Principles of influenza treatment
The therapeutic approach depends on the severity of the disease. In mild cases, symptomatic and pathogenetic therapy are usually sufficient. This group includes antipyretics, decongestants, and antihistamines, as well as vitamins, detoxification agents, and immunomodulators.
For non-specific suppression of viral replication, intranasal $\alpha$-interferon and agents stimulating endogenous interferon production are used.
In severe forms of the infection or when complications arise, immunotherapy (donor anti-influenza immunoglobulin or normal human intravenous immunoglobulin) is used. Antibacterial drugs are administered exclusively in the event of a bacterial superinfection.
Etiotropic therapy
Causal antiviral drugs work most effectively if initiated within the first 48 hours of illness onset. It is important to keep in mind potential side effects affecting the gastrointestinal tract and the nervous system.
- Rimantadine: active only against influenza A virus. It blocks M2 protein ion channels, altering the pH level within the lysosomes of the infected cell.
- Arbidol: effective against influenza A and B viruses. Characterized by low toxicity, it additionally acts as an interferon inducer and immunomodulator.
- Neuraminidase inhibitors (oseltamivir): inhibit all influenza virus types by binding to conserved regions of the neuraminidase enzyme.
Non-specific prevention
Non-specific prevention includes both anti-epidemic measures and medication use. The primary goal of sanitary measures is to disrupt the airborne and contact transmission routes of the infection.
These measures include:
- Isolation of infected individuals and implementation of quarantine (e.g., in schools or hospitals).
- Disinfection of dishware and linens.
- Compliance with mask mandates and thorough hand hygiene.
- General measures to enhance the body's resistance.
Emergency drug prophylaxis is used during epidemics. Intranasal $\alpha$-interferon or 0.25% oxoline ointment is used topically. Systemic chemoprophylaxis includes a course of treatment (at least 2–3 weeks) with arbidol, rimantadine, or neuraminidase inhibitors.
Specific routine prevention (vaccination)
Vaccination induces robust immunity and is administered at least one month before the start of the epidemiological season (in October or November). Revaccination is required annually. Medical personnel and risk groups are vaccinated first.
The following types of vaccines are approved in the Russian Federation:
- Live allantoic — administered intranasally. They induce complete (including mucosal) immunity, but may cause allergy to chicken protein.
- Inactivated whole-virion — administered subcutaneously; they also carry a risk of allergic reactions.
- Split vaccines — contain all viral antigens minus the lipid envelope. These are highly purified preparations with reduced pyrogenic activity.
- Chemical (subunit) — consist solely of protective antigens (hemagglutinin and neuraminidase).
- Polymer-subunit — next-generation preparations with polymeric adjuvants that provide an additional immunomodulatory effect.
Briefly: answers to topical questions
What is the mechanism of action of neuraminidase inhibitors?
The mechanism of action of neuraminidase inhibitors involves binding to conserved regions of the neuraminidase enzyme, which disrupts the release of virions from the infected cell. Neuraminidase is involved in viral invasion of the respiratory mucosa and the separation of budding virions from the cell wall. Neuraminidase inhibitors include oseltamivir and zanamivir; they are active against influenza A and B viruses.
What are the contraindications for live allantoic vaccines?
For live allantoic vaccines, sources indicate a contraindication in cases of hypersensitivity, specifically allergy to chicken protein. Live vaccines are also contraindicated in patients receiving immunosuppressive therapy due to the risk of infectious complications associated with administering a live attenuated pathogen against the background of suppressed immunity.
Which specific influenza virus strains are included in modern seasonal vaccines?
The provided sources do not list specific strains of seasonal vaccines. It is stated that vaccines include current variants of influenza A and B viruses, including circulating A(H1N1), A(H3N2), and type B viruses. Vaccine composition is updated based on epidemiological forecasting; one of the sources indicates strain updates every 2–3 years.
What specific side effects are characteristic of oseltamivir and rimantadine?
The sources do not describe side effects specific to oseltamivir or rimantadine individually. For anti-influenza chemotherapeutic agents in general, the potential for central nervous system excitation and gastrointestinal disorders is noted. Oseltamivir should be used with caution during pregnancy and breastfeeding.
What else to study on this topic
- Mechanism of action of endogenous interferon inducers
- Structural features of the influenza virus (role of M2 proteins, hemagglutinin, and neuraminidase)
- Pathogenesis of bacterial complications in influenza
- Contraindications to the use of various vaccine types
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