It was August of 2013 when the Centers for Disease Control and Prevention (CDC)

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It was August of 2013 when the Centers for Disease Control and Prevention (CDC) were notified of an alarming number of cases of acute febrile ("fever") respiratory illness on a cruise ship. The first reported illnesses occurred on a cruise that left Galveston, TX and traveled to San Juan, Puerto Rico from August 19 through August 28. Of 1445 passengers. 39 (2.7%) were seen at the ships infirmary. Additionally, of 631 of the ship's crew, three (0.5%] reported with the same type of symptoms. Upon arrival in San Juan, nine passengers (0.6%) went to hospitals and influenza A was confirmed. From August 24 through August 28, the ship made the return trip to Galveston with 1448 new passengers and the same crew. During this trip, 19 of the 1448 (1.3K) passengers and 17 of the 631 (2.7%) crewmembers went to the infirmary with influenza-like illness (ILI). A fever > 100 degree F and either a cough or sore throat is diagnostic of lLl. Realizing the potential disaster that might occur due to the possible elderly and immunosuppressed population, representatives of the CDC boarded the ship on September 27. The entire ship's crew was administered the influenza vaccine for the 2013-2014 season on September 27. Any crewmember with ILI was isolated in his or her cabin and given rimantadine. Those crewmembers who were not ill were prophylactically administered the same antiviral for two weeks. All passengers were informed of the influenza outbreak on the ship. Those who were ill were given rimantadine for five days, and those who were not were given the option of the same antiviral medication as a prophylactic measure. CDC conducted a survey and found that of 1284 passengers, 994 (77.4%) were over 65 years old, 336 (26.2%) had pre-existing health problems that predisposed them to severe complications from influenza, 52 (4.1%) had ILI. and 1020 (80.8%) of 1262 prophylactically used rimantadine. On the day that the shipped docked in Galveston, two (0.1%) passengers went to hospitals for respiratory complications. Thirteen patient samples were confirmed as influenza A/Sydney/05/97-like (H3N2) at CDC. On September 2, in Galveston, another group of passengers boarded the ship and was notified of the influenza outbreak. No new cases of ILI were reported, most likely due to the quick action of public health personnel. Where are those immune defenses that limit spread of the virus? 1. Because humans develop antibody against hemagglutinin of the virus, the organism has developed mechanisms for changing. How do new strains of type A influenza appear in a population? 2. What is the risk for exposure to influenza when one is traveling to different geographical areas? 3. Once an individual has experienced disease caused by on influenza virus, are they immune to that particular strain? 4. How does the mammalian host ultimately rid itself of the virus? 5. What is the function of the hemagglutinin and neuraminidase surface proteins that are inserted into the envelope of the influenza virus? 6. When have relatively recent epidemics occurred? 7. How does the human host protect itself against influenza? 8. Who should have the influenza vaccine? 9. What influenza strains are in the 2025-2016 vaccine? 10. In the previous question, how do you interpret "the code" for the strains? 11. Which antiviral drugs are available for influenza?

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