WEBVTT

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I'm going to quickly
sketch out a flu

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virus for you--
something like this.

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And it has an envelope, so
this is our little envelope.

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And on the inside
of this envelope

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are eight chunks of RNA,
so let's draw out the RNA.

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This is the genetic material.

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And this genetic material,
among other things,

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codes for protein.

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And so one of the proteins
here is sitting on the outside.

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I'm drawing it as if it
looks like a little hand.

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And the reason I do that is
because it reminds me that this

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H stands for hemagglutinin, but
it basically holds onto sialic

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acid .

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And that's how it gets
inside of little cells.

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And then there's another
protein over here.

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And I draw these as
a pair of scissors

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just to kind of remind me that
this one nicks the sialic acid.

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This is called neuraminidase,
and it nicks the sialic acid,

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and it helps it cut itself
loose from the cell.

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And so it can move on
to other cells- kind of

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helps with exiting.

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And I haven't actually been
drawing this other protein.

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There's another one here.

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And I'm going to draw it now.

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This is called an M2 protein.

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But it's not actually
found on all flu types.

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It's actually found
on flu A, but actually

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not found on flu B. So this is
a really important difference

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between flu A and flu B.

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And you'll see why, because
one of the medicines that we

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use now to treat flu-- and
yes, you heard me correctly,

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that we do have
anti-viral medications.

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You probably heard
from many people

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saying antibiotics
only treat bacteria,

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not viruses, and that's true.

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But we have a special
word for these other drugs

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that actually do treat viruses.

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And we call them
anti-viral drugs.

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And there are couple of them.

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I'm actually going to write
out some of the names.

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So this is called
Amantadine or Rimantadine.

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And it's kind of
easy to remember

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that they are in the
same class because they

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share a lot of the same letters.

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And these two anti-viral
drugs, they actually

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work on stopping or blocking
the activity of this enzyme.

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And I'm just kind of drawing
it like a little negative sign.

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But that's just to remind
you that it blocks the M2.

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So if you know that
flu B doesn't have M2,

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then you also know
that these drugs then

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don't work against flu B.

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These drugs don't even work
that well against flu A,

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because flu A has
become quite resistant.

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So remember, resistance
happens because there

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are little mutations.

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And it turns out that flu A has
kind of a mutated form of M2,

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so that it actually doesn't
get blocked by Amantadine

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or Rimantadine quite so easily.

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So unfortunately for
us, that's bad news.

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And the CDC in 2012,
2013 have recommended

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not using these
drugs because there's

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so much flu A resistance.

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So that's unfortunate,
but the good news

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is that we actually have
a couple of other drugs.

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So we have a drug
called Oseltamivir,

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and related to
it-- and you'll see

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with the spelling--
we have Zanamivir.

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And these, of course, share a
lot of the same letters again.

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And these two actually
block the neuraminidase.

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And this is actually
in flu A and flu B.

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So that's good news, because
it blocks both flu A and flu

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B. And let me actually just
write that down, flu A and flu

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B. And that's important, right?

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So we have these two drugs,
and one of them is a pill.

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This first one is a pill.

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And the second one is
kind of an inhaled powder.

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So they're taken
in different ways.

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And another important
difference between them--

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this is something that we have
to just kind of keep in mind--

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is that there are
age restrictions.

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So you have to be
a certain age to be

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able to take these medications.

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And they differ
between the two drugs,

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and whether you're
using it to treat,

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or if you're using it to prevent
getting sick from the flu.

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There's a difference there too.

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So there are age
restrictions that we just

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have to keep in mind.

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But overall, I'm pretty
happy with the fact

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that at least we
have these options

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if we need to treat someone
that's very sick from the flu.

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So let's talk about
that treatment then.

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So what if you have someone--
and this happens to me all

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the time where someone comes
in kind of frowny faced

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because they're sick with
the flu, and you're thinking,

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OK well, this person
obviously needs treatment.

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So I'm going to write
that at the top.

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They need some
sort of treatment.

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And I guess the
first question is,

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why would I treat this person?

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Of course, everyone's
going to be frowny faced

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if they get the flu.

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So why am I treating
this person?

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What makes them so special?

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Well, one thing that
could make them special

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is-- let's say that
they're high risk.

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Remember high risk groups in
our society, in our community,

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include real young
kids-- so let's

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say under two years
old-- or older folks--

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let's say people
over 65 years old.

