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Learning Scope #316
1 contact hour
This offering expires in 2 years:
September 28, 2011
The goal of this continuing education offering is to educate nurses about the H1N1 flu virus. After reading this article, you will be able to:
1. Identify the age groups that are most affected by novel H1N1.
2. Describe and discuss the top four symptoms of influenza and how the virus is spread.
3. Compare and contrast the difference between antigenic shift and antigenic drift.
You can earn 1 contact hour of continuing education credit in three ways: 1) For immediate results and certificate, take the test online; grade and certificate are available immediately after taking the test. 2) Send this answer sheet (or a photocopy) along with the $8 fee (check or credit card) to ADVANCE for Nurses, Learning Scope, 2900 Horizon Dr., King of Prussia, PA 19406. 3) Fax the answer sheet to 610-278-1426. If faxing or mailing, allow 30 days to receive certificate or notice of failure. A certificate of credit will be awarded to participants who achieve a passing grade of 70 percent or better.
Merion Publications Inc. is an approved provider of continuing nursing education by the Pennsylvania State Nurses Association (No. 008-0-07), an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation. Merion Publications Inc. is also approved as a provider by the California Board of Registered Nursing (No. 13230) and by the Florida Board of Nursing (No. 3298).
H1N1 is an influenza type A virus. Type A can infect people, birds, pigs, horses and other animals. The virus is divided into subtypes and named based on two proteins on its surface. The proteins are hemagglutinin (HA) and neuraminidase (NA). There are many different combinations of these proteins. The human influenza virus that is presently circulating the world today is the H1N1, H1N2 and H3N2.1New strains of the influenza virus emerge and continually evolve. A type A virus changes in two ways: antigenic shift or drift. Antigenic drift is a gradual change through small mutations in HA and NA. These changes are unpredictable. Therefore, if you have had the flu the year prior or were vaccinated, drift creates a new virus for which you do not have antibodies.
Antigenic shift is a sudden principle change creating a novel influenza A virus that has previously not been seen among the human population. This happens only occasionally. Shift is created by direct animal-to-human transference or by the mixing of animal and human influenza genes to produce a new virus. As the virus shifts and drifts, a new virus is created and the general population will not have antibodies against this virus.
Global surveillance is conducted by the World Health Organization (WHO) and, in the U.S., surveillance is conducted by the CDC. They monitor changes to the flu virus and select appropriate strains for vaccination.1
Epidemiology
June 11, 2009, the WHO declared a global pandemic, with more than 70 countries reporting cases of novel H1N1. Eight days later, cases of H1N1 had been reported from all 50 states, the District of Columbia, Puerto Rico and the U.S. Virgin Islands.2During seasonal flu season, influenza A (H1 and H3) along with the influenza B virus were circulating in the U.S. As the end of the 2008-09 typical flu season was drawing near, the CDC identified the first of two cases of novel H1N1 April 15 and 17.
Since then, this has been the prevalent strain of flu. As of Aug. 6, 2009, there have been 6,506 individuals hospitalized and 436 deaths (see Table 1). It is believed the true number of individuals infected with H1N1 is much higher. Many individuals with respiratory illness never received testing. Due to the expansive spread of the virus, testing and reporting outpatients for the virus stopped because it was very trying on local resources and health departments.3 Although testing stopped, treatment of these patients remained the same.
From the first case through July 24 of this year, 43,771 cases of probable and confirmed patients had been reported to the CDC. The highest number of cases per 100,000 population were in the 5- to 24-year-old group (26.7 per 100,000). The next group affected were children 0-4 years old (22.9 per 100,000 people).
The number of cases per 100,000 population drops dramatically for other age groups. The age distribution is different from what is normally expected in seasonal flu. The older-than 65 population had the lowest number of cases per 100,000 people at 1.3, leading to the belief they may already have some immunity.4
During flu season in the U.S., approximately 36,000 people die from complications of the flu. More than 200,000 people are hospitalized. Approximately 20,000 of them are children under 5 years old, and 60 percent are over 65. Of those who die of flu, 90 percent are older than 65.2
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