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Influenza (an orthomyxovirus) is a highly contagious disease transmitted by the respiratory route In contrast to RSV and rhinoviruses, transmission occurs by droplet nuclei rather than fomites or large particle aerosols Epidemics and pandemics appear at varying intervals, usually in the fall or winter (although sporadic cases occur as do summer outbreaks in northern areas such as Alaska) affecting 10 20% of the global population on average each year Antigenic types A and B produce clinically indistinguishable infections, whereas type C is usually a minor illness Annual influenza epidemics are the result of frequent and significant antigenic variation of the virus, or antigenic drift, which is more common in influenza A virus Pandemics associated with higher mortality typically are associated with type A infections in which significant genetic recombination of the virus (antigenic shift) has taken place The incubation period is 1 4 days Avian influenza is discussed in the next section

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myStrings. A ListBox control contains member properties and methods in addition to its array of strings, so the ListBox itself is not an array. However, it would be convenient to be able to access the ListBox array with an index, just as though the ListBox

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The trivalent inactivated influenza virus vaccine provides partial immunity (about 85% efficacy) for a few months to 1 year The vaccine s antigenic configuration changes yearly and is based on prevalent strains of the preceding year Vaccination in October or November each year is recommended for persons over 50 years of age (a substantial portion of the older population suffers from at least one chronic medical condition); children (6 59 months of age) and teenagers receiving long-term aspirin therapy; nursing home residents; patients of any age with chronic medical problems, including lung or heart disease, diabetes, renal failure, and immunodeficiencies (such as HIV); pregnant women; contacts of these high-risk groups, including health care workers, service personnel, and caretakers of children younger than 2 years In addition, all children 6 months to under 9 years who have never been vaccinated should receive two doses of vaccine The vaccine is contraindicated in persons with well-substantiated hypersensitivity to chicken eggs (based on dietary history) or other components of the vaccine (skin testing can be performed by an allergist), in persons with Guillain Barr syndrome, or in persons with an acute febrile illness until symptomatic improvement Concomitant warfarin or corticosteroid therapy is not a contraindication Side effects are infrequent and include tenderness, redness, or induration at the site of the injection and, rarely, myalgias, fever, or the oculorespiratory syndrome (conjunctivitis, facial edema, and respiratory symptoms within 2 48 hours of vaccination) Adequate immunity is achieved about 2 weeks after vaccination In healthy subjects, the antibody level remains sufficiently high throughout the season Levels wane quickly, however, in elderly nursing home patients Therefore, the time of administration of the vaccine should be based on surveillance data The vaccination effectively reduces both morbidity (preventing 35 60% of hospital admissions in the elderly) and mortality (preventing 35 80% of hospital deaths) A live attenuated, nasally administered, vaccine is licensed for use in the United States but is indicated only for healthy nonpregnant persons aged 5 49 years The live attenuated vaccine appears to show less efficacy in prevention than.

Typical uncomplicated influenza often begins abruptly Symptoms include fever, chills, malaise, myalgias, substernal soreness, headache, nasal stuffiness, and occasionally nausea Fever lasts 1 7 days (usually 3 5) Coryza, nonproductive cough, and sore throat are present Elderly patients may present with only lassitude and confusion, often without fever or respiratory symptoms Signs include mild pharyngeal injection, flushed face, and conjunctival redness Moderate enlargement of the cervical lymph nodes may be observed

Leukopenia is common Proteinuria may be present The virus may be isolated from throat washings by inoculation of embryonated eggs or cell cultures Rapid laboratory tests for influenza antigens from nasal or throat swabs are becoming widely available Complement-fixing and hemagglutinationinhibiting antibodies appear during the second week

itself were an array.* For example, such a property would let you do things like this:

Influenza causes necrosis of the respiratory epithelium, which predisposes to secondary bacterial infections Bacterial enzymes in turn (eg, proteases, trypsin-like compounds, streptokinase, and plasminogen) activate influenza viruses Frequent complications are acute sinusitis, otitis media, purulent bronchitis, and pneumonia Children (6 59 months), pregnant women, the elderly (aged 65 years or older), and the chronically ill (including HIV-infected individuals) are at high risk for complications Rhabdomyolysis is a rare late complication Pneumonia is commonly due to bacterial infection with pneumococci or, less often, staphylococci or Haemophilus Primary viral pneumonia (caused by the influenza virus itself)

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