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It could be someone
that's pregnant.

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That's another high risk group.

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Or it could be someone that has
some sort of chronic disease.

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And that could be like a
lung disease or asthma,

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any sort of chronic disease
that makes them ill.

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Maybe their immune
system isn't working.

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And that would be a
group I would definitely

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consider treatment for.

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Now another group-- I'm
going to put it just right

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below-- is let's say
you have someone that's

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completely healthy-- young,
healthy person, not pregnant.

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They still might get
treatment if there's maybe

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severe disease.

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Let's say they get
really, really sick.

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They're just feeling awful,
and I'm worried about them,

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and they might need
to be hospitalized.

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If they're very,
very sick, or they

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get some sort of
complication, or they're

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going to get hospitalization,
anything like that,

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then this is a person, again,
I would be careful with.

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And I would consider treatment.

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Let me bring up a
little bit of space.

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So this is the kind of group
that I would definitely

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consider treatment in.

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So what else should we
think about or consider?

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Well, the next question,
often, that comes up

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is how soon do you need
to start treatment?

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When do you need
to begin treatment?

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Or when do you start?

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And of course that
answer's going

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to be as soon as possible.

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But a bigger range on that
would be within two days.

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So really, if they've started
getting symptoms a week ago,

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I might still be
inclined to treat them.

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But I'd be more inclined
if it had just started.

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What other questions
or considerations

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should we just
kind of go through?

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What about treatment?

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So how long do you
treat them for?

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And generally speaking,
it's about five days.

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So five days of either
Oseltamivir or Zanamivir.

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And sometimes it goes
a little bit longer,

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but usually it's just five days.

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That's kind of a normal course.

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So this is how I
would manage someone

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that's being treated for flu.

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But of course, what if they're
not being treated for it?

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What if they come in,
and they're feeling fine?

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And we have to draw
another face here.

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This is a smiley face,
something like that.

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And I'm going to draw two.

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So let's say there's two.

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And we're going to deal
with them separately.

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So let me actually draw
a line between them,

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something like this.

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So we've got two more cases.

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Both are feeling fine, but
they might need prevention.

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Another thing these drugs
can do is prevent you

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from getting sick.

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So prevention is
important as well.

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And let's say these folks
are living in a home.

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Let me actually build
a little nice house

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around my first
smiley face person.

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And I'll do the same around
this second smiley face person.

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And let's say this
first person--

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this person gets a
visit from someone

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who's feeling flu symptoms.

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So this person comes to
visit, and our friend,

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our smiley friend, is worried.

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They think, oh my gosh,
now I'm going to get sick.

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So if they're high
risk-- and we went

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through some of the
categories-- actually,

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I should mention there are
other categories, not just these

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that I listed.

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There are some others as well.

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But if they're high
risk in some way,

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then I would
consider giving them

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a medication like
Oseltamivir or Zanamivir

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to prevent them
from getting sick.

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Now this whole bit about severe
disease or hospitalization--

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this doesn't really apply
because they're not sick.

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They're obviously not going
to have severe disease

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or hospitalization already.

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What about this question of
when would I start treatment.

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Well ideally, again, it's
going to be within two days.

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So within two days
of their exposure.

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We call the visit,
or whoever kind of

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made them worry that
they might get the flu,

00:08:40.789 --> 00:08:42.700
we call that the exposure.

00:08:42.700 --> 00:08:46.400
And so really you want to start
treatment within two days.

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And you also want to start
prevention within two days.

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So how long would you actually
give them the medications for,

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to prevent them
from getting sick?

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Well it really depends
on whether or not

00:08:57.430 --> 00:08:58.970
they've had the vaccine.

00:08:58.970 --> 00:09:01.970
So let's say they've had the
vaccine, the flu vaccine.

00:09:01.970 --> 00:09:03.230
And they were high risk.

00:09:03.230 --> 00:09:06.200
They got visited by
someone, or had an exposure.

00:09:06.200 --> 00:09:08.680
For this person,
I'm thinking I want

00:09:08.680 --> 00:09:10.620
to treat them for two weeks.

00:09:10.620 --> 00:09:13.740
Or give them two
weeks of medications.

00:09:13.740 --> 00:09:16.940
And the logic is that if
I kept them two weeks,

00:09:16.940 --> 00:09:19.170
then that basically covers them.

