zanamivir remains a treatment option in symptomatic patients with severe or deteriorating illness due to oseltamivir-resistant virus.

Twelve of these drug-resistant viruses were associated with the use of oseltamivir for post-exposure prophylaxis. Six were associated with the use of oseltamivir treatment in patients with severe immunosuppression. Four were isolated from samples from patients receiving oseltamivir treatment.

A further two were isolated from patients who were not taking oseltamivir for either treatment or prophylaxis. Characterization of the remaining viruses is under way.

These numbers are comparatively small at present. Worldwide, more than 10,000 clinical specimens (samples and isolates) of the pandemic H1N1 virus have been tested and found to be sensitive to oseltamivir.

Current conclusions

These data support several conclusions. Cases of oseltamivir-resistant viruses continue to be sporadic and infrequent, with no evidence that oseltamivir-resistant pandemic H1N1 viruses are circulating within communities or worldwide.

To date, person-to-person transmission of these oseltamivir resistant viruses has not been conclusively demonstrated. In some situations, however, local transmission may have occurred, but without any further onward or ongoing transmission.

Except for immunocompromised patients, those infected with an oseltamivir-resistant pandemic H1N1 virus have experienced typical uncomplicated influenza symptoms. No evidence suggests that oseltamivir-resistant viruses are causing a different or more severe form of illness.

The occurrence of oseltamivir-resistant viruses is expected and is consistent with observations from early clinical trials. As use of antiviral drugs continues to grow, further reports of drug-resistance viruses are certain to occur. WHO and its network of collaborating laboratories are closely monitoring the situation and will issue information and advice on a regular basis as indicated.

_______________________

[1] Briefing Note on recommendations for use of antivirals
[2] Weekly updates on cases of oseltamivir resistant pandemic H1N1 virus


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Recommended use of antivirals

Pandemic (H1N1) 2009 briefing note 8


21 AUGUST 2009 | GENEVA -- WHO is today issuing guidelines for the use of antivirals in the management of patients infected with the H1N1 pandemic virus.
The guidelines represent the consensus reached by an international panel of experts who reviewed all available studies on the safety and effectiveness of these drugs. Emphasis was placed on the use of oseltamivir and zanamivir to prevent severe illness and deaths, reduce the need for hospitalization, and reduce the duration of hospital stays.
The pandemic virus is currently susceptible to both of these drugs (known as neuraminidase inhibitors), but resistant to a second class of antivirals (the M2 inhibitors).
Worldwide, most patients infected with the pandemic virus continue to experience typical influenza symptoms and fully recover within a week, even without any form of medical treatment. Healthy patients with uncomplicated illness need not be treated with antivirals.
On an individual patient basis, initial treatment decisions should be based on clinical assessment and knowledge about the presence of the virus in the community.
In areas where the virus is circulating widely in the community, clinicians seeing patients with influenza-like illness should assume that the pandemic virus is the cause. Treatment decisions should not wait for laboratory confirmation of H1N1 infection.
This recommendation is supported by reports, from all outbreak sites, that the H1N1 virus rapidly becomes the dominant strain.

Treat serious cases immediately

Evidence reviewed by the panel indicates that oseltamivir, when properly prescribed, can significantly reduce the risk of pneumonia (a leading cause of death for both pandemic and seasonal influenza) and the need for hospitalization.
For patients who initially present with severe illness or whose condition begins to deteriorate, WHO recommends treatment with oseltamivir as soon as possible. Studies show that early treatment, preferably within 48 hours after symptom onset, is strongly associated with better clinical outcome. For patients with severe or deteriorating illness, treatment should be provided even if started later. Where oseltamivir is unavailable or cannot be used for any reason, zanamivir may be given.
This recommendation applies to all patient groups, including pregnant women, and all age groups, including young children and infants.
For patients with underlying medical conditions that increase the risk of more severe disease, WHO recommends treatment with either oseltamivir or zanamivir. These patients should also receive treatment as soon as possible after symptom onset, without waiting for the results of laboratory tests.
As pregnant women are included among groups at increased risk, WHO recommends that pregnant women receive antiviral treatment as soon as possible after symptom onset.
At the same time, the presence of underlying medical conditions will not reliably predict all or even most cases of severe illness. Worldwide, around 40% of severe cases are now occurring in previously healthy children and adults, usually under the age of 50 years.
Some of these patients experience a sudden and very rapid deterioration in their clinical condition, usually on day 5 or 6 following the onset of symptoms.
Clinical deterioration is characterized by primary viral pneumonia, which destroys the lung tissue and does not respond to antibiotics, and the failure of multiple organs, including the heart, kidneys, and liver. These patients require management in intensive care units using therapies in addition to antivirals.
Clinicians, patients, and those providing home-based care need to be alert to warning signals that indicate progression to a more severe form of illness, and take urgent action, which should include treatment with oseltamivir.
In cases of severe or deteriorating illness, clinicians may consider using higher doses of oseltamivir, and for a longer duration, than is normally prescribed.

Antiviral use in children

Following the recent publication of two clinical reviews, [1,2] some questions have been raised about the advisability of administering antivirals to children.
The two clinical reviews used data that were considered by WHO and its expert panel when developing the current guidelines and are fully reflected in the recommendations.
WHO recommends prompt antiviral treatment for children with severe or deteriorating illness, and those at risk of more severe or complicated illness. This recommendation includes all children under the age of five years, as this age group is at increased risk of more severe illness.
Otherwise healthy children, older than 5 years, need not be given antiviral treatment unless their illness persists or worsens.

Danger signs in all patients

Clinicians, patients, and those providing home-based care need to be alert to danger signs that can signal progression to more severe disease. As progression can be very rapid, medical attention should be sought when any of the following danger signs appear in a person with confirmed or suspected H1N1 infection:
  • shortness of breath, either during physical activity or while resting
  • difficulty in breathing
  • turning blue
  • bloody or coloured sputum
  • chest pain
  • altered mental status
  • high fever that persists beyond 3 days
  • low blood pressure.
In children, danger signs include fast or difficult breathing, lack of alertness, difficulty in waking up, and little or no desire to play.
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[1] Neuraminidase inhibitors for treatment and prophylaxis of influenza in children: systematic review and meta-analysis of randomised controlled trials. Shun-Shin M, Thompson M, Heneghan C et al. BMJ 2009;339:b3172; doi:10.1136/bmj.b3172
[2] Prescription of anti-influenza drugs for healthy adults: a systemic review and meta-analysis. Burch J, Stock C et al. Lancet Infect Dis 2009; doi:10.1016/S1473-3099(09)70199-9

 
http://www.who.int/csr/disease/swineflu/notes/h1n1_use_antivirals_20090820/en/index.html
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