00:09:19.170 --> 00:09:20.950
And then after
that, I would assume

00:09:20.950 --> 00:09:23.560
that the vaccine would
kind of take hold.

00:09:23.560 --> 00:09:25.580
Because remember, the
vaccine takes two weeks

00:09:25.580 --> 00:09:27.310
to really take full effect.

00:09:27.310 --> 00:09:29.730
So basically, I give
them a medication

00:09:29.730 --> 00:09:33.110
during that period of time when
the vaccine isn't completely

00:09:33.110 --> 00:09:34.260
protecting them.

00:09:34.260 --> 00:09:37.050
And then I expect their
vaccine to kind of take over,

00:09:37.050 --> 00:09:39.580
and for the rest
of the flu season,

00:09:39.580 --> 00:09:42.300
presumably, they should
have good protection.

00:09:42.300 --> 00:09:43.860
So that would be my strategy.

00:09:43.860 --> 00:09:47.290
Now let's say that they can
not take the vaccine, so

00:09:47.290 --> 00:09:48.710
no vaccine.

00:09:48.710 --> 00:09:52.440
And maybe this person
has a severe allergy,

00:09:52.440 --> 00:09:54.800
or had a horrible
reaction to the vaccine.

00:09:54.800 --> 00:09:58.180
For whatever reason, they
cannot take the vaccine.

00:09:58.180 --> 00:10:00.630
Well in this person, if
they can't take the vaccine,

00:10:00.630 --> 00:10:03.930
or don't have the vaccine,
then for this person

00:10:03.930 --> 00:10:07.130
I would actually treat
them for just one week.

00:10:07.130 --> 00:10:10.530
One week after exposure.

00:10:10.530 --> 00:10:14.320
So if the exposure
happened, let's say today,

00:10:14.320 --> 00:10:15.740
I would basically--
and then let's

00:10:15.740 --> 00:10:17.850
assume it's not going
to keep happening--

00:10:17.850 --> 00:10:22.260
so one week after exposure
would then make it next week,

00:10:22.260 --> 00:10:24.420
is when I would
stop the medication.

00:10:24.420 --> 00:10:26.990
So in this scenario,
I'm protecting them

00:10:26.990 --> 00:10:28.890
with the medication
against getting sick

00:10:28.890 --> 00:10:30.590
from this exposure.

00:10:30.590 --> 00:10:32.400
But because they've
had no vaccine,

00:10:32.400 --> 00:10:34.590
if they have ongoing
exposures-- let's

00:10:34.590 --> 00:10:38.979
say they get exposed again
to flu in three weeks-- then

00:10:38.979 --> 00:10:40.520
again they'd have
to come back to me,

00:10:40.520 --> 00:10:42.186
and we'd have to do
this all over again.

00:10:42.186 --> 00:10:45.870
So it really is ideal to have
that vaccine in your system

00:10:45.870 --> 00:10:47.760
to keep protecting
you and preventing you

00:10:47.760 --> 00:10:48.720
from getting ill.

00:10:48.720 --> 00:10:50.370
Now in this second
scenario, let's say

00:10:50.370 --> 00:10:52.590
instead of having a
visitor who's sick,

00:10:52.590 --> 00:10:55.530
let's say you've got people
around you that are sick,

00:10:55.530 --> 00:10:58.380
living in the same place as you.

00:10:58.380 --> 00:11:02.970
Now this person is obviously in
the home with a group of folks.

00:11:02.970 --> 00:11:04.390
So let's call that a group home.

00:11:04.390 --> 00:11:08.710
And what we call this scenario
is basically an outbreak.

00:11:08.710 --> 00:11:12.020
So this person is living
in an outbreak setting.

00:11:12.020 --> 00:11:15.740
And many, many people with
flu are living together

00:11:15.740 --> 00:11:18.070
causing an outbreak to happen.

00:11:18.070 --> 00:11:21.220
We really are worried
about other healthy people

00:11:21.220 --> 00:11:24.440
like our smiley faced friend
from getting sick with the flu

00:11:24.440 --> 00:11:25.020
as well.

00:11:25.020 --> 00:11:26.811
So in this setting,
who am I worried about?

00:11:26.811 --> 00:11:30.680
Who do I want to make sure gets
medications to prevent them

00:11:30.680 --> 00:11:31.650
from getting sick?

00:11:31.650 --> 00:11:35.560
Well, we've got high risk
people, again, living together.

00:11:35.560 --> 00:11:37.130
So if people are
living together--

00:11:37.130 --> 00:11:39.380
and this could be
senior citizens,

00:11:39.380 --> 00:11:43.290
or could be a chronic care
facility, or nursing home--

00:11:43.290 --> 00:11:46.120
and really any kind
of group setting

00:11:46.120 --> 00:11:48.160
where people are
institutionalized

00:11:48.160 --> 00:11:50.440
and they're high risk,
I'm going to be worried.

00:11:50.440 --> 00:11:53.920
And I want to make sure
that we consider prevention

00:11:53.920 --> 00:11:58.450
with one of these medications,
the Oseltamivir or Zanamivir.

00:11:58.450 --> 00:12:00.490
And do I have to worry
about severe disease

00:12:00.490 --> 00:12:01.290
or hospitalization?

00:12:01.290 --> 00:12:03.390
Well, no, again because
here specifically

00:12:03.390 --> 00:12:05.860
I'm talking about
the healthy person

00:12:05.860 --> 00:12:07.610
who happens to be
in an outbreak.

00:12:07.610 --> 00:12:08.919
So they're still healthy.

00:12:08.919 --> 00:12:09.960
They're not hospitalized.

00:12:09.960 --> 00:12:11.650
They don't have
severe disease yet.

00:12:11.650 --> 00:12:13.233
So the whole idea
is to make sure they

00:12:13.233 --> 00:12:15.360
don't get those things, right?

00:12:15.360 --> 00:12:17.270
And when would I
want to treat them?

00:12:17.270 --> 00:12:20.640
Well, it's hard to really
say within two days

00:12:20.640 --> 00:12:22.900
because that implies that
something specific is

00:12:22.900 --> 00:12:23.860
happening.

00:12:23.860 --> 00:12:26.150
When in fact,
during an outbreak,

00:12:26.150 --> 00:12:28.530
you just have constant
exposure, right?

00:12:28.530 --> 00:12:30.850
I mean, everyone
around you is sick.

00:12:30.850 --> 00:12:32.860
Let's say you go down
to eat in the cafeteria.

00:12:32.860 --> 00:12:33.980
Everyone is sick.

00:12:33.980 --> 00:12:36.050
So when you're having
constant exposure,

00:12:36.050 --> 00:12:38.864
we don't really think
about within two days.

00:12:38.864 --> 00:12:40.280
It doesn't really
make sense here.

00:12:40.280 --> 00:12:42.070
So here I would just
kind of be worried

00:12:42.070 --> 00:12:43.770
in general about this person.

00:12:43.770 --> 00:12:45.560
And as far as
treatment, you really

00:12:45.560 --> 00:12:47.540
end up just treating everybody.

00:12:47.540 --> 00:12:51.410
Vaccine or no vaccine,
you treat everybody

00:12:51.410 --> 00:12:55.690
throughout the outbreak
because the whole goal here

00:12:55.690 --> 00:12:58.080
is really to minimize
the outbreak.

00:12:58.080 --> 00:13:01.940
You don't want people to have
all the horrible consequences

00:13:01.940 --> 00:13:02.460
of flu.

00:13:02.460 --> 00:13:07.490
Remember, flu can kill people,
and can cause hospitalizations.

00:13:07.490 --> 00:13:10.160
So to prevent all that,
because it's a high risk

00:13:10.160 --> 00:13:12.620
group of people living
together, you would really just

00:13:12.620 --> 00:13:14.430
treat throughout the outbreak.

00:13:14.430 --> 00:13:22.000
And even one week after the
last case of flu is found.

00:13:24.520 --> 00:13:28.560
So here, unlike
the scenario where

00:13:28.560 --> 00:13:30.950
you have just a single
exposure, because you

00:13:30.950 --> 00:13:33.460
have so many people in
an outbreak that are sick

00:13:33.460 --> 00:13:36.400
and kind of exposing
each other, you basically

00:13:36.400 --> 00:13:40.790
just treat everybody with
Oseltamivir or Zanamivir.

00:13:40.790 --> 00:13:43.390
So now you see we have a
couple of anti-viral drugs,

00:13:43.390 --> 00:13:45.724
and you see when we can
use them to treat folks,

00:13:45.724 --> 00:13:47.640
and also when we can use
them to prevent folks

00:13:47.640 --> 00:13:49.540
from getting sick.